On April 15, 2022, the World Health Organization (WHO) published a report of severe cases of acute hepatitis of unknown origin in children in the United Kingdom. Since then, there have been continuous additional reports of cases.
We spoke with Dr. Leandro Soares Sereno, Counselor for Prevention and Control of Viral Hepatitis at the Pan American Health Organization (PAHO), about hepatitis and severe acute cases reported in a number of countries.
1. What is acute hepatitis?
Hepatitis is an inflammation of the liver. There are various etiologies – or causes – that can lead to this inflammation, such as infection or intoxication with drugs or substances. The most commonly involved infectious agents are the viruses responsible for hepatitis A, B, C, D and E.
When inflammation occurs quickly and sharply, we talk about acute hepatitis. In some cases, such as hepatitis B, C and D, the infection can become chronic. In this situation, we are still not sure of the reason.
2. Why is the outbreak of hepatitis in children considered unusual? Is it due to the adenovirus?
This is an event that is being further investigated by the WHO. So far, laboratory tests have ruled out cases of known viral hepatitis. In many cases, adenoviral infection has been found in affected children, and the relationship between the two has been investigated as one of the hypotheses for the root cause.
Adenovirus is a common virus that can cause respiratory symptoms or vomiting and diarrhea. In general, infection with such viruses is of limited duration and does not evolve into more serious conditions. However, there are rare cases of severe adenoviral infections that have caused hepatitis in immunocompromised patients or transplant patients, for example. However, these children do not fit this description – they used to be healthy.
3. How many countries have reported confirmed or suspected cases of hepatitis in children not related to hepatitis A, B, C, D or E viruses?
At this stage, we cannot talk about confirmed cases, as the specific cause is still unknown and is being investigated. Reported cases relate to children with severe acute hepatitis in whom hepatitis A, B, C, D or E have not been identified.
Using this definition, as of May 3, 2022, more than 200 cases from 20 countries have been reported. The majority of cases are in the United Kingdom, which was the first country to report cases to the WHO.
In North and South America, cases have been reported in the United States, and countries in the region are encouraged to monitor the situation. For the time being, the PAHO / WHO is providing information to the parties on the criteria and definitions to support the monitoring.
4. What is PAHO’s assessment of the situation?
There is still little data to determine whether there is an outbreak and so far the global risk is considered low. As there is still no certainty about the origin of the disease, it is possible to be aware of a situation that existed before, but went unnoticed because there have been so few cases.
5. Can the outbreak be related to COVID-19 or COVID-19 vaccines?
Based on current information, most of the children reported did not receive the COVID-19 vaccine, which excludes a link between the cases and the current vaccination.
The presence of SARS-CoV-2 virus has been detected in several cases, and this is one of the lines of study along with others, such as adenovirus.
6. What are the symptoms? Is it treatable?
Acute hepatitis has various symptoms: gastrointestinal, such as diarrhea or vomiting, fever and muscle pain, but the most common is jaundice – in which the skin and whites of the eyes turn yellow.
The current treatment aims to alleviate the symptoms and to manage and stabilize the patient if the case is severe. Treatment recommendations can be refined once the origin of the infection has been established.
7. What can parents do to protect their children?
The most important thing is to pay attention to symptoms such as diarrhea or vomiting, and color: if there are signs of jaundice – where the skin and whites of the eyes turn yellow – seek medical attention immediately.
We recommend basic hygiene measures such as washing your hands and covering your mouth when coughing or sneezing to prevent infections, which can also prevent the transmission of adenoviruses.
8. What measures does PAHO recommend to prevent the spread of the disease?
It is currently recommended that countries be informed and monitored. The origins of the cases remain under investigation and PAHO / WHO will continue to provide technical support to countries in the region in generating and disseminating information during the investigation.
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