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