Received: 14 October 2017
Accepted: 19 January 2018
Recombinant type Human mastadenovirus D85 associated
with epidemic keratoconjunctivitis since 2015 in Japan
Department of Microbiology, Kumamoto
Prefectural Institute of Public-Health and
Environmental Science, Kumamoto, Japan
Division of Bioinformatics, Research Center
for Zoonosis Control, Hokkaido University,
Infectious Disease Surveillance Center,
National Institute of Infectious Diseases,
Hinokuma Eye Clinic, Kumamoto, Japan
Tsuguto Fujimoto, PhD, Infectious Disease
Surveillance Center, National Institute of
Infectious Diseases, 1-23-1 Toyama,
Shinjuku-ku, 162–8640 Tokyo, Japan.
Health and Labor Sciences Research Grant
(Japan), Grant number: 201617011A
The aim of this study was to report the emergence of a recombinant human
mastadenovirus (HAdV) type 85 (HAdV-85) and to describe its genomic and clinical
characteristics. The strains were detected and identified in Japan in cases of adenoviral
conjunctivitis including epidemic keratoconjunctivitis (EKC). The type was designated
as HAdV-85 based on the novel combination of penton base (P = HAdV-37), hexon
(H = HAdV-19), and fiber (F = HAdV-8). The whole genome sequence determined for
HAdV-85 was compared against sequences of other types in the same species. The
results of the phylogenetic analysis suggested a recombinant origin between HAdV-53
and HAdV-64, which have been two major causes of adenoviral EKC in Japan over the
past decade. During the period between 2008 and 2016 in Kumamoto city, southwest
of Japan, 311 cases diagnosed with conjunctivitis were diagnosed as being the
consequence of adenoviral infections. Among them, 11 cases were determined to have
been caused by HAdV-85 since 2015. Thus, HAdV-85 could be an emerging causative
agent of adenoviral conjunctivitis.
adenovirus, conjunctiva, recombinant virus
Adenoviral conjunctivitisis a major causeof ocular morbidity worldwide.
The severity of adenovirus eye infections ranges from mild subclinical
cases to severe cases resulting in visual reduction for weeks or even
The infection is characterized by serious conjunctival
infection, severe discharge, the formation of follicles, and a pseudo-
membrane, lacrimation, hyperemia, papillary hypertrophy, and lymph-
Severe infections can also lead to ocular lesions that can
last from months to years.
Due to the structural stability of the
adenoviral capsids, the virus can survive outside of hosts in surfaces for
long periods, a characteristic facilitating its spread.
adenoviral epidemic kiratoconjunctivitis (EKC) is a highly contagious
disease found in communal and nosocomial outbreaks, with serious
social consequences for both health and economics.
Most severe cases of adenoviral EKC are caused by infections of
types of Human mastadenovirus D (HAdV-D) 8, 37, 53, 54, 56, and 64.
Type 64 was formerly known as type 19a and recently renamed due to
its recombinant origin.
Types 8, 37, and 64 have frequently been
isolated in EKC outbreaks worldwide since 1954.
In contrast, types
53, 54, and 56 were recently characterized as new types product of
The severity, frequency, and distribution of
the identified types worldwide vary from type to type. In Japan,
surveillance of infectious diseases is the only method through which to
take proper actions to minimize public health risks in cases of possible
communal and nosocomial outbreaks. During the period from 2008 to
2016 in Kumamoto city, southwest of Japan, HAdV strains were
detected from 311 cases diagnosed with adenoviral conjunctivitis
including EKC; among them, 11 cases suspected to be EKC were
determined to be caused by a recombinant strain of adenovirus.
J Med Virol. 2018;90:881–889. wileyonlinelibrary.com/journal/jmv © 2018 Wiley Periodicals, Inc.