What’s behind the mysterious rise in liver disease in children? | Doctor’s note

Health experts around the world are studying an increase in the number of cases of hepatitis, or inflammation of the liver, in children. The disease was first reported in a small number of children in the UK between January and April this year, but since then cases have been reported in Europe, parts of the US and one case in Asia.

According to World Health Organization (WHO), as of April 21, 2022, at least 169 cases of acute hepatitis of unknown origin have been reported. Countries reporting cases include the UK, US, Spain, Israel, Denmark, Ireland, Netherlands, Italy, Norway, France, Romania and Belgium. On Monday, Japan announced its first case and Canada said it was also investigating similar cases. Globally, confirmed cases are in patients between the ages of one month and 16 years old. Seventeen children – about 10% – needed a liver transplant. At least one death has been reported.

Although hepatitis in children is not unknown, the severity of these infections makes them unusual. The fact that these infections occur in previously healthy children is also concerning. The fact that some of these children required liver transplants makes the need to understand the cause of this mysterious disease even more urgent.

Even more unusual, these cases are not linked to any of the five typical strains of hepatitis – A, B, C, D and E. The children involved tested negative for these specific viruses.

What is hepatitis?

Hepatitis is a general term that refers to inflammation of the liver.

The liver is a vital organ located in the upper right of the abdomen. It has over 500 known functions including blood filtration, aiding digestion, blood sugar management, protein regulation and production, removal of drugs and other toxic substances from the blood, management blood iron levels and resistance to infection by creating immune factors. and eliminate bacteria from the bloodstream.

When the liver becomes inflamed – as it does in hepatitis – these functions can be impaired.

Hepatitis is usually the result of a viral infection (hepatitis A, B, C, D, E) or liver damage caused by alcohol consumption, and in some cases it can occur when the body’s immune system body attacks liver cells. Some types of hepatitis pass without serious problems, while others can be long-lasting (chronic) and cause scarring of the liver (cirrhosis), loss of liver function and, in some cases, liver cancer.

In the early or acute stages, children and adults with hepatitis may have no symptoms and not realize they have it. But if symptoms do develop, they are often nonspecific and can include:

  • Muscle and joint pain
  • A high temperature
  • feel and be sick
  • Lethargy
  • stomach pain
  • Dark urine
  • Pale gray stools
  • Yellowing of the eyes and skin (jaundice)

Children with these symptoms, especially if they do not settle, should be taken to the doctor. Most types of hepatitis can be treated or resolved on their own, but in some cases the disease can progress to liver failure, where the liver stops working altogether. If this happens, a liver transplant is needed.

What is the cause of this sudden increase in hepatitis in children?

The cases of hepatitis observed in children so far have not been caused by the usual hepatitis viruses. Experts believe the disease is caused by a group of viruses known as adenovirus – a common group of viruses known to cause a range of illnesses from stomach aches to upper respiratory tract infections, mainly in children.

There are 88 types of adenovirus known to infect humans, and these are grouped into seven different species, A through G. They are spread through close personal contact, respiratory droplets, and contaminated surfaces.

Most adenovirus infections are self-limiting in healthy children and adults and are treated with supportive measures such as fluids and rest. Fatal infections can occur in children and immunocompromised adults and less frequently in healthy people. They usually do not cause infections as severe as hepatitis in otherwise healthy children, although individual case reports of what happened in the past have been reported. documented.

Although the number of children identified as having hepatitis worldwide remains relatively low, it is still higher than what medical professionals are used to seeing and has prompted health organizations to publish alerts say that urgent investigations are underway.

Investigations will focus on whether a group of viruses that typically cause mild infection in most people have changed, or whether it is the host response to the virus that has changed.

Scientists and clinicians are now investigating whether there has been a change in the genetic makeup of the virus that could trigger liver inflammation more easily. The UK Health Security Agency (UKHSA) says a strain of adenovirus called F41 appears to be the most likely cause (PDF). It is not a new strain of adenovirus and usually causes diarrhea in children and is usually spread by the fecal-oral route. It is currently unknown if there is a new variant of the F41 adenovirus that makes it more dangerous to the liver in children or if some children react to it in unusual ways.

One potential hypothesis scientists are investigating is that children were less exposed to these common viruses while COVID-19 restrictions were in place, preventing social mixing. Now, as things open up and the kids start to mix again, they are suddenly exposed to a number of viruses in rapid succession and their immune systems overreact, eventually leading to liver inflammation.

Although most of the children who got mysterious hepatitis were under the age of five, some were older and this theory, although widely reported, has no substance for them as they are likely to have been exposed to adenoviruses when they were younger – before the pandemic started.

Another possible hypothesis is that a previous infection with the SARS-CoV-2 virus could be linked to the increase in cases of hepatitis in children. Some, but not all, of the children in the UK who have been diagnostic with hepatitis tested positive for COVID; the theory studied asks whether previous or current infection with COVID-19 could make children more susceptible to hepatitis when subsequently infected with an adenovirus. While isolated cases of hepatitis have been reported in patients with severe COVID, this is rare.

Importantly, none of the children in the UK – which has seen the majority of childhood hepatitis cases – had received one of the COVID-19 vaccinationmaking it impossible to link the disease to these vaccines.

What should parents do?

It is important to remember that although this is a concerning condition, it has so far only affected a small number of children worldwide. If a child has any of the above symptoms, especially if they are persistent or unexplained, parents should see a doctor.

Children should be encouraged to participate in simple hygiene activities, such as washing their hands regularly, especially after using the toilet or before eating. Children with symptoms of gastrointestinal infection, such as vomiting and diarrhea, should stay home and only return to school or day care 48 hours after symptoms resolve.

Simple respiratory hygiene during viral upper respiratory infections is also important; children should be shown how to blow their nose or wipe their nose with a tissue, which should then be placed in a trash can and the child should then wash their hands.

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