Over 1000 Cases of Severe Acute Hepatitis Cases in Children Recorded 
Distribution of probable cases of severe acute hepatitis of unknown aetiology in children by country, as of 8 July 2022 (n=1010), 5 PM CEST

Over 1000 probable cases of severe acute hepatitis of unknown cause in children have been reported across 35 countries in five World Health Organization (WHO) regions as of 8 July 2022, including 22 deaths.

Since the previous WHO Disease Outbreak News, published on 24 June 2022, 90 new probable cases and four additional deaths have been reported, bringing the new total of probable cases to 1010. The Disease Outbreak News provides updates on the epidemiology of the outbreak, as well as updates on the response to the event

Two new countries, Costa Rica and Luxemburg, have also been added to the list of countries with probable cases. 

Hepatitis is an inflammation of the liver, and acute hepatitis is a sudden onset of hepatitis. While the disease usually passes on without the need for special treatment, according to WHO, in rare cases, it can result in severe liver failure or even death.

Of the probable cases, 46 (5%) of children have required transplants. 

Between 5 April (when the outbreak was initially detected) and 8 July 2022, almost half of the probable cases have been reported from the WHO’s European Region (21 countries reporting 484 cases), including 272 cases from the United Kingdom. 

The second highest number of cases have been reported from the WHO Americas region (435 cases), including 334 (33%) of global cases from the US. This is followed by the Western Pacific region (70 cases), the Southeast Asia region (19 cases), and the Eastern Mediterranean region (2 cases).

Age and gender distribution of reported probable cases of severe acute hepatitis of unknown aetiology with available data, as of 8 July 2022 (n=479) 5 PM CEST

The majority of cases (76%, 364 cases) involve children under six years old. 

However, the Disease Outbreak News does note that “the actual number of cases may be underestimated, in part due to the limited enhanced surveillance systems in place.”

“The case count is expected to change as more information and verified data become available,” it reads. 

The WHO has assessed the global risk level to be moderate, which has been the case since May 2022

Adenovirus and SARS-COV-2 detected in some hepatitis cases 

Distribution of probable cases of severe acute hepatitis of unknown aetiology in children by WHO Region since 1 October 2021, as of 8 July 2022

Pathogens such as adenovirus and SARS-COV-2 have been detected by PCR testing in a number of cases, with the adenovirus the most frequently detected pathogen among cases with available data. 

In the European region, adenovirus was detected by PCR in 52% of cases (193/368). In Japan, adenovirus was detected in 9% of cases (5/58) with known results.

SARS-COV-2 has also been detected in 16% (54/335) cases in the European region, and 8% of cases in the US (15/197). In Japan, 8% (5/59) of cases also had SARS-COV-2.

Most cases did not appear to be epidemiologically linked, although there have been epidemiologically linked cases reported in Scotland and the Netherlands.  

Launch of global online survey 

The WHO has also launched a global online survey with an aim to estimate the incidence of severe acute hepatitis of unknown aetiology in 2022 compared to the previous five years, in order to understand where cases and liver transplants are occurring at higher-than-expected rates. 

Until more is known about the aetiology of these cases, WHO advises implementation of general infection prevention and control practices, including frequent hand washing, avoiding crowded spaces and ensuring good ventilation when indoors. 

“Efforts to communicate with empathy in a timely and transparent way, acknowledging what is known and unknown and what is being done to investigate will help to reassure parents and caregivers, maintaining trust in health authorities and interventions,” according to the WHO.

Image Credits: F1000research.com, WHO.

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