WHO addresses severe acute hepatitis in children at the World Hepatitis Summit, 2022

 

 

• WHO highlights the seriousness of severe acute hepatitis in children at the World Hepatitis Summit 
• As of 6th June, 704 cases have been reported from 34 countries, at least 38 children (5%) required liver transplantation and 10 children (1%) have died 
• WHO states that a link to the COVID-19 vaccine is highly unlikely as the majority of cases (85%) were unvaccinated 

 

 

Yesterday the World Hepatitis Summit addressed the World Health Organization’s (WHO) global response on severe acute hepatitis of unknown etiology that has been seen in children. 

On 5 April, 2022, the UK highlighted 10 cases of severe acute hepatitis to WHO, and by 15 April, WHO published their first Disease Outbreak News. Dr Philippa Easterbrook, technical lead of incident team at WHO headquarters, in a presentation at the Summit, confirmed that much of the data is from UK and USA cases, including retrospective cases from October 2021, and that the common viruses that cause acute viral hepatitis (hepatitis viruses A, B, C, and E) have not been detected in any of these cases. 

Some cases of hepatitis of unknown etiology are reported every year, but "in terms of how worried we should be about this outbreak, it’s the first time so many cases of severe acute hepatitis have been seen,” said Dr Easterbrook. “A proportion of cases have developed liver failure, required transplantation or resulted in death. It has to be taken seriously. An important step at the moment is to understand its cause”. 

The latest data shows that 704 cases have been reported from 34 countries, with 112 additional cases pending classification. From this, at least 38 children (5%) required liver transplantation and 10 children (1%) have died. The majority of cases and reporting countries are in the European Region; the countries reporting over 5 cases are US (246), UK (222), Japan (36), Spain (34), Italy (29), Portugal (15), Belgium (14), the Netherlands (14), Israel (12), Canada (12), Mexico (10), Sweden (9), Ireland (8), Denmark (7). 

WHO confirmed that several avenues of investigation are ongoing into the etiology of these acute viral hepatitis cases. Dr Easterbrook confirmed common bacterial infections have not been detected and there is no clear link to a particular geographic area, or common exposure to specific foods, medications, toxins, animals or to travel. In addition, there is no link to the COVID-19 vaccine, as the majority of cases (85%) were unvaccinated. 

One possible cause that is under active investigation is a link to adenovirus, a common viral cause of respiratory or gastrointestinal infections in children, but which does not usually cause serious disease. Another is prior or current COVID infection. 

Additional laboratory studies were undertaken by UK Health Security Agency (UKHSA), in 179 tested, 116 (68%) confirmed adenovirus detection, and SARS-CoV-2 was detected in 25 of 169 tested (15%). Planned investigations into etiology are ongoing by UKHSA including more detailed viral sequencing studies to characterize the type of adenovirus, and studies of the immune response of the children. WHO confirmed their key responses will focus on detailed country and case reporting, and to provide more guidance on testing. 

The World Hepatitis Summit is organized by World Hepatitis Alliance and co-sponsored by World Health Organization (WHO). Its mission is to support countries in meeting the targets needed to eliminate viral hepatitis. The Summit continues until the 10th June.