Deutsche Welle (English edition)
Mystery hepatitis: At least one child has died, WHO says
Doctors are scratching their heads over a new, unknown form of hepatitis that is causing severe illness in some cases. At least one child has died, according to the WHO. Does the COVID pandemic have a role to play?
Health officials in the European Union, the US and the UK are looking into an outbreak of unexplained, acute cases of hepatitis in young children.
According to the World Health Organization, 169 cases have been detected in 12 countries. At least one child has died, while 17 have required liver transplants.
It's very rare to come across serious cases of hepatitis in children, said William Irving, a professor of virology at the University of Nottingham. He said on average, hepatitis cases per year in children in the UK have likely been in the single digits. This year, the country has seen over 110 in the first four months.
"I find this absolutely extraordinary," Irving said. "I've not come across anything like this in my clinical practice. It's worrying because we don't know what's going on."
A mysterious liver inflammation in young children
All of the reported patients are under the age of 10, and many are under the age of 5. The children aren't testing positive for the typical hepatitis viruses — A, B, C, D or E — a situation Alastair Sutcliffe, a professor of general pediatrics at the University College of London, called "very unusual."
The outbreak was first reported by UK health officials at the start of April. On April 19, the European Center for Disease Prevention and Control announced additional cases in Spain, Denmark, the Netherlands and Ireland. It also flagged cases in the US state of Alabama.
So far, a quick survey of children hepatology centers in Germany did not detect any cases similar to those noted by the UK health authorities, said Burkhard Rodeck, secretary general of the German Society for Pediatric and Adolescent Medicine e.V.
Hepatitis means inflammation of the liver and has many causes, Irving said. It can result from infections caused by viruses and toxins in alcohol or by problems like obesity. He said although the cause of this specific outbreak is still unclear, it's being widely believed it could be related to the adenovirus.
Adenovirus a potential cause
Doctors found that some of the children diagnosed with the mysterious illness tested positive for a specific type of adenovirus infection: adenovirus 41. Irving said adenovirus 41 hadn't been found in all the cases, and it hasn't been looked for in all the cases, but it's been observed in enough cases to potentially be more than coincidental.
Adenovirus 41 is a common infection in young children that normally causes a bit of diarrhea and vomiting, Irving said, adding that it isn't known for being associated with hepatitis.
There could be something unusual about this specific adenovirus, Irving said. Or it could be interacting with something else that's causing hepatitis. Or it could be a brand new infectious agent, or a toxin, or some kind of environmental factor, or a combination of all these possibilities, he said.
What about COVID-19?
Whether it's related to COVID-19 is also up in the air, Irving said. It's possible some of these children had COVID, which impacted their immune system, making it harder to fight typical childhood viruses.
There are ample testing results available for the 13 cases found in Scotland. Of those 13, three tested positive for COVID infection, five tested negative and two had gotten the virus in the past three months. Only 11 of the 13 cases got tested for the adenovirus with five of them returning positive.
If COVID-19 infection is not the root of the problem, the pandemic's effect on children's health could be a part of it, Irving said.
"You've got a cohort of children who have been largely shielded, the very young children. So they've not been exposed to the range of virus infections that they would normally have been exposed to," Irving said.
"We have seen this winter much higher levels of a whole range of virus infections in children, including adenoviruses," he said. "Maybe there's something about the fact that they've sort of had two years of relative sterility where they're not being exposed and all of a sudden, they've got a whole pile of infections, including adenoviruses that they're not dealing with in the normal way."
Rise in hepatitis cases no need to panic
Sutcliffe said one thing is clear: The hepatitis isn't being caused by COVID-19 vaccines, because the children who have gotten the illness weren't vaccinated.
He cautioned parents to stay calm.
"My understanding is quite a lot of [the children with hepatitis] have gotten better, which is the usual. If we narrow it down to a risk of liver failure, the risk is very small. And so I think let's not exaggerate," he said.
Irving said he expected to see many more cases reported in the coming weeks as health authorities become aware of and start tracking the outbreak. The fact the UK caught it first is likely due to the country's rigorous reporting systems, he said.
"I don't understand Alabama," Irving said. "I mean, why you would have nine cases in one state and no cases from the other 49 states. It doesn't make any sense. I think that's got to be a function of surveillance. I think if it's occurring in Alabama, it is occurring elsewhere. It's just they don't know about it."
while. But many people regularly overstep the recommended fivegram limit.
Especially in some countries in east and central Asia, people consume too much salt. In China, the average salt consumption is around 10.9 grams per day — more than double the WHO limit.
Many European countries such as Germany, Portugal and Italy, as well as the United States, Canada, Australia and New Zealand, also exceed the daily guideline. The situation is similar in Latin America — particularly in Brazil, Colombia and Bolivia. Only a few African countries have healthy rates of salt consumption.
Too much salt equals high blood pressure?
But why does the WHO set this limit of five grams? Studies have shown that if this amount is exceeded, we start seeing negative health effects — especially on blood pressure.
That’s because salt bonds with water. This bonding causes the pressure in our tissues to rise, which can increase blood pressure and lead to a higher risk of stroke or heart attack.
But salt isn’t the only thing that influences blood pressure.
"The reality is that many different factors affect blood pressure," said Riedl. "In addition to salt consumption, other factors include physical activity, stress, preexisting medical conditions and the rest of your dietary habits."
According to Riedl, slim people from Asian countries with high salt consumption who eat an otherwise healthy and traditional diet often have fewer problems with blood pressure than people from Western countries, who often already suffer from obesity or diabetes.
Salt-sensitive and salt-resistant people
Furthermore, only about onethird the population is saltsensitive — this means their salt consumption impacts their blood pressure.
The remaining two-thirds are salt-resistant. In their cases, salt consumption and high blood pressure are probably not linked.
"With a simple blood test, you can find out which group you belong to," said Riedl. However, in many countries this can be expensive.
But even people who belong to the salt- resistant group should adhere to the five-gram limit. That's because too much salt can have other negative consequences for our health.
Stressed kidneys
When salt consumption is very high, our kidneys become consumed by the act of excreting the excessive salt. "This can stress the organ out," said Riedl. In the long term, it can lead to renal insufficiency.
Too much salt also affects the gut microbiome. The number of lactic acid bacteria decreases, while the number of so-called Th17 helper cells in the blood increases. Researchers assume that this interaction causes inflammation and autoimmune diseases.
Along with increasing the risk of stomach cancer and bone loss (osteoporosis), salt can even contribute to obesity — it stimulates the appetite, beckoning us to keep eating even when we aren’t hungry anymore.
How to reduce our salt consumption
The WHO estimates that if the entire world population reduced its salt consumption to five grams per day, around 2.5 million deaths caused by strokes and heart attacks could be prevented per year. But how can we keep our salt intake in check?
Luckily, there are different strategies. Instead of using salt to increase flavor while cooking, we could opt for fresh herbs. We could also stop adding salt when eating at the table. In Bolivia, for instance, salt shakers have been banned from restaurant tables since 2015.
Watch out for hidden salt
However, in many cases the problem of our excessive salt consumption does not result from cooking or adding salt at the table.
"The majority — about 75% — of our salt consumption is due to convenience products that contain a lot of hidden salt," said nutritionist Riedl.
This includes the classic frozen pizza, but also pastries, sausages such as salami, cheese, tomato ketchup, ready-to-eat sauces and soups, chips and canned foods. If we really want to reduce our salt consumption to a healthy level, we should try avoiding these products.
For people who already suffer from high blood pressure, socalled diet salt can be a solution. This is a seasoning that resembles ordinary table salt but contains less of the harmful sodium and more potassium.
Other types of salt such as sea salt or Himalayan salt are often claimed to be healthier. However, they have roughly the same composition as ordinary table salt — and thus the same effects on our health.
Finally, the right amount of salt is a matter of habit. If we consume a lot of salt over a long period of time, our tongue gets used to the taste — and demands saltier foods. But if we use salt carefully, even meals with hardly any salt taste great. So until we find a healthy balance, we might just need a pinch of patience.