Several unexplained cases of pediatric hepatitis have recently emerged around the world, stumping authorities and health experts. The Centers for Disease Control and Prevention (CDC) reported last week that 109 cases have been detected in the US.
The CDC also confirmed five deaths and 14 percent of patients who received liver transplants. The median age of children in the US who have these unexplained cases of acute hepatitis is 2 years.
In young children, hepatitis, an inflammation of the liver, is often caused by viral infections. Adenovirus, a very common pathogen found in children, has been detected in more than half of these cases, although a connection has not yet been established.
Adenovirus infections usually present as inflammation of the lungs or stomach. However, a connection between the virus and liver inflammation is not unheard of, particularly among immunosuppressed people. Normal hygienic measures, such as hand washing, are effective in limiting the spread of the adenovirus.
As the situation continues to evolve, here are five things to know about pediatric hepatitis:
Signs of possible pediatric hepatitis are evident
Rima Fawaz, a physician and medical director of pediatric hepatology and pediatric liver transplantation at Yale School of Medicine, told The Hill that the signs of hepatitis in children are hard to miss.
“They won’t feel good,” Fawaz said. “Not all patients who presented had severe jaundice. … I think they would look a little yellow.”
Signs of hepatitis include vomiting, dark urine, pale stools, and jaundice, a yellowing of the skin. Fawaz said that children with this disease will not play or run around as if nothing is wrong; They will clearly be sick.
The CDC has advised doctors across the country to report possible cases of pediatric hepatitis of unknown cause, as well as testing for adenovirus. Because of how common adenovirus is, it is not a commonly tested pathogen.
Most patients with acute pediatric hepatitis recover completely.
According to Fawaz, in most cases, acute hepatitis “heals itself.”
“The boy is completely fine with no chronic issues, no chronic liver disease. Usually acute hepatitis will recover and the patient will be fine,” she added.
The one-year survival rate for acute hepatitis is greater than 90 percent and generally has “excellent outcomes,” Fawaz said.
Regarding the cases detected in the US, a CDC official said during a press conference that “overall, most of these children have recovered and have fully recovered.”
However, Fawaz noted that in cases where the liver fails and a transplant is needed, the person will have to take immunosuppressants for the rest of their life, as is the case with organ transplants.
Like most cases of acute pediatric hepatitis, adenovirus also usually resolves on its own and does not require treatment.
It’s unclear if the recent reports represent an increase in cases.
The CDC has acknowledged that it is not sure if these recent cases indicate an increase in acute hepatitis or if the agency is simply noticing a current trend thanks to expanded testing.
“At this time, we haven’t seen an increase above baseline in the number of visits for pediatric hepatitis,” a CDC official said recently, though he stressed that just because they haven’t detected an increase doesn’t mean it is not happening.
The CDC official said the potential link to the adenovirus was what made these hepatitis cases notable, although it did not appear that cases were increasing above baseline.
Recent cases do not appear to be related to COVID-19
Due to how young most affected children are, most are not eligible for COVID-19 vaccines, ruling out the possibility that these cases are the result of an unforeseen side effect of immunization. The World Health Organization (WHO), which is supporting investigations into hepatitis cases around the world, said cases have been detected in children aged between 1 month and 16 years.
According to the CDC, most children who developed hepatitis from an unknown cause did not have a documented history of coronavirus, making it highly unlikely that these cases were related to the virus or prolonged COVID-19.
At least 11 countries are reporting cases of unknown cause
According to the WHO, at least 11 countries have reported cases of acute pediatric hepatitis of unknown cause, almost entirely in North America or Europe.
The United Kingdom (UK), Spain, Israel, the USA, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania, and Belgium have reported cases.
The UK currently appears to have the most confirmed cases, with 163 cases, no deaths and 11 liver transplants.