Hepatitis Outbreak in Children: What to Know

May 3, 2022 — The worldwide outbreak of acute hepatitis in kids totals almost 200 circumstances in 16 international locations.

The World Health Organization (WHO) has recognized greater than 20 extreme circumstances within the United States, particularly in Alabama, Delaware, Illinois, New York, and North Carolina. In Wisconsin, one toddler died of the illness. Of the worldwide circumstances, 17 have required a liver transplant.

While extreme hepatitis with acute liver failure is uncommon in wholesome kids and the percentages are significantly in your little one’s favor ought to they get hepatitis, your finest protection proper now towards the present, uncommon circumstances is data.

Understanding Hepatitis

Hepatitis is irritation of the liver and might be attributable to an infection, autoimmune problems, or remedy.

“The condition that comes to mind for most people is hepatitis A, B, or C,” says Michael Klatte, MD, chief of the Division of Infectious Disease at Dayton Children’s Hospital in Ohio. “Those are specific viral infections that can cause hepatitis.”

Cases of hepatitis can have quite a lot of signs, together with nausea, vomiting, stomach ache, darkish urine, yellow discoloration of the pores and skin and/or eyes (jaundice), fever, and fatigue.

“Most of the children in the reported cases presented with gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain,” says Norberto Rodriguez-Baez, MD, a professor of pediatrics on the University of Texas Southwestern Medical Center and medical director of the hepatology program at Children’s Medical Center in Plano, TX.

“These symptoms were followed by development of jaundice,” he says. “Interestingly, fever was not described as a common symptom in these cases. In addition, all children were previously healthy.”

When kids (or adults) come to the physician with liver damage, hepatologists go to work to search out the origin.

The liver specialists will check for infections, in addition to genetic and autoimmune illnesses, says Ryan Fischer, MD, chief of the Section of Hepatology & Transplantation at Children’s Mercy in Kansas City, MO. “We also ask about and send lab work to uncover potential toxins or medications that associate with liver injury. In some cases of severe hepatitis, we never find a cause.”

A Theory

With the present batch of hepatitis circumstances in kids, researchers are engaged on a idea that the trigger is adenovirus, which generally circulates every spring via fall.

None of the same old viral culprits – hepatitis A, B, C, and E – have been discovered infecting the kids within the present outbreak. Instead, medical doctors have discovered one kind of adenovirus, kind 41, in about half of the worldwide circumstances.

Adenoviruses unfold by respiratory droplets, shut private contact, and through objects individuals contact, like utensils or furnishings. More than 50 forms of adenoviruses can infect individuals. The commonest normally trigger respiratory sicknesses, however some additionally trigger signs within the intestine, which has been a theme within the circumstances resulting in extreme hepatitis.

“The true association between adenovirus infection and the cases of severe acute hepatitis in these children is currently under investigation,” says Rodriguez-Baez of UT Southwestern Medical Center.

There have been case studies beforehand of adenovirus kind 41 inflicting hepatitis in immunocompromised kids, however medical doctors haven’t seen it trigger hepatitis in in any other case wholesome kids.

As the analysis continues, scientists are taking a look at different well being points as doable causes, together with prior COVID an infection.

In the U.S., not one of the affected kids had COVID-19 that they know of, says Rodriguez-Baez. Some sufferers within the U.Okay. had COVID, “but a true association between the virus and the acute hepatitis have not been established.”

The circumstances don’t seem like related to COVID-19 vaccination, he stated, for the reason that kids had not gotten these vaccines.

What Parents Should Know

Anytime an sickness circulates that may result in extreme penalties in kids, dad and mom go on excessive alert.

While testing for some viruses is obtainable, it’s not possible to do widespread testing every time a baby will get sick. Even now, most medical doctors are solely testing for adenovirus if a baby is sick sufficient to be within the hospital.

“Severe hepatitis leading to liver failure is extremely rare,” says Klatte of Dayton Children’s Hospital. “A diagnosis of adenovirus shouldn’t make you reflexively worry it will lead to this rare complication.”

Treatment for adenovirus-associated hepatitis stays principally supportive, says Fischer of Children’s Mercy.

“With time and attention to meeting the child’s needs (e.g., intravenous fluids if they’re dehydrated), recovery is common,” he says. “The liver is capable of complete healing, and we would not expect long-term effects after recovery.”

In circumstances of extreme hepatitis, some medicines might assist, relying on the trigger.

If remedy doesn’t assist, “there are situations where liver transplant is needed to avoid death,” says Fischer. “Out of 500-600 liver transplants done in children each year in the United States, around 10% are done because of severe hepatitis leading to acute liver failure. We will need to see how these current cases affect those typical numbers. We haven’t seen enough data to know whether those numbers will change.”

“Parents should be aware of the symptoms and contact their primary care provider with questions or concerns,” says Rodriguez-Baez.