Public health officials in the United States and the United Kingdom are investigating a number of unusual cases of serious hepatitis in young children, the cause or causes of which are currently unknown.
Evidence from the U.K. and from Alabama — where cases have been recorded since last fall — points to the possible involvement of an adenovirus. Adenoviruses generally attack the respiratory track, causing cold-like illnesses. But they have been linked to bladder inflammation and infection, and occasionally to hepatitis, though rarely in children who are not immunocompromised.
The Alabama Department of Public Health has been investigating a “cluster of less than 10 children” who “developed acute liver injury,” Karen Landers, district medical officer, told STAT in an email. She said the cases were found in various parts of the state, and investigations to date have not found links among the children. Investigators in the U.K. have also not found links among the cases there.
“At this time, all of the patients have tested positive for adenovirus, and five have tested positive with Type 41,” Landers said, adding that the department is awaiting genetic sequencing results from others of the cases. There are a number of adenoviruses that infect people.
As in the U.K., the children in Alabama were quite sick, Helena Gutierrez, medical director of the pediatric liver transplant program at the University of Alabama at Birmingham. “We have seen a full spectrum of cases from severe hepatitis to acute liver failure,” she told STAT in an email.
Gutierrez said the Centers for Disease Control and Prevention have been involved with the state’s Department of Public Health to investigate the cases.
At the time of publication, STAT was still awaiting comment from the CDC, though a spokesperson confirmed the agency’s involvement in the investigation. It is currently unclear if other states are also seeing similar cases and the CDC has not issued an alert to states asking them to be on the lookout for cases.
Nirav Shah, director of the Maine Center for Disease Control and president of the Association of State and Territorial Health Officers, said the organization knows of the cases in the U.K., but had not been made aware there were similar cases in this country. “We have reached out to the U.S. CDC to learn more as well as to discuss how states can undertake surveillance for such cases,” he said.
In the U.K., where roughly 75 cases have been reported from England and Scotland, a small number of the children have had or may require liver transplants.
A number of the affected children in the U.K. have tested positive for adenoviruses and for SARS-CoV-2, the virus that causes Covid-19. But the former appears to be the leading suspect, according to a scientific article on the Scottish cases that was published Thursday in the online journal Eurosurveillance.
Still, even if the cause is adenovirus infection, there may be a link to the pandemic, the authors suggested, noting that young children — many of the cases are under the age of 5 — who haven’t been exposed to the normal array of germs during the pandemic may have been rendered more vulnerable when masks came off and social distancing measures were lifted.
“At the time of publication, the leading hypotheses center around adenovirus — either a new variant with a distinct clinical syndrome or a routinely circulating variant that is more severely impacting younger children who are immunologically naïve,” wrote the authors, from Public Health Scotland, the Royal Hospital for Children in Glasgow, and the University of Glasgow Center for Virus Research.
“The latter scenario may be the result of restricted social mixing during the Covid-19 pandemic,” they said. Five of the 13 children described in the article tested positive for adenovirus infection.
Hepatitis — inflammation of the liver — is a condition that can be caused by a number of factors, though often viral infections are the cause. A number hepatitis viruses — A, B, C, and E — are common causes of hepatitis, but they have been ruled out in these cases.
The European Center for Disease Control issued an alert on Wednesday urging doctors to be on the lookout for, and to report, cases of acute hepatitis in children aged 16 and younger where testing rules out infection with hepatitis viruses A, B, C, or E.