Health

What Scientists Know About the Unusual Hepatitis Cases in Children – The New York Times

Published

3 years ago

May 3, 2022

Officials are exploring the possibility that a common adenovirus might be responsible for the unexplained cases, which remain rare.

At least 16 countries and 10 U.S. states have either identified or are investigating reports of unusual hepatitis cases in otherwise healthy children.

The cases remain extremely rare, with about 200 children affected worldwide, according to a report issued last week by the European Centre for Disease Prevention and Control.

But even these small clusters are unusual. In Britain, where most of the cases have been reported, two pediatric liver units have already had at least as many admissions for acute, unexplained hepatitis in 2022 as they typically have in an entire year, according to a briefing from the U.K. Health Security Agency.

Most children should recover fully, experts said, but some cases have been severe. In nearly 10 percent of reported cases, children have required liver transplants, according to the World Health Organization. There has been at least one death, the W.H.O. said.

The cause remains unknown, but scientists are exploring the possibility that an adenovirus may be responsible. Adenoviruses are common, but they are not usually associated with hepatitis in healthy children. And with many nations only now beginning to look for cases in earnest, the scope of the problem remains unknown.

“It’s still early days,” said Dr. Richard Malley, an infectious disease specialist at Boston Children’s Hospital. “It’s hard to predict whether this will become more common or if, in fact, it will just be a blip in our 2022 infectious-disease story.”

Here’s what scientists know so far.

What is hepatitis?

Hepatitis is an inflammation of the liver and can have a wide range of causes. Viral infections can cause the condition; the viruses known as hepatitis A, B, C, D and E are all known triggers.

Heavy drinking, as well as certain medications and toxic substances, can also cause hepatitis. In autoimmune hepatitis, the body’s own immune system attacks the liver.

Sudden and severe hepatitis in previously healthy children is uncommon, which is why the new clusters of cases have prompted concern.

Where have the new cases been reported?

In early April, Britain became the first country to notify the W.H.O. of a cluster of unexplained hepatitis cases in children. The cases were unusual because they occurred over a short period of time in otherwise healthy children, and because clinicians quickly ruled out any of the common hepatitis viruses as the cause. They did not identify any patterns in travel, diet, chemical exposures or other risk factors that might explain the outbreak, according to the U.K. Health Security Agency’s briefing.

Since then, Austria, Belgium, Denmark, France, Germany, Ireland, Israel, Italy, Japan, the Netherlands, Norway, Poland, Romania, Spain and the United States have reported similar cases, the E.C.D.C. said.

In the United States, Alabama recorded nine cases between October and February. Three of the children developed liver failure, and two required liver transplants, the Centers for Disease Control and Prevention noted in a recent report. All of the children either recovered or are recovering, the agency noted.

“The two that received the transplant are actually doing quite well,” said Dr. Henry Shiau, a pediatric transplant hepatologist at the University of Alabama at Birmingham and the Children’s of Alabama hospital.

The cases prompted the C.D.C. to issue a nationwide alert, asking health care providers to keep an eye out for similar cases.

Illinois and Wisconsin have since announced potential cases. North Carolina, Delaware, Minnesota, California, New York, Georgia and Louisiana have also identified, or are investigating, possible cases, state officials told The New York Times.

What are the symptoms?

In many of the cases, children developed gastrointestinal symptoms, including vomiting, diarrhea and abdominal pain, followed by a yellowing of the skin or eyes, known as jaundice. They also had abnormally high levels of liver enzymes, a sign of liver inflammation or damage.

Gastrointestinal symptoms are common in children and should not, in isolation, be cause for alarm, Dr. Shiau said. But a yellowing of the skin or eyes are more telltale signs of liver problems, he said.

“The likelihood of your child developing hepatitis is extremely low,” Dr. Meera Chand, the director of clinical and emerging infections at the U.K. Health Security Agency, said in a statement. “However, we continue to remind parents to be alert to the signs of hepatitis — particularly jaundice, which is easiest to spot as a yellow tinge in the whites of the eyes — and contact your doctor if you are concerned.”

What’s causing it?

“That’s the million-dollar question,” Dr. Shiau said. “I want to be up front about this: We don’t know.”

But one leading hypothesis is that an adenovirus — one of a group of common viruses that often cause cold-like symptoms — is responsible. Of the 169 cases included in a recent W.H.O. report, at least 74 had an adenovirus infection, the organization said. Eighteen of those children were infected with what is known as adenovirus type 41, which typically causes gastrointestinal and respiratory symptoms.

Adenovirus infections have been on the rise in Britain, where most of the hepatitis cases have been reported, the W.H.O. said.

But the explanation is not a perfect fit. Not all of the children have tested positive for an adenovirus, and while the viruses can cause liver inflammation, that symptom is most common in people who are immunocompromised. “It is not a common cause of liver failure in kids,” said Dr. Aaron Milstone, a pediatric infectious diseases specialist at Johns Hopkins Children’s Center.

It is possible that a new adenovirus strain has emerged or that adenovirus infections are occurring in conjunction with some other risk factor — such as a toxic exposure or an infection with another pathogen — causing these unusually severe outcomes, the U.K. Health Security Agency said.

Or the adenovirus infections could be a red herring. Because the viruses are so common among children, it is difficult to determine whether they are the cause of these hepatitis cases or whether many of the children have been infected incidentally. “Somebody could be infected with adenovirus and then develop hepatitis based on something else,” Dr. Malley said. “For proof of causality you really need a lot of data, which we just don’t have.”

Is this connected to Covid-19?

Probably not directly, experts said. Of the 169 patients identified by the W.H.O., 20 tested positive for the coronavirus. That is not surprising, given how widely the virus has been spreading in recent months, scientists said.

And there is no evidence that the hepatitis is linked to the Covid-19 vaccines; the “vast majority” of the children in question had not been vaccinated, the W.H.O. said.

Still, a coronavirus connection cannot be entirely ruled out, experts cautioned, and the hepatitis cases may be linked to the pandemic in less direct ways. For example, the public health measures implemented over the past two years may have left fewer children exposed to common adenoviruses. That, in turn, might have made them more susceptible now, according to one of the U.K. Health Security Agency’s working hypotheses.

But that, too, is speculative.

“At this point,” Dr. Shiau said, “we still don’t know what’s going on.”

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Health

What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

Published

1 week ago

October 31, 2024

Press Release

Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

	Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Health

Here is how to prepare your online accounts for when you die

Published

2 weeks ago

October 24, 2024

Anne Joseph

LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Health

Pediatric group says doctors should regularly screen kids for reading difficulties

Published

3 weeks ago

October 23, 2024

Anne Joseph

The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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