The origin of acute childhood hepatitis is still a mystery after 894 cases, dozens of transplants and 18 deaths

The World Health Organization (WHO) has already identified 894 suspected cases of acute childhood hepatitis of unknown origin in the world, of which 30% have required hospitalization, 5% transplantation.

So far, it has caused 18 deaths.

But its cause and origin remains a mystery.

It is not even clear that it is a new phenomenon or one that is receiving more attention and that this is causing more detections.

The WHO wants to reinforce the investigation and has asked member countries for more complete data on the cases they locate, Philippa Easterbrook, an expert in the agency's hepatitis program, announced Thursday at the International Liver Congress, which is being held this week. in London and to which EL PAÍS has attended invited by the organization.

Among the unknowns about this disease, one is whether there are really more global cases now than at other times.

The alert jumped in the United Kingdom, which with 262 cases has detected a higher number of diagnoses than expected.

But in the country with the most registered cases, the United States (290), a study has been published that concludes that a rebound has not been seen: there are as many acute hepatitis in children of unknown origin as in the past.

The same happens in Spain.

“We are seeing a variety of situations around the world, with two countries reporting the most cases [the United States and the United Kingdom], and many reporting only a few.

Some told us yes [they saw an increase] because they have good surveillance data showing this, but others told us no.

And there are many who simply do not have the ability to compare, ”explains Easterbrook, who asks to improve the quality of data collection.

“We need more detailed reports that allow us to know exposures [to pathogens] in the past, the history [of the patient] and how the disease progresses while he is hospitalized”, she has claimed.

More information

Acute childhood hepatitis: 10 doubts resolved by a medical specialist

María Buti, director of the Policies and Public Health program of the European Association for the Study of the Liver, recalls that severe acute hepatitis in children of unknown etiology is not new: “We have had cases of deaths and transplants.

Every year we see these types of patients.

What is new is the quantity, particularly in the UK.

In other European countries there are few, they are sporadic, and sometimes we have incomplete information.

It is true that there are almost 900 diagnoses worldwide, but only half have complete documentation”.

What specialists are also looking for is a common feature in all cases.

But for now, there isn't.

The vast majority are not connected to each other, they have not located a toxin that is present in the body of all the affected children, nor a virus or a genetic condition that affects all of them, although it is necessary to continue digging into these incomplete data.

And this is what the WHO now wants to solve to find the root of the problem.

relationship with covid

One of the lines of research is the presence of adenovirus.

It does not seem to be the only cause, since it was only present in 52% of infected children, but its influence, which may be behind the worsening of symptoms, is being studied.

Due to its coincidence in time, covid is another suspect: although only 10% of those infected had the disease (which was expected given the transmission rates), what scientists are investigating is whether it can manifest itself after having passed the infection.

One hypothesis about the cases with the worst prognosis is a coinfection with both pathogens.

But to know if it is the good one, again, more precise data than they have is necessary.

“It is difficult information to collect and interpret, given that we know that earlier this year there were very high rates of transmission of the coronavirus, both in the adult population and in children.

It has been speculated that it is a variant of the multisystem inflammatory syndrome that occurs rarely, which has been reported in some children one or two months after covid, but the cases that have been reported with hepatitis do not seem to fit these characteristics ”, abounds Easterbrook.

The covid vaccine, which at first was looked at especially by those opposed to injections, is ruled out as suspicious: the vast majority of cases have occurred in children under five years of age, who have not received the punctures because until a few days ago there was no approved vaccine for them (the US gave Pfizer and Moderna's drug for under-fives the go-ahead last week).

One of the obstacles in the investigation is that the cases are not related to each other.

It only happens with four of the almost 900: two connected by a daycare center and another two, between siblings.

There is, therefore, no way to trace them and find this common cause that researchers are looking for.

Since the previous WHO data update, at the end of May, 244 new cases have been detected, although many of them are not new, but have been diagnosed retrospectively.

“One of the good news is that we are not seeing an increase,” says Buti.

Whatever the cause, and regardless of whether we are really facing an increase in cases or a greater detection, the researchers hope that the international alert that the WHO launched at the beginning of May with acute hepatitis in children will serve to search for more cases, trace them and find possible origins and solutions.

“Now most of the doctors are attentive when they find symptoms and they know that we can be facing an acute hepatitis”, ditch Buti.

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