The rise in these severe and mysterious cases has led the CDC to issue a health advisory to clinicians so that health care providers can be on the lookout and report cases accordingly.
What should parents know about the cases of hepatitis in kids? How worried should they be, and what are the symptoms they should be looking out for? Is there a link between the cases of hepatitis 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 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 the liver tissue. There are a number of causes. People might have heard of hepatitis A, B and C, which are liver infections caused by the contagious hepatitis viruses. Heavy alcohol use, certain medications and specific toxins can also lead to hepatitis, as can some medical conditions. There is also something called autoimmune hepatitis, which is where the body’s own immune system attacks the liver.
Hepatitis isn’t common in children, especially hepatitis that is not linked to one of the hepatitis viruses. This is the reason why the cases of unexplained hepatitis have been flagged thus far. There aren’t many cases, but they are significant enough to warrant closer investigation.
CNN: How many children have been affected by the unexplained hepatitis thus 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 child hepatitis with dozens more under investigation. These cases have been found in over 20 countries.
Twenty-five US states and territories have reported cases, with 109 cases under investigation thus far, according to the CDC. A week ago, a CDC report analyzed clinical details from one state, Alabama, that has been tracking these child hepatitis cases since October.
Nine children were identified who have no clear causes of hepatitis. They come from different locations in the state with no identified link to one another. All are generally healthy, no underlying medical conditions. The reported median age is about 3 years, with the range from 1 to 6 years old.
Three of the nine kids 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 of the children are currently recovering, including those with the liver transplants.
CNN: How come there are so many cases from one state?
Wen: We don’t know. My guess is that there isn’t necessarily something specific to Alabama, but possibly there are cases that are not being reported in other states. This is why the CDC issued its health advisory, so that clinicians can be aware and flag these cases if they see them.
The United Kingdom was the first to report cases to WHO. They have been actively looking for cases. Its Health Security Agency has identified at least 163 confirmed cases across England, Scotland, Wales and Northern Ireland. It’s possible that now that US clinicians are aware, more cases may be reported here, too.
CNN: What do we know about what causes these hepatitis cases?
Wen: When patients present with signs of hepatitis, they would normally get a diagnostic workup that looks at whether they have hepatitis A, B or C; whether they have been exposed to toxins and medications; whether they have certain autoimmune markers; and so forth. All of these are negative in the children thus far.
One commonality among the initial nine cases in Alabama in the CDC report is that all have bloodwork showing adenovirus infection. (Two more children were identified since those nine cases were first reported.)
Given the possible link, though, this is the reason why the CDC has issued its specific health alert. It advises clinicians to be on the lookout for child hepatitis cases and report them immediately to the CDC and to state health authorities. It also instructs health care providers to order specific adenovirus testing in these children.
CNN: Could these cases be related to Covid-19?
Wen: It seems unlikely. None of the children in the Alabama case series are in the hospital because of a Covid-19 infection. There is also no link with having received the Covid-19 vaccine. The United Kingdom Health Security Agency previously reported that none of its over 100 cases to date had been vaccinated.
CNN: How worried should parents be, and what are symptoms they should be on the lookout for?
Wen: These cases of unexplained hepatitis in children remain very rare. However, some have been extremely serious. Parents should not be overly concerned but should know that this is something under investigation and then should contact their doctor if they are concerned.
Initial symptoms of hepatitis are nonspecific, meaning that a lot of people get 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 turning yellow and yellow being seen in the whites of the eyes and eyelids.
A lot of children have viral illnesses that can cause gastrointestinal upset, fever and fatigue. If your child is unable to keep fluids down, that’s a sign that you should contact your doctor. Also, if the symptoms are persistent and not getting better, or if your child starts getting lethargic, contact your doctor.
The most concerning signs are if you start seeing dark urine, light-colored stools and yellowing of the skin or yellowing in the whites of the eyes. You should seek immediate medical attention if your child starts general viral symptoms and then proceeds to having these signs.
CNN: Is there anything that can be done to prevent these hepatitis cases?
Wen: Since the cause remains unknown, we can’t say what measures will help prevent them. If, indeed, there is a link to adenovirus, then the same strategies we have been using throughout the coronavirus pandemic would be helpful, such as thorough handwashing with soap and water and urging people to stay home when sick.