Ten cases of pediatric hepatitis not known to be caused by the hepatitis virus have been reported to the Public Health Agency of Canada (PHAC). Two of these cases have required liver transplants, however, PHAC says it is still too early to determine if this is an increase in the number of cases reported at this time each year.
The ten cases were reported in children aged one to 13 years old, according to a statement provided to Healthing. The children reportedly became sick between Nov. 3, 2021 and April 23, 2022 and were all hospitalized. Four of the cases occurred in Ontario, three in Alberta, two in Manitoba and one in Quebec.
The agency says they are continuing to work with territorial and provincial health bodies to determine if these cases are part of the global outbreak and are asking parents and pediatricians to remain vigilant.
“Parents and caregivers should be aware of the symptoms of hepatitis and should contact their child’s health care provider with any concerns they may have,” reads the statement. “Symptoms of acute severe hepatitis include jaundice (yellowing of the skin and eyes), abdominal pain, nausea, vomiting, dark urine, light-coloured stools, loss of appetite, fever and fatigue. Even in cases where the cause of acute severe hepatitis is not known, treatment is available, and most children recover with medical care.”
The WHO originally shared news of an outbreak regarding severe liver disease of “unknown aetiology in the U.K. on April 15. As of May 19, the WHO is reporting 614 probable cases and 14 deaths worldwide. The U.K. continues to report the majority of cases (197), followed by the United States reporting 180.
Before the announcement by the WHO, on April 14, PHAC alerted provincial and territorial public health agencies to monitor for cases of severe acute hepatitis of unknown origin in young children. The group says they will continue to monitor the situation and provide updates as they come available.
SickKids Hospital closely monitoring for cases of hepatitis
Previously, seven probable cases of hepatitis in young children were reported by SickKids Hospital in Toronto.
A statement from SickKids hospital on May 12 says physicians are remaining vigilant and watching for symptoms of hepatitis that would require further testing. The group is also “recommending a lower threshold for referral for specialist care.” However, they also reaffirmed it is too early to tell if these cases are part of the global uptick in hepatitis cases.
“Every year, SickKids sees patients with severe acute hepatitis of unknown origin who, like the rest of our patient population, may come from across Ontario and Canada,” reads the statement. “It remains to be seen whether this number represents an increase in cases of unknown origin compared to similar time periods in previous years or if any of these cases will be confirmed to be caused by a novel clinical entity.”
Hepatitis outbreak in children may be linked to adenovirus
An investigation by the U.K. Health Security Agency (UKHSA), Public Health Scotland, Public Health Wales and the Public Health Agency, found cases are mostly occurring in young children under the age of five.
In the U.K., investigators believe that this onslaught of cases is related to adenovirus, common viruses that can cause fevers, sore throats, pneumonia, diarrhea, and pink eye.
“Our investigations continue to suggest that there is an association with adenovirus and our studies are now testing this association rigorously,” Dr. Meera Chand, director of clinical and emerging infections at the U.K. Health Security Agency (UKHSA) said in a news release. “We are also investigating other contributors, including prior SARS-CoV-2.”
In the U.K., 68 per cent of the hepatitis cases tested positive for adenovirus (170 cases tested, 116 cases confirmed positive for adenovirus.)
Investigators say adenovirus strain 41 could be the culprit. This strain is known to cause gastroenteritis and is a “a prominent cause of diarrhea and diarrhea-associated mortality in young children worldwide,” according to Science Advances.
Hepatitis refers to inflammation of the liver, reports Johns Hopkins University, and is usually caused by one of the hepatitis viruses (hepatitis A-E), genetics, exposure to drugs, alcohol or other chemicals, or an autoimmune disorder.
Unclear how adenovirus is linked to hepatitis in children
How adenovirus is linked to these cases of hepatitis condition is unclear.
“None of [the tissue and liver samples] show any of the typical features you might expect with a liver inflammation due to adenovirus,” Philippa Easterbrook, Senior Scientist in the Global Hepatitis Programme with the WHO told reporters at a news briefing. “We are awaiting further examinations of biopsies.”
Researchers say the link could be due to a number of possibilities. Because children haven’t been exposed to many different viruses and germs through the pandemic, suddenly being exposed to adenovirus may lead to a more intense immune response than would otherwise occur. Another possibility is the evolution of a new adenovirus that may cause the liver to become inflamed.
Scientists are also searching to understand if a previous COVID-19 infection followed by infection with adenovirus could lead to liver inflammation. The WHO confirms there will be a focus on examining tissue and blood samples for evidence of previously having the virus.
Children under five years of age are not yet eligible for the COVID vaccine in the U.K. and the majority of children tested in the U.K. were not yet vaccinated, leading the groups to say there is no evidence of a link to the COVID vaccine.
This article is an update on a previous story published 2022-05-11.
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