The World Health Organization reports a Multi-Country Hepatitis Outbreak in Children

WebMD reports that at least 169 severe hepatitis cases have been identified in children in an outbreak that involves 12 countries, the World Health Organization (WHO) announced on Saturday. Among the cases, at least one child has died and 17 have required liver transplants. The children have been between 1 month and 16 years old. Among the 169 infections, 114 have occurred in the U.K., followed by 13 in Spain, 12 in Israel, and nine in the U.S. The outbreak has also spread to Belgium, Denmark, France, Ireland, Italy, the Netherlands, Norway, and Romania.

“It is not yet clear if there has been an increase in hepatitis cases or an increase in awareness of hepatitis cases that occur at the expected rate but go undetected,” the WHO said in a statement. Health authorities across the world are investigating the increase in severe cases of acute hepatitis, or inflammation of the liver. Although mild pediatric hepatitis can occur, severe hepatitis in healthy children is rare, according to The Guardian.

Many cases have included gastrointestinal symptoms, including belly pain, diarrhea, and vomiting, before showing signs of severe acute hepatitis, increased liver enzymes, and jaundice. Most cases didn’t have a fever, the WHO said. The common viruses that cause acute viral hepatitis – hepatitis viruses A, B, C, D and E – haven’t been detected in any of the cases. International travel and other country-based links also haven’t been identified.

A common cold virus, known as an adenovirus, has been detected in at least 74 cases, the WHO said. COVID-19 infection was identified in 20 cases, and infection with both COVID-19 and an adenovirus was detected in 19 cases. “While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent,” the WHO said. Health authorities have ruled out the chance that COVID-19 vaccines were involved in the cases, according to STAT News. Most of the children weren’t vaccinated.

The WHO said it is closely monitoring the cases and working with health authorities in the U.K. as well as other member states. The U.K., for instance, saw a significant increase in adenovirus infections in the community after low levels of circulation earlier in the COVID-19 pandemic, particularly in fecal samples in children. The Netherlands has also reported an increase in community adenovirus circulation.

Last week, the CDC sent out a nationwide alert, encouraging doctors to look for symptoms of pediatric hepatitis that could be linked to the cold virus. The CDC recommended that doctors consider adenovirus testing in children with hepatitis when the cause is unknown. The first U.S. cases were identified in October 2021 at a children’s hospital in Alabama, which admitted five children with significant liver injury, including some with acute liver failure. The viruses for hepatitis A, B, and C were ruled out, and the children tested positive for adenovirus.

The CDC is working with the Alabama Department of Public Health to investigate the cluster, which now includes nine children ages 1-6. All the children were previously healthy, and none were at the hospital due to a COVID-19 infection. “At this time, we believe adenovirus may be the cause for these reported cases, but investigators are still learning more,” the CDC said.

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