Origin of global childhood hepatitis cases still unclear

Cases of acute hepatitis in children are on the rise in at least 14 countries, and global health officials are unsure which cause or causes are to blame. The disease affects children from zero to 16 years old. Some children have needed liver transplants and at least four have died, one in Wisconsin and three in Indonesia.

As of April 21, the World Health Organization had confirmed at least 169 cases worldwide. So far, young patients in ten states – Minnesota, Wisconsin, Alabama, Delaware, Georgia, Illinois, Louisiana, New York, North Carolina and Tennessee – and many European and Asian countries are showing many of the same symptoms. Jaundice, diarrhea and abdominal pain are among the frequently reported symptoms, in addition to the liver inflammation typical of acute hepatitis. Other symptoms of hepatitis in children include dark urine, gray or pale feces, muscle and joint pain, fever, fatigue, loss of appetite, and stomach pain. Laboratory results have not yet detected hepatitis A, B, C, D or E viruses, which are the usual suspects, in any of the patients tested, according to the World Health Organization.

At least 74 children with this hepatitis, however, have been infected with pathogens called adenoviruses. Adenoviruses typically cause cold-like symptoms, including fever, sore throat, bronchitis, pneumonia, diarrhea, and pink eye. Detection of these viruses has increased in the UK and Europe, according to the WHO, but it is unclear if infection rates are increasing or if more cases have been discovered due to intensified testing.

[Related: A mysterious liver disease is sickening kids in the US and Europe]

The Centers for Disease Control and Prevention on Friday released a clinical analysis of nine cases of acute hepatitis in immunocompetent and otherwise healthy children in Alabama. None of the children’s cases were related to each other. Of the nine young patients, all tested positive for adenovirus. Five of them tested positive for the same strain of virus: adenovirus 41. However, when doctors performed liver biopsies, none of the samples showed traces of adenovirus.

The COVID-19 pandemic may also have helped prime children against these infections. In a paper published in mid-April on pediatric acute hepatitis in Scotland, the researchers wrote that whatever infection causes hepatitis “affects young children who are immunologically naïve more severely”, meaning their immune systems were less developed, possibly as a “result of restricted social mixing during the COVID-19 pandemic.

The WHO and CDC advise physicians to be on alert for any potential cases of pediatric acute hepatitis. Meera Chand, a doctor with the UK Health Security Agency, told the BBC that although these cases are alarming, the likelihood of children developing hepatitis is extremely low. The best thing parents can do, she added, is to be vigilant about handwashing and other hygiene practices, and “to be alert for signs of hepatitis – especially jaundice. – which is easier to spot as a yellow tint in the whites of the eyes.” Parents should contact doctors if there is a problem.

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