Ten children in the UK needed a liver transplant after a recent increase in severe hepatitis among young children, currently a total of 114 in all four British nations.
The lack of exposure to common adenoviruses due to Covid’s restrictions over the past two years, combined with a recent surge in adenovirus infection as society reopens, is the most likely explanation, experts say.
Adenoviruses are common viruses that can cause a range of symptoms, from cold-like symptoms to fever, pneumonia, diarrhea and conjunctivitis. They do not usually cause hepatitis, although this can be a very rare complication of some types of adenoviral infection.
Speaking at an emergency session of the European Congress of Clinical Microbiology and Infectious Diseases in Lisbon on Monday, Dr Meera Chand, director of the incident in the UKHSA investigation into the rise in hepatitis, said that of the 81 cases reported in England so far, 43 children have fully recovered, while 38 are still in hospital. Seven of the transplant cases are in England.
“It is not known that the cases in England are interconnected and scattered throughout the country,” she said.
The majority of cases involved children aged one to six (mean age: three) and occurred in the last three to five weeks. None of the affected children died.
A leading hypothesis is that an increase in severe hepatitis is an additional effect of the pandemic, with blockage and other restrictions meaning that many children have had less exposure to normal viruses than normal, leading to an inadequate immune response when faced with an infection such as society is reopening.
Adenoviruses are a major suspect: they spread through close personal contact, coughing or sneezing, and touching contaminated surfaces.
Of the 53 children with hepatitis in England who have been tested for adenovirus so far, 40 (75%) tested positive. Adenovirus infections among children aged one to four in England are also currently at their highest level compared to any other time in the past five years, Chand said.
“I think our main hypothesis, given the data we’ve seen, is that we probably have a normal adenovirus circulating, but we have a co-factor that affects a certain age group of young children, which either makes this infection more severe.” or makes it trigger some kind [inappropriate immune response]”Chand said.
Prof. Deirdre Kelly, a pediatric hepatologist at the NHS Trust for Women and Children in Birmingham and part of a group working with the UKHSA to investigate cases, said: “It may be due to the fact that children who have been largely isolated Respond to viruses that they would normally build immunity to at an early age or may have a previous Covid infection that has affected the body’s defense systems.
Between January and April 2018, the Birmingham Center, the largest of the three specialized centers in the UK that treats severe liver disease in children, saw six severe unexplained cases of hepatitis in children. “In the same time frame this year, we saw about 40,” Kelly said. “We don’t have an answer as to why, but it’s probably something to do with the pandemic, because we’ve never had one before.
Another possibility is that a recent Covid infection may suppress the immune system, making children more vulnerable to serious side effects from usually quite harmless viruses; or that a new, more virulent strain of adenovirus is in circulation, although initial genotyping has found no evidence, Kelly said.
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Most of the infections appear to include adenovirus 41F, which usually causes diarrhea, vomiting, abdominal pain and fever.
Cases of severe hepatitis among young children have been found in 12 other countries, with at least 169 cases reported by the World Health Organization to date. Most of the reported cases are in the United Kingdom, followed by Spain (13 cases) and Israel (12 cases). Cases have also been reported in the United States, Denmark, Ireland, the Netherlands, Italy, France, Norway, Romania and Belgium.
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