WHO calls for vigilance: unexplained cases of hepatitis in children

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An unusually high number of children in the UK develop acute hepatitis B infection of unknown cause. Cases have also been reported from other countries.

Update on Friday, April 15, 2022: After 74 children in Great Britain became acutely infected with hepatitis and the hepatitis virus could not be detected, the World Health Organization has now drawn attention to the case in a letter. The organization also says that “fewer than five cases (confirmed or probable)” have been reported in Ireland and are being investigated further. Three confirmed cases of acute hepatitis were reported in children aged 22 months to 13 years in Spain. The national authorities are currently investigating these cases.

It is not clear if there is a link to the SARS-CoV-2 coronavirus, which has been detected in some young patients in Great Britain. Adenoviruses have also been detected in some children, and none of the children has been vaccinated against Corona so far.

Hepatitis infection can have serious consequences. In the UK, the disease is now on the rise among children. © dpa / Angelica Warmott

WHO urges vigilance: identifying potential cases of hepatitis in children

In its announcement, the World Health Organization also added more information about cases of hepatitis from Great Britain: the symptoms of the children were digestive problems and jaundice, as well as significantly increased liver enzymes. Six of the children in the UK required a liver transplant due to hepatitis. The World Health Organization is now calling on all countries to be vigilant to detect possible cases.

Unusually high incidence of hepatitis in children in the UK

First report from Thursday, April 14, 2022: LONDON – There is currently an unusual backlog of cases of acute hepatitis in children in Great Britain. Since January, 74 cases – mostly of children between the ages of two and five – have been investigated. “Hepatitis, that is, inflammation of the liver, is actually very rare in children and is classically caused by known hepatitis viruses,” explains pediatric gastroenterologist Burkard Roddick, who is the general secretary of the German Society of Pediatrics and Adolescents (DGKJ). . However, hepatitis viruses have not been found in any of the cases being investigated in Great Britain, and the cause of hepatitis remains unclear.

“Mild hepatitis is very common in children after a series of viral infections, but what we are currently seeing is very different. In children, the inflammation is more severe, and in some cases leads to liver failure and the need for a transplant,” explains Graham Cook, an infectious disease specialist at Imperial College London.

Unusually high incidence of hepatitis in children in the UK

In addition to the well-known hepatitis viruses, other viral diseases can also affect the liver — such as Epstein-Barr viruses, cytomegaloviruses, or adenoviruses, Rodeck lists. The doctor asserts that “an association with Sars-CoV-2 is theoretically possible, but not very plausible.” The UKHSA also rules out vaccination against corona as a cause of hepatitis cases. “None of the currently confirmed cases in the UK have been vaccinated,” she said in a statement.

“One of the possible reasons we are investigating is that this is associated with adenovirus infection,” said Mira Chand, director of clinical and emerging infections at UKHSA. However, other potential causes – including coronavirus, other infections, and environmental causes – are also being investigated. “If adenovirus is suspected, the same precautions should be taken as with other viruses, such as washing hands and using alcohol-based sanitizers to prevent the spread of the virus,” explains hepatologist Simon Taylor Robinson of Imperial College London.

Unexplained hepatitis cases: children with acute liver failure and liver transplantation

The European Health Agency (ECDC) has also published a statement on previously unexplained cases of hepatitis in children in Great Britain. This indicates, among other things, that some of the cases examined in children led to acute liver failure, which made it necessary to transfer them to specialized pediatric liver wards. Few children have had liver transplants, according to a CDC report. Some sick children who were taken to the hospital tested positive for coronavirus, others had an adenovirus. So far, she added, there is no clear link between the reported cases and no connection with travel.

So far, 74 children have been infected in Great Britain – 49 live in England, 13 in Scotland, and 12 in Wales or Northern Ireland, according to the NHS. The NHS and ECDC now rely on the help of pediatricians, medical staff and parents. They should help identify other sick children as soon as possible so that they can be treated quickly and properly. They also hope to track down the cause of the unusual buildup of hepatitis infections.

Hepatitis is an inflammation of the liver, caused mostly by hepatitis viruses.
Hepatitis is an inflammation of the liver, caused mostly by hepatitis viruses. © IMAGO / Science Photo Library

Hepatitis in children: Parents should pay attention to the symptoms of jaundice

Chand stresses that parents should also pay special attention to symptoms of jaundice, which can accompany hepatitis infection. The yellow house is easy to identify by the white of the eye. The NHS recommends that parents contact medical staff if they have concerns. Taylor Robinson wants to reassure parents: “At the moment, there doesn’t seem to be cause for public concern because the numbers are small. If parents are concerned about their children’s symptoms, they should contact their GP.”

In its letter, the European Health Agency called on clinics across the European Union to report cases of acute and severe hepatitis in children to national health authorities if hepatitis A to E has been excluded. “The case numbers from Great Britain did not really worry us, but she told us so,” explains DGKJ Secretary General Roddick. “The corresponding observations in Germany are not yet known, but we are investigating this matter in more detail. We have to take this seriously,” emphasizes Roddick. His organization initiated an inquiry about similar cases in Germany.

Symptoms of hepatitis in children: Are they related to relief from the Corona virus?

The doctor has an assumption about the source of the inexplicable build-up of hepatitis infection in children in Great Britain: “It is more likely that with the dilution 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 germs,” warns the organ pathologist Children’s digestive system that this scenario can also be seen in Germany with severe relief.

According to Rodeck, symptoms of hepatitis in children can be varied:

  • Nausea/vomiting
  • Yellowing of the skin (jaundice).
  • Diarrhea
  • stomach pain
  • exhaustion
  • fever
  • Anorexia

In addition, symptoms of the viral illness that caused it — such as an upper respiratory infection — can also occur, Roddick continues. (tab)

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