Mysterious cases of acute liver disease in children spark international investigation

Zoom The baby is treated with blue light, a procedure to prevent jaundice.

Health officials in Scotland on Thursday published the early results of a burgeoning international investigation into dozens of mind-boggling cases of acute hepatitis in children. Some cases have even led to acute liver failure and liver transplants.

Thursday’s report included 13 serious cases in Scotland, mostly of children aged 3 to 5, almost all of which occurred in March and April this year. Scotland has typically reported fewer than four cases of unexplained hepatitis – also known as hepatitis – in children over one year of age. Of the 13 cases in Scotland this year, one has resulted in a liver transplant and five are still in hospital. No deaths have been reported.

Meanwhile, health officials in England reported: about 60 cases of unexplained acute hepatitis by 2022, they were mainly in children aged 2 to 5 years. Some of these cases progressed to acute liver failure, and a few also resulted in liver transplantation. Again, no deaths were reported.

In their report, officials in Scotland said they had also been in contact with researchers at the US Centers for Disease Control and Prevention, which is investigating its own group of hepatitis cases in children. The US CDC did not immediately respond to Ars’ request for more information about the group, including the number of children involved and the severity of their cases. This story will be updated as more information becomes available.

Health officials are scrambling to understand the cause of the acute illness. In the cases described so far, the most obvious infectious etiology of hepatitis – hepatitis A to E viruses – has been excluded, with children consistently showing negative results. Health researchers also haven’t found any common food, drink, or personal care product that explains the illnesses. There are no clear links between work and nothing to do with travel. Nor did the researchers see any strong evidence of a bacterial infection.

Hypotheses

Test results for some of the children showed that they had an adenovirus. For example, five out of 13 children in Scotland have tested positive for adenovirus – two through throat swabs, two through blood tests and one through stool samples. According to health officials in Scotland who have been in contact with researchers at the Centers for Disease Control and Prevention, a cluster of unexplained hepatitis cases in the United States has also been linked to adenovirus infection.

Adenoviruses are a large family of viruses that are widespread and often associated with respiratory diseases and eye infections. However, they can cause a variety of diseases, including gastrointestinal infections and diffuse infections. Adenoviruses are known to cause acute hepatitis in children, but they are rare in people who are not immunocompromised.

Some children in the UK have also been found to be infected with SARS-CoV-2. For example, five out of every 13 children in Scotland recently tested positive for the virus. None of the children were vaccinated against the virus.

According to health officials in Scotland, the main hypothesis is that diseases are caused by an infectious agent – not toxic exposure – and that adenovirus is the main suspect. Officials point to two possibilities if an adenovirus is behind the severe cases: a new adenovirus that has evolved to cause severe liver damage, or an existing variant that routinely circulates in children and causes serious illness because they were not previously exposed to adenoviruses while they were immune. To be . naive. Officials speculate that “the latter scenario may be the result of limited social mingling during the COVID-19 pandemic.”

But there is also the possibility that the clusters may be associated with infection with omicron subvariant BA.2, which is sweeping the UK and US, or even a variant that has not yet been identified. “At this time, it is not possible to rule out the presence of a new or undetected virus,” the officials wrote.

As researchers continue their investigation – which is still in its early stages – British health officials are warning doctors to look for children with symptoms of hepatitis, such as dark urine, pale stools, jaundice, itchy skin, nausea, vomiting and lethargy.

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