Adenovirus worsening risks for measles patients

Children infected with both measles and adenovirus are developing more severe complications, with their condition deteriorating rapidly, according to findings from the Bangladesh Shishu Hospital and Institute. Tests on a number of children hospitalised with measles have detected adenovirus, prompting physicians to say the virus should be taken into account when assessing the country''s ongoing measles outbreak.

Shishu Hospital has informed the Directorate General of Health Services (DGHS) about the findings. However, neither the DGHS nor the Ministry of Health has taken any action so far. Meanwhile, the US government and the US Centers for Disease Control and Prevention (CDC) have shown interest in the issue, with CDC experts already visiting the hospital.

Public health experts and physicians say adenovirus is not a new pathogen. It has circulated in Bangladesh and many other countries for years and is present year-round. On its own, adenovirus is generally not considered highly dangerous and typically causes fever, runny nose and cough, with most patients recovering without difficulty. However, physicans say complications appear to increase significantly when adenovirus and measles occur together.

At a DGHS meeting on measles management on 23 June, representatives from the Bangladesh Shishu Hospital and Institute raised the issue of simultaneous infection with measles and adenovirus.

Speaking to Prothom Alo on Sunday, DGHS Director of Disease Control Professor Halimur Rashid said, "I have never heard of measles and adenovirus co-infection. The Shishu Hospital also did not inform us about it. They could have written to us."

When asked how the CDC in Atlanta had learned about the issue while the DGHS had not—despite the meeting being held at the directorate—he replied, "I don''t recall that meeting."

The Bangladesh Shishu Hospital and Institute is among the country's main referral centers for children with severe measles, receiving many of the most critical cases from across Bangladesh.

Hospital Director Professor Mirza Md Ziaul Islam told Prothom Alo, "We noticed that some children with measles were not improving. No medication seemed to be working. That prompted us to investigate whether they had any additional infections."

Physicians began conducting respiratory panel tests on children with measles, particularly those whose condition was worsening despite treatment. These tests can detect five or six respiratory viruses simultaneously.

The results showed that many of the most critically ill children were infected with both measles and adenovirus. So far, the hospital has tested samples from 35 children with measles, and 16 of them were found to be positive for adenovirus.

Professor Ziaul Islam said respiratory panel testing is relatively expensive, and not all government hospitals have the capacity to perform it.

During the 23 June DGHS meeting, a professor representing the hospital formally presented the findings on measles-adenovirus co-infection. Senior health officials, physicians from several hospitals, measles specialists, representatives from UNICEF, and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) attended the meeting.

Bangladesh continues to face a worsening measles situation, with persistent daily deaths raising public concern about why the outbreak has not come under control. According to the report, it would have been expected for health authorities to take special measures after learning about the possible role of adenovirus, but they instead overlooked the issue.

Professor Ziaul Islam said the CDC had taken the matter seriously and had already sent a representative to visit the hospital.

Physicians also reported that infants younger than six months with measles often deteriorate rapidly and develop what they describe as "white lung," a condition in which the lungs are no longer able to absorb oxygen effectively.

According to three sources, a measles expert who attended the 23 June DGHS meeting shared information about the measles-adenovirus co-infection through an infectious disease network. The information eventually reached the CDC in Atlanta.

The CDC monitors infectious diseases and public health trends worldwide. It works closely with Bangladesh''s DGHS and the Institute of Epidemiology, Disease Control and Research (IEDCR), providing technical support and training, and has also collaborated with icddr,b for many years.

After learning about the situation, the CDC headquarters in Atlanta contacted its office at the US Embassy in Dhaka, and CDC officials subsequently visited the Bangladesh Shishu Hospital.

One source said a CDC delegation from Atlanta may visit Dhaka to assess what type of support is needed under the current circumstances and to hold discussions with hospital authorities.

Despite these developments, the DGHS disease control wing reportedly remains unaware of the issue.

Prominent virologist and former vice-chancellor of Bangladesh Medical University, Professor Nazrul Islam, told Prothom Alo, the Shishu Hospital has identified an important new finding amid the ongoing public health crisis situation. It is deeply unfortunate that the DGHS is unaware of it and has taken no action. That is very difficult to accept.