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Human adenoviruses typically cause self-limited respiratory, gastrointestinal, and conjunctival infections in healthy children. In late 2021 and early 2022, several previously healthy children were identified with acute hepatitis and human adenovirus viremia.We usedA total of 15 children were identified with acute hepatitis - 6 (40%) who had hepatitis with an identified cause and 9 (60%) who had hepatitis without a known cause. Eight (89%) of the patients with hepatitis of unknown cause tested positive for human adenovirus. These 8 patients plus 1 additional patient referred to this facility for follow-up were included in this case series (median age, 2 years 11 months; age range, 1 year 1 month to 6 years 5 months). Liver biopsies indicated mild-to-moderate active hepatitis in 6 children, some with and some without cholestasis, but did not show evidence of human adenovirus on immunohistochemical examination or electron microscopy. PCR testing of liver tissue for human adenovirus was positive in 3 children (50%). Sequencing of specimens from 5 children showed three distinct human adenovirus type 41 hexon variants. Two children underwent liver transplantation; all the others recovered with supportive care.Human adenovirus viremia was present in the majority of children with acute hepatitis of unknown cause admitted to Children's of Alabama from October 1, 2021, to February 28, 2022, but whether human adenovirus was causative remains unclear. Sequencing results suggest that if human adenovirus was causative, this was not an outbreak driven by a single strain. (Funded in part by the Centers for Disease Control and Prevention.).

Cardiac outcomes of 131 children with multisystem inflammatory syndrome (MIS-C) were examined. The majority of the cohort was male (66.4%) and half were Black (49.6%). Cardiac involvement was evident in 25% of the cohort at diagnosis. Favorable short- and mid-term outcomes were documented on follow-up, irrespective of the severe acute respiratory syndrome coronavirus 2 variants causing the infection.

Background MIS-C is a hyper inflammatory condition following SARS-CoV-2 infection. Although COVID-19 infection rates and severity have varied based on circulating SARS-CoV-2 variants, it is unclear if cardiac involvement in MIS-C varies following infection with different SARS-CoV-2 variants. The objective of this study is to describe the severity of cardiac involvement in children with MIS-C following three different waves of SARS-CoV-2 infections. Methods Children hospitalized with a diagnosis of MIS-C were enrolled in a prospective observational study. Demographic, clinical, laboratory (troponin I and B-type natriuretic peptide (BNP)), electrocardiogram (EKG) and echocardiogram (ECHO) data for children diagnosed between 4/20 and 12/21 and followed at 1- and 6-months was analyzed. The cohort was divided into 3 groups to represent cases that followed infection with the Wuhan (4/20-10/20, group 1), Alpha (B.1.1.7, 11/20-7/21, group 2) and Delta (B.1. 617.2, 8/21-12/21, group 3) variants. Cardiac involvement during hospitalization and follow-up was compared between the groups. Results The cohort includes 131 children with MIS-C (32, 61 and 38 in groups 1, 2 and 3, respectively) with a median age of 10 years. Two-thirds were male (66.4%) and 49.6% were Black. Elevated BNP and troponin I levels were seen in 82% and 52.7% of children at initial diagnosis. A third of the cohort had at least one abnormal EKG finding. The proportion of children with abnormal laboratory and EKG findings was not different between the groups. Decreased left ventricular function on ECHO was seen in 25% (33/131) of the cohort with similar distribution among the three groups (p = 0.79). Trivial-small pericardial effusions were detected in 22% (29/131). Coronary artery abnormalities were detected in 11.45% (15/131), a majority in group 1 (25%; 8/32). At 1- and 6-monthfollow-up visits, BNP and Troponin I were normal in all children. At the 6-month follow-up visit, EKG was normal in all and ECHO was normal in 37/41 children with trivial to mild valvular regurgitation in four children. Conclusion In this single center prospective study, while a significant proportion of children with MIS-C had evidence of cardiac involvement at diagnosis, most resolved on follow-up demonstrating good outcomes. Disclosures Claudette Poole, MD, Therapy Brands: Stocks/Bonds Scott H. James, MD, Bayer: Advisor/Consultant|Pantheon Biosciences: Grant/Research Support Suresh Boppana, MD, Merck, Inc: Advisor/Consultant|Merck, Inc: Grant/Research Support|Pfizer: Grant/Research Support.

During October-November 2021, clinicians at a children's hospital in Alabama identified five pediatric patients with severe hepatitis and adenovirus viremia upon admission. In November 2021, hospital clinicians, the Alabama Department of Public Health, the Jefferson County Department of Health, and CDC began an investigation. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.