When should you be worried?
Media headlines can be scary, so I want to break it down for you.
UPDATE (7/27): As of July 8, 35 countries had reported a collective 1,010 probable cases of severe acute hepatitis with an unknown cause to the WHO. 75% of cases in Europe had been in children under the age of 5, as of May 20, with a total of 12% of the children whose records were analyzed receiving a liver transplant. Scientists have uncovered a likely etiology: co-infection with two viruses that caused the hepatitis (and neither virus is COVID). Findings from two separate studies suggested that the key was adeno-associated virus 2 (AAV2), a pathogen that does not normally cause disease in itself but often accompanies infection with adenoviruses. AAV2 was found in 96% of cases. Researchers concluded that being simultaneously infected with AAV2 and either an adenovirus or, less commonly, the herpes virus HHV6, was likely to be behind the outbreak in acute pediatric hepatitis. It’s great having some more information, but more research is needed on risk factors for severe disease and why some children may get this hepatitis with this virus and some don’t. Read on for more!
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Last week, the CDC and WHO issued an alert for a rise in hepatitis cases in children across the country.
So, should you be worried?
The short answer? Please don’t panic, but be aware of signs and symptoms.
Since April, we have seen 348 cases globally (as of May 10th, 2022) potentially linked to adenovirus.
In the U.S as of May 10th, the CDC was investigating 109 pediatric cases of these hepatitis cases.
So far, adenovirus 41 has been found in 77% of European cases of hepatitis, and local health authorities are determining if this is the same trend here. None of the children had COVID-19 or the vaccine.
So, this is rare. But, I do believe it’s important to know what hepatitis is and what to look out for and to only seek medical attention accordingly.
Why issue this health alert if it’s rare?
Health alerts are usually meant for us clinicians so we can perform necessary testing based on trends and concerns. However, the media does report this to everyone. This is important; however, I find it can cause more panic than necessary in the general non-medical population.
Panic can lead to anxiety-ridden phone calls and doctor’s visits, so my hope is you can recognize the signs and symptoms that will warrant an evaluation. BUT, remember it is extremely rare.
What is hepatitis?
Hepatitis is an inflammation of the liver that can be caused by viral infections, alcohol use, toxins, medications, and certain other medical conditions. We have vaccines for hepatitis A and B for kids as these used to be common causes of hepatitis in children before vaccines.
What are the signs and symptoms of hepatitis?
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Dark urine
- Light colored stools
- Joint pain
- Jaundice
A child with hepatitis is sick and not your usual child with a stomach virus.
If you see normal gastroenteritis symptoms, please do not panic. Concerning signs should be jaundice (yellowing of the skin and/or white parts of the eyes) and white stools can sometimes occur – so if you do see this; visit an Emergency Room.
For images of a child with hepatitis, click this link. Due to rights of the image, I didn’t want to include the image directly in this blog.
If symptoms point to hepatitis, a doctor may order bloodwork to assess their liver (AST/ALT), adenovirus testing, as well as an ultrasound of the liver.
What is adenovirus 41?
Adenovirus 41 is the suspected strain in these cases (but more confirmation is needed. They have ruled out Hepatitis A, B, or C has etiologies). This particular health advisory has ruled out hepatitis A and B as causes. So, having the vaccine is important but is not protecting against this as it’s likely caused by adenovirus.
This virus can cause diarrhea, fever, and vomiting. Adenovirus can also be associated with respiratory symptoms like a runny nose, cough, and/or pink eye. It’s thought that IF a child develops this rare hepatitis it would be within 2-6 weeks of onset of the virus, however more information is still needed as they determine etiology. More confirmatory information is also needed to confirm the etiology in all cases.
What is the treatment for this hepatitis?
Hepatitis in general is usually supportive (hydration, monitoring of labs and vitals, and avoiding certain medicines). We do need more information about the course of this illness in the patients including any risk factors for the children who needed liver transplants.
What should you do?
I am also a mother to a young child and this has not changed how we are approaching childcare, possible travel, and future plans for the time being. I always modify based on public health recommendations and will keep you updated as well.
I will 100% be on the lookout for these symptoms in my child and patients.
Continue normal hygiene precautions you were doing already in this pandemic. Adenovirus is a contagious virus and we have yet to know why the kids who had hepatitis were at risk of that condition.
Please do remember, the risk of hepatitis is low. Adenovirus circulates in our community every year and this health alert is for us to have awareness; but not panic.
It’s most important to know signs and symptoms so you seek medical assistance when needed and you are not worried when it isn’t warranted.
