April 5, 2023

In The News: Possible Culprit Identified in Outbreak of Severe Liver Damage Cases in Children

Research from Nature and reported on by NBC News identifies the possible suspect behind cases of severe acute hepatitis and liver failure in children that began occurring in late 2021. The CDC investigated 390 cases, with around 1,000 cases identified worldwide, according to the WHO. In 93% of the cases investigated, adeno-associated virus 2 (AAV2) was detected, despite it lacking an association with illness.

Researchers noted that AAV2 needed other infections to infiltrate liver cells. In a majority of the 16 U.S. cases of children with severe hepatitis, patients had what authors called “an unexpected finding.” The children were found to be infected with three or four common viruses simultaneously. Three-quarters of the cases showed evidence of at least three viruses, about a third of those cases had evidence of four.

Adenovirus type 41, a previously identified suspect, was among the range of viruses detected. Researchers also found a herpes virus, an enterovirus and Epstein-Barr. No multiple viruses were found in the study’s control group. This study joins two preprint studies from last year in finding the AAV2 in pediatric patients with severe hepatitis.

COVID-19 – nor its vaccines – have been implicated in the cases. The pandemic, however, has likely abetted the cases. At a critical time in childhood immune system development, children worldwide were out of school and other community environments where viruses circulate. Once that came to an end, exposure to multiple viruses at once befell kids.

Lessons from this event are already being added to physician toolkits. Adenovirus screening for children with liver inflammation has been instituted at the hospital noted in the article, and understanding potential causes of such cases can help doctors into the future prevent and treat infections.

PIDS member Ibukun Kalu remarked it was not uncommon to see children with several viruses at the same time and cautioned, “historically nonpathogenic viruses are now becoming pathogenic when they combine or are present with some other virus.”

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