Acute pediatric hepatitis cases raise flags in UK, US and Spain

Clusters of acute hepatitis in children – many of which lead to liver failure – in Europe and the United States are prompting investigations by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), as the illnesses appear to be related to adenovirus infections.

Nine children in Alabama, 3 in Spain and at least 74 in Scotland and Northern Ireland have been diagnosed with acute hepatitis since January.

According to a WHO report, children present to healthcare providers with markedly elevated liver enzymes, often with jaundice, and sometimes have gastrointestinal symptoms, including vomiting. At least 6 of the 74 UK patients have required liver transplants, but so far no deaths have been reported.

“Laboratory tests excluded hepatitis viruses types A, B, C and E (and D where present) in these cases, while severe acute respiratory syndrome coronavirus type 2 (SARS-CoV- 2) and/or adenovirus were detected in several cases.” WHO mentioned.

“The UK has recently observed an increase in the activity of adenoviruses, which co-circulates with SARS-CoV-2, although the role of these viruses in pathogenesis (mechanism by which the disease develops) is unclear. not yet clear.”

Recent COVID-19 in some Scottish children

Although COVID-19 infection may play a role in disease, scientists describing cases in Scotland in this week’s issue of Eurosurveillance, hypothesize that adenoviruses were more likely to cause hepatitis.

Although they usually cause colds, adenoviruses have been associated with subsequent cases of hepatitis in the past.

“At the time of publication, the main hypotheses revolve around the adenovirus being either a new variant with a distinct clinical syndrome, or a regularly circulating variant that affects immunologically naïve young children more severely,” the report authors wrote. “This latter scenario may be the result of restricted social mixing during the COVID-19 pandemic.”

The case study included 13 cases in Scotland identified in March and April. The median age was 3.9 years and 7 patients were girls. There was no history of international travel or other notable geographic patterns for investigators.

All 13 children required hospitalization and 3 required liver transplant evaluation, with 1 child having received a successful transplant. Five of the 13 patients are still being treated in hospitals, the authors said.

Five children tested positive for adenovirus, with 2 tests pending, and 3 had active COVID-19 infections at the time of hepatitis diagnosis. Two other children had recent histories of COVID-19 infection.

Alabama lists 9 cases

In the United States, nine cases of acute hepatitis have been recorded since October 2021 throughout Alabama. The CDC is working with state health officials on the cause, but officials have told several media that adenovirus may be the cause.

The age of the American case-patients is 1 to 6 years. Five of the nine patients tested positive for type 41 adenovirus.

In Spain, three children aged 2 to 7 have also been diagnosed with acute hepatitis, and one child needs a liver transplant.