Since April, 650 children worldwide, mostly 5 years of age or younger, have been diagnosed with acute hepatitis of unknown cause, according to a recent statement from the World Health Organization (WHO). At least 38 children have required a transplant, and nine have died. There are also 99 cases pending classification.
The outbreak has left health officials baffled. While the cause remains unknown and under investigation, one virus has been detected as a common link between many of the cases —adenovirus type 41, which causes severe stomach illness in children. Although there have been previous reports of hepatitis in children with suppressed immune systems who were infected with adenovirus, adenovirus type 41 is not a common cause of hepatitis in otherwise healthy children.
Zachary Hoy, M.D., pediatric infectious disease specialist at Pediatrix® Nashville Pediatric Infectious Disease, shares that while it’s important to be aware of symptoms, the outbreak doesn’t warrant widespread fear as the condition is still extremely rare. Here’s what parents need to know.
What is hepatitis?
Hepatitis is an inflammation of the liver that can damage its cells, sometimes leading to liver failure in severe cases. Hepatitis in children is caused by being exposed to a virus that triggers it, including:
- Hepatitis viruses — There are five main types of the hepatitis virus: A, B, C, D and E.
- Cytomegalovirus — Part of the herpesvirus family, this common virus often goes undetected as it rarely causes problems in healthy people.
- Epstein-Barr virus — This virus is a member of the herpesvirus family and one of the most common human viruses. It can cause mono and other illnesses.
- Herpes simplex virus — This is a viral infection that causes genital and oral herpes.
- Varicella zoster virus (chickenpox) — This is a herpesvirus that causes chickenpox, a common childhood illness that is highly contagious.
- Enteroviruses — This is a group of viruses often seen in children, including coxsackieviruses and echoviruses.
- Rubella — This is a mild yet contagious disease that causes a rash on the face that then spreads to the rest of the body.
- Adenovirus — These are common viruses that typically cause mild cold- or flu-like illness.
- Parvovirus B19 — This virus causes fifth disease, a mild rash illness that usually affects children.
"We’ve been evaluating more patients for hepatitis with the elevated liver function test,” said Dr. Hoy. “The difference in this hepatitis thought to be caused by adenovirus is that we’re seeing levels in the 500s. Maybe you’ll see levels of 150 or 200 with mono or other viruses, so it’s a significant jump. It’s one of those things we commonly follow but the substantial elevation of the liver function seems to be at a level that is much higher than we typically see.”
What are adenoviruses?
Adenoviruses are a group of viruses that cause a range of infections, including respiratory illness (such as a cold), infection of the eye (conjunctivitis, or pink eye), croup, bronchiolitis and pneumonia. In children, adenoviruses most often cause respiratory or digestive tract infections:
- Respiratory — Fluid from the nose, mouth, throat and lungs (respiratory tract) can contain the virus. Respiratory infections are transmitted when someone with the virus coughs or sneezes on another person. It can also be spread by touching an object that is contaminated by the virus.
- Digestive tract — This form of the virus is spread by fecal-oral transmission, often due to lack of and/or poor handwashing. It can also be caused by eating or drinking contaminated food or water.
In these recent hepatitis cases, digestive tract infections have been more common, causing vomiting, diarrhea and subsequent dehydration. Dr. Hoy has also observed extremely red eyes and a severe sore throat in the patients he’s treated.
How is hepatitis treated?
Acute cases of hepatitis typically require inpatient hospitalization. “There’s not a lot of treatment options,” said Dr. Hoy. “It’s more in the category of supportive care, which is IV hydration and anti-nausea medicines, pain control for significant abdominal pain and sometimes blood transfusions, but that’s very rare. A lot of it is watchful observation.”
The virus typically lasts 14 to 21 days, though this bout of recent cases has extended beyond that timeframe. Once liver function levels begin to decrease to a safe level, the patient can be discharged home and followed closely in the clinic with regular monitoring of labs, Dr. Hoy said.
What can parents do?
Parents should be on the lookout for the following symptoms of liver inflammation:
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Dark urine
- Light-colored stools
- Joint pain
- Jaundice (yellowing of the skin)
For children with prolonged illness, including severe high fevers and/or jaundice, Dr. Hoy advises parents have their child seen by their pediatrician to have labs drawn.
In addition, parents should follow standard virus prevention protocols for their child, including staying up to date on vaccinations; regular hand washing with warm, soapy water; cleaning and disinfecting frequently touched surfaces, such as toys, doorknobs, countertops, etc.; avoiding close contact with people who are sick; covering coughs and sneezes; and teaching children to avoid touching the eyes, nose or mouth.
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