hepatitis lilo i tamaiti. Ole ki ole fa'amatala ole COVID-19?

Work continues to find the cause of the mysterious hepatitis, which affects children around the world who are still healthy. To date, more than 450 cases have been detected, of which around 230 in Europe alone. The etiology of the disease remains a mystery, but scientists have some speculations. There are many indications that the inflammation of the liver is a complication after COVID-19.

1. For the first time, the UK first raised concerns about the increase in hard-to-pinpoint hepatitis in children. At the beginning of April, it was reported that over 60 cases of the disease were studied. This is a lot, considering the fact that so far about seven of them have been diagnosed throughout the year
2. In some children, the inflammation caused such changes that a liver transplant was required. There have also been the first deaths due to inflammation
3. Among the theories taken into account in the analyzes of disease cases, the viral basis is the dominant one. Adenovirus was initially suspected, but now anti-SARS-CoV-2 antibodies are being detected in more and more children
4. Most cases are diagnosed in young children who have not been vaccinated, so they most likely have had COVID-19 and liver inflammation could be a complication following infection
5. E mafai ona maua nisi fa'amatalaga ile itulau autu ole Onet

Ignorance of the cause is more disturbing than the disease itself

Hepatitis is not a disease that children do not get at all. So why have the new cases of disease raised so much anxiety in the world? The answer is simple: none of the types of virus most commonly responsible for hepatitis, i.e. A, B, C and D have been detected in the blood of sick children. Moreover, in most cases nothing that could cause inflammation was detected. It is the unknown etiology, and not the disease itself, that is frightening. Until now healthy children who suddenly become ill, and very hard for an unknown reason, is a phenomenon that cannot be ignored.

That’s why doctors, scientists and health officials around the world have been analyzing cases for weeks, looking for possible causes. Various options were considered, but two were immediately ruled out.

The first is the impact of chronic diseases and autoimmune diseases that “like” to cause or worsen inflammation. This theory was quickly refuted, however, because most children were in good health before developing hepatitis.

The second theory is the effect of the active ingredient of the vaccine against COVID-19. However, this explanation was illogical – the disease affected children under the age of 10, and the predominant group are several-year-olds (under the age of 5). These are children who, in the vast majority of cases, have not been vaccinated, because they did not qualify for preventive vaccinations against COVID-19 (in Poland, vaccination of 5-year-olds is possible, but in many countries around the world, only 12-year-old children can approach the injection).

However, not adenovirus?

Among the theories more likely is viral origin. Since it was established that the popular HAV, HBC or HVC was not responsible for hepatitis in children, young patients were tested for the presence of other pathogens. It turned out that a large number of them were detected adenoviruses (type 41F). It is a popular microorganism responsible for gastroenteritis, which would be consistent with the most common symptoms of hepatitis in children (including abdominal pain, nausea, vomiting, diarrhea, increased temperature).

The problem was that adenoviruses tend to cause mild infections, and even if the course of the disease is more troublesome and the child is hospitalized, it is usually due to dehydration rather than extensive changes in internal organs, as is the case with the mysterious hepatitis.

O le isi vaega o loʻo i lalo ole vitio.

Have children with hepatitis been infected with the coronavirus?

The second possibility is infection with a different type of virus. In the era of a pandemic, it was impossible to avoid the association with SARS-CoV-2, especially since COVID-19 in children – starting from diagnosis, through course and treatment, to complications – is still a great unknown for medicine. However, problems have also been encountered in this context.

For one thing, not every child with hepatitis has a history of the disease. This was due to the fact that many pediatric patients, especially at the beginning of the pandemic, when variants Alpha and Beta were dominant, had no symptoms – thus, parents (and even more so a pediatrician) may not know to this day that they have undergone COVID-19. Also, the testing was not conducted on such a large scale then as with the successive waves caused by the Delta and Omikron variants, so there were not many “opportunities” to recognize the infection.

Lona lua, even if your child has had COVID-19, antibodies will not necessarily be detected in their blood (especially if a long time has passed since the infection) It is therefore not possible in all young patients with hepatitis to determine whether the coronavirus infection has occurred. There may be cases where a child has been ill and COVID-19 has had some effect on the development of liver inflammation, but there is no way to prove this.

It is a “superantigen” that sensitizes the immune system

The latest research on the effect of COVID-19 on the liver of children shows that it is not SARS-CoV-2 alone that can cause inflammation of the organ. The authors of the publication in “The Lancet Gastroenterology & Hepatology” suggest a cause-and-effect sequence. Coronavirus particles may have found their way into the digestive tract in children and influenced the immune system by causing it to overreact to adenovirus 41F. The liver was damaged as a result of the production of a large amount of inflammatory proteins.

The “Journal of Pediatric Gastroenterology and Nutrition” recalled the story of a three-year-old girl who was diagnosed with acute hepatitis. During an interview with the parents it was established that the child had had COVID-19 a few weeks earlier. After detailed tests (blood tests, liver biopsy), it turned out that the disease had an autoimmune background. This may suggest that SARS-CoV-2 led to an abnormal immune response and resulted in liver failure.

«We propose that children with acute hepatitis be tested for persistence of SARS-CoV-2 in the stool and other signs that the liver is damaged. The coronavirus spike protein is a “superantigen” that over-sensitizes the immune system»- say the authors of the study.

Did the children fall ill already last year?

Prof. Agnieszka Szuster-Ciesielska, virologist and immunologist at Maria Curie-Skłodowska University in Lublin. The expert drew attention to the observations of doctors from India, where last year (between April and July 2021) there were unexplained cases of severe acute hepatitis in children. Back then, the medics, although concerned about the situation, did not raise the alarm because no one had reported similar cases in other countries yet. Now they have linked these cases and presented their findings.

As a result of examining 475 children with hepatitis, it turned out that the common denominator in their case was the infection with SARS-CoV-2 (as many as 47 developed severe hepatitis). Indian researchers found no association with other viruses (not only those causing hepatitis A, C, E, but also varicella zoster, herpes and cytomegalovirus were investigated), including adenovirus, which was only present in a few samples.

– Interestingly, there was a decrease in the number of cases of hepatitis in children when SARS-CoV-2 stopped circulating in the region and a re-increase when the number of cases was high – emphasizes the researcher.

According to prof. Szuster-Ciesielska, at this stage of research on the etiology of hepatitis in children, the most important thing is to be vigilant.

– It is important for physicians to be aware that hepatitis is rare and can [develop] during an infection with SARS-CoV-2 or after suffering from COVID-19. It is important to perform liver function tests in patients who are not improving as expected. Parents should not panic, but if their child becomes ill, it may be worthwhile to see a pediatrician for check-ups. Timely diagnosis is the key to recovery – the virologist advises.

What are the symptoms of hepatitis and children?

The symptoms of hepatitis in a child are characteristic, but they can be confused with symptoms of “ordinary” gastroenteritis, the popular “intestine” or gastric flu. Primarily:

1. taʻavale,
2. tiga o le manava,
3. vili,
4. manava tatā,
5. leai se manaʻo
6. fiva,
7. tiga i maso ma sooga,
8. vaivai, vaivai,
9. lanu samasama o le paʻu ma / poʻo mata mata,

O se fa'ailoga o le fula o le ate e masani ona liu lanu o le mimi (e sili atu le pogisa nai lo le masani) ma le nofoa (e sesega, efuefu).

Afai e maua e lau tama lea ituaiga o ma'i, e tatau loa ona e fa'afeso'ota'i se foma'i o tamaiti po'o se foma'i lautelema, afai e le mafai, alu i le falemaʻi, lea o le a faia ai e le tamaititi maʻi se suʻega auiliili.

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