Adenovirus 41 diversity in Arizona (USA) using wastewater-based epidemiology, long-range PCR, and pathogen sequencing between October 2019 and March 2020.

By coupling long-range polymerase chain reaction, wastewater-based epidemiology, and pathogen sequencing, we show that adenovirus type 41 hexon-sequence lineages, described in children with hepatitis of unknown origin in the United States in 2021, were already circulating within the country in 2019. We also observed other lineages in the wastewater, whose complete genomes have yet to be documented from clinical samples.