New Outbreak of Acute Hepatitis in Children – Why?

May 16, 2022

Written by Clay Smith

Spoon Feed
A new, rare form of acute hepatitis has been seen in children, mostly under age 5 years, that presents with vomiting, diarrhea, and abdominal pain, followed by acute hepatitis with jaundice. If you see a child with a “stomach virus” who has jaundice – check labs!

Why does this matter?
We have seen so many kids with GI illness recently, but this is a new wrinkle. There is a rare new form of acute hepatitis in children. When should we suspect this, and what are the right next steps?

Vomiting + jaundice + under 16 years = check LFTs
There has been a recent outbreak of acute hepatitis cases in children under age 16 years, most under age 5, of unclear etiology. Cases have been seen largely in the UK but are being recognized in several countries around the world. The clinical syndrome appears to be acute GI symptoms, with abdominal pain, vomiting, and diarrhea followed by onset of acute hepatitis with jaundice. Liver injury can be severe; 10% of children (out of about 170 cases) have required a liver transplant. There appears to be an association with adenovirus infection, and liver injury may be triggered by nonspecific T-cell activation related to recent or concurrent COVID-19 infection. The most common subtype, adenovirus 41F, has not been previously known to cause acute hepatitis.

If you see a child with acute GI illness and jaundice, check labs. Transaminase levels are often in the thousands, and total bilirubin is elevated. Most patients were not old enough to get the COVID vaccine, so there does not appear to be a link with vaccination. The best prevention appears to be good handwashing. Inform parents who have children with gastroenteritis to watch for jaundice and call their doctor if they notice this.

Sources

• Acute hepatitis is identified in more children, but cause remains elusive. BMJ. 2022 May 6;377:o1156. doi: 10.1136/bmj.o1156.
• Multi-Country – Acute, severe hepatitis of unknown origin in children. WHO news release
• Severe acute hepatitis in children: investigate SARS-CoV-2 superantigens. Lancet Gastroenterol Hepatol 2022 Published Online May 13, 2022, https://doi.org/10.1016/S2468-1253(22)00166-2
• Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022. MMWR Morb Mortal Wkly Rep 2022;71:638–640. DOI: http://dx.doi.org/10.15585/mmwr.mm7118e1