Unexplained hepatitis in children, fear of a new epidemic

First the United Kingdom, then Denmark, Ireland, the Netherlands, Spain, and now France. Since early April, about 100 cases of pediatric acute hepatitis have been identified in Europe, according to the European Center for Disease Control and Prevention (ECDC). Suspected cases are also being investigated in Alabama and North Carolina, USA. “Investigations are underway in all countries that have reported cases. At the moment, the exact cause of hepatitis is still unknown,” ECDC says.

Very young children are affected

In France, two possible cases were reported by the University Hospital of Lyon, before they were excluded, one proved to be of genetic or metabolic origin (tests are still ongoing), and the other is viral. If at present these severe infections of the liver did not result in any death, six children would have to undergo a trans-ductal liver transplant.

“Acute hepatitis in children is not uncommon. However, it affects very young children – between the ages of 1 and 5 years – and requires a liver transplant,” Dr. Alexandre Fabre, a pediatrician specializing in hepatology and gastroenterology at Timon Hospital in Marseille explains.

→ Re-reading. Hepatitis of unknown origin has been detected in children in several European countries

However, in his hospital there is no sign of this mysterious disease, the main symptoms of which are jaundice, stomach pain and vomiting. “It is rather positive, because we are also a transplant center, and we cover a very large population in Baka, including one million children,” The doctor confirms.

There are no clear links between cases

However, the unexplained outbreak of hepatitis is raising the fear of a new epidemic, while Covid has not gone away. “Currently, we don’t even know if the cases of the different affected countries are comparable, Prof. Emmanuel Jacomen, Head of the Department of Pediatric Hepatology and Liver Transplantation at Hospital Bistri in Paris.. In my opinion, there is no evidence that the epidemic has started. »

Only determining the exact cause of these people will make it possible to be sure. Currently, the only data available are those of a Scottish study of 13 patients between 1Verse January 12 and April 2022. It appears that the infection will not be of toxic origin (excessive intake of paracetamol for example), and that, at first glance, there will be no clear link between the different cases.

Several hypotheses are on the table

There are several hypotheses on the table: metabolic diseases of genetic origin, immune blood diseases, autoimmune hepatitis … But viral infection seems to be the most plausible cause in the eyes of Professor Jacquemin. “Maybe an adenovirus?” He suggests. However, this virus responsible for the common cold and gastroenteritis was not detected in analyzes of Scottish patients.

→ Read. Why vaccinate infants against hepatitis B?

“Our British colleagues think it may in fact be a new breed, Alexander Faber explains, Doubtful. If a common pathogen is involved, there will be clusters of infection, as evidenced by recent cases of E. coli. coli. But this does not appear to be the case. Unless this strain only runs on a certain genetic background, some people are more likely to contract it or have serious forms, as is the case with Covid. »

Moreover, the Scottish study does not rule out a serious type of Covid or contamination by a still unknown variant. Other possibilities: co-infection (Covid with another disease), a post-infectious reaction to a virus (similar to PIMS, pediatric multisystem inflammatory syndrome, caused by Covid) or even an immune debt ‘contracted by some children.

« C’est un concept flow qui n’a pas encore de preuve formelle, mais l’idée serait que, avec la modification de la circulation virale en raison du Covid et des mesures barrières, des infections qui auraient été bénignes deviennent plus sévères dans the time. Especially if they are young children whose immunity was built in the shadow of Covid. So the responsible person will be the moment of exposure to this or that virus, ” Physician formulates. He says one thing for sure: “The occurrence of these unusual cases cannot be the result of chance. There is something.”

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What are adenoviruses?

– Definition of : Discovered in the 1950s, adenoviruses are a group of DNA viruses that infect mucous membranes. This family includes dozens of very common viruses, not all of which cause symptoms. The majority of the population is infected before the age of five.

Diseases: The most common types of adenovirus infections are: inflammation of the eye (conjunctivitis), respiratory (pharyngitis, bronchitis and pneumonia) and gastrointestinal (gastroenteritis). The infection can be more serious or even fatal for people who are immunocompromised.

– Transmission: It occurs through respiratory droplets or the fecal-oral route, with the peak of the epidemic (winter and spring). Mostly it concerns communities (nurseries, schools, etc.). Prevention consists of hygiene measures (hand washing, etc.)

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