What is the reason for the unusual increase in cases of hepatitis in children? An overview of the current state of knowledge.
FRANKFURT – The warning came first from Great Britain: The UKHSA reported in mid-April that an unusual backlog of hepatitis cases in mostly young children was being investigated. The European Health Agency, ECDC, then asked clinics in the European Union to report unusual cases of hepatitis in children to health authorities.
Many other cases are now known worldwide. ECDC contact from the end of April reached nearly 200 affected children. But what is unusual about hepatitis? What assumptions does research follow and what symptoms should parents look for in their children? An overview of the current state of knowledge:
What is hepatitis and why are the cases uncommon in children?
Hepatitis is inflammation of the liver that can result from a number of causes. These include toxic substances such as alcohol or some medications. However, the most important causes are viruses, which can lead to viral hepatitis A to E. But in reality, hepatitis viruses have not been detected in sick children, which makes cases unusual.
Graham Cooke, Professor of Infectious Diseases at Imperial College London, points out that “mild hepatitis is very common in children after a series of viral infections, but what we see at the moment is very different. Children have more severe inflammation, which in some cases leads to Liver failure and the need for a transplant.
What are the symptoms of hepatitis in children?
Many affected children had gastrointestinal symptoms (vomiting, diarrhea, abdominal pain) at the onset of hepatitis, followed by jaundice (yellowing of the skin or eyes). They also have very high levels of liver enzymes, which are a sign of liver inflammation or damage. “The chance of a child contracting hepatitis is very small,” said Mira Chand, UKHSA Director of Clinical and Emerging Infections. “However, we continue to urge people to look for signs of hepatitis — particularly jaundice, which is easy to recognize as yellowing of the whites of the eyes — and to contact their doctor if they are concerned.”
- Possible symptoms of hepatitis:
- Yellowing of the skin/eyes (jaundice).
- stomach pain
Where have unusual cases of hepatitis been reported and how are children doing?
To date, most cases of atypical hepatitis in children have been reported in Great Britain. However, there are now also cases in Germany, Austria, Belgium, Denmark, France, Ireland, Israel, Italy, Japan, the Netherlands, Norway, Poland, Romania, Spain and the USA, according to a European Center for Disease Control and Prevention report.
According to the World Health Organization (WHO), most children should make a full recovery – although some cases of hepatitis have been very severe. Approximately ten percent of reported cases have resulted in children needing a liver transplant. According to the World Health Organization, the children affected are between the ages of one month and 16 years. So far, there has been one death in the United States, and the deaths of three children in Indonesia are currently under investigation.
What causes unexplained cases of hepatitis in children?
So far, the cause of unusual cases of hepatitis in children is not clear, but the doctors involved have already managed to rule out some possible causes:
- Hepatitis viruses: Hepatitis A to E viruses have not been found in children, so they are not the cause.
- Corona vaccination: A large proportion of children (including all infected children from Great Britain) have not been vaccinated against coronavirus – so vaccination can be ruled out as a cause of hepatitis.
- Corona infection: According to the World Health Organization, only 20 out of 169 patients tested positive for the coronavirus. The researchers hypothesize that SARS-CoV-2, if present, is indirectly related to cases of hepatitis.
Researchers currently suspect an adenovirus is behind the unexplained hepatitis infection. Adenoviruses are common and often cause symptoms of the common cold, but they are not usually associated with hepatitis in healthy children. However, of the 169 cases listed by the World Health Organization in a recent report, at least 74 of the children had adenovirus infection. 18 of the children were infected with type 41 adenovirus, which usually causes digestive problems and breathing difficulties.
According to the World Health Organization, the number of adenovirus infections is increasing in Great Britain. Adenovirus was detected in 75 percent of confirmed cases of hepatitis in Great Britain, the British Health Authority said in a statement, adding that there was a marked increase in adenovirus infections, especially in the age group up to four years.
Cases of hepatitis in children: is it behind an adenovirus?
But the explanation that adenovirus could be responsible for the infection is not one hundred percent correct: not all children have been tested positive for the virus. Additionally, while adenovirus can cause hepatitis, symptoms are more common in people who are immunocompromised—and children were previously otherwise healthy. Is there a new strain of adenovirus that causes hepatitis infection, or did the infection originate from an adenovirus interacting with another risk factor? Researchers are currently studying several scenarios; Among other things, they look for things that the children have in common – were they exposed to a toxic load or were they all traveling in the same area?
The adenovirus infection present in many children is also likely to be misleading, the New York Times reports – citing Richard Malley, an infectious disease specialist at Boston Children’s Hospital: “Someone can be infected with adenovirus and then develop hepatitis because of something else. You Really need a lot of data to prove causation, which we simply don’t have.”
Is the corona epidemic related to hepatitis cases?
Perhaps the Corona virus is not directly related to the unusual cases of hepatitis in children, as only a small number of patients have been confirmed to be infected with Corona. However, contact cannot be completely ruled out – the coronavirus often surprises with new symptoms. However, experts can imagine that the epidemic has an indirect relationship to hepatitis. Pediatric gastroenterologist Burkard Roddick explains it this way: “It is likely that with the easing of restrictions in Great Britain, more and more children and young adults will come out of isolation in a relatively short time and will suddenly be exposed to many more germs that they have not been exposed to before due to the lockdowns various or other recently contacted actions in this abundance.”
The British Health Authority also suspects that Corona’s measures could make children more vulnerable to viruses. However, there is no confirmation of this theory yet. “We’re just getting started,” Richard Malley told the New York Times. It’s hard to predict whether hepatitis infection will become more common, “or whether it’s just a small glimpse into our history of infectious diseases in 2022.” (Tab)