As health officials continue their investigation of unexplained cases of liver inflammation in children, what is known is still outpaced by what isn’t.
At least 500 cases of hepatitis from an unknown cause have been reported in children in roughly 30 countries, according to health agencies in Europe and the United States. As of May 18, 180 cases are under review in 36 U.S. states and territories.
Many of the children have recovered. But some cases have been severe, with more than two dozen of the kids needing liver transplants. At least a dozen children have died, including five in the United States.
The illnesses have mainly been seen in children under age 5. So far, health agencies have ruled out common causes of hepatitis, while reporting that some of the children have tested positive for adenovirus. That pathogen — which infects basically everyone, usually without serious issues — is not known as a primary cause of liver damage. For some children who are positive, officials have identified the particular adenovirus: type 41.
But there are several reasons why pinning an adenovirus as the sole hepatitis culprit doesn’t fully add up, researchers say. Nor is it clear whether the recent cases indicate an uptick in hepatitis illnesses, or just more attention. Though the cases seem to have popped up out of nowhere, “we’ve seen similar rare severe liver disease like this in children,” says Anna Peters, a pediatric transplant hepatologist at the Cincinnati Children’s Hospital Medical Center.
Most of all, it’s important for parents to remember that the cases described so far “are a rare phenomenon,” Peters says. “Parents shouldn’t panic.”
Hepatitis in children
Hepatitis is an inflammation of the liver that can interfere with the organ’s many functions, including filtering blood and regulating clotting. Three hepatitis viruses, called hepatitis A, B and C, are common causes of the illness in the United States. Hepatitis A is spread when infected fecal material reaches the mouth. Children can get B and C when it’s transmitted from a pregnant person to an infant. There are vaccines available for A and B but not C. An excessive dose of acetaminophen can also cause hepatitis in children.
The signs of hepatitis can include nausea, fatigue, a yellow tinge to skin and eyes, urine that’s darker than usual and stools that are light-colored, among other symptoms. Hepatitis that arises quickly usually resolves, whereas some cases progress more slowly and lead to liver damage over time.
It’s rare for a child to develop sudden liver failure. An estimated 500 to 600 cases occur each year in the United States, and around 30 percent of those are “indeterminate,” meaning a cause isn’t found, according to the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
The indeterminate category of sudden liver failure has been known for some time, Peters says, and that subset of cases has similarities to the hepatitis under investigation. There hasn’t been data reported yet on whether the recent cases represent an increase over what’s been seen in prior years, Peters says. “Maybe this is just increased recognition of something that’s been going on.”
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