Hepatitis outbreak in children: What to look out for, according to health experts
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There are a lot of unanswered questions about a potentially life-threatening liver illness that's affecting hundreds of children around the world, including in Canada and the United States.
In a media briefing on May 10, the World Health Organization (WHO) says health officials and researchers are trying to find what's causing kids to get infected with severe acute hepatitis and whether it's at all linked to COVID-19.
There are now 450 cases of severe acute hepatitis in children across 20 countries. In the United States, several children have needed liver transplants and five children have died from the mysterious illness.
Health officials in Canada have identified at least 10 cases, including seven in Ontario and one in Manitoba. Last week, Alberta’s chief medical officer also confirmed two infections in that province.
In a statement to Yahoo Canada, The Hospital for Sick Children — also known as SickKids — in Toronto says there have been seven probable cases of the liver infection between Oct. 1, 2021 and April 30, 2022, and its physicians are closely monitoring patients for any signs of hepatitis.
“It remains to be seen whether this number represents an increase in cases of unknown origin compared to similar time periods in previous years or if any of these cases will be confirmed to be caused by a novel clinical entity,” SickKids adds.
Dr. Earl Brown, emeritus professor of virology at the University of Ottawa, says there is no need for parents to panic, but he does recommend they know what symptoms to look out for.
What is hepatitis?
Hepatitis is an inflammation of the liver — a condition that's extremely rare in children.
The liver is a vital organ that processes nutrients, filters blood and fights infections. When it’s inflamed or damaged, its functions can be affected, according to the Centers for Disease Control and Prevention.
While it's still possible for children to be infected by typical hepatitis viruses, including hepatitis A, B, C, D or E, none of the identified cases of this outbreak fall under those classifications. Moreover, the infected children are suffering from severe symptoms.
"It is unclear why the uptick has been among children, and difficulties in pinpointing the cause are due to lack of case positivity for the 'usual suspects' — the hepatitis viruses," says Selena Sagan, an associate professor of biochemistry, microbiology and immunology at McGill University in Montreal.
As scientists try to identify what’s driving this current outbreak, officials say it may be linked to adenovirus, a group of common viruses that can cause cold-like symptoms or gastroenteritis (the stomach flu).
Dr. Philippa Easterbrook of the World Health Organization's (WHO) global hepatitis programme says that's the “leading hypothesis” at this point, with 70 per cent of cases testing positive for adenovirus type 41.
Is there a link between hepatitis in kids and COVID-19?
Health officials have not been able to confirm if there is a link between COVID-19 and this mysterious liver illness.
Some of the children who have severe acute hepatitis had been previously infected with COVID-19.
According to the WHO, researchers are investigating the role of COVID-19 as either a co-infection or a past infection.
One cause that can be ruled out is the COVID-19 vaccine, as Dr. Brown says the majority of the infected children who developed hepatitis were under five-years-old and are not eligible to be vaccinated.
What are the signs and symptoms of hepatitis?
The Centers for Disease Control and Prevention is advising parents to be on the look out for symptoms of hepatitis.
Low-grade fever
Fatigue
Loss of appetite
Nausea
Vomiting
Stomach pain
Dark urine
Light-coloured stool
Joint pain
Jaundice (yellowing of the skin)
Sagan tells Yahoo Canada parents shouldn’t worry if they see gastro systems, but there are signs that should be seen as a red flag.
"Many children will experience acute gastrointestinal infections, including vomiting and diarrhea, and will recover in a few days time," she explains. "But, if your child is not recovering or experiencing yellowing of their eyes or skin, you would certainly want to seek medical attention."
Who is at risk?
Due to so many unknowns at this point, Brown says it’s hard to know which children are at risk of getting this illness.
“Right now, these appear to be outwardly healthy children," he says. "They’re not an at-risk group as far as being immunosuppressed or having some other condition they can identify, and so that makes it a bit more confusing."
Brown adds that toddlers are in an unusual state because children typically get around one infectious disease per month, either respiratory or gastrointestinal. But with lockdowns, toddlers have missed a number of infections they normally would have had, meaning they have fewer antibodies.
“That’s another concern in general, is that children are more susceptible to infection,” he explains. “[The] increased susceptibility is meaning that something that wasn’t a problem before is a problem now.”
Sagan agrees that's one of the working hypotheses at the moment, adding that the outbreak could also be caused by "a novel pathogen, toxin, drug or environmental exposure."
What are some preventative measures parents should be taking?
Since the COVID-19 pandemic is still ongoing, the same preventative measures people have implemented can be applied during this acute hepatitis outbreak in children.
These measures include washing your hands often, avoiding people who are sick as well as covering your coughs and sneezes.
Brown says it’s also important for parents to ensure their kids don’t share contact surfaces whenever possible.
“If you have a kid at the play group who’s sick with anything, you don’t go mingle right now," he adds. "You’re just a bit more careful, but that goes along with COVID, as well."
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