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Missouri investigating about 10 cases of mysterious hepatitis in children

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sick child in hospital bed

Sick child in a hospital bed. (123rf.com)

ST. LOUIS — Missouri health officials say they are investigating about 10 cases of a mysterious form of hepatitis that has sickened hundreds of healthy, young children across the U.S., the United Kingdom and several other countries.

Officials with the Missouri Department of Health and Senior Services are working with the U.S. Centers for Disease Control and Prevention in the investigation and will not yet say where the cases were reported in Missouri or how severe they were, said Lisa Cox, DHSS spokeswoman.

“We are in the process of collecting information, so what we do have is very limited, preliminary and likely to change,” Cox said.

The CDC began to zero in on the cases last month and on Friday said it was investigating a total 109 cases of hepatitis — inflammation of the liver — in children in 24 states and Puerto Rico where the hepatitis is “of unknown cause.”

The cases have been reported in the past seven months, and the children are under the age of 10 and otherwise healthy.

While most of the children have fully recovered, more than 90% were hospitalized, five have died and 14% required liver transplants, federal officials said.

What has experts stumped is the cause. The most common causes of viral hepatitis are hepatitis A, hepatitis B and hepatitis C viruses. But in these cases, those causes were ruled out.

In more than half of the cases, the children were found to be infected with a common adenovirus type 41, which typically causes diarrhea, vomiting and fever. Adenoviruses spread through contact with respiratory secretions when someone coughs or sneezes.

While it’s not unusual for the cause of hepatitis cases to be unknown, it is unusual for adenovirus to cause hepatitis in healthy children, experts say. And it’s unusual for healthy children to suffer with severe outcomes such as a transplant or death.

Given the small number of children who have died or needed transplants, federal and local officials are not saying where those cases occurred.

Washington University pediatric gastroenterologist Dr. Janis Stoll, who cares for patients at St. Louis Children’s Hospital, said hospital staff have seen an unusual uptick of acute hepatitis in children over the past few months where the cause was either adenovirus or unknown.

“There seemed to be more coming to us an outpatient or even coming into the hospital,” Stoll said.

The severity of the cases also caught doctors’ attention.

“If you are not immunocompromised … usually adenovirus is a run-of-the-mill virus that we see in kids frequently that may, in some cases cause liver enzyme elevation, but not to this degree in normal healthy kids,” Stoll said.

Stoll said parents can be on the lookout for signs of liver inflammation which include belly pain, vomiting and jaundice (yellowing of the skin and eyes). To prevent spread, wash hands frequently, stay home if sick and cover coughs and sneezes.

Officials with the World Health Organization in a press briefing on Tuesday said 348 potential hepatitis cases of unknown cause in children have been reported in 20 counties around the globe.

The United Kingdom is investigating 163 cases, 11 of which required liver transplants. The U.K. says of the cases that were tested, 91 had adenovirus infections.

Experts say they are casting a wide net in trying to determine the cause. They are looking at environmental factors such as an infection from a family pet or some other interaction makes adenovirus or the body’s immune response more dangerous to kids.

Despite speculation, experts say the COVID-19 vaccines are not responsible for the illnesses. Most of the cases involve children under the age of 5 who are not yet even eligible to receive a COVID-19 vaccine.

“COVID-19 vaccination is not the cause of these illnesses, and we hope that this information helps clarify some of the speculation circulating online,” said Dr. Jay Butler, the CDC’s deputy director for infectious diseases, during Friday’s briefing.

Most of the children have not had a known COVID-19 infection, but experts say they are not ruling out the possibility that the coronavirus played a role in the illnesses.

CDC officials say they first became aware of the cases in November, when a large children’s hospital in Alabama reported seeing five pediatric patients with significant liver damage and who all tested positive for adenovirus. None had ever reported having COVID-19.

Hospital officials continued to study cases and found four more pediatric patients with hepatitis and adenovirus infections admitted between October of last year and this February, for a total of nine patients.

The children ranged in age from 1 to 6. None of the children had significant underlying medical conditions. They came from different parts of the state, and no known contact or common exposure were found among the children.

In early April, the United Kingdom began reporting similar cases, which prompted the CDC on April 21 to issue a health advisory to health providers across the country notifying them of the cases.

The advisory asked providers to report to the CDC any serious cases of hepatitis in children under the age of 10 seen since Oct. 1 where the cause is unknown. The alert has since led to identification of more cases to investigate.

Stoll said it’s important for the CDC to study commonalities among the cases, and she does not want to be alarmist.

“Most kids do fine with these typical viruses and recover without needing any sort of a significant medical intervention,” she said. “We are keeping our eye on all these things that are going on so that we can make the best clinical judgment for these patients and help the best we can.”

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