Unexplained Hepatitis in Children: Should Parents Care?

The rise in these serious and mysterious cases has led the CDC to issue medical advice to physicians so that health care providers can stay tuned and report cases accordingly.

What should parents know about cases of hepatitis in children? To what extent should they be concerned and what symptoms should they be aware of? Is there a relationship between cases of hepatitis and Covid-19?

To help answer these questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at George Washington University’s Milken Institute School of Public Health. . She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and is the mother of two young children.

CNN: Let’s start at the beginning. What is hepatitis and how often is it in children?

Dr. Leana Wen: Hepatitis is an inflammation of the liver tissue. There are a number of causes. People may have heard of hepatitis A, B, and C, which are liver infections caused by contagious hepatitis viruses. Heavy alcohol consumption, certain medications, and specific toxins can also cause hepatitis, as well as some medical conditions. There is also something called autoimmune hepatitis, which is where the body’s own immune system attacks the liver.

Hepatitis is not common in children, especially hepatitis that is not related to one of the hepatitis viruses. This is the reason why so far cases of unexplained hepatitis have been reported. There are not many cases, but they are important enough to justify a more detailed investigation.

CNN: How many children have been affected by unexplained hepatitis so far, and what do we know about them?

Wen: As of May 1, the World Health Organization has reported at least 228 probable cases of childhood hepatitis with dozens more under investigation. These cases have been found in more than 20 countries.
Twenty-five U.S. states and territories have reported cases, with 109 cases under investigation so far, according to the CDC. One week ago, a CDC report looked at the clinical details of a state in Alabama that has been tracking these cases of childhood hepatitis since October.

Nine children with no clear causes of hepatitis were identified. They come from different parts of the state without any link identified between them. All are generally healthy, with no underlying disease. The average age reported is about 3 years, with a range of 1 to 6 years.

Three of the nine children in the Alabama cohort ended up with acute liver failure, a life-threatening condition. Two have received liver transplants. According to the CDC, the nine children are currently recovering, including liver transplants.

CNN: How come there are so many cases from the same state?

Wen: We do not know. My guess is that there isn’t necessarily something specific to Alabama, but there are possibly cases that aren’t being reported in other states. That’s why the CDC issued its health advice, so doctors can know and mark these cases if they see them.

The United Kingdom was the first to report cases to the WHO. They have been actively looking for cases. Its Health Safety Agency has identified at least 163 confirmed cases in England, Scotland, Wales and Northern Ireland. It is possible that now that American doctors know this, more cases can also be reported here.

CNN: What do we know about the causes of these cases of hepatitis?

Wen: When patients show signs of hepatitis, they usually receive a diagnostic study to see if they have hepatitis A, B, or C; if they have been exposed to toxins and medications; if they have certain autoimmune markers; and so on. All of this is negative in children so far.

A common feature among Alabama’s nine initial cases in the CDC report is that they all have blood tests that show adenovirus infection. (Two more children have been identified since these nine cases were first reported.)

Given the possible link, however, this is why the CDC has issued its specific health alert. Advise physicians to be alert for cases of childhood hepatitis and to report them immediately to the CDC and state health authorities. It also instructs health care providers to order specific adenovirus testing in these children.

CNN: Could these cases be related to Covid-19?

Wen: It seems unlikely. None of the children in the Alabama case series are in the hospital due to a Covid-19 infection. It also has nothing to do with getting the Covid-19 vaccine. The UK Health Security Agency previously reported that none of its more than 100 cases had been vaccinated to date.

CNN: How worried should parents be and what are the symptoms they should be aware of?

Wen: These cases of unexplained hepatitis in children remain very rare. However, some have been very serious. Parents shouldn’t be too worried, but they should know that this is something that is being investigated and then they should contact their doctor if they are concerned.

The initial symptoms of hepatitis are nonspecific, which means that many people have these symptoms for other reasons. They include nausea, vomiting, abdominal pain, fever, fatigue, loss of appetite, and joint pain. Subsequent signs include dark urine and light-colored stools, as well as jaundice: the skin turns yellow and yellow to the whites of the eyes and eyelids.

Many children have viral illnesses that can cause gastrointestinal upset, fever, and fatigue. If your child is unable to hold fluids, this is a sign that you should contact your doctor. Also, if your symptoms persist and do not improve, or if your child begins to get lethargic, contact your doctor.

The most worrying signs are if you start to see dark urine, light and yellowish stools on the skin or yellowish on the whites of the eyes. You should seek immediate medical attention if your child begins to experience general viral symptoms and then develops these signs.

CNN: Can anything be done to prevent these cases of hepatitis?

Wen: As the cause is still unknown, we cannot say what measures will help prevent them. If, indeed, there is a link to adenovirus, the same strategies we have been using during the coronavirus pandemic would be helpful, such as washing your hands thoroughly with soap and water and urging people to stay home when sick.

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