WHO has taken notice of the increase in unusual cases of hepatitis among children in Europe, the US, and the UK.
Earlier this month, the UK Health Security Agency (UKHSA) announced a surge in hepatitis cases of unknown origin among children in the UK. The sudden increase had led to multiple hospitalizations across England, Scotland, Wales, and Northern Ireland. As a result, health officials issued warnings to parents to remain vigilant for signs and symptoms of liver inflammation among their children. While the exact cause remained unclear, many of the cases tested positive for coronavirus and adenovirus. Thus, raising suspicions of a possible viral infection.
Recently, the UKHSA released an update on the situation. According to the press release, health officials have identified a further 34 cases of mystery origin hepatitis. This has brought the total number of affected children in the UK to 108. Out of which 79 are from England, 14 in Scotland, and the remaining in Wales and Northern Ireland. These cases occurred between January and April 12th, 2022, mostly affecting children under 10 years of age. The most common symptoms of the disease included yellow discolouration of the skin, abdominal pain, vomiting, and diarrhoea.
Similar to previous cases, doctors have not identified any of the known hepatitis viruses (A to E) within the infected individuals. Nor had any of the children received a COVID-19 vaccine; thus, ruling out a vaccine reaction. However, 77% of the total cases tested positive for adenovirus. As a result, researchers are also investigating any mutations in the adenovirus genome and other contributing factors such as COVID-19.
Information gathered through our investigations increasingly suggests that this is linked to adenovirus infection. However, we are thoroughly investigating other potential causes.
Dr. Meera Chand, Director of Clinical and Emerging Infections at UKHSA
CDC Issues Health Advisory
However, the UK is not the only one reporting cases of the mysterious liver inflammation in children. In November of last year, doctors in Alabama alerted the CDC of five pediatric cases of severe acute hepatitis. Three of the cases developed acute liver failure and also tested positive for adenovirus type 41. Further investigations have revealed a total of nine pediatric cases that occurred between October 2021 through February 2022. The children, aged 1 to 6, all tested negative for hepatitis viruses A, B, C, D, and E. Although no deaths have occurred, two of the children did require a liver transplant.
On Thursday, 21st April 2022, the CDC released a health advisory alerting public health authorities to conduct adenovirus testing in children with hepatitis of unknown origin. The advisory further recommends testing of whole blood and not just plasma.
This Health Advisory serves to notify US clinicians who may encounter pediatric patients with hepatitis of unknown etiology to consider adenovirus testing and to elicit reporting of such cases to state public health authorities and to CDC.
The US Center for Disease Control and Prevention
Adenoviruses typically spread via respiratory droplets, close contact, and contaminated surfaces. They most commonly cause respiratory infections in humans. However, adenovirus type 41 can cause gastroenteritis in children, along with respiratory symptoms. According to the CDC, adenovirus type 41 is also linked to causing hepatitis in immunocompromised children. But they rarely ever cause severe hepatitis in healthy individuals, such as those hospitalized in Alabama. Moreover, there is currently no vaccine against adenoviruses.
The CDC has requested health authorities to alert them of any possible cases, irrespective of their adenovirus status. This includes children under 10 years with liver inflammation of unknown aetiology and elevated liver enzymes.
WHO Takes Notice of Unusual Hepatitis Cases in Children
In a recent press release, the World Health Organization (WHO) announced that it was monitoring the acute hepatitis cases in the UK. The organization first became aware of the situation on 5th April when Scotland reported 10 cases of severe acute hepatitis. All 10 cases occurred in children under 10 years of age and had an unknown aetiology. Since then, several more cases have emerged in the UK, Europe, and the US. However, based on the surge in cases, WHO believes that there will likely be a further increase in the coming days.
WHO defines a confirmed case as ‘a person presenting with an acute hepatitis (non-hepatitis viruses A, B, C, D, E) with aspartate transaminase (AST) or Alanine transaminase (ALT) over 500 U/L, who is 10 years old and under, since 1 January 2022’.
WHO is currently working with the UK to closely monitor the trend in cases and investigate the role of adenoviruses in disease pathogenesis.
A recent case report from Scotland found that none of the affected children had a significant medical history prior to hospitalization. The most common symptom among them was jaundice, nausea, abdominal pain, lethargy, diarrhoea, and vomiting.
Although the exact cause remains unclear, health authorities are asking parents to enforce good hygiene practices in their households, such as regular handwashing. Moreover, parents are told to stay alert for signs of gastrointestinal infection in their child, especially if accompanied by jaundice.
Health authorities have not yet reported any deaths; however, eight of the children required a liver transplant.
Reference:
Marsh Kimberly, Tayler Rachel, Pollock Louisa, Roy Kirsty, Lakha Fatim, Ho Antonia, Henderson David, Divala Titus, Currie Sandra, Yirrell David, Lockhart Michael, Rossi Maria K., Phin Nick. Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022. Euro Surveill. 2022;27(15):pii=2200318. https://doi.org/10.2807/1560-7917.ES.2022.27.15.2200318
