The World Health Organization said it is investigating an outbreak of acute hepatitis among children that now involves 11 countries, including the United States.
Among the 169 reported cases, at least one child has died from this inflammation of the liver and 17 children needed liver transplants, the WHO said Saturday in a statement.
Of the cases WHO is monitoring:
- A common cold virus known as an adenovirus was detected in at least 74 cases
- 20 of those tested revealed a COVID-19 infection
- 19 had a co-infection of COVID-19 and adenovirus
"It is not yet clear if there has been an increase in hepatitis cases, or an increase in awareness of hepatitis cases that occur at the expected rate but go undetected," the WHO said. "While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent."
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The symptoms "among identified cases is acute hepatitis with markedly elevated liver enzymes," the statement added.
What causes hepatitis?
Hepatitis is typically caused by a virus. Adenoviruses are common, can spread between people and can cause people to be mildly or severely ill. Among these recent infections, adenoviruses have been detected in at least 74 cases, but they typically don't cause severe hepatitis in healthy people. The common viruses that cause acute viral hepatitis, including hepatitis viruses A, B, C, D and E, have not been detected in any of these cases, according to the WHO.
While most of the children did not have a fever, many reported gastrointestinal symptoms such as abdominal pain, diarrhea and vomiting "preceding presentation with severe acute hepatitis," as well as increased levels of liver enzymes and jaundice, CNN reports.
Most of the 169 cases were reported in the United Kingdom, which had 114. Nine cases were reported by the Alabama Department of Health last week.
Investigators are also aware of 13 cases in Spain, 12 in Israel, and smaller numbers in Belgium, Denmark, France, Ireland, Italy, the Netherlands, Norway and Romania.
The children are between the ages of 1 month and 16, CNN reports.
The liver processes nutrients, filters the blood and helps fight infection, and its function can be affected when it's either inflamed or damaged.
The WHO said the investigation needs to focus on "increased susceptibility amongst young children following a lower level of circulation of adenovirus during the COVID-19 pandemic, the potential emergence of a novel adenovirus, as well as SARS-CoV-2 co-infection."
Late week, the U.S. Centers for Disease Control and Prevention issued a health advisory about the acute cases of hepatitis with unknown cause.
Protecting your child
Adenoviruses and hepatitis share symptoms, but hepatitis is far more concerning with unique symptoms to be aware of, Dr. David Hill, a Wayne County, North Carolina-based pediatrician and the official spokesperson of the American Academy of Pediatrics notes.
“Adenoviruses typically run their course without needing medical intervention,” he says. Hepatitis, on the other hand, “sometimes leads to hospitalization and may even require a liver transplant.”
The symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain and jaundice.
Adenoviruses are spread from person-to-person and can cause a wide range of illnesses and symptoms. Those infected with the virus typically experience respiratory illness, but gastroenteritis, conjunctivitis (pink eye) and bladder infections can also occur.
Diarrhea and nausea can occur in patients with both hepatitis and adenoviruses, however, there are ways parents can differentiate between the two.
Parents should keep an eye on sick children and look out for severe abdominal pain, fever, dark-colored urine or light-colored stools. The most telling symptom to be aware of is jaundice, or a yellow coloring in the skin or in whites of the eyes, according to Dr. Nipunie Rajapakse, a pediatric infectious disease specialist at Mayo Clinic Children’s Center.
The CDC recommends providers consider adenovirus testing in children with hepatitis when the cause is unknown.
Testing the blood in whole, rather than just blood plasma, may be more sensitive, according to the CDC.
