Severe acute pediatric hepatitis of unknown origin: Update as of April 29, 2022
Following the report shared by the United Kingdom regarding cases of severe acute hepatitis of unknown origin in young children, a standardized reporting system involving a network of clinicians and laboratories has been established to detect any similar cases within the country. A case definition and a protocol describing the reporting and specimen collection process were established in collaboration with the networks of clinicians and laboratory professionals consulted by the agency.
Since this news item was published, a new case definition and guidelines have been released. To view them, click here.
Cases of Acute Hepatitis in Children: Actions Taken Immediately Upon Notification from the United Kingdom
On April 8, 2022, Santé publique France was alerted to an unusually high number of cases of severe acute hepatitis in children in the United Kingdom with no identified cause, notably without the children being carriers of hepatitis A, B, C, D, or E viruses.
Upon receiving this report, Santé publique France contacted its partners in the national public health network: the Francophone Group for Pediatric Intensive Care and Emergency Medicine, the French Society of Pediatrics, the French Society of Hepatology, and the National Reference Centers for Hepatitis B/C/delta, Hepatitis A/E, gastroenteritis viruses, and respiratory infection viruses.
In addition, Santé publique France also conducted an analysis:
data on emergency department visits from the OSCOUR® network for a selection of diagnostic codes consistent with acute hepatitis of unknown etiology (excluding, in particular, viral hepatitis A through E) in children aged 0 to 17 years between 2018 and April 24, 2022, to identify any unusual increase in these cases in the recent period;
hospitalization data (PMSI) between 2018 and January 2022 to detect a possible recent increase in the number of hospital stays consistent with acute hepatitis of unknown etiology.
At this stage, no excess of emergency department visits or hospital stays has been identified nationwide since January 1, 2022, compared to previous years (2018–2021).
Two cases of acute hepatitis (in children under 10 years of age) whose origin is still undetermined have been reported by the Lyon University Hospital. Investigations into acute hepatitis of unknown origin are complex (infectious, toxic, metabolic, autoimmune causes, etc.) and therefore sometimes lengthy; for both patients, investigations are still ongoing by medical teams, in collaboration with Santé publique France. It is not currently possible to determine whether these cases are linked to the outbreak observed in the United Kingdom.
Establishment of a reporting system for possible cases
A system for reporting and investigating potential cases has now been formalized, in collaboration with the Ministry of Health, with the aim of detecting any potential signal within the country similar to the one observed in the United Kingdom.
It relies on a network of clinicians and laboratories, including the four liver transplant centers (Necker, Bicêtre, Marseille, Lyon) and pediatric intensive care units, and enables standardized reporting of information.
As there has been no confirmation to date in France of a signal similar to that reported by the United Kingdom, the system relies on a more specific case definition than that of the United Kingdom. It was developed in collaboration with pediatric hepatologists and the three National Reference Centers involved (for viral hepatitis B/C/Delta, gastroenteritis viruses, and respiratory infection viruses). Finally, guidelines on how to proceed in cases of severe acute hepatitis in children under 18 have been developed and distributed by the Ministry of Health to the relevant healthcare professionals.
Cases of acute pediatric hepatitis: Update as of April 29, 2022, in France and internationally
In France:
Two patients meeting the case definition developed by the United Kingdom have been reported by the Lyon University Hospital and are still under investigation by medical teams, in collaboration with Santé publique France.
Internationally:
As of April 28, 2022, according to the ECDC’s Rapid Risk Assessment (RRA), 166 cases of acute hepatitis of unknown etiology in children aged 1 month to 16 years have been reported in 12 European countries (55 cases) and the United Kingdom (111 cases) and are currently under investigation to determine whether the cause is infectious, toxicological, or environmental. This RRA notes that four countries reported a higher-than-expected number of cases of severe acute hepatitis of unknown etiology in children during the period from October 1, 2021, to April 21, 2022: the United Kingdom, the Netherlands, Ireland, and Denmark.
