Published on 18 May 2022

    A recent spate of mysterious hepatitis cases in children has gotten the attention of health authorities and experts worldwide. Here’s what you should know.

    What is hepatitis?

    Hepatitis is an umbrella term referring to inflammation of the liver. In children, it commonly presents as a gastrointestinal illness, with symptoms such as vomiting, diarrhoea, fever, body pain, lethargy, and – in later stages – jaundice.

    In cases caused by known hepatitis viruses, the majority of patients recover without any problems. However, the initial reports of the new hepatitis indicated a much more severe disease course: out of the 74 patients in that group, six deteriorated to the point of liver failure and required a liver transplant. 

    When did this outbreak happen?  

    The first reports emerged in the UK, between January and mid-April 2022. Hospitals there saw an unusual spurt in the number of children being admitted with liver inflammation – and most concerningly, without any seeming known cause.

    “When we have children admitted with problems of this sort, we look for common viruses, mainly the hepatitis viruses (hepatitis viruses A, B, C, D, and E),” said Dr S. Venkatesh Karthik, Senior Consultant at the Department of Paediatrics at the National University Hospital (NUH). 

    “But all these 74 children were screened…and they couldn’t identify the cause.”

    According to the World Health Organisation (WHO), this number has since increased to at least 169 cases from 11 countries, primarily within Europe and America. Most patients are young children below 10 years of age, with a substantial number under five years of age and a few older children in the 10-16 age group. 

    What could this disease be caused by?

    The short answer: we don’t know yet. 

    “There is speculation ongoing that it could be related to adenovirus, which can cause liver problems. But it has not been proven,” said Dr Venkatesh. “[Experts] are also looking at what’s called epidemiological linking, which means they’re trying to find out if the disease spreads through contact between children. But there’s no conclusion yet, either.”

    Worldwide, public health authorities are in the midst of investigating the disease. And Singapore is no exception – on 30 April, the Ministry of Health (MOH) issued a statement on a 10-month-old boy found to have acute hepatitis with unknown cause. 

    “Investigations are ongoing to determine if the case has a similar presentation to the cases of acute hepatitis of unknown cause reported internationally and by the WHO,” said MOH.

    How is this disease treated?

    First, it’s important to understand why children are affected so severely, said Dr Venkatesh.

    “The immune system is probably not very well developed in young children, and so that makes them a bit more vulnerable to powerful viruses that overwhelm the immune system,” he explained.

    Unfortunately, with most viruses of this sort, there is no specific antidote or antiviral, he added. With this in mind, the first step is to keep a sharp look-out for these cases. This can be done through increased testing for patients with longer, more drawn-out symptoms, to check that the enzyme levels in their liver (indicating inflammation) are normal.

    If the enzyme levels are on the higher side, the next step is to isolate the patients, “as we’re still not sure as to how transmission happens,” said Dr Venkatesh. The medical team will monitor the parameters of liver function – things such as blood clotting and protein levels – to check if the patient’s condition worsens.

    Finally, if the patient continues to deteriorate to the point of liver failure, the last step is to arrange for a liver transplant.  

    What can we do?

    While the mode of transmission has not yet been confirmed, “I would say that general hygiene and universal precautions will go to a great extent in at least eliminating possibilities,” said Dr Venkatesh.

    These include consistent handwashing and avoiding crowded places if possible. In addition, it’s important that parents stay vigilant if their child presents with symptoms – especially if they seem a bit more severe, or a bit more persistent than usual.

    “If their symptoms are a bit out of proportion to what you would typically see, or even if you’re just concerned…it’s best to seek medical attention,” he advised.

    In consultation with Dr S. Venkatesh Karthik, Senior Consultant, Division of Paediatric Gastroenterology, Nutrition, Hepatology and Liver Transplantation, Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, NUH and Senior Consultant, Paediatric Liver Transplantation Programme, National University Centre for Organ Transplantation, NUH.

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