© Archive photo ANP
Arianne Mantel
Today at 22:02
Amsterdam
In the search for the cause of the sudden increase in young children with acute hepatitis, the World Health Organization (WHO) does not rule out the possibility that in some cases there is a transmissible cause, such as a virus. Cases of liver failure in which children were in contact with each other have been reported in the Netherlands and Scotland.
Professor of pediatrics and liver doctor Henk-Jan Verkade of the University Medical Center Groningen: “There have now been five serious cases of acute liver failure in our country, whereby a liver transplant has been successfully performed in four out of five children. In one of these five children, a classmate had recently had a period of jaundice.”
Spontaneously healed
“That may indicate an accumulation of bilirubin, which can be one of the symptoms of liver disease. This other child recovered spontaneously and did not develop severe acute liver failure. Incidentally, in the other four children with acute liver failure, we found no other cases of liver disease or acute hepatitis in the environment.”
Even if some patients are transmitted through contact, such as with a virus infection, according to Verkade, the ultimate consequence of an exposure also seems to be mainly determined by the individual response of the body to it. “The term contagiousness is therefore too strong. That would immediately fully explain the cause of liver failure. That is not true; it’s also about how the ‘recipient’s defenses’ react to it.”
Guessing a possible source
A liver transplant was successfully performed in four out of five children.© Archive photo ANP
Between early April and 26 May 2022, 650 possible cases from 33 countries of liver failure in young children have now been reported to the WHO, with the possible source and mode of transmission still unknown. While current data indicate that only a small proportion of (possibly) exposed children develop severe acute liver failure, the WHO does state that ‘reported cases are more severe and that a greater percentage develop acute hepatitis compared to previous reports’. The WHO has rated the risk at a global level as ‘moderate’.
Most cases, almost 60 percent, come from Europe. The United Kingdom and Northern Ireland are ‘leaders’ with no fewer than 222 reports. Three quarters of the children are younger than five years old; 165 children ended up in hospital and 22 in intensive care. Fourteen children have undergone a liver transplant.
Actual number may be higher
The WHO states that the true number of children with liver failure may be higher due to limited capacity to monitor and map this disease. Scientists do have some theories about the cause. One hypothesis suggests that the damage is caused by adenovirus—type F41—a common childhood infection that normally causes cold symptoms.
© Archive photo ANP
Another theory is that the cause is a poor immune response to a previous corona infection. And then there is the possibility that an adenovirus infection together with a corona infection is destructive to the liver. Incidentally, evidence of a previous or simultaneous corona infection has been found in only a small minority of children with acute hepatitis.
Less in contact with ‘normal’ viruses
Lever doctor Verkade is also not sure yet: “The social restrictions imposed by the pandemic may have led to young children being exposed to all kinds of viruses for the first time at a later point in their lives and that this has influenced the development of their immune system. . That in turn may have led to a different immune response in some. During the lockdowns, they have come into less contact with one of the normal viruses, so the immune system may have been a little less ‘experienced’. But the adenovirus is certainly not the only explanation, because of the five children we treated here in the hospital, only two had the adenovirus.”
Also read: Unexplained acute hepatitis strikes healthy young children. What is going on?