Unexplained hepatitis in children: should parents care?


The U.S. Centers for Disease Control and Prevention is investigating cases of unexplained hepatitis in children. As many as 109 cases are under investigation. On Friday, the CDC reported that the cases affected children in 25 states and territories. Almost all the children needed to be hospitalized; five children died, the CDC said.

The rise of these difficult and mysterious cases has led the CDC to issue health advice to clinicians so that health care providers can be vigilant and report cases accordingly.

What do parents need to know about cases of hepatitis in children? How much should you be concerned and what are the symptoms to look out for? Is there a link between cases of hepatitis and Covid-19?

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

CNN: Let’s start from the beginning. What is hepatitis and how common 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 infectious hepatitis viruses. Heavy use of alcohol, certain medications, and specific toxins can also lead to hepatitis, as can some medical conditions. There is also something called autoimmune hepatitis, where the body’s immune system attacks the liver.

Hepatitis is not common in children, especially hepatitis that is not associated with one of the hepatitis viruses. That is why the cases of unexplained hepatitis have been marked so far. There are not many cases, but they are significant enough to require closer 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, and dozens more are under investigation. These cases have been found in more than 20 countries.

Twenty-five U.S. states and territories have reported cases, and 109 cases are under investigation so far, according to the CDC. A week ago, a CDC report analyzed clinical details from one state, Alabama, which has been tracking these cases of childhood hepatitis since October.

Nine children have been identified who do not have clear causes of hepatitis. They come from different locations in the state with no identified interconnectedness. All are generally healthy, with no underlying health conditions. The reported mean age is about 3 years, ranging from 1 to 6 years.

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

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

Wen: we do not know. I guess there is not necessarily something specific to Alabama, but it is possible that there are cases that are not reported in other states. That’s why the CDC has issued its own health counseling, so doctors can be aware and label these cases if they see them.

The UK was the first to report cases to the WHO. They actively sought cases. Her Health Safety Agency has identified at least 163 confirmed cases in England, Scotland, Wales and Northern Ireland. It is possible that now, when American clinicians are aware, more cases can be reported here as well.

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

Wen: When patients have signs of hepatitis, they would usually receive diagnostic processing to check if they have hepatitis A, B, or C; whether they have been exposed to toxins and drugs; whether they have certain autoimmune markers; and so on. All of these are negative in children so far.

One common among the first nine cases in Alabama in the CDC report is that they all have blood counts showing adenovirus infection. (Two more children have been identified since the nine cases were first reported.)

However, given the possible link, that is why the CDC issued its special health warning. He advises doctors to be vigilant for cases of children’s hepatitis and to report them immediately to the CDC and state health authorities. It also instructs healthcare providers to order specific adenovirus testing in these children.

CNN: Can these cases be linked to Covid-19?

Wen: It seems unlikely. None of the children in the Alabama case series are in the hospital for Covid-19 infection. It also has nothing to do with receiving the Covid-19 vaccine. The UK Health Safety Agency has previously reported that none of the more than 100 cases have been vaccinated so far.

CNN: How worried should parents be and what are the symptoms to look out for?

Wen: These cases of unexplained hepatitis in children remain very rare. However, some were extremely serious. Parents should not be overly concerned, but they should know that this is something that is being researched and then they should consult their doctor if they are concerned.

The initial symptoms of hepatitis are nonspecific, which means that many people get these symptoms due to other causes. These include nausea, vomiting, abdominal pain, fever, fatigue, loss of appetite, and joint pain. Subsequent signs include dark urine and light stools, as well as (and) jaundice – the skin becomes yellow and yellow as seen in the whites of the eyes and eyelids.

A lot of children have viral diseases that can cause gastrointestinal upset, fever and fatigue. If your child is unable to retain fluid, this is a sign that you need to see your doctor. Also, if the symptoms persist and do not get better, or if your child begins to become lethargic, consult your doctor.

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

CNN: Is there anything that can be done to prevent these cases of hepatitis?

Wen: Since the cause is still unknown, we cannot say what measures will prevent them. If there really is a link to adenovirus, then the same strategies we used during the coronavirus pandemic would be helpful, such as washing your hands thoroughly with soap and water and encouraging people to stay home when they are sick.

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