Since the beginning of April, health professionals around the world have been on the lookout for healthy, young children who suddenly develop severe cases of hepatitis for no apparent reason.
According to the latest estimates by the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), there are at least 194 probable and confirmed cases reported worldwide, with the exception of an unknown number of potential cases in Canada.
Here is what we know so far about these cases.
WHAT IS HEPATITIS?
Hepatitis is an inflammation of the liver. The body can be damaged or inflamed as a result of a virus, heavy consumption of alcohol, toxins, certain medications or other health conditions. The liver performs many basic functions and acts as a filter for the blood that leaves the stomach and intestines. It regulates chemical levels in the blood, creates nutrients, removes waste, helps fight infections and more.
Acute hepatitis is when liver function is impaired in less than six months. Chronic hepatitis is when the inflammation lasts longer. Some cases of hepatitis can be severe – even fatal – if left untreated. Other cases may be mild and do not require treatment.
What makes these cases of acute hepatitis unusual is that doctors have not identified the cause.
WHAT ARE THE SYMPTOMS?
Medical officials said a number of cases began with gastrointestinal symptoms such as stomach pain, diarrhea and vomiting. Later, the children showed signs of jaundice, where the skin and whites around the eyes turned yellow. Jaundice is an indication that something is wrong with the liver and medical attention should be sought immediately.
Other common symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, dark urine, light stools and joint pain.
Dr Deirdre Kelly, a professor of pediatric hepatology at the University of Birmingham, told CTV News on Tuesday that most children had recovered spontaneously.
“Although it is a serious illness if their child develops it, the chances are that they will recover on their own,” she said.
HOW GLOBAL CASES AND HOW SERIOUS ARE THEY?
Based on figures collected by the ECDC in a report on 28 April and the WHO on 23 April, there are at least 194 cases of hepatitis for no apparent reason in countries including the United Kingdom, Spain, Israel, the United States, Denmark, Ireland, the Netherlands, Italy, Norway and France.
As of April 21, 114 cases were from the United Kingdom, according to the WHO. As of April 27, there were “approximately 55 probable and confirmed cases” from a dozen countries in the European Union and the European Economic Area, 12 cases from the United States and another 12 from Israel, the ECDC said. Japan reported one case.
“Severe hepatitis, for which there is no reason, we rarely see more than about 20, 25 maximum throughout the year. And we saw 114 in the first three to four months of this year, “Kelly said.
“These are completely normal children. They have no comorbidities or other infections and develop severe hepatitis, of which 10 percent needed a liver transplant.
The figure of 10 percent is based on an earlier number of cases from the WHO on April 23, according to which 17 children need a liver transplant. A child in the UK has reportedly died.
Cases of hepatitis include children between the ages of one month and 16, health agencies say, with the majority occurring in young children between the ages of two and five.
The Scottish Public Health Agency was the first to sound the alarm about these unusual cases of hepatitis in early April, after one child fell ill in January and nine others in March. They were all seriously ill and had to be taken to hospital where they were diagnosed with hepatitis.
The majority of such cases in the United States have been found in nine previously healthy children between the ages of one and six from Alabama. Two of the children reportedly needed a liver transplant. Five children with significant liver damage of unknown origin, including some with acute liver failure, were admitted to a children’s hospital in Alabama as early as October 2021.
Two additional serious cases were also reported in North Carolina and three in Illinois, with local media reporting that one led to a liver transplant and two others were on the transplant list.
ARE THERE CASES IN CANADA?
Although there are no confirmed cases in Canada, the Public Health Agency of Canada (PHAC) previously told CTV News that it was “aware of reports of severe acute hepatitis of unknown origin in young children in Canada.”
“[PHAC] is working with its international partners as well as provincial and territorial partners to gather information on this evolving situation, “the agency told CTV News in an email statement on Friday.
“Potential cases in Canada are being further investigated to determine if they are related to cases in the United Kingdom and the United States.
WHAT ARE SOME THEORIES INVESTIGATED?
Health authorities are investigating a number of possible causes for these cases of hepatitis. To date, the WHO has ruled out hepatitis A, B, C, D and E viruses based on laboratory tests.
While exposure to toxins is another consideration, experts believe it is less likely due to cases documented in different countries. Health authorities also found no links to international travel among the cases.
Currently, research suggests a link to adenovirus, according to the WHO and ECDC. Adenoviruses are a large family of viruses that can spread from person to person, causing a number of diseases, including colds, pink eye and gastroenteritis. Officials say there has been a recent increase in adenovirus infections, especially in the UK
Nearly half of the cases of hepatitis, including those in Alabama, are related to adenovirus, with laboratory tests showing that some children have been infected with type 41, which is linked to gastroenteritis, which causes diarrhea and vomiting. At least 19 cases included co-infection with SARS-CoV-2.
“While adenovirus is currently a major hypothesis, it does not fully explain the severity of the clinical picture,” the WHO said in a report on April 23. The health agency noted that this particular virus has not previously been linked to hepatitis, adding that it is a common pathogen that usually causes self-limiting infections.
COVID-19 is also being considered, although a number of cases are not related to a previously known infection.
“In fact, we still don’t know the reasons, and COVID may be involved in some cases,” Dr. Simon Taylor-Robinson, a professor and liver researcher at Imperial College London, told CTV’s Your Morning earlier. .
“We actually know that COVID can cause inflammation in every part of the body, not just the lungs.”
Another theory under consideration is that children’s immune systems, weakened during pandemic blockages and distancing, may be more vulnerable to other diseases.
It is also possible that two viruses, working “in sync” with each other, are behind the cases of hepatitis, some health experts say. Researchers are also investigating the possibility that the adenovirus has mutated.
CAN COVID-19 Vaccines BE THE CAUSE?
Despite social media misinformation suggesting a link between hepatitis cases and COVID-19 vaccinations, health authorities have categorically ruled out COVID-19 vaccinations as a potential cause because they say the majority of cases involve children who are too young. to be eligible for vaccinations.
“None of the currently confirmed cases in the UK have been vaccinated,” a spokesman for the UK Health Security Agency told Reuters. “Not related to the COVID-19 vaccine.”
WHAT CAN PARENTS DO?
Adenoviruses spread through close personal contact such as touching, through the air by coughing and sneezing, or by touching contaminated objects and surfaces, and then touching areas of the face before washing your hands. In some cases, it can be spread through the feces of an infected person, according to the US Centers for Disease Control and Prevention (CDC).
Daily measures, such as hand washing and general good hygiene measures, along with those adopted during the pandemic, should help, experts say, adding that the sudden development of a severe case of hepatitis for no apparent reason is still rare despite current global cases.
“They need to be reassured that it is relatively uncommon for normal children and the good hand hygiene we are all used to in the COVID pandemic and good general hygiene at home to be sufficient,” Kelly said.
With files from CTV National News reporter Vanessa Lee, Reuters and the Associated Press
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