Pediatric hepatitis outbreak cases are not above pre-COVID-19 pandemic levels: CDC

In response to the current pediatric hepatitis outbreak possibly related to adenovirusThe Centers for Disease Control and Prevention (CDC) noted that current data does not indicate an increase in pediatric hepatitis cases or adenovirus types 40/41 since the outbreak began compared to pre-COVID-19 levels, according to a recent morbidity – Pandemic Indicate and Mortality Weekly Report.

“Data from four major administrative databases were analyzed to assess trends in pediatric hepatitis and the percentage of stool specimens positive for adenovirus type 40/41,” the CDC said.

“Although this ecological analysis cannot conclusively confirm or disprove a possible association between pediatric hepatitis and adenovirus, it provides useful context for the ongoing investigation.”

The CDC compared data during the current period of the hepatitis outbreak from October 2021 to March 2022 to a pre-COVID-19 pandemic baseline because of behaviors in seeking medical care in 2020-21 in response may have changed in response to the pandemic.

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After identifying pediatric cases of hepatitis in the United States and United Kingdom that did not have a clear etiology, the CDC issued a health advisory in April 2022 to report additional cases.

They found that many of the reported cases also had positive test results for adenovirus type 41, a virus known to cause gastroenteritis but not known to cause hepatitis in children with intact immune systems, the agency said .

“With neither acute hepatitis of unknown etiology nor adenovirus type 41 being reportable in the United States, it is unclear whether both have recently increased above historical levels,” the CDC said.

Therefore, the agency analyzed data from four sources: the National Syndromic Surveillance Program (NSSP), the Premier Healthcare Database Special Release (PHD-SR), the Organ Procurement and Transplant Network (OPTN) and Labcorp.

NSSP collects electronic health information from emergency departments in every US state and the District of Columbia, representing 71% of the non-state emergency departments in the United States.

PHD-SR included records from approximately 1,000 hospitals, while data on pediatric liver transplants came from the national registry maintained by OPTN.

Labcorp data included results for stool samples tested for adenovirus types 40/41 but could not distinguish whether it was type 40 or 41, but the CDC found that about 90% of all adenovirus detected in the US -Cases with gastroenteritis type 41 are.

There was no significant difference in hepatitis-related hospitalizations or pediatric emergency department visits during the outbreak period from October 2021 to March 2022 compared to before the COVID-19 pandemic.

There was also no significant increase in the number of monthly liver transplants or the percentage of specimens positive for adenovirus types 40/41 over the period October 2021-March 2022 compared to pre-pandemic levels.

However, the UK reported an increase in the number of stool samples testing positive for adenovirus in children aged 1 to 4 compared to pre-pandemic levels, but the agency noted that data on the total number of im United Kingdom tested samples are not available, so the true percentage of adenovirus positive samples are unknown.

The CDC reports that the data has limitations because the analysis indirectly assessed trends in hepatitis through electronic health records because hepatitis cases without a clear cause are not reportable in the United States, so an exact baseline is currently unknown.

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They also note that although liver transplants are “well documented,” there is a two to three month lag time for reporting, so the data for March 2022 may be underreported.

Because the COVID-19 pandemic is likely to have changed health behaviors, pre-pandemic data is limited to 2017-2019 and it is unknown if these data represent an accurate baseline.

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The CDC also noted that the small sample size might make it difficult to pinpoint small changes in incidence because hepatitis cases are rare.

“Finally, these results are intended to provide an overview of trends in pediatric acute hepatitis of unspecified etiology and adenovirus types 40/41 in the United States and cannot be used to infer or disprove a causal relationship between these two diseases.”