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Outbreaks of hepatitis in children: what you need to know


May 3, 2022 – World Outbreak of Acute Disease hepatitis in children has about 200 cases in 16 countries.

The World Health Organization (WHO) has identified more than 20 severe cases in the United States, particularly in Alabama, Delaware, Illinois, New York and North Carolina. One baby died of the disease in Wisconsin. Of the worldwide cases, 17 demanded Fr. liver transplant.

While severe hepatitis with acute liver failure is rare in healthy children, and the chances are largely in favor of your child if he develops hepatitis, your best protection against the current rare cases – this information.

Understanding hepatitis

Hepatitis is inflammation with liver and may be caused by infection, autoimmune disease, or medication.

“A condition that comes to mind for most people hepatitis A, B or C, ”says Michael Clatt, MD, head of the infectious diseases department at Dayton Children’s Hospital in Ohio. “These are specific viral infections that can cause hepatitis.”

Cases of hepatitis can have a variety of symptoms, including nauseavomiting, abdominal pain, dark urineyellow skin and / or eyes (jaundice), feverand fatigue.

“Most children in reported cases showed gastrointestinal symptoms such as vomiting, diarrhea and abdominal pain“, Says Norberta Rodriguez-Baes, MD, professor of pediatrics at the University of Texas Southwestern Medical Center and medical director of the hepatology program at the Children’s Medical Center in Plana, Texas.

“Behind these symptoms came jaundice,” he says. “Interestingly, fever has not been described as a common symptom in these cases. In addition, all the children used to be healthy. “

When children (or adults) come to the doctor with liver damage, hepatologists go to work to find the origin.

Liver specialists will perform tests for infections as well as genetic and autoimmune diseases, says Ryan Fisher, MD, head of the Department of Hepatology and Transplantation at Child Mercy in Kansas City, Missouri. “We also ask and send lab work to identify potential toxins or medications that are associated with liver damage. In some cases of severe hepatitis, we never find the cause. “


In connection with the current batch of cases of hepatitis in children, researchers are working on the theory that the cause is the adenovirus, which usually circulates every spring until autumn.

None of the common viral culprits – hepatitis A, B, C and E – have been found to infect children during the current outbreak. Instead, doctors found one type of adenovirus, type 41, in about half the cases worldwide.

Adenoviruses are spread by airborne droplets, close personal contact, and through objects that people touch, such as utensils or furniture. More than 50 types of adenoviruses can infect humans. The most common usually cause respiratory disease, but some also cause symptoms in the gut, which has been a topic in cases leading to severe hepatitis.

“The true link between adenovirus infection and cases of severe acute hepatitis in these children is currently being studied,” said Rodriguez-Baes of UT’s Southwestern Medical Center.

There have been previous reports of type 41 adenovirus causing hepatitis in immunocompromised children, but doctors have not seen it cause hepatitis in healthy children.

While the study continues, scientists are considering other health problems as possible causes, including previous COVID infection.

In the U.S., none of the affected children had COVID-19, which they know about, says Rodriguez-Baes. Some patients in the UK have had COVID, “but a true link between the virus and acute hepatitis has not been established”.

He said these cases were not related to the COVID-19 vaccination because the children had not received these vaccines.

What parents need to know

Whenever a disease circulates that can lead to severe consequences in children, parents go on high alert.

Although testing for some viruses is available, it is impossible to conduct extensive testing every time a child becomes ill. Even now, most doctors test for adenovirus only if the child is sick enough to be in the hospital.

“Severe hepatitis, which leads to liver failure, is extremely rare,” says Clatt of Dayton Children’s Hospital. “A diagnosis of adenovirus should not make you reflexively worry that it will lead to this rare complication.”

Treatment for adenovirus-related hepatitis remains largely ancillary, says Fisher of Children’s Mercy.

“With time and attention to meeting a child’s needs (e.g., intravenous fluids when dehydrated), recovery becomes commonplace,” he says. “The liver is capable of complete healing and we did not expect long-term effects after recovery.”

In cases of severe hepatitis, some medications can help, depending on the cause.

If treatment doesn’t help, “there are situations where a liver transplant is needed to avoid death,” Fisher says. “Of the 500-600 liver transplants in children annually in the United States, about 10% are done because of severe hepatitis, which leads to acute liver failure. We need to look at how these current cases affect these typical figures. We have not seen enough data to know whether these figures will change. “

“Parents should be aware of the symptoms and consult a primary care physician with questions or concerns,” says Rodriguez-Baes.

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