Data suggest no increase in pediatric hepatitis, adenovirus above pre-pandemic levels
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Data reported in Morbidity and Mortality Weekly Report did not demonstrate an increase in pediatric hepatitis or adenovirus types 40/41 above pre-COVID-19 pandemic baseline levels.
“Following identification of pediatric hepatitis cases of unknown etiology in the United States and the United Kingdom, CDC issued a request in April 2022 for U.S. providers to report additional cases,” Anita K. Kambhampati, MPH, of the division of viral diseases at the CDC National Center for Immunization and Respiratory Diseases, and colleagues wrote. “Many reported cases had test results positive for adenovirus, which is not known to cause hepatitis in immunocompetent children.”
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Kambhampati and colleagues used data from the National Syndromic Surveillance Program (NSSP), the Premier Healthcare Database Special Release (PHD-SR), the Organ Procurement and Transplant Network (OPTN) and Labcorp to evaluate trends in pediatric hepatitis-associated emergency room visits and hospitalizations, liver transplantations, and stool testing for adenovirus type 40/41.
The NSSP provided electronic health data from EDs in all 50 states and the District of Columbia. Visits linked to hepatitis of unspecified etiology among children aged 0 to 4 years and 5 to 11 years from January 2018 to March 2022 were identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) discharge diagnosis codes, and data were queried on May 26, 2022. Data on hospitalizations for hepatitis of unspecified etiology were collected on May 25, 2022, from PHD-SR, using the same codes for ED data.
On May 20, 2022, data was collected via OPTN on pediatric LT in patients aged 18 years or younger in the U.S. from January 2017 to March 2022, with acute hepatic necrosis of unknown etiology as the primary diagnosis at time of transplant. On June 6, 2022, Labcorp data was accessed for results on all stool specimens tested for adenovirus types 40/41.
From October 2021 to March 2022, there was no increase in weekly ED visits with hepatitis-associated discharge codes compared with pre-COVID-19 pandemic baseline levels in children aged 0 to 4 years and 5 to 11 years. A median of 22 and 10 hepatitis-associated hospitalizations among children aged 0 to 4 years and 5 to 11 years, respectively, were recorded from January 2019 to March 2022.
Investigators noted there were no significant changes in hepatitis-associated hospitalizations from October 2021 to March 2022 compared with the same months before the pandemic among children aged 0 to 4 years (22 and 19.5, respectively) or 5 to 11 years (12 and 10.5, respectively). In addition, there was no significant increase in monthly LTs from October 2021 to March 2022 compared with the same months from 2017 to 2019.
From October to March in 2017 to 2018, 2018 to 2019 and 2019 to 2020, the percentage of specimens positive for adenovirus types 40/41 ranged from 5% to 19% in children aged 0 to 4 years and from 3% to 14% in children aged 5 to 9 years.
According to researchers, the percentage of specimens positive for adenovirus types 40/41 from October 2021 to March 2022 returned to but did not exceed pre-pandemic levels among both age groups, after a drop in testing volume and percentage of positive specimens from April 2020 to September 2021.
“The potential role of adenovirus in the etiology of the newly reported hepatitis cases is unknown; ongoing investigations are assessing this hypothesis along with the possible role of other factors, including current or past infections with SARS-CoV-2, the virus that causes COVID-19,” the authors wrote. “It remains unknown whether the recently reported cases represent a novel etiology of pediatric acute hepatitis or a previously existing phenomenon that is now being detected. The rarity of this outcome makes it difficult to detect small changes, and pandemic-associated disruptions in health care-seeking behavior and infectious disease epidemiology might still be normalizing.
“Ongoing assessment of trends in addition to enhanced epidemiologic investigations will help contextualize reported cases of acute hepatitis of unknown etiology in U.S. children,” they added.
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