Massachusetts officials have reported they are investigating two cases of mysterious pediatric hepatitis, its Department of Health announced Tuesday, making it the 26th state to report such cases. The two unnamed children reportedly tested negative for the adenovirus, which is the most speculated cause for this recent spike in cases of the devastating lung condition. Officials did not reveal the condition of the children, or when the suspected infections occurred.
A new hepatitis alert was issued by the Centers for Disease Control and Prevention (CDC) Wednesday telling doctors to take liver samples from the sickest patients — after five children died from the disease in the U.S. and 15 needed a liver transplant.
It comes as scientists remain stumped as to the cause behind the mystery illness, with adenovirus — which can cause the common cold — currently the chief suspect.
In its second alert in three weeks the CDC recommended clinicians widen their search for an adenovirus infection by taking samples from the organ 'if available', as well as collecting stool, throat and blood specimens to be tested for adenovirus.
Previously, the agency had only suggested taking samples from one of these — excluding the liver — to scan for the little-known virus.
Earlier this week Hawaii and Massachusetts became the 25th and 26th states to declare suspected mysterious hepatitis cases in children.
The U.S. currently has more than 100 cases suspected or confirmed and the highest death toll in the world, behind Indonesia which has reported three deaths.
Nearly 300 mysterious hepatitis cases have been spotted in children worldwide to date, with most in the UK (160) and U.S. — although this may be because the countries have better surveillance systems.
Scientists are puzzled as to what is causing the outbreak, but the leading theory is that it is triggered by adenovirus which most — but not all — patients have tested positive for.
EXCLUSIVE: Scientists are puzzled by the cause, but leading theories suggest a type of adenovirus spread by touching feces-contaminated surfaces is behind the illness. Dr Matthew Binnicker, the director of clinical virologist at the Mayo Clinic in Minnesota, told DailyMail.com cases will continue to crop up throughout the year as its transmission is 'not seasonal'. He warned schools and day care centers - where many children mix - were major hubs for spreading the virus. Dr Binnicker also warned many hepatitis cases among children remain undiagnosed in the U.S. because, in some cases, children will not have been unwell enough for their parents to take them to a doctor or hospital. The majority of children with the mysterious hepatitis in the U.S. have tested positive for adenovirus, but it is not clear whether the virus itself is causing the illness or the infection alongside another factor such as a previous Covid diagnosis.
No further deaths were reported over the last two weeks, but previously the CDC revealed it was probing five fatalities in the outbreak — with one in Wisconsin. One more child has required a liver transplant, bringing the national tally needing this procedure to 16.
A total of 180 cases of the mysterious hepatitis have now been linked to the outbreak across 36 states and territories in the U.S., with children around two years old.
This is the most out of any nation in the world with Britain, which first detected the outbreak, having the second-highest tally at 163 cases. The CDC said the 'vast majority' of these patients were retrospective, and came to hospitals before May but have only just been diagnosed with the mysterious disease.
Scientists are puzzled as to what is causing the outbreak, but CDC officials say adenoviruses — which can cause the common cold — remain a 'strong lead' with nearly half of patients testing positive for them. Other theories suggest a previous Covid infection, a mutation in adenoviruses or even exposure to pet dogs could be triggering the illness.
All the normal causes of the illness — hepatitis viruses A, B, C, D and E — have been ruled out.
Another 36 cases of mysterious pediatric hepatitis in children aged 10 or younger, health chiefs revealed Wednesday — after six deaths were reported in the outbreak.
It brings the tally of children affected by the liver inflammation to 216 across 37 states, with Mississippi and Utah the latest to be added to the growing list.
No new deaths or liver transplants were reported in the last week, the Centers for Disease Control and Prevention (CDC) said in their weekly update with the totals remaining at 14 and six respectively.
The agency has refused to reveal where the deaths have occurred sighting 'confidentiality issues', but at least one was registered in Wisconsin health chiefs in the state say.
Globally, the U.S. has recorded the most fatalities and suspected cases out of any nation — although this may be because of strong surveillance.
Indonesia has reported five deaths in the outbreak, while both Palestine and Israel have registered one each.
Scientists say it will still be weeks before the cause of the cases is revealed, although the CDC continues to consider adenoviruses — which can trigger the common cold — as the most likely source of the illness.
The outbreak may also be the result of weakened immunity due to lockdowns which harmed people's immunity, some experts warn.
A total of 37 states have now reported cases in the hepatitis outbreak. These are: Arkansas, Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, and Virginia, Washington and Wisconsin.
The territory of Puerto Rico has also recorded at least one case of mysterious hepatitis.
The U.S. Food & Drug Administration announced an investigation into FreshKampo or H-E-B brand organic strawberries for hepatitis A on Saturday.
The FDA said not to eat, serve or sell those brands of strawberries if bought between March 5 and April 25.
“Currently, the potentially affected FreshKampo and HEB products are past shelf life. People who purchased FreshKampo and HEB fresh organic strawberries between March 5, 2022, and April 25, 2022, and then froze those strawberries for later consumption should not eat them,” the FDA said.
The strawberries were distributed nationwide, according to the FDA. Known retailers for these products are:
Aldi
H-E-B
Kroger
Safeway
Sprouts Farmers Market
Trader Joe’s
Walmart
Weis Markets
WinCo Foods
During traceback investigations, the FDA found that, before becoming ill, individuals in California, Minnesota, and Canada purchased fresh organic strawberries as FreshKamp or H-E-B. Fifteen cases of a hepatitis A infection have been reported in California while Minnesota and North Dakota have each reported one case.
Of the 17 related cases, the FDA says 12 have been hospitalized.
Long COVID may be the cause of unexplained cases of hepatitis in children around the world in recent months, Israeli researchers from Schneider Children’s Medical Center, Rabin Medical Center – Beilinson Hospital, Rambam Medical Center and Tel Aviv University found in a study recently published in the peer-reviewed Journal of Pediatric Gastroenterology and Nutrition.
The Israeli scientists who conducted the study noted that liver injury has been recorded in adult patients with severe coronavirus infections and that children can be affected with multisystem inflammatory syndrome (MIS-C) as a result of COVID-19, which can injure the liver. Post-COVID-19 liver injuries have been increasingly reported among adults as well.
The new Israeli study analyzed the cases of five patients who were hospitalized in Schneider Children's Medical Center last year due to liver injury. All five patients had tested positive for SARS-CoV-2 before presentation of symptoms.
The first patient, a 3-month-old infant, was hospitalized for acute liver failure 21 days after being diagnosed with COVID-19. 11 days later, he underwent a liver transplant. The infant was negative for adenovirus, SARS-CoV-2, Epstein-Barr virus, cytomegalovirus (CMV) and herpes simplex virus.
The second patient, a 5-month-old patient, was hospitalized with a fever, jaundice and an enlarged liver (hepatomegaly) and his condition deteriorated, leading to him needing a liver transplant. He tested positive for both adenovirus and SARS-CoV-2. After the transplant, he tested positive for CMV as well.
The third patient, a previously healthy 8-year-old boy, tested positive for the novel coronavirus before experiencing liver injury. About 130 days after his COVID-19 diagnosis, he arrived at the hospital with abdominal pain, vomiting and jaundice. He was not found to be infected with adenovirus.
The fourth patient, an 8-year-old boy, began experiencing abdominal pain, vomiting, diarrhea and jaundice about 90 days after being diagnosed with COVID-19. He was not found to be infected with adenovirus.
The fifth patient, a previously healthy 13-year-old boy, tested positive for SARS-CoV-2 after presenting with weakness, diarrhea, jaundice and abdominal pain. 53 days after testing positive, he arrived at the hospital with vomiting, abdominal pain, jaundice, hepatomegaly and liver injury. During his hospitalization, he needed to undergo a liver transplant. After the operation, he tested positive for CMV and adenovirus.
The study noted that the two 8-year-olds and the 13-year-old experienced acute hepatitis with cholestasis (decreased bile flow), while the two infant patients experienced acute liver failure. The patients analyzed by the study had asymptomatic or mild presentation of COVID-19 before the onset of liver issues, while among adults most patients who experienced liver issues had been in the ICU for a prolonged period while suffering from severe cases of COVID-19.
Other studies conducted around the world have also found that some COVID-19 patients suffer from liver issues weeks or even months after being diagnosed with COVID-19. The scientists noted that while many of the unexplained acute hepatitis cases around the world have also tested positive for adenovirus, this may not be the cause for the liver issues as adenovirus usually causes severe hepatitis in immunocompromised patients and these patients were healthy before experiencing hepatitis.
The scientists analyzed samples of the livers of the patients to see if there were signs that adenovirus had caused the damage to the organ, but did not find any antigens indicating adenoviruses nor any features suggesting hepatitis caused by an adenovirus. A number of other analyses of the liver tissue of other cases from around the world also failed to find any signs of liver damage caused by an adenovirus.
A number of possible mechanisms may cause liver injury during acute disease and after recovery from COVID-19, including direct viral damage, injuries caused by an aberrant immune response, restricted blood flow (ischemia), increased blood clotting (hypercoagulability state) and drug-induced injuries.
As none of the patients in the study had severe cases of COVID-19, the scientists stated that this suggested that the liver injury may have been caused by direct viral damage caused through the ACE2 receptor to which the SARS-CoV-2 binds and enters the cell.
Another possible mechanism that could have caused the liver damage is if the immune system either underreacted or overreacted to the infection. Autoimmune and auto-inflammatory diseases such as MIS-C have been reported in both children and young adults with long COVID-19, which could lead to liver disease.
Inflammation and an unusual immune response could also have impaired the health of the patients and led to disease in predisposed individuals. The second patient in the study had a systemic inflammatory syndrome called secondary hemophagocytic lymphohistiocytosis (HLH), which could support the theory that the liver injury was caused by an immune-mediated mechanism.
The scientists concluded that the most likely causes of the acute hepatitis were either a post-infection immune reaction like MIS-C or an abnormal immune response to the novel coronavirus which primed the body for other infectious agents like adenovirus.
