What is known about the outbreak of hepatitis of unknown origin in children?

The Spanish health authorities are investigating three cases compatible with severe acute hepatitis of unknown origin affecting children under 10 years of age, one of whom has required a liver transplant. Last week, the Center for Control of Health Alerts and Emergencies of the Ministry of Health sent the autonomous communities an international health alert decreed by the World Health Organization as a result of dozens of very similar cases detected since the beginning of the year in the United Kingdom. .

Doctors and pediatricians insist that it is not, at the moment, a worrying fact, given that there are very few cases in Spain and it is not yet known if they are related to those in the United Kingdom, where the high number of hospitalizations that has occurred in such a short time is somewhat more worrying.

The following attempts to answer the main questions that may arise with these cases of childhood hepatitis:

What is hepatitis?

Hepatitis is basically an inflammation of the liver which may affect its proper functioning. Hepatitis can be acute (short-term) or chronic (long-term).

What are the common causes of hepatitis?

There are different types of hepatitis. The most common are the following:

– The viral hepatitis is the most common. It is caused by different types of viruses: hepatitis A, B, C, D and E.
– The alcoholic hepatitis It is caused by excessive alcohol consumption.
– The toxic hepatitis It can be caused by certain poisons, medications, or chemicals.
– The autoimmune hepatitis it is a chronic type in which the immune system attacks the liver.

Why does hepatitis usually occur in children?

The The most common cause of childhood hepatitis are infections caused by viruses, although they can also occur for other reasons, such as poisoning; autoimmune, genetic, metabolic diseases…

How many cases have been detected in the world?

According to the European Center for Disease Prevention and Control (ECDC), in England there are approximately 60 cases under investigation, with most cases in children between 2 and 5 years of age. Some of them progressed to acute liver failure and have required transfer to specialized pediatric liver units. A small number have had to undergo a liver transplant.

In Scotland, 10 cases that required hospital admission were in children between 1 and 5 years of age and are under investigation. Most of them were filed from March 2022. In Welsh, there are currently no known cases under investigation, but a very small number of cases from early 2022 had similar clinical presentations. In North Irelandthere are also no currently reported cases.

In USAthe Centers for Disease Control and Prevention (CDC) have assured that they are investigating nine cases in the state of Alabama, while doctors in Denmark Y Netherlands similar cases have also been reported, according to an article recently published in Science.

And in Spain?

In Spain, up to now, three isolated cases of children infected with severe acute hepatitis of unknown origin have been detected. Is about three minors between the ages of two and seven from Madrid, Aragon and Castilla-La Mancha. All of them have required hospital admission in a Madrid hospital and one of the minors has required a liver transplant. All three have evolved favorably

Are the cases of Spain related to those of the United Kingdom?

It is something that is not yet known, and that the health authorities are trying to find out.

What are the first symptoms?

As detailed by the ECDC, the clinical picture in the identified cases is that of severe acute hepatitis with markedly elevated transaminaseswhich often occurs with jaundice (yellow discoloration of the skin), sometimes preceded by gastrointestinal symptoms including abdominal pain Y vomiting. Other times, dark urine, light-colored stools, or itchy skin may appear.

What is the origin of these cases?

Health authorities do not know the cause, since the common viruses that can cause hepatitis (hepatitis A, B, C, D and E viruses) have not been detected in any of them. Likewise, the usual causes, such as travel or pharmacological history, have been ruled out.

Among the hypotheses on the table, the viral origin is the one that has more strength, and more specifically adenovirus. “One of the possible causes that is being investigated is that a group of viruses called adenoviruses may be causing this disease. However, other possible causes are also being actively investigated, including coronavirus (COVID-19), other infections or environmental agents. “, says the United Kingdom Health Security Agency (UKHSA) in a statement.

What are adenoviruses?

Adenoviruses are a family of common viruses that generally cause a variety of mild illnesses and most people recover without complications. They can cause a wide variety of symptoms, including colds, vomiting and diarrhoea. Although they do not usually cause hepatitis, it is a known rare complication of the virus.

Adenoviruses are commonly spread from person to person and by touching contaminated surfaces, as well as through the respiratory tract.

What protective measures can be taken?

The most effective way to minimize the spread of adenoviruses and many other viruses is to practice good hand and respiratory hygiene (Cover your cough with the inside of your elbow and use disposable tissues).

Which children are most vulnerable to hepatitis?

The immunocompromised patients they are the most vulnerable to hepatitis caused by infections. Also they younger childrenbecause their immune system is more immature.

Could it be caused by COVID-19?

Although it is one of the possibilities, the first investigations indicate that the childhood cases of severe hepatitis would not be related to a previous infection of COVID-19, despite the fact that some of the children hospitalized in the United Kingdom had tested positive for coronavirus.

And for the vaccine against COVID-19?

In no case. The UK health agency categorically rules out that the origin of the cases is the COVID-19 vaccine, for a very simple reason: none of the children with acute hepatitis had received it. “There is no link to the COVID-19 vaccine. None of the currently confirmed cases in the UK have been vaccinated,” the agency stresses.

What has requested Health to the autonomous communities?

The Ministry of Health has made a communication to the autonomous communities and the scientific societies of Paediatrics and hospital management to carry out a “active observation and search” for possible cases in children of acute hepatitis of unknown origin. It is the usual procedure, after the European Center for Disease Prevention and Control (ECDC) launched an international alert for doctors from other countries to watch for cases similar to those in the United Kingdom.


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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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