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Liver disease in children in Canada: the facts so far

Since early April, health officials around the world have been on high alert for healthy young children suddenly developing serious cases of hepatitis with no known cause.

According to the latest estimates from the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), there are at least 194 probable and confirmed cases reported worldwide, excluding an unknown number of potential cases in Canada.

Here’s what we know so far about these cases.

WHAT IS HEPATITIS?

Hepatitis is an inflammation of the liver. The organ can be damaged or inflamed as a result of a virus, heavy drinking of alcohol, toxins, certain medications, or another health condition. The liver performs many essential functions and acts as a filter for blood leaving the stomach and intestines. It regulates chemical levels in the blood, creates nutrients, flushes out waste, helps fight infections and more.

Acute hepatitis occurs when liver function is impaired for less than six months. Chronic hepatitis is when the inflammation lasts longer. Some cases of hepatitis can be serious or even fatal if left untreated. Other cases may be mild and do not require treatment.

What makes these cases of acute hepatitis unusual is that doctors have not determined its cause.

WHAT ARE THE SYMPTOMS?

Medical authorities said a number of cases started with gastrointestinal symptoms such as stomach pain, diarrhea and vomiting. The children then showed signs of jaundice, where the skin and the white around the eyes turn yellow. Jaundice is an indication that something is wrong with the liver, and medical advice should be sought immediately.

Other common symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, dark urine, pale stools, and joint pain.

Dr Deirdre Kelly, professor of pediatric hepatology at the University of Birmingham, told CTV News on Tuesday that the majority of children recovered spontaneously.

“While it is a serious condition if their child develops it, there is a good chance they will recover on their own,” she said.

HOW MANY CASES IN THE WORLD AND HOW SEVERE?

According to figures compiled by the ECDC in an April 28 report and by the WHO on April 23, there are so far at least 194 cases of hepatitis without a known cause in countries including the UK, Spain, Israel, the United States, Denmark, Ireland. , the Netherlands, Italy, Norway and France.

As of April 21, 114 cases were from the UK, according to the WHO. As of April 27, there were “approximately 55 probable and confirmed cases” in a dozen countries in the European Union and the European Economic Area, 12 cases in the United States and 12 others outside of Israel,” he said. said the ECDC.Japan has reported one case.

“Severe hepatitis for which there is no cause, we rarely see more than about 20, 25 max throughout the year. And we saw 114 in the first three to four months of this year,” Kelly said.

“These are perfectly normal children. They have no comorbidities or other infections and they develop severe hepatitis, 10% of which required liver transplantation.

The 10% figure is based on an earlier WHO case tally on April 23 which found that 17 children needed liver transplants. A child in Britain is said to have died.

Hepatitis cases are in children aged one month to 16 years, health agencies said, with the majority occurring in young children between the ages of two and five.

Scotland’s public health agency was the first to sound the alarm over the unusual cases of hepatitis in early April, after one child fell ill in January and nine more in March. All were seriously ill and had to be taken to hospital where they were diagnosed with hepatitis.

The majority of similar US cases were found in nine previously healthy children ages one to six from Alabama. Two of the children would have needed a liver transplant. Five children with significant liver damage of unknown origin, some with acute liver failure, were admitted to a children’s hospital in Alabama as early as October 2021.

Two other serious cases have also been reported in North Carolina and three in Illinois, with local media reporting that one resulted in a liver transplant and two others were placed on a transplant list.

ARE THERE CASES IN CANADA?

Although there are no confirmed cases in Canada, the Public Health Agency of Canada (PHAC) previously told CTV News that it was “aware of reports of severe acute hepatitis of unknown origin. in young children in Canada”.

“[PHAC] is working with its international partners as well as its provincial and territorial partners to gather information on this evolving situation,” the agency told CTV News in an emailed statement Friday.

“Potential cases in Canada are being further investigated to determine if they are linked to cases in the UK and the US.”

WHAT ARE SOME THEORIES STUDIED?

Health authorities are investigating a number of possible causes for these cases of hepatitis. So far, the WHO has ruled out viruses that cause hepatitis A, B, C, D and E, based on laboratory tests.

Although exposure to toxins is another consideration, experts believe this is less likely due to documented cases in different countries. Health authorities also found no link to international travel among the cases.

Currently, investigations suggest a link to an adenovirus, according to WHO and ECDC. Adenoviruses are a large family of viruses that can spread from person to person, causing a variety of illnesses, including the common cold, conjunctivitis, and gastroenteritis. Officials say there has been a recent increase in adenovirus infections, particularly in the UK

Nearly half of hepatitis cases, including those in Alabama, have been linked to an adenovirus, with lab tests indicating some children were infected with type 41, which is associated with gastroenteritis, causing diarrhea and vomiting. At least 19 cases also involved co-infection with SARS-CoV-2.

“While adenovirus is currently hypothesized as the underlying cause, it does not fully explain the severity of the clinical picture,” the WHO said in its April 23 report. The health agency noted that this particular virus has never been linked to hepatitis, adding that it is a common pathogen that usually causes self-limited infections.

COVID-19 is also being considered, although a number of cases do not involve a previously known infection.

“We don’t really know the causes yet and COVID may be involved in some cases,” Dr Simon Taylor-Robinson, a professor and liver researcher at Imperial College London, previously told CTV’s Your Morning.

“In fact, we know COVID can cause inflammation in any part of the body, not just the lungs.”

Another theory being considered is that children’s immune systems, weakened during pandemic lockdowns and distancing, may be more vulnerable to other illnesses.

It’s also possible that two viruses working “in concert” with each other could also be causing the hepatitis cases, according to some health experts. The researchers are also exploring the possibility that the adenovirus could have mutated.

COULD COVID-19 VACCINES BE THE CAUSE?

Despite misinformation circulating on social media suggesting a link between hepatitis cases and COVID-19 vaccinations, health authorities have definitively ruled out COVID-19 vaccinations as a potential cause because they say the vast majority of cases involve children too young to be eligible for vaccinations.

“None of the currently confirmed cases in the UK have been vaccinated,” a representative of the UK Health Security Agency told Reuters. “There is no connection to the COVID-19 vaccine.”

WHAT CAN PARENTS DO?

Adenoviruses are spread through close personal contact such as touching, through the air by coughing and sneezing, or by touching contaminated objects and surfaces, then touching areas of the face before washing hands. In some cases, it can also be spread through the stool of an infected person, according to the US Centers for Disease Control and Prevention (CDC).

Daily measures, such as hand washing and good general hygiene measures, as well as those adopted during the pandemic should help, experts say, adding that the sudden development of a severe case of hepatitis without a known cause is still rare despite current worldwide cases.

“They should (be) reassured that this is relatively unusual in normal children, and good hand hygiene as we have all become accustomed to in the COVID pandemic, and good general hygiene at home should be sufficient,” according to Kelly.


With files from CTV National News reporter Vanessa Lee, Reuters and The Associated Press