No apparent increase in cases of severe acute hepatitis of unknown etiology with fulminant liver failure in children in Germany, 2022

Objectives In April 2022, the United Kingdom and the United States reported alarming increases in cases of severe acute hepatitis of unknown etiology in children, indicating a multicountry outbreak. We aimed to determine if Germany was affected by the outbreak. Methods Cases were defined as patients 0–16 years with severe acute hepatitis (aspartate transaminase and/or alanine transaminase > 500 IU/l), with adenovirus detection or unknown etiology. Severely impaired liver function resulting in listing for liver transplant, undergoing liver transplant or death was defined as “fulminant” pediatric acute liver failure (pALF). We compared the 2017–2021 case numbers reported by German pediatric liver transplant centers (pLTxCs) with 05/2022–05/2023. Numbers of pediatric inpatients diagnosed with any of 12 selected hepatological ICD‐10 codes and number of liver transplants from national hospital discharge data in 2022 were compared with 2015–2021, using a two‐sample Poisson test. Results From 5/2022–5/2023, eight pLTxCs reported nine hepatitis cases with fulminant pALF, compared to 5–14 cases annually from 2017 to 2021, and a total of 26 hepatitis cases without pALF (no baseline data available). The number of pediatric inpatients diagnosed with any of 12 selected hepatological ICD‐10 codes was 373 in 2022, compared to 333–422 annually in 2015–2021. There were 85 liver transplants in 2022, compared to 91–114 annually in 2015–2021. Conclusions According to available data, there was no apparent increase in severe acute hepatitis cases of unknown etiology with fulminant pALF in children in Germany, 2022. We recommend implementing syndromic surveillance at pediatric emergency units and timely access to hospital discharge data.