Colorado has reported its first cases of severe hepatitis of unknown cause in children, adding to a growing number of cases being investigated nationally by the Centers for Disease Control and Prevention.
The Colorado Department of Public Health and Environment had reported five potential cases to the CDC as of Friday. All met the CDC’s broad case definition — primarily that they occurred in children 10 years of age or younger and doctors didn’t know what caused them. None of the five Colorado children died or required liver transplants as a result of their illness, although four were hospitalized. The CDPHE says all five children have recovered or are recovering.
One case dates back to December and was reported to the CDC last month. The other four cases were reported to the CDC within the past two weeks.
Several of the children were treated at Colorado Children’s Hospital. Dr Sam Dominguez, an infectious disease expert at the hospital, said not all of the children were seriously ill, but rather were sometimes admitted to prevent their condition from getting worse.
He said that despite concern over the cases, they remain rare.
“I think there are a lot of unanswered questions, and we’re still in the infancy of knowing what’s going on here,” he said.
Only one of the Colorado children tested positive for adenovirus, a common virus that is central to the main hypothesis of the cause of the new cases of mysterious hepatitis.
Watch out for jaundice
Hepatitis is an inflammation of the liver, and it can have many causes. The most well-known causes are viral – hepatitis A, B and C – but drugs and other health conditions can also cause it.
The CDC said earlier this month it had identified 109 potential cases across the country — the first of which were seen in Alabama last fall. Five deaths have been reported nationwide and 14 children have required liver transplants. Many affected children require hospitalization and suffer from jaundice.
Dominguez said children in Colorado were usually brought in for jaundice — parents noticed their skin or eyes turning yellow. Some had already had an illness with fever and diarrhea, but not all.
In briefing with journalistsDr. Jay Butler, CDC deputy director for infectious diseases, said the number of cases identified so far is not above baseline levels, but disease investigators are watching closely due to the number of cases in previously healthy children.
“Although rare, children can have severe hepatitis, and it’s not uncommon for the cause to be unknown,” Butler said.
Focus on adenovirus
A number of children with the mysterious hepatitis, both in the United States and the United Kingdom, have tested positive for a type of adenovirus known as adenovirus 41. Unlike most adenoviruses, which are respiratory insects, adenovirus 41 attacks the digestive system. It is known to cause hepatitis in immunocompromised children, but it has not previously been known to cause hepatitis in children without known underlying health conditions, Butler said.
This is just one of the mysteries surrounding the new cases. There’s no indication that adenovirus cases are increasing, Butler said, though he acknowledged the US doesn’t have the kind of robust case tracking system it has for COVID or even influenza. .
Scientists are hoping to genetically sequence the adenovirus found in children with hepatitis to see if it detected a significant mutation – but they are struggling to do so because viral loads are so low when children are diagnosed. Butler said this could point to an immune response to adenovirus infections as the real cause.
COVID vaccines are not to blame
Researchers are also trying to learn more about whether previous COVID-19 infections played a role, however, in a case study of nine Alabama children that the CDC released last week, none of the children had known previous COVID infections.
One thing Butler said is certain: COVID-19 vaccines are almost certainly not causing the cases. That’s because most children affected — “the vast majority,” Butler said — are too young to be vaccinated.
“COVID-19 vaccination is not the cause,” Butler said flatly.
So researchers continue to search for answers. Is there an environmental cause or perhaps another undiagnosed infection? Is it drug related? Is it something that happens every year but that doctors – especially vigilant during a pandemic – are only now beginning to understand?
“This is an evolving situation, and we are casting a wide net to help broaden our understanding,” he said.
The CDPHE, for its part, is also intensifying its monitoring. Usually, cases of non-infectious hepatitis are not things that doctors have to report to the state. But last month, the agency sent an alert to health care providers asking them to notify the state of any cases of pediatric hepatitis of unknown cause.
Dominguez, the children’s doctor, said parents will want to bring their children for medical help if they notice yellowing of the skin or eyes or if their children have had a persistent fever with diarrhea.
While it’s helpful to be aware of this, Dominguez said parents can take comfort in one thing.
“It’s still a relatively rare condition,” he said. “I think that’s the good news.”
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