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It is as if parents do not have enough to worry about – a global pandemic, a shortage of formula – there is a new mysterious disease that affects young children in the form of severe hepatitis.
Here is the conclusion: This is not a cause for panic, but it deserves vigilance. Parents should also be wary of speculation about the disease. There are still many things we do not know.
The Centers for Disease Control and Prevention is investigating at least 109 cases of the disease in the United States. Similar diseases have been reported in at least two dozen countries, from Argentina through Denmark to Indonesia. There are approximately 450 reports worldwide, with the largest number in the United Kingdom and the United States.
Many cases are severe. Among affected American children, more than 90 percent require hospitalization. Fifteen needed a liver transplant. Five died.
The disease appears to be concentrated in younger children. According to the CDC, most of those affected are under 5 years old, with an average age of only 2 years. There are many previously healthy children who do not have known basic medical conditions. The cases have been found in 25 states and there is no clear geographical model.
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The cause is unknown at this time. “Hepatitis” is a general term for inflammation of the liver, for many reasons. Hepatitis A, B and C viruses (and less commonly hepatitis D and E viruses) are known to cause inflammation of the liver. In adults, alcohol is another leading cause of hepatitis. Some drugs and toxins can also damage the liver and cause severe inflammation. However, none of the affected children tested positive for hepatitis viruses or had any open exposure to alcohol, drugs or toxins.
The only thing many have in common is a positive test for adenovirus, which is a common virus that causes colds, gastrointestinal disorders and other mild flu-like illnesses. The CDC said more than half of the cases in the United States have tested positive for adenovirus, and the UK’s Health Security Agency said more than 70 percent of them have. There is also a specific type of adenovirus, adenovirus 41, which has been found in many children in the United States, Britain and Europe.
The true percentage of positive adenovirus cases may be even higher, as cases may have been missed due to the way samples are collected. The CDC has issued a signal to clinicians to instruct healthcare providers to be vigilant and use specialized methods to test for adenovirus.
While adenovirus is the leading hypothesis, it may be purely an association rather than a causal relationship. After all, adenoviruses do not usually cause inflammation of the liver in healthy people. They also exist for years without being associated with acute hepatitis.
However, there is a precedent for an existing virus to cause a new syndrome. In 2012, a polio-like condition called acute sagging myelitis suddenly appeared, causing weakness in the arms or legs of healthy children that often lasted for months or years. Eventually, the terrifying but extremely rare disease was found to be linked to another common virus, an enterovirus. It remains unknown why most children who experience enterovirus have a runny nose and upset stomach, while a very small minority have suffered severe results.
Adenovirus may act similarly to enterovirus, although given the time of the coronavirus pandemic, there is active research on whether it is associated with covid-19. Some scientists speculate that a previous coronavirus infection may “trigger” an autoimmune reaction that may be exacerbated by subsequent exposure to adenovirus. But the coronavirus was identified in only 18 percent of reported cases in the UK. A CDC report of nine children hospitalized in Alabama found that none of them had an acute covid-19 infection or a documented history of infection in the past.
Others question whether two years of camouflage and social distancing may have led to children’s immune systems being less able to fight existing viruses. we do not know. What we do know is that there is no link to the coronavirus vaccine, as most children with this hepatitis are not old enough to qualify for vaccination.
It will take time for researchers to determine the cause. It may never be found. What is embarrassing to parents is that there is not much we can do to prevent this rare, anxious disease. If the leading theories are correct, adenoviruses are extremely common, and the CDC estimates that 75 percent of children are already infected with the coronavirus.
However, parents can seek immediate medical attention for jaundice and emphasize good hand washing to reduce the transmission of many diseases. Healthcare providers must also be vigilant in order to carry out the necessary tests and inform public health officials accordingly.
As we have learned from the coronavirus pandemic, emerging diseases require monitoring, research and vigilance. Hepatitis is no different.
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