Is Covid 19 responsible for an outbreak of hepatitis in UK children

Last week, hundreds of liver health experts gathered for the World Hepatitis Summit, and one topic dominated the agenda: the mysterious outbreak of childhood hepatitis that has spread to 34 countries, including the UK.

Speaking at the event, liver expert Dr Philippa Easterbrook said: ‘This is the first time that so many serious cases have been seen in children. It is important that we understand the cause and take these cases seriously.

At its extreme, hepatitis can cause the liver to stop functioning. So far, more than 240 cases have been reported in the UK, while 11 British children have required transplants.

What could be behind all this is a subject that divides the scientific world. But the latest development comes from intriguing research by Israeli scientists that suggests the answer may lie with Covid-19.

Last week, hundreds of liver health experts gathered for the World Hepatitis Summit, and one topic dominated the agenda: the mysterious outbreak of childhood hepatitis that has spread to 34 countries, including the UK.

Some experts have claimed there may be a link between the mystery outbreak and Covid 19

Some experts have claimed there may be a link between the mystery outbreak and Covid 19

Doctors analyzed the medical histories of five children who developed the condition – which is a dangerous inflammation of the liver.

They noticed a common factor: all of them had caught Covid in the previous year. Liver inflammation, they suggested, could be an extreme side effect of the immune system’s response to the virus.

Influential doctors took to Twitter to share news of the findings, coining the ‘long liver Covid’ phenomenon. British epidemiologist Dr Deepti Gurdasani, of Queen Mary University of London, tweeted her confidence in the results, accusing some who rejected them of “denying the harm Covid has done to children”. Yet many well-respected pediatric health experts and epidemiologists have angrily disputed these claims.

Professor Alasdair Munro, an expert in pediatric infectious diseases at Southampton University Hospital, said the study provides “almost no useful information” and no evidence that these cases of hepatitis are linked to Covid.

While Dr Jake Dunning, an infectious disease expert at the University of Oxford, said scientists calling Covid long liver disease “really should know better”.

The prevailing theory is that a nasty strain of a common childhood infection called adenovirus is to blame – three-quarters of children admitted to UK hospitals have tested positive for the variant.

Most children get the infection at some point, but it usually only causes minor upper airway problems, leading to coughing, runny nose and, in rare cases, pneumonia.

But experts believe a lack of exposure to adenoviruses during Covid lockdowns has left children’s immune systems without natural protection to fight it, leading to a severe reaction. Even so, the new claims could reignite parental concern – so could they be right?

On the surface at least, the Israeli research seems convincing. The report, published in the Journal Of Pediatric Gastroenterology And Nutrition, discusses five patients: two three-year-olds who required liver transplants, and two eight-year-olds and one 13-year-old who were hospitalized but recovered. are fully recovered. All five were infected with Covid in the four months before they were diagnosed with hepatitis.

The authors say their findings suggest that a Covid infection caused the immune system to malfunction and began attacking the liver. This is not uncommon with other viral infections, and in this case it is called post-viral hepatitis, a recognized illness in children.

Dr Gurdasani, a staunch supporter of the longstanding Covid liver theory, says another piece of evidence is the fact that the UK and US have seen the highest number of hepatitis cases. Both had very high infection rates among children, unlike many other countries which had strict Covid safety measures in schools.

“The UK has been an exception in the way we have tried to protect children from the virus,” says Dr Gurdasani. “We haven’t enforced mask-wearing the way other countries have, and we haven’t done anything to ventilate schools. We may see the impact of these decisions.

The study also casts doubt on the other probable cause: adenovirus was not detected in any of the five patients. And it’s not the only such study that has come to this conclusion. In late April, doctors in Alabama published research noting the absence of the virus in nine children with severe hepatitis who needed a transplant.

And many scientists have pointed out that adenovirus has never been linked to hepatitis – in fact, there is not a single case of adenovirus triggering hepatitis reported in the medical literature. “The argument that this is caused by an adenovirus is getting weaker and weaker,” says Dr Gurdasani. “It does not cause hepatitis and many studies have failed to find it in the livers of these children. So where is the evidence?

But experts say there are several problems with the Israeli study. The biggest: it’s just five children.

Israel has recorded 12 cases of childhood hepatitis, so the study includes less than half of these patients.

‘Researchers do not explain why these patients were selected, or why the other hepatitis cases were not,’ explains Professor Munro. “We don’t know if they only chose those who had Covid, so that doesn’t say how likely it is that a child who develops Covid will develop hepatitis.”

Professor Munro also points out that since Covid is so widespread, it is not necessarily surprising that these children had Covid infections. “Covid infection is so common and the time frame between these children getting the virus and then hepatitis is so varied that there is no clear evidence that one causes the other. This is not to say that Covid and hepatitis are unrelated, but this study provides no concrete evidence that they are.

Professor Will Irving, a virologist at the University of Nottingham, agrees it is too early to jump to conclusions. He says: “Five cases is not enough to prove anything, we need to look carefully at how many of the hundreds of UK cases have had Covid and go from there.”

To add to the confusion, last week US health officials said that while the country had recorded more than 270 cases of unexplained hepatitis in children this year, that’s not more than it sees. in a normal year. “There has always been a background level of these unexplained cases, even before Covid,” says Professor Irving.

The one thing all the experts agree on is that finding the cause remains an urgent task as it will help doctors know what treatment to give. In the UK, children hospitalized with hepatitis are treated for the adenovirus – using the antiviral drug cidofovir. But other countries, like Israel and Austria, treat them with steroids, which can help regulate a faulty immune system potentially impacted by Covid.

Dr Gurdasani warns: ‘If the adenovirus theory is wrong, we have been giving patients the wrong treatment for months. UK health officials must focus on the Covid theory if they are to protect children.

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