Are vaccines to blame and should we be afraid? In the world, children suffer from hepatitis of unknown nature – we tell you what is known about it

Cases of acute liver disease (hepatitis) have been reported in recent months in children aged one month to 16 years worldwide – mainly in Europe and the United States. What makes these episodes unusual is that the cause of the disease is still unknown. At the same time, in some cases, sick children needed a liver transplant, and by April 21, at least one child had died. Let’s talk about what we know about this phenomenon.

Photo: Reuters

On April 23, the World Health Organization (WHO) officially announced cases of a new disease. The news of the cases came from the United Kingdom, Spain, Israel, the United States, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania and Belgium. The WHO then announced 169 sick children, 17 of whom needed a liver transplant. As of May 3, at least 228 cases of the disease have been reported in children worldwide and dozens more cases are suspected.

What is acute hepatitis?

Acute hepatitis is an inflammation of the liver that can be caused by infection or other causes. The most common types of infectious hepatitis are caused by viruses A, B and C. There are hepatitis D and E, which, according to the WHO, are much less common, especially in high-income countries.

Acute hepatitis sometimes has no noticeable symptoms, but if the disease does occur, they may include:

  • Muscle and joint pain.
  • high temperature;
  • Fatigue;
  • loss of appetite;
  • Stomachache;
  • dark urine;
  • Skin itching?
  • Yellowing of the eyes and skin.

The WHO notes that severe cases of acute hepatitis in young children are rare. That is why the current outbreak of the disease is an unusual phenomenon, to which the medical departments immediately drew attention.

First cases – last fall in the USA

The first cases of unusual hepatitis in five children were observed in October 2021 in the state of Alabama, USA. As early as November, the US Centers for Disease Control and Prevention launched an investigation into these cases. As a result, four other children with the same disease were identified.

All the sick children lived in different parts of the state and had no kinship. The age ranged from one year and eight months to five years and nine months. Seven of the nine children were girls. None of them had any other serious illnesses or disorders of the immune system.

US Centers for Disease Control and Prevention in Atlanta.  Photo: James Gathany, Centers for Disease Control and Prevention
US Centers for Disease Control and Prevention in Atlanta. Photo: James Gathany, Centers for Disease Control and Prevention

The symptoms of the disease in children differed: vomiting, diarrhea, jaundice, swelling of the liver and in one case encephalopathy (non-infectious brain damage). Examinations revealed elevated levels of liver enzymes in the blood. At the same time, hepatitis A, B and C virus tests were negative.

Doctors also ruled out other possible causes of hepatitis, including rare and autoimmune diseases and other infections. The coronavirus also turned out to have nothing to do with it – none of the children had been infected with it in the past.

But in the blood samples of all patients it was adenovirus, in addition, in five cases it was possible to determine that it belonged to the same type – 41 (the type most often associated with acute gastroenteritis). At the same time, six patients underwent liver biopsy and found no viral inclusions or other signs of adenovirus in the samples.

Three patients developed acute liver failure – two underwent liver transplantation. He is now in recovery.

UK: Dozens of cases and confirmed adenovirus

On 5 April 2022, the United Kingdom notified the WHO of ten cases of acute hepatitis in children aged 11 months to five years. All were registered in central Scotland. The children’s symptoms began to appear in January-March and included jaundice, diarrhea, vomiting and abdominal pain.

By April 8, there were already 74 cases. As in the US, tests ruled out hepatitis A, B, C, D and E viruses and in some cases confirmed the presence of adenovirus. The level of liver enzymes in the blood was elevated. Six children needed a liver transplant. In contrast to the United States, several patients have also been diagnosed with SARS-CoV-2 coronavirus infection.

Distribution of the disease by country since April 23, 2022. Image: WHERE
Distribution of the disease by country since April 23, 2022. Shades of blue highlight countries with documented cases of the new disease. Picture: WHERE

The WHO notes that in the United Kingdom there has recently been a significant increase in adenoviral infections in the general population (infection has been particularly common in faecal samples from children). This is due to the fact that earlier, in the context of the coronavirus pandemic, adenovirus circulation was significantly reduced – and now it has begun to reach a “normal” level. The Netherlands also reported increased adenovirus circulation in the population.

Official announcement from the WHO

On April 23, the WHO published its information on cases of acute hepatitis of unknown origin. The agency confirmed and collected the symptoms that appeared in children in 11 countries:

  • Inflammation of the liver with a marked increase in the activity of liver enzymes.
  • abdominal pain, diarrhea and vomiting.
  • Jaundice (yellowing of the skin and mucous membranes).

At the same time, the WHO noted that in most cases, sick children did not have a fever. In all cases, the tests did not detect hepatitis A, B, C, D or E viruses. None of the patients had traveled abroad.

Adenovirus was detected in at least 74 cases, in 18 of which the adenovirus type was determined in 41. 20 children were diagnosed with coronavirus and another 19 – coronavirus and adenovirus simultaneously.

What is the relationship between new hepatitis and adenovirus? What is an adenovirus?

Today, the main hypothesis for what causes acute hepatitis in these cases is the presence of adenovirus infection. However, this is only a hypothesis so far – doctors are still gathering information and investigating cases by studying patients’ medical histories.

Adenoviruses are a group of extremely common viruses that are transmitted from person to person. Viruses of this type are transmitted through close personal contact, airborne droplets and contaminated surfaces. There is a risk of infection in the following cases:

  • Touching an infected person, handshake.
  • When you cough and sneeze.
  • Touching an infected object or surface and then touching your mouth, nose or eyes before washing your hands.
  • Contact with patient’s stools (for example, when changing diapers).

There are over 50 different types of adenoviruses that can cause infections in humans. They often lead to respiratory diseases (such as the “cold”), but depending on the type they can cause other diseases: gastroenteritis, conjunctivitis, cystitis and, in rare cases, neurological diseases. There is no specific treatment for adenovirus infection and it usually goes away on its own.

Electron micrograph of transmission of two adenovirus particles.  Photo: GrahamColm, CC BY 3.0
Two-part adenovirus electron micrograph. Photo: GrahamColm, CC BY 3.0

Adenovirus type 41, which can be detected in many patients with new hepatitis, usually causes acute gastroenteritis in children. Its main symptoms are diarrhea, vomiting and fever. It is often accompanied by respiratory symptoms. Type 41 adenovirus is known to cause hepatitis in immunocompromised children, according to the US Centers for Disease Control and Prevention, but so far this has not been the case in healthy children.

The WHO emphasizes that although the “adenoviral” nature of new hepatitis is a priority, it does not fully explain the severity of the clinical picture. On the other hand, during the COVID-19 pandemic, the adenovirus in the population has become much smaller, which means that young children are exposed to it less often. Perhaps this explains such a serious reaction in all these cases. This view is shared by a professor, a pediatric epidemiologist from Greece Vana Papaevangelou. He points out that young children are susceptible to the disease, many of whom were born shortly before or during the coronavirus pandemic. Due to isolation, they are less likely to develop infections, so they may react more strongly to them.

“Two- or three-year-olds grew up in a sterile environment and that created a vacuum of immunity. Now, with the repeal of the measures (“antiseptic” – about ed.), This gap is being filled by viruses. If before the child [из-за аденовируса] “He could stand two diarrhea, now he suffers from hepatitis,” says the doctor.

Is there a connection to the coronavirus or its vaccines?

Hypotheses related to the side effects of COVID-19 vaccines have not yet been confirmed. The point is that the vast majority of sick children did not get such vaccines. In the United Kingdom, for example, COVID-19 vaccines are only available from the age of five.

Photo: Reuters
Photo: Reuters

Coronavirus itself is not considered a cause of acute hepatitis in children, but doctors are investigating the possibility of “dual infection”, where co-infection with adenovirus and coronavirus can cause liver damage. At the same time, there are cases where very few children have had hepatitis due to COVID-19 in the US, Brazil and India. In most episodes, these patients recovered quickly and were discharged after a few days.

Is there a cure and what can you do to avoid getting sick?

There is currently no specific treatment for acute hepatitis of unknown origin, as the nature of the disease has not been clarified. In severe cases, it is necessary to resort to a liver transplant. According to the doctor Ryan FisherDirector of the Department of Hematology and Transplantation at Kansas City Children’s Hospital, treatment for suspected hepatitis-related hepatitis remains largely supportive.

“Over time, with due diligence in meeting the needs of the child (for example, by administering intravenous fluids in case of dehydration), recovery is common. “The liver is capable of full recovery and we do not expect long-term results after recovery,” says Fischer.

The WHO recommends that you follow the usual measures that help protect against common viruses. Parents are advised to make sure their children wash their hands regularly and properly and cover their mouths when coughing or sneezing. Head of the Infectious Diseases Department of Dayton Children’s Hospital in Ohio, Dr. Michael KlatteWe urge parents not to panic.

“Severe hepatitis leading to liver failure is extremely rare,” says Klatte. – Identification [у ребенка] “The adenovirus should not make you worry that the infection will lead to this rare complication.”

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