Children in other countries with acute hepatitis. Medics are still looking for the cause

In children, more and more cases of acute hepatitis of unknown cause are being detected. In total, the disease has already appeared in several countries around the world. Until now, it was mainly in Europe, now Asian countries are reporting the first cases.

1. Over 170 cases of acute hepatitis in children have already been reported worldwide, mainly in the UK
2. The latest reports mention cases detected in China and Japan
3. Our research increasingly shows that the increase in cases of acute hepatitis in children is related to an adenovirus infection, says British doctor
4. However, adenoviruses are not responsible for all cases
5. More information can be found on the Onet homepage

Acute hepatitis in children – already in several countries around the world

Over 170 cases of acute hepatitis in children of unknown origin have already been reported worldwide. The cases were detected, among others in: Great Britain (114), Spain (13), Israel (12), USA (9), Denmark (6), Ireland (5), Netherlands (4), Italy (4), Norway (2), France ( 2), Romania (1) and Belgium (1).

Now medical services from China and Japan have informed about the first small patients in their countries.

All patients ranged from one month to 16 years of age and had symptoms such as diarrhea, vomiting and abdominal pain. 17 children required a liver transplant and at least one died (WHO does not say in which country).

The first alarm in Europe was launched by the British Health Security Agency (UKHSA) in early April. More than 60 cases of hepatitis in children in England alone were then investigated. For comparison, so far about seven of them have been diagnosed annually.

“If your child has jaundice symptoms, which means their skin has a yellow tinge that is most visible in the whites of their eyes, you should contact their GP or other health care provider,” said Dr. Nicholas Phin, director of Public Health Scotland (PHS).

The European Center for Disease Control (ECDC) indicates on its website that it is working closely on this issue with European countries and the World Health Organization (WHO).

Acute hepatitis – how does it manifest itself?

Acute hepatitis of unknown etiology presents with elevated levels of liver enzymes such as AST and ALT, indicative of liver damage. It is accompanied by pain in the lower abdomen, diarrhea and vomiting. In most cases, however, there is no fever. However, there are children who require hospital treatment and even a liver transplant. Ten such operations have already been performed in Great Britain.

British specialists suspect that the cause of this condition may be an infectious agent or exposure to an infectious substance. However, it is stressed that this cannot in any way be linked to the COVID-19 vaccination. There were also no associations with nutrition or individual habits.

The new cases are unlikely to be caused by one of the known hepatitis viruses such as hepatitis A, B, C, D or E. It is also difficult to associate with the SARS-CoV-2 virus.

Research is underway to clarify whether a new, more dangerous form of adenovirus has emerged.

Acute hepatitis – guilty adenoviruses?

The World Health Organization and medical services in individual countries are constantly looking for the causes of this epidemic.

“Information from our research increasingly suggests that the rise in childhood acute hepatitis is related to an adenovirus infection,” said Dr. Meera Chand, director of infections for the UK Health Safety Agency (UKHSA). But we are also carefully examining other potential causes, including any possible link to infectious disease, he adds.

According to the WHO, adenoviruses have been detected in at least 74 cases, 18 of which have been identified as type 41 adenovirus (which was not previously associated with liver damage). In the United Kingdom, where the majority of cases have occurred so far, adenovirus has been detected in 75% of cases. surveyed children. 16 percent it also tested positive for COVID-19, although the UKHSA stressed that the coronavirus was so common back then that there was no surprise here.

Although adenovirus, especially adenovirus F type 41, emerges as the possible cause of hepatitis, it is still unclear what the mechanism is. According to Professor Will Irving of the University of Nottingham, this type of virus is associated with gastroenteritis in young children.

– There are very few reports of adenovirus infection causing hepatitis in children and adults with normal immunity in the world literature. If it turns out that adenovirus infection is actually the cause, it will be necessary to explain why the natural history of adenovirus infection changed so dramatically in 2022, says Irving.

Adenoviruses are common viruses that cause a variety of diseases. They are widespread and regularly cause infectious diseases in all age groups, causing symptoms of a cold, fever, sore throat, bronchitis, pneumonia or diarrhea, among others.

According to WHO, before drawing conclusions, additional information is needed on recent cases of infection. an interview about close contacts of infected children. Perhaps reduced contact between children during the coronavirus pandemic is of importance.

– Adenoviruses are viruses that cause colds in adults, but also diarrhea, abdominal pain and vomiting in children. The symptoms may be more severe, but they rarely cause hepatitis, says Prof. Simon Taylor-Robinson, hepatologist at Imperial College London.

It’s not unusual for adenoviruses to emerge in the spring. Given their seasonality, it may be that in the past two years, children have been isolated from their peers, so they have not contracted the usual viral childhood diseases that build immunity, he adds.

Hepatitis in children is most often caused by viruses

Inflammation of the liver can be caused by many factors. Among them are viral or bacterial infections, but inflammation can also be caused by inborn defects of metabolism, circulatory disorders, autoimmune diseases, pregnancy, consumption of certain drugs or toxins, and alcohol abuse.

In the case of children, the underlying cause of hepatitis is most often a viral infection, which is why in their first year of life they are vaccinated against pathogens that are most often responsible for them. Vaccination against hepatitis B is mandatory and the first dose is usually given in the hospital right after birth (up to the age of 7 months, the baby is vaccinated three times in total). Vaccination against hepatitis A is voluntary; it is listed as recommended in the vaccination calendar.

In Poland, the problem is another type of viral hepatitis – hepatitis C – for which there is no vaccine. The disease is often passed on from mother to child during labor and may be asymptomatic for a long time. Unfortunately, in most cases (80%) it eventually develops into a chronic condition.

Hepatitis – symptoms

“Parents and carers should be alert to signs of hepatitis (including jaundice) and contact a healthcare professional if necessary,” emphasized Dr. Chand.

“Classic hygiene practices, such as washing hands thoroughly and taking care of children, as well as good respiratory hygiene, help reduce the spread of many common infections, including adenovirus,” she added.

She emphasizes that children with symptoms of gastrointestinal infections, including vomiting and diarrhea, should stay at home and not return to school or kindergarten until 48 hours after the symptoms have resolved.

The most common symptoms that may indicate a child has hepatitis are:

1. dark color of urine,
2. a pale grayish stool
3. itchy skin
4. yellowing of the skin and eyes,
5. muscle and joint pain,
6. higher temperature,
7. abdominal pain,
8. loss of appetite
9. severe fatigue.

If you notice these symptoms in your baby, whether or not he has been vaccinated against hepatitis, make an appointment with a pediatrician or general practitioner.