The CDC continues to investigate the cause of a rash of hepatitis cases among youth, with at least 180 reports of the inflammatory condition nationwide.
Dr. Nipunie Rajapakse
Unexplained cases of pediatric hepatitis have now been identified in at least 20 countries, according to Mayo Clinic, with the CDC sharing 38 states and territories had reported cases which were under investigation as of May 25. The earliest cases stateside were detected in fall 2021 in Alabama, and at least six children nationwide have died.
“We are really in the investigation phase of all of this so it’s important to acknowledge what we know, but there are a lot of unknowns still,” says Dr. Nipunie Rajapakse, pediatric infectious disease expert at Mayo Clinic Rochester
Sara Hassan
The Wisconsin Department of Health Services (DHS) says there are at least four cases among youth in Wisconsin, with one patient requiring a liver transplant and one dying. The Minnesota Department of Health in a May 6 press release stated it was investigating three cases. The CDC lists states with cases under investigation, but does not report the number from each state in order to “protect patient privacy.”
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DHS delivered a Health Alert Network Health Advisory last month to make medical and public health staff aware of the appearance of acute hepatitis among area youth and potential links to the adenovirus, which was detected among around 50% of patients nationwide, per the CDC.
Experts are also looking at possible connections to the coronavirus, including long COVID, or increased susceptibility due to precautions like masking and distancing reducing exposure to adenovirus and thus decreased natural immunity. The majority of the hepatitis cases were among youth under 5, who are currently ineligible for the COVID vaccine.
“It’s difficult to ignore this is happening kind of on the background of the COVID pandemic, and so there are a lot of interesting questions of how they could be related,” says Rajapakse. However, the majority of patients were not COVID positive at the time of developing hepatitis, and Rajapakse says, “We think it’s probably unlikely to be related to acute COVID-19 infection.”
Vaccines for hepatitis A and B are standard for children, though the virus may materializing in types C, D and E. Hepatitis can have both infectious or non infectious causes, including ingestion of fecal matter through contaminated food or water, contraction from others with the infection through blood or bodily fluids, or overdoses of toxins or certain medications. The adenovirus usually causes cold-like symptoms, but adenovirus 41 can lead to stomach and intestine inflammation.
“We know that (adenovirus 41) can cause hepatitis, but the cases reported prior to this current cluster were primarily among people who had weakened immune systems or were immunocompromised,” says Rajapakse. “So that’s why this has generated so much interest.”
Liver inflammation can range from mild to severe, with symptoms including jaundice, abdominal pain, nausea and fatigue. Hepatitis has no cure, but medications can help minimize symptoms and reduce risk of liver damage.
“The liver is really one of the most important organs of our bodies — it receives a lot of the blood supply from the heart, it sends fresh blood up to the brain, removes all of those toxins, it controls sugars, it controls how thick or thin our blood is,” says Dr. Sara Hassan, a pediatric transplant hepatologist with the Mayo Clinic Children’s Center. “Once the liver fails all those functions (cease).”
In cases of liver failure, Hassan notes, a transplant is necessary in a matter of days or even hours. The CDC May 18 shared the number of pediatric hepatitis patients requiring a liver transplant declined from 15% to 9% in recent weeks.
“This is quite rare,” Hassan says of cases necessitating transplants. “We are keeping our eyes open. Not every hepatitis is going to progress. We will certainly be aware of this and monitoring for this and checking on progression.
“The liver is wonderful and most of the time if we have a little bit of injury, the liver is able to heal itself. So remember those cases are rare, and we’re working really hard to figure out how we can help, how we can investigate and how fast we can support.”
Rajapakse says parents should be aware of signs and symptoms of hepatitis, and consult a health care provider if any are present. It’s important to remain vigilant, but parents needn’t be fearful.
“I wouldn’t see this as cause for panic or significant anxiety at this point,” says Rajapakse. “And hopefully as we learn more we will be able to share some more.”
