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Serious cases of hepatitis among children have doctors stumped

Clusters are of unknown origin, and not believed related to COVID-19 at this time.

Mayo Clinic
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ROCHESTER, Minn. — Infectious disease specialists are urging the public to be on guard for suspected cases of hepatitis in children.

Mayo Clinic specialists offered that message in a news conference Thursday, May 5, in response to recent guidance from federal and international health organizations that unusual clusters of the inflammatory liver condition have been identified in children, some requiring transplants.

"I think one of the things that stands out in the clusters is that these are children who had been previously healthy," said Dr. Nipunie Rajapaske, a pediatric infectious disease specialist at Mayo Clinic Children's Center. "It's kind of unusual in that many of them have had severe illness with some of them going on to require transplants."

Almost 300 such cases of unexplained hepatitis in children have been identified globally, according to the World Health Organization. In the U.S., small clusters of cases dating back as far as last fall are being investigated in 12 states. Minnesota, North Dakota and South Dakota are among those states investigating suspected cases, according to news reports .

Among the many confusing elements of the outbreak is that the usual viruses that can cause hepatitis have not been identified in the children affected. It also is not clear why the condition is afflicting children only.

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While the timing of the new syndrome raises concerns it could be related to the pandemic, the Mayo clinicians say COVID-19 is not likely to have played a role in the outbreak — at least given what is known today. Few of the children identified had been sick with the illness at the time of diagnosis.

"We're still in the early days of this," Rajapaske said. "All of the different ideas about what might be causing this are just that. There's different theories, but we have to take the information that we're gathering and see whether that theory holds or not."

Dr. Nipunie Rajapakse
Dr. Nipunie Rajapakse

Rajapaske said that past COVID infection is under consideration as a possible cause, but added that any concerns over COVID-19 vaccination as a cause are unwarranted.

"A vast majority of the patients recorded by the World Health Organization and many of the patients we have reports on here in the United States were under 5 years of age," Rajapaske said. "So they were not eligible for COVID-19 vaccination, and have not received COVID-19 vaccination."

Many of the cases have been accompanied by adenovirus, said Dr. Sara Hassan, transplant hepatologist at Mayo Clinic Children's Center. But given that adenovirus is widely carried in children, and that many of the cases did not have adenovirus, even that connection is in question.

Barring its link to liver inflammation within those with compromised immune systems, adenovirus is not associated with hepatitis.

The symptoms of hepatitis are yellowing of the skin or around the eyes, Hassan said.

"That's really the telltale sign you are having liver disease."

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She added that dark colored urine or lighter stools can be indicative of hepatitis, as can fatigue and loss of appetite.

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Paul John Scott is the health reporter for NewsMD and the Rochester Post Bulletin. He is a novelist and was an award-winning magazine journalist for 15 years prior to joining the FNS in 2019.
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