Japan's health ministry has confirmed the first case of the infection
Cases of acute, severe hepatitis of unknown origin in children are on rise. "As of 21 April 2022, at least 169 cases of acute hepatitis of unknown origin have been reported from 11 countries," the World Health Organisation (WHO) said on April 27. Cases were found in the UK, Spain, Israel, USA, Denmark, Ireland, The Netherlands, Italy, Norway, France, Romania and Belgium.
On Tuesday, Japan's health ministry confirmed the first case of the infection.
"Japan’s Health Ministry found one probable case of the mysterious severe acute hepatitis affecting children in the U.S., the U.K. and 10 other countries, raising concerns that the disease is spreading outside of Europe and the U.S. The infection, likely the first case in Asia, was found in a young child. While an adenovirus was detected in more than 40% of cases globally, the patient in Japan tested negative, according to authorities. The child, whose age wasn’t disclosed, hasn’t had a liver transplant, it said," Bloomberg reported.
Of the total number of cases worldwide, 10% have required liver transplantation and one death has been reported, as per WHO records.
"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," the UK Health Security Agency (UKHSA) said on April 25.
On a possible link between COVID vaccine and the infection, the UKSHA has said, "There is no link to the coronavirus (COVID-19) vaccine. None of the currently confirmed cases in under 10 year olds in the UK is known to have been vaccinated."
Read: Why more children in the age of 5-11 are getting very sick with COVID in the US
Signs and symptoms
Liver inflammation with elevated liver enzymes like (aspartate transaminase (AST) or alanine aminotransaminase (ALT) greater the 500 IU/L) is observed during this infection.
Gastrointestinal symptoms like abdominal pain, diarrhoea and vomiting have also been observed in children.
Jaundice is also an indicator of the infection.
The common symptoms,as listed by the UKSHA, are:
- yellowing of the white part of the eyes or skin (jaundice)
- dark urine
- pale, grey-coloured faeces
- itchy skin
- muscle and joint pain
- a high temperature
- feeling and being sick
- feeling unusually tired all the time
- loss of appetite
- tummy pain
"Children experiencing symptoms of a gastrointestinal infection including vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped," Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said.
What causes it
Till now, adenoviruses are said to be the causative agent behind this infection.
So far, adenovirus has been detected in 74 cases and COVID causing coronavirus was found in 20 cases.
"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. International travel or links to other countries based on the currently available information have not been identified as factors," the WHO says.
In 19 cases, a co-infection of coronavirus and adenovirus was seen.
What is adenovirus?
Adenoviruses are common viruses that typically cause mild cold- or flu-like illness. As per a study, adenoviruses cause acute respiratory disease (usually), pneumonia (occasionally), acute follicular conjunctivitis, epidemic keratoconjunctivitis, cystitis, and gastroenteritis (occasionally). In infants, pharyngitis and pharyngeal-conjunctival fever are common.
Adenoviruses are transmitted to human beings through respiratory droplets.
The common signs of adenovirus infection are fever, upper respiratory tract infections, and conjunctivitis.
Enteric adenovirus types 40 and 41 cause gastroenteritis, usually in children, the US CDC says.
What is adenovirus-coronavirus co-infection?
A co-infection of COVID and adenovirus is possible.
In June 2020, a research report on the first case of an infant coinfected with COVID-19 and adenovirus was published in the BMJ.
The study found that the infant, a 4 month old boy, had symptoms consistent with adenovirus infection, but the child’s home exposure prompted the team to test for COVID-19. "If this child did not have in-home exposures, the child may have not undergone COVID-19 testing because of the positive adenovirus infection," the study found. The child had a history of muscular ventricular septal defect and atopic dermatitis presented with decreased oral intake, loose stools, stuffy nose, mild
cough and diaphoresis.
On the recent cases of hepatitis, the WHO has said, "laboratory testing has excluded hepatitis type A, B, C, and E viruses (and D where applicable) in these cases while Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and/or adenovirus have been detected in several cases."
What should parents do?
In order to keep the children safe from contracting the adenovirus infection, parents should take note of few essential things:
- Wash the hands of the child often with soap
- Do not allow the child to touch the eyes, nose and mouth with unwashed hands
- Do not allow the child near people who are sick
- Do not allow the child outdoors while sick
- Teach them how to sneeze and cough properly; by using elbows or into tissue papers
- Do not allow them to share foods and utensils with others
"Parents and guardians should be alert to the signs of hepatitis (including jaundice) and to contact a healthcare professional if they are concerned. Normal hygiene measures such as thorough handwashing (including supervising children) and good thorough respiratory hygiene, help to reduce the spread of many common infections, including adenovirus," Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said.
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