Hepatitis that affects dozens of children in Europe may be related to Covid-19

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The World Health Organization (WHO) is investigating more than a hundred cases of acute childhood hepatitis, which required liver transplants in dozens of young children. A "strange and alarming" epidemic that could be related to Covid-19.

Since April 15, a mysterious hepatitis has worried the World Health Organization (WHO). The organization follows the evolution of the number of cases of hepatitis identified in more than a hundred young children, first in the United Kingdom, then in the United States and in ten other European countries. The origin of this disease remains to be determined. In some cases, these infections have required liver transplantation. To date, no deaths have been reported.

Who are the victims?

This new hepatitis has been identified in children from one month to 16 years, specifies the WHO. A phenomenon that is not abnormal. "Hepatitis in children can occur, it is not uncommon, but it is always more annoying to see children affected by an epidemic," says Professor Yazdan Yazdanpanah, a specialist in infectious pathologies.

How many cases have been detected?

The United Kingdom was the first country affected by this epidemic. Until April 21, the WHO had no less than 169 cases, spread over 11 European countries and the United States. While the majority of cases were reported in the UK (114), there are currently:

13 cases in Spain,

12 in Israel,

9 in the United States,

6 in Denmark,

under 5 years in Ireland,

4 in the Netherlands and Italy,

2 in France and Norway

a case in Romania

and one case in Belgium.

"It is very likely that more cases will be detected before the cause can be confirmed and more specific control and prevention measures can be implemented," says the WHO in its latest report, published on April 23, 2022.

Two cases of acute hepatitis confirmed in France

In France, "the Lyon University Hospital has reported two cases of acute hepatitis whose etiology has not yet been determined," French Public Health announced to AFP on April 20. If this statement is worrying, the hospices of Lyon, contacted by BFM, wanted to reassure that these two cases "have been treated since then, one 15 days ago, the other a month ago".

What symptoms should alert?

This hepatitis is manifested by different symptoms. The UK Health Security Agency (UKHSA) points out several warning signs:

dark urine,

pale gray stools

skin itch,

yellowing of the eyes and skin,

muscle and joint pain,

a high temperature,

abnormal tiredness,

loss of appetite

and stomach pains.

Some cases required transfer to a specialized liver disease ward and six children required liver transplants, the WHO said. No deaths have been recorded at this time.

What do we know about the origin of this hepatitis?

Several pathways are being studied, because hepatitis can be viral, drug-induced, or even foodborne. In this case, the cause of this inflammation of the liver remains unknown. "Laboratory investigations of the cases excluded viral hepatitis types A, B, C, D and E in all cases," specifies the ECDC, Tuesday, April 19.

The WHO, for its part, favors the trail of adenoviruses. There are more than 50 types, generally responsible for infections of the lungs and airways, which can cause a cold and in some cases pneumonia.

However, an adenovirus infection "does not fully explain the severity of the clinical picture," says the WHO,

In his latest report, he advances three hypotheses to try to explain the appearance of this new form of hepatitis:

The possible appearance of a new adenovirus. An as yet unknown adenovirus could be the cause of this epidemic. The virus causes vomiting, cold symptoms, or conjunctivitis, but rarely hepatitis. Therefore, it could be a new variant of adenovirus, as Scottish researchers explain in the journal Science: "A variant with a distinct clinical syndrome or a commonly circulating variant that affects young children more severely."

Increased susceptibility in young children after lower circulating level of adenovirus during the Covid-19 pandemic. The passage of the disease could have saved the children's immune system, favoring the appearance of this hepatitis. After the lockdowns, children would actually have been more weakened by adenoviruses, because they were much less exposed.

In addition, the trace of a co-infection is not ruled out. Among the 169 children, 74 tested positive for adenovirus and SARS-CoV-2 was detected in 20 of them. "In addition, 19 with SARS-CoV-2 and adenovirus coinfection were detected," the WHO underlines in its report.

The organization recommends that analyzes of blood, serum, urine, feces, and respiratory samples, as well as liver biopsy samples (when available) be performed to refine ongoing investigations.

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