What is hepatitis?
The term hepatitis generally refers to inflammation of the liver. It is often caused by a virus, but can also be triggered by exposure to certain chemicals, alcohol, drugs and due to certain genetic diseases.
To date, the different hepatitis viruses are designated by letters ranging from A to E. Each virus has specific characteristics, but they all have one thing in common: their target, the liver. Viruses A, B and C are the most common hepatitis viruses in our regions.
According to the independent website infosante.be (established by the INAMI), 1.5 million new cases of hepatitis A are diagnosed each year in the world. In Belgium, this number is estimated at 1460 cases per year, mainly in children under 12 years of age. Since hepatitis B has been included in the basic vaccination program for children, the disease has become rare among us, especially among young people.
Why are we talking about these infantile hepatitises?
On April 5, the World Health Organization received notification of 10 cases of severe acute hepatitis of unknown origin in children under the age of 10 in central Scotland. The United Kingdom’s public health agency, the UK Health Security Agency (UKHSA) has launched an investigation. These children were previously healthy, with no comorbidities. Of these 10 cases, nine showed symptoms in March 2022; another, already in January 2022. Three days later, 74 cases had been recorded in the United Kingdom.
What is the difference with classic hepatitis?
In the case of these children, the most common viruses that cause acute viral hepatitis (A to E) were not detected in laboratory tests. Furthermore, international travel or links to other countries were not identified as explanatory factors. It is therefore probably another virus, unless another cause is found.
How many cases today?
At present, 190 cases have been reported in ten countries. One case has so far been reported in Belgium. Others have been reported in the UK (114), Spain (13), Denmark (6), Ireland (less than 5), the Netherlands (4), Italy (4), France (2), Norway (2) and Romania. Other cases have been reported outside Europe: in Israel and the United States, more specifically in Alabama.
How serious?
Affected children, aged one month to 16 years, had hepatitis of varying severity. In 17 cases, the clinical picture was severe and required kidney transplantation. A child has died.
What symptoms?
The symptoms are mainly jaundice (yellow skin and fundus of the eye), diarrhea, vomiting and abdominal pain. There may also be dark urine in children.
What explanations?
The cause of this inflammation of the liver is not known to date. Three avenues are currently being considered, with great caution.
1. An adenovirus?
In about three quarters of children with confirmed hepatitis who were tested, a specific human adenovirus called F41 was found. This virus generally causes acute gastroenteritis, especially in children. That’s the most likely lead at the moment.
Adenoviruses are a family of DNA viruses (and not RNA, like SARS-CoV-2). They usually do not cause hepatitis. So why would they be responsible for this unusual number of liver inflammations in children? One possibility among others is that it has mutated and become more virulent. Another would be that this F41 adenovirus makes a comeback after having almost disappeared during the Covid pandemic, due to the decrease in social contacts and protective measures. Young children would be exposed to it for the first time without being immune. This theory, however, has no current scientific basis, according to the ECDC, the European Center for Disease Control, and is easily exploited by opponents of restriction measures during the pandemic.
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