Last week, hundreds of liver health experts gathered for the World Hepatitis Summit, and one topic was dominating the agenda: the mysterious outbreak of hepatitis in children that had gradually spread to 34 countries – including the UK.
Speaking at the event, Liver Expert Dr Philippa Easterbrook said: “It is the first time that many severe cases have been seen in children. It is important to understand the cause and take these cases seriously.
At its most extreme, hepatitis can cause the liver to stop working. So far, more than 240 cases have been reported in the UK, while 11 British children need a transplant.
What could be behind this is a topic that divides the scientific world. But the latest development comes from the imagination of research by Israeli scientists that suggests the answer may lie in Covid-19.
Last week, hundreds of liver health experts gathered for the World Hepatitis Summit, and one topic dominated the agenda: the mysterious outbreak of hepatitis in children that had gradually spread to 34 countries – including the UK
Some experts have claimed that there may be a link between the outbreak of the mystery and the Covid 19 virus
Doctors analyzed the medical histories of five children who had this condition – dangerous hepatitis.
They noticed one thing in common: they all had Covid within the previous year. They suggested that hepatitis may be a severe side effect of the immune system’s response to the virus.
Influential doctors have taken to Twitter to share news of the results, coining the phenomenon of ‘Covid’s long-liver’. British epidemiologist Dr Dipti Gordasani of Queen Mary University of London wrote on Twitter with her confidence in the findings, accusing some of those who rejected them of being “denying the harm that Covid has done to children”. However, many well-respected child health experts and epidemiologists have disputed these claims.
Professor Alasdair Munro, an expert in pediatric infectious diseases at Southampton University Hospital, said the study provided ‘almost useful information’ and no evidence that these cases of hepatitis are linked to Covid.
While Dr Jake Dunning, an infectious disease expert at Oxford University, said the scientists who described the disease as Covid’s long-liver ‘should really know better’.
The prevailing theory is that a bad strain of a common childhood infection called adenovirus is to blame – three-quarters of children admitted to British hospitals have tested positive for this type.
Most children get infected at some time, but it usually causes minor upper respiratory problems, leading to coughing, a runny nose, and, in rare cases, pneumonia.
But experts believe the lack of exposure to adenoviruses during the Covid lockdowns has left children’s immune systems without natural protection to fight them off, triggering a severe reaction. However, the new allegations may raise concern among parents – could they be right?
On the surface at least, the Israeli research appears compelling. The report, published in the Journal of Pediatric Gastroenterology and Nutrition, tells of five patients: two three-year-olds who required a liver transplant, two eight-year-olds and a 13-year-old who were hospitalized but made full recovery. All five had contracted Covid within the four months before they were diagnosed with hepatitis.
The authors say their findings suggest that the Covid infection caused the immune system to malfunction and began attacking the liver. This is not unheard of in other viral infections, in which case it is known as postviral hepatitis, and is a well-recognized condition in children.
Dr Gordasani, the vocal proponent of the long-liver theory of Covid, says another piece of evidence is the fact that the UK and US have had the highest number of hepatitis cases. Both had very high infection rates among children, unlike many other countries that have imposed strict Covid safety measures in schools.
Dr Gordasani says: ‘The UK was far from how we tried to protect children from the virus. We haven’t mandated masks to be worn in the same way as other countries, nor have we done anything to ventilate schools. We may be seeing the impact of those decisions.
The study also casts doubt on another possible cause: the adenovirus was not detected in any of the five patients. And it’s not the only study of its kind that has reached this conclusion. At the end of April, doctors in Alabama published research indicating that the virus was absent in nine children who had acute hepatitis and required a transplant.
Several scientists have pointed out that adenovirus has not previously been linked to hepatitis – in fact, not a single case of adenovirus that causes hepatitis has been reported in the medical literature. “The argument made by the adenovirus is getting weaker and weaker,” says Dr. Gordasani. It does not cause hepatitis and several studies have failed to find it in the livers of these children. Where is the evidence?
But experts say there are multiple problems with the Israeli study. Eldest: Only five children.
Israel recorded 12 cases of hepatitis infection in children, so the study includes less than half of these patients.
“The researchers do not explain why these patients were selected, or why other hepatitis cases were not selected,” says Professor Munro. We don’t know if they only picked those who had Covid, so this doesn’t say how likely it is for a child who gets Covid to get hepatitis.
Professor Munro also points out that given the prevalence of Covid, it is not surprising that these children will necessarily have Covid infection. Covid infection is very common, the time interval between infection of these children with the virus and then hepatitis is very diverse, and there is no clear evidence that one causes the other. This does not mean that Covid and hepatitis are unrelated, but this study does not provide any concrete evidence of that.
Professor Will Irving, a virologist at the University of Nottingham, agrees that it is too early to jump to conclusions. He says: “Five is not enough to prove anything, we need to look carefully at the number of Covid cases out of several hundred in the UK and go from there. ”
To add to the confusion, US health officials said last week that while the country has seen more than 270 cases of unexplained hepatitis in children this year, that’s no more than you’d see in a typical year. “There has always been a level of background to these unexplained cases, even before Covid,” says Professor Irving.
The one thing that all experts agree on is that finding the cause remains an urgent task as it will help doctors know what treatment to give. In the UK, children with hepatitis in hospital are treated for adenovirus – with the antiviral drug cidofovir. But other countries, such as Israel and Austria, treat them with steroids, which can help regulate a malfunctioning immune system that may be affected by the Covid virus.
Gordasani warns: If the adenovirus theory is wrong, we’ve been giving patients the wrong treatment for months. UK health officials need to focus on the Covid theory if they want to protect children.