Hepatitis in Children: What a Parent Needs to Know

Hepatitis in Children:What a Parent Needs to Know

If you are a parent, you may be freaking out about the latest health scare involving kids, Hepatitis. And while we read and listen to the daily news reports on cases, many of us may be wondering what do we need to know about Hepatitis -especially Hepatitis in children. We chatted with Dr. Karen Acker, pediatric infectious diseases specialist at NewYork-Presbyterian Komansky Children’s Hospital and assistant professor of clinical pediatrics at Weill Cornell Medicine.

What is Hepatitis?

Hepatitis is a general term that refers to inflammation of the liver. Hepatitis has multiple potential causes including infection, medications (most commonly Tylenol), alcohol, and autoimmune conditions. Hepatitis is most commonly caused by viruses, and the particular viruses that we associate with hepatitis most often are Hepatitis A, B, and C (hence their names). Other viruses we also associate with hepatitis, albeit typically much milder than the Hepatitis viruses, are Epstein-Barr virus and cytomegalovirus which cause infectious mononucleosis (“mono”). The liver inflammation in children with mono is usually mild and resolves on its own. Previously, adenoviruses were not typically associated with hepatitis in previously healthy children.

What does the medical profession know so far about the current outbreak?

The common link in many of these cases of hepatitis was the detection of adenovirus 41. Adenovirus 41 is a strain of adenovirus that causes vomiting and diarrhea, most commonly in young children. Adenovirus infections are not typically associated with hepatitis which is a reason why these cases have prompted further investigation. Yet, we still do not know conclusively if all of these cases are linked or caused by adenovirus.

The World Health Organization (WHO) first reported cases of acute hepatitis without a known cause on April 15, 2022. As of April 21, the WHO reported 169 cases in children age 1 month to 16 years. Many had abdominal pain, vomiting, and diarrhea prior to presenting with hepatitis, as manifested by an increase level in liver enzymes or jaundice (yellowing of the skin).

The CDC posted a health advisory on April 21 notifying the public that nine patients had been identified in a large hospital in Alabama between October 2021 to February 2022 who were treated for hepatitis and found to have evidence of adenovirus infection. They advised physicians to consider adenovirus testing in patients presenting with hepatitis and unclear cause, and recommended that local departments of health report cases of hepatitis without a clear etiology.

What do parents need to know about the increase in unexplained Hepatitis cases that seem to be affecting young children?

These reports should not create increased alarm in parents as these cases are very rare and still require further investigation.  These reports do not necessarily indicate that we are seeing more hepatitis than before or that there is necessarily an outbreak of adenovirus. Whenever a cluster of cases that appear to have a common link or have an unknown cause, further investigation is needed. These alerts and warnings are meant to ensure that we keep a close eye on new potential cases. Parents should reach out to their pediatricians if they think their child may have symptoms consistent with hepatitis, such as severe abdominal pain with vomiting and diarrhea, or yellow eyes or skin.

What are the children’s ages that seem to be affected by Hepatitis?

Most of the children affected are less than 10 years old, although cases range from children age 1-16.

Is this COVID-19 related?

We do not know if these cases are COVID-19 related but this is also being looked into.

What are the signs or symptoms that parents should look out for?

Symptoms of hepatitis can include abdominal pain, vomiting, diarrhea, yellow skin (jaundice), yellow eyes. If a child has worsening increasingly worsening abdominal pain, vomiting, and diarrhea, or if they have jaundice, they should see their child’s pediatrician for evaluation. In these cases, their pediatrician may test their child’s liver enzymes to see if they are elevated.

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