Hepatitis Outbreak Symptoms to Watch Out for in Your Child

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Editor’s Note: This story has been updated to distinguish two separate hepatitis outbreaks.

Seven children have been hospitalized in Cincinnati with mysterious hepatitis as another hepatitis A outbreak is investigated by the US Food and Drug Administration.

Since October, more than 200 cases of acute hepatitis of unknown origin have spread among children. An investigation to determine if the cases are related to COVID-19 is ongoing.

In addition, an outbreak of hepatitis A caused the Food and Drug Administration to exam two brands of organic strawberries for a possible link to the epidemic. In an announcement published this weekend, the FDA urged people who bought FreshKampo and HEB strawberries from March 5 to April 25 not to eat them. The warning includes berries that were purchased and then frozen.

Strawberries are sold at the following locations:

  • Kroger.
  • Aldi.
  • HEB.
  • Safeway.
  • Cabbage growers market.
  • Trader Joe’s.
  • Walmart.
  • Weis Markets.
  • WinCo Foods.

After:CDC investigates mysterious outbreak of severe hepatitis in 109 children

After:CDC seeks answers after 6 children die in hepatitis outbreak that has spread to 36 states

“If you don’t know what brand you bought, when you bought your strawberries, or where you bought them from before freezing them, the strawberries should be discarded,” the FDA added.

The outbreak is currently under investigation by the Centers for Disease Control and Prevention, the Public Health Agency of Canada and the Canadian Food Inspection Agency.

Hepatitis A is a viral infection that causes inflammation of the liver and sometimes leads to liver damage.

It is usually spread by contact with food or water contaminated by the stool of an infected person, according to at the National Institute of Diabetes and Digestive and Kidney Diseases. Food and water contamination can occur when an infected food handler prepares food without proper hand washing hygiene, according to the FDA.

A drawing of the digestive tract, with the liver shaded.  Hepatitis A is a liver disease.

The disease normally lasts only a short time and requires no treatment; most people recover without complications. But hepatitis A can lead to liver failure and even emergency liver transplantation in rare cases, according to the national institute.

Hepatitis A has become relatively rare in the United States since a vaccine, usually given to children aged 12 to 23 months, became available in 1995, according to the institute. But since 2017, the CDC has been monitoring widespread outbreaks of hepatitis A in 37 states, with the homeless, drug users, men who have sex with men and those currently or recently incarcerated most at risk.

Sixteen states, including Kentucky, have declared their outbreaks under control. Ohio is among 21 that have not, with nearly 3,800 cases since 2018. The number of cases was highest in these eight of the state’s 88 counties (in alphabetical order): Butler, Clermont, Cuyahoga, Franklin, Hamilton, Montgomery, Summit and Scioto.

What to look for in your child

Hepatitis of unknown cause found in children has been discovered in 36 states in the past seven months, according to the CDC.

Health experts have not yet understood why an increase in cases among children has occurred in recent weeks. It is not known if the outbreak is related to COVID-19.

Seven children were hospitalized with hepatitis at Cincinnati Children’s Hospital Medical Center during the outbreak, according to a recent report from the Cincinnati Department of Health’s medical director.

Dr. William Balistreri with a 2014 liver transplant patient at Cincinnati Children's Hospital Medical Center.

Dr. William Balistreri, director emeritus of the Cincinnati Children’s Pediatric Liver Care Center, said the outbreak shouldn’t cause parents to panic. He noted that there is an increased awareness of viruses since COVID-19, which has made it easier for health experts to identify unusual symptoms and illnesses and added that only a minority of cases have progressed to a serious illness.

“We’ve seen that and the question is, in the past, haven’t they come to our attention because they’ve recovered as they will without developing liver damage?” Balistreri said.

Although many cases of hepatitis do not progress to serious levels, Balistreri said parents should always be on the lookout for signs and symptoms of the unusual illness and seek immediate medical advice if they see one of the following:

  • Jaundice.
  • Yellow eyes.
  • Yellow skin.
  • Dark urine.

“It’s going to be a very rare manifestation, but those are definitely the types of cases we want to see and we want to see fairly early in the course so we can plan our strategies,” he said.

Other symptoms a child may experience related to the outbreak include:

  • Fever.
  • Respiratory symptoms.
  • Vomiting.
  • Gastrointestinal symptoms.
  • Diarrhea.

Rising virus awareness is a good thing, Balistreri said, adding it could lead to earlier detections.

“I’m glad (parents) are aware of this, it makes everyone’s job easier,” he said. “But I would definitely tell parents not to panic. This is a minority of cases that will progress to serious illness. But if they see any warning signs of serious illness, we should be alerted.”

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