Hepatitis outbreak: what to know about mystery cases in children

  • Nearly 600 cases of severe, unexplained hepatitis have been reported in children worldwide since October
  • The cause of the outbreak is still unknown but doctors suspect that they are linked to adenovirus infections, a family of viruses
Reuters |

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Health authorities around the world are investigating a mysterious increase in severe cases of hepatitis – inflammation of the liver – in young children. Photo: Shutterstock

At least 600 children in at least 34 countries have developed cases of sudden severe liver inflammation, or acute hepatitis, for which doctors have no explanation.

Here is what health officials know so far:

Many cases have been detected in the US and UK

As of May 18, at least 175 children in the UK and 180 in the United States have become sick since October 2021, most of them younger than five years old.

By comparison, doctors usually see 20 children with acute hepatitis of unknown origin each year at the UK’s three specialist paediatric hepatology units, Dr Deirdre Kelly, a paediatric liver disease specialist at the University of Birmingham, told reporters on Thursday. “This is considerably more,” she said.

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How severe are these cases?

In the United States, more than 90 per cent of affected children have been hospitalised. Most have recovered, but at least five died, according to the US Centres for Disease Control and Prevention. Worldwide, more than two dozen children have needed liver transplants.

Most cases have been reported since April. The typical signs are dark urine, light stool, vomiting, and jaundice.

A common symptom of hepatitis is jaundice, a liver-related condition that causes a yellowing of the skin and the whites of the eyes. Photo: Shutterstock

The cause is a mystery

Acute hepatitis is unusual in young children. No common environmental exposures have been found, such as unsafe water or food. Doctors think a virus is most likely to blame, but none of the children have had viruses known to cause hepatitis.

Almost half of the children have tested positive for adenovirus, a common childhood virus, including some with a type called adenovirus-41F. Adenovirus-41 is known to cause gastrointestinal symptoms such as diarrhoea, vomiting, and fever. It has not been previously linked to this type of severe liver injury in healthy children, said Dr Rima Fawaz, a paediatric liver disease specialist from the Yale School of Medicine.

The UK Health Security Agency has said possible explanations include an exceptionally large wave of normal adenovirus infections causing unusual complication to turn up more often, a new adenovirus variant, a new Sars-CoV-2 variant, or a previously unknown infectious agent. Researchers have raised the possibility that some earlier infection caused the children’s immune system to overreact to pathogens that are usually relatively benign.

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Is there a Covid-19 link?

Disease experts have ruled out a link between the hepatitis cases and Covid vaccines, as most of the affected children were too young to receive the shots.

Most of the children did not currently have Covid-19, and prior infection with Sars-CoV-2 has not yet been determined for many cases, said Dr Jason Kindrachuk, an infectious diseases researcher at the University of Manitoba, Canada.

However, some may have had mild or asymptomatic Covid infections that went unnoticed. Lingering coronavirus particles in the gastrointestinal tract could be priming the immune system to overreact to a usually-milder adenovirus with high amounts of inflammatory proteins that ultimately damage the liver.

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Other experts also theorise that due to social distancing and other measures used to curb the pandemic, younger children had less exposure to adenoviruses that would have helped them build up immunity. As a result, their immune systems may be overreacting to infection now.

“More research would be needed to confirm either theory,” Fawaz said.

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