As of the first week of June, 275 young children across 39 states have developed hepatitis — inflammation of the liver. Georgia has under 10 known pediatric cases and public health officials cannot yet pinpoint the cause. GPB’s Ellen Eldridge reports.

A young girl reads in bed

Children’s hospitals in Atlanta are participating in ongoing studies to identify the cause of an outbreak of hepatitis with unknown etiology.

Credit: Pexels

Several children in Alabama, who were diagnosed last October with severe acute hepatitis, or inflammation of the liver, needed liver transplants.

But public health officials say these infections come from an unknown origin.

Case numbers grew slowly but steadily over recent months, with fewer than 10 young children in Georgia having now been infected, Georgia Department of Health epidemiologist Dr. Cherie Drenzek said.

"As of June 8, this past week, we have a total of 275 children here in the U.S. that have had acute hepatitis of unknown etiology, and it's in 39 different states," Drenzek said. "We have less than 10 of them here in Georgia and, in total, out of those 275, there have been nine children that have actually died."

Drenzek said almost all of the affected children had to be hospitalized, and 15% needed liver transplants.

"And the median age is 2 years old," she said. "So, very young children."

While the cause of hepatitis in these children still remains definitively unknown, evidence is accumulating that an adenovirus infection is playing a role. But there may be other cofactors as well.

Adenovirus type 41 is primarily spread via the fecal-oral route and predominantly affects the gut. It is a common cause of pediatric acute gastroenteritis typically with diarrhea, vomiting and fever, often accompanied by respiratory symptoms.

But adenovirus is not usually known as a cause of hepatitis in otherwise healthy children, and no known epidemiological link or common exposures among these children has been found, according to the Centers for Disease Control and Prevention.

Some potential causes of these mysterious pediatric hepatitis cases have already been ruled out, including:

  • hepatitis viruses A, B, and C
  • SARS-CoV-2 infection
  • autoimmune hepatitis
  • Wilson disease

Although liver transplants are well-documented, cases of hepatitis of unknown etiology are not reportable in the United States, the CDC said in its June 14 Morbidity and Mortality Weekly Report.

This analysis assessed trends using electronic health data on pediatric hepatitis of unspecified etiology as a proxy, but the exact baseline remains unknown, as does the accuracy and completeness of the diagnostic codes used for identification.

"We don't really have a good baseline (to assess), 'Is this really way higher than it should be?' You know, that's the true mark of an outbreak," Drenzek said.

Drenzek said children’s hospitals in Atlanta are participating in ongoing studies to identify the cause of this outbreak.

Tags: Hepatitis  Georgia  Atlanta