The origins of a continuing outbreak of acute, potentially lethal hepatitis striking children in countries around the world has experts mystified. But a cluster of recent cases in Alabama all show ties to common viruses, according to research just published in the early-release issue of the U.S. Centres for Disease Control and Prevention Morbidity and Mortality Weekly Report.
The official World Health Organization tally of such cases stands at 169 across 11 countries, although media reports suggest the number is now closer to 200. In these cases, otherwise healthy children have developed liver disease so severe as to require hospitalization. In the WHO case count, 17 of the children required a liver transplant to survive, and one child died.
The new CDC report focuses on cases in one U.S. state: Alabama. Three of the nine patients in Alabama were so ill that they developed liver failure, and two needed liver transplants, according to the CDC team led by Julia Baker, Ph.D., of the agency’s Division of Viral Diseases. All of the children have since recovered. As was found in many of the cases investigated by the WHO, “all nine patients [in Alabama] tested positive for adenovirus,” Baker and colleagues reported.
“Laboratory tests identified that some of these children had adenovirus type 41, which more commonly causes paediatric acute gastroenteritis,” the CDC team noted. Six of the children tested positive for the Epstein-Barr virus, but they had no antibodies against this common virus. That “implies an earlier, not active infection,” the researchers said.
None of the affected children in Alabama died. However, the Wisconsin Department of Health Services reported this week that four paediatric cases of acute hepatitis had occurred in that state. Tragically, they included “two children who had severe outcomes, one liver transplant and one fatality.”
According to the statement from the WHO, numerous potential causes for outbreaks in various countries are being investigated. For example, the agency said that “increased susceptibility [to adenoviruses] amongst young children following a lower level of circulation of adenovirus during the COVID-19 pandemic” might be responsible. Alternatively, there is the potential for the “emergence of a novel adenovirus” that might trigger acute hepatitis in children, along with co-infection with severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19.
REFERENCE: Baker et al: Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022; https://www.cdc.gov/mmwr/volumes/71/wr/mm7118e1.htm?s_cid=mm7118e1_w