The U.S. Centers for Disease Control and Prevention said Friday that it’s investigating 109 cases of severe and unexplained hepatitis in children in 25 states and territories that may be linked to a worldwide outbreak.
Among them, 14 per cent needed transplants, and five children have died.
Nearly all the children — more than 90 per cent — needed to be hospitalized.
Dr. Jay Butler, the CDC’s deputy director of infectious diseases, stressed that the investigation — a partnership between the CDC and state health departments — is an evolving situation. Not all the hepatitis cases they are studying now may ultimately be caused by the same thing.
“It’s important to note that this is an evolving situation, and we are casting a wide net to help broaden our understanding,” Butler said.
Hepatitis, or swelling of the liver, can be caused by infections, autoimmune diseases, drugs and toxins. A family of viruses well known for attacking the liver causes hepatitis A, hepatitis B and hepatitis C.
It’s not clear what’s driving these cases in young children. Butler said some of the common causes of viral hepatitis have been considered but were not found in any of the cases.
Adenovirus has been detected in more than 50 per cent of cases, although its role isn’t clear.
EARLY HEPATITIS REPORTS
On April 21, the CDC alerted doctors to a cluster of unusual cases of hepatitis in nine children in Alabama.
It asked doctors and public health officials to notify the agency if they had similar cases of children under the age of 10 with elevated liver enzymes and no apparent explanation for their hepatitis going back to October.
Since then, health departments have been working with pediatric specialists in their states to identify possible cases. The numbers shared at Friday’s news briefing are the first national look at cases.
Cases are under investigation in Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska, New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington and Wisconsin.
The CDC’s alert followed reports of children from England, Wales, Scotland, and Northern Ireland going to hospitals with unexplained hepatitis.
As of May 1, there are 228 probable cases linked to the outbreak in 20 countries, with more than 50 cases under investigation, Dr. Philippa Easterbrook, a senior scientist in the World Health Organization’s Global Hepatitis Program, said in a briefing Wednesday. Among these cases, one child has died, and about 18 have needed liver transplants, she said.
Most of the children were healthy when they developed symptoms that included fatigue, loss of appetite, vomiting, diarrhea, belly pain, dark urine, light-colored stools and yellowing of their skin and eyes — a sign called jaundice.
UNUSUALLY SEVERE LIVER INFLAMMATION
Pediatric gastroenterologist Dr. Heli Bhatt of M Health Fairview Masonic Children’s Center in Minneapolis has treated two children who are part of the CDC’s investigation. One, a 2-year-old from South Dakota, had a liver transplant this week.
Bhatt says liver failure in kids is “super rare.” And even before scientists started tracking this outbreak, half of cases were never explained.
Doctors who have treated these children say their cases stood out.
“Even during the first case, I thought it was weird,” says Dr. Markus Buchfellner, a pediatric infectious disease specialist at the University of Alabama at Birmingham, where staffers started seeing cases in October.
“And then when the second one came in, that’s when I said, ‘OK, we need to talk to someone about this.’ ” He reached out to senior physicians in his department, who contacted the state health department and the CDC.
Buchfellner says the cases stood out because the liver inflammation was so severe.
Sometimes, common viruses like Epstein-Barr or even SARS-CoV-2 will raise a child’s liver enzymes a little, indicating what Buchfellner calls “small bits of hepatitis,” but the kids typically recover as their bodies fight off the infection.
“But it’s very odd to see a child who’s healthy come in with the amount of liver injury that these kids had,” he said.
Initially, UAB saw nine kids with unexplained hepatitis, and all nine tested positive for adenovirus in their blood. None of them tested positive for COVID-19 during their hospitalization or had a documented history of COVID-19, Butler said at the news briefing.
Since those cases were reported, two more children in Alabama have been identified. Their cases are under investigation, bringing the state’s total to 11, said Dr. Wes Stubblefield, medical officer for Alabama’s Northern and Northeastern Districts.
There are about 100 kinds of adenoviruses. About 50 of them are known to infect humans, so experts needed a closer look at the virus to try to figure out if all the children had the same one.
When researchers tried to read the genes of the adenovirus in infected kids, only five had enough genetic material to get a full sequence. In all five, the virus was a particular kind called adenovirus 41. It typically causes diarrhea and vomiting in kids, sometimes with congestion or a cough, but has never before been associated with liver failure in otherwise healthy children.
Butler said Friday that adenovirus 40 and 41 have been linked to hepatitis but almost exclusively in immunocompromised children.
CLUES FROM THE U.K.
Also Friday, researchers with the UK Health Security Agency posted a new technical briefing with an update on its hepatitis investigation. Of 163 cases, 126 patients have been tested for adenovirus, and 91, or 72 per cent, were positive for that pathogen.
Investigators have tried to sequence the entire genome of an adenovirus from one of the patients but have not been able to get a sample with enough of the virus to do that. There were 18 cases in which where they were able to partially sequence the genome, and all of them have been adenovirus 41F, the same one found in the US cases.
Many have wondered whether the cases may somehow be related to SARS-CoV-2, the virus that causes COVID-19.
UK investigators say they’re still looking at that possibility, but only 24 out of 132 patients tested — 18 per cent — had SARS-CoV-2 detected.
The report says they are not ruling out some role for a COVID-19 infection in these cases. Perhaps a prior COVID-19 infection somehow primed the immune system to make these children unusually susceptible, or maybe a co-infection of the two viruses together overwhelms the liver.
Researchers also want to know if the hepatitis is part of some kind of syndrome that strikes kids after a SARS-CoV-2 infection, like the rare complication called multisystem inflammtory syndrome in children, or MIS-C.
Another working theory from UK investigators is that there’s some kind of outsized or irregular immune response in these children, perhaps because they were sheltered more than usual during the pandemic.
Yet another theory is that the adenovirus may have always caused liver failure in a tiny percentage of children who were infected, and these rare cases are coming to light only because it is causing an exceptionally large wave of infections.
And investigators in the UK say they are still testing for drugs, toxins or perhaps an environmental exposure, even though some kind of infection is probably more likely to be the cause.
SORTING OUT ROLE OF ADENOVIRUS 41
Another thing that’s puzzled doctors, Buchfellner says, is that they found adenovirus in blood samples but not in samples of liver tissue taken during biopsies of the patients in Alabama.
“All nine of them have liver biopsies that were showing lots of inflammation and hepatitis. But we did not find the virus in the liver. We only found the virus in the blood,” he said.
Bhatt’s case, a child from South Dakota, was also positive for adenovirus in her blood but not in her liver.
If adenovirus 41 is somehow responsible in these cases — and that’s still a big if — Buchfellner says he doesn’t know why it would only show up in the blood but not in heavily damaged liver tissue. But he has some theories.
“Maybe the liver is clearing the virus before it’s been cleared in the blood,” he said. “And so by the time that the damage has been done to the liver and we do the biopsy, the immune system has already cleared the virus from the liver. And what’s left over is just inflammation.”
His second theory is that it’s not the virus itself that’s responsible for the liver damage, but perhaps the immune system overreacts when trying to fight off the virus and ends up damaging the liver.
Adenovirus infections are common, so maybe finding the virus in some of these patients is just a coincidence. “We are not 100 per cent sure that this is just that adenovirus. There’s still a lot to be known,” Bhatt said.
In an April 29 statement on the cases, the CDC wrote, “we believe adenovirus may be the cause for these reported cases, but other potential environmental and situational factors are still being investigated.”
Butler said Friday that experts are considering a range of possibilities, including exposure to animals.
“We really are casting a broad net and keeping an open mind in terms of whether the adenovirus data may reflect an innocent bystander or whether there may be cofactors that are making the adenovirus infections manifest in a way that’s not been commonly seen before,” he said.
Investigators say they know that this news may worry parents.
Butler says investigators still believe these cases are very rare. They have not seen an increase, for example, in children coming to emergency rooms with hepatitis.
“We are still telling at least our families here in Alabama — and I would encourage other families the same way — not to be too concerned about this just yet.” Buchfellner said. “I mean, at the end of the day, this is still a pretty rare phenomenon.”
Buchfellner says adenoviruses are commonly passed around day cares and schools. They typically cause nothing worse than something that feels like stomach flu for a few days.
“it’s been around for a long time, and it’s gonna continue to go around. And in total, we only have around 200 cases that have been reported across the globe. So this isn’t a COVID pandemic-like situation where everybody needs to be really concerned about this,” he said.
The Key Role of Trustworthy Babysitters in Balancing Work and Family Life
Are you a busy parent in constant pursuit of the elusive work-life balance? We know firsthand how overwhelming and challenging it can be to juggle professional commitments while still having quality time with your children.
That’s why we’re here to discuss an essential ingredient that unlocks the secret to harmony: trustworthy babysitters.
What Characteristics Parents Should Look for When Choosing a Babysitter?
Parents should look for a few key characteristics when choosing a babysitter. A good babysitter should be patient, responsible, and reliable. They should also be comfortable with children and have prior experience caring for them.
Besides, the babysitter must be able to communicate effectively and follow directions well. The babysitter should be someone the parents can trust to care for their children in their absence.
Strategies for Parents to Establish Reasonable Anticipations
As a parent, finding babysitters you can trust to care for your children is vital. However, it is also important to establish reasonable expectations for your babysitters.
Some tips for establishing reasonable expectations for babysitters include:
- Set clear expectations: Sit down with your babysitter to discuss bedtime routines, dietary preferences, and any necessary medications.
- Allow flexibility: While clarity is vital, also provide room for your babysitter to use their judgment and feel comfortable in their role.
- Trust their expertise: Once expectations are set, trust your babysitter’s judgment as a professional caregiver to avoid undermining their authority and creating discomfort in their role.
Determining a Fair Payment Plan
Determine your babysitting budget, factoring in your income and family size, while researching local rates. Account for the babysitter’s experience and qualifications, giving preference to those recommended by trusted sources.
Engage in open negotiations with your chosen babysitter. This aims to find a mutually agreeable arrangement that accommodates both your budget and their needs.
Tips on Finding Trustworthy and Compassionate Caregivers
When seeking a caregiver for your child, to ensure you find the right fit:
- Seek recommendations from trusted sources such as friends, family, and neighbours who may have suggestions for caregivers in your area.
- Conduct online research to review feedback and check references to gauge candidates’ qualifications and experience.
- Request references and contact details from the caregivers’ previous employers or families they have worked with.
- Trust your instincts and ensure you feel at ease with the caregiver, ensuring they are someone you can entrust with your child’s well-being.
Being able to trust your babysitter means you can have peace of mind knowing your child is safe and cared for.
Spending some time researching online reviews or asking friends and family for recommendations will help you find the perfect fit so you can feel more at ease while juggling work commitments in today’s hectic world.
Facility-wide COVID-19 outbreak at Bethammi Nursing Home
THUNDER BAY — St. Joseph’s Care Group and the Thunder Bay District Health Unit have declared a facility-wide COVID-19 outbreak at Bethammi Nursing Home, part of the St. Joseph’s Heritage complex on Carrie Street near Red River Road.
The respiratory outbreak at the 112-bed facility was declared effective Sept. 15 but only announced publicly on Monday.
No details were provided with regard to the number of people affected to date.
Restrictions are now in place for admissions, transfers, discharges, social activities and visitation until further notice.
Alberta COVID hospitalizations up 73% since July: health minister
Three weeks after the start of the school year, Alberta’s health minister provided an update on the spread of airborne viruses in the province.
Adriana LaGrange also said more information about flu and next-generation COVID-19 vaccines will soon be released.
“Now that we will be spending more time indoors, we need to make doubly sure we are following proper hygiene protocols like handwashing and staying home when sick,” LaGrange said. “It also means respecting those who choose to wear a mask.”
Global News previously reported that influenza vaccines will be available on Oct. 16 with the new Moderna vaccine formulated to target the XBB.1.5 variant likely to be available at around the same time. On Sept. 12, Health Canada approved the use of the Moderna vaccine.
“More information on immunizations against respiratory viruses including influenza and COVID-19 will be available shortly,” the health minister said.
LaGrange said there have been 28 cases of influenza and five lab-confirmed cases of respiratory syncytial virus (RSV) since Aug. 28.
“This is consistent activity for this time of the year,” the health minister said in a statement.
The end of August or the beginning of September has typically marked the beginning of flu season for provincial health authorities.
LaGrange also provided an update on the ongoing COVID-19 pandemic in the province.
From Aug. 28 to Sept. 8, there were a total 92 new hospitalizations and three ICU admissions, bringing the total to 417 in hospital and seven in ICU, a 73 per cent increase of COVID hospitalizations from the last reported info.
On July 24 – the last update to the province’s COVID data dashboard – there were only 242 in hospital.
“Sadly, five Albertans died during that period due to COVID-19,” LaGrange said.
LaGrange said the reporting dashboard is being refreshed to include RSV, influenza and COVID-19 data, work that was originally expected to be completed on Aug. 30. The latest data on the province’s influenza statistics dashboard is dated July 22.
“This work is currently underway and will be available in the coming weeks,” LaGrange said.
She said data for the dates between July 24 and Aug. 27 will be available when the new dashboard goes online.
Amid more hospitals continent-wide reinstating masking requirements in the face of increased hospitalizations, the health minister made no mention of any such moves for Alberta hospitals. Acute care COVID-19 outbreaks in Alberta jumped from Sept. 5 to 12, with 146 per cent more healthcare workers and 55 per cent more patients testing positive for COVID.
LaGrange stressed the “collective responsibility” to prevent the spread of airborne viruses like COVID and influenza.
“As a mother and grandmother, I understand the anxiety that comes with sending your children back to school. I want to reassure you that Alberta’s government has the health and well-being of all young Albertans top of mind,” the health minister said.
–with files from Meghan Cobb, Global News
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