Mysterious form of hepatitis possibly found in 4 Arizona kids. Here's what to watch for
Arizona is one of the 36 states and territories that have reported possible cases of a severe and mysterious form of hepatitis in children.
The U.S. Centers for Disease Control and Prevention says 180 possible cases have been identified but that it is not releasing numbers for each state in order to protect patient privacy.
Officials with the Arizona Department of Health Services told The Arizona Republic on Thursday that Arizona has reported four possible cases to the CDC.
One of the cases was from late 2021 and the others are since early April, state Health Department spokesperson Steve Elliott wrote in an email.
The CDC says five of the patients whose cases are under investigation have died; others have needed liver transplants. Elliott said the state is aware of no deaths in the reported Arizona cases and can provide no further information on individual cases or treatments.
Federal and state officials emphasize that the cases are under investigation, which means they have not been confirmed. States near Arizona where possible cases are under investigation include California, Texas, Colorado and Nevada.
Although rare, children can and do develop serious hepatitis and it's not uncommon for the cause to be unknown. Some of the reported cases under investigation may not be linked, CDC officials have said.
In a news release Wednesday, the CDC said that it's continuing to work with health departments and clinicians across the country to identify and investigate the reports.
At least 200 cases have been reported from other parts of the world, including Great Britain, Ireland, Spain, Israel, Denmark, the Netherlands and France.
The World Health Organization has said that the possibility of increased susceptibility among young children following a lower level of circulation of adenovirus during the COVID-19 pandemic needs further investigation, as does the potential emergence of a novel adenovirus, as well as a SARS-CoV-2, or new coronavirus, co-infection.
There's no evidence the illness is related to side effects from the COVID-19 vaccine, WHO and CDC officials say.
"Hypotheses related to side effects from the COVID-19 vaccines are currently not supported as the vast majority of affected children did not receive COVID-19 vaccination," the World Health Organization said April 23.
'Adenovirus has been detected in nearly half of the children'
The CDC on Wednesday said states and territories have since October 2021 reported 180 pediatric patients under investigation for an acute form of hepatitis of unknown origin impacting children under the age of 10. That number jumped by 71 from 109 publicly reported cases as of May 5, CDC officials said.
"While this may appear to be a large increase in patients under investigation over the last two weeks, it’s important to understand that the vast majority of these are what we consider ‘retrospective’ patients," the CDC statement says.
The number may go up or down as the CDC and states review medical charts and learn more, federal health officials said.
CDC officials say there have been no reported deaths from the mysterious cases since February, and that the proportion of patients requiring liver transplants has gone down from 15% to 9% since May 5.
"CDC continues to examine possible causes, including testing for and ruling out some of the viruses that commonly cause hepatitis," Wednesday's statement says. "Adenovirus has been detected in nearly half of the children and continues to be a strong lead."
Adenoviruses are common viruses that typically cause mild cold- or flu-like illness, or stomach and intestinal problems, said Dr. Jay Butler, the CDC's deputy director for infectious diseases, during a May 5 telebriefing.
Of the 109 possible cases that had been reported as of May 5, 90% of the children had been hospitalized, Butler said.
"It's important to note this is an evolving issue and we're casting a wide net to help broaden our understanding," Butler said. "This includes a retrospective review of these reports going back to October of 2021."
Possible factors to consider in the recent cases are the adenovirus, the immune reaction to a particular strain of adenovirus, and whether an environmental co-factor may be contributing, he said.
More laboratory testing is underway to look at other potential pathogens, such as SARS-CoV-2, a CDC statement says.
"The issue of whether or not COVID infection may be related to these cases is still under investigation and certainly a hypothesis that we continue to pursue," Butler said.
CDC investigation began in Alabama
The CDC on April 21 issued a nationwide health alert about a cluster of nine children in Alabama with hepatitis and adenovirus infection, and asked physicians to be on the lookout for symptoms in children.
The children in the Alabama cases ranged in age from 1 to 6 years old, came from different parts of the state, all were previously healthy, and their median age was 2, CDC officials said. None had received the COVID-19 vaccine prior to being hospitalized, Butler said during the May 5 telebriefing.
The first U.S. cases were identified in October 2021 at a children’s hospital in Alabama that admitted five children with "significant liver injury," including some with acute liver failure, without known cause, according to the CDC. Those children also tested positive for adenovirus. Hepatitis A, hepatitis B, and hepatitis C viruses were ruled out, the CDC said.
Upon investigation, a review of hospital records identified four additional cases, according to the CDC, and laboratory tests identified that some of the children had adenovirus type 41, which more commonly causes pediatric acute gastroenteritis. Adenovirus type 41 typically presents as diarrhea, vomiting and fever, often accompanied by respiratory symptoms, federal officials say.
Additional possible cases were identified across the country after the April 21 health alert.
Parents and caregivers should watch for symptoms of liver inflammation
Parents, guardians and caregivers should be aware of the symptoms of hepatitis and adenovirus, state health officials say.
Adenoviruses most commonly cause respiratory illness but can manifest as gastroenteritis, pink eye and bladder infection.
Symptoms of liver inflammation are:
- Jaundice, which is a yellowing of the skin or eyes.
- Loss of appetite.
- Abdominal pain.
- Dark urine.
- Light-colored stool.
- Joint pain.
Everyday prevention, like washing hands often and avoiding people who are sick, helps reduce the spread of all diseases, officials with the state Health Department wrote in an email.
State health officials recommend covering coughs and sneezes, avoiding touching the eyes, nose or mouth and ensuring children are up-to-date on all vaccinations.