There are already 6 countries that have reported cases of children with a mysterious hepatitis: what are the symptoms

Six countries have already reported cases of hepatitis of unknown origin in children. The 74 cases reported in the United Kingdom and another 3 cases in Spain were already known. But this week health authorities have reported more cases of children with mysterious liver inflammation in Denmark, Ireland, the Netherlands, and the United States.

There are five major strains of the hepatitis virus. But at the moment, the origin of hepatitis in children has not been detected, and the exact cause remains unknown. In the United Kingdom, 6 of the affected children needed a liver transplant due to the severity of the condition.

Also in the State of Alabama, in the United States, 9 cases between 1 and 6 years old with the mysterious hepatitis have been detected. Two of those children required the transplant. And other suspected cases are being investigated in other states in that country.

The European Centre for Disease Control (ECDC) did not specify how many cases have been detected in the four European countries in total. But the World Health Organization (WHO) said fewer than five had been detected in Ireland and three in Spain. He added that more cases were likely to be detected in the coming days. So far he has not reported any deaths.

In Spain, the Community of Madrid was investigating last week the first three cases detected as children, aged between 2 and 7 years and coming from Madrid, Aragon and Castilla-La Mancha. They were hospitalized in a hospital in Madrid, as reported by the Ministry of Health.

Last week, the UK Health Security Agency had reported that the usual viruses that cause the disease had not been detected. infectious hepatitis. Researchers are looking for other possible causes, and they believe that the common adenovirus could be the cause. The origin of cases in other European countries is also being investigated.

WHO reported: “The United Kingdom has recently seen an increase in the activity of adenoviruses, which circulate in conjunction with SARS-CoV-2, although the role of these viruses in pathogenesis (mechanism by which the disease develops) is not yet clear”.

Dr Meera Chand, director of clinical and emerging infections at the UK health agency, asked parents to watch for signs of hepatitis, including yellowing of the skin or jaundice. He added: “Normal hygiene measures, such as good handwashing, including supervision of children, and respiratory hygiene, help reduce the spread of many of the infections we are investigating.”

The virologist added that parents should not be alarmed, and that cases are still exceptionally rare. He also clarified that there is no relationship between cases of hepatitis with the COVID-19 vaccine. None of the children affected by hepatitis in the UK had been immunized against the coronavirus.

Adenoviruses are a family of viruses that often cause a number of minor illnesses such as colds, vomiting, and diarrhea. “It seems that these cases are not related to COVID-19, and epidemiologically there are cases of symptoms of adenovirus, a very common respiratory virus in children, with respiratory and digestive symptoms. It seems that he could be involved, but these are preliminary data,” said the president of the Spanish Society of Outpatient Pediatrics and Primary Care (SEPEAP), Cristóbal Coronel.

According to Dr. Coronel, today most pediatric consultations are due to symptoms of respiratory symptoms, or vomiting, diarrhea or fever, which are common pathologies among children. To distinguish, it should be borne in mind that the symptoms of hepatitis are usually fever, abdominal pain, nausea, vomiting, or diarrhea, dark urine, and yellow skin. The diagnosis of hepatitis is confirmed by a blood test of transaminases, which are substances whose increase denotes active inflammation of the liver.

UK health authorities have also advised parents to watch out for symptoms such as yellowing of the skin or jaundice, which occurs when the liver is unable to efficiently process red blood cells as they break down.

The warning of childhood hepatitis outbreaks began on 5 April when the United Kingdom notified WHO of 10 cases of severe hepatitis in Scotland, before reporting a total of 74 three days later. Among the British cases, “many showed signs of jaundice and some patients reported gastrointestinal symptoms, including abdominal pain, diarrhea and vomiting in previous weeks,” according to the ECDC.

Conor Meehan, professor of microbiology at Nottingham Trent University in the United Kingdom, said in an article in The Conversation that “severe hepatitis in children is very rare and we still don't know what is causing this unusual increase in cases. The main theory is that it is some type of viral infection, perhaps even SARS-CoV-2, the coronavirus that causes COVID-19.

Inflammation of the liver is a general immune response to infection or injury, a sign that the body is trying to fight a possible disease. Symptoms in children are usually some (but not all) of the following: dark urine, gray stools, yellowing of the skin and eyes (called jaundice), and high temperature.

“The unusual thing about these cases in children is that none of the five hepatitis viruses have been detected in any of the patients. This rules out the most common cause of these symptoms, leaving public health authorities looking for answers,” Meehan said.

For the expert, it is rare that adenoviruses are behind cases of hepatitis in children who did not appear to be immunocompromised. “If adenovirus is the cause of these cases, it could mean that a new variant of adenovirus has emerged that causes hepatitis more easily,” he said.

But there are some alternative scenarios that need to be explored, according to Dr. Meehan. Autoimmune hepatitis, in which the body itself attacks the liver (rather than a virus or other pathogen), could be the cause of these cases. But it is a rare disease, affecting around 10,000 people in the UK and usually occurring in women around 45 years of age. “It is very unlikely that autoimmune hepatitis is the cause of a group of cases in children,” he said.

Another possibility is that it is a new symptom resulting from the interaction between viruses (perhaps adenovirus and coronavirus infect the same child, for example). Another possibility is that it is caused by a totally different virus that has not yet been detected, Meehan said.

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