Severe acute hepatitis in children

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On April 15, 2022, the World Health Organization (WHO) published an alert on cases of severe acute hepatitis of unknown cause in children in the United Kingdom. Since then, more cases have been reported.

We spoke with Dr. Leandro Soares Sereno, advisor for the prevention and control of viral hepatitis at the Pan American Health Organization (PAHO), about hepatitis and severe acute cases in children reported in several countries.

  1. What is acute hepatitis?

Hepatitis is an inflammation of the liver. There are different etiologies – that is, causes – that lead to this inflammation, such as an infection or drug or substance intoxication. The most frequent infectious agents are the viruses responsible for hepatitis A, B, C, D and E.

When the inflammation occurs quickly and abruptly, we speak of acute hepatitis. In some cases, such as hepatitis B, C and D, the infection can become chronic.

  1. Why is the outbreak of hepatitis in children considered unusual? Is it a new adenovirus?

It is an event of interest that is under investigation by the WHO. So far, laboratory tests rule out cases of known viral hepatitis. In many cases, adenovirus infection was found in children and the link between these two is investigated as one of the hypotheses about the underlying causes.

Adenovirus is a common virus that can cause respiratory symptoms or vomiting and diarrhea. In general, the infection is of limited duration and does not progress to worrisome conditions, although rare cases of serious adenovirus infections causing hepatitis have been reported in immunocompromised patients or transplant recipients. However, these children do not fit this description, as they were previously healthy.

  1. How many countries have reported confirmed or suspected cases of hepatitis in children unrelated to infection with hepatitis A, B, C, D or E viruses?

We are not talking about confirmed cases because currently the specific cause is unknown and under investigation. The reported cases refer to children with severe acute hepatitis where hepatitis A, B, C, D or E were not identified.

With this definition, as of May 3, 2022, more than 200 cases have been reported in 20 countries. Most are in the UK, which was the first country to report the occurrence of cases to the WHO.

In the Americas, cases were reported in the United States, and the countries of the Region are oriented to monitor the situation. At the moment, PAHO is informing the countries about criteria and definitions for monitoring.

  1. How does PAHO assess the situation?

There is still little data to define whether there is an outbreak or epidemic in the region, and for now the global risk is considered low.

And since there is no certainty about the origin either, there is the possibility that we are identifying a situation that previously went unnoticed because the cases were very few.

  1. Could the outbreak be linked to COVID-19 or COVID-19 vaccines?

Based on current information, most of the affected children did not receive the COVID-19 vaccine and for now it is ruled out that the cases are related to vaccination.

In some cases, the presence of the SARS-CoV-2 virus was detected, but this is a line of research in addition to others, such as that of the adenovirus.

  1. What are the symptoms? Is there treatment?

Acute hepatitis has different symptoms: gastrointestinal, such as diarrhea or vomiting, fever and muscle pain, but the most characteristic is jaundice — a yellow discoloration of the skin and eyes.

Treatment seeks to relieve symptoms, and manage and stabilize the patient if the case is severe. These recommendations may be adjusted when the origin is determined.

  1. What can parents do to protect their children?

The main thing is to be attentive to the symptoms, such as diarrhea or vomiting, and especially if there are signs of jaundice, which is the yellow discoloration of the eyes and skin, medical attention should be sought promptly.

For prevention, we recommend taking basic hygiene measures such as washing your hands, covering your cough or sneeze, all of which also serve to prevent the transmission of the adenovirus.

  1. What measures does PAHO recommend to national health authorities to prevent the spread of the disease?

At this time, the recommendation is to stay informed and monitor the situation. The origin of the cases is still under study and PAHO will continue to provide technical support to the countries to generate and disseminate information during the course of the investigation.

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