OPINION: This article contains commentary which may reflect the author's opinion
The Center For Disease Control, which has spent a lot of time focused on Global Health and Social Justice, issued a statement recently about a mysterious outbreak of the deadly liver disease in children, saying, “While rare, children may still get hepatitis, and we don’t always know the cause.”
“Mysterious cases of severe hepatitis have been reported in seven Tennessee children, according to the state Department of Health. Vanderbilt Children’s Hospital reported treating several pediatric patients with liver disease of unknown origin,” WPLN reported on Thursday.
The first cases were identified in Alabama and reported in late April. Dr. Jay Butler, deputy director for infectious diseases for the Centers for Disease Control and Prevention, says the illnesses are noteworthy despite the low case count.
“One of the things that does seem to be unusual in this instance is that many of the children who are affected, all of them among the nine in Alabama, did not have immune-compromising conditions,” Butler said.
Nationwide, the CDC is looking into at least 109 cases in 25 states. In nearly every instance, liver disease required hospitalization. Some needed liver transplants and five have died.
So far, no kids being treated at Vanderbilt have required a liver transplant, though the hospital has an active transplant program.
“CDC issues new hepatitis alert telling doctors to take LIVER SAMPLES from seriously ill children to test for adenovirus,” The Daily Mail reported on Thursday.
The agency told clinicians to take several tests to probe for adenovirus cases Previously, they had only been recommended to take one test for the virus. There was also no mention of taking a liver sample to test for adenovirus cases. Yesterday Hawaii and Massachusetts became latest states to detect hepatitis.
Epidemiologists still don’t have a working theory about where the illnesses are coming from. They’ve ruled out any connection to the COVID vaccine because almost all the children were too young to get it, but Butler says they are still looking at whether the COVID virus, itself, could play a role in the liver infections.
According to local news sources, the HI state Department of Health confirmed it is investigating a report of acute pediatric hepatitis of unknown origin in a Maui resident under the age of 10 years.
A DOH spokesperson reports that the child was hospitalized for several days with abdominal pain and fever at the end of April.
“An extensive medical investigation was performed and there are a number of laboratory test results outstanding,” the spokesperson said.
Department officials say no cause has been determined at this time. “DOH is collaborating with the Centers for Disease Control and Prevention to identify the cause of the hepatitis case,” officials said.
On Thursday, the CDC held a media telebriefing to discuss the latest regarding the cases of childhood acute hepatitis of unknown cause in the US.
Fifteen days prior, on April 21, the CDC issued a nationwide health alert to notify clinicians and public health authorities about an investigation involving nine children between the ages of 1 to 6 years old in Alabama, identified between October 2021 and February 2022, with hepatitis, or inflammation of the liver and adenovirus infection.
During the briefing, Jay Butler, M.D., Deputy Director for Infectious Diseases, said all of those patients were previously healthy, came from different parts of the state, and were hospitalized with significant liver injury without a known cause, including some with acute liver failure.
“If parents see signs of liver disease — yellowing of the eyes or skin (jaundice), dark urine, pale stool, itchy skin, vomiting and malaise — they should notify their child’s pediatrician,” says Dr. Anita Pai, assistant professor of pediatrics at Vanderbilt. “Our pediatric liver team at Children’s Hospital is available for consultation if community pediatricians have patients fitting this clinical profile.”
What We Know
Laboratory tests identified that some of the children had adenovirus type 41, which is more likely to cause severe stomach illness in children.
Although there have been previous reports of hepatitis in children with suppressed immune systems who were infected with adenovirus, adenovirus type 41 is not a common cause of hepatitis in otherwise healthy children.
Other common causes of viral hepatitis, such as infection with hepatitis A, B, C, D, and E viruses were considered, but evidence for these infections were not found in any of the patients. Some other causes have been ruled out for the children in Alabama, including:
- The virus that causes COVID-19
- Urinary tract infection
- Autoimmune hepatitis
- Wilson disease external icon
At this time, the cause of the reported illnesses in these children is still unknown. While adenovirus has been detected in some children, we do not know if it is the cause of the illness.
We do not know and are investigating what role other factors play in this illness, such exposure to toxins or other infections that the children might have.
Prevalence (Number of Cases)
It is not yet clear whether there has been an increase in the number of cases of hepatitis in children, or improvements in detecting cases. It is not unusual for the cause of some hepatitis cases in children to remain unknown.