EASL Statement on cases of severe acute hepatitis in children of unknown causes

EASL concurs with experts that the common viruses that cause acute viral hepatitis have not been detected in these patients. It is also in agreement with other authorities that at this stage with the information we have, international travel or links to other countries, based on the currently available information, have not been identified as important factors. 

Collaboration 

Though these cases are rare events, EASL welcomes the serious consideration of this outbreak being undertaken by scientific and medical institutions and public health authorities across the affected countries and regions. The severity of the acute hepatitis in some cases that has led to hospital admission and even liver transplants is a major public health concern. 

EASL itself is working on increasing awareness around the cases and is collaborating very closely with the European Centre for Disease Prevention and Control (ECDC) on investigating the l causes and characteristics of the cases and categorising them for purposes. The priority at present is to determine the cause of the illness to be better able to refine prevention, diagnosis and treatment of the disease. 

EASL believes that we have not seen many deaths so far is because the health systems in the affected countries have responded very well: the children have been attended by liver units that have active liver transplantation programs. Without liver transplantation some of them would have died.  

Causes 

One of the leading hypotheses is that it is caused by adenovirus, which is a group of common viruses spread from person-to-person causing respiratory symptoms, vomiting and diarrhoea in children. Adenovirus can cause acute hepatitis, but it is very unusual that by itself it may have caused the severe acute hepatitis that we are seeing in these cases. There could be other factors at play as UK heath officials are suggesting and which need further investigation: 

• increased susceptibility among young children following a lower level of circulation of adenovirus during the COVID-19 pandemic
• the potential emergence of a novel adenovirus 
• SARS-CoV-2 co-infection  

Treatment 

Acute hepatitis caused by the known hepatitis viruses, hepatitis B, C or E virus, can be treated with antiviral drugs. However, there is no specific treatment for acute hepatitis currently occurring in children. 

Prevention 

EASL supports a range of measures to help protect against common viruses: parents can supervise good handwashing and encourage good respiratory hygiene, such as covering up a cough or sneeze. 

The coming weeks 

EASL believes that it is highly likely that we will see more case evolve in the near future and it is working to identify additional cases, both in currently affected countries and elsewhere.