What is the reason behind the unusual increase in hepatitis cases in children? An overview of the current state of knowledge.
Frankfurt – The warning came first from Great Britain: A unusual accumulation of hepatitis cases in predominantly young children will be examined in the country, the British health authority UKHSA reported in mid-April. The European health agency ECDC called for clinics in the EU prompted them to report unusual cases of hepatitis in children to the health authorities.
Numerous other cases are now known worldwide. One ECDC Communication from the end of April comes to almost 200 affected children. But what is so unusual about hepatitis diseases? What assumptions does research follow and what symptoms should parents look out for in their children? An overview of the current state of knowledge:
What is hepatitis and why are cases so uncommon in children?
Hepatitis is an inflammation of the liver that can be triggered by a number of causes. These include toxic substances such as alcohol or certain medications. However, the most important causes are viruses, which can trigger viral hepatitis A to E. In fact, however, no hepatitis viruses were detected in the sick children, which makes the cases unusual.
Graham Cooke, Professor of Infectious Diseases at Imperial College London, points out: “Mild hepatitis is very common in children after a series of viral infections, but what we are seeing at the moment is quite different. The children have more severe inflammation, which in some cases leads to liver failure and the need for a transplant.”
What are the symptoms of children with hepatitis?
Many of the affected children had gastrointestinal symptoms (vomiting, diarrhea, abdominal pain) at the beginning of the hepatitis disease, followed by jaundice (yellowing of the skin or eyes). They also had very high levels of liver enzymes, which is a sign of liver inflammation or damage. “The chances of a child getting hepatitis are extremely low,” said Meera Chand, director of clinical and emerging infections at the UKHSA in a message. “However, we continue to urge people to look out for the signs of hepatitis – particularly jaundice, which is most easily recognized as yellowing of the whites of the eyes – and to contact a doctor if they are concerned.”
- Possible symptoms of hepatitis:
- nausea/vomiting
- yellowing of the skin/eyes (jaundice)
- Diarrhea
- stomach pain
- exhaustion
- Fever
- loss of appetite
Where were the unusual cases of hepatitis reported and how are the children doing?
In Great Britain most unusual cases of hepatitis in children have been reported so far. Meanwhile there are also cases in Germany, Austria, Belgium, Denmark, FranceIreland, IsraelItaly, Japan, the Netherlands, Norway, Poland, Romania, Spain and the USAreports the ECDC.
According to the World Health Organization (WHO), most of the children should make a full recovery – although some cases of hepatitis were very severe. Almost ten percent of the reported cases resulted in the children requiring a liver transplant. According to Information from the WHO The affected children are between one month and 16 years old. So far there has been one death in the USA, and the deaths of three children are currently being investigated in Indonesia.
What Causes Unexplained Hepatitis Cases in Children?
So far, the reason for the unusual cases of hepatitis in children is unclear, but the doctors involved have already been able to rule out some possible causes:
- Hepatitis Viruses: The hepatitis viruses A to E were not found in the children, so they are not the trigger.
- Corona vaccination: A large proportion of the children (including all affected children from Great Britain) were not vaccinated against the coronavirus – so the vaccination can be ruled out as a cause of hepatitis.
- Corona infection: According to the WHO, only 20 out of 169 patients tested positive for the corona virus. Researchers assume that Sars-CoV-2 – if at all – is more indirectly related to the hepatitis cases.
Researchers currently suspect an adenovirus behind the unexplained hepatitis infections. Adenoviruses are common, they often cause cold symptoms, but they are not usually associated with liver inflammation in healthy children. However, of the 169 cases listed by the WHO in a recent report, at least 74 of the children had an adenovirus infection. 18 of the children were infected with adenovirus type 41, which normally causes gastrointestinal problems and breathing difficulties.
According to the WHO, the number of adenovirus infections is increasing in Great Britain. An adenovirus was detected in 75 percent of confirmed hepatitis cases in Great Britain, the British health authority reports in a statement and adds that there is a noticeable increase in adenovirus infections, especially in the age group up to four years.
Hepatitis cases in children: is an adenovirus behind it?
But the explanation that the adenovirus could be responsible for the infections is not one hundred percent correct: not all children have tested positive for the virus. In addition, while adenovirus can cause hepatitis, the symptom is most common in immunocompromised individuals – and the children were previously healthy. Is there a new strain of adenovirus that causes hepatitis infections, or did the infections arise from an adenovirus that interacts with another risk factor? Researchers are currently investigating numerous scenarios; Among other things, they look for things the children have in common – were they exposed to a toxic load or were they all in the same region on a journey?
It’s also possible that the adenovirus infection found in many children is misleading, the New York Times reports – quoting Richard Malley, an infectious disease specialist at Boston Children’s Hospital: “Someone could be infected with the adenovirus and then develop hepatitis due to something else. You really need a lot of data to prove causality, which we simply don’t have.”
Does the corona pandemic have anything to do with the hepatitis cases?
The coronavirus probably has nothing to do directly with the unusual cases of hepatitis in children, since only a small number of patients tested positive corona has been tested. Nevertheless, a connection cannot yet be completely ruled out – the corona virus has often surprised with new symptoms. However, experts can imagine that the pandemic has something to do indirectly with the liver infections. The pediatric gastroenterologist Burkhard Rodeck explains it like this: “It is more likely that with the easing of restrictions in Great Britain, more and more children and young people will come out of isolation in a relatively short time and will suddenly be exposed to many germs with which they were not previously exposed due to various lockdown or other measures last came into contact in this abundance.”
The British health authority also suspects that the corona measures could have made the children more susceptible to viruses. However, there is no confirmation of this theory yet. “We’re just getting started,” Richard Malley told the New York Times. It is difficult to predict whether hepatitis infections will become more common, “or whether it is just a small blip in our history of infectious diseases in 2022.” (tab)
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