Massachusetts confirms state’s first two cases of unexplained hepatitis in children

Dr. Rochelle Walensky, director of the Centers for Disease Control and PreventionAL DRAGO/NYT

Massachusetts is investigating two cases of pediatric hepatitis of unknown origin, the state’s first such cases since the Centers for Disease Control and Prevention issued a nationwide health alert April 21 asking doctors to look out for unexplained cases of liver damage in children.

States have been watching for the condition since October, when five previously healthy young children with significant liver injury were identified in Alabama. The CDC said Friday it was tracking 109 children in 25 states and territories with the condition. The World Health Organization has reported cases in at least 11 countries, including more than 100 cases in the United Kingdom and a dozen each in Spain and Israel.

Hepatitis, or inflammation of the liver, can be caused by viral infections, alcohol use, medications, or other medical conditions. However the most common viral causes of hepatitis — hepatitis viruses A, B, C, D, and E — had been ruled out in the initial clusters. Adenovirus, a group of viruses that are usually mild and often occur in children, had been detected in more than half of the reported cases in the United States, the CDC said Friday. Approximately 90 percent of the patients were hospitalized, and 14 percent received liver transplants. Five patients have died.

Massachusetts released few details about the cases, saying only that both children had tested negative for adenovirus infection.

The CDC has asked health departments to report cases of hepatitis in children under 10 with markedly elevated liver function tests that don’t have a known cause. Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice. Providers have been encouraged to test children with hepatitis for adenovirus when other more common causes of the condition have been ruled out.

Doctors said they have been watching for such cases.

“It’s still very uncommon, but in a child presenting in a constellation of symptoms that include those we see in acute hepatitis, we should be firmly thinking about this entity,” said Dr. Raymond Chung, director of hepatology at Massachusetts General Hospital and a professor of medicine at Harvard Medical School.

As of Monday, neither Massachusetts General Hospital nor UMass Memorial Health was investigating any cases. Tufts Children’s also said Tuesday that the hospital didn’t have any suspected cases at its hospital.