CDC investigating more than 100 cases of hepatitis in children, including 5
Among them, 14% needed transplants, and five children have died.
Nearly all the children — more than 90% — needed to be hospitalized.
Dr. Jay Butler, the CDC’s deputy director of infectious diseases, stressed that the investigation — a partnership between the CDC and state health departments — is an evolving situation. Not all the hepatitis cases they are studying now may ultimately be caused by the same thing.
“It’s important to note that this is an evolving situation, and we are casting a wide net to help broaden our understanding,” Butler said.
Hepatitis, or swelling of the liver, can be caused by infections, autoimmune diseases, drugs and toxins. A family of viruses well known for attacking the liver causes hepatitis A, hepatitis B and hepatitis C.
It’s not clear what’s driving these cases in young children. Butler said some of the common causes of viral hepatitis have been considered but were not found in any of the cases.
Adenovirus has been detected in more than 50% of cases, although its role isn’t clear.
Early hepatitis reports
On April 21, the CDC alerted doctors to a cluster of unusual cases of hepatitis in nine children in Alabama.
It asked doctors and public health officials to notify the agency if they had similar cases of children under the age of 10 with elevated liver enzymes and no apparent explanation for their hepatitis going back to October.
Since then, health departments have been working with pediatric specialists in their states to identify possible cases. The numbers shared at Friday’s news briefing are the first national look at cases.
Cases are under investigation in Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska, New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington and Wisconsin.
The CDC’s alert followed reports of children from England, Wales, Scotland, and Northern Ireland going to hospitals with unexplained hepatitis.
As of May 1, there are 228 probable cases linked to the outbreak in 20 countries, with more than 50 cases under investigation, Dr. Philippa Easterbrook, a senior scientist in the World Health Organization’s Global Hepatitis Program, said in a briefing Wednesday. Among these cases, one child has died, and about 18 have needed liver transplants, she said.
Most of the children were healthy when they developed symptoms that included fatigue, loss of appetite, vomiting, diarrhea, belly pain, dark urine, light-colored stools and yellowing of their skin and eyes — a sign called jaundice.
Unusually severe liver inflammation
Pediatric gastroenterologist Dr. Heli Bhatt of M Health Fairview Masonic Children’s Center in Minneapolis has treated two children who are part of the CDC’s investigation. One, a 2-year-old from South Dakota, had a liver transplant this week.
Bhatt says liver failure in kids is “super rare.” And even before scientists started tracking this outbreak, half of cases were never explained.
Doctors who have treated these children say their cases stood out.
“Even during the first case, I thought it was weird,” says Dr. Markus Buchfellner, a pediatric infectious disease specialist at the University of Alabama at Birmingham, where staffers started seeing cases in October.
“And then when the second one came in, that’s when I said, ‘OK, we need to talk to someone about this.’ ” He reached out to senior physicians in his department, who contacted the state health department and the CDC.
Buchfellner says the cases stood out because the liver inflammation was so severe.
Sometimes, common viruses like Epstein-Barr or even SARS-CoV-2 will raise a child’s liver enzymes a little, indicating what Buchfellner calls “small bits of hepatitis,” but the kids typically recover as their bodies fight off the infection.
“But it’s very odd to see a child who’s healthy come in with the amount of liver injury that these kids had,” he said.
Initially, UAB saw nine kids with unexplained hepatitis, and all nine tested positive for adenovirus in their blood. None of them tested positive for Covid-19 during their hospitalization or had a documented history of Covid-19, Butler said at the news briefing.
Since those cases were reported, two more children in Alabama have been identified. Their cases are under investigation, bringing the state’s total to 11, said Dr. Wes Stubblefield, medical officer for Alabama’s Northern and Northeastern Districts.
There are about 100 kinds of adenoviruses. About 50 of them are known to infect humans, so experts needed a closer look at the virus to try to figure out if all the children had the same one.
When researchers tried to read the genes of the adenovirus in infected kids, only five had enough genetic material to get a full sequence. In all five, the virus was a particular kind called adenovirus 41. It typically causes diarrhea and vomiting in kids, sometimes with congestion or a cough, but has never…
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