Colorado has reported its first cases of severe hepatitis of unknown cause in children, adding to the growing number of cases being investigated nationally by the Centers for Disease Control and Prevention.
As of Friday, the Colorado Department of Public Health and Environment announced five potential CDC cases. They all meet the CDC’s broad definition of cases – mainly that they occurred in children aged 10 or younger and that doctors did not know what caused them. None of the five children in Colorado died or needed a liver transplant as a result of their illness, although four were hospitalized. The CDPHE says all five children have either recovered or are in the process of recovering.
One case dates back to December and was reported to the CDC last month. The other four cases have been reported to the CDC in recent weeks.
Several of the children were treated at a children’s hospital in Colorado. Dr Sam Dominguez, an infectious disease expert at the hospital, said not all children were seriously ill, but were sometimes admitted so as not to worsen their condition.
He said that despite concerns about the cases, they remain rare.
“I think there are a lot of unanswered questions and we are still in our early teens learning what is going on here,” he said.
Only one Colorado child has tested positive for adenovirus, a common virus that is at the heart of the leading hypothesis of what causes new cases of mysterious hepatitis.
Beware of jaundice
Hepatitis is an inflammation of the liver and can have many causes. The most common causes are viral – hepatitis A, B and C – but drugs and other health conditions can also cause it.
The CDC said earlier this month that it had identified 109 potential cases across the country – the first of which were observed in Alabama last fall. Five deaths have been reported across the country, and 14 children have needed a liver transplant. Many affected children need to be hospitalized and suffer from jaundice.
Dr. Sam Dominguez, Infectious Diseases Specialist at Colorado Children’s Hospital, is seen in the hospital’s COVID-19 testing laboratory on April 22, 2020 (Provided by Colorado Children’s Hospital)
Dominguez said children in Colorado were usually brought in for jaundice – parents noticed that their skin or eyes turned yellow. Some have had fever and diarrhea before, but not all.
Speaking to reporters, Dr. Jay Butler, CDC’s deputy director of infectious diseases, said the number of cases identified so far was not above baseline, but the researchers are keeping a close eye on how many cases have occurred in previous cases. healthy children.
“Although rare, children can have severe hepatitis, and it’s not uncommon for the cause to be unknown,” Butler said.
Increased adenovirus
A number of children infected with mysterious hepatitis, both in the United States and the United Kingdom, 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 children with weakened immune systems, but so far it has not 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 is no indication that the incidence of adenovirus is increasing, Butler said, although he acknowledged that the United States lacks such a robust case tracking system as COVID or even influenza.
Scientists hope to genetically sequence the adenovirus found in children with hepatitis to see if it has adopted a significant mutation – but they have had problems with it because the viral load is 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, but in a case study of nine Alabama children published by the CDC last week, none of the children knew about previous COVID infections.
One thing Butler said is certain: COVID-19 vaccines almost certainly do not cause cases. That’s because most of the affected children – “most,” Butler said – are too young to be vaccinated.
“Vaccination against COVID-19 is not the cause,” Butler said emphatically.
So researchers are still looking for answers. Is there an environmental cause or maybe another, undiagnosed infection? Is it drug related? Does this happen every year, but doctors – especially vigilant during a pandemic – are only just beginning?
“This is an evolving situation and we are throwing a wide net to help broaden our understanding,” he said.
Meanwhile, CDPHE is also stepping up its follow-up. Usually, non-infectious cases of hepatitis are not things that doctors should report to the state. But the agency last month sent a signal to health care providers asking them to tell the state about all cases of pediatric hepatitis for an unknown reason.
Dominguez, the pediatrician, said parents would want to bring their children for medical attention if they notice any yellowing of the skin or eyes or if their children have had persistent diarrhea.
Although it is worth knowing, Dominguez said parents can be comforted by one thing.
“It’s still a relatively rare disease,” he said. “I think that’s good news.”
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