The CDC investigates more than 100 cases of hepatitis in children, including 5 deaths

14% of them needed a transplant and five children died.

Almost all of the children – more than 90% – were hospitalized.

Dr. Jay Butler, the CDC’s deputy director of infectious diseases, said the investigation – a partnership between the CDC and the state health departments – was an evolving situation. Not all cases of hepatitis they are currently studying may be the result of the same thing.

“It’s important to note that this is an evolving situation, and we’re building a broad network to help broaden our understanding,” Butler said.

Hepatitis or liver cancer can be caused by infections, autoimmune diseases, medications, and toxins. Hepatitis A, B, and C are the families of viruses that attack the liver.

It is unknown what motivates young children to do this. Butler said some common causes of viral hepatitis have been addressed, but none have been found.

Adenovirus has been identified in more than 50% of cases, but its role is unclear.

Early signs of hepatitis

On April 21, the CDC warned doctors about an outbreak of hepatitis in nine children in Alabama.

He asked doctors and public health officials to notify the agency if children under the age of 10 had elevated liver enzymes and no clear explanation for their hepatitis by October.

Since then, health departments have been working with pediatricians in their respective states to identify possible cases. The figures shared at Friday’s news briefing are the first national review of the case.

Cases are in Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska, New York, Ohio, Pennsylvania, Pennsylvania, . , Tennessee, Texas, Washington and Wisconsin.

The CDC warning came after reports that children from England, Wales, Scotland and Northern Ireland were hospitalized with unknown hepatitis.
As of May 1, there were 228 suspected cases in 20 countries, more than 50 of which are under investigation, he said. Philip Easterbrook, a senior researcher at the World Health Organization’s Global Hepatitis Program, said at a briefing on Wednesday. One of them died and about 18 needed a liver transplant, he said.

Most of the children were healthy, with symptoms such as fatigue, loss of appetite, vomiting, diarrhea, abdominal pain, dark urine, light-colored stools, and yellowing of the skin and eyes – symptoms known as jaundice.

Unusually severe inflammation of the liver

Pediatric gastroenterologist Dr. Helie Bhatt of the M Health Fairview Masonic Children’s Center in Minneapolis treated two children included in the CDC investigation. A 2-year-old boy from South Dakota received a liver transplant this week.

Bhatt says liver failure in children is “extremely rare.” Half the work was never explained before scientists noticed the epidemic.

The doctors who treated these children said that their condition was special.

“At first, I thought it was weird,” says the doctor. Marcus Buchfelner, a pediatric infectious disease specialist at the University of Alabama in Birmingham, said staff began seeing the disease in October.

The CDC is releasing new clinical data on cases of unusual hepatitis in children

“Then when the second one came, I said, ‘OK, we need to talk to someone about this.’ “He turned to the senior doctors in his department, who contacted the State Department of Health and the CDC.

According to Buchfelner, these cases were special because the inflammation of the liver was so severe.

Occasionally, common viruses such as Epstein-Barr or SARS-CoV-2 slightly increase a child’s liver enzymes, indicating what Buchfelner calls “small pieces of hepatitis,” but children usually fight infection.

“But it’s amazing to see a healthy child come with a liver injury like these children,” he said.

at the beginning, UAB saw nine children with unknown hepatitis and had a positive test for adenovirus in the blood of nine children. At the Butler briefing, none of them passed a positive test for Covid-19 or had a documented history of Covid-19.

Two more children have been identified in Alabama since the incidents were reported. Their case was investigated and the total number of staff reached 11, the doctor said. Wes Stubfield, a medical officer in the North and Northeast districts of Alabama.

There are about 100 types of adenoviruses. About 50 of them are known to infect humans, so specialists had to examine all children to see if they were infected with the same virus.

When researchers tried to study the genes of infected children’s adenovirus, only five had enough genetic material to obtain a complete sequence. All five had a specific strain of the virus called adenovirus 41. It usually causes diarrhea and vomiting in children, sometimes constipation or coughing, but in healthy children the liver has already stopped working.

Butler said Friday that the adenovirus was associated with hepatitis 40 and 41, but was present in children with weakened immune systems.

Data from the United Kingdom

Researchers from the UK’s Public Health Agency also announced a new technical briefing on Friday with an update on hepatitis research. Of the 163 cases, 126 patients were tested for adenovirus and 91 or 72% were positive for the pathogen.

Investigators tried to determine the sequence of the entire adenovirus genome from one of the patients, but were unable to obtain a sufficient virus sample. There were 18 cases where they were able to partially sort the genome, and all of them were adenovirus 41F, found in the United States.

Many people are not yet associated with SARS-19, and the virus somehow produces Covid-19.

Health officials in the UK say cases of hepatitis in children may be linked to adenovirus

According to UK investigators, they are still considering the possibility, but only 24 of the 132 patients examined – 18% – have been diagnosed with SARS-CoV-2.

The report says they do not rule out any role for Covid-19 infection in these cases. It is possible that a previous Covid-19 infection prepared the immune system to make these children unusually susceptible, or that a combination of the two viruses infected the liver.

Researchers also want to know if hepatitis is part of a syndrome that affects children after SARS-CoV-2 infection, such as multiple systemic inflammatory syndrome in children or a rare complication called MIS-C.

Another working theory by British investigators is that these children have some major or abnormal immune response because they are more sheltered than usual during a pandemic.

According to another theory, adenovirus causes liver failure in only a small percentage of infected children, and these rare cases are only detected because they cause a particularly large wave of infections.

According to British investigators, they are still testing drugs, toxins or exposure to the environment, but any infection may be the cause.

Sorting the role of adenovirus 41

To the doctors’ surprise, Buchfelner said they found adenovirus in blood samples, not in liver tissue samples taken during a biopsy of patients in Alabama.

“Nine of them have a liver biopsy, which shows a lot of inflammation and hepatitis. But no virus was found in the liver. We only found the virus in the blood,” he said.

Bhatt, a boy from South Dakota, has adenovirus in his blood, but not in his liver.

If the adenovirus 41 was responsible for these cases – and it is still large – Buchfelner said he did not know why it only appeared in the blood, but not in the severely damaged liver tissue. But he has some theories.

“Maybe the liver is clearing the virus before it enters the bloodstream,” he said. “So before the liver was damaged and the biopsy was done, the immune system finished clearing the virus from the liver. And the rest was inflammation.”

His second theory is that it is not the virus itself that causes damage to the liver, but rather an overreaction when the immune system tries to fight the virus.

Adenovirus infections are common, so the discovery of the virus in some of these patients is just a coincidence. “We cannot be 100% sure that this is an adenovirus. Much more is known, ”Bhatt said.

active investigation

In a statement on April 29, the CDC wrote: “We believe that adenovirus may be the cause of these cases, but other potential environmental and situational factors are still being investigated.”

Butler said Friday that experts are considering a number of possibilities, including contact with animals.

“We’re building a really broad network, and we’re open about whether adenovirus data can reflect the person we’re looking at, or whether there are cofactors that show adenovirus infections like never before,” he said. he said.

Investigators know the news could worry parents.

Butler said investigators still find these cases very rare. They did not increase the number of children coming to the emergency departments with hepatitis, for example.

“We’re still at least telling our families in Alabama – and I would encourage other families to do the same – so don’t worry too much about it yet.” Buchfelner said. “I mean, at the end of the day, it’s still a rare phenomenon.”

According to Buchfelner, adenoviruses are most common in kindergartens and schools. They usually do nothing worse than feel the flu for a few days.

“This has been going on for a long time and it will continue to happen. In total, we have only about 200 cases worldwide. So it’s not like the Covid pandemic, it has to happen. Don’t worry about it,” he said.

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