Seven probable cases of severe acute hepatitis have been reported over a six-month period at one of Canada's major children's hospitals, as an unexplained outbreak of severe cases affects young, healthy children around the world.
Hepatitis is an inflammation of the liver. Acute hepatitis occurs when the liver function is impaired for less than six months and becomes chronic hepatitis when the inflammation lasts longer.
Ten cases of unexplained hepatitis in children were first reported in Scotland in early April. In a briefing, the World Health Organization (WHO) said on Tuesday that there are now 348 probable cases of acute hepatitis in children across five regions globally.
The Hospital for Sick Children in Toronto reported Monday that it had come across seven cases that met Public Health Ontario's case definition of acute hepatitis, but could not confirm if any of the cases were “caused by a novel clinical entity."
In Manitoba on Tuesday, Shared Health also confirmed one pediatric case of severe acute hepatitis in recent weeks.
In a statement to CTV News, the Public Health Agency of Canada (PHAC) confirmed an ongoing investigation into the rising number of hepatitis cases, both in Canada and internationally, though it remains unclear if the cases in Toronto are part of the unexplained global outbreak.
The cause of the cases of hepatitis among children around the world also remains unclear.
Dr. Curtis Cooper, director of the Ottawa Hospital and Regional Hepatitis Program, and a scientist in the Ottawa Hospital Research Institute’s Clinical Epidemiology Program believes it is unlikely the rise in hepatitis cases among children is connected to COVID-19.
“Only a very small proportion of kids were positive for (COVID) at the time that they presented with sick livers, so it seems unlikely that that's the cause for this. Many of these kids who were completely free of COVID, still got sick with (hepatitis),” he told CTV’s Your Morning on Wednesday.
CTV News medical specialist Dr. Marla Shapiro says that the typical viral causes associated with acute hepatitis are usually hepatitis A, B, or C, but none have been found thus far.
“There has been some association worldwide with adenovirus, which is a fairly common virus. (But) we really don't know what the common denominator here is. And what is causing these severe cases,” Shapiro told CTV News Channel on Tuesday.
Current investigations suggest a link to an adenovirus, according to the WHO and ECDC. Adenoviruses can spread from person to person, causing a range of illnesses including colds, pinkeye and gastroenteritis.
Officials say there has been a recent rise in adenovirus infections, particularly in the U.K.
Close to half of the hepatitis cases, including those in the U.S., have been tied to an adenovirus, with lab tests indicating some children were infected with the type 41 associated with gastroenteritis, causing diarrhea and vomiting. At least 19 cases also involved a COVID-19 co-infection.
Most of the unexplained cases in children have been mild, but the WHO has reported that the outbreak has also led to 17 liver transplants around the world, and at least one death has been reported in the U.K.
Dr. Dina Kulik, a Toronto-based pediatrician, advises parents not to panic.
“So we have seen over 200 cases of severe acute hepatitis around the world. That being said, there are millions and millions of children around the world. So while 200 plus cases are concerning, and definitely something to look into and be alert to, it isn't something we need to panic about at this point,” she told CTV News Channel on Tuesday.
Kulik did note that hepatitis symptoms can be mistaken for stomach flu or even COVID-19, with children experiencing fever, vomiting, diarrhea and stomach pain.
“But in particular, different from typical stomach flu kind of symptoms, kids will develop jaundice which is a yellow discoloration of the skin and yellow discoloration of the white of the eyes,” she said, adding that cautionary measures to prevent cases are hard to prescribe with the official cause still unknown.
The PHAC has not confirmed if there is an increase in the number of cases of acute hepatitis in Canada, but says they are “prepared to carefully and thoroughly investigate any cases reported that meet the national case definition.”
PHAC also recommends that parents should look out for symptoms that also include dark urine, loss of appetite, and light-coloured stools.
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