A number of cases of severe hepatitis of unknown origin in children have been reported in recent weeks. They have been found in several countries, including the United Kingdom of Great Britain and Northern Ireland, Spain and the United States of America.
What is acute hepatitis?
This is a term used to describe acute inflammation of the liver. It can be due to a number of infectious and non-infectious causes. There are 3 main types of acute viral hepatitis – hepatitis A, B and C. Viral hepatitis D and E are more common, especially in higher income environments.
What makes this epidemic unusual?
Severe acute hepatitis is uncommon in young children. The initial report of a possible increase in cases came from Scotland. This then led to reports elsewhere in the UK and around the world, with people then searching and finding more cases.
What we do know is that the common viruses that cause acute viral hepatitis have not been found in these patients. In addition, international travel or connections with other countries, based on currently available information, have not been identified as important factors.
How worried should we be?
This should be taken seriously – although these are rare events. Further work is needed to identify additional cases, both in the currently affected countries and elsewhere. The priority is to determine the cause of the disease in order to further refine control and prevention actions.
What are the leading theories about what causes this?
We work with countries and partners to consider a number of possible explanatory factors. A large number of roads are being studied. One of the leading hypotheses is the adenovirus, which is a group of common viruses that spread from person to person, causing respiratory symptoms, vomiting and diarrhea in children.
While adenovirus is currently a hypothesis, it does not fully explain the severity of the clinical picture. Cases of hepatitis have been reported in immunocompromised children with adenoviral infection, but it is uncommon to cause severe hepatitis in otherwise healthy children.
Factors such as hypersensitivity in young children after lower levels of adenovirus circulation during the COVID-19 pandemic, the potential emergence of new adenovirus, and co-infection with SARS-CoV-2 were suggested by the UK team as possible factors and should be further investigated.
Could the outbreak be related to COVID-19?
SARS-CoV-2 has been found in several cases. However, the prevalence of COVID-19 is currently widespread in the community in many of the affected countries, and the potential contribution of this virus to clinical presentation is unclear.
Could the outbreak be linked to COVID-19 vaccination?
There is no evidence that the presentation is related to vaccination, as the majority of affected children have not been vaccinated against COVID-19. Other infectious and non-infectious explanations need to be fully assessed to understand and manage the risk.
Are we expecting to see new cases?
With ongoing new notifications of recent cases, together with a wider demand for cases in other countries, it is very likely that more cases will be detected before the cause is confirmed and more specific control and prevention measures can be implemented.
What should parents be careful about?
First, it is important to emphasize that this is not a common disease, but parents should be alert to the symptoms of hepatitis, which are acute onset of diarrhea, vomiting, abdominal pain and jaundice – when the skin and whites of the eyes turn yellow – in more -small children. Most children do not have a fever. If you are concerned, we would advise parents to contact their healthcare professional.
What can parents do to protect their children from disease?
Take normal measures to help prevent common viruses, so parents should monitor good hand washing and promote good respiratory hygiene, such as masking coughing or sneezing, which together can help reduce the spread.
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