Hepatitis outbreak in children may be linked to adenovirus

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An epidemic of acute hepatitis affects young children in a dozen countries. AlexLinch/Getty Images
  • Mysterious cases of severe liver damage or hepatitis in children have been reported in more than 30 countries, including the United States, United Kingdom, Japan and Canada.
  • Health officials say there have been more than 600 cases, at least 38 liver transplants and nine deaths.
  • Health officials report that the outbreak may be related to adenovirus, a common cold virus.
  • Any child with signs of jaundice, a symptom of hepatitis, should be evaluated by a healthcare professional as soon as possible.

This is a developing story. We will provide updates as more information becomes available.

Health officials are looking for clues as a puzzling outbreak of severe liver disease affects young children in Europe, North America and Asia.

Worldwide, there have been more than 600 cases linked to acute hepatitis “of unknown origin”, according to the World Health Organization.

On May 27, the WHO confirmed that nine children have died from the disease. Of all cases identified worldwide, approximately 6%, or at least 38 children, required liver transplantation.

The cases were first recorded in the UK where the majority of cases have been identified. The outbreak has since spread to more than 30 countries, including the United States, Canada and Japan.

In the United States, cases have been identified in several states, including Alabama, North Carolina, Illinois and Wisconsin.

The ages of the children vary from 1 month to 16 years. However, more than 75% of cases are in children under the age of 5, according to the WHO.

So far, none have tested positive for the hepatitis A, B, C, D or E virussuggesting a new pathogenesis.

Hepatitis is indicated by excessively high liver enzyme levels. Medical experts are scrambling to identify the cause of the outbreak. Although unconfirmed, there is evidence that a common virus, adenoviruscould be involved, the UK Health Safety Agency (UKHSA) said in a technical briefing Monday.

According to the WHO, a strain of adenovirus known as F type 41 has been detected in the majority of cases.

“Although adenovirus is a possible hypothesis, investigations are ongoing for the causative agent,” the agency said in a statement.

As the medical community searches for new cases, the number of children affected is expected to rise as more cases have been reported in Ireland, Spain, Israel and other countries.

On April 21, the Centers for Disease Control (CDC) released a Health Alert Network Health Advisories inform clinicians and public health authorities of a cluster of unexplained cases of childhood hepatitis in Alabama. In November 2021, a major hospital notified the CDC that it had seen five children with significant and unexplained liver damage. Three of them presented with acute liver failure. In February, the hospital had identified four other patients. All had adenovirus type 41 infections.

Health officials in the UK had already informed the World Health Organization on April 5, of 10 cases of severe acute hepatitis in central Scotland. One case occurred in January this year, and the others were reported in March. By April 8, the number of cases had risen to 74. Some of them, children too, had the adenovirus.

There has not been a consistent link to SARS-CoV-2, although some children have tested positive.

According to the CDC, standard symptoms of hepatitis include “fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, pale stools, joint pain, and jaundice. “.

Dr. Anupama Kalaskara pediatric infectious disease specialist at Children’s Hospital of Minnesota in Minneapolis, said Medical News Today:

“We are learning more about cases of acute hepatitis in children and trying to understand any similarities in the cases that might help us identify them earlier. Some common symptoms that have been reported in known cases are the presence of diarrhea and jaundice in the absence of fever Diarrhea is a fairly common symptom in children and can be seen with a number of infectious causes, including many types of viruses, as well as non-infectious causes.

“Jaundice, however, particularly in the age group in which cases of hepatitis are more common, is a rarer symptom,” Dr. Kalaskar said. “Any child with diarrhea and jaundice should be seen for evaluation.”

With the presence of adenovirus F type 41 reported in many affected children, the virus is currently the medical community’s best clue to the source of hepatitis. However, Dr. Kalaskar added:

“We are learning even more about what exactly led to the known cases. It is true that a specific strain of adenovirus (41) has been identified in the majority of cases, but if and how this may have triggered the disease n is not yet known. Further investigation, including testing and identification of this and other viruses, will be required to help establish a connection, if found.

More than 100 adenoviruses have been identified to date. They are common pathogens for humans which mainly affects the eyes, respiratory tract and intestine, but they can also cause diseases in the liver, urinary tract and adenoid glands.

Adenovirus type 41 – and adenovirus type 40 – are associated with global diarrhea and diarrheal mortality in children.

Medical puzzles like this can take time to solve, according to Dr. Kalaskar:

“Mystery diseases are generally not common, and it may take some time to notice a trend in cases if they do not occur within a short period of time. In the case of these [newly] reported diseases, cases in Alabama occurred over a period of approximately five months, and it became clearer that this was an unusual disease with numbers in this range not typically seen.

“Once this new pattern has been established, then more can be done to investigate further to hopefully help determine the potential cause, for earlier recognition and diagnosis,” she added.

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