Hepatitis due to virus attack?: Robert Koch Institute alarmed because of destroyed children's livers

The health authorities in many countries are concerned with an alarming, if still completely unexplained, accumulation of acute and life-threatening liver inflammation (hepatitis) in children.

The disease is usually found extremely rarely in minors.

At least one child has already died in the UK and at least 17 were saved only by a liver transplant.

Joachim Müller-Jung

Editor in the feuilleton, responsible for the "Nature and Science" department.

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According to the World Health Organization and the European Center for Disease Control (ECDC) and the American National Disease Control Agency (CDC), after the first reports from Great Britain and Northern Ireland at the beginning of April, at least 169 cases of childhood hepatitis have been documented in a dozen countries.

Children between the ages of one month and 16 years are affected, with most cases occurring between the ages of two and five.

The Robert Koch Institute (RKI) in Berlin also reported a corresponding report in the latest Epidemiological Bulletin of April 29, which was published in advance, but without going into details.

The child's illness was officially reported in January 2022.

The RKI is asking doctors and the medical and pediatric specialist societies in the state to pay more attention.

Acute reactions to vaccinations are ruled out by the doctors as causes, possible poisoning is still being examined, but is highly unlikely due to the epidemiological occurrence and the clusters that have occurred, especially in Great Britain with well over a hundred cases alone.

Various hepatitis viruses, which are known to cause severe acute liver inflammation in adults, are also apparently eliminated.

Nevertheless, due to the tissue destruction, past infections with viruses are very likely to be the cause.

Adenoviruses and the SARS-CoV-2 virus in particular are being discussed among British experts.

According to the WHO, adenoviruses had been identified in at least 74 cases in Great Britain and all seven cases discovered in the US state of Alabama.

that the “majority” of cases indicate adenovirus infection.

The sequenced adenoviruses are almost always a special variant - serotype 41F - of these non-enveloped pathogens, which can normally cause colds or diarrhea.

These pathogens are not new, the vast majority of people are infected with these adenoviruses at least once in their lives.

However, it is possible that it is a modified virus strain.

There is also speculation that the sick children have only now come into contact with the adenoviruses due to the lifting of corona protection measures or that corona and adenoviruses work together.

However, this "corona hygiene hypothesis" or "lockdown thesis" has so far met with considerable skepticism among virologists because the evidence is weak,

In fact, downright waves of adenovirus infection were registered among children in Great Britain, which, however, were mainly noticeable due to diarrhea.

The Netherlands also reported more frequent adenovirus infections in children.

However, according to the WHO, it is also possible that the increased attention paid by doctors in general practices and clinics in recent weeks is only simulating an accumulation of adenoviruses.

A possible connection is also made by virologists with Sars-CoV-2 infections.

Among the hepatitis children tested for viruses, some of them seriously ill, there were at least twenty who had also had a Sars-CoV-2 infection – mostly the BA.2 variant – without severe Covid 19 symptoms.

In 19 of the cases reported to the WHO, a double infection with adenovirus and SARS-CoV-2 virus was also identified.

Life-threatening cases in autumn 2021

Jaundice develops in these children with liver disease, which is most likely to be recognized by the yellowish colored sections of the eyes around the pupils.

Diarrhea and vomiting are common.

Children, on the other hand, usually do not develop a fever.

However, the liver values ​​often deteriorate quickly, leading to severe gastrointestinal complaints and severe abdominal pain.

Severe liver inflammation was repeatedly found in adults in the course of Covid 19 infections.

But in the fall of 2021, four cases of life-threatening hepatitis in children aged four and six months and eleven and six years stood out at Lurie Children's Hospital Chicago.

Two cases had to be transplanted after liver failure.

The case series was described in the Journal of Pediatric Gastroenterology and Nutrition.

All four children were ill with Covid-19, none developed severe symptoms and not the multi-inflammatory syndrome PIMS.

The children's hepatitis was described by the doctors from Chicago and Philadelphia around Antala Swati as a serious, rare Covid 19 complication.

The fact that there is actually a connection with the new omicron variant BA.2, for example, is something that Geneva-based virologist Isabella Eckerle has so far considered to be pure speculation, which is inadmissible given the available data.