HEPATITIS CHILDREN. A mysterious epidemic of childhood hepatitis has been reported in Europe since March, particularly in France. New cases are confirmed and one death has been observed. Covid, adenovirus… Several causes are put forward by the WHO. Summary of the facts and opinion of our hepatologist.
[Mis à jour le 26 avril 2022 à 11h50] Of new cases acute hepatitis of unknown origin have been reported in young children, ‘between 1 month and 16 years), indicates the WHO in a report from Saturday, April 23, 2022. To date, at least 169 cases acute hepatitis of unknown origin have been reported in 11 European countries and the United States. At least one death has been reported. In France, two cases were detected at University Hospital of Lyon. 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“reassured Public Health France. This is a mysterious “strange and alarming” epidemic of “new” childhood hepatitisof unknown cause, observed between March and April 2022. Among the 3 causes put forward by the WHOwe find : an adenovirus infectionan infection at Covid-19 and a co-infection of these two viruses. “The increase is unexpected and the usual causes have been ruled out“, indicates 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?
As of April 21, 2022, at least 169 cases of acute hepatitis of unknown origin had been reported in 11 countries in the WHO European Region and one country in the WHO Region of the Americas, says the WHO report of April 23, 2022. Cases have been reported in children aged between 1 month and 16 years.
- 144 in the United Kingdom of Great Britain and Northern Ireland (UK)
- 13 in Spain
- 12 in Israel
- 9 in the United States of America
- 6 in Denmark
- Under 5 in Ireland
- 4 in the Netherlands
- 4 in Italy
- 2 in Norway
- 2 in France
- 1 in Romania
- 1 in Belgium
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. Member States are strongly encouraged to identify, investigate and report potential cases that meet the case definition.
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“, confirmed Public Health France on April 19. These two cases concerned children under the age of 10 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.
Are these cases of hepatitis serious?
Of all the cases identified, 17 children required a liver transplant. At least a death has been declared.
“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 WHO, these cases of hepatitis are more likely to be linked to an adenovirus (detected in at least 74 cases), a family of viruses that usually only cause a bad cold. “Although adenovirus is currently hypothesized as the underlying cause, it does not fully explain the severity of the clinical picture. Adenovirus type 41 infection, the type of adenovirus involved, has not previously been linked to such a clinical presentation. Adenoviruses are common pathogens that usually cause self-limiting infections. They spread from person to person and most often cause respiratory illnesses“, says the WHO. Indeed, half of children with hepatitis in the United Kingdom have tested positive for this virus, as have all the cases spotted in Alabama. The United Kingdomwhere the majority of cases have been reported to date, recently observed a significant increase in adenovirus infections in the community (notably detected in faecal samples from children) following low levels of circulation at the start of the COVID-19 pandemic. The Netherlands also reported a concurrent increase in community circulation of adenoviruses. The WHO recommends that blood tests (with initial anecdotal experience indicating that whole blood is more sensitive than serum), serum, urine, stool and respiratory specimensas well as samples liver biopsy (when available) be undertaken, along with further characterization of the virus, including sequencing. Other infectious and non-infectious causes should be thoroughly investigated.
The Covid at the origin of these hepatitis?
the Sars-CoV-2, virus responsible for Covid, was also detected in several children (at least in 20 cases among the children tested). 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. Indeed, the clinical syndrome among the cases identified is acute hepatitis (inflammation of the liver) with markedly elevated liver enzymes (aspartate transaminase (AST) Where alanine aminotransaminase (ALT) greater than 500 IU/L). Many cases have reported gastrointestinal symptoms, including abdominal pain, diarrhea and vomiting preceding the presentation of severe acute hepatitis and jaundice. Most cases had no fever. Genetic characterization of viruses should be undertaken to determine any potential association between the cases. This hepatitis epidemic is still under active investigation.
An adenovirus/Covid co-infection at the origin of these hepatitis?
The track of an adenovirus and Covid co-infection has also been put forward by the WHO. Among the cases of acute hepatitis identified, 19 were detected with co-infection by SARS-CoV-2 and adenovirus, underlines the WHO in its report.
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, especially with the United Kingdom, 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