Disease in children: what is behind the cases of hepatitis?


Status: 07.05.2022 1:25 p.m.

Mysterious cases of hepatitis in children are on the rise around the world. Where does the disease come from? Is there a connection with the corona pandemic? And what should parents pay attention to?

The WHO has reported a global increase in hepatitis of unknown origin in children under ten. Ongoing examinations of blood and stool samples on behalf of the Robert Koch Institute aim to provide information on the causative pathogens.

Experts, such as the general secretary of the German Society for Child and Adolescent Medicine, Dr. Burkhard Rodeck, suspect so-called adenoviruses as possible triggers of the disease and also speculate on possible links with the corona pandemic and associated measures.

What is hepatitis and what are the symptoms?

Hepatitis is an inflammation of the liver often preceded by a viral infection. Hepatitis A through E viruses are the best-known triggers of such infections. The severity, course and transmission of hepatitis depend on its type. Signs of hepatitis are elevated liver values.

However, hepatitis can also manifest as vomiting, diarrhea, fever, malaise, and jaundice, among others. The RKI and the Standing Committee on Immunization recommend vaccination against type B virus from infancy. Vaccination against hepatitis A is particularly recommended for people at risk and travellers.

In which countries are there currently more cases – and how are the authorities reacting?

After Britain reported the first five cases in March, the WHO learned of nearly 220 new illnesses in 20 other countries as of May 1, 2022, according to WHO spokesperson Tarik Jasarevic, the May 3. In Germany, individual cases have been reported by state health authorities.

In a letter to pediatric societies and on the official website, the Robert Koch Institute called for increased attention to suspected cases and referred to the corresponding reporting obligation under the Infection Protection Act. The RKI believes the number of cases in the UK in particular is unusually high. Developments in Germany should continue to be observed. Acute hepatitis of uncertain cause is rare in children, but also occurs occasionally in Germany.

What are the consequences of the disease in children?

The still unsolved phenomenon of hepatitis in children, which is spreading around the world, has experts perplexed. Particularly severe course of hepatitis occurs especially in affected individuals under the age of five. According to the World Health Organization, nearly ten percent of affected children required liver transplants as a result of hepatitis.

At least four children have already died of liver inflammation in recent weeks. Current laboratory tests showed that no hepatitis virus types A to E were detectable in the majority of affected children.

What could be the triggers for recent cases of childhood hepatitis?

Instead of the classic pathogens, type 41 adenoviruses have been detected in many affected people. These viruses have been found in 75% of sick children in Britain. As a rule, adenoviruses trigger, among other things, mild cold symptoms and gastrointestinal infections.

Serious complications such as inflammation of the liver, which can lead to liver failure, are rather atypical in adenovirus infections. These serious consequences usually only affect people with a particularly weakened immune system. Adenovirus was not previously known to cause hepatitis in healthy children.

Could there be a connection to Corona or a Corona vaccination?

The WHO reports dual infection in nearly 20 of the 200 reported cases. As a result, the affected patients appear to have been infected with both adenovirus and coronavirus.

A connection with the corona vaccination cannot be established because the affected children were not vaccinated at the time of the illness. However, the exact cause of the new hepatitis diseases is still unclear. However, experts including Rodeck believe the corona pandemic could be directly linked to serious infections.

What is the connection with the corona pandemic?

Rodeck and other experts suspect that children’s immune systems, which are particularly shaped in the first years of life, have been weakened by keeping their distance and other corona measures. During these important first years of life, children were therefore exposed to fewer viruses due to possible contact restrictions and were therefore unable to develop the corresponding antibodies.

On the one hand, the significantly increased hygiene measures can reduce the risk of infection, but on the other hand, the performance of a permanently understimulated immune system steadily decreases.

This increases the risk of getting infected and getting sick more easily if you come into contact with viruses. According to Rodeck, severe disease progressions, such as in cases of childhood hepatitis, may be the result of the young and naïve immune systems not being trained.

At the same time, there is the hypothesis that, as with SARS-CoV-2 variants, a more aggressive and contagious adenovirus variant could have emerged.

Could the cases of hepatitis have been caused by contaminated food?

Hepatitis can also be transmitted through contaminated food or drinking water. However, Tobias Tenenbaum, chief physician for pediatric and adolescent medicine at the Sana Klinikum Lichtenberg, rules out the possibility that the cases of hepatitis seen in children were caused by food contamination. His opinion is based on the knowledge that there is no common nutritional pattern in the different affected age groups.

What should parents pay attention to?

Chief Medical Officer Tenenbaum advises parents to pay special attention to children’s skin and conjunctiva if they are infected with a gastrointestinal virus. If these become yellowish, the urine darkens, or the stools become lighter in color, you should see your pediatrician. Strict hand and bathroom hygiene can also reduce the risk of infection.

How do the experts assess the situation?

Even though the manageable number of reported cases of hepatitis in children appears low, health authorities around the world are on alert because of the high health risk that can occur, according to pediatric infectious disease specialist Tenenbaum. The exact causes of mysterious cases of hepatitis in children are still being researched.

Mysterious hepatitis in children

Claudia Sarre, ARD Washington, May 7, 2022 1:48 p.m.

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