More and more cases: hepatitis in children is still a mystery

More and more cases
Childhood hepatitis remains a mystery

In the past few weeks, a severe strain of hepatitis has been identified in more than 150 children in 11 countries. At least one child dies from the infection. In the meantime, more and more information is being provided about cases with the authorities. What we know and what we don’t know.

How many special cases of hepatitis can be assumed?

According to the World Health Organization (WHO), 169 cases of acute hepatitis in children in 11 countries are known to date. The World Health Organization said at the weekend that at least one child had died of hepatitis, and that 17 children needed a liver transplant. WHO experts said it was not yet clear “whether there has been an increase in hepatitis cases or an increase in awareness of hepatitis cases that are occurring at the expected rate but are undetected”.

When did the first infections appear?

Myra Chand said doctors reported the first five cases in Scotland on March 31. The Director of Clinical and Emerging Diseases at the British Health Agency gave an emergency presentation on development at the European Conference on Clinical Microbiology and Infectious Diseases on Monday. Doctors had immediately realized that this buildup was unusual. The normal rate in Scotland is about five cases of hepatitis in children each year.

What countries have been affected so far?

The World Health Organization said in its update that the United Kingdom has reported 114 cases so far. Spain has the second highest number of cases at 13, followed by Israel with 12 and the United States at 9. Low infection numbers were also recorded in Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania and Belgium. Affected children ranged in age from one month to 16 years. However, in most cases, they are less than 10 years old, and many are under the age of five. There may be other infections that have not yet been identified.

What are the symptoms experienced by the patient?

The vast majority of children have no pre-existing diseases. Before the children showed signs of acute hepatitis, they had symptoms such as jaundice, diarrhea, vomiting and abdominal pain, but no fever. During the emergency presentation, the cases are “really concerning,” said Ekaterini Mojko, an expert on antimicrobial resistance at the European Center for Disease Prevention and Control (ECDC).

What do you know about the virus strain?

None of the five known hepatitis viruses A, B, C, D and E can be detected in children, according to Shand. Because the cause of infection is not yet known, the route of transmission is still unknown. “We don’t know the route of transmission and we don’t know how to prevent and treat it,” Mojko said.

What is the origin that experts suppose?

Hepatitis is inflammation of the liver and is generally rare in healthy children. According to the World Health Organization, international travel or trips to certain countries will be excluded according to the information currently available. Chand also said there is no link to acetaminophen, which overdoses can lead to liver failure. Any link to the administration of the corona vaccines was also ruled out, because most children were not old enough to be vaccinated. The most likely explanation so far is that adenoviruses are involved. It is spread through close personal contact, coughing or sneezing, and touching contaminated surfaces. 75 per cent of children with hepatitis in the UK have tested positive for adenovirus. According to infection expert, Chand, among children aged one to four years, comparison of five-year adenovirus infection is currently at its highest. According to the World Health Organization, there have been similar observations in Ireland and the Netherlands.

How can this link be explained?

Adenoviruses are common viruses that cause a range of illnesses including the common cold, bronchitis, and diarrhea. However, most of them do not lead to serious diseases. It is possible that a combination of the natural adenovirus with another factor may make the disease more severe. Experts suspect that young children in particular have not built up sufficient immunity to adenoviruses as a result of the coronavirus measures. A mixture of adenovirus and Sars-CoV2 can also be visualized. This can happen, for example, if the adenovirus encounters an existing or previous corona infection. SARS-CoV-2 has been identified in 20 out of 169 known cases of hepatitis. Co-infection of Sars-CoV-2 and adenovirus was detected in 19 cases.

What to do now?

Since adenovirus is a contagious disease, children in particular should wash their hands regularly and carefully. Doctors should pay more attention to signs of jaundice in children. The World Health Organization recommends blood tests. Urine, stool, and respiratory samples are also taken, as well as liver biopsies. Other infectious and non-infectious causes should also be thoroughly investigated. The priority, according to the World Health Organization, is to identify the cause of these cases in order to further improve control and prevention measures.

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