ECDC warns of increased obscure hepatitis in children

On April 12, ECDC issued: a warning to draw doctors’ attention to an unusual increase in unclear hepatitis, which primarily affects young children.

The background was that the UK had an unusual number of cases of acute hepatitis in otherwise healthy children. The increase took place this year. In January, 74 cases were reported in England, Scotland and Wales. Most children are between two and five years old. Some have suffered severe liver damage and a few have required a liver transplant.

The outbreak eludes both the UK authorities and the EU’s infection control authority. The cases have not been linked to any of the common viruses that cause or travel hepatitis A to E.

Since the warning went out last week, there have been similar reports from several other EU countries. According to a press release of ECDC, Denmark, Ireland, the Netherlands and Spain have also had severe and inconclusive cases of hepatitis in otherwise healthy children. Again, doctors have been unable to detect any of the common viruses that cause hepatitis.

Nine cases involving children between the ages of one and six have also been reported from Alabama in the United States.

Investigations are now underway in all affected countries to find out more. According to ECDC, international medical networks for liver diseases are also involved.

Adenovirus has been found in some of the children who became ill with acute hepatitis, a virus that has also been more widespread than usual in the UK in recent weeks. Some children are also infected with sars-cov-2.

Björn Fischler, a pediatric hepatologist in the gastroenterology, hepatology and nutrition section at Astrid Lindgren’s Children’s Hospital, tells Dagens Medicin that there are also slightly more patients with acute hepatitis in Sweden whose cause is unknown.

– We have seen slightly more cases since the end of December 2021, but we are not seeing as strong an increase as in the UK. In our case I do not rule out that it is a matter of random variation, he says to Dagens Medicin

Björn Fischler reminds Swedish GPs and pediatricians that children of all ages who show signs of jaundice, for example in the whites of the eyes or have elevated liver values, should always be referred for examination.

The Science magazine writes that the researchers’ main theory is that adenovirus is somehow behind the outbreak.

The UK authority UK Health Security Agency has developed: a guide for doctors on the occasion of the outbreak.
(updated 2022-04-20)

Anna Popplewell

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