Outbreak of Hepatitis in Children

Reporting on May 7, 2022

Dozens of countries, including the United States and many in Europe, have reported hepatitis infections in children. The approximate onset of the current outbreak was October 2021; the age range for these children has been one month of age to 16 years old. (3) Hepatitis, caused by adenovirus, is recognized but is known to be self-limiting in children and associated with a fever. This outbreak, in contrast, can lead to severe liver injury and failure, causing hospitalization and the need for a liver transplant, and death. Amid the COVID-19 pandemic, this outbreak creates another challenge for infectious disease experts and more uncertainty for the general public.  

This post describes a developing story. This story has implications for consumers and businesses who want factual, up-to-the-minute information. In addition, for businesses, it provides an association of your brand with reliable, researched health and wellness content to improve your marketing strategy and expand your audience. As a nurse content writer, it is important to be apprised of emerging healthcare content, research the facts, and present content in an easy-to-read, engaging format. I’ll explain the origins of this outbreak, the information gathered so far, and recommendations for the path forward.   

The liver is the largest organ. It is located in the right upper quadrant of the stomach. Hepatitis is an inflammation of the liver. Inflammation occurs due to exposure to something referred to as a pathogen (in this case, probably a virus) that the body perceives as dangerous or the ingestion (eating) of something toxic to the liver. Inflammation is the body’s natural immune response to attack the pathogen and repair itself.   

The liver has multiple life-sustaining functions. It can filter blood and remove toxins. It also metabolizes the food and medications we ingest; metabolism involves keeping what our bodies need (nutrients and minerals) and breaking down and excreting what we don’t. As the liver fails, waste products build-up, including ammonia and bilirubin (which causes yellow skin).  We can not live without a liver.

In the United States, from Oct. 2021-February 2022, 9 children were rushed to Children’s Hospital of Alabama. These children were diagnosed with acute hepatitis. Three of the cases became so severe that the children suffered liver failure. Two of them required liver transplants. All of the nine have recovered or are recovering. (1)   

On April 23, 2022, the World Health Organization (WHO) reported a continued increase in viral hepatitis in children of unknown etiology across 12 countries. The United Kingdom has the most cases, followed by Spain, Israel, the United States, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania, and Belgium. As of April 28, the WHO reported two-hundred cases, seventeen liver transplants, and one death. (4)  

What authorities know:  

• Children who present with this syndrome have markedly elevated liver enzymes. Elevated liver enzymes are a sign of liver impairment.   
• Many cases reported abdominal pain, nausea, and vomiting. Most patients did not have a fever. (3)  
• Seventy-four patients were positive for adenovirus. Eighteen were identified as F type 41 where molecular testing was available. Adenovirus is a family of 50 different viruses, including the common cold. Adenovirus 41 is one strain that affects the intestinal system, usually causing nausea, vomiting, stomach pain, fever, and respiratory symptoms. “While there have been case reports of hepatitis in immune-compromised children with adenovirus, adenovirus type 41 is not known to cause hepatitis in otherwise healthy children. (3)Adenovirus Type 41 primarily spreads through the fecal-oral route and affects the intestines. (2)  

• Twenty of the cases (that were tested) were positive for SARS-CoV-2. (3)  
• Nineteen were detected with SARS-CoV-2 and adenovirus co-infection. (3)  
• All tested negative for hepatitis A, B, C, D, and E (3)  
• Liver Biopsies from 6 patients had no viral particles identified by electron microscopy. (2)  
• Based on the current information, international travel or links to other countries have not been identified as factors. (3)  

  

Hypotheses of the WHO, Center for Disease Control (CDC)  

• Adenovirus seems to be the most common finding. Still, the presence of adenovirus does not explain the severity of the clinical picture. (3)  
• Increased susceptibility among young children following a lower level of circulation of adenovirus during the COVID-19 pandemic due to distancing, mask-wearing, and isolating. (3)  
• The potential emergence of a novel adenovirus. (3)  

• Most children did not receive the COVID-19 vaccine; therefore, the hypothesis r/t COVID-19 infection is not supported. (3)  
• Experts recommend continued research into toxic hepatitis (ingestion of or exposure to harmful substances) and infectious hepatitis (caused by a virus).  
• These children may have had COVID-19, which decreased their immune response, making them more susceptible to hepatitis. (1)  

According to the CDC, common signs of hepatitis are fatigue, fever, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice. Jaundice is a yellowing of the skin, whites of the eyes, and mucous membranes caused by the inability of the liver to break down bilirubin which is due to the natural breakdown of red blood cells.   

If a child is experiencing diarrhea and jaundice, it’s essential to seek medical attention.   

In the meantime, it is crucial to practice good hand washing and respiratory hygiene.   

The key takeaway is that the cause of a multi-country hepatitis outbreak in children has not been found. Public health surveillance through the WHO, CDC, and European Center for Disease Control (ECDC) is on high alert.   

Make sure to check back to this page for updates.  

Resources

1. Kluger, Jeffrey. A Mysterious Hepatitis Outbreak Among Children is Baffling Doctors. Time. May 5, 2022. https://time.com/6173477/mysterious-hepatitis-outbreak-children/

https://www.cdc.gov/mmwr/volumes/71/wr/mm7118e1.htm?s_cid=mm7118e1_w 

https://time.com/6173477/mysterious-hepatitis-outbreak-children/ 

      2. Acute Hepatitis and Adenovirus Infection among children-Alabama, Oct. 2021-Feb. 2022. Baker, Julia, et al. May 6, 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7118e1.htm 

      3. Multi-country-Acute, Severe Hepatitis of unknown origin in children. World Health Organization’ https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON376

     4. Chao, Angelo, and Berman, Robby. Medical News Today. April 28, 2022. Hepatitis Outbreak in children in US and Europe may be linked to Adenovirus. https://www.medicalnewstoday.com/articles/hepatitis-outbreak-in-children-in-us-and-europe-may-be-linked-to-adenovirus 

     5. Walker, Molly. Medpage. CDC: 5 Deaths, 109 cases of Kids’ Mystery Hepatitis under Investigation Hepatitishttps://www.medpagetoday.com/infectiousdisease/hepatitis/98596?xid=NL_breakingnewsalert_2022-0506&eun=g2111144d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=CDChepAlert_050622&utm_term=NL_Daily_Breaking_News_Active