RIVM and WHO warn against liver disease in children

RIVM has asked doctors and healthcare providers to be aware of children with acute hepatitis. Last week, the World Health Organization WHO and other health organizations sounded the alarm: In more and more countries, there are young children with as yet unexplained acute hepatitis. The disease is serious and sometimes even requires a liver transplant.

Also in the Netherlands, four children with the dangerous condition have so far been treated at UMC Groningen – three of them have had a liver transplant, the fourth has recovered remarkably quickly, says pediatrician Henkjan Verkade from UMC Groningen. “We only see the most serious cases, the tip of the iceberg,” he says. He expects more children with a milder form of liver disease to come.

The first signals came from the UK in early April. Since the beginning of this year, 74 children have been hospitalized there with this mysterious liver infection. Some children with this condition have also appeared in Spain, Ireland, Denmark and the US state of Alabama, the European Health Authority ECDC reported on Tuesday.

Vomiting, jaundice, abdominal pain

The children report to the doctor because they have to vomit, they often have jaundice and abdominal pain, they have nausea and feel the flu. Other important symptoms are drowsiness and clotting problems, which can lead to spontaneous bruising or nosebleeds, for example. The disease is seen in children under 16 years of age, but most patients are between 2 and 5 years old.

The condition is remarkable because none of the children were infected with any of the five known hepatitis viruses, hepatitis A, B, C, D or E.

In any case, the condition has nothing to do with corona vaccinations: none of the children in the UK had been vaccinated.

Hepatitis can be caused by some harmful substances – for example from an overdose of paracetamol. But so far no connection has been found to anything the children ate or drank. “The chances are greatest that it is due to an infection with a virus,” says Verkade. ‘There are several candidates, but none that really stand out. And it could also be an unknown virus. “One of the possible culprits could be adenovirus. Some patients in other countries were infected with it – it was not found in the four children in Groningen, says Verkade. Adenoviruses are respiratory viruses that usually only causes a cold.They can also lead to cystitis or hepatitis, but it usually occurs in people with weakened immune systems.Most patients were completely healthy before they developed acute hepatitis.

RIVM has asked the Pediatricians’ Association to decide whether this new form may also have occurred in previously admitted patients with acute hepatitis. RIVM hopes to be able to identify the source that led to the infections, a spokesman said.

In the countries where the condition has been seen, a link between the cases has not yet been established – only two pairs of children in Scotland appear to be in a family. One of the nursery friends of a patient in Groningen also turned out to have been ill and yellow, says Verkade. “It is possible that the child had a milder form and recovered spontaneously.”

liver transplants

Normally, there are about 6 children a year in the Netherlands with acute liver failure, of which 3 or 4 must undergo a liver transplant in UMC Groningen specialized in this. It is noteworthy that that figure has already been reached in April. “It is very possible that this is an indirect result of the pandemic,” says Verkade. “The isolation measures and shutdowns also made it harder for other viruses to spread. We now see a very different pattern of spread throughout the year for many viruses than we were used to, for example with RS virus and with influenza virus influenza A. Maybe that’s why children have a different exposure and a different defense structure. ”

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