Hepatitis Cases in Children Have Parents Asking, ‘Should We Worry?’

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More than 100 cases of severe hepatitis in children have been reported globally. What to know about symptoms, and how to spot signs that something is amiss

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Here’s what doctors know so far about the recent rise in cases, what could be causing them, and what symptoms parents and caregivers should watch for.

What is hepatitis?
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Hepatitis, or inflammation of the liver, is most commonly caused by an infection—usually due to the hepatitis viruses—or by high levels of alcohol consumption.

Mild hepatitis as a result of viral infections or reactions to medication can occur in children but is often so mild that it goes undetected, says Nipunie Rajapakse, a pediatric infectious-diseases physician at the Mayo Clinic.

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By contrast, severe hepatitis in children is normally rare. The illness can cause flu-like symptoms, including fever, fatigue, abdominal pain and, in rare cases, liver failure.

What are the symptoms of hepatitis in children?

Dark-colored urine and light- or clay-colored stool are signs of potential liver inflammation. Symptoms include fatigue, loss of appetite, fever, joint pain, nausea and vomiting. There is some overlap with symptoms of Covid-19, but there are also symptoms specific to hepatitis. One is jaundice, which is noticeable by yellowing in the whites of the eyes. Another is abdominal pain in the upper right part of the belly where the liver sits.

In babies or young children who can’t vocalize what they are feeling, parents should keep an eye out for visible signs, like jaundice, dark urine or light stool, as well as how the child is acting, says Markus Buchfellner, pediatric infectious- diseases physician at the University of Alabama at Birmingham medical school and Children’s of Alabama.

“Usually, kids who have acute hepatitis tend to be more tired, more lethargic, not really wanting to eat or drink,” says Dr. Buchfellner. “Those constellations of symptoms together would make me more concerned.”

If you’re unsure, he says, it is always a good idea to call your pediatrician.

What is known about the cases in the US and Europe?

Since November 2021, more than a dozen cases of hepatitis have been identified in the US among children, according to state health departments in Alabama, Illinois and North Carolina.

Cases have also been identified in the UK, Spain, Israel, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania and Belgium, according to WHO. One child has died, and 17 have required liver transplants.

What’s causing these cases?

Doctors can’t say for certain yet. They have ruled out some potential causes. Among the recent cases in children, none of the hepatitis viruses, including hepatitis A, B, C, D and E, has been detected, according to the Centers for Disease Control and Prevention and WHO. There have also been no discernible common links among patients to a particular food, drug or travel, says Philippa Easterbrook, a medical expert in WHO’s global HIV, hepatitis and sexually transmitted infections program.

There is also nothing to suggest a link to the Covid-19 vaccines, according to medical experts, as a majority of the children diagnosed weren’t vaccinated.

The leading hypothesis centers on adenoviruses, which can cause respiratory and gastrointestinal illnesses in kids. Many of the young patients in Europe and the US who were found to have hepatitis also had a type of adenovirus, according to the CDC and WHO.

Adenoviruses don’t normally lead to hepatitis in otherwise healthy children, says Dr. Rajapakse, and nailing down a precise cause will require further research, including whether a strain of adenovirus could have mutated.

WHO is investigating the cases and looking into various possible underlying factors, according to Dr. Easterbrook.

Has this happened in the past?

A handful of cases of unexplained hepatitis in children are reported every year, Dr. Easterbrook said, but this scale is unusual.

As a parent, should I be concerned?

Given the small number of cases, says Dr. Rajapakse, there is no need for alarm.

“I don’t see any reason for parents or families to panic about what’s going on,” she says. “The best thing that parents can do right now is to be aware of the signs and symptoms to look out for in their child.”

If you notice your child has symptoms, she says, talk to your primary-care provider.

Is there anything I can do to prevent my child from getting sick?

Since scientists don’t know exactly what is causing the hepatitis cases, it’s tough to know how to prevent them. Adenoviruses often spread through respiratory droplets. They also spread through direct contact, such as by touching a contaminated surface and then touching your eyes or mouth.

Following Covid-19 health precautions—such as wearing a mask in public indoor settings and frequent hand-washing—can also help curb the spread of adenoviruses and may give parents some peace of mind.

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Credit: www.wsj.com /

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