https://pubmed.ncbi.nlm.nih.gov/37088181/ hepatitis

J Pediatr. 2023 Apr 21;113439.
doi: 10.1016/j.jpeds.2023.113439. Online ahead of print.

Recent Increase in Incidence of Severe Acute Hepatitis of Unknown Etiology in Children Is Associated with Infection with Adenovirus and Other Non-hepatotropic Viruses

Anna L Peters 1, Seung Kim 2, Reena Mourya 2, Akihiro Asai 3, Amy Taylor 3, Michael Rogers 3, Kathleen Campbell 3, Lin Fei 4, Alexander Miethke 3, William F Balistreri 3, Jorge A Bezerra 5

Abstract
Objective: To evaluate whether the nature and severity of non-A-E severe acute hepatitis (NAESAH) in children noted by the WHO from late 2021 through early 2022 was indeed increased in 2021-2022 compared with prior years.

Study design: We performed a single-center, retrospective study to track the etiology and outcomes of children with NAESAH in 2021-2022 compared with the prior three year periods (2018-2019, 2019-2020, 2020-2021). We queried electronic medical records of children ≤16 years of age with alanine-(ALT) or aspartate-aminotransferase (AST) levels >500 International Units. Data were analyzed for the periods of October 1, 2021-May 1, 2022 and compared with the same time periods in 2018-2021.

Results: Of 107 children meeting entry criteria, 82 cases occurred during October-May of 2018-2022. The average annual case number was 16.3 in 2018-2021 compared with a two-fold increase (to 33) in 2021-22 (P=0.0054). Analyses of etiologies showed that this increase was associated with a higher number of children who tested positive for viruses (n=16) when compared with the average of 3.7 for 2018-2021 (P=0.018). Adenovirus (26.1%) and SARS-CoV-2 (10.3%) were the most frequently detected viruses in 2021-2022. Despite evidence of acute liver failure in 37.8% of children in the entire cohort and in 47% of those with virus infection, the overall survival rate was high at 91.4% and 88.9%, respectively.

Conclusions: The number of children with severe acute hepatitis in our center increased from 2021 to May 2022, with a greater frequency of cases associated with adenovirus, yet transplant-free survival remains high.