The US Centers for Disease Control and Prevention is investigating cases of hepatitis of unknown origin in children. About 109 cases are under analysis in the country.
Last Friday, the CDC reported that these cases affected children in 25 states and territories. Almost all had to be hospitalized; five children died, the agency said.
The rise in these serious and mysterious cases has prompted the CDC to issue a health advisory to doctors so that healthcare professionals can be on the lookout and report cases accordingly.
What should parents know about hepatitis in children? How worried should they be and what symptoms should they be on the lookout for? Is there a link between hepatitis cases and Covid-19?
To help answer these questions, I spoke with the analyst at CNN Leana Wen, an emergency physician and professor of health policy and management at the Milken Institute School of Public Health at George Washington University. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and mother of two young children.
CNN: What is hepatitis and how common is it in children?
Leana Wen : Hepatitis is an inflammation of liver tissue. There are several causes. People may have heard of hepatitis A, B and C, which are liver infections caused by the contagious hepatitis viruses.
Excessive use of alcohol, certain medications, and specific toxins can also lead to hepatitis, as can some medical conditions. There is also something called autoimmune hepatitis, which is where the body’s own immune system attacks the liver.
Hepatitis is not common in children, especially hepatitis that is not linked to one of the disease-causing viruses. This is the reason why cases of unexplained hepatitis have been flagged so far. There aren’t many cases, but they are significant enough to warrant further investigation.
CNN: How many children have been affected by unexplained hepatitis so far, and what do we know about them?
Wen : On May 1st, the World Health Organization reported at least 228 probable cases of childhood hepatitis, with dozens more under investigation. These cases were found in more than 20 countries.
Twenty-five US states and territories have reported cases, with 109 cases under investigation so far, according to the CDC. A week ago, a CDC report analyzed clinical details of one state, Alabamawhich has been following these cases of childhood hepatitis since October.
Nine children were identified without clear causes of hepatitis. They come from different locations in the state with no identified link between them. All are generally healthy, with no underlying medical conditions. The median age reported is around 3 years, ranging from 1 to 6 years.
Three of the nine children in the Alabama cohort ended up with acute liver failure, a life-threatening condition. Two received liver transplants. According to the CDC, all nine children are currently recovering, including those with liver transplants.
CNN: How come there are so many cases in one state?
Wen: We don’t know. My guess is that there’s not necessarily something specific to Alabama, but possibly there are cases that aren’t being reported in other states. That’s why the CDC has issued a health warning, so doctors can be aware and flag these cases if they see them.
The UK was the first to report cases to the WHO. They are actively looking for cases. THE Health Security Agency site identified at least 163 confirmed cases in England, Scotland, Wales and Northern Ireland. It is possible that now that US doctors are aware, more cases could also be reported here.
CNN: What do we know about what causes these cases of hepatitis?
Wen : When patients show signs of hepatitis, they usually receive a diagnostic work-up that checks whether they have hepatitis A, B, or C; whether they have been exposed to toxins and medications; whether they have certain autoimmune markers; and so on. All these are negative in children so far.
One similarity among the initial nine cases in Alabama in the CDC report is that they all have blood tests showing adenovirus infection. (Two more children have been identified since these nine cases were first reported.)
Given the possible link, though, this is why the CDC issued its specific health alert. The agency advises doctors to be on the lookout for cases of childhood hepatitis and to report them immediately to the CDC and state health authorities. It also instructs healthcare professionals to request adenovirus specific tests in these children.
CNN: Could these cases be related to Covid-19?
Wen : It seems unlikely. None of the children in the Alabama case series are in the hospital because of a Covid-19 infection. There is also no link to having received the Covid-19 vaccine. The UK Health Safety Agency previously reported that none of its more than 100 cases to date had been vaccinated.
CNN: How worried should parents be and what symptoms should they be on the lookout for?
Wen : These cases of hepatitis in children remain very rare. However, some were extremely serious. Parents shouldn’t be too concerned, but they should know that this is something under investigation and then they should contact their doctor if they are concerned.
The initial symptoms of hepatitis are non-specific, which means that many people experience these symptoms due to other causes. They include nausea, vomiting, abdominal pain, fever, fatigue, loss of appetite, and joint pain. Later signs include dark urine and light-colored stools, as well as jaundice — the skin turning yellow and yellow being seen on the whites of the eyes and eyelids.
Many children have viral illnesses that can cause gastrointestinal upset, fever, and fatigue. If your child can’t keep fluids down, that’s a sign you should see a doctor. Also, if symptoms persist and do not improve, or if your child starts to become lethargic, see a specialist.
The most worrisome signs are if you start to see dark urine, light-colored stools, and yellowing of the skin or yellowing of the whites of the eyes. You should seek immediate medical attention if your child starts having general viral symptoms and then goes on to have these signs.
CNN: Is there anything that can be done to prevent these cases of hepatitis?
Wen : As the cause remains unknown, we cannot say what measures will help to prevent them. If indeed there is a link to adenovirus, the same strategies we used during the coronavirus pandemic would be helpful, such as washing hands with soap and water and asking people to stay home when they are sick.
Source: CNN Brasil
