The World Health Organization (WHO) has identified more than 20 serious cases in the United States, including Alabama, Delaware, Illinois, New York, and North Carolina. In Wisconsin, a baby died of the disease. Of the global cases, 17 have required a liver transplant.
Although severe hepatitis with acute liver failure is rare in healthy children and the odds are very much in favor of your child if they have hepatitis, your best defense right now against the rare cases today is information.
Hepatitis is an inflammation of the liver and can be caused by an infection, autoimmune disorders, or medications.
“The condition that comes to mind for most people is hepatitis A, B or C,” says Michael Klatte, MD, head of the Infectious Diseases Division at Dayton Children’s Hospital in Ohio. “These are specific viral infections that can cause hepatitis.”
Cases of hepatitis can have a variety of symptoms, such as nausea, vomiting, abdominal pain, dark urine, yellowing of the skin and / or eyes (jaundice), fever, and fatigue.
“Most children in the reported cases had gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain,” says Norberto Rodriguez-Baez, MD, a professor of pediatrics at the University of Texas Southwestern Medical Center and medical director of hepatology. program at Children’s Medical Center in Plano, TX.
“These symptoms were followed by the 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 children (or adults) go to the doctor with a liver injury, hepatologists go to work to find the source.
Liver specialists will test for infections as well as genetic and autoimmune diseases, says Ryan Fischer, MD, head of Children’s Hepatology and Transplant at Children’s Mercy in Kansas City, MO. “We also ask for and submit lab work to discover possible toxins or medications that are associated with liver damage. In some cases of severe hepatitis, we never find a cause.”
With the current batch of hepatitis cases in children, researchers are working on a theory that the cause is adenovirus, which usually circulates every spring through fall.
None of the usual viral culprits (hepatitis A, B, C and E) have been found to infect children in the current outbreak. In contrast, doctors have found one type of adenovirus, type 41, in about half of all cases worldwide.
Adenoviruses are transmitted through respiratory droplets, close personal contact, and objects that touch people, such as utensils or furniture. More than 50 types of adenovirus can infect people. The most common ones usually cause respiratory illnesses, but some also cause symptoms in the gut, which has been an issue in cases that have led to severe hepatitis.
“The true association between adenovirus infection and cases of severe acute hepatitis in these children is currently being investigated,” says Rodriguez-Baez of UT Southwestern Medical Center.
There have been reports of previous cases of type 41 adenovirus causing hepatitis in immunocompromised children, but doctors have not seen it cause hepatitis in healthy children.
As research continues, scientists are looking at other health issues as possible causes, including previous COVID infection.
In the U.S., none of the affected children had COVID-19 known to them, says Rodriguez-Baez. Some patients in the UK had COVID, “but no real association has been established between the virus and acute hepatitis.”
The cases do not appear to be associated with vaccination against COVID-19, he said, as the children had not received these vaccines.
What parents should know
Whenever a disease circulates that can have serious consequences for children, parents are put on high alert.
Although there is evidence of some viruses available, it is not feasible to do widespread testing whenever a child becomes ill. Even now, most doctors only test for adenovirus if a child is sick enough to be in the hospital.
“Severe hepatitis leading to liver failure is extremely rare,” says Klatte of Dayton Children’s Hospital. “An adenovirus diagnosis should not cause you to think thoughtfully that it will lead to this rare complication.”
Adenovirus-associated hepatitis treatment remains primarily supportive, says Fischer of Children’s Mercy.
“With time and attention to meet the child’s needs (e.g., intravenous fluids if they are dehydrated), recovery is common,” he says. “The liver is able to heal completely and we do not expect long-term effects after recovery.”
In cases of severe hepatitis, some medications can help, depending on the cause.
If treatment does not help, “there are situations where a liver transplant is needed to prevent death,” says Fischer. “Of the 500-600 liver transplants performed on children each year in the United States, about 10% are due to severe hepatitis leading to acute liver failure. We need to see how these current cases affect these usual figures. “We haven’t seen enough data to see if these numbers will change.”
“Parents need to be aware of the symptoms and contact their primary care provider with questions or concerns,” Rodriguez-Baez says.