The mystery hepatitis illness affecting children

Hepatitis.

I know about this subject. I covered the scandal in the early 90s of the infection of women with Hepatitis C from a contaminated blood product.

Thankfully there are good treatments now.

Since the early 90s, there have been more versions of hepatitis discovered and now we have six types: A, B, C, D, E and F.

Hepatitis is usually a food-borne sickness and often spread through poor hygiene, contaminated water and food that it not washed.

There are vaccines for Hepatitis A (for people who are traveling) and for Hepatitis B as part of the childhood immunization schedule.

Hepatitis C is a liver disease caused by a viral infection.

Why is it in the news now?

A hepatitis of unknown origin has been identified affecting children recently.

According to the European Center for Disease Control, on 5 April last, the UK reported an increase in acute hospital admissions of unknown cause among previously healthy children aged under 10 years from Scotland.

Not long after, more cases were reported in England, Wales and Northern Ireland, mostly aged between two and five years. Many cases were jaundiced and some of the cases reported gastrointestinal symptoms like abdominal pain, diarrhea and vomiting in the weeks previously.

The initial view of investigators was that the cause could be an infectious agent, or a toxic exposure.

No link to the Covid-19 vaccine was identified.

Laboratory tests excluded the known types of hepatitis.

At this point, there have been around 450 cases worldwide of this hepatitis of unknown origin.

Have there been cases in Ireland?

There have been around six probable cases so far identified in Ireland.

For reasons of patient confidentiality, details are limited.

The six children here were aged between one and 12 years.

All of the children were hospitalized.

Sadly, one child who was being treated has died.

A fatality is very rare on a European and international level.

There have been 11 deaths so far worldwide.

More than 170 cases have been identified in the UK but there have so far been no deaths there.

A second child in Ireland who was being treated underwent a liver transplant.

A small number of other cases are being examined here to see if they are also cases of hepatitis of unknown origin.

The Government has said it is concerned about the unexplained form of hepatitis and is monitoring the situation, as are other countries.

Ireland is liaising with the European Center for Disease Control, the UK and World Health Organization colleagues.

What is the cause?

The exact cause is as yet unknown.

None has been found and many of the children never had any Covid-19 vaccine.

Experts are examining whether there is a link with Covid-19 infection.

In Ireland and other countries, investigations are underway to determine if current or prior Covid-19 infection may increase the risk of this disease in some children.

On social media and elsewhere, some people who are anti-vaccination and others with different agendas have tried to claim, without any factual basis, that this hepatitis is linked to Covid-19 vaccines.

This is irresponsible and will cause upset and fear among parents.

None of the Irish cases who were tested on admission to hospital had evidence of Covid-19 infection at that time.

And the majority of those cases had not received Covid-19 vaccination.

One area that is being examined is whether the hepatitis is linked to an increase in infections caused by adenovirus – a common cause of childhood illness.

Adenovirus is a contagious disease with symptoms akin to the common cold.

According to the British Medical Journal (BMJ) there had always been a background level of low incidence of severe hepatitis in young children without a known cause but now the numbers have increased significantly.

These cases are referred to as non-AE hepatitis, because although the patients are known to have hepatitis, all the markers for the usual suspects – Hepatitis A, B, C, and E – are negative.

What are the symptoms?

For parents, the general signs are temperature, muscle pain, aches and pains.

But the difference with this hepatitis is if the child’s bowel movements are paler, gray colored or the urine is a darker color than usual. Or if the child looks a little yellow around the eyes and skin. These are usually signs that the liver is inflamed.

Parents should contact their GP or nearest emergency department if this is the case.

What next?

Dr Suzanne Cotter, Specialist in Public Health Medicine with the HSE’s Health Protection Surveillance Center, told RTÉ News this week that the hepatitis cases are “relatively rare” but the situation is of “serious concern”.

“Unfortunately, we did have one fatality associated with the disease in Ireland, but this is very rare both at a European level and internationally.”

She described the research into the matter as a “serious investigation”.

Dr Cotter said that it is possible that this investigation might “artificially inflate” the level of the problem.

“What is important to remember is that we don’t all know that all of these cases are associated with this investigation, because hepatitis – where you cannot identify the reason behind – does occur even in normal times, so during this time there’s a lot of active case follow-up and looking for cases, so some of these numbers may artificially inflate what we think is the problem.

“But, certainly in the UK, in Europe and in Ireland for a period of time we are seeing more cases than we would expect to see at this time.”

Dr Ciara Martin, the HSE’s National Clinical Lead for Children and Young People, said a lot of work is being done to find a cause and to be able to support those affected.

Dr Martin, a consultant in paediatric emergency medicine at Children’s Health Ireland, said it is a difficult situation because they are asking parents to look out for something while also trying to reassure them that doctors manage hepatitis on a regular basis.

In time, science will get to the bottom of what is causing this infection.

Speculation and misinformation, deliberate or otherwise, will not.

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