Nearly 200 cases of unexplained hepatitis have been reported in children globally, according to the European Centre for Disease Prevention and Control (ECDC).
As of April 20, 111 cases have been reported in the United Kingdom, and as of April 27, 55 cases have been reported in 12 countries in the European Union: Austria, Belgium, Denmark, France, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Romania, and Spain. Twelve cases have been detected in Israel, and one case has been reported in Japan.
In the United States, there have been nine cases in Alabama, two cases in North Carolina, and three cases in Illinois. Wisconsin announced on April 27 that the state is investigating at least four similar cases in children, and, according to the Wisconsin Department of Health Services, there has been one death reported.
Seventeen children required a liver transplant, according to a World Health Organization (WHO) Alert on April 23, and one child has died, though the alert did not specify where the death took place. The Wisconsin Department of Health Services did not confirm if their reported death was included in the WHO announcement or if it is separate.
Reported cases have occurred in patients aged 1 month to 16 years.
These cases have tested negative for hepatitis A, B, C, D, and E — the more common viruses that can cause acute hepatitis. The most common pathogens in these cases have been adenovirus and SARS-CoV-2, according to the ECDC.
Any link between these cases and COVID-19 vaccination has been ruled out, the WHO alert stated, because “the vast majority of affected children did not receive COVID-19 vaccination”
About 75% of children affected in England and 50% of cases in Scotland have tested positive for adenovirus, hinting there may be a connection between these cases of severe hepatitis and the virus. While adenovirus can cause hepatitis in children, it is usually only in children who are immunocompromised. These recent cases have generally been in “previously healthy children,” according to the ECDC and WHO.
“The current leading hypothesis is that a cofactor affecting young children having an adenovirus infection, which would be mild in normal circumstances, triggers a more severe infection or immune-mediated liver damage,” the ECDC alert stated.
New Clinical Information From Alabama
A new report from the Centers for Disease Control and Prevention (CDC) suggests there is no connection between the nine cases in Alabama and COVID-19. All patients tested negative for SARS-CoV-2, and they had no history of previous COVID infection, according to the Morbidity and Mortality Weekly Report released on April 29. The cases were identified between October and November 2021.
All cases occurred in children younger than 6 years, and the median age of patients at admission was 2 years and 11 months.
Vomiting and diarrhea were the most common initial symptoms, and, upon examination, most had yellowing of the eyes, an enlarged liver, and jaundice.
All patients were from different parts of the state, and there were no epidemiological links between the cases.
All patients tested positive for adenovirus, six tested positive for Epstein-Barr virus (later determined to be from previous infections), and four had enterovirus/rhinovirus. Two patients required liver transplants, and all have recovered or are recovering, according to the report.
“This cluster, along with recently identified positive cases in Europe, suggests that adenovirus should be considered in the differential diagnosis of acute hepatitis of unknown etiology among children,” the authors write. “The CDC is monitoring the situation closely to understand the possible cause of illness and identify potential efforts to prevent or mitigate illness.”