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After the Centers for Disease Control and Prevention (CDC) issued a national health alert regarding a mysterious cluster of severe hepatitis in pediatric patients in Alabama, at least ten additional states are reporting similar cases that are now part of larger international outbreak, according to an ABC7 Chicago report.
The children are between the ages of 1 month to 16 years old with typical symptoms of acute hepatitis, including jaundice, abdominal pain and diarrhea.
The CDC reported the first cases in Alabama did not have significant medical problems, and ranged from ages younger than two to older than five years old, with five out of nine patients contracting adenovirus type 41, the virus known to cause the common cold.
But the agency noted the liver biopsies from the six patients who showed varying degree of hepatitis did not reveal any evidence of adenovirus on pathology, according to a recent Morbidity and Mortality Weekly Report.
Researchers are investigating a possible link to adenovirus, but out of the 50 known types of adenoviruses, type 41 usually causes only respiratory or gastrointestinal symptoms, not severe hepatitis, so investigations are also looking into other viruses, environmental toxins and medications that can cause severe hepatitis in children, per the news outlet.
Minnesota is one of the latest states to report several cases, with M Health Fairview reporting two cases to Minnesota Department of Health involving an infant and a 2 year old, one who was treated several months ago while the other who required a liver transplant, according to KSTP-TV.
“Why this kid had such severe acute hepatitis is unknown,” said Dr. Heli Bhatt, pediatric gastroenterologist and transplant hepatologist at M Health Fairview.
“It was kind of fitting enough for me to let Minnesota Department of Health know and they are going to investigate the case further.”
Other states include: Delaware and Louisiana, with each reporting one, North Carolina with two, three in Illinois, six in Tennessee and a “handful” in New York and Georgia, per the New York Post.
California is also investigating seven cases, with the first case reported this past October, per the San Francisco Chronicle.
“We do not know yet if adenovirus played a role in these rare illnesses or if these cases are connected,” said Ali Bay, a spokeswoman for the California Department of Public Health.
“While only a few cases of this rare illness have been reported, we urge parents and guardians to take common sense general measures to prevent infection and illness, such as good hand hygiene, covering coughs and sneezes, and keeping children home from school or childcare while they are ill.”
The World Health Organization have reported at least 169 cases in 12 countries, including at least one death and 17 others requiring a liver transplant. The majority of the cases are in the United Kingdom, per the April 23 release.
“One potential important clue that has not been reported yet is the pathology of the liver [from patients in Europe]. The 17 liver transplant cases across several countries means that a detailed analysis of the microscopic histopathology of the liver in these cases is available,” said Dr. Daniel R. Lucey, clinical professor of medicine at Dartmouth Geisel Medical School and a member of the Infectious Diseases Society of America Global Health Committee.
Adenovirus was detected in 74 of these cases worldwide, but SARS-CoV-2, the virus that causes COVID-19, was identified in 20 cases, with the common viruses that usually cause acute viral hepatitis ruled out.
“Right now, a lot is unknown,” Bhatt said.
“We are blaming all of this on adenovirus, and yes a lot of cases do have this adenovirus, but whether it is just that kid had adenovirus and had this, is it coincidental or proven? We don’t know.”