Two Michigan children had suspected cases of a rare and severe form of hepatitis that is now believed to have sickened at least 109 children in the United States and may be linked to an adenovirus infection.
The two children from Michigan were under 5 years old. One was from Oakland County and the other from the city of Detroit, said Lynn Sutfin, spokeswoman for the state health department.
A child was sick in October, Sutfin said; she could not provide details on the timing of Michigan’s second suspected case.
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The United States Centers for Disease Control and Prevention is investigating the two cases as part of a national look at this mysterious acute form of hepatitis, looking for clues.
Of the U.S. children whose cases are being investigated, 90% have been hospitalized and 14% have required liver transplants, said Dr. Jay Butler, CDC deputy director for infectious diseases, at a press conference on Friday.
“Fifteen days ago, the CDC issued a nationwide health alert to notify clinicians and public health authorities of an investigation involving nine children in Alabama identified between October 2021 and February 2022 with hepatitis or liver inflammation and an adenovirus infection,” Butler said.
“All of these patients were previously healthy, came from different parts of the state, and were hospitalized with significant liver injury with no known cause, including some with acute liver failure.
“All nine eventually tested positive for adenovirus, which is a common virus that typically causes mild cold or flu symptoms, or stomach and gut problems.”
Since the CDC issued the health alert, more possible cases have been identified in the United States, Butler said, in children living in 24 states and one U.S. territory.
As of Friday, cases were being investigated in Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska , New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington, Wisconsin.
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Hundreds of similar cases have also been identified in the UK, Northern Ireland, Spain, Denmark, Romania, Norway, France, Italy, Belgium, the Netherlands and Israel, according to the ‘World Health Organization.
Some of the children who have developed this severe form of hepatitis also have a strain of adenovirus known as adenovirus 41, which can cause vomiting and diarrhea as well as respiratory symptoms.
“Some of the common causes of viral hepatitis such as hepatitis A, B, C, delta, and E have been looked at and tested, but none of these cases have been found,” Butler said. “Additionally, none of the nine children in Alabama had a COVID-19 infection while hospitalized or a documented history of COVID-19.”
Neither of the children had been vaccinated against COVID-19 either, he said, before being hospitalized with hepatitis. The average age of infected children was 2 years old.
“Adenovirus was detected in some of the children, but we don’t know if it is the actual cause of these illnesses,” Butler said. “Of the 109 patients currently under investigation, more than half have evidence of adenovirus infection. Additionally, adenovirus has been detected in many, but not all, cases that occurred outside of the United States.”
Other factors are also considered, such as environmental exposures, medications and other infections children might have had before they got sick, he said.
The CDC issues new guidelines for doctors to step up adenovirus testing and report possible cases of hepatitis with no known cause in children.
“Because we are still investigating the possible link between adenovirus infection and hepatitis, we also recommend that clinicians evaluate these patients and consider testing for adenovirus.”
And although the disease is extremely rare, Butler urged parents and caregivers to be aware of the symptoms of hepatitis, which can include:
- Dark urine
- Light colored stools
- Jaundice or yellowing of the skin
The majority of children who developed the disease made full recoveries, said Dr. Umesh Parashar, head of the viral gastroenteritis branch in the CDC’s division of viral diseases.
The adenovirus can spread through droplets when a person coughs or sneezes and also through fecal-oral transmission, Parashar said.
“We really don’t know if that’s the cause of the disease,” Parashar said of the adenovirus. “We’re going to look at it very broadly.”
Among the questions are whether underlying immune conditions in children who develop this disease might play a role or whether prior exposure to the coronavirus might have affected how the adenovirus manifests in these children, he said. he declares.
“There could be changes in the virus itself and we won’t know until after some of the whole genome sequencing studies…are completed,” Parashar said.
“We’re certainly keeping an open mind to that and looking at drugs, toxins, other environmental exposures or other pathogens.
“It is still too early to identify the cause and understand the mechanism of the disease in these children.”
Contact Kristen Jordan Shamus: email@example.com. Follow her on Twitter @kristenshamus.
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