MYSTERY ORIGIN OF ACUTE HEPATITIS IN CHILDREN

Since the publication of the World Health Organisation’s ‘Disease Outbreak News on Acute hepatitis of unknown aetiology – the United Kingdom of Great Britain and Northern Ireland’ in April, there have been continuing further reports of cases of acute hepatitis of unknown origin among young children across the world. The cases are more clinically severe and a higher proportion develops acute liver failure compared with previous reports of acute hepatitis of unknown causes in children. While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent. There have been at least 650 cases of acute hepatitis of unknown origin reported from 33 countries between April 5 and May 26. Cases are aged 1 month to 16 years old.

At least 38 children have required transplants, and nine deaths have been reported to WHO.

The common viruses that cause acute viral hepatitis (hepatitis viruses A, B, C, D and E) have not been detected in any of these cases. Adenovirus has been detected in at least 69.6 per cent of cases. SARSCoV-2 was identified in 12.2 per cent of those that were tested. Regarding COVID-19 vaccination, 84.1 per cent were unvaccinated. The clinical syndrome among identified cases is acute hepatitis (liver inflammation) with markedly elevated liver enzymes. Many cases reported gastrointestinal symptoms including abdominal pain, diarrhoea and vomiting preceding presentation with severe acute hepatitis, and increased levels of liver enzymes and jaundice. The UK first reported an unexpected significant increase in cases of severe acute hepatitis of unknown origin in young, generally previously healthy children.