But we investigate other factors “which cannot yet be excluded”. 55 cases in Europe, “risk not assessable”
For acute hepatitis of unknown origin in children “the current hypothesis is that adenovirus infection or co-infection is the most likely cause. However, other factors are also being investigated, which cannot yet be ruled out“. The European Center for Disease Control (ECDC) highlights this in the risk assessment published today. For the ECDC, at this point,” the priority is to determine the cause, the pathogenesis of the disease and the risk factors for severity of acute hepatitis cases in children “.
CASES IN EUROPE – As of Wednesday 27 April, there are about 55 cases of severe acute hepatitis of unknown etiology among previously healthy children reported by countries of the European Union / European Economic Area, including Italy, the figure reported by the ECDC. In addition to our country, among the countries that made reports there are Austria, Belgium, Denmark, France, Germany, Ireland, the Netherlands, Norway, Poland, Romania, Spain. “The incidence in the EU / SEE is very low. As the causative agent of the reported acute hepatitis cases remains unknown and under investigation, the risk to the European pediatric population cannot currently be accurately assessed”, is the conclusion of the EU body.
The ECDC alert on the phenomenon was triggered following the initial report on April 5 of an increase in cases by the United Kingdom (a country that had identified 111 cases as of April 20, in patients aged 10 years or younger) . Sporadic cases have been reported from other countries around the world (Canada, Israel, Japan, USA).
The ECDC explains that at this time “the likelihood of seeing an increase in severe acute hepatitis of unknown origin in children cannot be quantified, due to the lack of evidence regarding the causative agent, transmission routes and risk factors”.
The working hypothesis for now is that there may be a cofactor affecting young children who have an adenovirus infection. Infection that would be mild under normal circumstances, but instead triggers a more serious infection or immune-mediated liver damage. In the UK, an increase in adenovirus circulation in young children has been observed to coincide with the increase in detections of severe hepatitis in this pediatric age group. If adenovirus is proven to be the agent that causes or contributes to this phenomenon, then “similar increases in the circulation of adenovirus could lead to an increase in severe hepatitis in children in other European countries”. In any case “with strengthened surveillance activities – the ECDC points out – we expect more cases to be identified and reported”.
Considering that some of the reported cases required liver transplantation, adds the EU body, “the potential impact for the affected pediatric population is considered to be high. Transplant and support capacities for pediatric patients with hepatic insufficiency vary widely between countries. of the EU / See – points out the ECDC – Therefore, access to highly specialized pediatric intensive care services and transplant services can affect the outcomes, especially if the number of cases increases “.