What parents need to know about the rise in cases of unexplained hepatitis in children

The increase in these serious and mysterious cases has led the CDC to issue a health advisory to clinicians so health care providers can be on the lookout and report cases accordingly.

What should parents know about cases of hepatitis in children? How worried should they be and what symptoms should they watch out for? Is there a link between hepatitis cases and Covid-19?

To help answer these questions, I spoke with Dr. Leana Wen, CNN medical analyst, emergency physician and professor of health policy and management at George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and a mother of two young children.

CNN: Let’s start at the beginning. What is hepatitis and how common is it in children?

Dr. Leana Wen: Hepatitis is an inflammation of liver tissue. There are a number of causes. People may have heard of hepatitis A, B, and C, which are liver infections caused by contagious hepatitis viruses. Heavy alcohol consumption, certain medications, and specific toxins can also lead to hepatitis, as can certain medical conditions. There is also what is called autoimmune hepatitis, where the body’s immune system attacks the liver.

Hepatitis is not common in children, especially hepatitis that is not related to any of the hepatitis viruses. This is the reason why cases of unexplained hepatitis have been reported 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?

Magnifying glass: As of May 1, the World Health Organization has reported at least 228 probable cases of childhood hepatitis and dozens more are under investigation. These cases have been 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 from one state, Alabama, which has been tracking these childhood hepatitis cases since October.

Nine children have been identified who have no clear causes of hepatitis. They come from different places in the state with no identified connection to each other. All are generally healthy with no underlying medical conditions. The reported median age is around 3 years, with a range of 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 who underwent liver transplants.

CNN: How come there are so many cases in one state?

Magnifying glass: We do not know. I guess there isn’t necessarily something specific to Alabama, but there may be cases that are not being reported in other states. That’s why the CDC released its health advisory, so clinicians can be aware and report these cases if they see them.

The UK was the first to report cases to the WHO. They are actively looking for cases. Its health security agency has identified at least 163 confirmed cases in England, Scotland, Wales and Northern Ireland. It is possible that now that clinicians in the United States are aware, more cases will also be reported here.

CNN: What do we know about the causes of these hepatitis cases?

Magnifying glass: When patients show signs of hepatitis, they normally get a diagnostic workup that examines whether they have hepatitis A, B, or C; if they have been exposed to toxins and drugs; if they have certain autoimmune markers; And so on. All of these are negative in children so far.

A commonality among the first nine cases in Alabama in the CDC report is that all of them have blood tests showing an adenovirus infection. (Two more children have been identified since these nine cases were first reported.)

Given the possible link, however, that’s why the CDC issued its specific health alert. He advises clinicians to be on the lookout for cases of hepatitis in children and report them immediately to the CDC and state health authorities. It also asks health care providers to order specific adenovirus tests in these children.

CNN: Could these cases be linked to Covid-19?

Magnifying glass: It seems unlikely. None of the children in the Alabama case series are hospitalized due to Covid-19 infection. There is also no connection with having received the Covid-19 vaccine. The UK’s Health Security Agency previously reported that none of its more than 100 cases so far had been vaccinated.

CNN: How worried should parents be and what symptoms should they watch out for?

Magnifying glass: These cases of unexplained hepatitis in children remain very rare. However, some have been extremely serious. Parents should not be overly concerned, but should be aware that this is being investigated and should then contact their doctor if they are concerned.

The early symptoms of hepatitis are nonspecific, which means that many people have these symptoms for 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 (as well as) jaundice – the skin turning yellow and sallow visible in the whites of the eyes and eyelids.

Many children have viral illnesses that can cause gastrointestinal upset, fever, and fatigue. If your child is unable to retain liquids, this is a sign that you should contact your doctor. Also, if symptoms persist and do not improve, or if your child begins to become lethargic, contact your doctor.

The most concerning 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 see a doctor right away if your child starts showing general viral symptoms and then continues to show these signs.

CNN: Is there anything that can be done to prevent these cases of hepatitis?

Magnifying glass: As the cause remains unknown, we cannot say what measures will help prevent them. If indeed there is a link to adenovirus, then the same strategies we have used throughout the coronavirus pandemic would be helpful, such as washing hands thoroughly with soap and water and urging people to stay home when they are sick.

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