Acute hepatitis in children, of which more than 150 cases were detected in a dozen countries, raise questions in specialists, who still do not find an explanation to the cause of the disease and fear for a new epidemicbecause “the origin of these inflammations of the liver remains unknown,” the European Center for Disease Prevention and Control (ECDC) announced today.
The issue arose in the United Kingdom, which has the highest number of cases, with 114; Spain registered 13 cases; Denmark, 6; Ireland, 5; Netherlands, 4; Italy, 4; France, 2; Norway, 2; Romania, 1 and Belgium, 1, according to data from the World Health Organization (WHO).
Outside of Europe, Israel and the United States join the list with 12 and 9 cases, respectively.
“Affected children range from one month to 16 years old, but most are younger than 10 years old, and many are younger than five years old. None had any other illness and there was one death.“, detailed the AFP news agency.
At the moment, an infectious cause appears to be “most likely”, but no common link to a contaminated or toxic food has been established that can be identified, the ECDC reported.
“The rising number of children affected by sudden hepatitis is unusual and worrying,” said Zania Stamataki, from the Center for Liver and Gastrointestinal Research at the University of Birmingham.
Hepatitis is an inflammation of the liver, as a reaction to a virus, toxic or autoimmune or genetic diseases, its evolution is usually benign and its main symptoms -fever, diarrhoea, abdominal pain- resolve quickly or are weak and, sometimes, although is not so common, they can cause kidney failure.
The fact that some hepatitis affects children between one and five years of age surprises specialists as well as the need, in some cases, for a transplant.
In addition, the usual viruses that cause acute viral hepatitis (from A to E) were not detected in any of the cases, indicated the ECDC and the WHO.
What clues do the specialists have?
Meanwhile, among the possible clues considered by the specialists, are adenoviruses, since they were detected in at least 74 children, of which 18 adenoviruses of the so-called “type 41” were detected.
“Adenoviruses are banal and well-known viruses that generally cause respiratory symptoms (bronchitis, pharyngitis, etc.), eye symptoms (conjunctivitis) or digestive problems (gastroenteritis) and most humans are infected by these viruses before the age of five.“, indicated the specialists.
Several countries, including Ireland and the Netherlands, reported increasing circulation of these adenoviruses.
However, its “role” in the development of hepatitis is unclear and adenovirus 41 “is not known to cause hepatitis among healthy children,” WHO specialists noted.
Adenoviruses are commonly transmitted by close personal contact, respiratory droplets, and surfaces. There are more than 50 types of adenoviruses, the ones that most commonly cause colds, but also many other illnesses
Is the new hepatitis related to COVID 19?
Among the main hypotheses is the possibility of a relationship with COVID 19, detected in 20 of the children, while another 19 showed a coinfection of covid and adenovirus. “If those hepatitis were caused by COVID, it would be very surprising if they weren’t much more numerous given the strong circulation of Sars-Cov2,” said Graham Cooke, an infectious disease specialist at Imperial College London.
Finally, the relationship with coronavirus vaccines was ruled out: “the vast majority of affected children were not vaccinated,” the WHO concluded.
Case studies in the United States
In the southern United States, there are about 170 similar cases detected in eleven countries in recent weeks, said the US Centers for Disease Control and Prevention (CDC) and WHO.
The new CDC article deals specifically with the cluster tested in Alabama, even as investigations continue across the country. The US health authority highlighted that nine young children affected by mysterious cases of hepatitis in this southern state, tested positive for the pathogen adenovirus 41, which would explain these serious inflammations of the liver, while in Wisconsin, a fatal case is being investigated.
“At this time, we believe that adenovirus may be the cause of these reported cases, but other potential environmental and situational factors are still being investigated.”the agency said in a statement that accompanied the study, according to the AFP news agency.
Adenovirus 41 is known to cause gastroenteritis in children, but is “not generally known to cause hepatitis in otherwise healthy children,” according to the CDC.
The nine Alabama cases occurred between October 2021 and February 2022. Three experienced acute liver failure, two of which required liver transplants.
Before hospitalization, most of the children had vomiting and diarrhea, while some had upper respiratory symptoms. During hospitalizations, most had yellow eyes and skin (jaundice) and had enlarged livers.
Hepatitis.
“All patients have recovered or are recovering, including the two transplant recipients”indicated the study.
Six tested positive for Epstein-Barr virus but did not have antibodies, implying prior, non-active infection. Last week, the CDC issued a health alert to notify doctors and public health authorities on the lookout for similar cases.
The CDC recommends that children be up to date on their immunizations and that parents and caregivers take preventive actions such as hand hygiene, avoiding sick people, covering coughs and sneezes, and avoiding touching your eyes, nose, or mouth.