Addressing the reported global increase in hepatitis cases in children, interim Chief Medical Officer Dr. Autilia Newton said Cayman needs to be “aware” but “not alarmed”.
Public Health surveillance is under way locally “as a precautionary measure”, she said.
She confirmed no cases of the severe acute hepatitis noted by the World Health Organization have been detected in children in the Cayman Islands.
However, she says the current findings on the increased presence of acute hepatitis in children outside Cayman are extremely limited.
“As we await more details from governing medical bodies such as the WHO, ECDC (European Centre for Disease Prevention and Control) and UK HSA, we advise parents to remain aware, but not to be alarmed,” Newton said in an emailed statement in response to Cayman Compass queries.
The World Health Organization is monitoring the situation after a rise in cases in children, particularly in the United Kingdom.
So far, there are an estimated 348 cases under investigation across 36 countries, the latest being Canada and Indonesia.
As of 16 May 2022, there have been 197 cases in the UK and 180 in the US.
The origin is unknown, the WHO reported, which added that studies are ongoing.
“It is not yet clear if there has been an increase in hepatitis cases, or an increase in awareness of hepatitis cases that occur at the expected rate but go undetected. While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent,” the WHO said in a report on its website.
According to the WHO, confirmed cases are aged from 1 month to 16 years old; 17 children have required liver transplants.
At least one death has been reported, the WHO said in its latest surveillance report.
Specialist paediatrician and neonatologist Dr. Siobhan Jaques, at Integra Healthcare in Cayman, has written about the increase in cases.
She said there is a lot that’s not understood at the moment about the spread of the illness, “but we know that there are increasing reports of acute hepatitis in children, which is quite unusual up until now”.
However, she said the numbers are still very low, so this isn’t something to panic about.
“It’s just to be aware of the symptoms that need to have further investigation and just to see your paediatrician, if at all,” she explained.
What is acute hepatitis?
Dr. Leandro Soares Sereno, Advisor for Viral Hepatitis Prevention and Control at the Pan American Health Organization (PAHO,) in a PAHO FAQ, explained that hepatitis is an inflammation of the liver.
“There are different aetiologies – or causes – that can lead to this inflammation, such as an infection or intoxication by drugs or substances. The most frequently implicated infectious agents are the viruses responsible for hepatitis A, B, C, D and E. When inflammation occurs rapidly and abruptly, we speak of acute hepatitis. In some cases, as in hepatitis B, C and D, the infection may become chronic. In this situation, we are not yet sure of the cause,” he wrote.
He pointed out that based on current information, “most of the reported children did not receive the COVID-19 vaccine, ruling out a link between cases and vaccination at this time”.
In a few cases, however, he said the presence of the SARS-CoV-2 virus was detected, “and this is one of the lines of investigation along with others, such as the adenovirus”.
Jaques of Integra Healthcare explained that pediatricians are used to seeing adenovirus, because it’s a relatively common virus for children to have in early childhood.
“But we’re not used to adenovirus making children very sick and certainly not causing acute hepatitis. So the adenovirus normally causes a bit of a runny nose, can also have a cough and some disturbance of the gut, like diarrhea or vomiting, but it’s usually short lived and children clear the viral infection by themselves and fully recover,” she said.
What are the symptoms?
CMO Newton said symptoms of acute hepatitis include diarrhea, vomiting, jaundice (yellowing of the whites of the eyes and skin) and gastroenteritis.
“Patients suspected of having hepatitis will be identified via relevant blood testing,” she added.
Jaques said she has seen some concerned parents who have brought their children for check-up wondering whether they have hepatitis, “which was absolutely the right thing to do”.
She said she did not see it any of those children.
Soares Sereno said the current treatment for acute hepatitis “seeks to alleviate symptoms, and to manage and stabilize the patient if the case is severe. Treatment recommendations can be refined once the origin of infection is determined”.
Jaques added that mostly hepatitis is something that’s short-lived and it gets better by itself.
“The main treatment is supportive and by that we mean supporting the rest of the body, so supporting nutrition, supporting blood pressure, supporting the rest of the organs and trying to minimise any further inflammation in the body. But sometimes that supportive treatment is not enough and actually there have been children who have needed to have very intensive care around this and some children have gone on to need liver transplants,” she said.
What can parents do?
Jaques advised parents who may be concerned about their child to visit their pediatrician, who will know what to look out for and can give an objective assessment.
“If your child is complaining of pain in their tummy and especially under the rib cage, or certainly, if your child has any discoloration of the whites of their eyes. So if you notice any jaundice… yellow discoloration of the skin or the whites of the eyes, absolutely come and bring your child to the pediatrician straight away. Just be more aware if your child has any of the diarrhea and vomiting symptoms,” she said.
Jaques reminded that hand washing and hygiene is key to preventing the spread of illness.
“We’re all so used to talking about that now because of COVID, but actually lots and lots of childhood infections are transmitted by droplets, and hand washing is really important at all times, but especially before eating.
“If your child has had diarrhea and vomiting, please make sure that they’re kept away from school or nursery or childcare settings for 48 hours after symptoms, because you can still be contagious with any childhood bug during that time. So it’s really important to prevent the spread,” she said.
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