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In response to the current pediatric hepatitis outbreak 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 from when the outbreak began compared to levels pre-COVID-19 pandemics, according to a recent Morbidity 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 refute a potential association between pediatric hepatitis and adenovirus, it provides useful context for the ongoing investigation.”
The CDC compared data during the current hepatitis outbreak period of October 2021 through March 2022 with a pre-COVID-19 pandemic baseline, as health care-seeking behavior may have changed during 2020- 21 in response to the pandemic.
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After pediatric cases of hepatitis began to be identified in the US and UK that had no clear etiology, the CDC issued a healthy advisory in April 2022 to report additional cases.
They found that many 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. depending on the agency.
“Because neither acute hepatitis of unknown etiology nor adenovirus type 41 are reportable in the United States, it is unclear whether either has recently exceeded historic levels,” the CDC said.
The agency therefore analyzed data from four sources: the National Syndromic Surveillance Program (NSSP), the Special Version of the Premier Healthcare Database (PHD-SR), the Supply and Transplant Network of bodies (OPTN) and Labcorp.
The NSSP collects electronic health information from emergency departments in all US states and the District of Columbia, which represents 71% of non-federal emergency rooms in the United States.
PHD-SR included records from around 1,000 hospitals, while pediatric liver transplant data was obtained from the National Registry, which is managed by OPTN.
The Labcorp data included results from 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 about 90% of all cases of adenovirus 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 outbreak period of 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 increase in the percentage of samples positive for adenovirus types 40/41 between October 2021 and March 2022 compared to pre-levels. -pandemics.
But the UK has reported an increase in the number of stool samples positive for adenovirus in children aged 1 to 4 compared to pre-pandemic levels, but the agency noted that data on the total number UK tested samples are not available. specimens positive for adenovirus is unknown.
The CDC advises that the data has limitations because the analysis assessed trends in hepatitis indirectly through electronic health data, as cases of hepatitis 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 while liver transplants are “well documented,” there is a two to three month reporting lag, so data from March 2022 may be underreported.
Also, because the COVID-19 pandemic has likely changed health care-seeking behavior, pre-pandemic data is limited to 2017-2019, and it is unclear if 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. causality between these two diseases.
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