CDC investigating 109 childhood hepatitis cases, five deaths


“Vaccination against COVID-19 is not the cause of these illnesses. We hope this information will help clarify some of the speculation circulating online.”

The Centers for Disease Control and Prevention is investigating 109 cases of severe hepatitis of unknown cause in children, officials said Friday. Five of the children died.

Jay Butler, CDC deputy director for infectious diseases, said the cases dated back to October and were found in 24 states and one territory. More than 90% of patients were hospitalized and 14% received liver transplants, he said. The majority have recovered, he said.

The cases, which have been discovered in at least 20 countries, continue to mystify scientists, who have been unable to determine the cause. Officials say severe hepatitis in young children remains rare and urge parents not to panic but to watch for unusual signs including jaundice – which causes yellowing of the skin and whites of the eyes – dark urine and light stools.

“Although rare, children can have severe hepatitis and it’s not uncommon for the cause to be unknown,” Butler said. He said there had been no “significant increase” in the number of cases of pediatric hepatitis or liver transplants, including before the pandemic.

The main suspect is adenovirus – a common family of about 50 viruses that cause symptoms ranging from colds and stomachaches to pink eye and, in rare cases, conditions that affect the brain or spinal cord. About half of U.S. children whose hepatitis cases are investigated had confirmed adenovirus infection, Butler said, but officials don’t yet know if that’s the cause of the illnesses.

Officials said some of the most common causes of viral hepatitis – such as hepatitis A, B, C, D and E – have not been found. Officials don’t yet know what role other factors, such as environmental exposure, medications or other infections, might play in the illnesses.

“This is a very rare presentation of a common scenario,” said Helena Gutierrez, pediatric gastroenterologist at Children’s of Alabama.

Nine children were diagnosed in hospital between October and February, all of whom were previously healthy and had the adenovirus in their blood, officials said. Some of them had adenovirus 41, which commonly causes stomach illnesses and can cause hepatitis in immunocompromised children – although none of the Alabama children were immunocompromised, officials said .

“Children get sick, they catch viruses,” she said.

Gutierrez, who was involved in treating the nine cases, said there had been no cases since February at Children’s. Although two of the nine children required liver transplants, all have recovered or are on the mend.

CDC officials said sick children in Alabama had a median age of 2 years. None of them were infected with COVID-19 or had a history of having had COVID-19, officials said. Authorities are working to determine, through blood tests, whether any of the children had previously contracted unknown coronavirus infections.

None of the Alabama children had received a coronavirus vaccine, officials said.

“COVID-19 vaccination is not the cause of these illnesses,” Butler said. “We hope this information will help clarify some of the speculation circulating online.”

Butler said cases have been found in the following states and territories: Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota. North, Nebraska, New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington and Wisconsin.

As of May 1, the World Health Organization has recorded more than 220 cases in 20 countries in children aged 1 month to 16 years. An additional 50 cases are under investigation, according to a WHO press briefing on Wednesday.

WHO officials said reports of new cases, coupled with further investigation, would lead to more cases being detected before the cause could be determined. In early April, British officials alerted the WHO to cases of severe hepatitis in Scotland; the CDC issued an alert on the US cases on April 21.

Officials have urged clinicians to be alert to cases.

“Generally, we don’t report cases of acute liver failure to any type of public agency,” Gutierrez said. “Because it is under investigation, cases will come to the surface; people will test for adenovirus.

Under normal circumstances, doctors may miss cases of adenovirus-related hepatitis, because in mild cases they usually do not order viral studies beyond testing for hepatitis A, B, or C common, said Ryan Fisher, a pediatric gastroenterologist and transplant hepatologist. at Children’s Mercy in Kansas City.

“It could be that we are missing many cases of adenovirus-associated hepatitis in otherwise healthy children because we don’t check it and the children are recovering uneventfully,” Fisher said.

Doctors can now go back to previous resolved cases and check samples to see if there is evidence of the virus, pushing the numbers even higher.

Leina Alrabadi, a pediatric gastroenterologist at Stanford Children’s Health, had a case of hepatitis in a 4-year-old child in March and reported it a few weeks ago, after the CDC’s April 21 alert. This particular case did not result in liver failure.

“We have always had children progressing to transplant of unknown etiology,” Alrabadi said, adding that it is too early to know what is causing the outbreak of severe cases.

Still, WHO scientists said they don’t believe adenovirus alone is responsible for the severity of liver inflammation. Investigators in the UK and elsewhere are looking at other factors, including whether young children have become more susceptible to adenovirus after being less exposed during the pandemic; whether a new adenovirus may have emerged; and whether co-infection with the coronavirus could be a factor, although it seems unlikely: although some children have tested positive for the coronavirus, according to the WHO, the infection rate is only slightly higher than in the general population.

Doctors have advised seeing a pediatrician if children have unusual symptoms and said the pandemic is reinforcing lessons in protecting children from adenovirus and other pathogens.

“Continue to perform hand hygiene,” Gutierrez said, “before eating, after playing on the playground, and before touching a younger sibling who hasn’t been to school or daycare.” .


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