Wisconsin DHS Health Alert #45: Updated Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology
Bureau of Communicable Diseases
June 3, 2022
Key Points:
- In a May 11 Health Advisory, the Centers for Disease Control and Prevention (CDC) provided updated testing guidance for cases of pediatric acute hepatitis of unknown etiology. Clinicians are now recommended to consider adenovirus testing for patients with hepatitis of unknown etiology and to report such cases to their state or jurisdictional public health authorities.
- As of June 1, CDC is reporting that 246 children with acute hepatitis of unknown etiology are under investigation in the United States.
- The Wisconsin Department of Health Services (DHS) is currently investigating 13 pediatric cases of acute hepatitis of unknown etiology. Wisconsin clinicians are urged to report any new suspected cases to public health electronically via the Wisconsin Electronic Disease Surveillance System (WEDSS) and selecting “hepatitis unknown” as the disease type, or by contacting DHS at 608-267-9003.
Background
DHS is issuing this Health Alert Network (HAN) Health Advisory to update clinicians and public health authorities on the recent increase in cases of acute hepatitis and adenovirus infection in children.
A possible association between pediatric hepatitis and adenovirus infection in children who tested negative for hepatitis viruses A, B, C, D, and E is currently under investigation worldwide. This Health Alert serves to update clinicians who may encounter pediatric patients with hepatitis of unknown etiology of additional CDC recommendations regarding adenovirus testing and to elicit continued reporting of such cases to DHS.
Updated Testing Recommendations
CDC recently issued an updated official Health Advisory on May 11, 2022, describing additional updated testing recommendations. This testing guidance was updated on May 24, 2022, and the recommendations below are consistent with this updated guidance.
Clinicians should consider collecting the following specimen types if available from pediatric patients with hepatitis of unknown cause for adenovirus detection:
- Blood specimen collected in Ethylenediaminetetraacetic Acid (EDTA) (whole blood, plasma, or serum); whole blood is preferred to plasma and serum
- Respiratory specimen (nasopharyngeal swab in VTM/UTM, sputum, or bronchioalveolar lavage [BAL])
- Stool specimen or rectal swab in VTM/UTM; a stool specimen is preferred to a rectal swab
- Liver tissue, if a biopsy was clinically indicated, or if tissue from native liver explant or autopsy is available:
- Formalin-fixed, paraffin embedded (FFPE) liver tissue
- Fresh liver tissue, frozen on dry ice or liquid nitrogen immediately or as soon as possible, and stored at ≤ -70°C
Nucleic acid amplification testing (NAAT), such as polymerase chain reaction (PCR), is preferred for adenovirus detection (currently not available for FFPE liver biopsy or native liver explant). Testing whole blood by PCR is more sensitive and is preferred over testing plasma by PCR.
For patients under investigation with acute hepatitis, clinical laboratories are being requested to send all residual clinical specimens or specimen aliquots (stool, blood or respiratory) to the Wisconsin State Laboratory of Hygiene (WSLH). These specimens will be sent by the WSLH to the CDC lab for further analysis.
Clinical Criteria for Case Reporting
- Children under age 16, presenting with hepatitis of unknown etiology (with or without any adenovirus testing results) since January 1, 2021, AND
- Elevated liver function tests (i.e., aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >500 U/L).
Suspected cases of pediatric acute hepatitis of unknown etiology should be reported to public health electronically via WEDSS and selecting “hepatitis unknown” as the disease type, or by contacting DHS at 608-267-9003.
Thank you for your collaboration on this matter.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
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