Covid: Hepatitis cases rise in UK children

Nottingham Trent University Nottingham, April 20 (The Conversation) There has been a sharp rise in cases of severe hepatitis in children under ten in the UK in recent months. The UK Health Security Agency has been notified of 74 cases since January 2022, including 49 in England, 13 in Scotland and the remaining 12 split between Wales and Northern Ireland.

Other isolated cases of severe acute hepatitis in children have been identified in the United States, Spain and Ireland.

Severe hepatitis in children is very rare and we don’t yet know what is causing this very unusual increase in cases. The leading theory is that it’s some kind of viral infection, possibly even SARS-CoV-2, the coronavirus that causes COVID-19.

But how likely are these hepatitis cases to be COVID-related? Or is there a more likely cause to be found elsewhere?

Let’s first see what hepatitis is and how it is related to viral infections.

Hepatitis is the medical term for inflammation of the liver. Inflammation is a general immune response to infection or injury – a sign that the body is trying to fight off potential disease. Symptoms in children usually include some (but not all) of the following: dark urine, gray-colored stools, yellowing of the skin and eyes (called jaundice), and high temperature.

With the proper medical care, the condition can usually be treated, but some patients may require a liver transplant. The World Health Organization has reported that six of the affected children in the UK have so far undergone transplants.

The causes can be varied but in children, hepatitis is usually associated with viral infections. The most common of these are the five hepatitis viruses: hepatitis A, B, C, D and E. Other viruses such as adenoviruses can cause hepatitis, but this is rare.

What is unusual about these cases in children is that none of the five hepatitis viruses were detected in any of the patients. This rules out the most common cause of these symptoms, leaving public health authorities to search for answers.

Adenovirus and hepatitis

Adenoviruses are a very common viral infection in humans, especially in children. Almost all children have at least one adenovirus infection before the age of ten.

Usually these viruses cause lung and respiratory tract infections, leading to cold symptoms and sometimes pneumonia. In some cases, mainly in children aged five and older, adenoviruses can cause what is sometimes called “pool fever”, resulting in a sore throat, fever and eye inflammation.

In immunocompromised patients (anyone whose immune system is not working properly, such as those undergoing an organ transplant or cancer treatment), adenoviruses can, in rare cases, cause hepatitis.

But seeing it on this scale is extremely rare, especially in children who don’t seem to be immunocompromised. If adenovirus is the cause of these cases, it could mean that a new variant of adenovirus has emerged that more easily causes hepatitis.

Other potential causes

Adenovirus seems to be the most likely explanation, as it is a common infection in children and can cause hepatitis. But there are alternative scenarios that should be explored.

Autoimmune hepatitis, where the body itself attacks the liver (as opposed to a virus or other pathogen attacking it), could potentially cause such cases. But it is a rare condition, affecting around 10,000 people in the UK and usually found in women around 45 years of age. With that in mind, autoimmune hepatitis is highly unlikely to be the cause of a cluster of cases in children.

It has been suggested that COVID may be the cause of these hepatitis cases, as SARS-CoV-2 was detected in some of the children. Isolated cases of hepatitis have been reported in COVID patients, but this is even rarer than autoimmune hepatitis, and has mostly been seen in adults with severe COVID.

It is important to note that none of the children diagnosed with hepatitis in the UK have received a COVID vaccine, so there is no reason to believe that COVID vaccines have anything to do with this spike.

Another possibility is that it is a new symptom resulting from an interaction between viruses (perhaps adenovirus and coronavirus both infecting the same child, for example). Alternatively, it could be caused by a totally different virus that hasn’t been detected yet.

And now?

The UK Health Safety Agency advises parents and carers to be alert for signs of hepatitis in children.

While adenovirus currently appears to be the most likely cause here, further investigation will be needed to confirm this and rule out other possible explanations such as new viruses. It may even turn out that the cause is not common to all cases.

As the COVID pandemic continues, we must consistently consider the coronavirus as a possible cause for unusual healthcare scenarios. At the same time, we should not assume that there is always necessarily a connection. Such thinking carries the risk of blinding us to what is really going on.

If the adenovirus turns out to be the main cause, what can we do to protect ourselves from it and thus minimize any risk of serious complications? Adenoviruses are spread through the air and by touch. The main preventive measure is good hand washing – by children and adults alike – as well as good respiratory hygiene, such as coughing into your elbow. (The Conversation) AMS AMS

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Edward L. Robinett