The US Centers for Disease Control and Prevention is investigating cases of unexplained hepatitis in children. Up to 109 cases are under investigation. On Friday, the CDC reported that these cases have affected children in 25 states and territories. Almost all of the children required hospitalization; five children have died, the CDC said.
The increase in these serious and mysterious cases has prompted the CDC to issue a Physician Health Notice so that health care providers can be vigilant and report cases accordingly.
What should parents know about hepatitis cases in children? How worried should they be and what are the symptoms they should watch for? Is there a link between hepatitis cases 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 the 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 liver tissue. There are a number of causes. People may have heard of hepatitis A, B, and C, which are liver infections caused by contagious hepatitis viruses. Excessive alcohol consumption, certain medications, and specific toxins can also cause hepatitis, as can some medical conditions. There is also something called autoimmune hepatitis, which is when the body’s own immune system attacks the liver.
Hepatitis is not common in children, especially hepatitis that is not related to one of the hepatitis viruses. This is the reason why cases of unexplained hepatitis have been reported so far. There are not many cases, but they are significant enough to warrant further investigation.
CNN: How many children have been affected by unexplained hepatitis so far, and what do we know about them?
Wen: As of May 1, the World Health Organization has reported at least 228 probable cases of childhood hepatitis with dozens more under investigation. These cases have been found in more than 20 countries.
Twenty-five states and US territories have reported cases, with 109 cases under investigation so far, according to the CDC. A week ago, a CDC report looked at clinical details for one state, Alabama, that has been tracking these childhood hepatitis cases since October.
Nine children with no clear causes of hepatitis were identified. They come from different parts of the state with no identified link to each other. All are generally healthy with no underlying medical conditions. The reported median age is about 3 years, with a range of 1 to 6 years.
Three of the nine children in the Alabama cohort ended up with acute liver failure, a life-threatening condition. Two have received liver transplants. According to the CDC, all nine children are currently recovering, including those with liver transplants.
CNN: How come there are so many cases from one state?
Wen: we don’t know. I guess there’s not necessarily something specific to Alabama, but there are possibly cases that are not being reported in other states. That’s why the CDC issued its health advisory, so doctors can be aware and flag these cases if they see them.
The UK was the first to report cases to the WHO. They have been actively looking for cases. Its Health Security Agency has identified at least 163 confirmed cases in England, Scotland, Wales and Northern Ireland. It is possible that now that doctors in the US know about it, more cases will be reported here as well.
CNN: What do we know about the causes of these hepatitis cases?
Wen: When patients show signs of hepatitis, they typically receive a diagnostic test that tests for hepatitis A, B, or C; if they have been exposed to toxins and medications; if they have certain autoimmune markers; Etc. All of these are negative in children so far.
A common feature among the nine initial Alabama cases in the CDC report is that they all have blood tests that show 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 alert. He advises doctors to watch for cases of childhood hepatitis and report them immediately to the CDC and state health authorities. It also instructs health care providers to order specific adenovirus tests in these children.
CNN: Could these cases be related to covid-19?
Wen: It doesn’t seem likely. None of the children in the Alabama case series are in the hospital due to a COVID-19 infection. There is also no link with having received the Covid-19 vaccine. The UK Health Security Agency previously reported that none of its more than 100 cases to date had been vaccinated.
CNN: How concerned should parents be, and what are the symptoms they should watch for?
Wen: These cases of unexplained hepatitis in children are still very rare. However, some have been extremely serious. Parents shouldn’t be overly concerned, but they should know that this is something that is being investigated and then they should contact their doctor if they are concerned.
The early symptoms of hepatitis are nonspecific, which means that many people have these symptoms due to 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 jaundice: the skin turns yellow, and the whites of the eyes and eyelids appear yellow.
Many children have viral illnesses that can cause gastrointestinal upset, fever, and fatigue. If your child can’t keep fluids down, it’s a sign that he should contact his doctor. Also, if symptoms persist and do not improve, or if your child begins to feel lethargic, contact your doctor.
The most concerning signs are if you start to see 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 starts with general viral symptoms and then progresses to these signs.
CNN: Is there anything that can be done to prevent these cases of hepatitis?
Wen: Since the cause remains unknown, we cannot say what measures will help prevent them. If, in fact, there is a link to adenovirus, then the same strategies we have been using during the coronavirus pandemic, such as thorough hand washing with soap and water and urging people to stay home when sick, would be helpful.