Mysterious cases of hepatitis in children in several countries

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Cases of acute hepatitis infection in young children have been reported in many countries. The trigger is not yet known – experts suspect a virus.

Update on Tuesday, April 19, 2022: The UKHSA has reported several cases of unexplained hepatitis in children in Great Britain (see first report), and the World Health Organization (WHO) is aware of several cases in Ireland and Spain (see update from 15 April 2022). There appear to be cases of unexplained hepatitis infection in children in the United States as well, but these cases have not yet been formally linked to cases in Europe.

The Alabama Department of Health and Human Services (ADPH) issued a statement on April 15, 2022 announcing that it was investigating an “increased incidence of hepatitis in young children.” Nine children under the age of 10 in different areas of the state were treated for gastrointestinal symptoms and “varying degrees of liver damage including liver failure”. The agency said that subsequent analysis revealed a possible link between this hepatitis infection and adenovirus 41. All nine children tested positive for adenovirus, and two of them required a liver transplant. The children had no previous health problems. No possible coronavirus infection for children was mentioned in the letter.

Unusual cases of hepatitis in young children: There are also cases in the USA

The US CDC is working with the Alabama Health Authority on the cases, which they say have also been “discussed with international colleagues.” And the American Stat News portal quoted a statement issued by the authority that they are also working with health authorities in other states “to find out if there are other cases in the United States and what are the causes of these cases.” While cases in Europe are also suspected that MERS could be related to hepatitis infection in children, adenovirus is more suspected in the USA. “Currently, adenovirus could be the cause of these cases, but investigators are still learning more — including ruling out more common causes of hepatitis,” the statement said.

Hepatitis infection can have serious consequences. The disease is now on the rise in children in the UK and other countries. © dpa / Angelica Warmott

WHO urges vigilance: identifying potential cases of hepatitis in children

Update from Friday, April 15, 2022: After 74 children in Great Britain developed acute hepatitis infection and the hepatitis virus was undetectable, the World Health Organization has now drawn attention to the case in a statement. 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 unclear 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.

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.

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

“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. Among other things, this indicates 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 of whom 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 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 didn’t really worry us, but they 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 must 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 originally caused it — such as an upper respiratory infection — can occur, Roddick continues. (tab)

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