Rates of Severe Acute Hepatitis of Unknown Causes in Children Are Increasing in US, UK

A research review showed that sudden cases of severe acute hepatitis of unknown causes (SAHUC) and pediatric acute liver failure reportedly increased in the US and the UK between October 2021 and May 2022. By June 2022, 920 SAHUC cases were reported worldwide in children aged 10 to 16 years, but the disease was also found in children even younger.

According to the World Health Organization (WHO), 5% of patients received a liver transplant and 2% died from the disease. However, there remains no agreed upon definition for ‘confirmed cases’ because there is still no concrete diagnosis or treatment, with the cause still unknown.

“Physicians expect early clarification of the etiology and availability of specific, effective, and safe therapeutic and preventive approaches to treat it. With this in mind, this mini review aimed to understand the major characteristics of SAHUC, as well as raise some questions and discuss opinions and preliminary recommendations to better understand and control the disease,” said Getu Zhaori, MD, editor-in-chief of Pediatric Investigation, in a press release.

Zhaori referenced approximately 30 articles for his survey. Combining data from PubMed literature, WHO websites, UK Health Security Agency, CDC, and the European Centre for Disease Prevention and Control, he observed that levels of alanine aminotransferase, aspartate aminotransferase, and serum bilirubin were high in most SAHUC cases. Additionally, liver biopsy reports revealed varying degrees of liver inflammation as well, with the most common symptoms including jaundice, vomiting, and diarrhea, though they varied with patient geographical location.

While cofactors like modifying adenovirus activity, altering the host immune response, and COVID-19-induced immune deficiency are current hypotheses, Zhaori noted in his article published in Pediatric Investigation that more sensitive laboratory tests and imaging, such as computer tomography and liver and biliary ultrasounds, could provide more conclusive answers.

Existing treatment is supportive and symptomatic therapy. Specifically, for patients who suffer from high adenoviral load, antiviral drugs like cidofovir or combinations of western and ancient Chinese medicine have been found to help to treat SAHUC symptoms. However, it is ultimately suggested to start any type of antiviral therapy within 3 to 5 days of disease onset, as once live failure occurs, liver transplant is the only available option for pediatric patients.

“The indications for liver transplantation are very important. The pediatricians working in the hepatology ward, intensive care unit, or community clinics should be familiar with the basic indications for transplantation,” Zhaori said in the press release. “This will ensure they do not miss the critical time for patient preparation and performing the actual transplantation.”

Reference

Severe acute hepatitis of unknown causes in children is on the rise: A pediatric investigation review probes deeper for insights. Cactus Communications; July 19, 2022. Accessed July 20, 2022. https://www.eurekalert.org/news-releases/959195