Severity of hepatitis of unknown origin in children classified as ‘highly unusual’ –

Cases of hepatitis of unknown origin in children have been registered in 20 European countries. While cases of hepatitis of unknown origin are reported each year, the severity of the cases observed this time is consistent “very unusual”according to medical experts.

Reports of these cases of hepatitis of unknown origin first came from the United Kingdom, where an increase in cases of acute hepatitis of unknown etiology was reported on April 5th.

As of June 9, 2022, 402 cases of acute hepatitis of unknown origin in children aged 16 years and younger have been reported across Europe. The vast majority is seen in children five years of age or younger.

Great Britain has the highest incidence with 224 cases. In the EU, Spain and Italy have recorded the most cases, each with more than 30.

To date, 87 children have been admitted to an intensive care unit and 17 have received liver transplants. On May 12, Irish Health Authorities announced the death of a child under the age of 12 from hepatitis of unknown cause.

“The seriousness of this situation is obviously very worrying, […] Normally we wouldn’t see this kind of disease progression, that’s for sure.”Cary James, Managing Director of World Hepatitis Alliance.

Philippa Easterbrook, technical director of the incident management team at World Health Organization (WHO) headquarters, speaking at a hepatitis summit, said that while a few cases of hepatitis of unknown origin are reported each year, “How concerned we should be about this outbreak, this is the first time such a large number of cases of severe acute hepatitis have been observed.”.

Mrs Watson points this out“A portion of the cases developed liver failure, required a transplant, or caused death. The situation must be taken seriously. An important step now is to understand the cause.”.

A long way to eliminate viral hepatitis in Europe

Despite the United Nations aiming to eliminate viral hepatitis by 2030, a report published on Wednesday (15 June) found that around a quarter of EU/EEA countries have no plans for disease prevention and control measures or strategies .

The cause remains unknown

Speaking about the reasons for this spread, Mr James said scientists “I still don’t really understand what’s going on. Which is really a shame.”.

Hepatitis is an inflammation of the liver, usually caused by a viral infection or excessive alcohol consumption. There are several common types such as A, B, C, D and E, all of which have different degrees of contagion or causes, but these common viruses A through E have not been detected in any of these cases.

“It could be a new virus or just a form of liver disease caused by something else.”said Mr. James.

Several hypotheses are explored to understand the cause of this hepatitis in these children. Adenovirus remains a prime suspect as it was the most frequently detected virus in samples tested in the UK.

“The main hypotheses that are currently maintained concern the involvement of the adenovirus, probably linked to a cofactor that triggers more severe infection or immune-mediated liver damage, or the fact that the measures taken during the Covid-19 pandemic led to a deficiency have exposure for the youngest age group and greater vulnerability”according to a report by the European Center for Disease Control (ECDC).

It is considered unlikely that there is a connection with the Covid-19 vaccine, as most cases were not vaccinated.

The pathogenesis of the disease and its transmission routes are still unknown. The cases do not appear to be related and very few of them have an epidemiological link.

“Although the risk of spread cannot be accurately estimated as liver transplantation is required in some cases, the potential impact on the affected pediatric population is considered high.”says the ECDC report.

The probability of contracting hepatitis remains low

Separately, said Sophia Makki, Incident Director at the UK Health Security Agency “The probability of children contracting hepatitis remains extremely low”.

She added that it is important to follow normal hygiene measures, “including ensuring children wash their hands regularly and properly to reduce the spread of many common infections, including adenovirus.”.

Symptoms reported so far, as described by the ECDC, include: “marked transaminase elevations, often accompanied by jaundice, sometimes preceded by gastrointestinal symptoms including vomiting, in children 16 years and older”.

“We continue to remind everyone to look out for signs of hepatitis, particularly jaundice, which is a yellow tinge in the whites of the eyes, and to contact their doctor with any concerns.”said Mrs. Makki.

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