CDC finds no Covid link to serious liver disease in Alabama

A new report from the Centers for Disease Control and Prevention appeared to rule out Covid as a factor in the mystery cases of severe hepatitis in children, at least in the nine confirmed cases in Alabama.

The report, released Friday, details the cases from Alabama, which first brought attention to liver disease in the United States. Last week, the CDC issued an alert advising doctors across the country to be on the lookout for unusual cases of hepatitis.

More than a dozen other cases are now being investigated in eight other states: one in Delaware, one in Louisiana, three in Illinois, two in North Carolina and four in Wisconsin.

On Friday, the Tennessee Department of Health said it has six cases. And the Georgia and New York state health departments also said they are investigating “a handful” of potential cases.

At least three children have required liver transplants and Wisconsin authorities are investigating the death of one child.

Transmission electron microscopy (TEM) image of some of the ultrastructural details exhibited by a small group of adenovirus virions.Dr. G. William Gary, Jr./CDC

According to the new report, none of the Alabama children tested positive for Covid when they were admitted to the hospital, and none had a previously documented case of the disease. None had received a Covid vaccine.

The children, seven girls and two boys, ranged in age from 1 month to 6 years, with a median age of 2, and were all diagnosed with hepatitis from October to February. On February 1, a statewide alert was sent to doctors, but no other patients were identified.

All of the patients came from different regions of Alabama, suggesting they had no connection to one another, although they were all treated at Children’s of Alabama, a hospital in Birmingham.

Study co-author Dr. Markus Buchfellner, a fellow in pediatric infectious diseases at the University of Alabama at Birmingham, was the first to note the unusual pattern of unexplained hepatitis in these children.

“When we see a healthy child who comes into the hospital and has signs and symptoms of hepatitis, the most common cause is a virus,” Buchfellner told NBC News.

All were previously healthy children, without any underlying health problems. But none tested positive for the usual viruses that cause hepatitis, including hepatitis A, B and C viruses. Several other causes of hepatitis in children were also ruled out.

Six children showed signs of past Epstein-Barr virus infections, but it is unclear whether reactivation of these old infections might play a role.

Symptoms of liver problems in children

However, all nine children tested positive for an adenovirus, a virus typically associated with cold-like symptoms. Five of the nine tested positive for a specific type: adenovirus 41.

While adenovirus 41 has not been shown to be the cause of these cases, Buchfellner said it could be a key clue.

“That’s one of the main reasons for publishing our case series, talking to the CDC and looking into this to see if there really is a link between adenovirus and hepatitis,” he said.

According to the report, the specific virus is a common cause of gastrointestinal illness in children, with symptoms including:

  • Diarrhea
  • vomiting
  • fever
  • respiratory symptoms

Seven patients reported vomiting, six reported diarrhoea, and three reported upper respiratory symptoms.

Symptoms related to liver problems were also common, including:

  • yellowing of the whites of the eyes, seen in eight children
  • an enlarged liver, seen in six.
  • One child had encephalopathy, a type of impaired brain function.

Also puzzling: Doctors performed liver biopsies on some of the patients, but found no adenovirus particles in any of them.

Buchfellner said that, in general, the viruses that cause hepatitis can usually be detected in liver tissue, because those viruses attack the organ.

Why the virus was found in patients’ blood, but not necessarily in their livers, is an area of ​​ongoing research.

“Some of my theories are that it might have something to do with the samples we sent that didn’t have the virus and the timing of the biopsies,” Buchfellner said. “This is one of the big questions we hope to answer by looking at affected liver tissue from other patients across the country.”

Adenovirus type 41 is transmitted primarily through fecal matter, once again highlighting the importance of proper handwashing.

The World Health Organization said around 170 cases of severe, unexplained hepatitis have been reported in children in 16 countries.

Most of those patients are in the United Kingdom, where the incidence of adenoviruses has recently increased, the head of the WHO/Europe high-threat pathogens team, Richard Pebody, said Thursday during a question-and-answer session at line.

The WHO has alerted doctors around the world to be on the lookout for these unusual cases of hepatitis.

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