Abstract：
Human adenovirus type 41 (HAdV-F41) usually causes pediatrics gastroenteritis. However, it was reported to be associated with the outbreaks of severe acute hepatitis of unknown aetiology (SAHUA) in pediatrics during COVID-19 pandemic. In this study, we investigated the prevalence of enteric HAdV-F41 in 37,920 paediatric gastroenteritis cases from 2017 to 2022 in Guangzhou, China. All children presented were tested negative for SARS-CoV-2 during the \"zero-COVID\" period. The main clinical symptom of the children was diarrhea (96.5%). No fatalities nor liver abnormal symptoms was found. In 2021, one year since the pandemic of COVID-19, the prevalence of HAdV-F41 abruptly increased from 3.71% to 8.64% (P < 0.001). All of HAdV-F41 circulating worldwide were classified into eight different subtypes (G1-G8) based on the phylogenetic clustering permutation of the four capsid genes of HAdV-F41. G3 was the predominant subtype (56.2%; 77/137). CRV5 isolates from SAHUA cases belong to this subtype, in which N312D and H335D mutations in the short fiber knob were identified in both Guangzhou and CRV5 isolates, presumably changing the virus tropism by directly interacting with the heparin sulfate (HS) receptor. Additionally, a novel recombinant G6 subtype, which is unique and only circulating in China was first identified in this study. This is the first study highlighting the prevalence of HAdV-F41 in paediatric cases of gastroenteritis during COVID-19 pandemic in China. The clinical and viral evolution finding of HAdV-F41 provide insight into the clinical characteristics of children with HAdV-F41 infections as well as the uncertain role of HAdV-F41 in the cause of SAHUA.
摘要：
人41型腺病毒(HAdV-F41)通常引起儿科胃肠炎。然而,据报道,这与COVID-19大流行期间儿科重症急性病因不明肝炎(SAHUA)的暴发有关.在这项研究中,我们调查了2017年至2022年广州市37,920例小儿胃肠炎患者肠道HAdV-F41的患病率，中国。在“零COVID”期间，所有儿童的SARS-CoV-2检测均为阴性。患儿的主要临床症状为腹泻(96.5%)。未发现死亡或肝脏异常症状。在COVID-19大流行一年后的2021年，HAdV-F41的患病率突然从3.71％上升到8.64％（P<0.001）。根据HAdV-F41的四个衣壳基因的系统发育聚类排列，将全世界流行的所有HAdV-F41分为八种不同的亚型（G1-G8）。G3是主要亚型(56.2%;77/137)。来自SAHUA病例的CRV5分离株属于该亚型，其中在广州和CRV5分离株中都鉴定了短纤维旋钮中的N312D和H335D突变，推测通过与硫酸肝素（HS）受体直接相互作用来改变病毒的嗜性。此外,一种新的重组G6亚型，在这项研究中首次发现了这种独特的，仅在中国流通。这是首次强调中国COVID-19大流行期间小儿胃肠炎病例中HAdV-F41患病率的研究。HAdV-F41的临床和病毒进化发现提供了对HAdV-F41感染儿童的临床特征以及HAdV-F41在SAHUA病因中的不确定作用的见解。
