By Mary Hearty

Even though there is still no evidence to determine the underlying cause of the current Hepatitis outbreak in children, an early clue points that a common virus called ‘Adenovirus’ may have a role in the emergence of the disease.

This is according to Dr Philippa Easterbrook, a Senior Scientist in the Global Hepatitis Programme, HIV department at the World Health Organization (WHO) during WHO’s Science in 5 interview.

Dr Easterbrook stated that this came about after investigations were carried out on the affected children. First, none of the children were infected with the viruses that commonly cause hepatitis.

Secondly, there was no evidence for a common exposure to foods or water, or to medications or other household members. And thirdly, there was no evidence for a link to COVID vaccination since almost none of the affected children had been vaccinated.

“But there was an early clue that a common virus called adenovirus may have a role either acting alone or as a co-infection with another virus such as COVID -either past or current COVID infection,” Dr Easterbrook explained.

She noted that around half to three quarters of all the affected children in those who had blood tests or blood samples available and that were tested were positive for adenovirus.

According to the Senior scientist, this outbreak could be as a result of the young children becoming more susceptible and sensitive to adenovirus following the public health measures put in place when COVID-19 was at its peak. The measures which include closure of schools, wearing of masks prevented them from getting exposed to such infections hence they became more sensitive to them.

Dr Easterbrook’s second possible explanation was a role for previous COVID infection.

“We know that this was very common in the children. Around 70% had evidence of past COVID infection. And it could be that in some of these children who were then exposed to adenovirus, they had a hyper reactive immune response that led to liver inflammation and the hepatitis.

Although, from their investigations, they observed that only 10% of the affected children had current active COVID infection, so, they exempted the possibility that active COVID infection plays a part or is a cause.

Notably, she advised countries to remain alert to the possibility of further cases; and that they put in place referral pathways, and facilities to provide appropriate care.

Dr. Easterbrook also advised parents to remain aware that if their child were to develop symptoms of gastroenteritis like abdominal pain, nausea and vomiting which were to worsen or to develop jaundice, shown by pale stools, dark urine and yellowing of the skin or the eyes, they should seek medical care promptly.

Over the last four months, more than a thousand cases have been reported from 35 countries worldwide. Around a third of the cases have required intensive care support, 48 — that’s around 5% needed an urgent liver transplant for acute liver failure, while 18 children, that’s around 2.5% have died.

In Africa, the WHO reports that more than 91 million Africans live with Hepatitis B or C, which are the deadliest strains of the virus, but it can take decades after infection from the virus before an individual starts manifesting symptoms.

Furthermore, in 19 countries, more than 8% of the population is infected with Hepatitis B, while in 18 countries, more than 1% of the population lives with Hepatitis C. In 2020, the African region accounted for 26% of the global burden for Hepatitis B and C and 125,000 associated deaths.

“Hepatitis has been called the silent epidemic, but the prevalence of the disease in Africa is sounding an alarm for the region and the world to hear,” Dr Matshidiso Moeti, WHO Regional Director for Africa said.

“We must do better and stop this disease from stealing away our children’s future. There is a safe and effective vaccine that offers nearly 100% protection against Hepatitis B, one of the deadliest strains of the virus. We must ensure that all African children are vaccinated within 24 hours of their birth and are followed up with two or more doses of the vaccine.”

Hepatitis can be spread through contaminated blood products, and much more progress is needed to ensure blood safety.

In the African region, only 80% of blood donations are screened with quality assurance, while 5% of syringes are re-used. Only six syringes are distributed per injecting drug user, compared to the global annual target of 200.

Moreover, diagnosis and treatment rates are alarmingly low. In 2021, only an estimated 2% of persons infected with Hepatitis B were diagnosed, and only 0.1% were treated. For Hepatitis C, an estimated 5% of infected persons were diagnosed, with close to 0% treated.

To make a difference and fast-track the elimination targets, Dr Moeti said countries must consider the hepatitis threat a priority and bring hepatitis care closer to their communities by: increasing domestic funding for the elimination of tuberculosis, HIV, sexually transmitted infections and hepatitis; establishing a platform for the integrated delivery of interventions (including the life-course approach;reproductive, maternal, newborn, child and adolescent health care; and immunizations) investing in information and surveillance for action.