Detection of human adenovirus F41 in wastewater and its relationship to clinical cases of acute hepatitis of unknown aetiology

Marina I. Reyne*, Danielle M. Allen, Ashley Levickas, Pearce Allingham, Jonathan Lock, Arthur Fitzgerald, Cormac McSparron, Behnam F. Nejad, Jennifer McKinley, Andrew Lee, Stephen H. Bell, Joshua Quick, Charlotte J. Houldcroft, Connor G.G. Bamford, Deirdre F. Gilpin, John W. McGrath

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases.

Original languageEnglish
Article number159579
Number of pages5
JournalScience of the Total Environment
Issue numberPart 2
Early online date22 Oct 2022
Publication statusPublished - 20 Jan 2023


  • Human adenovirus F41
  • Wastewater-based epidemiology
  • Wastewater
  • Acute hepatitis of unknown aetiology


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