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A possible case of a mysterious liver disease affecting some children in the U.S. is being investigated in a child in Illinois, officials with Advocate Healthcare said Monday, days after the Centers for Disease Control and Prevention put out a nationwide alert about the infections.
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, but health officials are still awaiting further test results to determine if he had the same strain of adenovirus as previous cases reported in the U.S.
"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.
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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.
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.
The CDC on Thursday issued a public health alert to physicians nationwide, asking doctors to be on the look out for unusual cases of severe liver disease in children.
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.
The U.K. Health Security Agency has recorded 111 cases of unexplained hepatitis in children under 10 since January. Ten of the children needed liver transplants. 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 clear what’s causing the illnesses, a leading suspect is adenovirus, which was detected in 75% of the confirmed cases tested, the U.K. agency said in statement Monday.
“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. 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.
The CDC's advisory Thursday urges pediatric doctors to consider adenovirus testing.
It was that alert that led to Advocate Children's Hospital's recent discovery, Biank said. It's possible additional cases may have been gone undetected prior to the CDC's alert, he added.
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."
So what should parents be watching for?
"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.
Experts say the public health protocols in place from coronavirus are the best measures for preventing adenovirus as well.
That includes washing hands properly, avoiding close contact with people who are sick, staying home when you are sick, covering your cough or sneeze, disinfecting surfaces and keeping hands away from faces and eyes.
"Those are just the basic public health precautions," Alonso said. "If a child or a friend, a sibling member has a viral gastroenteritis with vomiting or diarrhea, that child should be kept to themselves not attending playdates not attending school, so that the virus doesn't spread. Because our thinking is that this adenovirus may actually spread in several children where they don't have hepatitis, but then in certain individuals, it causes an infection that does become the hepatitis. So in general, it'd be good to practice public health measures that reduce the spread of adenovirus in general in our community."