A recent wave of severe liver inflammation (hepatitis) has been reported in healthy children. As of 21 April, there were 169 confirmed cases of ‘acute hepatitis of unknown origin’ in children in 12 countries, with the majority (114) occurring in the United Kingdom. Many of the children are under ten years old.
What is very worrying for health professionals reporting these cases is the severity of the disease in these young, otherwise healthy children. Seventeen needed a liver transplant, and one child died of liver failure.
The number of transplants is much higher than what is usually observed in similar periods of time in previous years. While acute hepatitis is not unheard of in children, these latest data are unprecedented and so far only partially explained.
One suspect is an adenovirus infection. According to the UK Health Security Agency, adenovirus is the most common pathogen found in 40 of the 53 confirmed cases tested in the UK. The agency said “investigations are increasingly showing that the increase in severe hepatitis may be linked to adenovirus infection, but other causes are still being actively investigated.”
Adenoviruses Adenoviruses are a large group of viruses that can infect a wide range of animals as well as humans. They got their name from the tissue from which they were originally isolated: the adenoids (tonsils).
Adenoviruses have at least seven different species, and there are genetic variants within these species, just as we see with coronaviruses and other viruses. In this case, instead of variants, they are referred to as adenoviral subtypes.
Adenoviruses cause mild illness in humans most of the time. Some species cause respiratory diseases, such as croup in young children and babies. Others cause conjunctivitis, and a third group causes gastroenteritis.
The subtype associated with the current acute hepatitis epidemic in children is called adenovirus subtype 41, and the virus has so far been detected in at least 74 cases. Subtype 41 belongs to the adenoviral groups, which are usually associated with mild to moderate gastroenteritis; essentially a stomach gurgling with symptoms of diarrhea, vomiting, and abdominal pain.
In most children and adults with a healthy immune system, adenoviruses are just annoying, leading to a disease that is expected to pass in a week or two. Viral hepatitis from adenovirus infection has only been reported previously as a rare complication.
Due to the number of cases and the severity of the disease in children, scientists are urgently investigating the cause of the outbreak. At the beginning of the epidemic, epidemiologists tried to establish contact links with these cases and, of course, to determine the cause of viral hepatitis. It quickly became clear that this was not just a small isolated group of cases.
Data from the Scottish National Health Service revealed that none of these children lived in a noticeable geographical pattern (as near an open water source), that the average (average) age at hospital was four years and there were no other obvious features, such as ethnicity or gender has been found to be related to the disease. Similar findings have been reported by the US Centers for Disease Control and Prevention.
As some of the COVID vaccines used adenoviruses, some people on social media wondered if the vaccines were the cause of the outbreak. However, none of the cases reported in the United Kingdom have received a vaccine against COVID, and vaccines against COVID that use adenoviruses use an unrelated virus that cannot reproduce.
Questions to be answered. Researchers have yet to find a direct causal link between adenovirus 41 and these cases of hepatitis. Are there other complicating factors that contribute to a serious illness, such as co-infection with another virus, such as coronavirus? Sampling the population (both adults and children) to get an idea of how prevalent adenovirus 41 is in these reporting areas compared to other areas with low or no morbidity would help strengthen the link. Scientists also need to find out the genetic makeup of the virus. Has it changed significantly from the reference information we have about it? It will be crucial to understand the immune response in these cases to other mild adenoviral infections. In addition, research on prevention (vaccination) and treatment options such as antiviral drugs should be launched.
We hope to have some answers soon – and treatments. Meanwhile, parents should be vigilant about the symptoms of hepatitis in their children, including yellowing of the eyes and skin (jaundice), dark urine, pale stools, itchy skin, feeling tired and abdominal pain.
(This story was not edited by Devdiscourse staff and is automatically generated by a syndicated channel.)
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