Prompted by a cluster of cases of hepatitis of unknown origin in children in multiple states and countries, public health officials are asking parents to watch their children for signs of liver inflammation, especially after bouts of diseases of the upper respiratory tract or stomach and intestine.
Signs of liver inflammation may include yellowing of the eyes or skin, sometimes called jaundice. Although cases are rare in children, in about 10% of those affected, inflammation of the liver has led to liver failure and the need for a transplant.
Minnesota Department of Health (MDH) epidemiologists are investigating three Minnesota children under the age of 3 who had liver inflammation and who may be part of a nationwide childhood hepatitis cluster. Although the cause remains under investigation, hepatitis may be associated with infection with a type of virus known as adenovirus type 41. Some illnesses reported in the United States date back to fall 2021; the illnesses occurred in children under 10 years of age.
“If your child has recently had vomiting and diarrhea or symptoms of a cold and then develops yellowing of the eyes and skin, it is important to have your child evaluated immediately by a health care provider,” said Minnesota state epidemiologist Dr. Ruth Lynfield. . “Other symptoms may include abdominal pain, fatigue, dark urine and clay-colored stools. Getting medical attention early can help diagnose and treat the condition if needed.
Of the Minnesota cases, one child required a liver transplant and recovered while the other two recovered without needing a transplant. Dr. Lynfield said MDH epidemiologists are aware of at least two other possible cases in Minnesota hospitals who are not Minnesota residents; these were referred to their respective health departments.
MDH epidemiologists began searching for possible cases in the state in late April after learning of cases in Europe and other parts of the United States. They alerted health care providers at the time, asking them to report any recent cases of hepatitis of unknown cause in children.
“We are grateful for the reports we have received from clinicians so far and look forward to continuing to work with them in this investigation,” said Dr. Lynfield. “The more information we can gather, the sooner we can help determine how best to protect other children.”
According to a CDC announcement today, at least 109 children in 25 states have been identified in the United States as part of the cluster of cases. At least 228 probable cases in 20 countries have been identified, according to the World Health Organization. Among the domestic cases, before hospitalization, most children suffered from vomiting and diarrhea, while some presented with upper respiratory tract symptoms. During hospitalization, most had yellowish eyes and skin and enlarged livers.
While health officials have identified adenovirus in many affected children, other potential factors are being investigated. Adenovirus 41 often causes vomiting and diarrhea in children, but it is not typical for the virus to cause hepatitis in otherwise healthy children, and to date disease investigators have not found no common epidemiological link or exposure in children.
Until more information becomes available, the best advice for people looking to protect themselves and their children is to use general disease prevention measures, such as frequent and thorough hand washing; avoid touching your eyes, nose or mouth with unwashed hands; cover coughs and sneezes; and avoid close contact with sick people.
More information about the ongoing national investigation can be found on the CDC’s website at CDC Alerts Providers to Hepatitis Cases of Unknown Origin. General information about hepatitis in Minnesota can be found on the MDH Hepatitis homepage.