Pennsylvania is investigating cases of unusual hepatitis in children

Emily Mullin
Pittsburgh Post-Gazette (TNS)

The Pennsylvania Department of Health said it is investigating "multiple" reported cases of unexplained hepatitis infection in previously healthy young children.

A spokesman for the department told the Pittsburgh Post-Gazette that no cases have been confirmed yet. Pennsylvania is one of 25 states and territories that have reported possible cases to the Centers for Disease Control and Prevention. In Pittsburgh, UPMC Children's Hospital has had a "handful of children that meet [CDC's] reporting requirement but none of these cases have been confirmed as of this time," according to a spokeswoman for the hospital system.

The infections date back to October 2021.

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Hepatitis, or inflammation of the liver, is most often caused by viruses such as hepatitis A, B and C, but these viruses have not been found in any of these cases. Hepatitis is often associated with adults because it can be spread through needle sharing or sex, but it can also be transmitted through contaminated food and water.

Symptoms of hepatitis that parents should look for:

  • Abdominal pain
  • Diarrhea
  • Loss of appetite
  • Vomiting
  • Dark-colored urine
  • Light-colored stools
  • Jaundice or yellowing of the skin or eyes

"Although rare, children can have serious hepatitis, and it's not uncommon for the cause to be unknown," said Dr. Jay Butler, the CDC's deputy director for infectious diseases, during a news conference on Friday.

The agency is investigating 109 U.S. cases of hepatitis of unknown cause in children over the past seven months, including five reported deaths. More than 90% of these patients were hospitalized and 14% received liver transplants, according to the CDC. Cases have also been reported in the United Kingdom, Israel and several European countries.

"That's obviously very alarming if these children are getting so sick that they require transplantation as a treatment," said Dr. James Squires, a pediatric gastroenterologist at Children's Hospital. Squires said none of the hepatitis patients at Children's have needed liver transplants.

The CDC first issued a health alert on April 21, notifying health care providers of a cluster of nine children in Alabama with hepatitis and liver injury from October to February. Two of the children required liver transplants, and three developed liver failure. Most of the children who have developed hepatitis have since recovered.

The Centers for Disease Control and Prevention headquarters in Atlanta. Officials this week released the CDC's most detailed report yet on nine cases of pediatric hepatitis in Alabama that have captured national attention. (Dreamstime/TNS)

None of the nine children had COVID-19 infection during their hospitalization or a documented history of COVID-19. They also had not received the COVID-19 vaccine before being hospitalized for hepatitis.

The cause of the outbreak is still unknown, but health officials have identified a type of virus called adenovirus in many of the 109 U.S. children identified with unusual hepatitis. Specifically, many have tested positive for adenovirus 41, which typically causes mild gastrointestinal and respiratory symptoms and is not known to be a cause of hepatitis in otherwise healthy children.

"Adenoviruses have not historically been known to cause much in the way of liver disease," Squires said. "Even though this adenovirus 41 has been linked or discovered in association with some of these children who have hepatitis, it has not been found in the liver itself. When they've actually tested the liver tissue, the adenovirus 41 isn't there. It's actually picked up mostly in the stool."

He cautioned that more information is needed to determine if adenovirus 41 is truly the cause.

The CDC is also looking into other potential causes, such as medications, environmental exposures or other pathogens.

"We really are casting a broad net and keeping an open mind," Butler said on Friday.

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Among the nine initial patients in Alabama, all were previously healthy with no underlying conditions and ranged in age from about 1 to 6 years old. Before being hospitalized, most of the children had vomiting and diarrhea and some experienced upper respiratory symptoms. While in the hospital, most had an enlarged liver and jaundice — that is, yellowing of the eyes and skin.

While the number of cases being investigated may seem alarming, Squires said not all of them may end up being linked to the current outbreak.

Butler reiterated that these cases are rare, even with the potential increase in recently reported infections.

"We encourage parents and caregivers to be aware of the symptoms of hepatitis. These can include vomiting, dark urine, light-colored stools, and yellowing of the skin, also known as jaundice," Butler said.

Parents and caregivers should contact their child's health care provider with any concerns.

He recommended that children and their parents and caregivers be up to date on all their vaccinations and practice the same everyday actions for preventing infections, including washing hands often and avoiding people who are sick, covering coughs and sneezes, and avoiding touching the eyes, nose or mouth.