#cases #severe #childhood #hepatitis #Coronavirus
1. What is hepatitis?
Hepatitis is an inflammation of the liver caused by viral infections (including Hep-A, Hep-B, and Hep-C viruses), alcohol use, toxins, medications, and certain medical abnormalities.
Symptoms are nausea, vomiting, abdominal pain, dark urine, jaundice, fever, and fatigue.
Acute hepatitis rarely occurs in children, and the exact cause is often difficult to identify. Dr. Theresa Tam, Canada’s director of public health, also recalled this week that even before the pandemic, about half of severe pediatric hepatitis cases had no known cause.
In Canada, we see cases of indeterminate hepatitis every year, maybe two or three, usuallysays Dr. Fernando Alvarez, director of the liver transplant program at University Hospital center Saint Justin.
2. How many cases have been reported?
According to a report published this week by the European Center for Disease Prevention and Control (New window), there are currently approximately 450 cases worldwide and 11 deaths (5 in Indonesia, 1 in Palestine, and 5 in the United States).
In the UK, there are more than 160 children under the age of 16 affected. Eleven of them received a liver transplant. In the United States, where 109 cases have been identified, 90% of children have been hospitalized; fifteen of them needed a liver transplant.
Cases have also been reported in Italy (36), Portugal (22), Argentina (8), Brazil (8), Costa Rica (2), Indonesia (15), Israel (12), Japan (7), Panama (1 ), Palestine (1), Serbia (1), Singapore (1), and South Korea (1).
In Canada, as of May 13, there are 7 cases in Ontario, 2 in Alberta, and 2 in Manitoba.
Whether this number represents an increase in cases of unknown origin compared to previous years remains to be determined.a spokeswoman for Toronto’s SickKids Hospital writes in an email.
Cases are still relatively rare, but there are enough severe cases to monitor the situation closely. says Dr. Christopher Labos, a Montreal epidemiologist.
The first cases were seen in Alabama, USA, in October 2021, but researchers initially believed this was a localized problem. It was not until early April that the UK informed the World Health Organisation of an abnormally high number of cases.
Dr. Labos points out that it is still difficult to know with certainty the real number of cases of severe hepatitis in the world.
Now that the international community has been alerted, we will be able to detect the cases better, we will be able to make associations between them and thus better understand the cause.
3. What hypotheses are studied to determine the cause?
Drs. Labos and Alvarez say the researchers aren’t ruling anything out.
For now, environmental factors do not appear to be involved. The viruses normally associated with viral hepatitis (Hep-A, Hep-B, and Hep-C) were not detected in these children.
Another element is clear, according to Dr. Labos: vaccination against COVID-19 is not in question as most cases are under the age of five and not yet eligible for the COVID-19 vaccine. More than 65% of children with severe hepatitis in the UK and more than 80% of children in Europe were unvaccinated.
Everything else is possible. It may be a combination of factors that caused the cases of hepatitissays Dr. Alvarez, adding that one should not jump to premature conclusions.
Dr. Labos suggests that some of the recently reported cases may be linked, while others are not.
The cause may not be found in some of these cases.
At the moment, authorities and researchers are mainly looking at two possible causes: an adenovirus and SARS-CoV-2.
4. Can an adenovirus be the cause?
According to Dr. Caroline Quach, a microbiologist, infectious disease specialist, and pediatrician at University Hospital center Sainte-Justine, the adenovirus theory seems the most plausible. This theory is also the one currently prevailing in the UK.
Adenoviruses are viruses that are spread through close personal contact. There are more than 50 types that can cause infections in humans (respiratory diseases, gastroenteritis, conjunctivitis, cystitis, and less frequently, neurological diseases).
According to the latest report from theWorld Health Organisation (New window)among 169 cases, 74 children tested positive for adenovirus, including 18 for adenovirus 41. In children, it usually causes acute gastroenteritis presenting as diarrhea, vomiting, and fever.
In the UK, 72% of children tested positive for adenovirus. In Alabama, 7 out of 9 children had been infected with adenovirus.
But according to World Health Organisation,
although adenovirus is currently believed to be an underlying cause, it does not fully explain the severity of cases. For example, no children in Israel with severe hepatitis have tested positive for adenovirus.
” This adenovirus has been detected in some cases, but not in all. It may be a plausible theory, but it doesn’t explain everything. »
Also, according to Dr. Alvarez, adenovirus type 41 is not generally known to cause hepatitis in healthy children.
In those who are not on medication or who are not immunosuppressed, adenovirus hepatitis is usually mild or almost non-existent.
Dr. Quach, like other experts, wonders if the adenovirus possibly involved has a different genotype, leading to more severe lesions than is commonly seen.
The researchers also wonder if the fact that children were less exposed to adenoviruses during the pandemic could partly explain this increase in hepatitis. Sudden and more frequent exposure to adenoviruses when sanitary measures were lifted may have resulted in a more vigorous immune response in some, causing severe hepatitis.
5. What about SARS-CoV-2?
The researchers are also investigating the potential role of SARS-CoV-2.
Another theory would be COVID-19, which would not be surprising given the recent number of cases, particularly in the UK and US, where many cases of hepatitis have been reported. But not all children with hepatitis tested positive for COVID-19says Dr Labs.
According to Dr. Álvarez, it is known that a COVID-19 infection can increase the incidence of hepatitis in some people, but that, in general, this hepatitis are not as serious as those currently being studied.
In Israel, 11 out of 12 children had COVID-19. However, of the eight registered cases in Alabama, none had been diagnosed with COVID-19 when admitted to the hospital. However, it is not known if these children have been infected in the past, and it is not known how many of the other children with hepatitis in the United States have been infected with COVID-19.
In the UK, only 18% of children tested positive for SARS-CoV-2 while in hospital. In Scotland, 8 out of 13 children tested negative for PCR.
In Europe, (New window) only 12% of the 173 cases were diagnosed with COVID-19 through a PCR test. On the other hand, among the 19 cases who underwent a serological test (to detect a previous infection), 74% tested positive for COVID-19. That is why several researchers believe that a serological test should be performed on all children with severe hepatitis to know exactly how many of them have been infected with SARS-CoV-2 in recent months.
Furthermore, researchers from India (New window) estimate that COVID-19 may have caused dozens of unexplained cases of severe hepatitis between April and July 2021.
Their non-peer-reviewed study shows that among 475 children with COVID-19, 47 had severe hepatitis. Among these 47 children; 37 were classified with what the researchers called
hepatitis associated with COVID-19 .
The only common factor we found was that they were all infected with COVID-19 or they all had a prior COVID-19 infection told CBC (New window) Dr. Sumit Rawat, lead author, microbiologist, and associate professor at Bundelkhand Medical College, Madhya Pradesh, India.
It adds that hepatitis cases suddenly dropped when COVID-19 infection rates fell, but rose when the number of cases was high. According to Dr. Rawat, this is another sign that COVID-19 could be involved.
Another hypothesis, proposed by researchers in the lancet (New window)is that coinfection of adenovirus and SARS-CoV-2 would possibly have caused this hepatitis.
6. Should parents worry?
The three doctors say that the authorities must be alert, but not panic. The number of cases remains relatively low, they recall.
For most children, gastroenteritis is a common illness. But as usual, you should check if it lasts more than a few days and if there are signs of yellowing in the eyes. says, Dr. Alvarez.
Dr. Quach would like to remind you that adenovirus can be easily destroyed with common cleaning products.
We must continue to maintain our usual hygiene practices.
For his part, Dr. Labos adds that it is prudent to continue protecting children from COVID-19 by wearing masks in crowded and closed places.
It is common sense, even if we find that SARS-CoV-2 is not the cause of hepatitis.