Unexplained Hepatitis in Children: Should Parents Be Worried?

The increase in these serious and mysterious cases has prompted the CDC to issue a health advisory to clinicians so that health care providers can be on the lookout and report cases accordingly.

What should parents know about cases of hepatitis in children? How concerned should they be and what symptoms should they watch for? Is there a link between the 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 the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and mother of two young children.

CNN: Let’s start at 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 the contagious hepatitis viruses. Heavy alcohol use, 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 own immune system attacks the liver.

Hepatitis is uncommon in children, especially hepatitis that is not linked to any of the hepatitis viruses. This is why the cases of unexplained hepatitis have been highlighted so far. There are not many cases, but they are important enough to warrant further investigation.

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

woman: As of May 1, the World Health Organization reported at least 228 possible 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, with 109 cases 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 were identified who have no apparent cause of hepatitis. They come from different locations in the state with no identified link to each other. All are generally healthy, no underlying medical conditions. The reported median age is approximately 3 years, with a range of 1 to 6 years.

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

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

woman: We do not know. I suspect there isn’t anything specific to Alabama per se, but there may be cases that go unreported in other states. This is why the CDC has issued its health advisory so that clinicians can be informed and flag these cases when they see them.

The United Kingdom was the first to report cases to the WHO. They are actively looking for cases. The Health Security Agency has identified at least 163 confirmed cases in England, Scotland, Wales and Northern Ireland. It is possible that now that US clinicians are aware, more cases can be reported here as well.

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

woman: When patients show signs of hepatitis, they are normally given a diagnostic test to see 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. These have all been negative in the children so far.

A similarity between the first nine Alabama cases in the CDC report is that they all have blood tests that show an adenovirus infection. (Two more children have been identified since those nine cases were first reported.)

However, given the possible link, this is why the CDC has issued its specific health warning. It advises clinicians to be wary of childhood hepatitis cases and 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?

woman: It seems unlikely. None of the children in the Alabama case series are hospitalized due to a Covid-19 infection. There is also no link to receiving the Covid-19 vaccine. The United Kingdom Health Security Agency previously reported that none of the more than 100 cases had been vaccinated so far.

CNN: How concerned should parents be and what symptoms should they watch for?

woman: These cases of unexplained hepatitis in children remain very rare. However, some were very serious. Parents should not be overly concerned but should know that this is something under investigation and should contact their doctor if they are concerned.

The initial symptoms of hepatitis are non-specific, meaning that many people develop these symptoms from other causes. They include nausea, vomiting, abdominal pain, fever, fatigue, loss of appetite and joint pain. Later signs include dark urine and light-colored stools, as well as (as well as) jaundice – the skin turns yellow and yellow in 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 keep fluids down, it is a sign that you should contact your doctor. If symptoms persist and don’t get better, or if your child starts to feel lethargic, talk to your doctor.

The most worrisome signs are if you start seeing dark urine, light-colored stools, and yellowing of the skin or yellowing of the whites of the eyes. You should seek immediate medical attention if your child develops common viral symptoms and then develops these symptoms.

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

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

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