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In response to current Pediatric hepatitis outbreak possibly related to adenovirusThe Centers for Disease Control and Prevention (CDC) found that current data show no increase in cases of pediatric hepatitis or adenovirus types 40/41 since the start of the outbreak compared to pre-COVID-19 levels, according to a recent incidence report. and Weekly Mortality Report.
“Data from four large administrative databases were analyzed to assess trends in pediatric hepatitis and the percentage of stool samples positive for adenovirus type 40/41,” the CDC said in a statement.
“While this environmental analysis cannot conclusively confirm or refute a possible link between childhood hepatitis and adenovirus, it provides a useful context for ongoing research.”
The CDC compared data for the current hepatitis outbreak period from October 2021 to March 2022 with pre-COVID-19 baseline levels, as 2020-2021 health care seeking behavior may have changed in response to the pandemic.
After cases of pediatric hepatitis that had no clear etiology began to be identified in the United States and the UK, the CDC released healthy lifestyle guidelines in April 2022 to report additional cases.
They found that many of the reported cases also tested positive for adenovirus type 41, a virus known to cause gastroenteritis but does not cause hepatitis in children with an intact immune systemaccording to the agency.
“Because neither acute hepatitis of unknown etiology nor adenovirus type 41 has been reported in the United States, it is unclear whether any of these have recently increased above historical levels,” the CDC said.
Therefore, the agency analyzed data from four sources: the National Syndrome Surveillance Program (NSSP), the Premier Healthcare Database Special Edition (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 non-federal emergency departments in the United States.
Records from approximately 1,000 hospitals were included in the PHD-SR, and data on pediatric liver transplantation was obtained from a national registry maintained by OPTN.
The Labcorp data included results from stool samples tested for adenovirus types 40/41 but could not determine if it was type 40 or 41, but the CDC noted that approximately 90% of all adenovirus cases found in the US with gastroenteritis are type 41 .
During the outbreak period from October 2021 to March 2022, there was no significant difference in the number of hepatitis-related hospital admissions or pediatric emergency department visits compared to the period before the outbreak. COVID-19 pandemic.
There was also no significant increase in the number of monthly liver transplants or an increase in the percentage of positive samples for adenovirus types 40/41 between October 2021 and March 2022 compared to pre-pandemic levels.
But the United Kingdom has reported an increase in adenovirus-positive stool samples among children aged 1 to 4 compared to pre-pandemic levels, but the agency noted that data on the total number of samples tested in the UK is not available, so the true percentage is positive. the result for adenovirus is unknown.
The CDC says the data is limited because analysis assessed hepatitis trends indirectly through electronic health data because cases of hepatitis with no apparent cause are not reportable in the United States, so the exact baseline is currently unknown.
They also note that while liver transplants are “well documented,” there is a two to three month reporting delay, so March 2022 may be an underestimate.
In addition, because the COVID-19 pandemic has likely changed health care-seeking behavior, pre-pandemic data are limited to 2017-2019 and it is not known if these data are accurate baseline data.
The CDC also noted that the small sample size may make it difficult to detect 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 the two diseases.”