Regarding the clusters of cases of severe hepatitis in children under investigation

Health officials in the United States and around the world are sounding the alarm over a growing number of mysterious cases of severe hepatitis occurring among the children.

Earlier this month, researchers in the United States and Europe announced they were investigating small clusters of emerging cases around the world. Shortly after, the US Centers for Disease Control and Prevention issued an alert to doctors and providers to be on the lookout for unusual cases.

Worldwide, around 278 cases have been identified, according to World Health Organization officials, with many sick children under the age of 10.

“What is particularly unusual is that the majority of these children were previously healthy,” Dr Philippa Easterbrook, a medical expert with the WHO Global Hepatitis and STI Programme, said during the interview. a press conference on Thursday.

The causative agent of these cases of acute hepatitis, or inflammation of the liver, remains unknown. Experts say hepatitis is often caused by an infection, but not always.

In an effort to identify what could be driving the outbreaks, the WHO has launched a full investigation, encouraging countries to report affected cases, with a team of scientists now hoping to find any potential links between cases.

Officials from 10 states – Alabama, Delaware, Illinois, New York, North Carolina, Wisconsin, Georgia, Louisiana, Minnesota and Tennessee – confirmed to ABC News that they are investigating cases of severe hepatitis, with an overall total of 20 cases. have been identified so far.

In the United States, at least four children have needed liver transplants and on Wednesday, Wisconsin Department of Health Services officials reported that a child had died of a serious case of hepatitis.

Wisconsin officials later issued a health alert over concerns over the recent discovery of a cluster of four cases in children with acute hepatitis, urging clinicians to be alert for affected cases.

Similarly, at the University of Alabama Hospital in Birmingham, doctors have been investigating a worrying increase in the number of children infected with severe acute hepatitis since the fall.

“What caught our attention, early on, was that all of these cases were positive for adenovirus,” Dr. Helena Gutierrez, medical director of UAB and the liver transplant program, told ABC News on Thursday. Alabama Children’s Pediatric Hospital, adding that officials were also alarmed by the severity of the cases.

Nine pediatric hepatitis patients in Alabama tested positive for the adenovirus-41 strain through blood tests, two of whom required liver transplants, according to state officials. However, an official correlation has yet to be confirmed.

The majority of these children, mostly under the age of 10, and many under the age of 5, came to the hospital with similar symptoms – diarrhea and vomiting, which later led to dehydration, according to Gutierrez. These first symptoms were followed by jaundice, the skin turning yellow, then the sclera, or white, of the eyes later turning yellow.

Experts say these outbreaks are highly ‘unusual’ and there is likely a confluence of factors behind the increase in severe cases.

“These unexplained cases of hepatitis have always existed, but at a very low level, where the standard tests have been carried out, and there is no clear cause. And these occur at a very low level in most countries,” Easterbrook said.

WHO officials have reported that one of the “main threads of the investigation” is the potential link to adenovirus. However, a direct link has yet to be established.

“Ultimately, most likely, this will all be multifactorial, it could be a virus driving it, plus an exaggerated response from these patients to try and fight these viruses,” Gutierrez said. “Knowing that there are different centers that see more of these cases, it’s certainly rare, and it’s not the norm.”

With a hepatitis outbreak, doctors often look for infectious and non-infectious causes to explain the resurgence of the disease, according to WHO officials. So far, none of the common hepatitis viruses (A, B, C, E) can be attributed to this outbreak, and there have been no other known potential exposures to drugs, environmental agents or toxins.

The emergence of these severe childhood hepatitis clusters comes after many children were forced to stay indoors and away from social activities, due to the COVID-19 pandemic. One hypothesis, that the outbreak could potentially be linked to a lack of exposure to other germs, is one that health experts are investigating, Gutierrez said.

The COVID-19 pandemic has reduced the circulation of other viruses, and now that life is returning to normal, officials have seen an increase in adenoviruses.

It is still unclear what role COVID-19 is playing in this outbreak, according to Dr Richard Peabody, who leads WHO Europe’s high-risk pathogens team. It could ‘potentially’ play a role, but any link ‘really needs further investigation to understand if [COVID-19] could be a factor.

There is also no evidence, at present, that vaccination against COVID-19 is linked to outbreaks, as the majority of children were unvaccinated.

When asked what parents can do to protect their children, given the lack of information regarding the causative agent of hepatitis, Gutierrez said parents should not be alarmed, given that children get sick regularly and if they develop symptoms such as diarrhea and vomiting, it is essential to keep them hydrated.

However, she urged parents to seek medical attention if children develop abnormal symptoms.

If the symptoms “continue to be a problem and hydration is a problem, like any other type of illness, just see your pediatrician, but especially if you see your child starting to have skin that turns yellow or white his eyes turn yellow or the urine is very dark in color,” Gutierrez said.

Such symptoms should be brought to the attention of the pediatrician, so that the child can be evaluated and to determine if care needs to be escalated.

Mayo Clinic pediatric hepatologist Dr. Sara Hassan also recommends continuing to wash your hands and keeping up to date with routine hepatitis vaccinations.

“It’s also important to establish the same precautions that we used for COVID, you know, just making sure we’re safe and avoiding sick children, who have obvious symptoms of diarrhea or cough or excessive sneezing,” Hassan said, speaking at a news conference on Thursday.

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