May 3, 2022 – The global outbreak of acute hepatitis in children amounts to nearly 200 cases in 16 countries.
The World Health Organization (WHO) has identified more than 20 serious cases in the United States, particularly in Alabama, Delaware, Illinois, New York and North Carolina. In Wisconsin, a baby died of the disease. Of the cases worldwide, 17 required a liver transplant.
While severe hepatitis with acute liver failure is rare in healthy children and the chances are very good for your child if he gets hepatitis, your best defense at the moment against current, rare cases is information.
Understanding hepatitis
Hepatitis is an inflammation of the liver and can be caused by infection, autoimmune diseases or medications.
“The condition that comes to most people’s minds is hepatitis A, B or C,” said Michael Clatt, Ph.D., chief of the infectious disease department at Dayton Children’s Hospital in Ohio. “These are specific viral infections that can cause hepatitis.”
Cases of hepatitis can have a variety of symptoms, including nausea, vomiting, abdominal pain, dark urine, yellow skin and / or eyes (jaundice), fever and fatigue.
“Most of the children reported had gastrointestinal symptoms such as vomiting, diarrhea and abdominal pain,” said Norberto Rodriguez-Baez, MD, professor of pediatrics at the University of Texas Southwestern Medical Center and medical director of hepatology. program at the Children’s Medical Center in Plano, Texas.
“These symptoms are followed by the development of jaundice,” he said. “Interestingly, fever is not described as a common symptom in these cases. In addition, all children were previously healthy. “
When children (or adults) come to the doctor with liver damage, hepatologists go to work to find the origin.
Liver specialists will test for infections as well as genetic and autoimmune diseases, said Ryan Fisher, PhD, head of the Department of Hepatology and Transplantation at Children’s Mercy in Kansas City, MoD. “We also ask and send laboratory tests to detect potential toxins or drugs that are associated with liver damage. In some cases of severe hepatitis, we never find a cause.
Theory
With the current batch of cases of hepatitis in children, researchers are working on the theory that the cause is the adenovirus, which usually circulates every spring to autumn.
None of the common viral culprits – hepatitis A, B, C and E – have been found to infect children in the current epidemic. Instead, doctors have found one type of adenovirus, type 41, in about half of the world’s cases.
Adenoviruses are spread through respiratory droplets, close personal contact, and through objects touched by humans, such as utensils or furniture. More than 50 types of adenoviruses can infect humans. The most common ones usually cause respiratory diseases, but some also cause symptoms in the gut, which has been a topic in cases leading to severe hepatitis.
“The true link between adenovirus infection and cases of severe acute hepatitis in these children is currently being investigated,” said Rodriguez-Baez of UT’s Southwestern Medical Center.
Cases of adenovirus type 41, which causes hepatitis in immunocompromised children, have been reported in the past, but doctors have not seen it cause hepatitis in otherwise healthy children.
While the study continues, researchers are looking at other health problems as possible causes, including a previous COVID infection.
In the United States, none of the affected children had COVID-19, which they know about, says Rodriguez-Baez. Some patients in the UK have had COVID, “but no real link has been found between the virus and acute hepatitis.”
The cases did not appear to be related to vaccination against COVID-19, he said, as the children had not received those vaccines.
What parents need to know
Every time a disease circulates that can lead to severe consequences for children, parents are on high alert.
Although testing for some viruses is available, it is not possible to perform widespread tests when a child becomes ill. Even now, most doctors only test for adenovirus if the child is sick enough to be in the hospital.
“Severe hepatitis leading to liver failure is extremely rare,” said Clatt of Dayton Children’s Hospital. “The diagnosis of adenovirus should not make you reflexively worry that it will lead to this rare complication.”
Treatment for adenovirus-related hepatitis remains largely supportive, says Fisher of Children’s Mercy.
“With time and attention to meeting the child’s needs (eg, intravenous fluids if dehydrated), recovery is common,” he said. “The liver is capable of a complete cure and we would not expect long-term effects after recovery.
In cases of severe hepatitis, some medications can help, depending on the cause.
If treatment doesn’t help, “there are situations where a liver transplant is needed to avoid death,” Fischer said. “Of the 500-600 liver transplants performed on children each year in the United States, about 10% are performed due to severe hepatitis, leading to acute liver failure. We will have to see how these current cases affect these typical numbers. We have not seen enough data to know if these numbers will change.
“Parents need to be aware of the symptoms and contact their primary care provider with questions or concerns,” says Rodriguez-Baez.
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