Amid recent warnings from the Centers for Disease Control and Prevention and the Illinois Department of Public Health surrounding unusual hepatitis cases in children, what should parents be watching for?
IDPH on Monday issued a warning that three possible cases of the mysterious liver disease being reported in U.S. children, possibly associated with adenovirus, have been detected in Illinois.
Last week, the Centers for Disease Control and Prevention put out a nationwide public health alert to physicians, asking doctors to be on the look out for cases amid recent outbreaks.
The agency said in its advisory that nine cases of hepatitis, or liver inflammation, have been reported in Alabama in children aged 1 to 6, and NBC News reports an additional two have been identified in North Carolina, according to the state's health department.
Internationally, the U.K. Health Security Agency has recorded 111 cases of unexplained hepatitis in children under 10-years-old since January. Ten of the children needed liver transplants.
All of the children were previously healthy.
The U.N. health agency said it has so far received reports of at least 169 cases of “acute hepatitis of unknown origin,” and that one death had been reported.
While it isn’t entirely clear what’s causing the mysterious illnesses, a leading suspect is in fact the adenovirus, which was detected in 75% of the confirmed cases tested, the U.K. agency said in statement Monday.
Here's what to know:
What Are the Symptoms of Hepatitis in Kids?
The symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain and jaundice.
Diarrhea and nausea are reported in patients with both hepatitis and adenoviruses, but doctors say there are ways to differentiate between the two.
Parents should keep an eye on sick children and look out for severe abdominal pain, fever, dark-colored urine or light-colored stools. The most telling symptom to be aware of is jaundice, or a yellow coloring in the skin or in whites of the eyes, said Dr. Nipunie Rajapakse, a pediatric infectious disease specialist at Mayo Clinic Children’s Center.
"The symptoms of hepatitis in childhood can be vague at first - abdominal pain, loss of appetite, severe fatigue - but then, as it progresses, the children do start to have dark urine, pale stools, yellowing of the whites of their eyes," said Dr. Estella Alonso, a hepatologist at Lurie Children's Hospital in Chicago. "These are the things that parents notice. And if parents do notice that they should seek medical attention from their pediatrician or in an emergency or urgent care setting as soon as possible."
According to Lurie Children's Hospital, the most common symptoms of acute hepatitis include:
- Flu-like symptoms
- Nausea and/or vomiting
- Decreased appetite
- Not feeling well all over
- Abdominal pain or discomfort
- Later symptoms include dark-colored urine and jaundice (yellowing of the skin and eyes). The symptoms of hepatitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
The hospital notes that symptoms will likely vary by child.
How Can It Be Prevented?
Parents and caregivers are being asked to contact health care providers with any concerns, and to encourage their children to take everyday preventative actions including washing hands often, avoiding people who are sick, and covering coughs or sneezes.
Experts say the public health protocols in place from coronavirus are the best measures for preventing adenovirus as well.
What Do We Know About the Illinois Cases?
At least three Illinois children have been stricken with suspected severe cases of hepatitis in recent weeks, with one of those children requiring a liver transplant after contracting the illness.
According to a press release from the Illinois Department of Public Health, the cases of hepatitis, which all occurred in children under the age of 10, are potentially linked to a strain of adenovirus.
Two of the cases occurred in suburban Chicago, and one occurred in western Illinois, officials said.
A 4-year-old boy was brought to Advocate Children's Hospital in Park Ridge roughly two weeks ago with hepatitis, or "inflammation of the liver," Dr. Vincent Biank, who specializes in pediatric gastroenterology, told NBC Chicago.
Biank said the child also tested positive for adenovirus, a test they conducted following the CDC warning. "That seems to be the virus that's being identified both in the UK individuals and in the individuals that were identified in Alabama," Biank said.
Doctors are still waiting on results to see whether the strain is the specific one linked to the unexplained cases.
"His liver numbers spiked to over 3,000 and we followed him in the hospital for three, four days and actually got a liver biopsy to kind of see how bad the injury was on his liver and it was pretty severe," Biank said.
The good news is that the child's condition improved and his liver started recovering on its own, not requiring a transplant, as in some cases reported previously.
He was discharged from the hospital last week.
What Is Hepatitis and How is It Related to Adenovirus?
The liver processes nutrients, filters the blood and fights infections. The infections caused symptoms like jaundice, diarrhea and abdominal pain.
Hepatitis can be life-threatening if left untreated.
“Mild hepatitis is very common in children following a range of viral infections, but what is being seen at the moment is quite different," said Graham Cooke, a professor of infectious diseases at Imperial College London. Some of the children in the U.K. have required specialist care at liver units and a few have needed a liver transplant.
Adenovirus, a common group of viruses, is now circulating in children at higher than average levels after dropping to unusually low levels during the pandemic.
Adenoviruses can cause a wide range of illnesses and symptoms, and are spread person-to-person. Most commonly those infected with the virus experience respiratory illness, but gastroenteritis, conjunctivitis (pink eye) and bladder infections can also occur.
Adenoviruses and hepatitis share symptoms, but hepatitis is far more concerning with unique symptoms to be aware of, according to Dr. David Hill, a Wayne County, North Carolina-based pediatrician and the official spokesperson of the American Academy of Pediatrics.
“Adenoviruses typically run their course without needing medical intervention,” Hill said. Hepatis, on the other hand, “sometimes leads to hospitalization and may even require a liver transplant.”
Is There Any Link to COVID?
One avenue of inquiry being explored is that the outbreak may be linked to a surge in common viral infections after COVID-19 restrictions were phased out. Children who weren’t exposed to adenovirus over the last two years may now be getting hit harder when they are exposed to the viruses.
“Information gathered through our investigations increasingly suggests that this rise in sudden onset hepatitis in children is linked to adenovirus infection,’’ said Dr Meera Chand, director of clinical and emerging infections at UKHSA. “However, we are thoroughly investigating other potential causes.”
The usual viruses that cause infectious liver inflammation -- hepatitis A to E -- weren’t detected in any of the 111 cases being investigated in the U.K.
Though there are dozens of adenoviruses, many of them associated with cold-like symptoms, fever, sore throat and pink eye, U.S. authorities said the nine Alabama children tested positive for adenovirus and officials there are exploring a link to one particular version — adenovirus 41 — that’s normally associated with gut inflammation.
"It's been found in these kids and in a good portion of the kids in Britain, but it's also very common so I can't say for sure cause and effect. It's certainly a possible cause," said Dr. Sharon Welbel, director of hospital epidemiology and infection control at Cook County Health.
Public health officials ruled out any links to COVID-19 vaccines, saying none of the affected children were vaccinated.
What Do Experts Say?
The WHO noted that although there has been an increase in adenovirus in Britain, the potential role of those viruses in triggering hepatitis is unclear. WHO said there were fewer than five possible cases in Ireland and three confirmed cases in Spain, in children aged 22 months to 13 years.
The U.N. health agency said that given the jump in cases in the past month and heightened surveillance, it was “very likely” more cases will be detected.
Still, experts say the risk of severe hepatitis in healthy children remains rare.
"It's still very unusual, you know," Welbel said. "So far we've seen very, you know, a very small handful of cases, some of those cases were severe and a couple did require liver transplant in the U.S., but so far it's still what I would call rare."