A number of unexplained cases of pediatric hepatitis have recently emerged around the world, baffling health experts and authorities. The Centers for Disease Control and Prevention (CDC) reported last week that 109 cases had been detected in the United States
The CDC also confirmed five deaths and 14% of patients who received liver transplants. In the United States, the median age of children with these unexplained cases of acute hepatitis is 2 years.
In young children, hepatitis, an inflammation of the liver, is often caused by viral infections. Adenovirus, a very common pathogen found in children, has been detected in more than half of these cases, although a link has yet to be established.
Adenovirus infections usually present as inflammation of the lungs or stomach. However, a link between the virus and liver inflammation is not unknown, especially in immunocompromised people. Normal hygiene measures such as hand washing are effective in limiting the spread of adenovirus.
As the situation continues to evolve, here are five things you need to know about pediatric hepatitis:
Signs of potential pediatric hepatitis are evident
Rima Fawaz, physician and medical director of pediatric hepatology and pediatric liver transplantation at the Yale School of Medicine, told The Hill that signs of hepatitis in children are hard to miss.
“They will be sick,” Fawaz said. “Not all of the patients who came forward had severe jaundice. … I think they would look a little yellow.
Signs of hepatitis include vomiting, dark urine, pale stools, and jaundice, yellowing of the skin. Fawaz said that children with this condition will not play and run around as if nothing had happened; they will clearly be sick.
Clinicians nationwide have been advised by the CDC to report possible cases of pediatric hepatitis of an unknown cause as well as test for adenovirus. Due to the frequency of adenoviruses, it is not a commonly tested pathogen.
Most patients with acute pediatric hepatitis make a full recovery
According to Fawaz, in most cases, acute hepatitis “cures on its own”.
“The kid is doing very well with no chronic issues, no chronic liver disease. So usually the acute hepatitis will recover and the patient is fine,” she added.
The one-year survival rate for acute hepatitis is over 90% and generally has “excellent results,” Fawaz said.
Regarding the cases detected in the United States, a CDC official said during a press briefing that “in general, the majority of these children have recovered and made a full recovery.”
Fawaz noted, however, that in cases where the liver fails and a transplant is needed, a person will need to be on immunosuppressants for the rest of their life, as is the case in organ transplants.
Like most cases of acute pediatric hepatitis, adenovirus usually resolves on its own and does not require treatment.
It is unclear whether recent reports represent an increase in cases
The CDC acknowledged that it’s uncertain whether these recent cases indicate an increase in acute hepatitis or whether the agency is simply catching up on an ongoing trend through expanded testing.
“At this point, we haven’t seen an increase above the number of pediatric hepatitis visits,” a CDC official said recently, though he stressed that it’s not because he did not detect an increase that it is it does not happen.
The CDC official said the potential link to adenovirus was what made these hepatitis cases notable, although it did not appear that cases were increasing above baseline.
Recent cases do not appear to be linked to COVID-19
Due to the youth of the majority of affected children, most are ineligible for COVID-19 vaccines, ruling out the possibility that these cases were the result of unforeseen side effects from vaccination. The World Health Organization (WHO), which supports investigations of hepatitis cases around the world, said cases had been detected in children aged 1 month to 16 years.
According to the CDC, most of the children who developed hepatitis from an unknown cause had no documented history of coronavirus, making it highly unlikely that these cases were related to the virus or long COVID-19.
At least 11 countries report cases of unknown cause
According to the WHO, at least 11 countries have reported cases of acute pediatric hepatitis of unknown cause, almost entirely in North America or Europe.
The United Kingdom (UK), Spain, Israel, United States, Denmark, Ireland, Netherlands, Italy, Norway, France, Romania and Belgium have all reported case.
The UK currently appears to have the most confirmed cases, with 163 cases, no deaths and 11 liver transplants.