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Severe acute pediatric hepatitis of unknown origin: Update as of June 28, 2022

Update as of June 28, 2022, following reports of acute pediatric hepatitis cases in France and internationally. A case definition for healthcare professionals and guidelines on how to proceed are available on our website.

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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 was established in France to detect any similar cases within the country. An initial case definition for healthcare professionals was thus published on May 3, 2022. Today, based on evolving knowledge and following further discussions with its network of partners (clinicians, laboratory professionals), Santé publique France is updating the case definition to improve its sensitivity and to be able to identify less severe cases, which may be more numerous. Additionally, the recommended actions have been updated to reflect this new case definition.

Cases of acute pediatric hepatitis: Update as of June 28, 2022, in France and internationally

In France:

Eight possible cases have been reported, and four are currently under investigation by medical teams in collaboration with Santé publique France. The occurrence of these cases is not unexpected and does not, at this stage, indicate an excess of cases in France. Data from the OSCOUR® network on emergency department visits for hepatitis of unknown etiology are very stable and do not indicate any excess of cases.

Internationally:

  • As of June 16, 2022, 180 cases of acute hepatitis of unknown origin in children aged 16 or younger have been reported by 16 European countries.

  • As of June 21, 2022, 258 cases of acute hepatitis of unknown etiology have been identified in children aged 10 or younger in the United Kingdom.

  • As of June 22, 2022, a total of 920 probable cases had been reported by 33 countries across five WHO regions; however, it is not currently possible to determine whether these represent an excess of cases or whether they reflect the usual number of cases in most countries.

This update will be revised if there are significant developments in the situation in France.

A reporting system for suspected cases to complement syndromic surveillance

The formalized system for reporting and investigating possible cases, established in collaboration with the Ministry of Health, relies on a network of clinicians and laboratories, including the four liver transplant centers (Necker, Bicêtre, Marseille, Lyon) and pediatric intensive care units. Its objective is to detect any potential signal within the country similar to that observed in the United Kingdom.

The system is based on a new case definition 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). The protocol for managing cases of severe acute hepatitis in children under 18 has consequently been updated and distributed by the Ministry of Health to the relevant healthcare professionals.

In addition, Santé publique France continues to regularly analyze:

  • emergency department visit data 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 under 18 years of age, in order to identify any unusual increase in such cases in the recent period;

  • hospitalization data (PMSI) to detect any potential increase in the number of hospital stays consistent with acute hepatitis of unknown origin (data currently available through the end of January 2022).