Updates on Hepatitis Outbreak in Children

Family at sunset

By Patty Blevins
May 25, 2022

May 24, 2022

The Center for Disease Control (CDC) reported on May 20, 2022, that 36 states and one territory in the United States had reported 180 pediatric “patients under investigation,” which is an increase of 71 patients from the 109 reported on May 5, 2022. The CDC adds perspective by explaining that many of these 71 clients are retrospective, meaning the CDC has just become aware of them even though their symptoms and illness date back to October 1, 2021; therefore, they are not new cases. They are considered preliminary cases and are subject to change once more data becomes available. A patient under investigation is defined as a person less than ten years of age with elevated liver enzymes (AST or ALT) who has had an unknown cause of hepatitis since October 1, 2021. The proportion of those requiring liver transplants has decreased from 15 percent to 9 percent since May 5, 2022. (1) 

What is known:

The CDC reports that although this outbreak continues to evolve, this severe hepatitis remains rare.

Most children who have contracted this severe hepatitis are 1-5 years old. 

This is a global outbreak of this severe hepatitis. (1) As of May 20, 2022, 276 cases of acute hepatitis of unknown etiology in children aged 16 years and below have been reported from the European region. The largest number of cases are in Belgium (14), Italy (27), Spain (29), Netherlands (14), and Portugal (11). (6)  As of May 16, 2022, there have been 197 cases in the United Kingdom. Eleven cases have received liver transplants. No cases residents in the United Kingdom have died. (4)

The CDC is communicating with medical groups to provide updated reporting, recommendations for testing, and access to experts. (1)

The hepatitis vaccine is not effective against this outbreak. (7)

The COVID-19 vaccine did not contribute to this outbreak. The children were too young to have received the vaccine. (1)

 

Working Hypotheses:

1. Adenovirus continues to be a strong lead. (1)  Test results have shown it in the blood of more than half the children in the United States and nearly three-fourths of those in the United Kingdom. Some children also tested for the same adenovirus 41 strain associated with a severe stomach illness. Doctors have yet to find the virus in the liver tissue, which would be expected if that was the cause of the liver injury. (4) 

  •  Researchers are considering a massive wave of common adenovirus infections, causing a rare or under-recognized complication to present more frequently.  (6)
  • Researchers are also considering a typical adenovirus infection in combination with abnormal susceptibility
    • allowing the adenovirus infection to progress more frequently, such as lack of exposure during the pandemic.
    • caused by a weakened response due to prior infection with SARS-CoV-2 or other infection
    • driven by coinfection with SARS-CoV-2 or another infection
    • caused by a toxin, drug, or environmental exposure (6)

2. A novel variant of adenovirus

3. A post-infectious SARS-CoV-2 syndrome

4. A drug, toxin, or environmental exposure

5. A new variant of SARS-CoV-2 (6)

  •  

 

Recommendations for parents from the CDC: (7)

  • Make sure your child is up to date on their vaccinations. 
  • Be aware of the symptoms of hepatitis: nausea,  fatigue, fever, yellow skin, dark or orange urine, and white or clay stools. Report these symptoms to your child’s pediatrician as soon as possible. 
  • Parents and children should carefully follow hygiene practices such as frequent hand washing, avoiding people who are sick, covering coughs and sneezes, and avoiding touching the eyes, nose, and mouth

 

 

Resources:

  1. Center for Disease Control and Prevention. May 18, 2022. https://www.cdc.gov/media/releases/2022/s0518-acute-hepatitis.html
  2. Firth, Shannon. MedPage Today. May 20, 2022. Adenovirus Remains a ‘Strong Lead” for unusual Hepatitis in Kids, CDC says.https://www.medpagetoday.com/pediatrics/generalpediatrics/98853?xid=nl_mpt_DHE_2022-05-20&eun=g2111144d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%202022-05-20&utm_term=NL_Daily_DHE_dual-gmail-definition
  3. Brodin, Peter and Arditi, Moshe. Severe Acute Hepatitis in Children: investigate SAR-CoV-2 superantigens. The Lancet Gastroenterology and Hepatology. May 13, 2022. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00166-2/fulltext
  4. Sun, Lena H. Inside the Global Hunt for a culprit in mysterious hepatitis cases. The Washington Post. May 17, 2022. https://www.washingtonpost.com/health/2022/05/17/hepatitis-children-investigation-cause/
  5. UK Health Security Agency. 19 May 2022. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1077027/acute-hepatitis-technical-briefing_3.pdf
  6. Joint ECDC WHO Regional Office for Europe Hepatitis of Unknow Origin in Children  Surveillance Bulletin. 20 May 2022. https://cdn.ecdc.europa.eu/novhep-surveillance/
  7. Kindelan, Katie. CDC issues alerts for parents on the outbreak of hepatitis among children. Here’s what to know. May 11, 2022. https://www.goodmorningamerica.com/wellness/story/cdc-issues-alert-parents-outbreak-hepatitis-children-heres-84640750

Patty Blevins