CDC issues nationwide alert about mysterious hepatitis cases in children

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The Centers for Disease Control and Prevention issued a nationwide health alert Thursday about an unusual group of serious hepatitis cases in young children with unknown cause or causes.

Federal health officials and the Alabama Department of Public Health are investigating nine cases of hepatitis in children ages 1 to 6 who were hospitalized between October 2021 and February 2022 with significant liver involvement. All of the children were previously healthy, officials said, and two of them required liver transplants. No deaths have been reported. The CDC alert is to notify physicians and public health authorities across the country to be on the lookout for symptoms and to report suspected cases.

Officials said that none of the children had been hospitalized due to infection with the Corona virus. The children were from all over the state and officials did not find any epidemiological link to them.

Alabama health officials said a case has also been identified in another state, but neither state nor federal officials have provided any details.

Symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light stools, joint pain, and jaundice.

Officials are investigating a possible link between hepatitis in children and adenovirus, a family of viruses that cause a range of infections, the most common of which are respiratory diseases.

“At this time, adenoviruses may be the culprit, but investigators are still learning more, including ruling out other potential causes and identifying other potential contributing factors,” the Centers for Disease Control and Prevention said in a statement.

All nine children in Alabama have tested positive for adenovirus, which is spread by respiratory droplets and touching infected people or the virus on surfaces. Adenoviruses often cause respiratory disease, but they can also cause gastritis. The virus rarely causes hepatitis.

The cases in the United States come after European counterparts reported unusual outbreaks of acute hepatitis in dozens of previously healthy children — also without a known cause. The UK has reported 74 cases; The first was in January in Scotland. Spain has confirmed three cases, and Ireland is investigating a handful of cases, according to the World Health Organization. European health authorities have also reported cases in Denmark and the Netherlands.

The World Health Organization said six children had undergone liver transplants in the UK. No deaths have been reported.

Adenovirus has been confirmed in some, but not all, European cases, the CDC said. And the World Health Organization said many UK patients have also contracted coronavirus. None of the children in the UK, who were all under the age of 10, had been vaccinated against the coronavirus, according to the UK’s Health Security Agency.

Hepatitis can be caused by a variety of factors, from toxic chemicals to autoimmune disorders and viruses that cause chickenpox and the common cold. The most common causes of viral hepatitis are hepatitis A, B and C viruses.

These common causes have been ruled out in Alabama children, the CDC said. The authorities there said that they were also excluded in the UK children.

The first cases were identified in Alabama in October 2021. Five children were admitted to a children’s hospital with significant liver injury, including some with acute liver failure. There was no known cause. The Centers for Disease Control and Prevention said all tests have tested positive for the adenovirus. After further investigation, the hospital identified four more cases, all of whom had liver and adenovirus infections.

Five of the nine tested positive for a specific type of adenovirus, adenovirus 41, which more commonly causes acute gastroenteritis in children, said Karen Landers, a health officer for the Alabama Department of Public Health. The CDC health warning said symptoms typically include diarrhea, vomiting and fever and can often be accompanied by respiratory symptoms.

While there have been reports of cases of hepatitis in immunocompromised children with adenovirus infection, “type 41 adenovirus is not known to be a cause of hepatitis in healthy children,” the health warning states.

The Centers for Disease Control and Prevention is asking clinicians to consider adenovirus testing of pediatric patients with hepatitis of an unknown cause and to report any such cases.

In mild cases of hepatitis, Amy Edwards, a pediatric infectious disease specialist at Rainbow University Children’s Hospitals and Children’s Hospital Cleveland, said Parents and children may not even know there is a problem and it will resolve itself. She said the more serious cases would be very obvious, in which the child was becoming increasingly tired or jaundiced with abdominal pain, nausea and vomiting.

“The main thing parents might be wondering is, ‘What if my child has hepatitis and I don’t know it?’ “But if you don’t know it, the child has mild symptoms it doesn’t matter.” “If it’s bad, you’ll have symptoms.”

Edwards said she’s following news of the outbreak closely, but “at this time I’m not particularly concerned and I don’t think parents need to be concerned.”

With mask mandates lifted and social distancing restrictions lifted, children may be more susceptible to infection after being isolated from one another for too long.

said Monica Gandhi, an infectious disease expert at the University of California, San Francisco.

At Children’s Mercy Kansas City Center, physician Ryan Fisher said his area has not seen an increase in hepatitis cases similar to what was seen in Alabama. The hospital usually sees 1-3 cases of liver failure in children who need transplants annually or close to it. There have been 4 patients this year, Fisher said, and two of those patients had coronavirus.

“It’s really interesting and it’s very difficult trying to figure out why they have it,” said Fisher, chair of the division of hepatology and transplant medicine.

“First of all, acute liver failure is rare, even at this time of heightened awareness,” he said.

This is the first time in his career that he has heard of clusters of liver failure in different countries like this in children.

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