U.S., U.K. investigating unusual cases of hepatitis in young children - April 15, 2022+

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Source: https://www.idsociety.org/science-sp...te_na_dt/desc/


Updates on severe hepatitis of unknown etiology
Daniel R. Lucey, MD, MPH, FIDSA
5/13/2022 Facebook Twitter LinkedIn Email

While the cause(s) of acute, severe hepatitis of unknown etiology remain uncertain, several key updates are cited below from the past week, May 5-12.

Whole genome sequencing has not been reported yet for the adenovirus 41 found in the majority of patients (in whole blood much more often than stool or respiratory samples). Low viral loads of this adenovirus 41 are making whole genome sequencing difficult. (See page 20 of the U.K. Health Security Agency’s May 6 technical briefing.)

Liver histopathology on biopsy and explanted livers also has not been reported to show any direct evidence of adenovirus infection. Surprisingly, no immunologic analyses have been reported yet on any of these livers, e.g., including lymphocyte subsets, cytokines or activation markers....

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Source: https://www.statnews.com/2022/05/16/...ccid-myelitis/

Puzzling pediatric hepatitis cases echo an earlier mysterious illness
Helen Branswell
By Helen Branswell May 16, 2022

In early April, when word began to circulate that hospitals in the United Kingdom were seeing unexplained hepatitis cases in very young children, some physicians and researchers on this side of the Atlantic experienced a moment of déjà vu.

Kevin Messacar and colleagues at Children’s Hospital Colorado found themselves remarking on how reminiscent the unfolding investigation was of a medical mystery they’ve been enmeshed in for the past eight years — acute flaccid myelitis, or AFM, a polio-like condition in children.

Meanwhile, Carlos Pardo, the co-principal investigator of a National Institutes of Health study into the natural history of AFM, started fielding queries from hepatologists at Johns Hopkins Medicine, where he teaches, about what kinds of samples they should be collecting from suspected hepatitis cases.

“There are many parallels between this initial investigation of these cases of hepatitis of unknown origin and our initial investigations of AFM cases,” Messacar, a pediatric infectious disease physician and an associate professor at the University of Colorado, told STAT...

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Source: https://coloradosun.com/2022/05/16/c...unknown-cause/

Colorado has identified five cases of a mystery hepatitis in children
The disease remains rare, and the state has not seen any deaths or kids who needed a liver transplant
John Ingold
4:23 AM MDT on May 16, 2022

Colorado has reported its first cases of severe hepatitis of unknown cause in kids, adding to a growing number of cases nationally being investigated by the Centers for Disease Control and Prevention.

As of Friday, the Colorado Department of Public Health and Environment had reported five potential instances to the CDC. All met the CDC’s broad definition for cases — mainly that they occurred in kids ages 10 or younger and that doctors didn’t know what caused them. None of the five kids in Colorado died or required liver transplants as a result of their illnesses, though four were hospitalized. CDPHE says all five children either recovered or are in the process of recovering.

One case dates to December and was reported to the CDC last month. The other four cases were reported to the CDC over the past couple of weeks...

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Source: https://www.northjersey.com/story/ne...er/9828034002/


Hepatitis outbreak in children: Four NJ kids are among those in CDC study for liver pain
Lindy Washburn
NorthJersey.com
May 18, 2020

Four children in New Jersey who developed acute hepatitis between October and February have become part of a widening federal investigation into an outbreak of liver inflammation with no apparent cause. The New Jersey children all survived, and none required a liver transplant.

Nationwide, the Centers for Disease Control said Wednesday it was investigating 180 reports of the unexplained hepatitis from 36 states, an increase of 71 cases since May 5.

The additional reports do not mean the children became ill recently, but reflect the work of doctors and state health officials to review hepatitis cases dating back to October for potential links to the outbreak, the agency said.

The New Jersey patients ranged in age from under 1 to 7 years old, said Donna Leusner, a spokeswoman for the state Health Department. They were hospitalized between October and February, and all recovered. All tested negative for COVID....

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Source: https://www.cdc.gov/media/releases/2...hepatitis.html


Update on Children with Acute Hepatitis of Unknown Cause

Media Statement
For Immediate Release: Wednesday, May 18, 2022
Contact: Media Relations
(404) 639-3286


The Centers for Disease Control and Prevention (CDC) continues to work with health departments and clinicians nationwide to identify and investigate hepatitis of unknown cause impacting children. As of today, 36 states and territories have reported 180 pediatric patients under investigation over the past 7 months, which is an increase of 71 from the 109 publicly reported on May 5.
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. Since CDC’s investigation looks at patients reported back to October of 2021, most of these numbers involve patients that are just now being reported, rather than new cases of hepatitis – so not all are recent, and some may ultimately wind up not being linked to this current investigation. Additionally, there have been no reported deaths since February 2022, and the proportion of patients requiring liver transplants has gone down from 15 percent to 9 percent since May 5.
CDC continues to examine possible causes, including testing for and ruling out some of the viruses that commonly cause hepatitis (hepatitis A, B, C, D, and E). Adenovirus has been detected in nearly half of the children and continues to be a strong lead. Further laboratory tests are being conducted to look more closely at the virus genome and other potential pathogens, such as SARS-CoV-2. In addition, CDC is communicating with key medical groups and continues to provide updated reporting and laboratory guidance for clinicians who may identify hepatitis of unknown cause in children. A Community Outreach and Clinician Activity (COCA) call is scheduled for Thursday, May 19^th, where CDC will provide key updates and experts in treating hepatitis will answer clinical questions.
It’s important to note that severe hepatitis in children remains rare. However, we encourage parents and caregivers to be aware of the symptoms of hepatitis – particularly jaundice, which is a yellowing of the skin or eyes – and to contact their child’s healthcare provider with any concern.
CDC will begin posting regular online updates specific to the number of patients under investigation on a weekly basis. As we learn more, we will share additional information and updates.

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Source: https://cdphe.colorado.gov/hepatitis

Colorado data below:


Centers for Disease Control and Prevention (CDC) and health departments around the country are monitoring reports of cases of children with hepatitis of unknown cause; investigators are examining a possible relationship to adenovirus. CDC has put out a call for cases of children <10 years old with hepatitis of unknown cause since October 2021.
As of May 19, 2022, CDPHE has reported 13 cases that meet these criteria to CDC. Numbers will be updated weekly on Thursday.
Case numbers are listed below according to the month in which patients first presented with liver disease. Case counts for all time periods may change as CDPHE identifies more patients.

Date of presentation	Number of cases
November 2021	1
December 2021	2
January 2022	1
February 2022	1
March 2022	1
April 2022	4
May 2022	3

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Source: https://nationalpost.com/pmn/health-...is-in-children

U.S. CDC says adenovirus leading hypothesis for severe hepatitis in children
Reuters
Deena Beasley
Publishing date:
May 20, 2022 • 58 minutes ago

Infection with adenovirus, a common childhood virus, is the leading hypothesis for recent cases of severe hepatitis of unknown origin in children that have led to at least six deaths, U.S. health officials said on Friday...

...Dr. Jay Butler, CDC deputy director for infectious diseases, said on a conference call that around half of the children diagnosed in recent months were also infected with a type of adenovirus, a virus that causes the common cold, but the agency is still investigating the exact cause of the illness.

“Evidence is accumulating that there is a role for adenovirus, particularly adenovirus-41,” he said....

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Source: https://abcnews.go.com/Health/6th-ch...ry?id=84867139

6th child dies in connection to mysterious hepatitis cases with unknown cause

Officials had previously reported the deaths of five children.
ByArielle Mitropoulos
20 May 2022, 17:05

Another child in the U.S. has died in connection with the mysterious cases of severe hepatitis that have been occurring among children around the country and the globe, officials from the Centers for Disease Control and Prevention confirmed on Friday.

Investigators learned of the additional death on Thursday, Dr. Jay Butler, deputy director for infectious diseases for the CDC, told reporters during a phone briefing.

Officials had previously reported that the deaths of five other children were under investigation in connection to the disease.

"Unfortunately, the illness in many of these patients is severe ... and the extent of the injury to the liver can be quite extensive. And so, this is clearly a severe disease that we're taking very carefully for that reason, and the proportion of these, despite treatment, do unfortunately die," said Dr. Umesh Parashar, chief of the viral gastroenteritis branch at the CDC's Division of Viral Diseases...

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Increase in hepatitis (liver inflammation) cases in children under investigation


Regular UKHSA updates on the ongoing investigation into higher than usual rates of liver inflammation (hepatitis) in children across the UK.
From:UK Health Security Agency

Published 6 April 2022

Last updated 20 May 2022 — See all updates


Latest


The UK Heath Security Agency (UKHSA) has published its third detailed technical briefing on the UK-wide investigations into a rise in cases of sudden onset hepatitis in children, updating data and findings on cases resident in the UK up to 16 May 2022.

Since the last update on 6 May, investigations have identified a further 34 confirmed cases, bringing the total number of UK cases to 197 as of 16 May. Of the cases to date, 11 have received a liver transplant. No cases resident in the UK have died.

The investigation continues to suggest an association with adenovirus. Adenovirus is the most frequently detected virus in samples tested.

Amongst 197 UK cases, 170 have been tested for adenovirus of which 116 had adenovirus detected. In 31 cases where adenovirus was not detected, 13 had not had whole blood sample testing, and therefore it is not possible to definitively rule out adenovirus in these cases.

So far, SARS-CoV-2 has been detected in 15% of UK patients with available results, reflecting testing on or around the time of admission.

There is no evidence of any link to the coronavirus (COVID-19) vaccine. The majority of cases are under 5 years old and too young to have received the vaccine.

Following further investigation, there is no evidence linking dog ownership and cases of hepatitis in children.

Standard hygiene measures, including covering your nose and mouth when you cough and sneeze, thorough handwashing and making sure children wash their hands properly are vital in reducing the spread of many common infections, including adenovirus.

Jaundice and vomiting are the most common symptoms experienced by the children affected.

Dr Renu Bindra, Senior Medical Advisor at UKHSA, said:

It’s important that parents know the likelihood of their child developing hepatitis is extremely low. However, we continue to remind everyone to be alert to the signs of hepatitis – particularly jaundice, look for a yellow tinge in the whites of the eyes – and contact your doctor if you are concerned.

Our investigations continue to suggest that there is an association with adenovirus infection, but investigations continue to unpick the exact reason for the rise in cases.

...

https://www.gov.uk/government/news/i...-investigation

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France -

Translation Google

Severe pediatric acute hepatitis of unknown origin: new case definition and update as of May 23, 2022

Update on 05/23/22 following the cases of acute pediatric hepatitis reported in France and internationally. A case definition for healthcare professionals and guidelines are available on our website.

Posted May 23, 2022


To download

• Case definition
• To behave

Following the report shared by the United Kingdom relating to cases of severe acute hepatitis of unknown origin in young children, a standardized information feedback system involving a network of clinicians and laboratories has been set up. in France to detect a possible similar signal on the territory. An initial case definition for healthcare professionals was thus published on May 3, 2022. Today, based on the evolution of knowledge and after new exchanges with its network of partners (clinicians, biologists), Santé public France adapts the case definition to improve its sensitivity and to be able to identify less severe cases, and therefore potentially more numerous. In addition,the course of action has been updated to reflect this new case definition .

A signaling circuit for possible cases in addition to syndromic surveillance

The formalized circuit for reporting and investigating possible cases, in conjunction with the Ministry of Health, relies on a network of clinicians and laboratories including the four liver transplant centers (Necker, Bicêtre, Marseille, Lyon ) and pediatric intensive care units. Its objective is to detect on the territory a possible signal similar to that observed in the United Kingdom.

The system is based on a new case definition developed in collaboration with hepato-paediatricians and the three National Reference Centers involved (viral hepatitis B/C/Delta, gastroenteritis viruses and respiratory infection viruses) . The action to be taken in the event of severe acute hepatitis in children under 18 has therefore been updated and disseminated by the Ministry of Health to the professionals concerned.

In addition, Public Health France continues to regularly analyze:

• emergency room visit data from the OSCOUR® network for a selection of diagnostic codes compatible with acute hepatitis of unknown etiology (notably excluding viral hepatitis A to E) in children under 18 in order to identify a possible increase unusual number of these cases over the recent period;
• hospitalization data (PMSI) to be able to detect a possible increase in the number of hospital stays compatible with acute hepatitis of unknown origin (data currently available until the end of January 2022).

Why are we changing the case definition?

The first definition relating to pediatric cases of acute hepatitis was developed with the objective of rapidly identifying severe cases of unknown origin and characterizing them precisely. The investigation circuit set up in conjunction with the Ministry of Solidarity and Health identified 2 cases. It is not possible in the current state of knowledge to know if there is a link between these cases and the signal reported by the United Kingdom.

After further exchanges with its network of partners (clinicians, biologists), Public Health France is adapting the case definition to improve its sensitivity and be able to identify less severe cases, and therefore potentially more numerous.

What's new ?

The main changes made to the case definition were discussed with the Agency's network of partners, in particular hepato-paediatricians and virologists. They concern, among other things:

• The systematic consideration of cases of acute hepatitis with infection by SARS-CoV-2 or by an adenovirus.
• The withdrawal of the criterion of a prothrombin level below 50% (criterion of severity marking major liver dysfunction) in order to extend the collection to less severe hepatitis.
• A clarification of the exclusion factors of the definition of a possible case and in particular: hepatotoxicity linked to a drug, the viruses classically responsible for acute hepatitis, and the other well-known causes that can lead to acute hepatitis.

These changes should result in more cases being reported. These cases are not unexpected in France but reporting them will allow them to be thoroughly investigated and linked, if necessary, to the alert in the United Kingdom.

The publication of this case definition is for investigation and epidemiological surveillance purposes, but does not modify the medical care of the children concerned.

Cases of pediatric acute hepatitis: update on 05/23/2022 in France and abroad

In France :

Two possible cases have been reported and 4 are being investigated by medical teams, in conjunction with Public Health France. The occurrence of these cases is not unexpected and does not reflect, at this stage, an excess of cases in France.

Internationally :

1. As of 19 May 2022, 125 cases of acute hepatitis of unknown origin in children aged 16 years or younger have been reported in 14 European countries.
2. As of 16 May 2022, 197 cases of acute hepatitis of unknown etiology have been identified in children aged 10 years or younger in the UK .
3. In other countries, as of May 19, 2022, 313 cases of acute hepatitis in children have been reported by 16 countries, without it being possible at present to know whether they represent an excess of cases or This is the usual number of cases in most countries.

A total of 614 cases have been reported worldwide.

https://www.santepubliquefrance.fr/les-actualites/2022/hepatites-aigues-pediatriques-severes-d-origine-inconnue-nouvelle-definition-de-cas-et-point-de-situation-au-23-mai-2022

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Source: https://www.cdc.gov/ncird/investigat...e/updates.html


Persons Under Investigation

Children with Acute Hepatitis of Unknown Etiology


While rare, children can still have serious hepatitis, and we don’t always know the cause. That’s why investigators continue to look at possible causes and investigate.
Numbers of persons under investigation (PUI): 216

PUI does not mean this person is a confirmed case. The states and CDC are looking broadly (including hepatitis cases of unknown origin in children under 10 years of age, since October, 2021), so this number may go up or down as CDC and states review medical charts and learn more.
States and Jurisdictions Reporting at Least One Person Under Investigation (38)* as of May 25, 2022

*These may not be recent cases of hepatitis being reported.
To protect patient privacy, numbers for each state will not be released.


These data were posted on May 25, 2022 and reflect data from October 1, 2021. Reported PUIs are preliminary and subject to change as more data become available. Data will be updated weekly....

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Source: https://www.dailymail.co.uk/health/a...ew-deaths.html

Another 36 cases of mysterious hepatitis have been recorded in children less than 10 years old, after six died in the U.S. outbreak
U.S. total for suspected and confirmed cases of hepatitis has now risen to 216
There have also been 14 liver transplants and a total of six deaths
Mississippi and Utah both reported their first cases of hepatitis in the update
America has now recorded the most fatalities and cases out of any country
But this may be due to better surveillance in the U.S. compared to other nations
By Luke Andrews Health Reporter For Dailymail.Com
Published: 17:39 EDT, 25 May 2022 | Updated: 17:39 EDT, 25 May 2022

Another 36 cases of mysterious pediatric hepatitis in children aged 10 or younger, health chiefs revealed Wednesday — after six deaths were reported in the outbreak.

It brings the tally of children affected by the liver inflammation to 216 across 37 states, with Mississippi and Utah the latest to be added to the growing list.

No new deaths or liver transplants were reported in the last week, the Centers for Disease Control and Prevention (CDC) said in their weekly update with the totals remaining at 14 and six respectively.

The agency has refused to reveal where the deaths have occurred sighting 'confidentiality issues', but at least one was registered in Wisconsin health chiefs in the state say...