CDC investigating more than 100 cases of unexplained hepatitis in children, including 5 deaths – Fresno, California

Fresno, California 2022-05-06 22:45:24 –

The US Centers for Disease Control and Prevention said Friday that it is investigating 109 cases of severe and unexplained hepatitis in children in 25 states and territories that may be associated with a global outbreak.

Among them, 14% needed a transplant and five children died.

Almost all children (more than 90%) needed to be hospitalized.

Dr. Jay Butler, Deputy Director of Infectious Diseases at the CDC, emphasized that the study, a partnership between the CDC and the State Health Department, is in an evolving situation. Not all cases of hepatitis they are currently studying are ultimately caused by the same thing.

“It’s important to note that this is an evolving situation. We are casting a wide range of nets to broaden our understanding,” Butler said.

Hepatitis, or swelling of the liver, can be caused by infections, autoimmune diseases, drugs, and toxins. A family of viruses well known for attacking the liver causes hepatitis A, hepatitis B, and hepatitis C.

It is not clear what is causing these cases in infants. Butler said some of the common causes of viral hepatitis were considered, but were not found in any of the cases.

The role of adenovirus is unclear, but it has been detected in more than 50% of cases.

Early hepatitis report

On April 21, the CDC warned doctors about a cluster of abnormal cases of hepatitis in nine children in Alabama.

Doctors and public health officials were asked to notify authorities if they had similar cases of children under the age of 10 with elevated liver enzymes and there was no clear explanation for hepatitis that returned in October.

Since then, the health department has worked with state pediatricians to identify possible cases. The numbers shared at the news briefing on Friday are the first national investigation of the incident.

Cases are being investigated in Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska, New York, Ohio, Pennsylvania, and Puerto Rico. , Tennessee, Texas, Washington, Wisconsin.

The CDC warning followed reports of children in England, Wales, Scotland, and Northern Ireland going to the hospital for unexplained hepatitis.

Dr. Philippa Easterbrook, a senior scientist at the World Health Organization’s World Hepatitis Program, said at a briefing on Wednesday that as of May 1, there were 228 cases and 50 cases that could be related to outbreaks in 20 countries. He said that the above is under investigation. Of these cases, one child died and about 18 needed a liver transplant, she said.

Most children were healthy when they developed symptoms such as fatigue, loss of appetite, vomiting, diarrhea, abdominal pain, dark urine, light-colored stools, and yellowing of the skin and eyes. It is a sign called jaundice.

Abnormally severe liver inflammation

Dr. Heli Bhatt, a pediatric gastroenterologist at the M Health Fairview Masonic Children’s Center in Minneapolis, treated two children who are part of a CDC study. A 2-year-old from South Dakota received a liver transplant this week.

Bert says liver failure in children is “very rare.” And even before scientists began tracking this outbreak, half of the cases were unexplained.

Doctors who treated these children say their cases stood out.

“Even during the first case, I found it strange,” says Dr. Markus Buchfellner, a pediatric infectious disease specialist at the University of Alabama at Birmingham. There, staff began looking at cases in October.

“And when the second one came in, that’s when I said,’OK, we need to talk to someone about this.'” He contacted a senior doctor in his department, I contacted the State Health Department and the CDC.

Buchfellner says the case was outstanding because the liver was so inflamed.

Common viruses like Epstein-Barr and SARS-CoV-2 raise the liver enzymes in children a little, indicating what Buffferner calls “small hepatitis”, but children are usually infected by the body. Heals as he fights.

“But it’s very strange to see healthy children coming in with the amount of liver damage they had,” he said.

Initially, UAB examined nine children with unexplained hepatitis, all of whom were tested positive for adenovirus in their blood. Butler said in a news briefing that no one tested positive for Covid-19 or recorded a medical history of Covid-19 during hospitalization.

Two more children have been identified in Alabama since these cases were reported. Their cases are under investigation, bringing the state to a total of 11, said Dr. Wes Stubblefield, Head of Health in the northern and northeastern regions of Alabama.

There are about 100 types of adenovirus. About 50 of them are known to infect humans, so experts needed to scrutinize the virus to understand if every child had the same thing.

When researchers tried to load the adenovirus gene in infected children, only five had enough genetic material to obtain the complete sequence. In all five, this virus was a specific type called adenovirus 41. It usually causes diarrhea and vomiting in children, sometimes with congestion and cough, but in healthy children it was not associated with liver failure.

Butler said Friday that adenoviruses 40 and 41 are associated with hepatitis, but mostly only in immunocompromised children.

Clue from the UK

Also on Friday, researchers at the UK Health Security Agency posted a new technology briefing containing the latest information on hepatitis investigations. Of the 163 cases, 126 were tested for adenovirus and 91 (72%) were positive for the pathogen.

Researchers attempted to sequence the entire adenovirus genome from one of the patients, but were unable to obtain a sample containing enough virus to do so. There were 18 cases in which a part of the genome could be sequenced, and all of them were the same adenovirus 41F as in the United States.

Many suspect that this case is somehow related to SARS-CoV-2, the virus that causes Covid-19.

British researchers say they are still exploring the possibility, but only 24 (18%) of the 132 patients tested detected SARS-CoV-2.

The report states that in these cases it has not ruled out any role of Covid-19 infection. Presumably, previous Covid-19 infections stimulate the immune system to make these children abnormally sensitive, and co-infection of the two viruses overwhelms the liver.

Researchers also want to know if hepatitis is part of some syndrome that attacks children after SARS-CoV-2 infection. For example, pediatric multisystem inflammatory syndrome and a rare complication called MIS-C.

Another theory by British researchers is that these children have some sort of oversized or irregular immune response, perhaps because they were more protected than usual during a pandemic.

Yet another theory is that adenovirus can always cause liver failure in a small proportion of infected children, and these rare cases are only because it causes a very large wave of infection. It is becoming clear in.

Researchers in the UK also say that drugs, toxins, or perhaps environmental exposures are still being tested, although they are likely due to some infection.

Organize the role of adenovirus 41

Another thing that doctors are confused about is the finding of adenovirus in blood samples rather than liver tissue samples taken during biopsies of patients in Alabama.

“All nine have liver biopsies that showed a lot of inflammation and hepatitis, but we didn’t find the virus in the liver. We just found the virus in the blood.” He said.

A case of Bhatt, a child in South Dakota, was also positive for adenovirus in the blood, but not in the liver.

If adenovirus 41 is some cause in these cases, and if it is still large, Buchfellner says he does not know why it appears only in the blood and not in the severely damaged liver tissue. But he has some theories.

“Maybe the liver is clearing the virus before it’s cleared in the blood,” he said. “And by the time the liver is damaged and a biopsy is done, the immune system has already cleared the virus from the liver, and all that remains is inflammation.”

His second theory is that the cause of liver damage is not the virus itself, but trying to fight off the virus can cause the immune system to overreact and damage the liver.

Since adenovirus infections are common, it may be a coincidence to find the virus in some of these patients. “I’m not 100% sure that this is exactly that adenovirus. There’s still a lot known,” Bhatt said.

Aggressive investigation

In a statement on the case on April 29, the CDC “believes that adenovirus may be the cause of these reported cases, but other potential environmental and contextual factors remain. We are investigating. “

Butler said on Friday that experts are considering various possibilities, including exposure to animals.

“We’re throwing a really wide net, and there are cofactors that make adenovirus data reflect innocent bystanders, or expose adenovirus infection in ways previously uncommon. I’m still open-minded in terms of virus, “he says. He said.

Investigators say they know this news may be worrisome to their parents.

Butler says investigators still believe these cases are extremely rare. They have not seen an increase in children coming to the emergency room with hepatitis, for example.

“We’re still talking at least to the Alabama family here-and I recommend it to other families as well-don’t worry too much about this yet,” Buchferner said. “That is, after all, this is still a fairly rare phenomenon.”

Buchfellner says that adenovirus is commonly prevalent in day care and school. They usually do nothing worse than what you feel like gastroenteritis for a few days.

“This has been and will continue for a long time, and only about 200 cases have been reported worldwide, so it’s like a Covid pandemic that everyone needs. It’s not a bad situation. I’m really worried about this. “

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CDC investigating more than 100 cases of unexplained hepatitis in children, including 5 deaths Source link CDC investigating more than 100 cases of unexplained hepatitis in children, including 5 deaths

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