Hepatitis in children, here is what the Italian National Institute of Health says
Hepatitis in children: in the cases that have emerged in Great Britain there does not seem to be any correlation with the Covid vaccine or with adenovirus, but toxicological investigations have not revealed any useful elements either. Various surveillance systems in Italy
What are the hypotheses on the origin of paediatric hepatitis in recent months?
“At the moment, none of the theories formulated on the origin of hepatitis has been confirmed by scientific evidence,’ explains the Istituto Superiore di Sanità in an in-depth study on the subject.
In addition, every year in Italy, as in other countries, there is a certain number of hepatitis with an unknown cause, and analyses are underway to establish whether there is actually an excess.
The initial hypothesis of the UK investigation team proposed an infectious aetiology or possible exposure to toxic substances.
Detailed information collected through a questionnaire regarding the food, drink and personal habits of the cases did not reveal common exposures.
Toxicological investigations are ongoing, but an infectious aetiology seems more likely based on the epidemiological and clinical picture.
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Microbiological investigations have ruled out hepatitis A, B, C, D and E viruses in all cases
Among 13 cases notified from Scotland, for which detailed testing information is available, three had a confirmed SARS-CoV- infection, five were negative and two had a SARS-CoV-2 infection three months previously.
Five cases had a positive test for adenovirus among the 11 of the 13 cases for which testing data were available.
HEPATITIS, WHAT IS THE EVOLUTION FROM THE FIRST CASES TO TODAY?
On 5 April 2022, the UK reported an increase in the number of hepatitis cases in previously healthy children under the age of 10.
On 12 April, the country reported that, in addition to the cases reported in Scotland, some 61 cases had been identified under investigation in England, Wales and Northern Ireland, most of them aged between 2 and 5 years.
On 14 April, Scotland reported 13 cases under investigation, including two pairs with epidemiological links.
The clinical presentation of the UK cases was severe acute hepatitis with transaminase (AST/ALT) elevations above 500 IU/L and in many cases jaundice.
In the preceding weeks, some cases had presented with gastro-intestinal symptoms including abdominal pain, diarrhoea and vomiting.
Most cases did not present a fever.
Some cases received specialist care in paediatric hepatology units and some received liver transplants.
“As of 21 April 2022, cases of acute hepatitis n.o.d. in children have been reported in Belgium, Denmark, France, Ireland, the Netherlands, Romania, Spain, potentially in Sweden, on 19 April in Israel (12 cases) and on 20 April in Italy (4 cases)-Iss continues.
Most countries report a limited number of cases.
The exception is the United Kingdom which, as of 21 April 2022, had identified more than 100 children under 10 years of age with acute hepatitis. A total of 8 children have received a liver transplant.
Outside the European Union, as of 15 April 9 cases of acute n.o.d. hepatitis among children aged 1-6 years with a positive test for adenovirus have been reported by health authorities in the US state of Alabama, some of them with adenovirus serotype 41 infection.
“At the moment,’ reports the ECDC in its latest bulletin updated on 23 April, ‘there is no clear correlation between the reported cases.
No clear epidemiological risk factors have emerged among the cases, nor any association with travel.
IS THERE A LINK BETWEEN HEPATITIS AND THE SARS-COV-2 VACCINE?
At the moment “there are no elements that suggest a connection between the disease and vaccination, and indeed several considerations would lead to exclude it,” says the IST – in almost all cases in which we know the status of the children affected had not been vaccinated, the hypothesis that it is an adenovirus to cause hepatitis, advanced by some researchers, is in itself unlikely, as this type of virus is not normally associated with liver disease.
“In any case, the adenovirus contained in the adenoviral vector vaccines against Sars-Cov-2 used in some countries (in Italy AstraZeneca and Janssen), is genetically modified so as not to replicate in the cells of our body.
At the current state of knowledge, therefore, recombination between the circulating adenovirus and the vaccine strain does not seem to be biologically possible.
These in fact presuppose the mixing of genes between viruses as they multiply, but this is not possible for the vector used for vaccination”.
WHAT IS THE IRS DOING?
At the moment, several ISS structures have been activated.
Specifically, the Seieva Network, i.e. the Integrated Epidemiological System of Acute Viral Hepatitis, which is the special surveillance of acute hepatitis, active since 1985.
Seieva supports and integrates the ‘Information System of Infectious and Diffusive Diseases’ (Simid) managed by the Ministry of Health, in order to promote local and national investigation and control of acute viral hepatitis.
Then there is SARS-CoV-2 genomic surveillance. The Italian network is active in sharing data on the sequencing of SARS-CoV-2 strains from paediatric cases of acute hepatitis in which this infection has been confirmed.
This will allow a better understanding of whether the SARS-CoV-2 infection is an incidental event, due to the high circulation of the virus in Europe, or whether it should be considered the aetiological factor of these forms of hepatitis.
With the Ministry of Health circular of 19 October 2021, event-based surveillance in Italy was then formally established.
The main actor for the implementation of surveillance is the Italian epidemic intelligence network.
The network’s contact persons became active following the alert on 5 April 2022.
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