The European disease agency on Thursday classified unexplained cases of acute hepatitis affecting children as a “worrying public health event”, while acknowledging that it was unable to accurately assess the risk.
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“Considering the unknown etiology (cause of the disease), the pediatric population affected, and the potentially serious impact, this constitutes at this stage a public health event of concern”, indicates the European Center for Disease Control and Prevention. (ECDC) in its first public risk estimate since the onset of the disease.
First reported in Scotland at the end of March, the number of cases recorded worldwide is currently 191 (111 in the United Kingdom, 55 in 12 other European countries, 12 in the United States, 12 in Israel and 1 in Japan), according to the ECDC.
“The disease is quite rare and evidence of human-to-human transmission remains unclear. Cases in the European Union are sporadic with an unclear trend,” notes the agency responsible for diseases and epidemics.
The risk to children in Europe “cannot be estimated precisely”, according to the agency, which covers the 27 EU countries as well as Norway, Iceland and Liechtenstein.
“However, considering the reported cases of acute liver failure, with cases requiring transplantation, the potential impact for the pediatric population is considered high,” she says.
Affected children ranged in age from one month to 16 years old, but most were under 10 years old, and many under 5 years old. None had comorbidities.
The main working “hypothesis” is that the disease is linked to adenoviruses, fairly commonplace and known viruses, which generally cause respiratory, ocular and digestive symptoms.
“An adenovirus infection, which would be mild under normal circumstances, would trigger a more severe infection or immune-mediated liver injury,” according to this lead.
Other causes, including toxic, “are still under investigation and have not been ruled out, but are considered less plausible,” according to the ECDC.
The agency recommends that countries improve their surveillance to detect cases.
As the cause of the disease remains unknown, “effective control measures cannot be defined at this stage”. But the agency recommends “reinforcing good hygiene practices” (cleaning hands and surfaces “in places frequented by young children”.
