Last week, hundreds of liver health experts gathered for the World Hepatitis Summit, and one topic dominated the agenda: the mysterious outbreak of hepatitis in children, which gradually spread to 34 countries, including the United Kingdom.
Speaking at the event, liver expert Dr Philippa Easterbrook said: “This is the first time so many severe cases have been reported in children. It is important to understand the cause and take these cases seriously.
At its most extreme, hepatitis can cause the liver to stop working. So far, more than 240 cases have been reported in the UK, while 11 British children needed a transplant.
What may be behind this is a topic that divides the scientific world. But the latest development comes from an intriguing study by Israeli scientists, which suggests that the answer may lie in Covid-19.
Last week, hundreds of liver health experts gathered for the World Hepatitis Summit, and one topic dominated the agenda: the mysterious outbreak of hepatitis in children, which has gradually spread to 34 countries, including the United Kingdom.
Some experts say there may be a link between the mysterious epidemic and Covid 19
Doctors analyzed the medical history of five children who developed the condition – a dangerous inflammation of the liver.
They noticed a common factor: everyone had caught Covid the previous year. Inflammation of the liver, they suggest, could be a major side effect of the immune system’s response to the virus.
Influential doctors turned to Twitter to share news of the findings, inventing the phenomenon of “Covid’s long liver.” British epidemiologist Dr Deepty Gourdasani of Queen Mary University of London tweeted her confidence in the findings, accusing some of them of denying them “denying the harm done to children by Covid”. Yet many respected pediatric health experts and epidemiologists have angrily challenged the allegations.
Professor Alasder Munro, an expert in pediatric infectious diseases at Southampton University Hospital, said the study provided “almost no useful information” and there was no evidence that these cases of hepatitis were linked to Covid.
While Dr. Jake Dunning, an expert on infectious diseases at the University of Oxford, said that scientists marking Covid’s long liver disease “really need to know better.”
The prevailing theory is that the culprit is a bad strain of a common childhood infection called adenovirus – three-quarters of children admitted to British hospitals tested positive.
Most children will catch the infection at some point, but it usually causes only minor upper respiratory problems, leading to cough, runny nose and, in rare cases, pneumonia.
But experts believe that the lack of exposure to adenoviruses during the blockade of Covid has left children’s immune systems without natural defenses to fight it, leading to a severe reaction. However, the new allegations may raise concerns among parents – so can they be right?
At least on the surface, the Israeli study seems convincing. The report, published in the Journal of Pediatric Gastroenterology And Nutrition, tells the story of five patients: two three-year-olds who needed liver transplants, and two eight-year-olds and 13-year-olds who were hospitalized but fully recovered. All five were infected with Covid within the four months that led to their diagnosis of hepatitis.
The authors say their findings show that Covid infection has caused a malfunction of the immune system and is starting to attack the liver. This is not unheard of in other viral infections and in this case is known as post-viral hepatitis, a recognized condition in children.
Dr Gourdasani, a vocal supporter of Covid’s long-liver theory, says another piece of evidence is the fact that the United Kingdom and the United States have the highest number of cases of hepatitis. Both had very high rates of infection in children, unlike many other nations, which imposed strict safety measures on Covid in schools.
“The United Kingdom has been extraordinary in the way we have tried to protect children from the virus,” said Dr Gourdasani. “We did not have to wear masks in the same way as other countries and we did nothing to ventilate the schools. It is possible to see the impact of these decisions.
The study also called into question another possible cause: adenovirus was not detected in any of the five patients. And this is not the only study of its kind to come to this conclusion. In late April, Alabama doctors published a study noting the virus in nine children with severe hepatitis who needed a transplant.
And many scientists point out that the adenovirus has never been linked to hepatitis – in fact, there is not a single case of hepatitis-induced adenovirus reported in the medical literature. “The argument caused by adenovirus is getting weaker and weaker,” said Dr. Gurdasani. “It does not cause hepatitis and many studies have failed to detect it in the liver of these children. So where is the evidence?
But experts say there are many problems with the Israeli study. The biggest: these are just five children.
Israel has registered 12 cases of hepatitis in children, so the study includes less than half of these patients.
“Researchers do not explain why these patients were selected or why other cases of hepatitis were not,” said Professor Munro. “We don’t know if they only chose those who had Covid, so that doesn’t show how likely a child who develops Covid is to develop hepatitis.”
Prof. Munro also points out that because Covid is so prevalent, it is not necessarily surprising that these children have had Covid infections. “Covid infection is so common and the time between these children getting the virus and then hepatitis is so varied that there is no clear evidence that one causes the other. This does not mean that Covid and hepatitis are not related, but this study does not provide any specific evidence that they are related.
Professor Will Irving, a virologist at the University of Nottingham, agrees that it is too early to jump to conclusions. He says: “Five cases are not enough to prove something, we need to look carefully at how many of the several hundred cases in the UK have had Covid and go from there.”
To add to the confusion, U.S. health officials said last week that while the country has seen more than 270 cases of unexplained hepatitis in children this year, it is no more than in a normal year. “There has always been a background to these unexplained cases, even before Covid,” says Professor Irving.
The only thing all experts agree on is that finding the cause remains an urgent task, as it will help doctors know what treatment to offer. In the United Kingdom, children hospitalized with hepatitis are treated for adenovirus with the antiviral drug cidofovir. But other countries, such as Israel and Austria, are treating them with steroids, which can help regulate a malfunctioning immune system potentially affected by Covid.
Dr Gourdasani warns: “If the adenovirus theory is wrong, we have been giving patients the wrong treatment for months. UK health officials need to focus on Covid’s theory if they want to protect children.
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