Is Covid 19 to blame for an outbreak of hepatitis in UK children?

Last week, hundreds of liver health experts gathered for the World Hepatitis Summit and one topic dominated the agenda: the mysterious outbreak of childhood hepatitis that has gradually spread to 34 countries – including the UK.

liver expert dr. Philippa Easterbrook said at the event: “It is the first time that so many serious cases have been observed in children. It is important that we understand the cause and take these cases seriously.”

In extreme cases, hepatitis can cause the liver to stop working. So far, more than 240 cases have been reported in the UK, while 11 British children have required a transplant.

Behind this could be a topic that divides the scientific world. But the latest development comes from fascinating research by Israeli scientists that suggests the answer may lie with Covid-19.

Doctors analyzed the medical histories of five children who developed this disease – a dangerous inflammation of the liver.

They noticed one thing in common: everyone had been infected with Covid in the previous year. The liver inflammation, they suggested, could be an extreme side effect of the immune system’s response to the virus.

Influential doctors took to Twitter to share news of the findings, coining the ‘long Covid liver’ phenomenon. British epidemiologist Dr. Deepti Gurdasani of Queen Mary University of London tweeted her confidence in the results and accused some who dismissed them of “denying the harm Covid has done to children”. But numerous well-respected child health experts and epidemiologists have furiously denied the claims.

Professor Alasdair Munro, an expert in pediatric infectious diseases at Southampton University Hospital, said the study provided “almost no useful information” and no evidence that these hepatitis cases were linked to Covid.

while dr Jake Dunning, an infectious disease expert at Oxford University, said scientists who brand the disease long Covid liver “should really know better”.

The prevailing theory is that a nasty strain is to blame for a common childhood infection called adenovirus – three quarters of children admitted to UK hospitals have tested positive for the variant.

Most children get the infection eventually, but it usually causes only minor upper respiratory problems, resulting in coughing, runny nose, and in rare cases, pneumonia.

But experts believe a lack of exposure to adenoviruses during the Covid lockdowns has left children’s immune systems without natural protection to fight them off, leading to a severe reaction. Still, the new claims could reignite parents’ concerns – so could they be right?

At least on the surface, the Israeli research appears convincing. The report, published in the Journal Of Pediatric Gastroenterology And Nutrition, tells of five patients: two, three years old, who required liver transplants, and two, eight-year-olds and one, 13-year-old, who were hospitalized but made a full recovery. All five were infected with Covid within the four months prior to their hepatitis diagnosis.

The authors say their findings suggest that Covid infection caused the immune system to malfunction and started attacking the liver. This is not uncommon in other viral infections, and when it occurs it is known as postviral hepatitis, a recognized childhood disease.

dr Gurdasani, a vocal supporter of the long-running Covid-liver theory, says further evidence is the fact that Britain and the US have seen the largest number of hepatitis cases. Both had very high rates of infection among children, in contrast to many other nations which have enforced strict Covid safety measures in schools.

“The UK has been an outlier in our attempt to protect children from the virus,” says Dr. Gurdasani. “We haven’t enforced mask-wearing like in other countries, and we haven’t done anything to ventilate schools. It is possible that we will see the impact of these decisions.

The study also casts doubt on the other likely cause: no adenovirus was detected in any of the five patients. And it’s not the only study of its kind that has come to this conclusion. In late April, doctors in Alabama released research finding the absence of the virus in nine children with severe hepatitis who needed a transplant.

And many scientists have pointed out that adenovirus has never been linked to hepatitis before – in fact, there is not a single case in the medical literature of adenovirus causing hepatitis. “The argument that this is caused by an adenovirus is becoming weaker,” says Dr. Gurdasani. “It doesn’t cause hepatitis, and several studies have failed to detect it in the livers of these children. So where is the evidence?’

But experts say there are several problems with the Israeli study. The biggest thing: There are only five children.

Israel has registered 12 cases of hepatitis in children, so the study includes less than half of these patients.

“The researchers do not explain why these patients were selected or why the other hepatitis cases were not selected,” says Prof. Munro. “We don’t know if they only picked those who had Covid, so that doesn’t say how likely it is that a child who develops Covid will develop hepatitis.”

Prof Munro also points out that given Covid is so widespread, it is not necessarily surprising that these children had Covid infections. “Covid infections are so common and the time lag between the virus and hepatitis in these children is so variable that there is no clear evidence that one causes the other. That’s not to say that Covid and hepatitis aren’t linked, but this study doesn’t provide any concrete evidence.”

Prof Will Irving, a virologist at the University of Nottingham, agrees it’s too early to jump to conclusions. He says: “Five cases are not enough to prove anything. We need to look closely at how many of the several hundred cases in the UK have had Covid and move on from there.”

Adding to the confusion, US health officials said last week that while the country had seen more than 270 cases of unexplained hepatitis in children this year, that was no more than a normal year. “There was always a background level of these unexplained cases even before Covid,” says Prof Irving.

All experts agree that finding the cause remains an urgent task as it will help doctors find the right treatment. In the UK, children hospitalized with hepatitis are treated for adenovirus – with the antiviral drug cidofovir. But other countries like Israel and Austria are treating them with steroids, which can help regulate a malfunctioning immune system potentially affected by Covid.

dr Gurdasani warns: “If the adenovirus theory is wrong, we have been giving patients the wrong treatment for months. UK health officials need to focus on the Covid theory if they are to protect children.”