Under the microscope: Adenovirus

  • 6 Minutes
Under the Microscope

Pathogen profile

Adenovirus

Through the lens of ENT care

Type

DNA virus without a fatty outer envelope

Found in

The respiratory tract, including tonsils and adenoids

Spreads through

Respiratory secretions, droplets, close contact, hands and objects

Commonly causes

Respiratory illness, from cold-like symptoms to pneumonia

Examining the nose and throat brings ENT clinicians close to patients and their respiratory secretions. Reusable instruments may also touch mucous membranes, the moist lining of these areas. Adenovirus offers a useful lens through which to understand why infection prevention matters at each examination.⁠[1, 2, 5]

At Tristel, we explain the science behind infection prevention in everyday practice. Here, we look at adenovirus through the lens of ENT care, from its presence in the respiratory tract to the evidence needed for effective instrument disinfection.

What is adenovirus?

Adenoviruses are DNA viruses without a fatty outer envelope. Instead, a protein shell protects their genetic material.⁠[1, 2]

Why structure matters

This structure is relevant to disinfection

Enveloped viruses

Have a fatty outer envelope.

Adenovirus

No envelope. A protein shell protects its genetic material.

Activity against enveloped viruses cannot automatically be assumed to cover adenovirus.⁠[1, 2]

Where is adenovirus found?

Adenovirus can be present in the respiratory tract, including tonsils and adenoids, and may be released in respiratory secretions. Contaminated hands and objects can also carry it.

Its presence in these tissues makes it relevant to examinations of the nose and throat.⁠[2, 3]

ENT clinician examining a patient's nose with an endoscope, where adenovirus can be present

US study, 2025

12.5%

65 of 522 children

A US study published in December 2025 detected adenovirus DNA in tonsil tissue from 65 of 522 children, or 12.5%, undergoing elective surgery without acute respiratory symptoms. Samples were collected in 2018–2020.⁠[3]

DNA detection alone does not establish infectious virus or transmission to another person.

What illness can it cause?

Adenoviruses commonly cause respiratory illness, from cold-like symptoms and pharyngitis, inflammation of the throat, to bronchitis or pneumonia.⁠[1, 2]

Most infections are mild, but people with weakened immune systems or underlying cardiac or respiratory disease have a higher risk of severe illness. This article focuses on respiratory relevance to ENT care.⁠[1, 2]

How does it spread?

Adenovirus can spread through respiratory secretions and droplets, close contact, or contact with contaminated hands and objects. In an ENT consultation, these routes are relevant to close examination, handling equipment and contact with the patient’s mucous membranes.⁠[2]

A possible route of cross contamination

Secretions

Respiratory secretions from the patient

A hand or instrument

Secretions reach a hand or an instrument

Another contact

Relevant moments in an ENT consultation:

Close examinationHandling equipmentMucous membrane contact

Good to know

Contamination is not the same as infection

  • This route applies known transmission mechanisms to ENT practice. The studies cited here do not demonstrate an outbreak involving nasendoscopes.
  • Contamination means viral material is present. It does not by itself demonstrate infection in a patient.⁠[2–4]

Why is adenovirus a microbial threat?

Threat profile

Four features that matter for infection prevention

Remains infectious on surfaces and instruments

Resists many common disinfectants

Infections can be asymptomatic

Some people shed virus for weeks or longer without symptoms, particularly those with weakened immune systems

Shedding means releasing virus from the body.⁠[1, 2]

?Did you know?A visibly clean instrument is not a reliable guide.Find out more

Together, these features explain why visible illness and a visibly clean instrument are insufficient guides to infection prevention.⁠[1, 2]

How can transmission be prevented?

Layers of protection

Prevention involves the whole consultation. Each layer adds to the one inside it.

Core · all patients

Standard precautions

Hand hygiene, respiratory hygiene, appropriate protective equipment, and cleaning and disinfection of shared surfaces.

When needed

Additional precautions

Additional precautions should reflect the patient’s clinical presentation and the suspected infection, following the service’s infection prevention protocol.

Complements both

Device reprocessing

Device reprocessing complements these measures.⁠[6]

Healthcare worker wiping a flexible endoscope with a disinfectant wipe

How can reusable instruments be protected?

Semicritical devices

Instruments that touch mucous membranes

Reusable instruments that touch mucous membranes are classed as semicritical and require at least cleaning followed by high level disinfection.⁠[5]

This requirement follows the device’s intended use, including when a patient has no recognised infection. Adenovirus helps explain why evidence of appropriate viral activity matters within that process. Device compatibility and the full manufacturer’s instructions remain essential.⁠[5]

Meet your solution

Tristel chlorine dioxide for ENT

Explore our chlorine dioxide solutions for ENT device reprocessing

Our chlorine dioxide chemistry underpins Tristel solutions for high level disinfection of compatible reusable ENT instruments. Product information for Stella System and the disinfecting stage of Trio Wipes System includes activity against adenovirus.⁠[8, 9]

  • Efficacy depends on the specific formulation and validated process
  • Follow the selected product’s instructions
  • Confirm device compatibility

Which EN standards matter?

European test standards help explain what a disinfectant has demonstrated. For adenovirus and reusable ENT devices, two methods are especially useful to understand.⁠[7]

Scientist in purple gloves using a pipette and test tubes in a laboratory
EN test standards evaluate disinfectants under defined laboratory conditions.
1EN 14476: suspension test

EN 14476 evaluates virucidal activity in a quantitative suspension test. Virus and disinfectant are brought together under defined laboratory conditions. It provides evidence of viral inactivation at the concentration, contact time and conditions tested.

What it doesn’t show: by itself, it does not reproduce the full reprocessing procedure on an instrument.⁠[7]

2EN 17111: carrier test

EN 17111 evaluates virucidal activity using a carrier test for instrument disinfectants. It adds evidence from virus deposited on a test carrier, complementing suspension testing.

What it doesn’t show: it remains a standardised laboratory test rather than proof of reduced patient infections.

When reviewing chlorine dioxide solutions

Check the evidence for the specific formulation and process, including:

  • Test virus
  • Standard test method
  • Contact time
  • Test conditions
  • Intended device use
References and further reading (9)
  1. CDC. Clinical Overview of Adenovirus. 16 December 2025.
  2. INSST. Adenovirus excepto serotipos 40 y 41. BaseBIO. Updated 7 April 2022.
  3. Leber AL, Xu L, Oyeniran SJ, Wang H. Molecular detection of respiratory pathogens in tonsillar tissue from asymptomatic children: implications for result interpretation among the asymptomatic and symptomatic. Microbiology Spectrum. Published 3 December 2025. DOI 10.1128/spectrum.02872-25. Samples collected April 2018–January 2020.
  4. Andrés C et al. The value of primary care networks for molecular surveillance of paediatric respiratory infections. Eur J Clin Microbiol Infect Dis. 2026;45:845–853. Published online 29 November 2025. DOI 10.1007/s10096-025-05353-9. Samples collected October 2021–April 2024.
  5. CDC. A Rational Approach to Disinfection and Sterilization. 28 November 2023, based on the 2008 guideline.
  6. CDC. Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings.
  7. BSI. BS EN 14476:2025. Quantitative suspension test for virucidal activity in the medical area, Phase 2 Step 1.
  8. Tristel. Stella System. Australian product page.
  9. Tristel. Trio Wipes System. Australian product page.