In the hunt for the cause of the sudden increase in young children with acute hepatitis, the World Health Organization (WHO) does not rule out the possibility that in some cases there is a transmissible cause, such as a virus. Cases of liver failure in which children were in contact with each other have been reported in the Netherlands and Scotland.
Professor of pediatrics and liver doctor Henk-Jan Verkade from University Medical Center Groningen: “There have now been five serious cases of acute liver failure in our country, where a liver transplant has been performed successfully in four out of five children. In one of those five children, a classmate had recently had a period of jaundice. “
“It may indicate an accumulation of bilirubin, which may be one of the symptoms of liver disease. This second child recovered spontaneously and did not develop severe acute liver failure. In the other four children with acute liver failure, we found no other cases of liver disease or acute hepatitis in the environment. “
Even if some patients are transmitted through contact, such as with a viral infection, the ultimate consequence of an exposure, according to Verkade, also seems to be mainly determined by the body’s individual response to it. ‘The concept of contagion is therefore too strong. It would immediately fully explain the cause of liver failure. It’s not true; it is also about how the ‘recipient”s defense responds to it. “
Guessing on possible source
Between early April and May 26, 2022, 650 possible cases from 33 countries of liver failure in young children have now been reported to the WHO, with the possible source and mode of infection still unknown. While current data indicate that only a small proportion of vulnerable children (if any) develop severe acute liver failure, the WHO states that “reported cases are more severe and that a larger percentage develop acute hepatitis compared to previous reports”. The WHO has assessed the risk globally as ‘moderate’.
Most cases, almost 60 percent, come from Europe. The United Kingdom and Northern Ireland are ‘leaders’ with no fewer than 222 reports. Three-quarters of the children are younger than five years old; 165 children ended up in hospital and 22 in intensive care. Fourteen children have undergone a liver transplant.
The actual number may be higher
The WHO states that the true number of children with liver failure may be higher due to limited capacity to monitor and map this disease. Researchers have some theories about the cause. One hypothesis suggests that the damage is caused by adenovirus type F41 — a common childhood infection that usually causes cold symptoms.
Another theory is that the cause is a poor immune response to a previous coronary infection. And then there is the possibility that an adenovirus infection along with a coronary infection is devastating to the liver. Incidentally, only evidence of a previous or concomitant coronary infection has been found in a small minority of children with acute hepatitis.
Less in contact with ‘normal’ viruses
Liver doctor Verkade is also not sure yet: “The social restrictions imposed by the pandemic may have led to young children being exposed to all kinds of viruses for the first time at a later stage in their lives, and this has affected development. of their immune system .. This in turn may have led to a different immune response in some. During the shutdowns, they have come into less contact with one of the normal viruses, so the immune system may have been a little less ‘experienced’. certainly not the only explanation, because of the five children we treated here at the hospital, there were only two who had the adenovirus. “
Also read: Unexplained acute hepatitis affects healthy young children. What happens?