Worldwide cases of acute hepatitis in children have surged to 450 children in at least 20 countries since the outbreak was first brought to the attention of the World Health Organization (WHO) by the Scottish National Health Service in early April. Acute hepatitis is inflammation of the liver that can lead to impending liver failure, a life-threatening condition. At present, 12 children worldwide have died during the ongoing outbreak.
In their first report to WHO, NHS Scotland wrote that “five children aged three to five presented with severe hepatitis of unknown etiology at the Royal Hospital for Children in Glasgow within a three-week period. The typical number of hepatitis cases of unknown etiology in Scotland would be less than four per year.”
By April 8, the worldwide number of cases had risen to 74. All cases had tested negative for the usually suspected viruses. A number of children were documented to be infected with an adenovirus or COVID-19, although other factors were considered.
On April 15, the WHO issued the first of three disease outbreak warnings, asking health systems and public health officials to raise awareness and commitment to identifying, investigating and reporting cases of hepatitis. They said, “Given the increase in the number of reported cases over the past month and the improved search activity for cases, more cases are likely to be reported in the coming days.”
As of April 21, 169 cases had been reported in 12 countries, ranging in age from one month to 16 years old. The majority of these cases came from the UK, while the US had seen 11 cases by then. At that time, the WHO made it clear that the COVID-19 vaccines were not involved in the hepatitis outbreak, as a significant majority of affected children had not been vaccinated.
On Tuesday, the WHO announced that the number of probable cases of childhood hepatitis now stands at 348, spanning 20 countries in five global regions.
The recent spike in global pediatric hepatitis cases since late last month reflects the additions of the U.S. Centers for Disease Control and Prevention (CDC) in their ongoing investigation. There are currently 109 such cases in the US from a total of 25 states and territories.
dr. Jay Butler, the CDC’s deputy director for infectious diseases, noted that 90 percent of these children were hospitalized in October 2021, when nine such cases were identified in Alabama. He said 14 percent needed an emerging liver transplant and five of the children died tragically.
dr. Philippa Easterbrook, a senior scientist with the WHO’s global HIV, hepatitis and STI programs, said on Tuesday: “Currently, the leading hypotheses remain those involving adenovirus, but I think there is still important consideration about the role of COVID. , either as a co-infection or as a past infection. More testing has been done in the past week… confirming that about 70 percent of cases tested are still positive for adenovirus.”
On Wednesday, the European CDC published a Updating indicating that the total number of cases worldwide has reached 450. In the EU/European Economic Area, the total number of cases stands at 105, with Italy reporting the most cases with 35, followed by Spain with 22, then Sweden with 9. The United Kingdom currently has the most confirmed cases of all countries with 163 , and six countries have reported more than five cases.
On Thursday, Ireland reported the death of a child from acute liver failure, bringing the grand total to 12. Brazil is investigating eight more cases, bringing their total to 28. Overall, the death rate is between 2-3 percent and the rates of liver transplantation vary between 10-15 percent.
The etiology of the devastating cases remains to be elucidated. Easterbrook’s statement is opaque, and many scientists have noted that the presence of adenovirus in cases does not directly imply that this ubiquitous virus is the cause.
It seems more than a coincidence that the sudden emergence of a rare disease never before described in healthy children, just months after the massive wave of COVID-19 infections that swept across the United States during last winter’s Omicron BA.1 wave. spread all over the world has taken place. Seroprevalence studies indicate that as of last December, hundreds of millions of children worldwide may have been infected, increasing the likelihood of rare manifestations of COVID-19 infection occurring.
Notably, acute hepatitis has previously been associated with childhood multisystem inflammatory syndrome (MIS-C), which affects children after the acute phase of COVID-19 infection. In the US, the incidence of MIS-C is reported to be about one in 3,000-4,000 cases of COVID-19.
In a tweet that has now been shared more than 10,000 times, gastroenterologist Dr. Farid Jalali states that adenoviruses have only caused acute liver failure in patients with severe immunodeficiency and previously healthy children. The severity of the disease depends on the intensity and duration of immunosuppression in cases where patients are being treated for malignancy with chemotherapy or taking anti-rejection medications after organ transplantation.
dr. Jalali explained that adenovirus infections are very common in children and can be detected in up to 11 percent of healthy, asymptomatic children from throat samples. In addition, the virus can persist for months to years in about 30 percent of “immunocompetent” children.
He wrote, “Relying on adenovirus detection by PCR in children (often incidentally due to persistence and excretion) may mistakenly attribute adenovirus as the cause of disease for which the physician may have no other good explanation (e.g., acute liver failure in children in the context of Covid19 pandemic?).”
Because of his knowledgeable and well-researched statements and concerns, Dr. Jalali received numerous threats and slander by right-wing commentators.
Australian epidemiologist Dr. Raina MacIntyre weighed in on these issues with a rare but lengthy Twitter thread, noting, “It’s most likely a complication of COVID-19, but it may take a while for this much to be decided.”
dr. MacIntyre added: “Hepatitis is a known presentation of MIS-C and MIS-C is a late complication after the acute infection [of COVID]† So the fact that [SARS-CoV-2] PCR is negative, not surprising… SARS-CoV-2 is tropical to the liver and usually causes liver damage, so biological plausibility (one of the Bradford-Hill criteria for causation) is present.
Interestingly, many of these children had not undergone COVID-19 antibody testing, nor were the liver biopsies checked for the SARS-CoV-2 virus.
dr. MacIntyre asks emphatically, “And what about ideological reasons why there is a concerted effort to deny COVID as a cause and find another explanation? Any explanation? It’s been called ‘escalating commitment to a failing proposal’ and is a normal response to gathering evidence that an incumbent is wrong.”
The impact of COVID-19 on children has been repeatedly minimized by almost every world government. Last year, US President Joe Biden famously told a sophomore that she need not fear COVID-19, that schools are safe to return to and that she was unlikely to infect her parents. These have turned out to be bald lies and COVID-19 is arguably dangerous for children, with probably tens of thousands of children worldwide having died from the virus.
dr. MacIntyre concludes her thread with the comment: “In the UK the vaccination for children was refused the longest, then they offered it too late and reluctantly. When countries and experts have invested in this position, and there is mounting evidence that it is a wrong position, we see an escalating stakes for a failed proposal… Perhaps this is why we do not yet have a good epidemiological analysis of causation. have seen…yet. Yes, it could be caused by something else. But amid the pandemic, COVID is the most likely cause.”
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