Hepatitis in childhood: an unexplained phenomenon

More than 150 cases in ten countries, mainly in Europe: Acute hepatitis in children raises questions and even fears a new epidemic, but the origin of this severe liver inflammation remains unknown.

• Also read: Mysterious childhood hepatitis in five European countries

• Also read: The WHO investigates hepatitis of unknown origin in children

It all started in the UK, which has the most cases (now 114). Since then, cases have also been reported in Spain (13), Denmark (6), Ireland (less than 5), the Netherlands (4), Italy (4), France (2), Norway (2), Romania (1), in Belgium (1), according to World Health Organization (WHO) data.

Outside Europe, Israel (12 cases) and the United States (at least 9 cases) add to the list.

The children affected ranged in age from one month to 16 years, but most were under 10 years old and many under 5 years old. None had comorbidities.

There were 17 kidney transplants and one death.

“Investigations continue in all countries reporting cases. At present, the exact cause of hepatitis is still unknown,” according to the European Center for Disease Prevention and Control (ECDC).

At the moment, an infectious cause seems to be considered the most likely, but no common association with contaminated food or a toxin has been identified.

“You always have to take things seriously” and “take a good look” but “not fall into psychosis either” because “until then we don’t even know where it’s coming from,” said Yazdan Yazdanpanah, chief of Bichat Hospital’s infectious diseases department in Paris and member of the French Science Council, in a recent interview with Express.

Hepatitis is inflammation of the liver, in response to viruses, toxins (drugs, poisons, etc.), autoimmune, or genetic diseases. The main symptoms – fever, diarrhea, stomach pains, jaundice – are often benign and quickly disappear or remain mild. More rarely, they can lead to kidney failure.

Acute hepatitis was detected in sick children.

“The growing rise in the number of children with sudden onset hepatitis is unusual and worrying,” said Zania Stamataki of the University of Birmingham.

The fact that certain types of hepatitis affect young children between the ages of 1 and 5 years surprises specialists even more, as does the need for a transplant in some cases.

And the usual viruses that cause acute viral hepatitis (from A to E) have not been detected in any of the cases, ECDC and WHO stressed.

Among the traces examined, “adenoviruses” were detected in at least 74 children, including 18 so-called “type 41” adenoviruses. Several countries, including Ireland and the Netherlands, have reported increased prevalence of these adenoviruses.

Quite banal and well-known viruses, adenoviruses, in general, cause respiratory symptoms (bronchitis, pharyngitis, etc.), ocular symptoms (conjunctivitis), digestive disorders (gastroenteritis).

Transmission is via the faecal-oral or respiratory route, with epidemic peaks often in winter and spring and more common in communities (kindergartens, schools, etc.). The majority of people become infected before they are 5 years old.

But their role in the development of the mysterious hepatitis is unclear.

If children infected with an adenovirus have had hepatitis in the past, they are immunocompromised children. And adenovirus 41 is not known to cause hepatitis in healthy children, WHO observes.

Therefore, according to some British scientists, a new strain of the adenovirus could be involved.

Or other infections and environmental causes could exacerbate the adenoviral inflammation.

The possibility of a connection with the still circulating COVID-19 is also included in the hypotheses.

COVID-19 was detected in 20 of the children tested. And 19 other children showed co-infection with COVID and an adenovirus.

But “if these hepatitises are from COVID, it would be surprising not to see them more widespread given the high prevalence of Sars-Cov2,” noted Graham Cooke, an infectious disease specialist at Imperial College London, of the Science Media Center.

After more than two years of pandemic and barrier gestures, the question of an immune “guilt” that would make certain children weaker is being raised by some scientists with no certainty.

Finally, a possible role of anti-COVID vaccines was ruled out: according to the WHO, a large majority of children were not vaccinated.

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