Global cases of acute hepatitis in children have risen sharply to 450 children in at least 20 countries since the outbreak was first brought to the attention of the World Health Organization (WHO) by the Scottish National Health Service in early April. Acute hepatitis is inflammation of the liver that can lead to impending liver failure, a life-threatening condition. At present, 12 children have died worldwide during the ongoing outbreak.
In its initial report to WHO, NHS Scotland wrote that “five children aged three to five presented to the Royal Hospital for Children, Glasgow with severe hepatitis of unknown etiology within three weeks. The typical number of cases of hepatitis of unknown etiology in Scotland would be less than four per year.
As of April 8, the global number of cases had risen to 74. All cases had tested negative for the viruses usually suspected. A number of children have been documented as having been infected with adenovirus or COVID-19, although other factors have been considered.
On April 15, WHO issued the first of three outbreak alerts, asking health systems and public health officials to increase awareness and diligence in identifying, investigating and reporting cases. of hepatitis. They said: “Given the increase in reported cases over the past month and improved case-finding activities, more cases are likely to be reported in the coming days.”
As of April 21, 169 cases had been reported in 12 countries, ranging in age from one month to 16 years old. The bulk of those cases came from the UK, while the US had seen 11 cases at the time. At that time, the WHO made it clear that COVID-19 vaccines were not implicated in the hepatitis epidemic, as a large majority of affected children were unvaccinated.
On Tuesday, the WHO announced that the number of probable cases of hepatitis in children now stands at 348 in 20 countries across five regions of the world.
The recent spike in pediatric hepatitis cases around the world since late last month reflects additions made by the US Centers for Disease Control and Prevention (CDC) in their ongoing investigation. There are currently 109 such cases in the United States out of a total of 25 states and territories.
Dr. Jay Butler, deputy director of infectious diseases at the CDC, noted that 90% of those children have been hospitalized since October 2021, when nine such cases were identified in Alabama. He said 14% needed an urgent liver transplant and five of the children died tragically.
Dr Philippa Easterbrook, senior scientist for the WHO’s global programs on HIV, hepatitis and STIs, said on Tuesday: “At the moment the main hypotheses remain those involving the adenovirus, but I think that there is always an important consideration on the role of COVID as well. , either as a co-infection or as a previous infection. Over the past week, further testing has been done…confirming that approximately 70% of cases that have been tested are still positive for adenovirus.
On Wednesday, the European CDC published a update indicating that the total number of cases worldwide has reached 450. In the EU/European Economic Area, the total number of cases stands at 105, with Italy reporting the most cases at 35, followed by Spain with 22, followed by Sweden with 9. The United States The Kingdom currently has the most confirmed cases of any country at 163, and six countries have reported more than five cases.
On Thursday, Ireland reported the death of a child from acute liver failure, bringing the global total to 12. Brazil is investigating eight more cases, bringing their total to 28. In total, the death rate is between 2 and 3% and the rates of liver transplantation vary between 10 and 15%.
The etiology of the devastating cases remains to be elucidated. Easterbrook’s statement is opaque, and many scientists have noted that the presence of adenovirus among the cases does not directly implicate this ubiquitous virus as causative.
It seems more than a coincidence that the sudden emergence of a rare disease never before described in healthy children occurred just months after the massive wave of COVID-19 infections that swept across the world during the Omicron BA.1 push last winter. Seroprevalence studies indicate that potentially hundreds of millions of children have been infected worldwide since last December, making the occurrence of rare manifestations of COVID-19 infection more likely.
Notably, acute hepatitis has previously been associated with multisystem inflammatory syndrome in children (MIS-C), which affects children after the acute phase of COVID-19 infection. In the United States, the incidence of MIS-C would have been approximately one in 3,000 to 4,000 cases of COVID-19.
In a tweet now shared more than 10,000 times, gastroenterologist Dr Farid Jalali explained that adenoviruses have only caused acute liver failure in patients with severe immunodeficiency and not in previously healthy children. . The severity of the disease depends on the intensity and duration of immunosuppression in cases where patients are treated for a malignancy with chemotherapy or take anti-rejection drugs after an organ transplant.
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Dr. Jalali explained that adenovirus infections are very common in children and can be detected in up to 11% of healthy, asymptomatic children from throat swabs. In addition, the virus can persist for months or years in about 30% of “immunocompetent” children.
He wrote: “Relying on the detection of adenovirus by PCR in children (often incidental due to persistence and shedding) may falsely attribute adenovirus as the cause of a disease for which the clinician may have no other appropriate explanation (e.g. pediatric acute liver failure in the context of the covid19 pandemic?).”
Due to his expert and well-reasoned explanations and concerns, Dr. Jalali has received many threats and slanders from right-wing commentators.
Australian epidemiologist Dr Raina MacIntyre weighed in on the issues with a rare but lengthy Twitter thread, noting: “This is most likely a complication of COVID-19 but it may take some time to be judged as much.”
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Dr MacIntyre added: “Hepatitis is a known presentation of MIS-C and MIS-C is a late complication after acute infection. [of COVID]. So the fact that [SARS-CoV-2] PCR negative is not surprising… SARS-CoV-2 is liver-tropic and usually causes liver damage, so biological plausibility (one of the Bradford-Hill criteria for causation) is present.
Interestingly, many of these children had not obtained a COVID-19 antibody test and liver biopsies had not been checked for the SARS-CoV-2 virus.
Dr. MacIntyre pointedly asks, “And what about the ideological reasons why there is a concerted effort to deny COVID as a cause and find some other explanation? An explanation ? This is called “increasing commitment to a failing proposition” and is a normal reaction to the accumulation of evidence that an acquired position is wrong.
The impact of COVID-19 on children has been repeatedly downplayed by nearly every government in the world. Last year, US President Joe Biden told a second-grader that she shouldn’t be afraid of COVID-19, that schools can return safely and that she is unlikely to infect her children. parents. These turned out to be outright lies and COVID-19 is clearly dangerous for children, with tens of thousands of children likely killed by the virus worldwide.
Dr MacIntyre concludes his thread by noting: “In the UK, children were denied vaccination for the longest time and then belatedly and reluctantly offered it. When countries and experts have invested in this position, and the evidence mounts that it is a bad position, we see a growing commitment to a failing proposal… Maybe that’s why we have yet to see a proper epidemiological analysis of causation. Yes, it can be caused by something else. But amid the pandemic, COVID is the most likely cause. »
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