Scientific discovery, not politics, can find the cause of the pediatric hepatitis outbreak

Real science involves a discovery process that evolves and changes direction based on emerging facts. Unfortunately, science itself has been injured during the pandemic by self-glorifying prophets, dogma and politics. 

Luckily, not all scientists have been infected with this situational narcissism. The Centers for Disease Control and Prevention’s disease detectives, also known as the Epidemic Intelligence Service, have resisted any attempt at self-glorification. This is the greatest epidemiological training program in the country, and many of our future health leaders arise from it. These are the unsung heroes who have helped track and battle the Ebola outbreaks in Africa and our own epidemics of obesity, heart disease and cancer here. They have been at the heart of the two-year battle to track and control COVID-19 both here in the U.S. and overseas, even if their efforts have been submerged beneath the constant politics and politicking which has obscured and undermined the spectacular evolving science.

You want to see more science in action? Presently EIS is investigating the strange hepatitis outbreak in 24 states and one territory (Puerto Rico) in the U.S. (over 100 children) and over 20 countries around the world, mostly involving young children, and leading to liver transplant in 14 percent of cases in the U.S. Close to 300 probable cases involving children and young teens have been reported worldwide with many more suspected, with most of the afflicted landing in the hospital, and the cause is still unknown. Parents everywhere are scared and despite the rareness of the disease they are on the lookout for symptoms in their children including fatigue, muscle aches, yellow eyes (jaundice), brown urine and light-colored stool. 

Adenovirus 41 is common a DNA virus that has been found in the blood in a majority of the cases. It does affect young children, generally causing acute gastroenteritis but not hepatitis or liver failure. It is possible that the virus has mutated or has catalyzed liver inflammation, but this has yet to be shown.

There are clues to causation, and the CDC disease detectives and other infectious disease and liver sleuths around the country and in the United Kingdom and Europe are assembling them.  For one thing, the adenovirus is not found in all the cases and since there are small clusters that are not spreading widely, it is quite possible that this virus alone isn’t the answer.

Dr. Simon Horslen, director of hepatology at the Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center, one of the top institutions for liver transplants in the world, told me on Doctor Radio Reports on SiriusXM this week that reports from the U.K. and the U.S. appear to show inflammation in the liver but not the presence of the adenovirus in liver cells. This could mean that the virus is triggering an autoimmune response, perhaps because of a co-factor like prior COVID or because the patient’s own immune system isn’t responding properly to the virus. Young children are exposed to a multitude of viruses every day, it would be a tragic irony if these cases are resulting from the pandemic shutdowns and closures where there is an immune dysregulation from delayed exposure to common viruses.

This past Friday Dr. Jay Butler, the CDC’s deputy director for infectious diseases, said that the CDC was certain that COVID vaccination is not the cause of these illnesses, and in fact, most of the children here who have gotten ill are too young to have been vaccinated. Adenoviruses commonly cause hepatitis in dogs, and Butler mentioned that animal exposures are being investigated as a majority of infections (according to a questionnaire) came from households with dogs. But CDC spokesperson Kristen Nordlund told me “adenovirus continues to be a strong lead, and the identification of that virus as a connection is what prompted this investigation.”

Examination of liver tissue from sick children, both from biopsies as well as livers that have been removed, will provide more important clues, as will viral surveillance (adenovirus) in areas where the clusters have occurred. Adenovirus infections generally strike in the fall not the spring, and adenovirus infections have not generally been reported to health departments before. 

In any case, science will figure this out, not via debate or social media barrage, but by careful investigation. We can only hope that the final answer saves many children from acquiring this severe disease or finding a way to treat them if they do.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”