THE DOCTOR IS IN
OP-ED BY DR. ADIL MANZOOR
The word “outbreak” is really not one anyone wants to hear because of “you-know-who.” This is even more so in the United States, which has borne the brunt of the coronavirus. Unfortunately, there is a multi-country acute outbreak of hepatitis of unknown origin in children. I know you have questions, so stay with me as I explore the outbreak, cause, and implication in our country.
Before I proceed, it makes sense first to establish what hepatitis is. Hepatitis is an inflammatory condition of the liver. While there are other possible causes of the condition, viral infections are the most common culprits.
There are five main strains of Hepatitis – A, B, C, D, and E. While they all cause liver disease, they differ in crucial respects, such as manner of transmission, degree of illness, geographical distribution, and prevention measures. According to the World Health Organization, 354 million people live with a hepatitis B or C infection globally.
Hepatitis is really not one to treat with levity, considering how important the liver is to the normal functioning of the body system. This, therefore, makes the outbreak report by the WHO even more concerning.
In mid-April, the WHO published a report on “Acute hepatitis of unknown etiology – the United Kingdom of Great Britain and Northern Ireland.” Since then, the condition has spread to other countries globally, including the United States.
Right now, there are about 230 cases worldwide. The CDC has stated that it is currently investigating 109 cases in 24 states of the pediatric hepatitis outbreak. Cases are in children between 1 month and 16 years. Approximately 10% of all cases have required liver transplantation.
Now that we have that out of the way, the next natural question is the cause. The report first published by the WHO stated an unknown cause. Furthermore, none of the initial positive cases resulted from the five viral strains typically responsible for hepatitis A, B, C, D, and E. In other words, there’s a strong possibility that this current hepatitis outbreak has a novel cause.
As I write this, the suspected cause is adenovirus, which has been detected in at least 74 cases. The adenovirus strain, F Type 41, has been identified in at least 18 of those cases. Adenoviruses are not at all new to us. According to the WHO, they are pathogens that commonly result in self-limited infections. These adenoviruses can be transmitted from person to person and usually cause respiratory illness but may result in a host of other conditions, like gastroenteritis, conjunctivitis, and cystitis. More than 50 different identified adenoviruses can cause illnesses in humans.
While the adenovirus hypothesis is the one medical experts are riding with at the moment, there remain several questions. One such question is on the clinical occurrence and severity of the condition. Not only has adenovirus type 41 never been known to cause hepatitis in otherwise healthy children, but the symptoms of illnesses caused by this adenovirus aren’t usually this severe. Common symptoms are usually diarrhea, fever, vomiting, and respiratory symptoms.
More work definitely has to be done on the causative agent of the outbreak before any definitive cause can be identified, but adenovirus type 41 is the early frontrunner.
WHO has not recommended any travel restrictions with countries where the outbreak is – yet; however, all countries are advised to “identify, investigate, and report potential cases fitting the case definition.” Stay safe.
This article was written by Dr. Adil Manzoor DO, a Board Certified Internist & Board Eligible Pediatrician, who works as a Hospitalist, and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice Mobile Medicine NJ.
References
- https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON376
- https://www.medicalnewstoday.com/articles/hepatitis-outbreak-in-children-in-us-and-europe-may-be-linked-to-adenovirus#Vigilance
- https://www.who.int/health-topics/hepatitis#tab=tab_1
- https://www.webmd.com/children/news/20220425/who-multi-country-hepatitis-outbreak
