Mysterious accumulation of hepatitis – you need to know

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Mysterious accumulation of hepatitis – you need to know
Infection with hepatitis can have serious consequences. Several children around the world are infected with hepatitis – extremely unusual. © dpa / Angelika Warmuth

What is the cause of the unusual increase in cases of hepatitis in children? An overview of the current state of knowledge.

Frankfurt – The warning first came from the UK: The UKHSA reported in mid-April that an unusual accumulation of hepatitis cases in predominantly young children was being investigated in the country. The European Health Agency ECDC then asked EU clinics to report unusual cases of hepatitis in children to the health authorities.

Numerous other cases are now known worldwide. According to an ECDC report from the end of April, almost 200 children were affected. Pr. On May 1, the World Health Organization (WHO) reported that 228 cases of hepatitis were known and another 50 were investigated. But what is so unusual about hepatitis diseases? What assumptions do the research follow, and what symptoms should parents be aware of in their children? An overview of the current state of knowledge:

What is hepatitis and why are cases so rare in children?

Hepatitis is an inflammation of the liver that can be triggered by a variety of causes. These include toxic substances such as alcohol or certain medications. However, the main causes are viruses that can trigger viral hepatitis A to E. In fact, however, no hepatitis virus was detected in the sick children, making the cases unusual.

Graham Cooke, Professor of Infectious Diseases at Imperial College London, points out: “Mild hepatitis is very common in children after a number of viral infections, but what we are currently seeing is completely 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 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 hepatitis or damage. “The likelihood of a child getting hepatitis is extremely small,” said Meera Chand, UKHSA’s director of clinical and new infections. “But we continue to encourage people to keep an eye out for signs of hepatitis – especially 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
  • abdominal pains
  • exhaustion
  • Fever
  • lost appetite

Where were the unusual cases of hepatitis reported and how are the children?

To date, most unusual cases of hepatitis in children have been reported in the UK. But there are now also cases in Germany, Austria, Belgium, Denmark, France, Ireland, Israel, Italy, Japan, the Netherlands, Norway, Poland, Romania, Spain and the United States, reports ECDC.

According to the World Health Organization (WHO), most of the children had to recover fully – although some cases of hepatitis were very serious. Nearly ten percent of the reported cases resulted in the children needing a liver transplant. According to the WHO, the affected children are between one month and 16 years old. So far, there has been one death in the United States, and the deaths of three children are currently being investigated in Indonesia.

In hepatitis, the liver is inflamed.  Researchers are currently trying to determine what triggers unusual hepatitis in children.  (icon image)
In hepatitis, the liver is inflamed. Researchers are currently trying to determine what triggers unusual hepatitis in children. (Iconic image) © Science Photo Library / Imago Images

What causes unexplained hepatitis cases in children?

So far, the cause of the unusual cases of hepatitis in children is unclear, but the doctors involved have already been able to rule out some possible causes:

  • Hepatitis virus: Hepatitis viruses A to E were not found in the children, so they are not the trigger.
  • Corona vaccination: A large proportion of children (including all affected children from the UK) were not vaccinated against coronavirus – so vaccination can be ruled out as the 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 any – is more indirectly related to 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 hepatitis in healthy children. But 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 usually causes gastrointestinal problems and difficulty breathing.

According to the WHO, the number of adenovirus infections is increasing in the UK. An adenovirus was detected in 75 per cent of confirmed hepatitis cases in the UK, the UK Health Authority reports in a statement, adding 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 adenovirus may be responsible for the infections is not one hundred percent correct: Not all children have been 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 originate from an adenovirus that interacts with another risk factor? Researchers are currently investigating several scenarios; Among other things, they look for things the children have in common – were they exposed to a toxic load, or did they all travel in the same region?

It is also possible that the adenovirus infection found in many children is misleading, reports the New York Times – referring to Richard Malley, an infectious disease specialist at Boston Children’s Hospital: “Someone can become infected with adenovirus and then develop hepatitis due to “Something else. You really need a lot of data to prove causality that we simply do not have.”

Does the corona pandemic have anything to do with the hepatitis cases?

The corona virus probably has nothing directly to do with the unusual cases of hepatitis in children, as only a small number of patients tested positive for corona. Nevertheless, a connection can not yet be completely ruled out – the corona virus has often surprised with new symptoms. However, experts may imagine that the pandemic indirectly has something to do with the liver infections. Pediatric gastroenterologist Burkhard Rodeck explains it this way: “With the easing of restrictions in the UK, more and more children and young people are coming out of isolation in a relatively short time and suddenly being exposed to many bacteria like they did not before. have been exposed due to various lockdown or other measures last came into contact in this abundance. “

The UK health authority also suspects that corona measures could have made children more susceptible to the virus. However, there is as yet no confirmation of this theory. “We’re just started,” Richard Malley told the New York Times. It’s hard to predict whether hepatitis infections will become more common, “or whether it’s just a small shift in our history of infectious diseases in 2022.” (Tanja Banner)

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