Acute Hepatitis in Children

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More than 20 countries have detected alarming increases in cases of severe hepatitis, or inflammation of the liver, in previously healthy children. The number of cases world-wide is currently at 230. Most of the cases are found in Europe, especially in the United Kingdom, but the disease has also been reported in 10 states of the US, Israel and Indonesia. Children aged 1 month to 16 years have been affected. A small number of children have died and some needed liver transplants. The disease seems to have started spreading towards the end of last year.

Hepatitis is normally caused by viruses or toxins present in food, but the absence of common hepatitis viruses or food-related causes in these cases is puzzling. A current hypothesis is that the disease is linked to adenovirus 41, that was detected in 74 cases. Adenoviruses, which are normally trivial and cause respiratory problems, conjunctivitis or digestive disorders are easily transmitted in nurseries and schools and prevalent in times of cooler weather. It could be that this virus has mutated to cause more severe illness. A link with COVID-19 is also being investigated, but there seems to be low evidence to support this, with only 16% of cases having tested positive in the UK. It is at present equally unclear if the disease occurs in clusters with most infections being asymptomatic, or if these are isolated cases that happen to be globally distributed.

At this moment, the risk for a child to contract acute hepatitis is very low, but parents should be vigilant. Especially in those under 6 years of age. Symptoms of the disease are a yellowing of the skin that is more easily noticed in the whites of the eyes. Dark (brownish) urine is another easily noticeable symptom and itchy skin is frequently accompanied by it. Later symptoms are fever, feeling sick, loss of appetite and stomach pains. If discoloration of the skin or frequent dark urine is noticed in a child, parents should immediately seek medical attention.

Adenoviruses are spread by fecal-oral route and good hygiene can limit their spread. Making sure children wash their hands thoroughly can help to reduce lots of common infections. As a precaution, any children who have diarrhea or who are vomiting should stay at home and not return to school or a nursery until 48 hours after the symptoms have passed.

Adenovirus particles electron micrograph

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