Research uncovers likely cause of mysterious childhood hepatitis outbreak

Researchers believe they have uncovered the likely cause of mysterious liver problems affecting young children around the world, the BBC reported.

In two independent research papers, scientists concluded that two common viruses spread rapidly after the end of the Covid-19 lockdown, which then led to the rare and damaging cases of hepatitis.

In the UK, most of the 268 children affected by sudden onset hepatitis were under the age of five, with almost 40 per cent of children being admitted to hospital and requiring intensive care.

Ireland has had 20 probable cases detected since March, according to the Health Protection Surveillance Center (HPSC). One child has died and two have required liver transplants.

In total, at least 1,000 cases have been reported worldwide.

Two new studies, led by the University of Glasgow and Great Ormond Street Hospital (GOSH) in London, have now been published and are yet to be peer-reviewed.

Because of the Covid-19 restrictions, researchers say infants have missed out on early immunity against adenovirus – which typically causes colds and stomach upset – and adeno-associated virus two (AAV2) – which is not known to normally cause diseases itself causes and often accompanies infection with adenoviruses, which can cause a cold or flu-like illness.

They said this was probably why some children developed the mysterious liver complications.

Experts said they couldn’t completely rule out that affected children had somehow developed an increased susceptibility to disease, but they said it was extremely unlikely to be caused by Covid-19.

The researchers found that AAV2, which cannot replicate without a “helper” virus such as an adenovirus, was present in all nine cases in the Glasgow study and in 94 percent (16 of 17) of the cases in the GOSH study was.

The 94 percent is significantly higher than the 16 percent typically found in the general population.

The scientists therefore believe that a dual infection with AAV2 and an adenovirus or possibly a herpesvirus HHV6 could offer the best explanation for the occurrence of severe liver disease in affected children.

Both teams said the rise in adenovirus infections following the Covid-19 lockdown may have contributed to the outbreak, as being indoors left children with lower levels of immunity and not being exposed to the normal spectrum of viruses.

Professor Judy Breuer, Volunteer Advisory Virologist at GOSH, said: “While we still have some unanswered questions about what exactly has led to this increase in acute hepatitis, we hope these results can give some reassurance to parents concerned about Covid-19 , as neither team found anything directly related to SARS-CoV-2 infection.

“However, our data indicate that AAV2 in the liver and/or blood of the cases is the strongest biomarker for hepatitis.

“In addition, the presence of HHV6 and adenovirus in the damaged livers collected from the five children who required liver transplantation raises questions about the role of co-infections with these three viruses in the most severe cases.”

The Scottish study also looked at the genetics of affected children to see if any of them might be more susceptible to acute hepatitis.

The researchers were able to identify differences in the human leukocyte antigen gene that were not commonly found in control groups of healthy children or in the genes of children with other forms of hepatitis.

The team said these genetic sequences could provide another part of the answer as to why some children have become seriously ill.

Professor Emma Thomson, senior author of the Scottish study and infectious disease expert, said: “There are many unanswered questions and larger studies are urgently needed to investigate the role of AAV2 in pediatric cases of hepatitis.

“We also need to understand more about the seasonal circulation of AAV2, a virus that is not routinely monitored – it may be that a peak in adenovirus infection coincides with a peak in AAV2 exposure, resulting in an unusual manifestation of hepatitis vulnerable young children.”

Additional coverage from PA Media

https://www.independent.ie/irish-news/health/research-reveals-likely-cause-of-mystery-child-hepatitis-outbreak-41867206.html Research uncovers likely cause of mysterious childhood hepatitis outbreak

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