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Mysterious cases of hepatitis detected in children

On Thursday, April 21, 2002, the Centers for Disease Control and Prevention (CDC) issued a nationwide health alert concerning an unusual cluster of serious hepatitis cases with unknown origin in young children in the United States. These U.S. cases were identified soon after the United Kingdom and several European countries such as Spain, Denmark, and the Netherlands have also reported mysterious cases of hepatitis of unknown etiology.

The first known case in the United Kingdom occurred in January in Scotland, followed by over 100 other cases across, most of them in England. These cases presented clinically with severe acute hepatitis, exhibiting increased levels of liver enzymes, jaundice, as well as – in some cases – gastrointestinal symptoms, such as abdominal pain, diarrhoea, and vomiting. Eight children in the U.K. underwent liver transplants, but no deaths have yet been reported. In the U.S. nine cases of hepatitis in children aged 1-6 have been identified in Alabama and two in North Carolina, between October 2021 and February 2022. The experts did not manage to identify any epidemiological link connected these cases.

Hepatitis can be triggered by many factors, including toxic chemicals, autoimmune disorders, or viruses, such as those causing chickenpox or common cold. However, the most common cause of viral hepatitis are the hepatitis A, B, and C viruses. According to health experts though, all these common causes have been ruled out in both the U.S. and the U.K.

Officials are now investigating a possible association between these mysterious cases of pediatric hepatitis and adenoviruses – a family of widespread viruses that cause various infections, most commonly respiratory illnesses. Although such viruses rarely cause hepatitis, all nine children in Alabama were infected with adenoviruses, with five of the nine cases testing positive for a specific type of adenovirus (adenovirus 41) which often causes cases of pediatric acute gastroenteritis. In the U.K. several – but not all – children tested positive for adenovirus too. While some of the U.K. children were also found to be infected with SARS-CoV-2, no such infections were yet detected in the U.S.

“At this time, adenovirus may be the cause for these, but investigators are still learning more, including ruling out other possible causes and identifying other possible contributing factors,” reported the CDC.

According to Amy Edwards, a pediatric infectious disease expert at the University Hospitals Rainbow Babies & Children’s Hospital in Cleveland, with the lifting of mask mandates and social distancing measures, it is normal for children to be more susceptible to a wide range of infections.

“Now that COVID is down, viral interference has been released and I think we are going to see a lot of old pathogens coming back and maybe some new ones, which worries me too,” confirmed Monica Gandhi, a professor of Medicine at the University of California, San Francisco.

CDC urges clinicians who may encounter pediatric patients with hepatitis of unknown origin to consider adenovirus testing and to immediately report such cases to state public health authorities.

By Andrei Ionescu, Staff Writer

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