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U.S., U.K. investigating unusual cases of hepatitis in young children - April 15, 2022+

Increase in hepatitis (liver inflammation) cases in children under investigation


Regular UKHSA updates on the ongoing investigation into higher than usual rates of liver inflammation (hepatitis) in children across the UK.
From:UK Health Security Agency
Published6 April 2022
Last updated 6 May 2022 — See all updates
ukhsa-master-logo-960x640-grey.jpg


Latest


The UK Heath Security Agency (UKHSA) has published its second detailed technical briefing on the UK-wide investigations into a rise in cases of sudden onset hepatitis in children, updating data and findings on cases resident in the UK up to 3 May 2022.

Since the last update on 29 April, active case finding investigations have identified a further 18 confirmed cases, bringing the total number of UK cases to 163 as of 3 May. Of these children, 11 have received a liver transplant. None have died.

Jaundice and vomiting are the most common symptoms experienced by the children affected.

The investigation continues to suggest an association with adenovirus. Adenovirus is the most frequently detected virus in samples tested.

However, as it is not common to see hepatitis following adenovirus infection in previously well children, investigations are continuing into other factors which may be contributing. These include previous SARS-CoV-2 or another infection, a change in susceptibility possibly due to reduced exposure during the pandemic, or a change in the adenovirus genome itself.

These possibilities are being tested rapidly. The association with adenovirus is undergoing a formal epidemiological study.

Research studies of the immune system are being undertaken to determine if changes in susceptibility or the effect of prior infections could be contributing factors.

There is no evidence of any link to the coronavirus (COVID-19) vaccine. The majority of cases are under 5 years old, and are too young to have received the vaccine.

Normal hygiene measures, including thorough handwashing and making sure children wash their hands properly, help to reduce the spread of many common infections, including adenovirus.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said:
It’s important that parents know the likelihood of their child developing hepatitis is extremely low. However, we continue to remind everyone to be alert to the signs of hepatitis – particularly jaundice, look for a yellow tinge in the whites of the eyes – and contact your doctor if you are concerned.

Our investigations continue to suggest that there is an association with adenovirus and our studies are now testing this association rigorously.

We are also investigating other contributors, including prior SARS-CoV-2, and are working closely with the NHS and academic partners to understand the mechanism of liver injury in affected children.

...
https://www.gov.uk/government/news/...investigation#full-publication-update-history
 
Source: https://www.cnbc.com/2022/05/06/cdc-investigating-severe-hepatitis-in-children.html

CDC investigating 109 cases of severe hepatitis in kids across two dozen states, including 5 deaths
Published Fri, May 6 20221:50 PM EDTUpdated 24 Min Ago
thumbnail
Spencer Kimball

The Centers for Disease Control and Prevention is investigating 109 cases of severe hepatitis in children, including five deaths, the public health agency said on Friday.
More than 90% of the children were hospitalized and 14% required liver transplants, according to the CDC.
The public health agency has not yet determined a cause, but more than half the children had adenovirus infections.

The Centers for Disease Control and Prevention is investigating 109 cases of severe hepatitis in children, including five deaths, to determine a cause, with adenovirus infection as a primary line of inquiry, the public health agency said Friday.

More than 90% of the children were hospitalized and 14% required liver transplants, according to the CDC. The cases under investigation occurred over the past seven months across 25 states and territories. A majority of the patients have fully recovered and have been discharged from the hospital, according to the CDC....
 
Has autoimmune hepatitis been ruled out for most of these cases? This was increasing in children prior to the pandemic. You would expect that cases were reduced while children were isolated or masked during the pandemic - less stimulation by antigens and chemicals. Now that children are mingling again, those with the tendency towards autoimmunity are being exposed to more potential triggers. So at least some, perhaps many, of these cases could be a timeline cluster of autoimmune hepatitis. If that is the case then they should remain rare and return to baseline hopefully soon.

Seronegative autoimmune hepatitis in children: a single-center experience

Influence of genes, sex, age and environment on the onset of autoimmune hepatitis

Bystander activation and autoimmunity
 
Argentina -
Relevant information from the Ministry of Health of the Nation regarding suspected cases of severe acute hepatitis of unknown origin in the pediatric population

The health portfolio recalls the importance of completing vaccination schedules and keeping in mind the prevention and detection measures for this disease.
Posted on Thursday, May 05, 2022​

The health portfolio reports that eight suspected cases have been registered in our country that are under study and epidemiological investigation by the jurisdictions and have not yet been classified as serious hepatitis of unknown origin.

From the Ministry of Health it is highlighted that these are isolated cases and without any connection between them, at the same time that it is emphasized that it is not an outbreak but a situation that does not escape what is reported on a regular basis, since that every year there are cases with similar symptoms of severe acute hepatitis without diagnosis.

Likewise, given the epidemiological alert that occurred in other countries of the world and that was also issued in our country on April 27, 2022, it is recommended that the population control and complete the schedules of the National Vaccination Calendar for each age, perform frequent hand hygiene, avoid contact with sick people, cover your cough or sneeze, and avoid touching your eyes, nose, and mouth.

In the presence of symptoms compatible with those of hepatitis (fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, white stools, joint pain and jaundice) in children under 16 years of age, it is advisable to consult a doctor.

For their part, the health teams in charge of caring for the pediatric population are recommended to suspect acute hepatitis of unknown origin in those cases with symptoms compatible with hepatitis with negative tests for viral hepatitis (A, B, C, D and E). It is recommended to include the detection of adenovirus in the study of these patients.

On the other hand, and with the aim of strengthening the surveillance of this type of event and studying each case in depth, a working group was formed made up of different areas of the National Ministry of Health, such as the Epidemiology Directorate, the Perinatal and Childhood Health, the Directorate for the Control of Vaccine-preventable Diseases, the Viral Hepatitis Control Program, the Environmental Health Coordination and the National Reference Laboratory for Viral Hepatitis and Viral Gastroenteritis (INEI-ANLIS). They will also be joined by representatives of the Garrahan Hospital and scientific societies.

In addition to analyzing the epidemiological situation, the team will be in charge of generating a guide of recommendations for a comprehensive approach to severe hepatitis of unknown origin and establishing mechanisms for disseminating information. In turn, samples will be requested from each of the suspected cases to carry out complementary studies at the National Reference Laboratory for Viral Hepatitis.

Hepatitis means inflammation of the liver that can be of infectious, toxic or autoimmune cause. In most cases, hepatitis is caused by a virus. Viral hepatitis is most frequently caused by hepatitis A, B and C viruses. Testing for hepatitis B and C allows timely treatment to be started and transmission to be minimized. Hepatitis A and B are preventable through vaccines. Treatments for chronic hepatitis B and hepatitis C are safe and highly effective.




https://www.argentina.gob.ar/notici...-salud-de-la-nacion-ante-casos-sospechosos-de
 
Source: https://www.wkrn.com/news/local-news/mystery-hepatitis-found-in-tennessee-children/

Mystery hepatitis found in Tennessee children
by: Nikki McGee
Posted: May 9, 2022 / 06:14 PM CDT
Updated: May 9, 2022 / 06:14 PM CDT

NASHVILLE, Tenn. (WKRN) — Hepatitis is known for causing inflammation in the liver. Although it’s a well-established diagnosis, doctors at Vanderbilt are noticing a concerning uptick in children.

“What we’re seeing right now is what we’d classify as severe hepatitis, where the liver seems more inflamed. We would usually see maybe two or three cases of this per year. And in the last six months, at least at Vanderbilt, we’ve seen about eight cases,” said Dr. Saeed Mohammad, Director of Pediatric Solid Organ Transplant Center at Monroe Carell Jr. Children’s Hospital...
 
Source: https://globalnews.ca/news/8822995/who-acute-hepatitis-children-cases/

348 probable cases of acute hepatitis in children reported globally: WHO
By Eric Stober Global News
Posted May 10, 2022 12:09 pm
Updated May 10, 2022 5:56 pm

The World Health Organization (WHO) said Tuesday that there are now 348 probable cases of acute hepatitis among children across five regions globally.

The new cases are in addition to 70 others previously reported, according to Dr. Philippa Easterbrook, a senior scientist in the WHO’s hepatitis department.

The U.K. currently leads in cases with around 163, and only six countries are reporting more than five cases. The U.S. recently announced it was investigating 109 probable cases of “unknown origin” on Friday, and the WHO’s numbers reflect that addition.

The cases reported are a mixture of new cases and historic ones, Easterbrook said...
 
Source: https://arstechnica.com/science/202...worldwide-in-growing-child-hepatitis-mystery/

450 cases, 11 dead worldwide in growing child hepatitis mystery
WHO expects data this week to help tell if adenovirus is incidental or not.
5/11/2022, 1:30 PM



Beth Mole - 5/11he global tally of unexplained hepatitis cases in children has reached about 450, including 11 reported deaths, according to an update from the European Centre for Disease Prevention and Control.

The cases come from more than two dozen countries around the world, with about 14 countries reporting more than five cases. The countries with the largest case counts so far are the United Kingdom and the United States.

In the UK, officials have identified 163 cases in children under the age of 16, 11 of whom required liver transplants. Last week, the US Centers for Disease Control reported 109 cases under investigation in children under the age of 10 from 25 states. Of those cases, 14 percent required liver transplants, and five children died.

Fourteen countries in the European Union reported about 106 cases collectively, with Italy (35) and Spain (22) reporting the largest tallies of EU member countries. Outside the EU, officials have reported cases in Argentina (8), Brazil (16), Canada (7), Costa Rica (2), Indonesia (15), Israel (12), Japan (7), Panama (1), Palestine (1), Serbia (1), Singapore (1), and South Korea (1).

The 11 deaths were reported in Indonesia (5), Palestine (1), and the US (5).

The cause of the severe hepatitis—liver inflammation—remains a mystery, despite the growing tally. Some of the cases have been identified retrospectively, dating back to October 1, 2021.

Health officials worldwide have been on the lookout for child cases of acute hepatitis that can't be explained by common culprits, such as hepatitis viruses A, B, C, D, and E, which are known to injure the liver. Those with cases also have elevated levels of liver enzymes...
 
Child in Ireland dies with hepatitis in case believed to be linked to recent infection rise
...
about 6 hours ago
Jack Power

A child has died from a case of hepatitis in Ireland believed to be linked to an increase in unexplained cases of infections across several countries in recent weeks.

The Health Service Executive (HSE) confirmed while six probable cases of children with hepatitis of an unknown cause had been identified, one of the children had died from the infection. Another child had required a liver transplant.

The six children were aged between one and 12 years old and all were hospitalised, a HSE spokeswoman said.

The spike in unexplained child hepatitis cases, which causes an inflammation of the liver, was first identified in the UK and has since seen 450 suspected cases reported worldwide.
...
https://www.irishtimes.com/news/hea...-be-linked-to-recent-infection-rise-1.4876599
 
Increase in hepatitis (liver inflammation) cases in children under investigation


Regular UKHSA updates on the ongoing investigation into higher than usual rates of liver inflammation (hepatitis) in children across the UK.
From: UK Health Security Agency
Published 6 April 2022

Last updated 12 May 2022See all updates
ukhsa-master-logo-960x640-grey.jpg



Latest


The UK Health Security Agency (UKHSA), working with Public Health Scotland, Public Health Wales and the Public Health Agency, are continuing to investigate cases of sudden onset hepatitis in children aged 10 and under that have been identified since January 2022.

The usual viruses that cause infectious hepatitis (hepatitis A to E) have not been detected. The cases are predominantly in children under 5 years old who showed initial symptoms of gastroenteritis illness (diarrhoea and nausea) followed by the onset of jaundice.

Active case finding investigations have identified a further 13 confirmed cases since the last update on 6 May, bringing the total number of cases in the UK to 176, as of 10 May. Of the confirmed cases, 128 are resident in England, 26 are in Scotland, 13 are in Wales and 9 are in Northern Ireland. No children have died. As part of the investigation, a small number of children over the age of 10 are also being investigated.

UKHSA continues to investigate possible causes and will regularly publish technical updates. The investigation continues to suggest an association with adenovirus. Adenovirus is the most frequently detected virus in samples tested and a formal epidemiological study is continuing. Research studies of the immune system are also being undertaken to determine if changes in susceptibility or the effect of prior or concurrent infections could be contributing factors.

Normal hygiene measures, including thorough handwashing and making sure children wash their hands properly, help to reduce the spread of many common infections, including adenovirus.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said:
It’s important that parents know the likelihood of their child developing hepatitis is extremely low. We continue to remind everyone to be alert to the signs of hepatitis – particularly jaundice, look for a yellow tinge in the whites of the eyes – and contact your doctor if you are concerned.

Our investigations continue to suggest that there is an association with adenovirus and our studies are now testing this association rigorously.

We are working closely with the NHS and academic partners to actively investigate the role of other contributors, including prior SARS-CoV-2 and other infections.

...
https://www.gov.uk/government/news/i...-investigation
 
Severe acute hepatitis and acute liver failure of unknown origin in children: a questionnaire-based study within 34 paediatric liver centres in 22 European countries and Israel, April 2022
To detect potential concern about severe acute hepatitis in children, we conducted a survey among 50 ERN RARE-LIVER centres. By 26 April 2022, 34 centres, including 25 transplant centres, reported an estimated median of 3–5, 0–2 and 3–5 cases in 2021, 2020 and 2019 and a mean of 2 (range: 0–8) cases between January and April 2022 (mean in 10 large liver transplant centres: 3). Twelve centres reported suspicion of an increase, but no rise.

https://www.eurosurveillance.org/co...jY1bF4USsOEui1WXh_wg8YlAJDGEFss#html_fulltext
 
Case numbers of acute hepatitis of unknown aetiology among children in 24 countries up to 18 April 2022 compared to the previous 5 years
An increase of acute hepatitis of unknown aetiology has been reported among children in multiple countries worldwide. With a rapid online survey among hospitals in and outside of Europe, we describe case numbers recorded from 1 January to 18 April 2022 vs the previous 5 years. Of 24 countries that responded, we identified 5/17 European and 1/7 non-European countries with an elevation in probable cases of unexplained acute hepatitis, and severe cases were elevated in five European countries.


https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.19.2200370
 
Note from the editors: Acute hepatitis among children, establishing evidence and baselines for comparison


Two rapid communications in this issue report on attempts to gauge the extent of the recently reported increase in acute hepatitis cases among children in several countries in Europe and on other continents. They show that at the start of a possible outbreak with a yet unknown aetiology but features suggestive of an infectious cause, it is challenging to establish a sound evidence-base and to measure increase against a baseline of a syndrome or disease which is not under systematic surveillance and governed by standard case definitions. The short communications by van Beek et al. [1] and de Kleine et al. [2] both report results on quick surveys among different networks of clinical experts working with (paediatric) liver diseases and use different approaches to try and shed light on whether there is—or is not—a widespread increase. Both cover a similar period in 2022 and apply a similar case definition for acute hepatitis of unknown aetiology.

Van Beek et al. set out to establish the incidence for acute hepatitis of unknown aetiology in children over the previous 5 years (2017─21) as comparison baseline to assess the increase and included data from the United Kingdom (UK). They further investigate geographical distribution of cases up to 26 April 2022. This year, of 24 countries with experts responding, five of 17 identified an increase in probable cases of unexplained acute hepatitis in European countries and in one of seven non-European countries. An increase in severe cases was noted in five European countries.

De Kleine et al. establish estimates of paediatric acute liver failure (pALF) registered by specialised liver centres within the European Reference Network on Hepatological Diseases over 3 previous years (2019─21) that fulfil the definition of the Paediatric Acute Liver Failure Study Group [3]. The survey also captures the number of paediatric hepatitis cases and pALF at the centres in the first 3.8 months of 2022. The 34 participating centres in Europe and Israel, not including the UK, detected a mean of 2 (range: 0–8) up to 26 April 2022. Twelve reported a suspected increase but documented no rise in numbers, and 22 reported no suspicion of an increase. Of 64 children with severe hepatitis and/or pALF with further details available, a cause was identified in 11, while for 27 it remained indeterminate and for 26 unknown.

The results from these surveys show that the condition remains rare also in 2022. They do not provide a uniform picture but indicate that while in some countries or centres there are signals for an increase in cases, this is not evident in others. As examples of the former, Marsh et al. described the clear signal seen in Scotland and the initial investigation and clinical details of the first Scottish cases on 14 April [4] and the UK Health Security Agency published a technical briefing on 25 April [5].

Despite acknowledged limitations, the two Rapid communications in this issue provide some useful information in the form of ‘best available evidence’ at this moment in time. International collaboration is needed to support robust and timely epidemiological and clinical investigations to establish if there is an excess of cases of severe hepatitis of unknown origin that demands targeted studies to determine the aetiological agent. Over the coming weeks we hope to see more data and results from ongoing investigations that should help to fill the present gaps

.https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.19.220512m
 
Source: https://www.dailymail.co.uk/health/...titis-Ireland-global-death-toll-hits-six.html

Thirteen more children fall sick with mystery hepatitis bringing UK total to 176 as Ireland says one child has died from liver disease 'of unknown origin'

One child has died and another needed transplant after suffering liver disease
Ages not revealed but Ireland said all six of its cases been under age of twelve
Nearly 350 cases of 'severe hepatitis of unknown origin' in children globally

By Connor Boyd Deputy Health Editor For Mailonline
Published: 09:01 EDT, 12 May 2022 | Updated: 12:12 EDT, 12 May 2022

Thirteen more children in the UK have been struck down by a mystery hepatitis that has been spotted in more than 20 countries.

There have now been 176 cases of the deadly liver disease among children under the age of 10 in Britain, with the majority (128) in England.

The UK Health Security Agency (UKHSA) said it was also probing a 'small number' of suspected cases in children over 10.

It came as a child in Ireland has become the latest casualty of the outbreak, with a second child receiving a liver transplant.

The latest death is thought to bring the global fatality toll to nine, with five reported in the US and three in Indonesia. There have been none in Britain so far...
 
Source: https://www.euro.who.int/en/health-...-launch-the-first-joint-surveillance-bulletin


Hepatitis of unknown origin in children - WHO/Europe and ECDC launch the first joint surveillance bulletin

13-05-2022The first joint Hepatitis of Unknown Origin in Children weekly surveillance bulletin was released on 13 May 2022 by WHO/Europe and the European Centre for Disease Prevention and Control (ECDC).
This report provides an overview of cases of hepatitis of unknown origin in children aged 16 and below, reported to ECDC and WHO Regional Office for Europe for the period up to 12 May 2022, through The European Surveillance System (TESSy).
Figures and tables describe national case-based data for surveillance of hepatitis of unknown origin from countries and areas of the WHO European Region, including the 27 countries of the European Union (EU) and the additional three countries of the European Economic Area (EEA).

Since the first alert launched by the United Kingdom on 5 April 2022, cases of hepatitis of unknown aetiology in children have been reported from multiple countries worldwide.

The aetiology and pathogenetic mechanisms of disease are still under investigation. A possible association with current adenovirus infection has been identified, but other hypotheses and possible co-factors are under investigation.


The Joint Surveillance Bulletin can be found at this link Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin


Multi-Country – Acute, severe hepatitis of unknown origin in children 24-04-2022


Q&A on hepatitis in children 04-05-2022
 
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