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A review on acute, severe hepatitis of unknown origin in children: A call for concern
Olivier Uwishema1,2,3, Ashraf Mahmoud1,4, Jack Wellington1,5
1Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.
Insights
Severe acute hepatitis outbreaks in children, affecting over 650 cases globally, are under investigation. Common symptoms include high transaminases and jaundice, with adenovirus suspected but no definitive cause found.
Area of Science:
- Hepatology
- Pediatric Infectious Diseases
- Public Health Surveillance
Background:
- Hepatitis, defined as liver inflammation, can be acute or chronic.
- An unexplained severe acute hepatitis outbreak in children has been reported globally by the World Health Organisation (WHO).
- Over 650 probable cases have been identified, with symptoms including elevated transaminases, vomiting, pale stools, and jaundice.
Purpose of the Study:
- To summarize the current understanding of the global outbreak of severe acute hepatitis of unknown origin in children.
- To highlight the clinical presentation and etiological investigations.
- To emphasize public health recommendations for case identification and management.
Main Methods:
- Review of World Health Organisation (WHO) reports and available literature on the hepatitis outbreak.
- Analysis of reported clinical presentations and etiological findings.
- Synthesis of current hypotheses regarding the outbreak's cause.
Main Results:
- The outbreak affects children worldwide, with common symptoms like jaundice and elevated liver enzymes.
- Hepatitis viruses A-E have not been detected in identified cases.
- Human enteric adenovirus type 41F has been reported in some cases, with occasional SARS-CoV-2 co-infection.
Conclusions:
- The etiology of the current severe acute hepatitis outbreak in children remains unknown, with no consensus on the cause.
- Adenovirus is a potential factor, but further research is needed.
- Adherence to hygiene, infection control, prompt reporting, and surveillance are crucial public health measures.
Abstract:
Hepatitis is defined as the inflammatory reaction of the liver parenchyma. It is either acute, which resolves within six months or may be chronic. An outbreak of severe, acute hepatitis of unknown origin in children was reported in nearly all World Health Organisation (WHO) regions except in the Africa. As per the recent update on the 26th of May, approximately 650 cases have met the WHO's probable criteria. While some are yet to be confirmed, the WHO warns that the figure may be underestimating the real situation. The observed clinical presentation includes outstanding immoderate levels of transaminases, vomiting from the previous presentation, pale/mild stools, and jaundice. So far, the viruses which can cause viral hepatitides, like Hepatitis A, B, C, D, and E, have not been detected in any of the identified cases. Some literature reported human enteric adenovirus type 41F in the majority of cases aged sixteen or younger, with few cases of co-infection with SARS-CoV-2. Currently, only several hypotheses have discussed the causality of the outbreak. However, no consensus has been reached. During this outbreak, it is important to adhere to both hand and body hygiene, general infection and control prevention strategies, and lastly, case presentation matching the criteria of case definition set by the WHO. Said identified cases should be reported to concerned health authorities on an urgent basis and must be kept under proper surveillance.
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