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May 11, 2022 • 14 minutes ago • 3 minutes of reading • Join the conversation A child sent by CHEO to SickKids Hospital in Toronto is among seven cases of severe acute hepatitis of unknown origin in children being investigated in Ontario. Photo by Bruce Deitchman / Postmedia
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Ontario health officials are investigating seven cases of severe acute hepatitis of unknown origin in children – including one sent by CHEO to SickKids Hospital in Toronto for emergency treatment last December – amid reports of case groups in parts of the world .
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Authorities say it is too early to say whether there is an increase in such cases.
“More information is needed to assess the situation and all the potential risks to people in Canada,” said Public Health Officer Dr. Teresa Tam in a tweet this week.
Both CHEO and SickKids monitor all cases of severe hepatitis. The seven reported this week meet the definition of probable case and Ontario public health time for cases that require further investigation.
The World Health Organization said this week that there are now 348 possible cases of acute hepatitis of unknown origin among children in five regions of the world. One hundred and sixty-three of these cases are in the United Kingdom, and the United States recently said it is investigating 109 possible cases.
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SickKids spokesman Jessim Luck of Toronto said the hospital treats children with severe acute hepatitis of unknown origin each year, and it remains to be seen whether the cases investigated between October 1, 2021 and April 30, 2022 represent an increase over previous years or whether anyone will be confirmed to have been caused by a “new clinical site”.
In Ottawa, spokesman Patrick Moore said the December case, one of seven reported by SickKids, was the only suspicious case of CHEO.
“CHEO experts continue to work with their counterparts across the country and around the world and will report to Ontario’s public health authorities on all possible cases treated locally.
He said these and other cases would be reviewed by health authorities and could become part of a national investigation into the global problem.
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The problem has caused concern over obvious groups in some parts of the world of cases so severe that some children have needed liver transplants and others have died.
In the United States, where there is a group of such cases in Alabama, the Centers for Disease Control and Prevention is considering a common virus, adenovirus, as a possible cause, but has not yet reached any conclusions. Investigators are also looking into any connection to COVID-19.
Ontario experts say there are still many questions to be answered about the cases, but there is no reason for parents to panic. Cases, although serious, are extremely rare, and what has happened in Ontario in recent months is not necessarily distinctive.
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Dr Alison McGuire, an infectious disease specialist at Sinai Health in Toronto, said the groups of cases observed in Alabama and the number of cases observed in Scotland appear to be different from those observed in the rest of the world. She said cases elsewhere “are obviously not so different from baseline”, although information is evolving rapidly.
“There’s a lot of work to be done before we have a clear idea of what’s really going on in different parts of the world,” she said.
“What I’ve heard about Canada so far is that there is nothing at the moment that stands out as different or unusual. That doesn’t mean we haven’t had cases, it just means that if we have, it seems like a really small number. “
Although she is at the beginning of the investigation, she said there has been a lot of adenoviral activity in recent months.
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McGuire also said it was too early to rule out a link to COVID-19, although the disease was clearly not vaccine-related, as most of the children affected were too young to be vaccinated.
She said this could be directly related to COVID-19, adding that there was little evidence so far that it was a factor. But it could also be linked to the pandemic, as some viruses were largely suppressed during the pandemic due to public health measures, and are coming back stronger as people increase contact.
Earl Brown, a virologist at the University of Ottawa, agreed that the cause remains an open question, although adenovirus 41 has been found in many of the children affected.
He speculated that the link to COVID-19 may be that it lays the groundwork for worse disease than other infections, but said there are still too many unanswered questions to pinpoint the cause.
Meanwhile, doctors are being told to watch out for patients with signs and symptoms of hepatitis, such as recent jaundice, dark urine or pale stools, which require further testing.
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