Acute hepatitis in children, over a thousand cases worldwide. The causes remain unknown

The causes are unknown or, to use scientific terminology, the etiology is unknown. The more than a thousand cases of acute hepatitis in children (1,010 to be exact) recorded worldwide, including 22 deaths, remain a mystery. It is known for sure that they are not caused by viruses hepatitis A and E. Although data can not be considered completely reliable, some cases can actually escape the diagnosis (more likely) and others can be mistakenly attributed to the category in question (more difficult) . So much so that the World Health Organization, in its latest report updated on July 8, continues to talk about 1,010 “probable” cases, 90 more than in the bulletin of 24. June.

Two other new countries, Luxembourg and Costa Rica, have reported cases of acute hepatitis in children.

Between April 5 (when the outbreak was first detected) and July 8, 2022, 35 countries in five WHO regions reported 1,010 likely cases and 22 deaths. Of the probable cases, 46 (5%) children required a transplant. Nearly half (48%) of cases were reported from the WHO European Region, 27% of global cases from the United Kingdom. The region of North and South America follows with 435 cases, of which 334 cases (33% of global cases) in the United States.

Hypothesis of the causes

Tests performed on patients ruled out the presence of hepatitis A and E viruses. In some cases, adenoviruses and SARS-CoV-2 were detected, but it was not possible to determine whether they were responsible for liver disease.

Adenovirus remains the most frequently detected pathogen among cases with available data. In the European region, adenovirus was detected in 52 percent of the tested cases, in Japan in 9 percent. However, given that adenoviruses do not usually end up in standard epidemiological surveillance, it is difficult to understand whether the data are abnormal or whether they fall within an expected range.

The epidemiological properties

For the most part, the cases are not epidemiologically related.

Of the 479 cases where there is information about patients’ gender and age, 48 percent are men, and the majority are under six years of age.

The symptoms were only reported in detail in 100 cases. The reported manifestations are nausea or vomiting (60% of cases), jaundice (53% of cases), general weakness (52% of cases) and abdominal pain (50% of cases). The time interval between onset of symptoms and hospitalization is on average four days.

The level of risk

The WHO considers the risk globally to be “moderate” and not “mild”, given that the etiology of acute hepatitis remains unknown and is still under investigation, that the available epidemiological, laboratory, histopathological and clinical information is limited, that the actual number of cases may be underestimated, in part due to limited monitoring systems, and the possible mode of transmission is unknown. Although so far there have been no reports of infections among healthcare professionals who have cared for patients, human-to-human transmission cannot be ruled out.

Preventive measures

While waiting to discover the causes of hepatitis in children, the WHO recommends some general infection prevention and control strategies, some of which are already indicated to protect against Covid, including: Wash hands frequently with soap and water, avoid crowded spaces and keep away from others, ensure good ventilation inside enclosed spaces, wear mask when necessary. In the kitchen, follow the 5 rules for safe food: wash your hands before and after contact with food, separate raw and cooked foods, cook well, keep food at safe temperatures and use clean water and ingredients.

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