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In recent weeks, an increase in cases of severe hepatitis of unknown origin in children between 2 and 6 years of age has been reported in several countries. For example, every year about 4 cases per year are detected in Scotland, but now there are more than 13 in a couple of months.
So far, 74 cases have been reported in the United Kingdom, 3 in Spain (Madrid, Aragón and Castilla-La Mancha) and some cases are being investigated in Denmark, the Netherlands and the US (the CDC reports 9 suspected cases in the state of Alabama). Possible cases since October that may have gone unnoticed are being reviewed.
Causes and symptoms
Hepatitis is an inflammatory disease that affects the liver. Its cause can be very diverse: infectious (viral or bacterial), immune (autoimmune hepatitis) or toxic (alcohol, toxic substances or drugs).
All children were healthy one week before of the diagnosis. The symptoms are the usual ones in this disease: abdominal pain, vomiting, diarrhoea, jaundice (yellow discoloration of the skin and mucous membranes), skin itching, dark colored urine and poorly pigmented stools.
So far there has been no death. Some have recovered, but others have had to be hospitalized and seven have even required Liver transplant (one of the Spanish cases).
What hypotheses are considered?
What is disconcerting is the increase in cases in a very short period of time, their severity and that the cause is not known, at the moment. There are several possibilities and hypotheses:
-The first possibility: the hepatitis A, B, C and E virus is ruled out because no sample has been positive for these viruses.
-Some intoxication by food, drinks or toys. Toxins or poisons can affect the liver very seriously. At the moment it does not seem likely because no common link has been found between all the cases, but the possibility of a still unknown toxin is not ruled out.
-It does not seem to be of bacterial origin either, it does not present with a fever.
-No child had been vaccinated against Covid-19, so it is also ruled out that it is a possible side effect of the vaccine.
-Some, not all, have tested positive for SARS-CoV-2. One hypothesis would be that coronavirus infection leaves children more vulnerable to other infections. A possible complication or sequel to Covid-19 cannot be ruled out either.
-However, the hypothesis that seems most probable for some researchers at the moment is that of a adenovirus infection. Half of the cases have tested positive for these viruses, which typically cause diarrhea, vomiting and flu-like symptoms.
In very rare cases, adenoviruses can cause fulminant hepatitis. It has been suggested that it could be a new, more aggressive adenovirus variant. Another possibility is that it was a common adenovirus but now has a more serious impact on children with a weakened immune system due to the lack of exposure to other pathogens due to confinement and other measures during the pandemic.
-Nor can we rule out that the cause is a virus not yet identified.
At the moment, all these cases are under investigation. As always, you should not panic and you have to act following the health recommendations.
Ignacio López-Goñi. Professor of Microbiology, University of Navarra.
This article was published on The Conversation.
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