A new form of severe hepatitis affects very young and previously healthy children. No definitive explanation yet.
What are we talking about ?
In early April, the UK alerted the World Health Organization to reports of an “unusual” number of childhood hepatitis cases.
Symptoms include high fever, jaundice, discolored stools and dark urine. More surprisingly, this hepatitis begins with a violent digestive syndrome (nausea, diarrhea, vomiting, etc.).
But above all, they occur in particularly young children – under ten, and even under five for the most part – and in perfect health.
Where were these infections detected?
These severe forms of hepatitis were first reported in the UK and Spain. Quickly, during the month of April, cases were detected in France, Ireland, the Netherlands and even Denmark.
In France, the first two cases had been reported in Lyon.
For now, most of these acute hepatitis have been identified in Western Europe, but the United States, Israel and Japan have also reported several cases.
How many cases are we talking about?
So far, only 188 cases have been formally identified, more than half of them (111) in the United Kingdom. This may not seem like a lot, but this number is very significant for an extremely rare pathology, especially in perfectly healthy children.
In addition, the number of detected cases is likely to increase, as detailed by medical biologist Claude-Alexandre Gustave in Liberation :
The extent of the phenomenon remains limited for the moment, but the detection of these cases is likely to increase significantly in the weeks to come.
Claude-Alexandre Gustave, medical biologist
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For a simple reason: reports have so far been made “by chance”, as they are detected. But now, “the alerts issued with the establishment of diagnostic criteria, a systematic biological assessment and reporting procedures to the health authorities” will make it possible “to centralize the data and to advance the epidemiological investigation”, explains Claude -Alexander Gustav.
The results are already severe: many of these 188 cases of severe childhood hepatitis required hospitalization. Importantly, almost 10% resulted in liver transplantation and one child died.
What is its origin ?
Researchers are only at the hypothesis stage.
But some tracks – such as the responsibility for vaccines – can be abandoned: almost all patients under the age of 10, very few are vaccinated. Most are even under the age of five, and not even eligible for the vaccine, as doctor and writer Christian Lehman reminds us:
The infectious hypothesis remains the main track, without ruling out, at this stage, toxicological or environmental causes.
Christian Lehman
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Among the infectious hypotheses, the scientific community is divided: the first, which have been widely expressed, accuse an adenovirus. The others refer to Sars-Cov-2 – the virus responsible for Covid-19.
Thus, many researchers note that 30 to 40% of children who are victims of these hepatitises are positive for the adenovirus. However, as Dr. Lehman reminds us, “it’s not surprising! the adenovirus is responsible for colds, nasopharyngitis, it is extremely common and commonplace in children – as in adults”.
It would be like saying that if 30% of children have tartar on their teeth, it is tartar that is responsible for these hepatitis: it makes no sense!
Christian Lehman
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Of the 166 European cases, 50 children test positive for an adenovirus (30%), and 13 are positive for Sars-CoV-2 (7.8%) at the time of diagnosis.
Except that we do not know how many of these 166 children have been tested, whether for adenoviruses or for Covid-19… In France, for example, the Ministry of Health “maintains its recommendation not to search for Sars- CoV-2 in children under 6 years old”.
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In other words, in most cases, we didn’t find a Covid-19 infection… because we didn’t look for it.
On the other hand, as the biologist Claude-Alexandre Gustave reminds us, among the cases identified in Israel, 90% positive for Sars-Cov-2.
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Covid infection in the fifteen weeks preceding hepatitis is even the only common denominator among the cases of hepatitis identified.
This hypothesis therefore appears as a “favorite”. Especially since when the suspected adenovirus (41F) causes severe hepatitis, these only affect severely immunocompromised children.
On Twitter, scientist Marie Bayle-Normand detailed at length why the adenovirus thesis does not hold water:
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With a simple observation: in cases where a liver biopsy was performed, no trace of adenovirus was detected in any child.
Finally, the WHO does not exclude a possible combined role of Sars-CoV-2 and an adenovirus, with a weakening of the immune system by Covid which would make children more vulnerable to this hepatitis, sometimes caused in children. fragile by an adenovirus.
Can the confinements and the mask be in question?
The discourse that children are never at risk from Covid-19 is still frequently heard. And that’s serious, according to Dr. Lehman:
If the Covid is in question, that means that all those who have minimized the Covid in children, explained that they must build their immunity by becoming infected, not wearing the mask… all these people will have made a mistake, even a fault
Christian Lehman
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And to add: “This is what the French Pediatric Society, which has long distinguished itself by its denial of the role of children in the circulation of Covid, evokes under the term “immune debt” – a stupid concept which does not exist anywhere in the scientific literature and clashes with epidemiological data”, recalls the doctor.
“Scientifically it makes no sense: firstly because adenoviruses and other rhinoviruses have circulated completely normally in recent months according to all epidemiological data. Children’s exposure to these viruses therefore continued during the two years of the pandemic. Then because we are seeing an explosion of these cases of hepatitis, in time and space, where the Covid-19 has soared among children in recent months: countries like New Zealand or Korea from the South, who have chosen “zero covid”, do not identify any”, recalls Christian Lehman.
A coincidence which, on a scientific level, does not translate a cause and effect link, but at least allows to give one more clue in favor of the hypothesis according to which the Covid would be in question.
What can we expect?
At this stage, it is still too early to say with certainty that Covid-19 is the cause, or at least the only one involved. Sars-Cov-2 has not yet revealed all its secrets – as we have seen with “Pims”, these severe conditions which also strike children several weeks after their infection. For these, the link with Covid-19 is now confirmed.
Regularly accused of “alarmism”, Dr. Lehman is pessimistic and resigned:
“If in four to six weeks, we confirm that it is indeed the Covid which causes these hepatitis, I will not be rubbing my hands saying “we were right”. No, I will say to myself “shit, we were right”. At the end of the day, there is still the death of kids, ”he recalls. Hoping for a return to respect for barrier gestures in children, to avoid such consequences in the medium term, and an amplification of pediatric vaccination against Covid.
* Christian Lehman is notably the author of “Holding the Line, Epidemic Journal”, published by L’Olivier (19 €).
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