“People are speculating until they turn blue, but all we have is a bunch of correlations and no specific cause,” Isaac Bogoch, MD, of the University of Toronto, told the Financial Times.
As previously mentioned, a group of pediatric hepatitis cases was first diagnosed two weeks ago in the United Kingdom. At that time, 60 cases in England and 13 cases in Scotland were under investigation, mainly in children aged 2 to 5 years. Shortly afterwards, nine cases were reported in Alabama, dating back to last fall.
As soon as the health workers knew what to look for, they started flooding with more reports. The unexplained disease has now been found in more than a dozen countries, including Canada, Japan, Israel and many European nations. Nearly 200 children are affected, from 1 month to 16 years old, although most are preschoolers. At least 17 children have needed liver transplants and at least one has died, according to a World Health Organization bulletin that is now a week old.
CDC National Health Alarm: A group of children diagnosed with #hepatitis and #adenovirus infection. Doctors should be alert for symptoms and report any suspected cases of hepatitis of unknown origin to their local and state health services.
– CDC (@CDCgov) April 21, 2022
In the United States, the Centers for Disease Control and Prevention (CDC) issued a national health warning on April 21, urging doctors to be on the lookout for potential cases. So far, more than a dozen cases have been reported in states such as Alabama, California, Delaware, Illinois, New York, North Carolina and Wisconsin.
What causes an outbreak? Hepatitis is simply inflammation of the liver and can have many causes. Viral hepatitis (including hepatitis A, hepatitis B and hepatitis C) is better known. The disease can also be caused by fatty liver disease, heavy alcohol use, toxins and certain inherited diseases.
Signs and symptoms of hepatitis — regardless of the cause — include elevated liver enzymes, jaundice (yellowing of the skin and eyes), dark urine, and light stools. It can also cause less specific symptoms such as fatigue, fever, loss of appetite, abdominal pain, nausea and vomiting.
While the cause of childhood hepatitis remains unknown, many suspects are under investigation. Press releases and discussions on social media have suggested that it may be a complication of COVID-19 or a result of restrictions due to COVID-19, but none have been confirmed by the available data.
Several key issues were outlined during a special session of the recent European Society of Clinical Microbiology and Infectious Diseases conference in Lisbon and presented in an information paper by the United Kingdom Health Organization.
There are so many uncertainties. Jobs include: -adenovirus infection with other infections -factors that increase the susceptibility and severity of adenovirus-toxin, drug or environmental infection There is still more work to be done # ECCMID2022 pic.twitter.com/byIbb
– Muge Cevik (@mugecevik) April 25, 2022
First, some causes can be ruled out:
Infected children tested negative for known hepatitis viruses (A, B, C, D and E). Few, if any, of the infected children have been vaccinated against COVID-19 because children of this age are not yet eligible in most countries. Most of the children are over 2 years old, which means that their mothers would not be pregnant during the COVID pandemic. The adenoviruses used as vectors in some COVID vaccines (type 26 adenovirus in the J&J vaccine and a chimpanzee adenovirus in the AstraZeneca-Oxford vaccine) are inactivated and do not cause disease. To date, no common exposure to potential toxins, contaminated food, drugs or other environmental agents has been identified.
The main suspect is adenovirus type 41, according to most health experts investigating the outbreak. More than 50 types of adenoviruses can cause infection in humans. Although these viruses are best known for causing the common cold, this particular type is associated with gastrointestinal diseases.
The majority of infected children had detectable adenovirus in their blood and type 41 was more common among those with available molecular sequence results. However, in the cases of Alabama, the adenovirus was not found in liver biopsy specimens.
Adenoviruses are widespread and infection is common in children and adults. This raises the question of why they have not previously been linked to cases of liver disease. There have been previous reports of adenoviruses causing hepatitis, especially in immunocompromised individuals, but this seems to be rare.
It is possible that a new or previously unrecognized adenovirus strain is the culprit or that an adenovirus is interacting with another pathogen to cause a more serious illness.
Some experts, including the authors of a Eurosurveillance case report on Scotland, have suggested that reduced exposure to germs due to “limited social involvement” during the COVID-19 pandemic may have left children with poor immunity. But this raises the question of why cases occur in areas with and without lockdown and at various intervals after the end of the COVID restrictions.
What about COVID?
The emergence of an unexplained outbreak of pediatric hepatitis during a global pandemic has led many to wonder if SARS-CoV-2, the coronavirus caused by COVID-19, is to blame.
“Whatever theory you come up with, it has to come from the huge public health event of the last two years,” Alastair Sutcliffe, a professor of general pediatrics at University College London, told the Financial Times. “It’s a great coincidence – whether it’s a drop in adenovirus immunity or the adenovirus is working with COVID to cause hepatitis, but the pandemic has to play a role.”
SARS-COV-2 has only been detected in a minority of children involved in the epidemic. But the virus usually disappears after a few weeks and the absence of viral material at present does not mean that a child has not had COVID in the past. Indeed, the rising prevalence of COVID – a recent CDC study found that 75% of children in the US have SARS-CoV-2 antibodies – suggests that many of these children were probably infected. Researchers are now combing medical records, testing for antibodies and analyzing liver biopsy specimens in an effort to learn more.
SARS-CoV-2 is not just a respiratory virus and it has become increasingly clear that it can damage organs throughout the body. During the pandemic, there were reports of possible COVID-related liver disease in adults and children.
In August 2020, for example, researchers in New York reported that 19 of the 44 pediatric patients with multisystem inflammatory bowel disease in children (MIS-C) had inflammation of the liver. Another US team recently reported four previously healthy children with severe hepatitis as the main manifestation of COVID-19. And in India, researchers reported 37 cases of “COVID-19-associated hepatitis in children” during the second wave in that country, 10 of which were severe.
This raises even more questions. Given that the pandemic is in its third year, why should a hepatitis outbreak appear in children only now? In part, this may be because clinicians and health care providers are now looking for it, and sporadic cases observed in the last two years may actually be the same situation.
SARS-CoV-2 may interact with an adenovirus (several infected children tested positive for both coronavirus and type 41 adenovirus). Maybe there’s something unique about the Omicron variant that makes it more likely to cause liver disease in children – or maybe the culprit is a new, unrecognized SARS-CoV-2 variant. COVID may trigger an immune system malfunction that leaves children less able to repel other viruses or keep them under control.
Important information for parents about hepatitis in children? ;;;;;;;
Consider the home: if your child shows signs of jaundice (yellowing of the eyes / skin) see a doctor right away!
Dr. Jerome Adams talks about mysterious disease affecting children’s liver – WISH-TV
– Jerome Adams (@JeromeAdamsMD) April 27, 2022
Good science takes time and experts stress that it is vital to investigate all possible causes and not rush to conclusions prematurely. While this investigation is ongoing, health officials are urging parents to be vigilant about symptoms of hepatitis and asking clinicians to report suspicious cases to their local or national health authorities.
Click here for more news about hepatitis.
Click here for more news about COVID-19.
