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

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In response to the current pediatric hepatitis outbreak possibly related to adenovirusThe Centers for Disease Control and Prevention (CDC) found that current data does not suggest an increase in cases of pediatric hepatitis or adenovirus types 40/41 from the time the outbreak began in compared to levels before the COVID-19 pandemic, according to a recent study in Morbidity. 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.

“Although this ecological analysis cannot conclusively confirm or refute a potential association between pediatric hepatitis and adenovirus, it provides useful context for ongoing research.”

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

Atlanta, Georgia, USA - August 28, 2011: Close up of the Centers for Disease Control and Prevention entrance sign.  Sign located near the 1700 block of Clifton Road in Atlanta, Georgia, on the Emory University campus.  Upright composition.

Atlanta, Georgia, USA – August 28, 2011: Close up of the Centers for Disease Control and Prevention entrance sign. Sign located near the 1700 block of Clifton Road in Atlanta, Georgia, on the Emory University campus. Upright composition.
(iStock)

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After pediatric cases of hepatitis began to be identified in the United States and the United Kingdom that had no clear etiology, the CDC issued a healthy advisory 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 not known to cause hepatitis in children with an intact immune systemaccording to 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 increased above historical levels,” the CDC said.

So the agency analyzed data from four sources: the National Syndromic Surveillance Program (NSSP), the Premier Healthcare Database Special Version (PHD-SR), the Organ Procurement and Transplantation Network (OPTN), and Labcorp.

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.

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

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

PHD-SR included records from approximately 1,000 hospitals, while pediatric liver transplant data was obtained from the national registry, which is managed by OPTN.

The Labcorp data included stool sample results tested for adenovirus types 40/41, but could not distinguish between type 40 or 41, but the CDC noted that approximately 90% of all adenovirus cases detected in USA with gastroenteritis are type 41.

There was no significant difference in hepatitis-associated hospitalizations or pediatric emergency department visits during the outbreak period between October 2021 and March 2022 compared 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 samples positive for adenovirus types 40/41 during October 2021 to March 2022 compared to pre-pandemic levels.

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

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

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

The CDC reports that the data has limitations because the analysis assessed trends in hepatitis 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 unknown.

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They also note that although liver transplants are “well documented,” there is a two- to three-month lag period for reporting, so March 2022 data may not have been reported.

Additionally, because the COVID-19 pandemic likely altered health care-seeking behavior, pre-pandemic data is limited to 2017-2019, and it is unknown whether this data is an accurate baseline.

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The CDC also noted that the small sample size may 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 types 40/41 in the United States and cannot be used to infer or refute a causal link between these two diseases.”

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