I have a two year old daughter. Last Tuesday at 10:35 p.m. she was admitted to the Maternal-Children’s Hospital in Granada. She had a temperature of 41 degrees, hepatomegaly and altered liver enzymes. All the alarms went off. In recent days, the European Center for Disease Control had issued an alarm for an acute hepatitis of unknown origin that was already affecting more than 60 children in England.
When Aina entered, three cases were being investigated in Spain. One of them had needed a liver transplant. As I write these lines, with the girl already out of danger (and once that strange hepatitis has been ruled out), there are at least two more cases under suspicion and Denmark, Ireland, the Netherlands and the USA have detected cases. From what the authorities are saying, more cases are expected, and certainly many more suspicions are expected. This is all we know so far about this mysterious disease.
What happened? On April 5, the World Health Organization reported ten cases of severe acute hepatitis in central Scotland. As of April 8, the UK had 74 cases. In all, the patients were 10 years old (mostly between two and five); in all, hepatitis viruses (A, B, C, E and D) had been ruled out, as well as other similar possible causes. That is, the etiology was unknown.
It must be said that it is not uncommon for cases of hepatitis of unknown origin to appear. It is, in fact, quite common and every year hundreds (or even thousands) of patients with liver disorders of unclear aetiology are received in emergency services. The striking thing about the alert is that it occurs in children with such a similar profile and that it occurs so quickly. Moreover, since the WHO and the ECDC launched the alarm, cases compatible with this strange disease have not stopped emerging.
What does the disease consist of? ‘Hepatitis’ means ‘inflammation of the liver’ and, for this reason, one of the first symptoms is a liver that is larger than normal on abdominal palpation. However, the quintessential clinical sign of this pathology is the alteration of liver enzymes; especially tansaminases and bilirubin. National and international authorities use this as a criterion: if serum transaminase values exceed 500 IU/L and the origin is unknown, it should be reported.
Apart from these laboratory signs, little is known about the progression of the disease. The latest reviews indicate that the majority of cases presented jaundice (yellowish color of the skin and mucous membranes) as well as abdominal pain, vomiting and diarrhea during the previous week. Also striking is the fact that high fiber is not being very common.
On the other hand, although it is a severe hepatitis and it has a very rapid progression; in most cases, the children are recovering well. Very few seem to need a transplant or develop liver problems in the medium term.
Why happens? That is the great mystery: for now we do not know. Discarding the main known viruses, the WHO has been clear that “the priority is to determine the etiology of these cases to guide future clinical and public health actions.” That is, the international teams are trying to understand what all the cases have in common and are carrying out laboratory tests to detect possible additional infections, chemicals and toxins in the identified cases. The idea is to identify the epidemiological links that allow the development of treatments and introduce measures that curb its possible expansion.
This also means that most theories and hypotheses that are handled are unreliable. The connection with the coronavirus vaccine, for example, is ruled out (by age, almost none of the children are vacua). And the adenovirus hypothesis that has been used in recent days needs to be confirmed. After all, adenoviruses are very common and not very dangerous viruses. It is documented that, on rare occasions, they can cause liver problems; but until the cause is located and analyzed in detail, they remain mere speculation.
Next steps. With the international authorities behind the disease, it is likely that more cases will emerge in the coming days and the epidemiological connections will begin to become clearer. Until then, the most reasonable thing is to remain calm, be vigilant and hope that the cases that arise are as mild as possible.
