The European Center for Disease Prevention and Control said the number of unusual pediatric hepatitis cases has reached 450, double the number reported two weeks ago.
The European Center for Disease Prevention and Control said the number of unusual pediatric hepatitis cases has reached 450, double the number reported two weeks ago.
Hepatitis is an inflammation of the liver. The unusual cases in children have been reported in more than 25 countries, although about 160 of them are in the UK and approximately 110 in the United States. The incidents have mostly affected children under the age of 5. In the U.S., more than 90% have been hospitalized, with 14% receiving liver transplants. Five potentially related deaths are being investigated by the U.S. Centers for Disease Control and Prevention.
Experts aren’t certain what is causing these cases. The top theory is that they are caused by an adenovirus, which more typically causes cold- or flu-like symptoms and potentially stomach issues. Most research is currently focused on adenovirus type 41, which has been identified in most of the European and many U.S. cases. Typically, adenovirus type 41 causes an upset stomach, not hepatitis.
Tissue and liver samples obtained in the U.K., according to Dr. Phillipa Easterbrook, a senior scientist at the WHO, said they do not “show any of the typical features you might expect with a liver inflammation due to adenovirus, but we are awaiting further examination of biopsies.”
The CDC notes that adenovirus type 41 is primarily spread by way of the fecal-oral route and typically affects the gut. It is a common cause of pediatric acute gastroenteritis, which causes diarrhea, vomiting and fever. There are often respiratory symptoms. It is associated with hepatitis in immunocompromised children.
The focus is on adenoviruses, specifically type 41, but researchers haven’t ruled out other potential links. It’s possible that the COVID-19 pandemic is associated with these cases, although there is no evidence that SARS-CoV-2, the virus that causes COVID-19, causes hepatitis in children. The primary association with adenovirus type 41 is that it has been identified in many of the childhood cases, but whether it is a cause or some sort of opportunistic infection is not yet clear.
“Although adenoviruses can cause hepatitis, it is uncommon in adenovirus type 41, which was found in a cluster of children with hepatitis in Alabama,” said Dr. Rima Fawaz, M.D., a Yale Medicine pediatric transplant hepatologist. “Most of the cases have occurred in children under age 5, who have not received vaccination” against COVID-19.
The first cases were identified in October 2021 at an Alabama hospital. The children were diagnosed with significant liver disease, including some with liver failure. All the children tested negative for hepatitis A, B and C, but were positive for adenovirus. All patients were previously healthy and came from different parts of the state. Eventually, there were nine reported cases in the state. None had any indications of COVID-19 infection before or during hospitalization.
In the U.S., about 50% of reported pediatric hepatitis cases since October 2021 have been associated with adenovirus.
Shelton, CT-based NanoViricides has launched a program to screen its library of broad-spectrum antiviral nanoviricides against adenovirus type 41. The company focuses on anti-viral therapies and its top priority is launching human clinical studies of NV-CoV-2 on COVID-19. It had previously developed a drug candidate that in animal assays was effective against adenoviral Epidemic Kerato-Conjunctivitis (EKC).
NanoViricides believes it can develop a drug against the adenovirus in a “relatively short period of time, if one or more of its existing pipeline candidates or other nanoviricide candidates in its drug candidate library are found to be effective.”
