Increasing cases of severe hepatitis among children in the UK – what role does Covid play? | Health

There was a serious increase hepatitis Cases of children under 10 years in the UK in recent months. The UK Health Department has been informed of 74 cases since January 2022, of which 49 have spread to England, 13 to Scotland and the remaining 12 to Wales and Northern Ireland. (Read again: XE Variant: Beware of these symptoms of Covid-19 in children).

Other isolated cases of severe acute hepatitis in children have been identified in the United States, Spain, and Ireland.

Severe hepatitis in children is extremely rare, and the cause of this highly abnormal increase in cases remains unknown. The main theory is that even SARS-CoV-2, the coronavirus that causes COVID-19, is a type of viral infection.

But how likely are these hepatitis cases to be associated with COVID? Or is there a cause that is likely to be found elsewhere?

First, let’s analyze what hepatitis is and how hepatitis is associated with viral infections.

Hepatitis is a medical term for inflammation of the liver. Inflammation is a common immune response to infections and injuries and is a sign that the body is trying to fight potential illnesses. Symptoms in children usually include dark urine, gray feces, yellowing of the skin and eyes (called jaundice), and some (but not all) of high temperatures.

With proper medical treatment, this condition can usually be treated, but some patients may require a liver transplant. The World Health Organization reports that six affected children in the UK have been transplanted so far.

Hepatitis is usually associated with a viral infection in children, although the causes vary. The most common of these are the five hepatitis viruses, hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Other viruses, such as adenovirus, can cause hepatitis, but this is rare.

What is unusual about these cases in children is that none of the five hepatitis viruses have been detected in any of the patients. This eliminates the most common causes of these symptoms and forces public health officials to look for answers.

Adenovirus and hepatitis

Adenovirus is a very common viral infection in humans, especially children. Almost all children have at least one adenovirus infection before they are 10 years old.

Usually, these viruses cause lung and respiratory infections, common cold symptoms, and sometimes pneumonia. In some cases, adenovirus can also be called “pool fever”, mainly in children over the age of 5, causing sore throat, fever, and eye irritation.

In rare cases, adenovirus can cause hepatitis in immunocompromised patients (people whose immune system is not functioning properly, such as those undergoing organ transplants or cancer treatment).

However, it is very rare to see it on this scale, especially in children who do not look like immunodeficiency. If adenovirus is the cause of these cases, it may mean that new variants of adenovirus that cause hepatitis more easily have emerged.

Other potential causes

Adenovirus is a common infection in children and can cause hepatitis, so it seems to be the most likely explanation. However, there are some alternative scenarios that need to be considered.

Autoimmune hepatitis can cause such cases if the body itself attacks the liver (rather than a virus or other pathogen attacking the liver). However, this is a rare condition, affecting about 10,000 people in the United Kingdom, usually found in women around the age of 45. With these things in mind, autoimmune hepatitis is unlikely to cause a mass case in a child.

Since SARS-CoV-2 was detected in some children, there was a suggestion that COVID may be behind these hepatitis cases. Isolated cases of hepatitis have been reported in patients with COVID, which is even rarer than autoimmune hepatitis and is predominantly observed in adults with severe COVID.

Importantly, no child diagnosed with hepatitis in the UK has been vaccinated with COVID, so there is no reason to believe that the COVID vaccine is associated with this surge.

Another possibility is that this is a new symptom due to the interaction between the viruses (for example, both adenovirus and coronavirus infect the same child). Or it could be due to a completely different virus that has not yet been detected.

What now?

The UK Health and Security Agency advises parents and caregivers to be aware of signs of hepatitis in their children.

Adenovirus currently appears to be the most probable cause here, but further investigation is needed to confirm this and rule out other possible explanations such as new viruses. It may even turn out that the causes are not common in all cases.

As the COVID pandemic continues, we must routinely consider the coronavirus as a possible cause of anomalous healthcare scenarios. At the same time, the link does not always exist. Such thinking carries the risk of blinding us to what is really happening.

If adenovirus turns out to be the main cause, what can be done to prevent it and minimize the risk of serious complications? Adenovirus spreads through the air and contact. The main precautions are proper hand washing and good respiratory hygiene such as coughing on the elbows, from children to adults. (Conversation) AMS AMS

Conor Meehan, Nottingham Trent University

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