A mysterious wave of acute hepatitis in young children is taking on global dimensions, with approximately 200 cases in 14 counties with no clear epidemiological link.
What Happened: Hepatitis results in liver inflammation and can lead to organ failure and death. None of the confirmed pediatric cases have been linked to five typical strains of hepatitis — A, B, C, D and E.
The World Health Organization (WHO) has confirmed cases impacting children between the ages of one month and 16 years, with at least 17 children requiring liver transplants and one child dying. The impacted children were all in good health with no history of compromised immune systems, and none showed any signs of COVID-19.
As of today, cases have been confirmed in the U.S., Canada, U.K., Ireland, Spain, France, Italy, Belgium, Netherlands, Norway, Denmark, Romania, Israel and Japan. The U.K. has recorded the largest outbreak, with nearly 120 cases, In the U.S., at least 18 cases in four states have been confirmed, including nine children in Alabama; the first U.S. case was identified last October, but it is not certain in which country this illness wave first occurred.
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Potential Causes: Initial research into this outbreak is pointing to adenoviruses as a potential cause — this was detected in at least 74 confirmed cases. According to the U.S. Centers for Disease Control and Prevention (CDC), adenoviruses are common viruses responsible for illnesses ranging in severity from the common cold and a sore throat to more acute conditions such as bronchitis, pneumonia and acute gastroenteritis; less common results of adenovirus infection include bladder inflammation or infection and neurologic disease.
Adenoviruses are spread by close personal contact, respiratory droplets, and fomites. Yet the common viruses associated with viral hepatitis have not been detected in any of the reported cases, and there is no evidence of international travel as a cause of spreading the disease.
The CDC noted there are 88 types of immunologically distinct adenoviruses, but there is no specific treatment for adenovirus infections.
“Adenovirus type 41 commonly causes pediatric acute gastroenteritis, which typically presents as diarrhea, vomiting, and fever; it can often be accompanied by respiratory symptoms,” the CDC said in a health alert. “While there have been case reports of hepatitis in immunocompromised children with adenovirus type 41 infection, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children.”
The WHO issued a statement cautioning that although “adenovirus is a possible hypothesis, investigations are ongoing for the causative agent.”
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What Happens Next: For parents and health care professionals, warning signs that a child may have this hepatitis include jaundice, a yellowing tinge to the skin and other body parts.
Additional warning signs include dark urine, pale excrement, itchy skin, muscle and joint pains, a high temperature, complaints of feeling sick and unusually tire, appetite loss and stomach pain.
Children should be encouraged to follow hygienic measures to decrease the chances of transmission, including washing their hands regularly — particularly after using the bathroom, before eating and after blowing or wiping their nose with a tissue.
According to Johns Hopkins Medicine, children and adults should be vaccinated against hepatitis B and hepatitis A. There are no vaccines against hepatitis types C, D and E, and there is no cure for hepatitis once it occurs, with treatment focusing on preventing additional liver damage and, if applicable, reversing the existing damage. Most cases of acute hepatitis resolve over time.
