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. 2020 Jun 1;15(6):e0232948.
doi: 10.1371/journal.pone.0232948. eCollection 2020.

Epidemiological analysis of an outbreak of an adenovirus type 7 infection in a boot camp in China

Zuiyuan Guo  1 , Libo Tong  1 , Shuang Xu  1 , Bing Li  1 , Zhuo Wang  1 , Yuandong Liu  1
Affiliations

Epidemiological analysis of an outbreak of an adenovirus type 7 infection in a boot camp in China

Zuiyuan Guo et al. PLoS One. .

Abstract

Background: An outbreak of respiratory disease associated with adenovirus type 7 occurred in a boot camp in China and was characterized by many cases, severe symptoms, and intrapulmonary infection in many patients.

Methods: We implemented a series of comprehensive preventive and control measures. We analyzed the incubation period and generation time by using the maximum likelihood method, assessed the symptom period and hospitalization duration using the Kaplan-Meier method, and estimated the basic reproductive number and dormitory transmission rate by using established methods.

Results: The epidemic lasted for 30 days, and 375 individuals were affected. Overall, 109 patients were hospitalized, and 266 individuals were isolated and treated. The median incubation period was 5.2 days (95% confidence interval [CI]: 5.0 to 5.4 days). The median generation time was 7.3 days (95% CI: 7.1 to 7.6 days). The median symptom period was 6 days (95% CI: 6 to 7 days). The median hospitalization duration was 9 days (95% CI: 9 to 11 days). The basic reproductive number was 5.1 (95% CI: 4.6 to 5.6), and the dormitory transmission rate was 0.15 (95% CI: 0.12 to 0.18).

Conclusion: Patients in the early stage of the epidemic were treated as having a regular cold and were not isolated; therefore, the virus continued to be transmitted to other susceptible individuals.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig 1
Fig 1. Temporal distribution of new laboratory-confirmed cases and clinically diagnosed cases by day.
Legend: Patients with positive viral nucleic acid tests were defined as confirmed cases, and patients who were not tested or whose test results were negative but who exhibited clinical symptoms consistent with adenovirus infection were defined as clinically diagnosed cases.
Fig 2
Fig 2. Age distribution and body temperature distribution for the patients.
Legend: A. Age distribution of the trainees, the trainers, and the total population. B. Body temperature distribution of the trainees, the trainers, and the total population.
Fig 3
Fig 3. Clinical symptoms.
Legend: The percentages for fever, pharyngalgia, expectoration, cough, weakness, headache, chills, and diarrhea were 100%, 67% (95% CI: 62% to 72%), 61% (95% CI: 55% to 66%), 59% (95% CI: 54% to 64%), 54% (95% CI: 49% to 59%), 48% (95% CI: 42% to 53%), 48% (95% CI: 42% to 53%), and 34% (95% CI: 30% to 40%), respectively.
Fig 4
Fig 4. Cumulative probability distributions of the incubation period, generation time, symptom duration, and hospitalization duration.
Legend: A. Cumulative probability distribution function of the incubation period. The blue area indicates 1000 cumulative probability distribution function curves with lognormal distribution drawn by the bootstrap method; the point and interval estimations were obtained from the lognormal distribution. B. Cumulative probability distribution function of the generation time. The blue area represents the interval estimate of the Weibull distribution. C. Survival curves of symptom duration and hospitalization duration.
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Grants and funding

The work was supported by National Science and Technology Major Project [2018ZX10713003].