J Korean Med Sci.  2023 Dec;38(47):e401. 10.3346/jkms.2023.38.e401.

A Report on a Nationwide Surveillance System for Pediatric Acute Hepatitis of Unknown Etiology in Korea

• Lee KJ
• Ko JS
• Park KY
• Kang KS
• Lee K
• Hong J
• Kim SC
• Lee Y
• Kang B
• Kim YB
• Kim HJ
• Eun BW
• Cho HK
• Kim YJ
• Kim MJ
• Lee J
• Lee TJ
• Oh SH
• Park S
• Hwang EH
• Sohn S
• Lim JG
• Kim Y
• Lee YJ

• KMID: 2548803
• DOI: http://doi.org/10.3346/jkms.2023.38.e401

Abstract

Background
Several cases of pediatric acute hepatitis of unknown etiology related to adenoviral infections have been reported in Europe since January 2022. The aim of this study was to compare the incidence, severity, possible etiology, and prognosis of the disease with those in the past in Korea.
Methods
The surveillance group collected data between May and November 2022 using a surveillance system. Acute hepatitis of unknown etiology was defined in patients aged < 16 years with a serum transaminase level > 500 IU/L, not due to hepatitis A-E or other underlying causes. For comparison, data from 18 university hospitals were retrospectively collected as a control group between January 2021 and April 2022.
Results
We enrolled 270 patients (mean age, 5 years). The most common symptom was fever. However, the incidence was similar between 2021 and 2022. Liver function test results, number of patients with acute liver failure (ALF), liver transplantation (LT), death, and adenovirus detection rates did not differ between the two groups. None of the adenoviruspositive patients in either group experienced ALF, LT, or death. In the surveillance group, adenovirus-associated virus-2 was detected in four patients, one of whom underwent LT. Patients with an unknown etiology showed significantly higher bilirubin levels, a lower platelet count, and a higher LT rate than patients with a possible etiology.
Conclusion
The incidence of pediatric acute hepatitis of unknown etiology and adenovirus detection rate have not increased in Korea.

Keyword

Hepatitis; Children; Adenovirus; Unknown Etiology

Figure

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  Fig. 1 A flow diagram of the current study of pediatric acute hepatitis of unknown etiology in Korea.AST = aspartate transaminase, ALT = alanine transaminase.

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  Fig. 2 Differences in laboratory test results of pediatric acute hepatitis in Korea. (A) Differences in laboratory test results between the unknown- and possible-etiology subgroups of pediatric acute hepatitis in Korea during the surveillance system. (B) Differences in laboratory test results among the unknown-etiology, possible-etiology, and adenovirus subgroups of pediatric acute hepatitis in Korea during the surveillance system.TB = total bilirubin, DB = direct bilirubin, WBC = white blood cell count.*P < 0.05.

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