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Nebraska health officials report 9 cases of liver illness in children | Health and Fitness

Nebraska health officials Friday reported that they are investigating nine cases of unexplained hepatitis in young children, including two in Douglas County and two in the health district that covers Sarpy and Cass counties.

The Nebraska cases are among a total of 109 such cases in 25 states and territories under study by the federal Centers for Disease Control and Prevention dating back to October, agency officials said Friday.

Worldwide, well over 200 cases have been reported in at least 20 countries, according to the World Health Organization. 

In the U.S., more than 90% of children with the condition had to be hospitalized, said Dr. Jay Butler, the CDC’s deputy director of infectious diseases. Of them, 14% required liver transplants and five have died. More than half had a confirmed infection with an adenovirus that commonly causes cold-like illnesses and gastrointestinal symptoms. 

Butler noted that adenovirus has not been confirmed as a cause. While rare, children can develop hepatitis, an inflammation of the liver with a range of causes, and it’s not uncommon for the cause to be unknown.

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Based on a preliminary analysis with limited data, he said, the agency has not identified a significant increase in pediatric hepatitis or liver transplants in the U.S. The United Kingdom, however, does appear to have had an increased number of cases.

The cases the agency is reviewing date back seven months, he said, and some ultimately may not be linked to the investigation.

“It’s important to note that this is an evolving situation,” Butler said, “and we’re casting a wide net to help broaden our understanding.”

The nine Nebraska cases were identified between Nov. 5 and March 6, according to the Nebraska Department of Health and Human Services. The patients ranged in age from 1 to 9, with a median age of 2. Three tested positive for adenovirus. No liver transplants or deaths have been identified.

Lindsay Huse, director of the Douglas County Health Department, said the notification should be more of an alert to parents to keep an eye out for symptoms of hepatitis than a cause for alarm. 

Both of the children in Douglas County were hospitalized but have since been released, Huse said.

“This probably seems really scary to parents to hear about,” she said. “But it’s important to keep in mind it’s very rare.”

Parents should contact their child’s doctor if they notice jaundice or yellowing of the skin or eyes. Other symptoms may include abdominal pain, vomiting, dark urine or clay-colored stools.

Health care providers who see children under age 10 with hepatitis of unknown origin should notify their local health department.

To prevent the spread of the adenovirus, people are urged to wash their hands frequently, cover coughs and sneezes and avoid touching eyes, mouths and noses.

The first reported cases in the U.S. were in Alabama in October. The CDC issued an alert a little more than two weeks ago outlining nine cases in that state through February. All nine children previously were healthy and all nine tested positive for adenovirus, with five having a specific strain called adenovirus 41.

That type of adenovirus typically causes more severe stomach illness but is not usually known as a cause of hepatitis in otherwise healthy children, Butler said.

Based on initial investigations in the U.S. and abroad, none of the common causes of viral hepatitis, hepatitis viruses A, B, C, D and E, have been found in any of the cases.

None of the nine children initially identified in Alabama had COVID-19 during hospitalization or a documented history of COVID. And none of the children in Alabama had received the COVID vaccine before they were hospitalized. The mean age is 2, so most of the children were not yet eligible for the shots.

“COVID-19 vaccination is not the cause of these illnesses, and we hope this information helps clarify some of the speculation circulating online,” Butler said. 

Meanwhile, investigators in the U.S. and abroad continue to investigate a variety of possible causes, including environmental causes, exposures to animals or even reactions to the adenovirus itself.

Said Dr. Umesh Parashar, head of the CDC’s division of viral diseases enteric viruses epidemiology team, “It’s still early days in terms of pinpointing the cause and the mechanism of illness in these children.”


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