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Severe acute pediatric hepatitis of unknown origin: Update as of June 7, 2022

Update as of June 7, 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 enable the identification of 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 7, 2022, in France and internationally

In France:

Seven possible cases have been reported, and six 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.

Internationally:

  • As of May 30, 2022, 146 cases of acute hepatitis of unknown origin in children aged 16 or younger have been reported by 13 European countries.

  • As of May 25, 2022, 222 cases of acute hepatitis of unknown etiology have been identified in children aged 10 or younger in the United Kingdom.

  • Possible or pending cases have been reported in 13 other countries as of May 26, 2022, although it is not currently possible to determine whether these represent an excess of cases or whether they are within the usual range of cases in most countries.

  • As of May 26, 2022, a total of 650 cases had been reported worldwide.

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).