Reassuring Trend Emerges in Unusual Kids’ Hepatitis CasesJune 15, 2022
No significant increase in hospitalizations for hepatitis of unknown etiology were observed in kids when compared with the years leading up to the COVID-19 pandemic, according to CDC researchers.
According to four data sources, there were no recent increases in hepatitis-associated emergency department (ED) visits or hospitalizations, liver transplants, or adenovirus types 40/41 positivity among kids 11 and younger compared with pre-pandemic time periods, reported Anita K. Kambhampati, MPH, of the CDC in Atlanta, and colleagues in an early edition of the Morbidity and Mortality Weekly Report.
From October 2021 to March 2022, a similar number of hepatitis-related hospitalizations occurred among children compared with averages during those same months in three pre-pandemic time periods (2017-2018, 2018-2019, and 2019-2020):
- Ages 0-4 years: 22 and 19.5 per month, respectively (P=0.26)
- Ages 5-11 years: 12 and 10.5 per month (P=0.42)
Furthermore, although there has been a surge in adenovirus testing, no increases in adenovirus type 40 or 41 positivity rates were seen during the pandemic time period.
During the pre-pandemic time periods, the monthly percentage of adenovirus types 40/41-positive specimens ranged from 5% to 19% among children 0-4 and from 3% to 14% in those 5-9. After a decrease in positivity in April 2020 to September 2021, the percentage of positive specimens in October 2021 to March 2022 returned to pre-pandemic levels in both age groups.
The researchers also found no increase in weekly ED visits for children up to age 11 from October 2021 to March 2022 compared with the pre-pandemic time periods. Moreover, no significant increases in the number of monthly liver transplants were observed in the pandemic time period compared with the same months in 2017-2019 (5 vs 4 transplants, P=0.19).
Beginning last fall, cases of hepatitis of unknown etiology were identified in a cluster of previously healthy children at a single hospital in Alabama, and many of these cases tested positive for adenovirus, which is not typically a recognized cause of hepatitis in healthy kids. Despite issuing new recommendations for testing, adenovirus has still not been determined to be the definitive cause for these cases.
“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,” Kambhampati and colleagues noted.
For this report, the researchers used data from the National Syndromic Surveillance Program, the Premier Healthcare Database Special Release, the Organ Procurement and Transplant Network, and Labcorp, a large commercial laboratory network. ICD-10 diagnostic codes were also used to identify ED visits and hospitalizations. Stool samples were used to test for adenovirus in kids ages 0-9.
Hospitalizations and liver transplants that occurred from January 2020 to September 2021 were excluded due to possible effects from the pandemic.
Kambhampati and colleagues acknowledged that since pediatric hepatitis remains rare, the relative low incidence of cases could have limited the ability to detect subtle changes in trends. In addition, changes in healthcare-seeking behavior could have influenced the findings, despite best efforts to control for this.
They also noted that the pre-pandemic dates may not represent a reliable baseline. Continued surveillance is needed to monitor additional changes over time, they said.
Kambhampati reported no conflicts of interest.
Co-authors who were employees of Labcorp reported contracts with BioMerieux for BioFire equipment, funding from SpeeDx, and stock in Labcorp as part of employee compensation.