US health officials have sent out a nationwide alert warning doctors to be on the lookout for symptoms of unexplained hepatitis in children, after clusters of mystery cases in the US and UK.
The Centers for Disease Control and Prevention is expanding its investigation after dozens of young children contracted severe liver inflammation but did not have the hepatitis A, B or C viruses that usually cause it.
In Thursday’s alert, the CDC said it was working with its counterparts in Europe to understand the cause of the infections and urged doctors across the country to report potential cases.
A common cold virus known as adenovirus has been confirmed in several of the European cases, but not all.
In the UK, researchers have speculated that children may have weakened immune systems due to series of COVID-19 pandemic lockdowns.
However, the US cases of pediatric hepatitis so far are all in Alabama, a state that has not enforced the strictest pandemic restrictions, deepening the mystery.
Clusters of mysterious pediatric hepatitis prompted the CDC to issue a national alert
British health authorities said on Thursday they had identified a total of 108 cases of pediatric hepatitis. In some cases, the cases were so severe that the children required liver transplants.
WHAT IS HEPATITIS?
Hepatitis is an inflammation of the liver that is usually caused by a viral infection or liver damage caused by alcohol consumption.
Short-term hepatitis often has no noticeable symptoms.
But if some do develop, they may include dark urine, pale gray stools, itchy skin, and yellowing of the eyes and skin.
They can also include muscle and joint pain, high temperature, nausea and vomiting, and unusual tiredness all the time.
When hepatitis is transmitted by a virus, it is usually caused by eating food and drink contaminated with the feces of an infected person, or by blood-to-blood or sexual contact.
Other cases have been reported in Denmark, Ireland, the Netherlands and Spain, according to the European Center for Disease Prevention and Control.
Hepatitis simply means inflammation of the liver, which can have causes ranging from viruses and toxins to alcohol abuse.
The US alert directs doctors to report any suspected cases of the disease of unknown origin to their state and local health departments.
He also suggests doctors perform adenovirus tests in young patients with symptoms of the disease, including fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, pale stools, joint pain and jaundice.
The warning follows a CDC investigation with the Alabama Department of Public Health into a cluster of nine cases of hepatitis of unknown origin in previously healthy children ages 1 to 6.
The first such U.S. cases were identified in October 2021 at a children’s hospital in Alabama that admitted five young patients with significant liver damage — some with acute liver failure — of unknown cause.
In these cases, the children tested positive for adenovirus, a common family of viruses that can cause respiratory and gastrointestinal symptoms, but are rarely fatal.
The most common forms of liver disease – hepatitis A, hepatitis B and hepatitis C – were excluded.
A review of hospital records identified four additional cases, all of whom had liver damage and adenovirus infection.
Centers for Disease Control and Prevention expand investigation after dozens of young children contract severe liver inflammation
Laboratory tests revealed that some of these children were infected with adenovirus type 41, which causes an acute infection of the digestive system. The state found no new cases beyond the original cluster.
The CDC is working with state health departments to identify other cases in the United States.
While the main theory is that the cases are caused by a specific type of adenovirus, health officials are also considering other possible contributing factors.
Writing in the journal Eurosurveillance, a team led by Public Health Scotland epidemiologist Dr Kimberly Marsh said more children could be ‘immunologically naive’ to adenovirus strains due to pandemic restrictions.
They wrote: “The main hypotheses center on the adenovirus – either a new variant with a distinct clinical syndrome, or a regularly circulating variant that affects immunologically naïve young children more severely.
“This latter scenario may be the result of restricted social mixing during the pandemic.”
Nine American children – all under the age of six – have had serious cases of inflammatory liver disease since October. Adenovirus is a prime suspect in the outbreak (Pictured: A stock image of a virus)
The Scottish Public Health Agency first sounded the alarm over unusual cases of hepatitis in children on April 6.
There are now 14 cases identified in Scotland, including an additional case under investigation this week, Public Health Scotland director Jim McMenamin told Reuters.
A growing number of researchers believe that adenovirus infection could be behind the cases, possibly ‘in concert’ with another virus, as 77% of children in the UK had tested positive for the adenovirus, McMenamin said.
However, he said, other causes have not been ruled out, including exposure to a toxin, COVID-19 or a novel pathogen, either in tandem with an adenovirus infection or alone.
None of the cases in the UK or US have been linked to the COVID-19 vaccine. And Alabama state health officials said none of the nine cases had a history of COVID-19 infection.