A mysterious liver disease that has infected children in a number of countries around the world has reached Asia and Canada.
According to the World Health Otganization (WHO), as of April 23, at least 169 cases of acute hepatitis of unknown origin have been reported from 11 countries in the WHO European Region and one country in the WHO Region of the Americas.
Cases are aged 1 month to 16 years old. Seventeen children (approximately 10 percent) have required liver transplantation; and at least one death has been reported.The bulk of the cases, 114, have been identified in the United Kingdom.
As of Tuesday, April 26, one case has been reported in Japan in a child who had tested negative for adenovirus – a possible cause being investigated worldwide – and Covid-19, according to The Guardian.
The patient had not had a liver transplant, the health ministry said on Monday, without giving further details.
Canada’s Public Health Agency said on Tuesday it was investigating reports of severe acute hepatitis of unknown origin in young children. It did not reveal the number of cases or their location.
“The Public Health Agency of Canada is aware of reports of severe acute hepatitis of unknown origin in young children in Canada,” the department said in a statement on Tuesday, in response to questions from CBC News.
“These are being investigated further to determine if they are related to cases in the United Kingdom and the United States. As the investigation evolves, we will keep the public updated accordingly.”
On Tuesday, the European Centre for Disease Prevention and Control (ECDC) released an even higher estimate of nearly 200 cases in children around the world.
The Centers for Disease Control and Prevention (CDC) has identified more than a dozen cases across several states. The CDC has a health advisory out to notify US clinicians who may encounter pediatric patients with hepatitis of unknown etiology to consider adenovirus testing and to elicit reporting of such cases to state public health authorities and to the CDC.
An Adenovirus may be a possible cause
Hepatitis is usually caused by one of several contagious hepatitis viruses, but these have not been found in the affected children. Jaundice, diarrhoea and abdominal pain are among reported symptoms.
While adenovirus is currently one hypothesis as the underlying cause, it does not fully explain the severity of the clinical picture. Infection with adenovirus type 41, the implicated adenovirus type, has not previously been linked to such a clinical presentation.
Adenoviruses are common viruses that usually cause self-limiting infections. They spread from person-to-person and most commonly cause respiratory illness, but depending on the type, can also cause other illnesses such as gastroenteritis, conjunctivitis (pink eye), and cystitis (bladder infection).
There are actually over 50 types of adenoviruses that can affect humans, and adenovirus type 41usually presents as diarrhea, vomiting, and fever, often accompanied by respiratory symptoms. It is generally believed that adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children.
And that is why this whole global outbreak is so strange. There are several factors that need to be explored, including an increased susceptibility amongst young children following a lower level of circulation of adenovirus during the COVID-19 pandemic, as well as the potential emergence of a novel adenovirus.
The virus behind COVID-19, SARS-CoV-2, was also identified in 20 cases of those that were tested — while 18 of the young patients with hepatitis were infected with both viruses.
