Unusual Pediatric Hepatitis Cases: What Parents Should Know

Last updated: June 14, 2022

The United States and other countries have identified or are investigating reports of unusual hepatitis cases in otherwise healthy children.


What is hepatitis?

Hepatitis is inflammation of the liver that can be caused by viral infections, alcohol use, toxins, medications and certain other medical conditions. In the United States, the most common causes of viral hepatitis are hepatitis A, hepatitis B and hepatitis C viruses.

 

What is the cause of these unusual hepatitis cases? 

At this time, health care providers do not know what is causing these cases. Some experts think that adenovirus may be a contributing factor. However, not all of the children have tested positive for an adenovirus, and while these viruses can cause liver inflammation, that symptom is most common in people who are immunocompromised.


What is known about these unusual hepatitis cases in children?

It began in October 2021, when five pediatric cases of severe hepatitis with unknown cause were identified in children at an Alabama hospital. The children had significant liver illness, including some with liver failure. All tested negative for hepatitis A, B and C, but positive for adenovirus.

The children, who ranged in age from 1 to 6, were previously healthy and came from different parts of the state with no known contact or common exposures. Furthermore, none of the children in Alabama—which later grew to nine reported cases—had any signs of COVID-19 infection prior to or during hospitalization.

Since then, more cases of pediatric hepatitis with unknown origin have been reported in other states and around the world. Adenovirus has been detected in some of these patients, but not all. Investigators around the world are looking into other possible causes and contributing factors.

For now, the Centers for Disease Control and Prevention (CDC) recommends that doctors who treat children with unexplained hepatitis consider testing them for adenovirus.

 

Is this connected to COVID-19?

Currently, medical experts say that it is probably not directly connected to COVID-19. There is also no evidence that the hepatitis is linked to the COVID-19 vaccines. Most of the children involved have not been eligible for the vaccine due to age.

 

What are the symptoms of hepatitis?

In many of the cases, children developed gastrointestinal symptoms, including vomiting, diarrhea and abdominal pain, followed by a yellowing of the skin or eyes, known as jaundice. They also had abnormally high levels of liver enzymes, a sign of liver inflammation or damage.

Gastrointestinal symptoms are common in children and should not, in isolation, be cause for alarm.

 

What have the outcomes been for children with unusual pediatric hepatitis? 

This unusual form of hepatitis could be fatal, however, there have been no reported deaths since February 2022.  Some children had to undergo a liver transplant, however the proportion of patients requiring liver transplants has gone down.  Severe hepatitis in children remains rare.

 

What can parents do?

  • Be aware of the symptoms of liver inflammation, which include:
    • fever
    • fatigue
    • loss of appetite
    • nausea
    • vomiting
    • abdominal pain
    • dark urine
    • light-colored stools (poop)
    • joint pain
    • jaundice (yellowing of the skin)
  • Keep children up to date on all their vaccinations.
  • Help your child take everyday actions to help prevent disease, like:
    • washing hands often,
    • avoiding people who are sick,
    • covering coughs and sneezes, and
    • teaching them to avoid touching the eyes, nose or mouth.

 

What can health care providers do?

Health care providers should notify the Anne Arundel County Department of Health by calling 410-222-7254 about any children <10 years of age with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) (>500 U/L) who have an unknown etiology for their hepatitis (with or without any adenovirus testing results, independent of the results) since October 1, 2021. The Anne Arundel County Department of Health will work with the Maryland Department of Health to determine what, if any additional testing is indicated.

 

Resources:

Children with Hepatitis of Unknown Cause – CDC

Adenoviruses – CDC

Rise of Hepatitis Cases in Children: What Parents Need To Know – Yale School of Medicine

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