Acute childhood hepatitis: neither Covid nor adenovirus?

[Mis à jour le 22 avril 2022 à 16h34] A mysterious epidemic “strange and alarming” of “new” childhood hepatitisof unknown cause, was observed between March and April 2022. On Friday April 15, 2022, several scientists launched the alert of an abnormal incidence severe hepatitis at the house of healthy young children reports an article published in the journal Science. To date, 74 cases have reportedly been recorded in the UK. But also in other European countries (Spain, Denmark…) and to UNITED STATES. In France, two cases were detected at the Lyon University Hospital. That “does not show, at this stage, an excess of cases in France. Given the active search for cases that has been launched by the health authorities, other reports are likely to be expected in the coming days.“, wanted to reassure Public Health France. “The increase is unexpected and the usual causes have been ruled out“, worries for its part the Regional Office of the World Health Organization (WHO) for Europe in a press release dated April 15, 2022. “This is’a serious phenomenon [qui touche] healthy children“, insisted Deirdre Kelly, pediatric hepatologist at Birmingham Children’s Hospital in the United Kingdom, quoted by the journal Science. “Hepatitis of undetermined origin still exists. Even if we carry out all the examinations and sweep all the known causes, there are always unexplained cases. But it is necessary to eliminate the most important causes, to find a treatment and to guarantee a good vital prognosis.“, indicates Pr Patrick Marcellin, hepatologist, whom we interviewed on April 22, 2022. Among the warning symptoms that were mentioned, we find: jaundice, diarrhea, vomiting and abdominal pain… What do we know about the origin of these hepatitis?

How many cases of childhood hepatitis in the world?

Several cases of severe hepatitis have been reported in healthy young children, the vast majority aged between 11 months and 13 years. To date, no deaths have been reported.

• In Scotland, WHO has been notified of 13 cases of severe acute hepatitis of unknown etiology in children under 10 years old, in the center of the country (as of 12 April 2022). Of these 10 cases, 9 would have presented warning symptoms in March 2022 and one child, in January 2022. Normally, Scotland observes less than 4 cases of this type of hepatitis per year.
• UK : 74 cases have been recorded as of 8 April 2022 (including cases seen in Scotland). No deaths are to be deplored, but all the children were admitted to hospital and 6 had to undergo a liver transplant.
• In Spain : 3 cases were detected (no deaths, one child had to undergo a liver transplant)
• In Denmark and the Netherlands: several similar cases would also have been identified
• In the USAthe Centers for Disease Control and Prevention (CDC) is currently investigating 9 cases in Alabama.
• In Irelandless than 5 cases would have been identified.

Given the increase in reported cases over the past month and improved case-finding activities, more cases are likely to be reported in the coming days, WHO said.

Two cases of acute hepatitis whose etiology is still undetermined have been reported by the Lyon University Hospital

How many cases of childhood hepatitis in France?

“Two cases of acute hepatitis whose etiology is still undetermined have been reported by the Lyon University Hospital“, confirms Public Health France this Tuesday, April 19, 2022. These two cases concern children under 10 years old and are being investigated by medical teams. “Cases of acute hepatitis of undetermined etiology in children are not uncommon. The occurrence of these two cases is not unexpected and does not, at this stage, indicate an excess of cases in France. Given the active search for cases that has been launched by the health authorities, other reports are likely to be expected in the coming days.“, continues the health authority.

“The adenovirus or the Covid virus are not viruses known to attack liver cells and cause real hepatitis”

Half of children with hepatitis in the UK have tested positive for adenovirus

The hepatitis viruses (A, B, C, E and D, as appropriate) have been excluded after laboratory tests while further investigations are underway to understand the etiology of these cases, the WHO says. No other epidemiological risk factor has been identified to date, including recent international travel. According to the scientists, quoted in the journal Science, these cases of hepatitis would rather be linked to an adenovirus, a family of viruses that usually only cause a bad cold. Indeed, half of children with hepatitis in the UK have tested positive for the virus, as have all the cases spotted in Alabama. the Sars-CoV-2, virus responsible for Covid, has also been detected in several children (the exact number has not been revealed). However, this is only a guess:the evidence is too thin to solve the mystery“, say researchers and doctors. “The adenovirus or the Covid virus are viruses that can give a small elevation of transaminases, reflecting the impact of viral infection. On the other hand, these are not viruses known to attack liver cells and cause real hepatitis“details Pr Patrick Marcellin, hepatologist, interviewed by the Journal des Femmes Santé on April 22, 2022. Genetic characterization of viruses should be undertaken to determine any potential association between the cases. This hepatitis epidemic is still under active investigation.

Can we travel despite these cases of hepatitis?

Yes. In its statement of April 15, 2022, the WHO does not recommend no restrictions on travel and/or trade with the UK, or any other country where cases are identified, based on currently available information.

Sources: Acute hepatitis of unknown aetiology – the United Kingdom of Great Britain and Northern Ireland, WHO, April 15, 2022 / Mysterious hepatitis outbreak sickens young children in Europe as CDC probes cases in Alabama, Science, April 15, 2022