Hepatitis outbreak in children

[MumbleCrumbs]

I'm currently really quite unwell with Covid and not sleeping very well so please be gentle, but is anyone else really worried about the reports of this hepatitis outbreak in children now being monitored by the WHO? It seems to have gained traction over the last few days and lots of reports coming out about it now. I know very little about hepatitis but I know its quite rare to see such severe cases in children. Could Covid be the cause? I'm just feeling really quite worried about it and so sad for these poor children and their families, how horrendous after we've all just come through a pandemic .

Some are still definitely investigating a prior Covid infection.

www.sciencedirect.com/science/article/pii/S2468125322001662

11 out of 12 Israeli patients had a confirmed prior covid infection, according to that. How many under 5s were being routinely tested for asymptomatic covid infection? Are there are statistics on that?

It's definitely something they should (and are, as far as I can see) be at least looking to rule out.

The problem is 95% of children have antibodies to Covid. So proving cause and correlation there is going to be tricky. Most children have now been exposed to Covid. It’s not a rare event.

They are looking at this as my post above indicated. They are looking at the Omicron variant in particular, which fits the timeline of the emergence of these cases.

They are looking at it but I’ve not seen a single argument to support that hypothesis that makes any sense. Why 3 year olds in particular? Why younger kids and not adults? Whereas there’s a very straightforward explanation with the lockdown argument. As many scientists have explained- not being exposed to viruses - especially adenovirus in the formative years has a negative impact on the immune system- a big susceptibility factor.

if 95% of children have had/ been exposed Covid how will they find the link there for this very rare event?

Of course they need to explore all avenues but some are definitely more likely than others..

I think in this instance the scientists and experts in this area and their thoughts on it are the ones to listen to.

Many children have had Covid - that’s not a link and proves nothing! Correlation does not imply causation. That’s not how science works. They will be doing a much more complicated analysis than that.

They are looking at it to rule it out. Not because it’s the likely cause.

If you say so.

if 95% of children have had/ been exposed Covid how will they find the link there for this very rare event?

@Delatron

If nearly 100% (or any more accurate figure if you happen to have it and a source to hand?) of children were exposed to restrictions, including social distancing, isolation and lack of social activities leading to a decrease in opportunity to build their immune system, how will they find the link there for this very rare event?

Almost all children have been affected by covid restrictions (or Lockdown as you might prefer). Why are only an incredibly small number of them now presenting with hepatitis related illness or adenovirus 41F?

Correlation does not imply causation.

Because @kittensinthekitchen not all of them will have been exposed to the adenovirus. But due to social restrictions then easing there are more cases than normal and in some children we are seeing issues. They don’t know why yet.

The source of the figure was Dr Elizabeth Whittaker - Consultant in paediatric infectious diseases and Immunology at Imperial College London. But what does she know? It’s only her job. I’m sure you know better. Or maybe she’s been misquoted like all those other scientists were...

Not one of these scientists are stating they think it’s to do with Covid. It’s been investigated to rule it out. Many have come out with their views of the impact of lockdowns and social distancing on immune systems of young children. I’ve quoted earlier in the thread.

So you can hand pick those scientists whose opinions tally with yours, and dismiss those scientists whose opinions don't? Well, that's not been a pattern of behaviour for certain groups at all these past few years!

FWIW, I hope research shows it isn't covid related, by the way, in case I am branded a 'lockdown lover'.

But I'm sure you know better.

Not one of these scientists are stating they think it’s to do with Covid.

The freaking WHO think it may be to do with Covid. Either past infection or a co-infection. The adenovirus link should be clearer/disproved within a week.

Ah yes the WHO. The people who have banned Taiwan from the upcoming meeting because China doesnt like them.

Far out.

www.abc.net.au/news/health/2022-05-17/hepatitis-mystery-cases-children-symptoms-what-we-know/101062808

www.cbc.ca/news/health/severe-hepatitis-children-covid-suspect-1.6451267

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1073704/acute-hepatitis-technical-briefing-2.pdf

The latter which states:

The working hypotheses have been refined. The leading hypotheses remain those which involve adenovirus. However, we continue to investigate the potential role of SARS-CoV-2 and to work on ruling out any toxicological component.

Well exactly. The WHO who praised China’s approach to the pandemic. I don’t have a whole load of faith in them I’m afraid. They also have to remain neutral and they don’t state opinion. (Apart from praising China).

I’d happily quote all the scientists and experts that think this is due to Covid. If I could find any (other than the lockdown lover lady.) If you go through the thread you’ll see I’ve listed and quoted many experts and scientists. But as ever random Mumsnetters think hey know better than Immunologists and experts In hepatitis.

I

You’re not quoting anything new @milkyaqua

The leading hypothesis is an adenovirus not Covid.

They are investigating it to rule it out. Most kids have had Covid. There’s zero evidence to link Covid to Hepatitis.

This is from the article you quoted @milkyaqua

It is not really saying it’s down to Covid if that is how you’ve interpreted it. In fact funnily enough it mentions lockdowns again!! Far out indeed...

They are investigating it to rule it out.

Who are 'they'? You do understand this is an international phenomenon, and that there are scientists in other countries investigating their own cases and gathering their own and comparative data? I've linked the freaking uk gov report, along with articles quoting multiple scientists and doctors, immunologists, etc etc. The role of Covid infection, particularly Omicron - although India had a surge of acute severe hepatitis cases in children earlier in 2021 - is a large consideration, outside your very 'special' pool of scientists.

Their observational pre-print study, which has not yet been peer reviewed due to challenges with funding, analyzed 475 children from throughout India who had tested positive for COVID-19 — 47 of whom presented with severe hepatitis.
Among that group, 10 were found to have symptoms of Multiple Inflammatory Syndrome in children (MIS-C) and were ruled out, while the remaining 37 were classified as having what the researchers named COVID-19 Associated Hepatitis in Children (CAH-C).

"The one common factor we found was that they all were infected with, or they all had a history of COVID," said Dr. Sumit Rawat, lead author, microbiologist and associate professor at Bundelkhand Medical College in Madhya Pradesh, India, in a phone interview.

"We also did antibody testing for COVID in these children, and the maximum number of children who were coming in with this were antibody positive."

Seriously, get help. Your blinkers are glued on too tight.

What @milkyaqua because I’d rather get my information from scientists and experts than you? Ok.

And in Alabama they’ve ruled out Covid as the cause..
Its almost as if they have no idea what is causing this and are working through the hypotheses.

Well, as it happens, I am getting my information from multiple sources quoting scientists and experts, most of whom, being doctors and scientists - research scientists, gastroenterologists, immunologists, virologists, and epidemiologists - are keen to learn what each other has discovered, in order to solve the mystery of what is causing this outbreak of hepatitis and causing some of these poor little children's livers to fail. I guess they did not get the memo that only a few select scientist's opinions and findings count.

And in Alabama they’ve ruled out Covid as the cause.

No, they haven't. That just means that these nine children weren't Covid positive at the time. Nobody has ruled out Covid as an exacerbating or causative factor. (Well, apart from you.)

I’ve been back through the thread to find all these scientists and virologists and immunologists that you have quoted speaking about their views linking this to Covid @milkyaqua and I just can’t find any! I can find all the ones I quoted with their views on lockdown/social distancing and immune systems..

And like I said 95% of children have antibodies to Covid.The scientists are not that stupid to think that proves Covid is causing this. Most children admitted to hospital with this condition will have Covid antibodies. It’s a bit more nuanced than that.

Nothing has been ruled out but your determination to prove that this is Covid is making you look ill informed. Adenovirus is still the leading theory. Then they need to work out why it is affecting children of this young age in this way.

I've been trying to find out the answer to this and curious if anyone else read anything about the prevelance of the adenovirus?

I'd be interested to know if it's a case of all children infected would end up with liver inflammation, or if its like a sliding scale where some are asymptomatic some are very mildly ill and a small portion become acutely ill.

the possibility of acute hepatitis in children following COVID-19 infection cannot be ruled out, rather than the AdV pathogenic hypothesis previously proposed by the UK Health Security Agency (UKHSA), in part because no adenovirus was detected in liver biopsies in children with acute hepatitis at the moment.

Isabella Eckerle, co-Head of the Centre for Emerging Viral Diseases at the Geneva University Hospitals link

So far, none have been identified, but it's early days and "everything is still on the table"

Dr Ian MacKay, University of Queensland link

We are working closely with the NHS and academic partners to actively investigate the role of other contributors, including prior SARS-CoV-2 and other infections.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA link

Another working theory, as Professor Hardikar notes, is that a "cofactor" — such as a prior or existing infection with another virus like SARS-CoV-2 — may have primed some children to have a more severe reaction or abnormal immune response to adenovirus infection.

Professor Winita Hardikar, Director of the Gastroenterology and Clinical Nutrition Department Royal Children’s Hospital, and Head of the Liver and intestinal transplant program. link

Pediatric Acute Liver Failure Due to Type 2 Autoimmune Hepatitis Associated With SARS-CoV-2 Infection: A Case Report

Osborn, Julie MD, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Szabo, Sara MD, Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Peters, Anna L. MD, PhD, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH link

Medical staff analyzed those recent cases, including genetic testing, and the only link between them was that each one had faced a previous bout of COVID-19, identified through serological testing and each family's medical history.

Dr. Yael Mozer Glassberg, head of the liver transplant unit at Schneider Children's Medical Center link

COVID-19 Associated Hepatitis in Children (CAH-C) during the second wave of SARS-CoV-2 infections in Central India: Is it a complication or transient phenomenon

Radha Kanta Ratho, Dept. of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Ajit Anand Asati, Dept. of Pediatrics, Bundelkhand Medical College, Sagar, MP India
Nitu Mishra, Dept. of Microbiology, Bundelkhand Medical College, Sagar, MP India
Ashish Jain, Dept. of Pediatrics, Bundelkhand Medical College, Sagar, MP India link

"The one common factor we found was that they all were infected with, or they all had a history of COVID,"

"We also did antibody testing for COVID in these children, and the maximum number of children who were coming in with this were antibody positive."

Dr. Sumit Rawat, lead author, microbiologist and associate professor at Bundelkhand Medical College in Madhya Pradesh, India link

And I did actually have formatting in that post to make it easier to read.

FFS