2 Mass. pediatric hepatitis cases under investigation, DPH says

The Massachusetts Department of Public Health is investigating two cases of pediatric hepatitis in the state, but both cases have tested negative for adenovirus infection.The DPH said no additional details are being released to respect the privacy of the pediatric patients. Last week, the U.S. Centers for Disease Control and Prevention said that it was investigating more than 100 cases of severe and unexplained hepatitis in children.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.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.”This could be due to exposure to toxins. It could be due to exposure to medication or other components in the environment. Or, also, a consequence of viral infection,” said Dr. Richard Malley of Boston Children’s Hospital.More than half of cases worldwide, 70%, have been connected to an adenovirus, a common virus that causes a variety of illnesses.There are dozens of adenoviruses, many of them associated with cold-like symptoms, fever, sore throat and pink eye. But some versions can trigger other problems, including inflammation in the stomach and intestines. Officials are exploring a link to one particular version that’s normally associated with gut inflammation.”As clinicians, we should be watching out for our children with the same types of symptoms,” Dr. Brian Chow with Tufts Medical Center said. “Earlier on in this outbreak, many of these cases have been caused by a virus called adenovirus.”The adenovirus, however, was not found in either of the pediatric hepatitis cases in Massachusetts.”It’s possible that they have no link whatsoever to the outbreak that’s being studied right now,” Malley said.Dr. Ali Raja, deputy chair of the Department of Emergency Medicine at Massachusetts General Hospital, said last week that more than 90% of the children affected by the current pediatric hepatitis outbreak needed to be hospitalized.”In fact, 14% of them required a liver transplant. So it’s a pretty big deal,” Raja said.Raja also noted that the kids affected have been young. “They’ve generally been between 1 to 6 years — old,” Raja said.”What parents should be looking out for is, first of all, the recognition that, so far, this is really quite rare,” Malley said.Authorities said these pediatric hepatitis cases have no link to the COVID-19 vaccine, since most of the children involved are too young to receive one. But health officials are now investigating how many of these children were previously had COVID-19.

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