DOH: Acute pediatric hepatitis in child on Maui

The state Department of Health confirmed it is investigating a report of acute pediatric hepatitis of unknown origin in a Maui resident under the age of 10 years.

A DOH spokesperson reports that the child was hospitalized for several days with abdominal pain and fever at the end of April.

“An extensive medical investigation was performed and there are a number of laboratory test results outstanding,” the spokesperson said.

Department officials say no cause has been determined at this time. “DOH is collaborating with the Centers for Disease Control and Prevention to identify the cause of the hepatitis case,” officials said.

On Thursday, the CDC held a media tele-briefing to discuss the latest regarding the cases of children acute hepatitis of unknown cause in the US. Fifteen days prior, on April 21, the CDC issued a nationwide health alert to notify clinicians and public health authorities about an investigation involving nine children between the ages of 1 to 6 years old in Alabama, identified between October 2021 and February 2022, with hepatitis, or inflammation of the liver and adenovirus infection.

During the briefing, Jay Butler, M.D., Deputy Director for Infectious Diseases said all of those patients were previously healthy, came from different parts of the state, and were hospitalized with significant liver injury without a known cause, including some with acute liver failure.

Since issuing the alert, which called for the notification of possible cases extending back to Oct. 1, 2021, Dr. Butler said the CDC received a number of reports of similar illnesses from health care providers and state health departments across the country.

As of Thursday, the CDC had expanded its investigation to 109 children with hepatitis of unknown cause, occurring in 25 states and territories over the past seven months. Dr. Butler said this includes five reported deaths.

“Overall, more than 90% of these patients under investigation were hospitalized, 14% received liver transplants, and more than half had a confirmed adenovirus infection,” said Dr. Butler. “It is important to note that this is an evolving situation and we’re casting a wide net to help broaden our understanding.”

According to Dr. Butler, although it is rare, children can have serious hepatitis, and it’s not uncommon for the cause to be unknown.

He said a preliminary analysis of limited data shows no significant increase in pediatric hepatitis cases or liver transplants, including from before the COVID-19 pandemic.

Among the patients originally identified in Alabama, lab tests identified that some had adenovirus type 41, which more commonly causes severe stomach illness. None of these children had significant underlying conditions, which is more commonly seen in adenovirus type 41, which occurs in immunocompromised patients, and is not usually known as a cause of hepatitis in otherwise healthy children, according to Dr. Butler.

Based on initial investigations both in the US and abroad, “some of the common causes of viral hepatitis, such as hepatitis A, B, C, delta, and E, have been considered and tested, but not found in any of these cases,” he said.

In addition, none of those from the nine Alabama cases initially reported, had COVID-19 infection during their hospitalization, or a documented history of COVID-19, according to Dr. Butler. Additionally, none of those children from the Alabama report had received the COVID-19 vaccine prior to being hospitalized with hepatitis, he said.

“The children infected are young, with a median age of two years, which means that most are not eligible to receive the COVID-19 vaccine,” said Dr. Bulter, who noted that COVID-19 is not the cause of these illnesses, saying he hopes the information clears up some of the speculation that has surfaced online.

Officials with the CDC said they still do not know the cause of these cases. While there was evidence of adenovirus in more than half of the cases under investigation, it is unknown at this time if it’s the cause. Dr. Butler said the CDC also does not know what role other factors may play like environmental exposures, medications, or other infections that the children might have.

“We know this update may be of concern, especially to parents and guardians of young children. It’s important to remember that severe hepatitis in children is rare–even with the potential increase in cases that we are reporting today,” said Dr. Butler on Thursday.

Symptoms include “vomiting, dark urine, light colored stools, and yellowing of the skin (also known The CDC says the symptoms of hepatitis, or inflammation of the liver, include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice and can be caused by viruses.”

The CDC continues to recommend that children be up to date on vaccinations and take everyday actions as they would to prevent any number of other infections.