Could Long Covid in Kids Lead to Hepatitis?

Basic info and questions on the Children's hepatitis outbreak

Hey Guys,

I sometimes cover global news and the weird children’s Hepatitis outbreak while extremely rare, is most concerning. It’s also a medical mystery thus far in the reported hepatitis outbreak we appear to be experiencing all around the world.

Hepatitis — which refers to inflammation of the liver — is rare among children. It's typically caused by the family of hepatitis viruses, but can also be sparked by alcohol use, exposure to toxins, or other pathogens.

The cases identified by health officials around the world in recent months don't appear to have any of those usual causes.

However globally a new cluster of cases of inflammation of the liver (where 10-15% need liver transplants) points to a likely impact of long-covid on Children. Since it is new and global, Covid-19 in some way is the most likely explanation, but nothing has been proven of its origin.

Acute Pediatric Severe Hepatitis of unknown origin by country

While diagnosis of the new condition is extremely rare, this also means it’s likely going undiagnosed.

Hepatitis is a viral disease that causes inflammation and damage to the liver. There are several types of hepatitis. Children are more likely to get hepatitis A and hepatitis B, but these diseases are becoming less common in children in the U.S. because of vaccinations.

The US Centers for Disease Control and Prevention is investigating cases of unexplained hepatitis in children. As many as 109 cases are under investigation. However in many countries even as far as Japan there have also been new cases, mostly since around October, 2021.

The WHO’s statement on this is pretty confusing. It said recently: “It is not yet clear if there has been an increase in hepatitis cases, or an increase in awareness of hepatitis cases that occur at the expected rate but go undetected. While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent.” However the WHO has a very strange case of late realizations when it comes to emerging new diseases like we saw with Covid-19 and its manifold variants.

Even as of two weeks ago in late April, 2022 cases have been reported in the United Kingdom of Great Britain and Northern Ireland (the United Kingdom) (114), Spain (13), Israel (12), the United States of America (9), Denmark (6), Ireland (<5), The Netherlands (4), Italy (4), Norway (2), France (2), Romania (1), and Belgium (1).

Hepatitis is an inflammation of the liver. Acute hepatitis is when the liver function is impaired for less than six months, while chronic hepatitis is when the inflammation lasts longer. Ten cases of unexplained hepatitis were first reported in Scotland in early April.

The cause of the cases of hepatitis among children remains unclear. It is my reasonable speculation that these new emerging cases are in some way related to Covid-19 in Kids.

What do you think?

There has been some association worldwide with adenovirus, which is a fairly common virus. Some of these children have tested positive for COVID-19 as well, but we don't really think that this is a link to COVID.

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 type 41, which is associated with gastroenteritis, causing diarrhea and vomiting. At least 19 cases also involved a COVID-19 co-infection.

Photo by Alvin Mahmudov on Unsplash

Signs and Symptoms

The clinical syndrome among identified cases is acute hepatitis (liver inflammation) with markedly elevated liver enzymes. Many cases reported gastrointestinal symptoms including abdominal pain, diarrhea and vomiting preceding presentation with severe acute hepatitis, and increased levels of liver enzymes (aspartate transaminase (AST) or alanine aminotransaminase (ALT) greater the 500 IU/L) and jaundice.

• Acute hepatitis

• Markedly elevated liver enzymes

• Abdominal pain

• Diarrhea

• Vomiting

• Increased levels of AST or ALT > 500 IU

• Jaundice

Why Experts are Concerned

Most cases did not have a fever. The common viruses that cause acute viral hepatitis (hepatitis viruses A, B, C, D and E) have not been detected in any of these cases.  International travel or links to other countries based on the currently available information have not been identified as factors.

Experts say that a lack of a cause is concerning because the severity of hepatitis is often determined according to its cause, as while some of the unexplained cases in kids have been mild, others have required liver transplants.

The U.K. has seen more than 160 cases. We know Covid-19 has circled widely in the United Kingdom.

The WHO reported that there are cases as well in India, Israel, South East Asia, Ireland, Holland and several other European countries. There are reports of a significant increase in these cases, and the severity of the liver inflammation has also been noted.

Researchers are looking at evidence that links the liver inflammation to adenovirus infections — colds, flu and other common ailments — and to COVID-19, or a combination of both. Many children of course have not had access to Covdi-19 vaccines during the past two years.

Apparently it’s not just my suspicious I found some reports that there is a growing body of evidence that this hepatitis in children may be a post-viral (i.e., post-COVID) issue. According to the WHO, the majority of cases it reviewed are in children who are not vaccinated.

As the Journal of Paediatric Gastroenterology & Nutrition reported this month, a three-year-old with acute liver failure (due to type 2 Autoimmune Hepatitis Associated With SARS-CoV-2 Infection) was successfully treated with steroids, avoiding the need for a liver transplant.

The researchers wrote: “This case highlights a possible association between SARS-CoV-2 infection and subsequent development of autoimmune liver disease, presenting with acute liver failure.”

The paper addresses evidence of a connection between Covid (SARS-CoV-2) and several autoimmune diseases, concluding: “Although it is impossible to directly prove that SARS-CoV-2 infection caused Autoimmune Hepatitis in this patient, the temporal association of infection with subsequent liver failure cannot be ignored.”

I’m not sure why we ever brought up the adenovirus as a potential cause. This is because severe illness caused by adenoviruses is almost always seen in the immunocompromised. Just as we have seen various weird symptoms of Long covid, including brain shrinkage (usually with prolonged brain fog) it’s not unthinkable to assume that in rare cases it could lead to hepatitis among unvaccinated kids.

Hopefully we’ll know more soon guys,

Have a good week!