Health authorities are investigating the cause of the mysterious spike in hepatitis in children up to 16 years old, but especially in children aged 5 to 6 years. The Centers for Disease Control and Prevention has issued a national alert about an unusual increase in the peak of severe cases of hepatitis in children .
Active case investigation in the UK has confirmed 108 cases of hepatitis. All these cases presented to health services between January and April 2022. The Spanish health authorities have confirmed 3 isolated cases of hepatitis of unknown origin .
Although the number of cases is not high compared to the UK, hepatologists working at the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) believe that increased vigilance among healthcare professionals and the public and public awareness will prevent further spread of this puzzling outbreak. The Spanish Ministry of Health has issued an international health alert from the World Health Organization (WHO) to regional governments. Additional cases have also been detected in children in Denmark, Ireland and the Netherlands.
What are the underlying causes of the hepatitis outbreak?
The European Center for Disease Prevention and Control (ECDC) monitored these cases and found that similar outbreaks also exist in other countries.
In the state of Alabama, in the United States,nine cases have tested positive for adenovirusin cases of hepatitis among children aged 1 to 6 years. Investigations are still being carried out in different countries, but the exact causes of this outbreak are still unknown.
The viruses ofhepatitis A, B, C, D y E(different viruses from each other) are the most common causes of hepatitis, but have been ruled out in all cases in the recent outbreak in the UK and Spain. In almost ¾ of cases (up to 77% of cases) a positive result for a form of the adenovirus has been detected. Adenovirus can cause hepatitis among immunosuppressed children.
The CDC health alert issued an order for all doctors to performadenovirus testing for all children with hepatitis, and also report these cases to CDC and state public health authorities. A nucleic acid amplification test (NAAT) is recommended to detect adenovirus in nasal swabs, rectal swabs, stool samples, or blood.
Among the nine cases that have tested positive for adenovirus in the state of Alabama, five are related to the adenovirus 41. This variant of the adenovirus causesintestinal inflammation. Health authorities continue to explore more causes.
Kristen Nordlund, a CDC spokesperson, stated in a STAT News report that the CDC is currently working with the state health department to find more cases and causative agents in the US. At the moment, adenovirus could be the cause. of this outbreak. But researchers are still exploring to rule out the most common cause of hepatitis.
Signs and symptoms:
Children up to 10 years old who tested positive presented with abdominal pain, vomiting, diarrhoea, jaundice and yellowish skin discoloration. These symptoms were not associated with fever .
Cases of severe hepatitis in the UK have had elevated serum enzyme levels (on lab tests), ie, aspartate transaminase (AST) or alanine aminotransaminase (ALT), greater than 500 IU/L.
In six of the cases, a liver transplant was performed. No deaths have yet been reported in the United States or Europe.
Other explanations for this outbreak:
Although we are still in the realm of conjecture when it comes to these outbreaks, some argue that home isolation and excessive use of masks in the last two years due to the COVID-19 pandemic caused children children will be immunocompromised . The children could not come into direct contact with the germs that help them gain immunity.
On the other hand, there are those who also suspect that these are long-term complications of the COVID-19 infection , which made children vulnerable to other infections and diseases.
When talking about the etiological origin and toxic exposure, no relationship of this puzzling disease with vaccination against COVID-19 has yet been identified. Detailed data have been collected through a questionnaire on food, drink and habits in affected children, but no common exposure could be identified.
Toxicological investigations are also being considered, but infectious aetiology is more likely to support the statistics.
In the United States, none of the affected children are infected with COVID-19, but few positive cases have been detected in the United Kingdom; none of them received the COVID-19 vaccine .
References:
Hicks, L. (2022, 15 de Abril). Pediatric Hepatitis Cases May be Linked to Adenovirus, CDC Says. Medscape. https://www.medscape.com/viewarticle/972272
Mannion, K. (2022, 21 de Abril). Puzzling outbreak of liver disease in kids also spreads to Spain. Olive Press News Spain. https://www.theolivepress.es/spain-news/2022/04/21/puzzling-outbreak-of-liver-disease-in-kids-also-spreads-to-spain/
News Desk. (2022, 15 de Abril). Spain investigating three cases of child hepatitis of unknown origin. Spain in English. https://www.spainenglish.com/2022/04/15/spain-investigating-three-cases-of-acute-hepatitis-in-children-of-unknown-origin/
Rigby, J., & Grover, N. (2022, 22 de Abril). Explainer: Scientists investigate hepatitis outbreak in children in Europe, US. Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/scientists-investigate-hepatitis-outbreak-children-europe-us-2022-04-22/
Tillman, R. (2022, 22 de Abril). CDC issues advisory on mysterious hepatitis outbreak among children. Spectrum News 1. https://spectrumlocalnews.com/nc/triad/news/2022/04/22/cdc-health-advisory-hepatitis-in-children-alabama
UK Health Security Agency. (2022, 6 de Abril). Increase in hepatitis (liver inflammation) cases in children under investigation. GOV.UK. https://www.gov.uk/government/news/increase-in-hepatitis-liver-inflammation-cases-in-children-under-investigation
Update: Hepatitis of unknown origin in children. (2022, 19 de Abril). European Centre for Disease Prevention and Control.
