A number of unexplained pediatric hepatitis cases have recently sprung up around the world, stumping health experts and authorities. The Centers for Disease Control and Prevention (CDC) reported last week that 109 cases have been detected in the U.S.
The CDC also confirmed five deaths and 14 percent of the patients having received liver transplants. The median age of the children in the U.S. found to have these unexplained cases of acute hepatitis is 2 years old.
In young children, hepatitis, an inflammation of the liver, is often caused by viral infections. Adenovirus, a very common pathogen found in children, has been detected in more than half of these cases, though a connection has yet to be established.
Adenovirus infections typically present as inflammation of the lungs or stomach. However, a connection between the virus and liver inflammation is not unheard of, particularly among immunocompromised people. Normal hygienic measures such as handwashing are effective at limiting the spread of adenovirus.
As the situation continues to evolve, here are five things you should know about pediatric hepatitis:
Signs of potential pediatric hepatitis are obvious
Rima Fawaz, a physician and the medical director of pediatric hepatology and pediatric liver transplant at the Yale School of Medicine, told The Hill that the signs of hepatitis in children are hard to miss.
“They will be unwell,” said Fawaz. “Not all patients that presented had severe jaundice. … I would think they would look a little bit yellow.”
Signs of hepatitis include vomiting, dark urine, light stools and jaundice, a yellowing of the skin. Fawaz said children with this illness will not be playing and running around as if nothing is wrong; they will clearly be ill.
Clinicians around the country have been advised by the CDC to report possible cases of pediatric hepatitis from an unknown cause as well as test for adenovirus. Because of how common adenovirus is, it is not a pathogen that is commonly tested for.
Most patients with acute pediatric hepatitis fully recover
According to Fawaz, in most cases, acute hepatitis is “healed by itself.”
“The kid is completely fine without chronic problems, without chronic liver disease. So, typically, the acute hepatitis will recover and the patient is fine,” she added.
The one-year survival rate for acute hepatitis is more than 90 percent and usually has “excellent outcomes,” Fawaz said.
Regarding the cases detected in the U.S., a CDC official said during a press briefing that “in general, the majority of these kids have recovered and recovered fully.”
Fawaz noted, however, that in cases where the liver fails and a transplant is needed, a person will have to be on immune suppressants for the rest of their life, as is the case in organ transplants.
Like most cases of acute pediatric hepatitis, adenovirus also usually resolves itself and does not require treatment.
It’s unclear if recent reports represent an uptick in cases
The CDC has acknowledged that it is unsure if these recent cases indicate a rise in acute hepatitis or if the agency is simply catching on to an ongoing trend thanks to expanded testing.
“At this point in time, we have not seen an increase above the baseline in the number of visits for pediatric hepatitis,” a CDC official recently said, though they stressed that just because they haven’t detected an increase does not mean it isn’t occurring.
The CDC official said the potential link to adenovirus was what made these hepatitis cases notable, even though it did not seem that cases were rising above the baseline.
The recent cases don’t appear to be related to COVID-19
Because of how young the majority of the affected children are, most are ineligible for COVID-19 vaccines, ruling out the possibility that these cases are a result of unanticipated side effect from immunization. The World Health Organization(WHO), which is supporting investigations into the hepatitis cases around the world, said that cases have been detected in children aged between 1 month old and 16 years old.
According to the CDC, most of the children who developed hepatitis from an unknown cause did not have documented histories of coronavirus, making it highly unlikely that these cases are related to the virus or long COVID-19.
At least 11 countries are reporting cases from an unknown cause
According to the WHO, at least 11 countries have report instances of acute pediatric hepatitis from an unknown cause, almost entirely in either in North America or Europe.
The United Kingdom (U.K.), Spain, Israel, U.S., Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania and Belgium have all reported cases.
The U.K. appears to currently have the most confirmed cases, with 163 cases, no deaths and 11 liver transplants.