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

[Pathfinder]

IDPH Issues Warning About Three Potential Cases of Severe Hepatitis in Children in Illinois


News – Monday, April 25, 2022

Department Urges Illinois Healthcare Providers to be on the Lookout and to Report Potential Cases to Public Health Authorities

SPRINGFIELD – The Illinois Department of Public Health (IDPH) announced today that it has learned of three suspected cases of severe hepatitis in children under ten years of age, potentially linked to a strain of adenovirus. Two of the cases are in suburban Chicago and one is in Western Illinois. One case resulted in a liver transplant. IDPH is working to learn of other suspected cases in Illinois and is asking healthcare providers in the state to be on the lookout for symptoms and to report any suspected cases of hepatitis in children of unknown origin to local public health authorities.

The IDPH announcement follows a nationwide alert issued by the CDC in response to a cluster of nine cases of hepatitis of unknown origin in children in Alabama ranging in age from 1 to 6 years old, all of whom were previously healthy.

The CDC said that symptoms of hepatitis, or inflammation of the liver, include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice and can be caused by viruses. These cases appear to have an association with adenovirus 41. Adenoviruses spread from person-to-person and most commonly cause respiratory illness, but depending on the type, can also cause other illnesses such as gastroenteritis (inflammation of the stomach or intestines), conjunctivitis (pink eye), and cystitis (bladder infection). Adenovirus type 41 typically presents as diarrhea, vomiting and fever, and is often accompanied by respiratory symptoms. While there have been case reports of hepatitis in immunocompromised children with adenovirus infection, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children.

CDC said it is working with state health departments to see if there are additional U.S. cases, and what may be causing these cases. At this time, CDC said it believes adenovirus may be the cause for these reported cases, but investigators are still learning more – including ruling out other possible causes and identifying other possible contributing factors.

CDC is asking physicians to consider adenovirus testing using PCR or NAAT on respiratory samples, stool or rectal swabs and whole blood for pediatric patients with hepatitis of unknown etiology, and to report any possible cases of hepatitis of unknown origin to CDC and state public health authorities.

In addition, CDC is encouraging parents and caregivers to be aware of the symptoms of hepatitis, and to contact their healthcare provider with any concerns. CDC continues to recommend children be up to date on all their vaccinations, and that parents and caregivers of young children take the same everyday preventive actions that it recommends for everyone, including washing hands often, avoiding people who are sick, covering coughs and sneezes, and avoiding touching the eyes, nose or mouth.

For more information, go to: https://emergency.cdc.gov/han/2022/han00462.asp


https://dph.illinois.gov/resource-c...t-three-potential-cases-of-severe-hepati.html

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[TD="width: 100%"]Wisconsin DHS Health Alert #42: Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology


Bureau of Communicable Diseases

April 27, 2022

Summary


The Wisconsin Department of Health Services (DHS) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of a recent increase in cases of acute hepatitis and adenovirus infection in children.

From November 2021 to February 2022, clinicians at a large children’s hospital in Alabama identified nine pediatric patients with significant liver injury, including three with acute liver failure, who also tested positive for adenovirus. All children were previously healthy. All five of the nine specimens that were sequenced had adenovirus type 41 infection identified. Two patients required liver transplant; no patients died.

Since being notified of this adenovirus-associated hepatitis cluster, DHS is now investigating at least four similar cases among children in Wisconsin. This includes two children who had severe outcomes, one liver transplant, and one fatality.

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Background


A possible association between pediatric hepatitis and adenovirus infection in children who tested negative for hepatitis viruses A, B, C, D, and E is currently under investigation worldwide. This Health Alert serves to notify U.S. clinicians who may encounter pediatric patients with hepatitis of unknown etiology to consider adenovirus testing and to elicit reporting of such cases to state public health authorities and to the Centers for Disease Control and Prevention (CDC). Nucleic acid amplification testing (NAAT, e.g., PCR) is preferred for adenovirus detection and may be performed on respiratory specimens, stool or rectal swabs, or blood.

CDC issued an official Health Advisory describing a cluster of cases in Alabama and provided recommendations for testing and reporting on April 21. The World Health Organization has also published a Disease Outbreak News report on April 23 describing 169 cases of acute hepatitis of unknown etiology, of these, adenovirus had been detected in at least 74 cases.

Clinical


Hepatitis is inflammation of the liver that can be caused by viral infections, alcohol use, toxins, medications, and certain other medical conditions. In the U.S, the most common causes of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C viruses.

Signs and symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice. Treatment of hepatitis depends on the underlying etiology. Adenoviruses are doubled-stranded DNA viruses that spread by close personal contact, respiratory droplets, and fomites. There are more than 50 types of immunologically distinct adenoviruses that can cause infections in humans. Adenoviruses most commonly cause respiratory illness. However, some adenovirus types can cause other illnesses, such as gastroenteritis, conjunctivitis, cystitis, and, less commonly, neurological disease.

There is no specific treatment for adenovirus infections. Adenovirus type 41 commonly causes pediatric acute gastroenteritis, which typically presents as diarrhea, vomiting, and fever; it can often be accompanied by respiratory symptoms. While there have been case reports of hepatitis in immunocompromised children with adenovirus type 41 infection, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children.

Recommendations

1. Clinicians should consider adenovirus testing in pediatric patients with hepatitis of unknown etiology. NAAT (e.g., PCR) is preferable and may be done on respiratory specimens, stool or rectal swabs, or blood.
2. Anecdotal reports suggest that testing whole blood by PCR may be more sensitive than testing plasma by PCR; therefore, testing of whole blood could be considered in those without an etiology who tested negative for adenovirus in plasma samples.
3. If patients are still under medical care or have residual specimens available, please save and freeze specimens for possible additional testing and contact DHS at 608-267-9003.

Clinical Criteria for Case Reporting

1. Children under age 16, presenting with hepatitis of unknown etiology (with or without any adenovirus testing results) since January 1, 2021, AND
2. Elevated liver function tests (i.e., aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >500 U/L).

Suspect cases should be reported to public health electronically via the Wisconsin Electronic Disease Surveillance System (WEDSS) and selecting “hepatitis unknown” as the disease type, or by contacting DHS at 608-267-9003.

Sincerely,

Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist
Bureau of Communicable Diseases
Division of Public Health
Wisconsin Department of Health Services

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[Shiloh]

Source: https://www.dailymail.co.uk/health/...ious-spate-hepatitis-months-experts-warn.html

Another 34 British children are sickened with hepatitis amid fears health chiefs won't know cause of mysterious outbreak for three months
Professor Alastair Sutcliffe says it could take months to prove cause
There have been more than 200 global cases of liver disease of 'unknown origin'
Up to two young children have died globally with 17 needing a liver transplant
By Joe Davies Health Reporter For Mailonline
Published: 08:32 EDT, 29 April 2022 | Updated: 12:31 EDT, 29 April 2022

Another 34 children in Britain have been struck down by hepatitis as the mysterious outbreak continues to sweep the world.

Health bosses confirmed nearly three dozen cases of liver inflammation have been detected in those aged 10 and under since Monday, bringing the total UK-wide total to 145.

Of these cases, 108 are in England, 17 are in Scotland, 11 are in Wales and nine are in Northern Ireland.

Ten youngsters have needed a liver transplant but no deaths have been reported in the UK.

It comes as experts warned the cause of the peculiar hepatitis pattern — which has been spotted in 200 children worldwide since March — won't be known for months.

Globally, one child is confirmed to have died and another fatality in the US is currently being probed. At least 18 sickened youngsters have needed a liver transplant...

 

[sharon sanders]

Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022


Early Release / April 29, 2022 / 71



Julia M. Baker, PhD[SUP]1[/SUP][SUP],2[/SUP]; Markus Buchfellner, MD[SUP]3[/SUP]; William Britt, MD[SUP]3[/SUP]; Veronica Sanchez, PhD[SUP]3[/SUP]; Jennifer L. Potter, MPH[SUP]3[/SUP]; L. Amanda Ingram, MPH[SUP]4[/SUP]; Henry Shiau, MD[SUP]5[/SUP][SUP],6[/SUP]; Luz Helena Gutierrez Sanchez, MD[SUP]5[/SUP][SUP],6[/SUP]; Stephanie Saaybi, MD[SUP]5[/SUP]; David Kelly, MD[SUP]6[/SUP][SUP],7[/SUP]; Xiaoyan Lu, MS[SUP]1[/SUP]; Everardo M. Vega, PhD[SUP]1[/SUP]; Stephanie Ayers-Millsap, MPH[SUP]8[/SUP]; Wesley G. Willeford, MD[SUP]8[/SUP]; Negar Rassaei, MD[SUP]9[/SUP]; Hannah Bullock, PhD[SUP]9[/SUP][SUP],10[/SUP]; Sarah Reagan-Steiner, MD[SUP]9[/SUP]; Ali Martin[SUP]4[/SUP]; Elizabeth A. Moulton, MD, PhD[SUP]11[/SUP][SUP],12[/SUP]; Daryl M. Lamson[SUP]13[/SUP]; Kirsten St. George, PhD[SUP]13[/SUP][SUP],14[/SUP]; Umesh D. Parashar, MD, MBBS[SUP]1[/SUP]; Aron J. Hall, DVM[SUP]1[/SUP]; Adam MacNeil, PhD[SUP]1[/SUP]; Jacqueline E. Tate, PhD[SUP]1[/SUP]; Hannah L. Kirking, MD[SUP]1[/SUP] (View author affiliations)

During October–November 2021, clinicians at a children’s hospital in Alabama identified five pediatric patients with severe hepatitis and adenovirus viremia upon admission. In November 2021, hospital clinicians, the Alabama Department of Public Health, the Jefferson County Department of Health, and CDC began an investigation. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.*

Clinical records from the hospital were reviewed to identify patients seen on or after October 1, 2021, with hepatitis and an adenovirus infection, detected via real-time polymerase chain reaction (PCR) testing on whole blood specimens, and no other known cause for hepatitis. An additional four children were identified, for a total of nine patients with hepatitis of unknown etiology and concomitant adenovirus infection during October 2021–February 2022. On February 1, 2022, a statewide health advisory[SUP]†[/SUP] was disseminated to aid in the identification of cases at other facilities in Alabama; no additional patients were identified.

All nine children were patients at Children’s of Alabama. These patients were from geographically distinct parts of the state; no epidemiologic links among patients were identified. The median age at admission was 2 years, 11 months (IQR = 1 year, 8 months to 5 years, 9 months) and seven patients were female (Table). All patients were immunocompetent with no clinically significant medical comorbidities.

Before admission, among the nine patients, vomiting, diarrhea, and upper respiratory symptoms were reported by seven, six, and three patients, respectively. At admission, eight patients had scleral icterus, seven had hepatomegaly, six had jaundice, and one had encephalopathy (Table). Elevated transaminases were detected among all patients[SUP]§[/SUP] (alanine aminotransferase [ALT] range = 603–4,696 U/L; aspartate aminotransferase [AST] range = 447–4,000 U/L); total bilirubin ranged from normal to elevated (range = 0.23–13.5 mg/dL, elevated in eight patients). All patients received negative test results for hepatitis viruses A, B, and C, and several other causes of pediatric hepatitis and infections were ruled out including autoimmune hepatitis, Wilson disease, bacteremia, urinary tract infections, and SARS-CoV-2 infection. None of the children had documented history of previous SARS-CoV-2 infection.

Adenovirus was detected in whole blood specimens from all patients by real-time PCR testing (initial viral load range = 991–70,680 copies/mL). Hexon gene hypervariable region sequencing was performed on specimens from five patients, and adenovirus type 41 was detected in all five specimens. Low viral loads precluded sequencing among three patients, and residual specimens were not available for sequencing for one patient. Seven patients were coinfected with other viral pathogens (Table). Six received positive test results for Epstein-Barr virus (EBV) by PCR testing but negative test results for EBV immunoglobulin M (IgM) antibodies (one patient did not have IgM testing), suggesting that these were likely not acute infections but rather low-level reactivation of previous infections. Other detected viruses included enterovirus/rhinovirus, metapneumovirus, respiratory syncytial virus, and human coronavirus OC43.

Liver biopsies from six patients demonstrated various degrees of hepatitis with no viral inclusions observed, no immunohistochemical evidence of adenovirus, or no viral particles identified by electron microscopy. Three patients developed acute liver failure, two of whom were treated with cidofovir (off-label use) and steroids, and were transferred to a different medical facility where they underwent liver transplantation. Plasma specimens from these two patients were negative for adenovirus by real-time PCR testing upon arrival at the receiving medical facility, but both patients received positive test results when retested by the same real-time PCR test using a whole blood specimen. All patients have recovered or are recovering, including the two transplant recipients.

Adenovirus type 41 is primarily spread via the fecal-oral route and predominantly affects the gut. It is a common cause of pediatric acute gastroenteritis typically with diarrhea, vomiting and fever, often accompanied by respiratory symptoms (1). Adenovirus is recognized as a cause of hepatitis among immunocompromised children (2). It might be an underrecognized contributor to liver injury among healthy children (3); however, the magnitude of this relationship remains under investigation.

This cluster, along with recently identified possible cases in Europe (4–6), suggests that adenovirus should be considered in the differential diagnosis of acute hepatitis of unknown etiology among children. Clinicians and laboratorians should be aware of possible differences in adenovirus test sensitivity for different specimen types; tests using whole blood might be more sensitive than those using plasma. CDC is monitoring the situation closely to understand the possible cause of illness and identify potential efforts to prevent or mitigate illness. Enhanced surveillance is underway in coordination with jurisdictional public health partners. Clinicians are encouraged to report possible cases of pediatric hepatitis with unknown etiology occurring on or after October 1, 2021, to public health authorities for further investigation.[SUP]¶[/SUP]

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Acknowledgments


Paige A. Armstrong, Julu Bhatnagar, Neil Gupta, Senad Handanagic, Megan Hofmeister, Philip Spradling, CDC; James J. Dunn, Texas Children’s Hospital, Houston, Texas; Advanced Technology and Genomics Core, Wadsworth Center, New York Department of Health, Albany New York.

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Corresponding author: Julia M. Baker, ncirddvdgast@cdc.gov.

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[SUP]1[/SUP]Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; [SUP]2[/SUP]Epidemic Intelligence Service, CDC; [SUP]3[/SUP]Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama; [SUP]4[/SUP]Alabama Department of Public Health; [SUP]5[/SUP]Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Alabama at Birmingham, Birmingham, Alabama; [SUP]6[/SUP]Children’s of Alabama, Birmingham, Alabama; [SUP]7[/SUP]Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama; [SUP]8[/SUP]Jefferson County Department of Health, Birmingham, Alabama; [SUP]9[/SUP]Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; [SUP]10[/SUP]Synergy America, Inc., Duluth, Georgia; [SUP]11[/SUP]Department of Pediatrics, Division of Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas; [SUP]12[/SUP]Texas Children’s Hospital, Houston, Texas; [SUP]13[/SUP]Wadsworth Center, New York State Department of Health; [SUP]14[/SUP]Department of Biomedical Sciences, University at Albany, Albany, New York.

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All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. William Britt reports consulting fees from Hookipa Pharma and stocks from Kroger Care, First Energy Corporation, MDU Resources Group, and PG&E Corporation. Elizabeth A. Moulton serves as a coinvestigator for Pfizer SARS-CoV-2 vaccine trials in healthy and immunocompromised pediatric patients with payment made to her institution. Kirsten St. George reports receipt of research support for her institution through equipment and materials from Thermo Fisher, and royalties from ZeptoMetrix Corporation paid to her institution. No other potential conflicts of interest were disclosed.

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* 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

[SUP]†[/SUP] https://www.alabamapublichealth.gov/bcd/assets/adph_han_report_adenovirus_020122.pdfpdf iconexternal icon

[SUP]§[/SUP] Normal ranges are ALT = 9–25 U/L; AST = 21–44 U/L; total bilirubin = 0.1–1.0 mg/dL.

[SUP]¶[/SUP] https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_462.pdfpdf icon

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References

1. Kang G. Viral diarrhea. In: Quah SR, ed. International encyclopedia of public health. 2nd ed. Cambridge, MA: Elsevier; 2017:360–7. https://www.sciencedirect.com/referencework/9780128037089/international-encyclopedia-of-public-healthexternal icon
2. Hierholzer JC. Adenoviruses in the immunocompromised host. Clin Microbiol Rev 1992;5:262–74. https://doi.org/10.1128/CMR.5.3.262external icon PMID:1323383external icon
3. Munoz FM, Piedra PA, Demmler GJ. Disseminated adenovirus disease in immunocompromised and immunocompetent children. Clin Infect Dis 1998;27:1194–200. https://doi.org/10.1086/514978external icon PMID:9827268external icon
4. UK Health Security Agency. Increase in acute hepatitis cases of unknown aetiology in children. London, United Kingdom: Department of Health and Social Care, UK Health Security Agency; 2022. https://www.gov.uk/government/publications/hepatitis-increase-in-acute-cases-of-unknown-aetiology-in-children/increase-in-acute-hepatitis-cases-of-unknown-aetiology-in-childrenexternal icon
5. Marsh K, Tayler R, Pollock L, et al. Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022. Euro Surveill 2022;27. https://doi.org/10.2807/1560-7917.ES.2022.27.15.2200318external icon PMID:35426362external icon
6. World Health Organization. Multi-Country – acute, severe hepatitis of unknown origin in children. Geneva, Switzerland: World Health Organization; 2022. Accessed April 23, 2022. https://www.who.int/emergencies/disease-outbreak-news/item/multi-country-acute-severe-hepatitis-of-unknown-origin-in-childrenexternal icon

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https://www.cdc.gov/mmwr/volumes/71/...cid=mm7118e1_x


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Media Statement
EMBARGOED FOR 1PM ET Friday, April 29, 2022
Contact: CDC Media Relations (404) 639-3286

MMWR on children with acute hepatitis and adenovirus infection in Alabama A new study published by the Centers for Disease Control and Prevention (CDC) today, “Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022” provides additional clinical and epidemiologic information from an ongoing investigation involving children in Alabama with hepatitis (inflammation of the liver) of unknown cause. These findings build on previous information shared about the cluster of nine cases currently under investigation by CDC and the Alabama Department of Public Health. In the fall of 2021, clinicians at a children’s hospital in Alabama identified five patients with severe hepatitis and adenovirus infection, including some with acute liver failure. A review of hospital clinical records identified four additional cases, all of whom had liver injury and adenovirus infection. All were previously healthy, ranged in age from about 1 to 6-years-old, and had no significant underlying conditions. Among the findings in the MMWR: two of the pediatric patients in Alabama required liver transplants, and three developed liver failure, but all have since recovered or are recovering. Prior to hospitalization, most of the children experienced vomiting and diarrhea, while some experienced upper respiratory symptoms. During hospitalization, most had yellowing eyes, yellowing skin (or jaundice), and an enlarged liver. All nine patients tested positive for adenovirus, and six tested positive for Epstein-Barr Virus but did not have antibodies, which implies an earlier, not active infection. Laboratory tests identified that some of these children had adenovirus type 41, which more commonly causes pediatric acute gastroenteritis. Additionally, some showed a history of other viruses including enterovirus/rhinovirus, metapneumovirus, respiratory syntactical virus, and human coronavirus OC43.

 

[sharon sanders]

via email


From:
"Media@cdc.gov (CDC)" <sohco@CDC.GOV>[Add to Address Book]
To: <MMWR-MEDIA@LISTSERV.CDC.GOV>
Subject: CDC Media Statement: Proactive Statement: MMWR on children with acute hepatitis and adenovirus infection in Alabama
Date: Apr 29, 2022 3:21 PM


Media Statement

For Immediate Release
Friday, April 29, 2022

Contact: CDC Media Relations
(404) 639-3286


Proactive Statement: MMWR on children with acute hepatitis and adenovirus infection in Alabama

A new study published by the Centers for Disease Control and Prevention (CDC) today, “Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022” provides additional clinical and epidemiologic information from an ongoing investigation involving children in Alabama with hepatitis (inflammation of the liver) of unknown cause.

These findings build on previous information shared about the cluster of nine cases currently under investigation by CDC and the Alabama Department of Public Health. In the fall of 2021, clinicians at a children’s hospital in Alabama identified five patients with severe hepatitis and adenovirus infection, including some with acute liver failure. A review of hospital clinical records identified four additional cases, all of whom had liver injury and adenovirus infection. All were previously healthy, ranged in age from about 1 to 6-years-old, and had no significant underlying conditions.

Among the findings in the MMWR: two of the pediatric patients in Alabama required liver transplants, and three developed liver failure, but all have since recovered or are recovering. Prior to hospitalization, most of the children experienced vomiting and diarrhea, while some experienced upper respiratory symptoms. During hospitalization, most had yellowing eyes, yellowing skin (or jaundice), and an enlarged liver. All nine patients tested positive for adenovirus, and six tested positive for Epstein-Barr Virus but did not have antibodies, which implies an earlier, not active infection. Laboratory tests identified that some of these children had adenovirus type 41, which more commonly causes pediatric acute gastroenteritis. Additionally, some showed a history of other viruses including enterovirus/rhinovirus, metapneumovirus, respiratory syntactical virus, and human coronavirus OC43.

At this time, we believe adenovirus may be the cause for these reported cases, but other potential environmental and situational factors are still being investigated. Adenovirus type 41 is not usually known as a cause of hepatitis in otherwise healthy children, and no known epidemiological link or common exposures among these children has been found. Some causes have already been ruled out, including:

• hepatitis viruses A, B, and C
• SARS-CoV-2 infection
• autoimmune hepatitis
• Wilson disease

It’s important to note that this report is specific to the Alabama investigation, and CDC does not have an update at this time on any other suspected cases in the U.S. CDC is taking every potential reported case seriously and working vigilantly with state and local public health officials and clinicians to identify and investigate other potential cases. On April 21, CDC issued a nationwide Health Alert Network (HAN) Advisory asking all physicians to be on the lookout for symptoms and to report any suspected cases of hepatitis of unknown origin to their local and state health departments. CDC is working with commercial and state public health laboratories to provide guidance on how to submit testing.

CDC is also aware of an increase in cases of pediatric hepatitis without a known cause recently reported in Europe, and has been in contact with our European counterparts to understand what they are learning. Adenovirus has been confirmed in several of the European cases, but not all. Investigators are ruling out other possible causes and identifying other possible contributing factors. As we learn more, we will share additional information and updates.

 

[Pathfinder]

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 29 April 2022 — See all updates

Latest


The UK Health Security Agency (UKHSA), working with Public Health Scotland, Public Health Wales and the Public Health Agency, are continuing to investigate the cases of sudden onset hepatitis in children aged 10 and under that have been identified since January 2022.

The usual viruses that cause infectious hepatitis (hepatitis A to E) have not been detected. The cases are predominantly in children under 5 years old who showed initial symptoms of gastroenteritis illness (diarrhoea and nausea) followed by the onset of jaundice.

Active case finding investigations have identified a further 34 confirmed cases since the last update on 25 April, bringing the total number of cases to 145. Of the confirmed cases, 108 are resident in England, 17 are in Scotland, 11 are in Wales and 9 are in Northern Ireland.

Of these cases, 10 children have received a liver transplant. No children have died. As part of the investigation, a small number of children over the age of 10 are also being investigated.

Findings continue to suggest that the rise in sudden onset hepatitis in children may be linked to adenovirus infection, but other causes are still being actively investigated.

As it is not typical to see this pattern of symptoms from adenovirus, we are investigating other possible contributing factors, such as another infection – including coronavirus (COVID-19) – or an environmental cause.

We are also exploring whether increased susceptibility due to reduced exposure during the COVID-19 pandemic could be playing a role, or if there has been a change in the genome of the adenovirus.

UKHSA is working with scientists and clinicians across the country to answer these questions as quickly as possible.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said:

We know that this may be a concerning time for parents of young children. The likelihood of your child developing hepatitis is extremely low. However, we continue to remind parents to be alert to the signs of hepatitis – particularly jaundice, which is easiest to spot as a yellow tinge in the whites of the eyes – and contact your doctor if you are concerned.

Normal hygiene measures, including thorough handwashing and making sure children wash their hands properly, help to reduce the spread of many common infections.

As always, children experiencing symptoms such as vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped.

...
https://www.gov.uk/government/news/...mmation-cases-in-children-under-investigation​

 

[sharon sanders]

bump this

 

[Shiloh]

Source: https://www.kare11.com/article/news...in-mn/89-d4ade00d-5cc9-459c-b121-2fb0f8c131e3

Hospital reports two cases of rare, unexplained child liver illness in Minnesota
M Health Fairview is in the process of submitting these cases to the Minnesota Department of Health.
Author: Chris Hrapsky
Published: 3:41 PM CDT April 29, 2022
Updated: 7:00 PM CDT April 29, 2022

MINNEAPOLIS — A pediatric doctor with M Health Fairview is reporting two cases of unexplained, severe hepatitis in children in Minnesota that appear to match similar cases around the globe.

Dr. Heli Bhatt, a pediatric gastroenterologist and hepatologist with M Health Fairview Masonic Children’s Hospital, says a four-week-old baby received a liver transplant six months ago following unexplained, severe liver inflammation. Another, otherwise healthy child, is currently awaiting a liver transplant due to hepatitis with no known origin. M Health Fairview says one child is from Minnesota and the other is from South Dakota.

On Friday evening, the Minnesota Department of Health confirmed that it's investigating "several cases," saying they're waiting on additional clinical information and lab testing.

"What is unique about this situation is that they are really severe, and they are going on to need transplants, and even one death, which is what is mind boggling to call of us," said Dr. Bhatt. "I think the best thing you can do is not panic, good hand hygiene and let your pediatrician know if your kid is having symptoms."

This adds to the 19 other recent U.S. cases the Centers for Disease Control and Prevention (CDC) calls unusual hepatitis in children...

 

[Pathfinder]

Translation Google

Childhood hepatitis: Sciensano expects an increase in cases in Belgium and will analyze the last 7 months

RTL INFO with the Belga agency , published on April 30, 2022 at 07:57

Sciensano will go back until October 1, 2021 to examine possible cases of acute unexplained hepatitis affecting children, said Friday Steven Van Gucht, virologist at the public health institute.

There are currently two confirmed cases in Belgium. They are two children under the age of 10 who were hospitalized for a period of time with acute inflammation of the liver. No link has been established between the two young patients.

The virologist expects cases to increase next week. "A number" of possible cases are currently under investigation. These are children, aged from one month to 14 years, with acute inflammation of the liver for which the cause has not been found. Additional analyzes should be performed.

Sciensano also works retroactively. The health institute is thus examining cases that have occurred from October 1, 2021. “We are therefore also analyzing fairly old cases” , underlines Mr. Van Gucht.

Common symptoms but with unusual frequency

Acute inflammations of the liver without any cause being found have already occurred in the past. “In itself, this is nothing new” , underlines the virologist. “What set off the alarm bells is that in some countries, a greater number of cases have been observed over a shorter period than expected” , he punctuates.
...
An adenovirus in question?

It is difficult to explain this upsurge. No common cause has been identified so far.

However, adenoviruses “can occasionally lead to inflammation of the liver, depending on genetic factors or other co-factors ,” says Van Gucht. The two cases identified in Belgium were positive for the adenovirus, but it has not yet been proven that this virus is actually the cause of the inflammation.

https://www.rtl.be/info/belgique/so...-va-analyser-les-7-derniers-mois-1373340.aspx

 

[Shiloh]

Source: https://patch.com/georgia/atlanta/ga-hepatitis-outbreak-causing-liver-disease-children

GA Hepatitis Outbreak Causing Liver Disease In Children
Several "suspect cases" of hepatitis in children have been reported to the Georgia Department of Public Health, a spokesperson confirmed.
Nikki Gaskins,
Patch StaffVerified Patch Staff Badge
Posted Tue, May 3, 2022 at 4:06 pm ET

ATLANTA, GA — After several cases of severe hepatitis were reported in children in nearby states, health officials confirmed they are also looking into reports of liver disease in children throughout Georgia.

"Several suspect cases have been reported to DPH, but they all remain under investigation at this time," Nancy Nydam, a spokesperson for the Georgia Department of Public Health, told Patch in an email.

Nydam did not say how many cases have been reported to the department so far or from what counties...

 

[sharon sanders]

bump this

 

[Shiloh]

Source: https://www.paho.org/en/news/3-5-2022-qa-acute-severe-hepatitis-children


Q&A - Acute severe hepatitis in children
3 May 2022


On 15 April 2022, the World Health Organization (WHO) published an alert on severe acute hepatitis cases of unknown origin in children in the United Kingdom. Since then, there have been continuing additional reports of cases.
We spoke with Dr. Leandro Soares Sereno, Advisor for Viral Hepatitis Prevention and Control at the Pan American Health Organization (PAHO), about hepatitis, and the severe acute cases reported in a number of countries.

1. What is acute hepatitis?

Hepatitis is an inflammation of the liver. There are different aetiologies – or causes – that can lead to this inflammation, such as an infection or intoxication by drugs or substances. The most frequently implicated infectious agents are the viruses responsible for hepatitis A, B, C, D and E.
When inflammation occurs rapidly and abruptly, we speak of acute hepatitis. In some cases, as in hepatitis B, C and D, the infection may become chronic. In this situation, we are not yet sure of the cause.

2. Why is the outbreak of hepatitis in children considered unusual? Is it due to the adenovirus?

This is an event under further investigation by WHO. So far, laboratory tests exclude cases of known viral hepatitis. In many cases, adenovirus infection was detected in the affected children, and the link between the two is being investigated as one of the hypotheses for the underlying cause.
Adenovirus is a common virus that can cause respiratory symptoms or vomiting and diarrhea. In general, the infection with such viruses is of limited duration and does not evolve into more serious conditions. There have been rare cases, however, of severe adenovirus infections that have caused hepatitis in immunocompromised- or transplant patients, for example. However, these children don’t match that description – they were previously healthy.

3. How many countries have reported confirmed or suspected cases of hepatitis in children that are not linked to hepatitis viruses A, B, C, D or E?

We cannot speak of confirmed cases at this point because the specific cause is still unknown and under investigation. The reported cases refer to children with severe acute hepatitis where hepatitis A, B, C, D or E were not identified.
Using this definition, as May 3, 2022, over 200 cases have been reported from 20 countries. The vast majority of cases are in the United Kingdom, which was the first country to report cases to WHO.
In the Americas, cases have been reported in the United States, and countries in the region are advised to monitor the situation. For now, PAHO/WHO is providing information to countries about criteria and definitions to assist in monitoring.

4. What is PAHO's assessment of the situation?

There is still little data to define whether there is an outbreak, and for now the global risk is considered low. As there is still no certainty about the origin of the disease, it is possible that we are becoming aware of a situation that existed before but went unnoticed because there were so few cases.

5. Could the outbreak be linked to COVID-19 or COVID-19 vaccines?

Based on current information, most of the reported children did not receive the COVID-19 vaccine, ruling out a link between cases and vaccination at this time.
In a few cases, the presence of the SARS-CoV-2 virus was detected, and this is one of the lines of investigation along with others such as the adenovirus.

6. What are the symptoms? Is it treatable?

Acute hepatitis has different symptoms: gastrointestinal, such as diarrhea or vomiting, fever and muscle pain, but the most characteristic is jaundice – where the skin and the whites of the eyes turn yellow.
The current treatment seeks to alleviate symptoms, and to manage and stabilize the patient if the case is severe. Treatment recommendations can be refined once the origin of infection is determined.

7. What can parents do to protect children?

The most important is to pay attention to symptoms, such as diarrhea or vomiting, and to the color: if there are signs of jaundice – where the skin and whites of the eyes turn yellow – medical attention should be sought immediately.
We recommend basic hygiene measures such as washing hands and covering your mouth when coughing or sneezing to prevent infections, which can also guard against the transmission of adenoviruses.

8. What measures does PAHO recommend to prevent the spread of the disease?

At this time, the recommendation to countries is to stay informed and to monitor for cases. The origin of cases remains under study, and PAHO/WHO will continue to provide technical support to countries in the region in generating and disseminating information during the course of the investigation.

 

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Translation Google

Belgium -

Acute hepatitis of unknown origin: update of May 4, 2022

Published on :
Wednesday, May 4, 2022

There are currently 3 cases of acute liver inflammation in Belgium that meet the case definition to report to the European Center for Disease Prevention and Control ( ECDC ), as part of the investigation into the extent and cause of this condition. These are children who fell ill between February and April.

In addition, a number of older cases (since October 1, 2021) have been reviewed. This revealed 2 other possible cases. These are cases that may meet the case definition, but for which no conclusion can be drawn because further laboratory examinations are no longer possible.

The age of these cases varies between 1 month and 10 years.

The search for new possible cases continues. We are still waiting for new notifications, but for the moment it seems that the disease is rare in Belgium. We don't yet know if there is a common cause or if the condition is caused by a virus.

Except for good hand hygiene, no special precautions are necessary.

https://www.sciensano.be/fr/coin-presse/hepatite-aigue-dorigine-inconnue-mise-a-jour-du-4-mai-2022

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Portugal -

Four suspected cases of hepatitis

Portugal has four suspected cases of acute hepatitis of unknown origin in children, aged 7 months to 8 years, announced the Directorate General of Health (DGS).

By TPN/Lusa, in News , Portugal , Health · 3 hours ago · 0 Comments


The four suspected cases were identified in the North, Center and Lisbon and Tagus Valley health regions and all tested negative for hepatitis A, B and C and for the SARS-CoV-2 virus, the results for hepatitis E being still awaited in two cases, reveals the DGS in a press release.

According to the health authority, one of the cases has already tested positive for the adenovirus, and the sample has been sent for sequencing to the National Institute of Health Dr. Ricardo Jorge.

"The children presented symptoms in April and were hospitalized, but none had serious complications, having recovered from the clinical picture", indicates the health authority, pointing out that epidemiological factors such as travel or connections between the cases are being investigated, in collaboration with the Ministry of Health and the European Center for Disease Prevention and Control (ECDC).

In the context of the international epidemic, a "taskforce" has been set up by the DGS, which includes specialists from the Portuguese Society of Pediatrics (SPP).

On April 15, the World Health Organization issued an alert about the increase in the number of cases of severe acute hepatitis in healthy children.

So far, the highest number of cases have occurred in Europe, particularly the UK, and were most common in children aged 3 to 5 years.

https://www.theportugalnews.com/fr/nouvelles/2022-05-05/quatre-cas-suspects-dhepatite/66823

 

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Translation Google

Inserm -
(French National Institute of Health and Medical Research)


Translation Google


An update on acute hepatitis identified in children

On April 15, 2022, the World Health Organization (WHO) published a report to describe the cluster of cases of acute hepatitis of unknown origin in children in the United Kingdom. Since then, other cases have been reported. What data is available so far?​

#Public Health Detox​

May 05, 2022 - 4:28 p.m. | By INSERM PRESS OFFICE

So far, five viruses have been identified as capable of causing hepatitis. This image was taken in the context of research on hepatitis C: cells infected with the virus accumulate large lipid droplets, a phenomenon called steatosis which contributes to the development of liver fibrosis in patients with chronic hepatitis C. © Inserm, P. Roingeard

On April 15, 2022, the World Health Organization (WHO) published a report to describe the cluster of cases of acute hepatitis of unknown origin in children in the United Kingdom. Since then, more cases have been reported, in a total of 16 countries. While the prevalence of this disease remains very rare – around 200 cases have been identified worldwide – the clusters that have formed in several places are unusual and raise questions for the scientific community.

It is not yet clear whether there has really been an increase in cases of pediatric hepatitis or an increase in awareness of cases that were previously undetected or poorly detected and are now better identified thanks to to enhanced monitoring.

The track of an infection by an adenovirus which would cause the disease is privileged. In the United Kingdom, for example, nearly 80% of the cases described at the end of April had indeed tested positive for an adenovirus.

To read also to go further:

A study published by the Centers for Disease Control (CDC) in the United States looked at nine cases of pediatric hepatitis with varying degrees of severity, described in Alabama between October 2021 and February 2022. PCR tests revealed the presence of an adenovirus in each of the nine children, but seven patients were also co-infected with other viruses.


However, this adenovirus trail is not yet confirmed – the presence of a specific virus in patients does not necessarily imply a causal link with hepatitis and other as yet unidentified factors that could potentially be as well. in question. The investigations are continuing.

Canal Détox returns to the main questions raised in the media in recent days.

What is hepatitis?

Hepatitis is an inflammation of the liver of viral origin in the majority of cases, although the disease can sometimes be caused by toxic substances. So far five viruses have been identified as capable of causing this targeted liver infection and inflammation. They are designated by the letters A, B, C, D and E, and do not have the same mode of transmission or the same aggressiveness.

Some forms of hepatitis can become chronic: they last more than six months. Common causes of this chronicity include hepatitis B and C viruses, non-alcoholic steatohepatitis (or NASH), alcohol-related liver disease, and autoimmune liver disease (autoimmune hepatitis). ). The cases reported in recent weeks in children are acute hepatitis: patients recover even if in 10% of cases the lesions were severe and required a liver transplant.

Care and treatment differ depending on the origin of the hepatitis. Currently, chronic hepatitis C is unique in that it is the only chronic viral disease that can be cured.

Some forms of hepatitis are called “non-alphabetic” because the A, B, C, D or E viruses are not found in patients. These “non-alphabetic” viruses can be responsible for hepatitis of varying severity depending on the terrain. This is what seems to be taking shape here, even if the data is still patchy.

What are adenoviruses?

Adenoviruses are a family of envelopeless DNA viruses. Over 80 types of adenovirus are known to infect humans. Some adenoviruses are also the cause of zoonoses .

Adenovirus 41, which has been identified in several of the hepatitis cases in recent weeks, is already well known as a cause of gastroenteritis in children. In general, the target cells of adenoviruses are mainly located in the conjunctiva and the digestive, respiratory and urinary tracts.

Is there a link with the Covid-19 pandemic?

Some commentators quickly mentioned a link between these pediatric hepatitis and Covid-19. But while some of the children were co-infected with SARS-CoV-2 when the hepatitis broke out, not all of them. Additional studies on the subject are therefore necessary to see more clearly.

On the other hand, in the face of claims that vaccination could be involved, it should be noted that the vast majority of the children concerned were too young to have been vaccinated.

Finally, some hypotheses suggest that children could be more sensitive to adenoviruses, due to their lower circulation during confinement, or that a more virulent adenovirus could be responsible for hepatitis, but work still needs to be done. to confirm or refute these theses.

This text will be regularly updated as new data becomes available.



https://presse.inserm.fr/en/un-point...enfants/45268/

 

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North Dakota Department of Health Investigating Hepatitis in Child with Unknown Cause

<< All NewsThursday, May 5, 2022Categories:
General

Infectious Disease
The North Dakota Department of Health (NDDoH) is working with the Centers for Disease Control and Prevention (CDC) in investigating a child with hepatitis of unknown cause. The child resides in Grand Forks County. The child is recovering at home after a brief hospitalization. North Dakota is among a growing list of states investigating children with hepatitis where usual causes have been ruled out.

“We are encouraging medical providers to review their records back to October 2021 for any patients that warrant further investigation,” said Kirby Kruger, Medical Services Section Chief. “NDDoH is working with the CDC to help identify cases that will aid in understanding the cause of hepatitis in children and to understand how we can prevent these illnesses from happening in the future.”

Parents are encouraged to watch for symptoms of hepatitis, or inflammation of the liver. These symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, and jaundice, or yellow skin or eyes. Talk to your medical provider if your child is experiencing these symptoms.

A link between cases of hepatitis and adenovirus infection has been suggested. Because of this, CDC is asking physicians to consider adenovirus testing. Adenovirus infections are common and occur among persons of all ages. Symptoms may include cold-like symptoms, fever, sore throat, pneumonia, diarrhea, or pink eye.

NDDoH encourages everyday precautions to keep children safe, including washing hands often, staying home when ill, avoiding people who are sick, covering coughs and sneezes, avoiding touching the eyes, nose, or mouth, and staying up-to-date on routinely recommended vaccines.

https://www.health.nd.gov/news/nort...h-investigating-hepatitis-child-unknown-cause

 

[Shiloh]

Source: https://local12.com/news/local/sudd...er-inflammation-treatment-cdc-adenovirus-ohio

Cincinnati Children's Hospital now treating at least 6 children with sudden hepatitis
by Liz Bonis, WKRCThursday, May 5th 2022

CINCINNATI (WKRC) – A dangerous mystery illness hitting young children is now in the Tri-State. Cincinnati Children’s Hospital has now treated at least six children with sudden hepatitis.

The children were otherwise healthy, which is raising new alarm.

The cause of these cases is still bit of a mystery, but the CDC put providers on the lookout nationwide to try and narrow down what is causing this dangerous outbreak...

...The children treated so far at Cincinnati Children’s Hospital are all between the ages of 18 months and 10 years old. One of them required a liver transplant...

 

[Shiloh]

Source: https://www.grandforksherald.com/ne...nvestigating-mystery-pediatric-hepatitis-case


North Dakota Department of Health investigating mystery pediatric hepatitis case
The child resides in Grand Forks County and is recovering at home after a brief hospitalization.
By Ingrid Harbo
May 05, 2022 02:48 PM


GRAND FORKS – The North Dakota Department of Health is working with the Centers for Disease Control and Prevention in investigating a child with hepatitis of an unknown cause. The child resides in Grand Forks County and is recovering at home after a brief hospitalization, the Health Department said in a news release. North Dakota is among a growing list of states investigating children with hepatitis where usual causes have been ruled out...

 

[Shiloh]

Source: https://www.macaubusiness.com/panama-confirms-first-new-acute-hepatitis-case-in-2-year-old-boy/


Panama confirms first new acute hepatitis case in 2-year-old boy
By
Xinhua News Agency

Panamanian health authorities on Thursday confirmed a case of acute hepatitis in a two-year-old boy, which corresponds to an alert issued by the World Health Organization/Pan American Health Organization (WHO/PAHO) in late April.

Lourdes Moreno, national head of Epidemiology at the Health Ministry, said that she received the confirmation from the Gorgas Memorial Institute of Health Studies, and that the boy from the province of East Panama is out of danger after hospitalization...

 

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[Shiloh]

Source: https://www.lbc.co.uk/news/pet-dogs-investigated-hepatitis-outbreak-children/

Pet dogs being investigated as the cause of mystery hepatitis outbreak in children
6 May 2022, 17:59
By Liam Gould

Pet dogs are being investigated as a potential cause of the hepatitis outbreak that's been affecting children around the world.

The UK Health Security Agency (UKHSA) said the "significance of this finding is being explored".

They said a "high" number of children that tested positive for the disease - all aged 10 or under - come from families who own a dog, or have been exposed to a dog.

Officials gave families of infected children questionnaires to help in identifying the cause of the illness. One of the responses found 70 per cent — 64 of 92 respondents — owned a dog or had been exposed to a dog.

But, health officials said the 'common' ownership of dogs might make the findings a coincidence. Around half of UK adults own a pet, figures suggest.

Nearly 300 cases have now been detected across the world in over 20 countries, World Health Organisation figures suggest. One death has been confirmed, while four are under investigation...