Pediatric Hepatitis Outbreak Cases Not Above Pre-COVID-19 Pandemic Levels: CDC

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In response to the current outbreak of pediatric hepatitis possibly linked to adenovirusthe Centers for Disease Control and Prevention (CDC) found that current data does not suggest an increase in pediatric hepatitis cases or adenovirus types 40/41 since the start of the outbreak compared to pre-COVID-19 pandemic levels, according to a recent Morbidity and Mortality Weekly Report.

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

“While this ecological analysis cannot definitively confirm or refute a potential association between pediatric hepatitis and adenovirus, it provides a useful context for the ongoing investigation.”

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

Atlanta, Georgia, USA – August 28, 2011: Close up of the entrance sign for the Centers for Disease Control and Prevention. Sign located near the 1700 block of Clifton Road in Atlanta, Georgia on the campus of Emory University. Vertical composition.
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After pediatric cases of hepatitis began to be identified in the US and UK that did not have a clear etiology, the CDC issued a health warning 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, according to the agency.

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

Then 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 the emergency departments of every state in the United States and the District of Columbia, which account for 71% of non-federal emergency rooms in the United States.

Pediatric cardiologist Ryan Serrano, right, talks to his patient, Richard Barnes, left, and his father Steve Barnes, during an exam Thursday, March 11, 2021, at Riley Hospital for Children.  The PHD-SR included data from approximately 1,000 hospitals, while data on pediatric liver transplants was obtained from the national registry, which is managed by the OPTN.

Pediatric cardiologist Ryan Serrano, right, talks to his patient, Richard Barnes, left, and his father Steve Barnes, during an exam Thursday, March 11, 2021, at Riley Hospital for Children. The PHD-SR included data from approximately 1,000 hospitals, while data on pediatric liver transplants was obtained from the national registry, which is managed by the OPTN.
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The PHD-SR included data from approximately 1,000 hospitals, while data on pediatric liver transplants was obtained from the national registry, which is managed by the OPTN.

Labcorp’s data included results for stool samples tested for adenovirus types 40/41 but could not distinguish whether the type was type 40 or 41, but the CDC noted that approximately 90% of all adenovirus cases detected in the United States with gastroenteritis are type 41.

There were no significant differences in hepatitis-associated hospitalizations or pediatric emergency room visits during the October 2021 to March 2022 outbreak period compared to before the COVID-19 pandemic.

In addition, there was no significant increase in the number of monthly liver transplants or an increase in the percentage of samples positive for adenovirus types 40/41 in the period October 2021-March 2022 compared to pre-pandemic levels.

But the UK has reported an increase in the number of adenovirus positive stool samples among children aged 1 to 4 years compared to pre-pandemic levels, but the agency noted that data on total samples tested in the UK United are not available, so the true percentage of adenovirus positive samples are not known.

British Prime Minister Boris Johnson leaves 10 Downing Street on his way to the House of Commons in London.  The UK has reported an increase in the number of adenovirus positive stool samples among children aged 1 to 4 years compared to pre-pandemic levels, but the agency noted that data on total samples tested in the UK not available

British Prime Minister Boris Johnson leaves 10 Downing Street on his way to the House of Commons in London. The UK has reported an increase in the number of adenovirus positive stool samples among children aged 1 to 4 years compared to pre-pandemic levels, but the agency noted that data on total samples tested in the UK not available
(AP / Alberto Pezzali)

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

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They also note because even though liver transplants are “well documented,” there is a two to three month delay period for reporting, so the March 2022 data may be underestimated.

Additionally, as the COVID-19 pandemic likely altered health seeking behavior, pre-pandemic data is limited to 2017-2019, and it is not known whether this data is an accurate baseline.

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

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