An investigation is underway into clusters of severe hepatitis in children

U.S. and global health officials are sounding the alarm about the growing number of mysterious cases of severe hepatitis among children.

Earlier this month, researchers in the United States and Europe announced that they were studying small clusters of emerging cases around the world. The U.S. Centers for Disease Control and Prevention soon issued a warning to doctors and providers to beware of emergencies.

According to the World Health Organization, there are about 278 cases worldwide, most of which are children under 10 years of age.

“Surprisingly, most of these kids were healthy before,” he said. Philip Easterbrook, a medical expert with the World Health Organization’s Global Hepatitis and STI Program, told a news conference on Thursday.

The cause of these cases of acute hepatitis, or inflammation of the liver, remains unknown. According to experts, hepatitis is usually caused by an infection, but not always.

In an effort to determine the cause of the disease, the WHO has launched a full investigation, urging countries to report on the case, and hopes that a team of scientists will now find some link between the cases.

Officials in 10 states – Alabama, Delaware, Illinois, New York, North Carolina, Wisconsin, Georgia, Louisiana, Minnesota and Tennessee – have confirmed to ABC News that they are investigating a total of 20 cases of severe hepatitis. has been identified, so far.

At least four children in the United States have been required to have a liver transplant, and Wisconsin Department of Health officials said Wednesday that one child died of severe hepatitis.

Wisconsin officials have issued health warnings about the latest four cases of severe hepatitis in children and urged clinicians to be vigilant when appropriate.

Similarly, doctors at the University of Alabama Hospital in Birmingham have been investigating an increase in the number of children with acute hepatitis since the fall.

“What caught our attention was that in all of these cases, the adenovirus was positive,” Dr. Helena Gutierrez, medical director of the UAB and Alabama Children’s Liver Transplant Program, told ABC News on Thursday. officials were also concerned about the severity of the case.

Nine Alabama patients with pediatric hepatitis were found to have a positive adenovirus-41 strain through blood, two of whom required liver transplants, government officials said. However, the official connection has not been confirmed yet.

Most of these children, mostly under the age of 10, and most of them under the age of 5, came to the hospital with similar symptoms – diarrhea and vomiting, which later led to dehydration, Gutierrez said. After these initial symptoms, jaundice appears, the skin turns yellow, and then the sclera of the eye turns white.

According to experts, these epidemics may be a combination of factors behind the growth of very “exceptional” and difficult cases.

“These unexplained cases of hepatitis have always existed, but at a very low level, standard tests have been performed and there is no clear cause. These are very low in most countries, ”said Easterbrook.

The World Health Organization says one of the “key areas of research” is a potential link to adenovirus. However, a direct connection has not yet been established.

“In the end, it’s all multi-factorial, it’s the virus that controls it, and it could be an exaggerated response from these patients to fight these viruses,” Gutierrez said. “Knowing that there are different centers that see a lot of such cases, this is rare and this is not the norm.”

According to the WHO, with the onset of hepatitis, doctors often look for infectious and non-infectious causes to explain the increase in the disease. So far, none of the common hepatitis viruses (A, B, C, E) have been observed in this epidemic, and there have been no potential effects of any other known drugs, environmental agents, or toxins.

The emergence of these clusters of severe hepatitis among children came after many children were forced to stay home and stay away from social activities due to the COVID-19 pandemic. According to Gutierrez, the hypothesis that the epidemic may be due to the lack of exposure to other microbes is a hypothesis being studied by health professionals.

The COVID-19 pandemic has reduced the circulation of other viruses, and as life began to recover, officials noticed an increase in adenovirus.

Dr. Richard Peabody heads the World Health Organization’s Dangerous Pathogens Group in Europe. This may play a “potential” role, but further research is needed to understand whether any reference is “real” or not. [COVID-19] may be a factor. ”

There is also currently no evidence that COVID-19 vaccination is related to the epidemic, as most children have not been vaccinated.

Asked what parents should do to protect their children, given the lack of information they have about the hepatitis B virus, Gutierrez said parents should not worry if children become chronically ill and develop symptoms such as diarrhea and diarrhea to keep them hydrated. is very important.

However, he urged parents to seek medical attention if their children develop abnormal symptoms.

“If symptoms persist and hydration is a problem, like any other illness, just see a pediatrician, but especially if you notice that your child’s skin is starting to turn yellow or white. His eyes will turn yellow or his urine will be too black,” Gutierrez said. .

Such symptoms need the attention of a pediatrician, so to determine whether the child should be evaluated and cared for.

Pediatric hepatologist at the Mayo Clinic, Dr. Sara Hassan also recommends continuing hand hygiene and being aware of daily hepatitis.

“It’s more important to establish the precautions we use for COVID, you know, to make sure we’re safe and avoid children who are sick and have obvious signs of diarrhea or coughing or excessive sneezing,” Hassan said. before a media briefing on Thursday.

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