Questions and answers about hepatitis in children

In recent weeks, a number of cases of severe hepatitis of unknown origin in children have been reported. These have been detected in several countries including the United Kingdom of Great Britain and Northern Ireland, Spain and the United States of America.

What is acute hepatitis?

It is a term used to describe acute inflammation of the liver. It can be due to a range of infectious and non-infectious causes. There are 3 main types of acute viral hepatitis – hepatitis A, B and C. Viral hepatitis D and E are rarer, especially in high income settings.

What makes this outbreak unusual?

Severe acute hepatitis is unusual in young children. The initial report of a possible increase in cases came from Scotland. This then led to alerts going off elsewhere in the UK and around the world, with people searching and finding more cases.

What we do know is that the common viruses that cause acute viral hepatitis were not detected in these patients. Additionally, international travel or ties to other countries, based on currently available information, have not been identified as significant factors.

How worried should we be?

This should be taken seriously – even if these are rare occurrences. Further work is needed to identify additional cases, both in currently affected countries, but also elsewhere. The priority is to determine the cause of the disease in order to be able to further refine control and prevention actions.

What are the main theories on what causes this?

We are working with countries and partners to examine a range of possible explanatory factors. Many avenues are explored. One of the main hypotheses is the adenovirus, which is a group of common viruses transmitted from person to person causing respiratory symptoms, vomiting and diarrhea in children.

Although adenovirus is currently a hypothesis, it does not fully explain the severity of the clinical picture. Cases of hepatitis have been reported in immunocompromised children with adenovirus infection, but it is unusual for it to be a cause of severe hepatitis in otherwise healthy children.

Factors such as increased susceptibility in young children following a decline in the circulating level of adenovirus during the COVID-19 pandemic, the potential emergence of a new adenovirus, as well as co-infection with SARS-CoV-2 have been suggested by the UK team as possible factors, and need further investigation.

Could the outbreak be linked to COVID-19?

SARS-CoV-2 has been detected in several cases. However, circulation of COVID-19 is currently widespread in the community of many affected countries and the potential contribution of this virus to the clinical presentation is unclear.

Could the outbreak be linked to the COVID-19 vaccination?

There is no evidence that the presentation is related to vaccination since the vast majority of affected children have not received a COVID-19 vaccine. Other infectious and non-infectious explanations must be fully evaluated to understand and manage the risk.

Are we expecting to see more cases?

With continued new notifications of new-onset cases, as well as more extensive case-finding in other countries, it is very likely that more cases will be detected before the cause can be confirmed and control measures taken. and more specific prevention can be implemented.

What should parents pay attention to?

First of all, it is important to emphasize that this is not a common disease, but parents should be alert to the symptoms of hepatitis, which are an acute onset of diarrhea, vomiting, abdominal pain and jaundice – where the skin and the whites of the eyes turn yellow – in young children. Most children do not have a fever. If there is any concern, we advise parents to contact their healthcare professional.

What can parents do to prevent their children from getting sick?

Take the normal steps that help protect against common viruses, so parents should supervise good hand washing and encourage good respiratory hygiene, such as covering a cough or sneeze, which taken together can help reduce spread.

Mary I. Bruner