Hepatitis

2022 - 5 - 6

hepatitis in children

CDC investigating 109 unusual hepatitis cases in kids in outbreak (STAT)

Of the 109 cases under investigation in 25 states, eight of the children needed liver transplants and five have died.

The Covid vaccines are not authorized for use in children under the age of 5, who make up 75% of the British cases. Still another option under consideration is that exposure to a drug, a toxin, or something in the affected children’s environment predisposed them to have an abnormal reaction to adenovirus infection. But other hypotheses are also being explored, including the possibility that there is a combination of factors — for instance, that a prior infection with another virus such as SARS-CoV-2, which causes Covid-19, might have primed some children to become more ill when they were infected with adenoviruses. The U.K. report’s leading hypotheses focus around infection with an adenovirus — though there are a number of explanations for why it might be causing hepatitis being explored. “The viral load in these children, by the time they’re diagnosed, tends to be fairly low,” Butler said. Experts have cautioned that some of the reported cases may turn out to have another explanation. While some of the patients are as old as 16, most are under the age of 5. Eleven of the U.K. children have needed liver transplants, but none to date has died. The condition — inflammation of the liver — can be triggered by a host of pathogens as well as by exposure to toxins, some medications, and alcohol misuse. Changes in the number of rare events are easier to spot in countries with single-payer health systems, he suggested. As a consequence, CDC is mining what’s known as syndromic surveillance data, trying to see if there are changes in rates of children presenting for care with jaundice, a sign of liver disorder. But the CDC warned that the investigations are in an early stage and it is too soon to draw conclusions.

CDC investigating 109 cases of hepatitis among children, five deaths (The Washington Post)

The Centers for Disease Control and Prevention is investigating 109 cases of severe hepatitis of unknown cause in children, officials said Friday.

Some of them had adenovirus 41, which typically causes stomach illness and can cause hepatitis in immunocompromised children — though none of the children in Alabama were immunocompromised, officials said. WHO officials said that notifications of new cases, together with more extensive searches, would lead to more cases being detected before the cause could be determined. About half the U.S. children whose hepatitis cases are under investigation had a confirmed adenovirus infection, Butler said, but officials do not yet know if it is the cause of the illnesses. Officials are working to determine through blood tests whether some of the children had prior unknown coronavirus infections. Officials say severe hepatitis in young children remains rare and urge parents not to panic but be on alert for unusual signs including jaundice — which causes yellowing of the skin and whites of the eyes — dark urine and light stool. “Although rare, children can have serious hepatitis and it’s not uncommon for the cause to be unknown,” Butler said.

C.D.C. Is Investigating 109 Cases of Hepatitis in Children, Including ... (The New York Times)

The deaths of five children and what may be an unusual group of more than 100 hepatitis cases in young children in the United States are under investigation ...

It is not known how likely it would be for nine children tested at random to have had adenovirus infections. The alarm began two weeks ago when the C.D.C. issued an alert, citing nine hepatitis cases among young children in Alabama that began last fall into this year. Dr. Butler also said there was no evidence so far that either a Covid-19 infection or the Covid vaccine was linked to the U.S. cases. He urged doctors to consider testing for adenovirus if children were ill with certain symptoms. But the agency has not determined a cause for the cases or a common link among all of them, and it cautioned against drawing conclusions. Dr. Jay Butler, deputy director for infectious diseases at the C.D.C., said most of the children had fully recovered. Doctors do not normally test children for adenovirus infections — it is not a reportable disease in the United States — which makes it difficult to untangle causes and effects. All had evidence of an adenovirus infection. Symptoms include yellowing skin and eyes, nausea, and abdominal pain. The United Kingdom is investigating a far greater number — more than 160 cases — of young children reported to have or have had hepatitis recently. The C.D.C. said it was examining cases involving 109 children in 25 states and territories who had or have what the agency is calling “hepatitis of unknown cause.” The deaths of five children and what may be an unusual group of more than 100 hepatitis cases in young children in the United States are under investigation by the Centers for Disease Control and Prevention, the agency said on Friday.

2 Michigan kids suspected of having rare form of severe hepatitis ... (Detroit Free Press)

Two Michigan children had suspected cases of a rare, severe form of hepatitis that's now believed to have sickened at least 109 kids in the U.S..

"Adenovirus has been detected in some of the children, but we don't know if it is the actual cause of these illnesses," Butler said. In addition, adenovirus has been detected in many, but not all, of the cases occurring outside of the United States." "We are going to look at it in a very broad way." "In addition, none of the nine children in Alabama had COVID-19 infection during their hospitalization or a documented history of COVID-19." None of the children had gotten COVID-19 vaccines, either, he said, prior to being hospitalized for hepatitis. "It's still early days in terms of pinpointing the cause and understanding the mechanism of illness in these children."

CDC investigating more than 100 cases of hepatitis in children ... (CNN)

The US Centers for Disease Control and Prevention said Friday that it's investigating 109 cases of severe and unexplained hepatitis in children in 25 states ...

And in total, we only have around 200 cases that have been reported across the globe. "And so by the time that the damage has been done to the liver and we do the biopsy, the immune system has already cleared the virus from the liver. "I mean, at the end of the day, this is still a pretty rare phenomenon." Adenovirus infections are common, so maybe finding the virus in some of these patients is just a coincidence. "We are still telling at least our families here in Alabama -- and I would encourage other families the same way -- not to be too concerned about this just yet." There were 18 cases in which where they were able to partially sequence the genome, and all of them have been adenovirus 41F, the same one found in the US cases. But we did not find the virus in the liver. The report says they are not ruling out some role for a Covid-19 infection in these cases. We only found the virus in the blood," he said. In all five, the virus was a particular kind called adenovirus 41. When researchers tried to read the genes of the adenovirus in infected kids, only five had enough genetic material to get a full sequence. None of them tested positive for Covid-19 during their hospitalization or had a documented history of Covid-19, Butler said at the news briefing.

Hepatitis Outbreak in America: Which States Have Reported Cases ... (Today.com)

A pediatric hepatitis outbreak with unknown cause is growing. Minnesota, Wisconsin, Illinois and more states are investigating cases of kids with liver ...

The Texas Department of State Health Services told TODAY in a May 6 statement that the state has no confirmed cases of pediatric hepatitis associated with adenovirus 41. The California Department of Public Health told TODAY in a statement on May 5 that it has "received reports of seven young children in California with severe hepatitis since October 2021. Two of the cases are in suburban Chicago and one is in Western Illinois." The child was under 10 and tested negative for adenovirus at the time. All of the children, between 1 and 6 in age, tested positive for adenovirus, which the CDC and WHO are investigating as a possible cause of the global outbreak. The first reported cases in the U.S. were in Alabama in October. The CDC issued an alert and a report on the cluster of nine cases. "Indiana currently has four pediatric patients with non-viral hepatitis under investigation. The Pennsylvania health department is investigating "multiple cases for a possible connection" to the ongoing pediatric hepatitis outbreak of unknown origin but has not confirmed any, according to a statement to TODAY. Five of the Alabama children tested positive for a specific type of adenovirus, adenovirus 41. Most of the 109 children required hospitalization, and eight needed a liver transplant. Adenoviruses are common, usually causing cold-like and gastrointestinal symptoms. The Minnesota Department of Health is investigating "several cases" of hepatitis in kids with an unknown cause, local NBC affiliate KARE 11 reported in late April.

Michigan reports first 2 suspected cases of unexplained hepatitis in ... (mlive.com)

LANSING, MI – Two Michigan children are suspected of having a severe and rare form of hepatitis that is under investigation by the U.S. Centers for Disease ...

“Investigators both here, abroad and around the globe are working hard to determine the cause,” Butler said. With a median age of 2, the patients were too young to get the COVID-19 vaccine. More than 90% of the patients were hospitalized and 14% have received liver transplants. “It’s important to remember that severe hepatitis in children is rare even with the potential increase in cases that we’re reporting today,” Butler said. Cases of the severe hepatitis in children have popped up in 11 other countries. “MDHHS has provided this data to the Centers for Disease Control and Prevention as part of their Health Alert Network Health Advisory to notify clinicians and public health authorities of a cluster of children identified with hepatitis and adenovirus infection,” state health officials said in a statement.