The World Health Organization on Friday announced an outbreak of hepatitis (inflammation of the liver) in children under 10 out of 74 children in the UK so far.
This type of inflammation can be caused by a variety of infections and toxins. Hepatitis viruses A, B, C, E and D are excluded in the UK. Symptoms in children last until January and include jaundice (yellowing of the skin and eyes), abdominal pain, vomiting, and diarrhea. Upon testing, their liver enzymes increased significantly. Many children required hospitalization, and so far six children have had liver transplants.
Some cases have also been reported in Scotland and Spain. Science reports cases in Denmark and the Netherlands. Also on April 15, the US registered cases in Alabama.
Testing for the virus has shown SARS-CoV-2 (which causes COVID) in some children; Others have had adenovirus infection, and some have shown evidence of both viruses on testing.
The Alabama Department of Public Health reports 9 children with acute hepatitis. Adenovirus-41 has been found in all these children. Two needed a liver transplant. No epidemiological relationship has been found between cases.
CDC is developing a national health advisory – this will alert all states to the problem and request further reporting of suspected cases.
Whenever there is a higher than expected increase in unusual cases, public health experts jump into action by conducting epidemiological testing and analysis. They form a case definition.
Investigators will test this initial hypothesis and take a detailed exposure history for the cases, as well as conduct extensive laboratory testing. All this will be standardized to obtain uniform information.
One hypothesis raised by Scottish investigators is that perhaps the diseases are more serious because they are infecting “immunologically naive” children who have been sheltered during the COVID pandemic.
It is unknown how many children previously had covid infection. None of the Scottish children were vaccinated. Other reports did not mention this detail for their cases.
Adenoviruses commonly cause respiratory symptoms or conjunctivitis (pink eye) and are fairly easily transmitted. Others have caused outbreaks in the military. Additional presentations include inflammation of the bladder or neurological disease. According to one review, type 41 most commonly causes gastroenteritis in children, although more commonly in children under the age of 2. , This is often the reason for hospitalization.
There is no specific treatment for adenovirus. Treatment with fluids is helpful to prevent dehydration.
Again, we do not know whether adenoviruses are the cause of all these infections; This is the prime candidate at the moment. It is unknown how this fits in with the recent Omicron B2 wave of Covid infections. The outstanding feature so far is the severity of hepatitis infection in these children and the number of transplants needed. Further monitoring and study needs to be done. stay tuned.