BQ Journal Vol 48 - Q3 2022 - 22

Early Release / Vol. 71
Morbidity and Mortality Weekly Report
June 14, 2022
Trends in Acute Hepatitis of Unspecified Etiology and
Adenovirus Stool Testing Results in Children - United States, 2017-2022
Anita K. Kambhampati, MPH1; Rachel M. Burke, PhD1; Stephanie Dietz, PhD2; Michael Sheppard, MS2; Olivia Almendares, MSPH1;
Julia M. Baker, PhD1,3; Jordan Cates, PhD1; Zachary Stein, MPH2,4; Dylan Johns, MS2,4; Amanda R. Smith, PhD2,3; Lara Bull-Otterson, PhD2;
Megan G. Hofmeister, MD5; Stacy Cobb, PhD2,6; Suzanne E. Dale, PhD7; Karl A. Soetebier, MAPW2; Caelin C. Potts, PhD1; Jennifer Adjemian, PhD2; Aaron
Kite-Powell, MS2; Kathleen P. Hartnett, PhD2; Hannah L. Kirking, MD1; David Sugerman, MD1; Umesh D. Parashar, MD, MBBS1; Jacqueline E. Tate, PhD1
In November 2021, CDC was notified of a cluster of previously
healthy children with hepatitis of unknown etiology
evaluated at a single U.S. hospital (1). On April 21, 2022,
following an investigation of this cluster and reports of similar
cases in Europe (2,3), a health advisory* was issued requesting
U.S. providers to report pediatric cases† of hepatitis of
unknown etiology to public health authorities. In the United
States and Europe, many of these patients have also received
positive adenovirus test results (1,3). Typed specimens have
indicated adenovirus type 41, which typically causes gastroenteritis
(1,3). Although adenovirus hepatitis has been reported in
immunocompromised persons, adenovirus is not a recognized
cause of hepatitis in healthy children (4). Because neither
acute hepatitis of unknown etiology nor adenovirus type 41
is reportable in the United States, it is unclear whether either
has recently increased above historical levels. Data from four
sources were analyzed to assess trends in hepatitis-associated
emergency department (ED) visits and hospitalizations,
liver transplants, and adenovirus stool testing results among
children in the United States. Because of potential changes
in health care-seeking behavior during 2020-2021, data
from October 2021-March 2022 were compared with a pre-
COVID-19 pandemic baseline. These data do not suggest an
increase in pediatric hepatitis or adenovirus types 40/41 above
baseline levels. Pediatric hepatitis is rare, and the relatively
low weekly and monthly counts of associated outcomes limit
* https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_462.pdf
† Since April 2022, providers have been encouraged to report to public health
authorities persons under investigation for acute hepatitis meeting the following
definition: children aged <10 years with elevated aspartate aminotransferase or
alanine aminotransferase levels (>500 U/L) with an unknown etiology for their
hepatitis since October 1, 2021.
the ability to interpret small changes in incidence. Ongoing
assessment of trends, in addition to enhanced epidemiologic
investigations, will help contextualize reported cases of acute
hepatitis of unknown etiology in U.S. children.
Data in this report were obtained from the National
Syndromic Surveillance Program (NSSP), the Premier
Healthcare Database Special Release (PHD-SR), the Organ
Procurement and Transplant Network (OPTN), and Labcorp,
a large commercial laboratory network. NSSP collects electronic
health data from EDs in all 50 states and the District
of Columbia, representing 71% of nonfederal EDs in the
United States. ED visits associated with hepatitis of unspecified
etiology among children aged 0-4 and 5-11 years during
January 2018-March 2022 were identified via International
Classification of Diseases, Tenth Revision, Clinical Modification
(ICD-10-CM) discharge diagnosis codes§ (3); data were queried
on May 26, 2022, and restricted to facilities with high data
quality¶ and consistent reporting during 2018-2022. Data on
hospitalizations associated with hepatitis of unspecified etiology
were obtained on May 25, 2022, from PHD-SR, which
includes inpatient records from approximately 1,000 hospitals.
§ ICD-10-CM codes queried by NSSP and PHD-SR were as follows: B17.8
(other specified acute viral hepatitis); B17.9 (acute viral hepatitis, unspecified);
B19.0 (unspecified viral hepatitis with hepatic coma); B19.9 (unspecified viral
hepatitis without hepatic coma); K71.6 (toxic liver disease with hepatitis, not
elsewhere classified); K72.0 (acute and subacute hepatic failure); K75.2
(nonspecific reactive hepatitis); and K75.9 (inflammatory liver disease,
unspecified). These codes were previously used in a technical briefing published
by the United Kingdom Health Security Agency.
¶ To reduce artifactual impact from changes in reporting patterns, analyses were
restricted to facilities with a coefficient of variation ≤35% and >70% discharge
diagnosis informativeness during 2018-2022. Visit data from a monthly average
of 1,817 facilities were included in this analysis from state and regional
jurisdictions representing 44 states.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
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22
A Henry Schein Publication

https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_462.pdf

BQ Journal Vol 48 - Q3 2022

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