Two Michigan children had suspected cases of a rare and severe form of hepatitis that is now believed to have infected at least 109 children in the United States and may be related to an adenovirus infection.
The two Michigan children were under 5 years old. One was from Oakland County and the other from the city of Detroit, said Lynn Sutfin, a spokeswoman for the state health department.
One child became ill in October, Sutfin said; could not provide details on the timing of Michigan’s second suspicious case.
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The U.S. Centers for Disease Control and Prevention is investigating both cases as part of a national look at this mysterious acute form of hepatitis, looking for clues.
Of the U.S. children whose cases are being investigated, 90 percent were hospitalized and 14 percent needed liver transplants, Dr. Jay Butler, the CDC’s deputy director of infectious diseases, told a news conference Friday. .
“Fifteen days ago, the CDC issued a nationwide health alert to notify doctors and public health officials of an investigation involving nine children in Alabama identified between October 2021 and February 2022 with hepatitis or inflammation of the skin. liver and adenovirus infection, “Butler said.
“All of these patients were previously healthy, came from different parts of the state, and were hospitalized with significant liver injury without a known cause, including some with acute liver failure.
“In the end, all nine tested positive for adenovirus, which is a common virus that usually causes mild symptoms of a cold or flu, or stomach and intestinal problems.”
Since the CDC issued the health alert, more cases have been identified in the U.S., Butler said, in children living in 24 states and one U.S. territory.
As of Friday, cases were being investigated in Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska, New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington, Wisconsin.
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Hundreds of similar cases have also been identified in the United Kingdom, Northern Ireland, Spain, Denmark, Romania, Norway, France, Italy, Belgium, the Netherlands and Israel, according to the World Health Organization.
Some of the children who developed this severe form of hepatitis also have an adenovirus strain known as adenovirus 41, which can cause vomiting and diarrhea along with respiratory symptoms.
“Some of the common causes of viral hepatitis such as hepatitis A, B, C, delta and E have been considered and tested, but have not been found in any of these cases,” Butler said. “In addition, none of Alabama’s nine children had COVID-19 infection during their hospitalization or a documented history of COVID-19.”
None of the children had received COVID-19 vaccines, he said, before being hospitalized for hepatitis. The mean age of infected children was 2 years.
“Adenovirus has been detected in some of the children, but we don’t know if it’s the real cause of these diseases,” Butler said. “Of the 109 patients currently under investigation, more than half have evidence of an adenovirus infection. In addition, adenoviruses have been detected in many, but not all, cases outside the United States.”
Other factors are also being considered, such as environmental exposures, medications and other infections that children may have had before they became ill, he said.
The CDC is issuing new guidelines for doctors to step up adenovirus testing and report possible cases of hepatitis without a known cause in children.
“Because we are still investigating the possible link between adenovirus infection and hepatitis, we also recommend that physicians evaluate these patients and consider performing adenovirus testing.”
And while this disease is extremely rare, Butler urged parents and caregivers to be aware of the symptoms of hepatitis, which may include:
- Vomiting
- Dark urine
- Light colored stools
- Jaundice, or yellowing of the skin
Most children who have developed this condition have fully recovered, said Dr. Umesh Parashar, head of the viral gastroenteritis branch in the CDC’s viral disease division.
Adenovirus can be spread by drops when a person coughs or sneezes and also by fecal-oral transmission, Parashar said.
“We don’t really know if it’s the cause of the disease,” Parashar said of the adenovirus. “We will look at it in a very broad way.”
Questions include whether the underlying immune conditions in children who develop the disease could play a role or whether prior exposure to coronavirus could have affected the way adenovirus manifested in those children, he said.
“There may be some changes in the virus itself and we will only know after some of the genome sequencing studies have been completed …” Parashar said.
“We’re definitely keeping an open mind to this and looking at drugs, toxins, other environmental exposures or other pathogens.
“These are still the first days to identify the cause and understand the mechanism of the disease in these children.”
Contact Kristen Jordan Shamus: [email protected] Follow her on Twitter @kristenshamus.
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