Disease in children: what is behind the hepatitis cases?

The mysterious cases of hepatitis in children are increasing worldwide. Where does the disease come from? Is there a connection with the corona pandemic? And what should parents pay attention to?

The WHO has reported a worldwide increase in hepatitis infections of unknown origin in children under the age of ten. Ongoing examinations of blood and stool samples on behalf of the Robert Koch Institute should create knowledge about the triggering pathogens.

Experts, such as the Secretary General of the German Society for Child and Adolescent Medicine Dr. Burkhard Rodeck, suspect so-called adenoviruses as possible triggers of the disease and also speculate about possible connections to the corona pandemic and the associated measures.

What is hepatitis and what are the symptoms?

Hepatitis is an inflammation of the liver that is often preceded by a viral infection. The hepatitis viruses A to E are the most well-known triggers of such infections. The severity, course and transmission of hepatitis depends on its type. Signs of hepatitis are elevated liver values.

However, hepatitis can also manifest itself in the form of vomiting, diarrhea, fever, malaise and jaundice, among other things. Recommend against type B virus the RKI and the Standing Committee on Vaccination recommend vaccination in infancy. Hepatitis A immunization is especially recommended for people at risk and travellers.

In which countries are there currently more cases – and how are the authorities reacting?

After Great Britain reported the first five cases in March, the WHO became aware of almost 220 new diseases in 20 other countries by May 1, 2022, according to WHO spokesman Tarik Jasarevic on May 3. In Germany, individual cases have been reported by the state health authorities.

In a letter to pediatric specialist societies and on the official website, the Robert Koch Institute called for increased attention to suspected cases and referred to the corresponding obligation to report under the Infection Protection Act. The RKI estimates that the number of cases in the United Kingdom in particular is unusually high. The development in Germany should continue to be observed. Acute hepatitis diseases of unclear cause are rare in children, but they also occur occasionally in Germany.

What are the consequences of the disease in children?

The still unsolved phenomenon of hepatitis in children, which is spreading worldwide, leaves experts puzzled. Particularly serious courses of hepatitis occur in particular in those affected under the age of five. According to the World Health Organization, nearly ten percent of affected children needed it Liver transplantation as a result of hepatitis infection.

At least four children have already died of liver inflammation in the past few weeks. Current laboratory tests showed that no type A to E hepatitis viruses were detectable in the majority of affected children.

What could be triggers for the recent cases of childhood hepatitis?

Instead of the classic pathogens, adenoviruses of type 41 were detected in many of those affected. These viruses were found in 75 percent of sick children in Great Britain. As a rule, adenoviruses trigger mild cold symptoms and gastrointestinal infections, among other things.

Serious complications such as liver inflammation, which can lead to liver failure, are rather untypical in adenovirus infections. Such serious consequences usually only affect people with particularly weak immune systems. The adenovirus was not previously known to be the cause of hepatitis in healthy children.

Could there be a connection with Corona or a Corona vaccination?

The WHO reports in almost 20 of the 200 reported cases of a double infection. Accordingly, the affected patients seem to have been infected with both the adenovirus and the coronavirus.

A connection with the corona vaccination cannot be established because the affected children were not vaccinated at the time of the illness. However, the exact cause of the novel hepatitis diseases is still unclear. However, experts, including Rodeck, speculate that the corona pandemic could be directly related to the serious infections.

What is the connection to the corona pandemic?

Rodeck and other experts suspect that children’s immune systems, which are particularly shaped in the first few years of life, have been weakened by keeping their distance and other corona measures. In these important first years of life, children were therefore exposed to fewer viruses due to any contact restrictions and were therefore unable to develop corresponding antibodies.

On the one hand, the significantly increased hygiene measures can reduce the risk of infection, but on the other hand, the performance of a permanently under-challenged immune system decreases steadily.

This increases the risk of getting infected and falling ill more easily if you come into contact with viruses. According to Rodeck, severe disease progressions, such as in childhood hepatitis cases, can be a result of the lack of training of young, naïve immune systems.

At the same time, there is the hypothesis that, as with the SARS-CoV-2 variants, a more aggressive and contagious adenovirus variant could have emerged.

Could the hepatitis cases have been caused by contaminated food?

Hepatitis can also be transmitted through contaminated food or drinking water. However, Tobias Tenenbaum, the chief physician for pediatric and adolescent medicine at the Sana Klinikum Lichtenberg, rules out the possibility that the cases of hepatitis observed in children were caused by contamination of food. His statement is based on the knowledge that there is no common dietary pattern in the differently affected age groups.

What do parents have to watch out for?

Chief physician Tenenbaum advises parents to pay particular attention to the children’s skin and conjunctiva if they are infected with a gastrointestinal virus. If these become yellowish, the urine darkens, or the stool becomes lighter, you should see your pediatrician. Strict hand and bathroom hygiene can also reduce the risk of infection.

How do experts assess the situation?

Even if the manageable number of reported hepatitis cases in children seems low, health authorities worldwide are on the alert due to the high health risk that can arise, according to pediatric infectiologist Tenenbaum. The exact causes of the mysterious cases of hepatitis in children are still being researched.