May 2, 2022 –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 children aged 1 month to 16 years.

These children have tested negative for hepatitis A, B, C, D, and E — the more common viruses that can cause acute hepatitis. The most common pathogens detected have been adenovirus, which normally causes a common cold, and SARS-CoV-2, according to the ECDC.

Any link between the hepatitis 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 those 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.

It’s possible that another thing affecting the children makes the adenovirus infection more severe than usual or causes the immune system to harm the liver, the ECDC alert stated.

New Information From Alabama

A new report from the CDC suggests there is no connection between the nine cases in Alabama and COVID-19. All children 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 hepatitis cases were identified between October and November 2021.

All cases occurred in children younger than 6 years, and the median age of the children was 2 years and 11 months.

Vomiting and diarrhea were the most common initial symptoms. When doctors examined the children, 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."

Show Sources

European Centre for Disease Prevention and Control: “Increase in severe acute hepatitis cases of unknown aetiology in children.”

Wisconsin Department of Health Services: “Wisconsin DHS Health Alert #42: Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology.”

World Health Organization: “Multi-Country – Acute, severe hepatitis of unknown origin in children.”

Morbidity and Mortality Weekly Report: “Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022.”

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