The CDC is investigating more than 100 cases of childhood hepatitis, including 5 deaths

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The US Centers for Disease Control and Prevention said on Friday that it is investigating 109 cases of severe, unexplained hepatitis in children in 25 states and territories that may be associated with a global outbreak. ..

Among them, 14% needed a transplant and five children died.

Almost all children (more than 90%) needed to be hospitalized.

Dr. Jay Butler, Deputy Director of Infectious Diseases at the CDC, emphasized that the study, a partnership between the CDC and the State Health Department, is in an evolving situation. Not all cases of hepatitis they are currently studying are ultimately caused by the same thing.

“We are casting a wide range of nets to broaden our understanding,” Butler said.

Hepatitis, or swelling of the liver, can be caused by infections, autoimmune diseases, drugs, and toxins. A family of viruses well known for attacking the liver causes hepatitis A, hepatitis B, and hepatitis C.

The cause of these cases in infants is not yet clear. Butler said some of the common causes of viral hepatitis were considered, but were not found in any of the cases. The role of adenovirus is unclear, but it has been detected in more than 50% of cases.

April 21, CDC Warning doctor A cluster of abnormal cases of hepatitis in nine children in Alabama.

Authorities have asked doctors and public health officials to notify authorities of similar cases of children under the age of 10 with elevated liver enzymes and no clear explanation for hepatitis dating back to October 2021. rice field.

Since then, the state health department has worked with state pediatricians to identify possible cases. The numbers shared at Friday’s news briefing are the first national investigation of the incident in the United States.

The states and regions under investigation in the case are: Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska State, New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington, Wisconsin.

CDC warning continued Previous report Dozens of children from the United Kingdom, Wales, Scotland and Northern Ireland coming to the hospital for unexplained hepatitis from the United Kingdom and Europe.

As of May 1, there are 228 cases that may be associated with outbreaks in 20 countries, and more than 50 cases are under investigation, a senior scientist at the World Health Organization’s World Hepatitis Program. Dr. Philippa Easterbrook said. At the briefing on Wednesday. Of these cases, one child died and about 18 need a liver transplant, Easterbrook said.

Most children were healthy when they experienced symptoms such as fatigue, loss of appetite, vomiting, diarrhea, abdominal pain, dark urine, light-colored stools, and yellowing of the skin and eyes. There were signs of jaundice.

Dr. Heli Bhatt, a pediatric gastroenterologist at the University of Minnesota Medical Center, treated two children who are part of a CDC study. A two-year-old from South Dakota received a liver transplant on Friday morning.

Bert says liver failure in children is “very rare.” And even before scientists began tracking this outbreak, half of the cases were unexplained.

Doctors who treated these children say their cases stood out.

“Even during the first case, I found it strange,” says Dr. Markus Buchfellner, a pediatric infectious disease specialist at the University of Alabama at Birmingham.

“And when the second one came in, it was when I said it was okay, we need to talk to someone about this.” He contacted the State Health Department and the CDC in his department. I contacted a senior doctor.

Buchfellner says the case was conspicuous because the liver was so inflamed.

Common viruses like Epstein-Barr and SARS-CoV2 raise a child’s liver enzymes a bit, indicating what Buffferner calls “small hepatitis,” but children usually have their bodies fighting the infection. It will recover as you go.

“But it’s very strange to see healthy children coming in with the amount of liver damage they had,” he said.

Initially, UAB examined nine children with unexplained hepatitis and all nine were tested positive for adenovirus in the blood.

Two more children have been identified in Alabama since these cases were first reported, their cases are under investigation, and 11 cases are under investigation across the state, northern and northeastern Alabama. Dr. Wes Stubblefield, Head of Health in the Department, said in an interview. On CNN.

There are about 100 types of adenovirus. About 50 of them are known to infect humans, so we needed to scrutinize the virus to see if all children had the same virus.

When researchers tried to load the adenovirus gene in infected children, only five had enough genetic material to obtain the complete sequence. In all five, the virus is a specific type of adenovirus called adenovirus 41, which usually causes diarrhea and vomiting in children, sometimes with congestion and cough, but has never been associated with liver failure. There was not.

In addition to the CDC briefing, researchers at the UK Health and Safety Agency posted a new technology briefing on Friday, including the latest information on hepatitis investigations. Of the 163 cases, 126 were tested for adenovirus and 91 (72%) were positive for the pathogen.

Researchers have tried to sequence the entire adenovirus genome from one of the patients, but have not yet obtained a sample containing enough virus to do so. Of the 18 cases in which the viral genome could be partially sequenced, all 18 cases were the same adenovirus 41F as in the United States.

Many suspect that this case is somehow related to SARS-CoV2, the virus that causes Covid-19.

British researchers say they are still exploring the possibility, but only 24 (18%) of the 132 patients tested detected SARS-CoV2.

The report states that it does not rule out any role of Covid-19 infection in these cases. Presumably, previous Covid-19 infections stimulate the immune system to make these children abnormally sensitive, and co-infection of the two viruses overwhelms the liver. Researchers also want to know if hepatitis is part of some syndrome that attacks children after SARS-CoV2 infection. It seems to be a rare complication of multisystem inflammatory syndrome, or MIS-C, in children.

Another theory by British researchers is that these children may have some oversized or irregular immune response, perhaps because they were more protected than usual during a pandemic.

Yet another theory reveals that adenovirus may have always caused liver failure in a small proportion of infected children, and these rare cases are due to causing a very large wave of infection. It’s on the way.

Researchers in the UK also say that drugs, toxins, or perhaps environmental exposures are still being tested, although they are likely due to some infection.

Another thing that doctors are confused about is that adenovirus was found in blood samples rather than in liver tissue samples taken during a biopsy. o of Patients in Alabama.

“All nine of them have liver biopsies that showed a lot of inflammation. And hepatitis. But no virus was found in the liver. Only in the blood the virus was found,” he said.

A case of Bhatt, a child in South Dakota, was also positive for adenovirus in the blood, but not in the liver.

If this adenovirus 41 is some cause in these cases, and if it is still large, Buchfellner says he does not know why it appears only in the blood or not in the severely damaged liver tissue, There are several theories.

“Maybe the liver is clearing the virus before it’s cleared in the blood,” he said. “And by the time the liver was damaged and a biopsy was done, the immune system had already cleared the virus from the liver, and all that remains is inflammation.”

His second theory is that the cause of liver damage may not be the virus itself, but trying to fight off the virus can cause the immune system to overreact and damage the liver.

Since adenovirus infections are common, it may be a coincidence to find the virus in some of these patients. “I’m not 100% sure that this is exactly the adenovirus. We still need to know a lot, “says Bhatt.

April 29 Statement on the incident“We believe that adenovirus may be the cause of these reported cases, but other potential environmental and circumstantial factors are still under investigation,” the CDC wrote.

“We’re still talking to our family here in Alabama, so I’d like to encourage other families not to worry too much about this,” Buchferner said. “That is, after all, this is still a fairly rare phenomenon,” he said.

Buchfellner says that adnoviruses are commonly delivered in nurseries and schools. They usually do nothing worse than what you feel like gastroenteritis for a few days.

“It’s been around for a long time and it’s going to keep spinning. And in total, only about 200 cases have been reported worldwide. So this really needs everyone to worry about this. It’s not like a Covid pandemic, “he said.