Following USA – WHO Reports on Wave of Acute Childhood Hepatitis in the UK and Ireland
There have been isolated case reports of SARS-CoV2-induced hepatitis in adults. Displayed here is a liver sample from a 34-year old SARS-CoV2 infected man displaying mild hepatitis inflammation, from a report published in May, 2021.

The World Health Organization has reported that it is investigating some 74 cases of acute childhood hepatitis, of an unknown origin, in the United Kingdom along with five suspected and confirmed cases in the Republic of Ireland.

That follows on previous reports of similar, severe hepatitis cases of an unknown origin among a cluster of nine children in the United States, as well as three children in Spain.

Oddly enough, WHO’s first “Disease Outbreak News (DON)” announcement of the mysterious hepatitis outbreak, which is puzzling scientists and healthcare providers, did not make any mention of the US cases already under investigation by the US Centers for Disease Control.

Altogether, some 91 children in the USA and Europe have now been reported to be confirmed or suspected ill, with the mysterious, and potentially deadly disease, since January.

That includes nine children in Alabama, 3 in Spain, and at least 74 in England, Scotland and Northern Ireland, according to a report from the University of Minnesota’s, Center for Infectious Disease Research and Policy (CIDRAP). Another five cases, confirmed or possible, have been reported in the Republic of Ireland, WHO also said on Friday.

The acute infections appear to be mostly associated with circulating adenoviruses – the viruses responsible for the common cold – rather than known hepatitis virus strains, US investigators have said.  But SARS-CoV2 has also been detected in several cases, WHO noted in its DON.

“Laboratory testing has excluded hepatitis type A, B, C, and E viruses (and D where applicable) in these cases,” the WHO said.  It added, however, that “Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and/or adenovirus have been detected in several cases,” the WHO said.

“The United Kingdom has recently observed an increase in adenovirus activity, which is co-circulating with SARS-CoV-2, though the role of these viruses in the pathogenesis (mechanism by which disease develops) is not yet clear,” WHO added.

“Following the notification from the UK, less than five cases (confirmed or possible) have been reported in Ireland, further investigations into these are ongoing. Additionally, three confirmed cases of acute hepatitis of unknown aetiology have been reported in children (age range 22-month-old to 13-year-old) in Spain. The national authorities are currently investigating these cases,” WHO added. It made no mention, however, of the outbreak in the USA.

According to the WHO report, children present to healthcare providers with markedly elevated liver enzymes, often with jaundice, and they sometimes have gastrointestinal symptoms, including vomiting. At least 6 of the 74 UK patients required liver transplants.  So far no deaths have been reported.

The US CDC has said that it is working with Alabama on its investigation into the cases, as well as with other state health departments to see if there are cases elsewhere.

In a separate statement, The Alabama Department of Public Health, said that it had been investigating the increase in hepatitis cases in young children since November 2021.

“These children presented to providers in different areas of Alabama with symptoms of a gastrointestinal illness and varying degrees of liver injury including liver failure. Later analyses have revealed a possible association of this hepatitis with Adenovirus 41.

“To date, nine children less than 10 years old have been identified as positive for adenovirus and two have required liver transplants. The affected children were from throughout the state of Alabama, and an epidemiological linkage among them has not been determined. None of these children has had any underlying health conditions of note.”

There have been isolated case reports of acute hepatitis developing in SARS-CoV2 in young, and previously healthy adult patients. Some degree of liver injury has also been described among people hospitalized for severe COVID-19.

See the full WHO Disease Outbreak News report here.

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