Viruses (May 2024)

The Outbreak of Unexplained Acute Hepatitis in Children: The Role of Viral Infections in View of the COVID-19 Pandemic

  • Eyal Shteyer,
  • Orna Mor,
  • Orith Waisbourd-Zinman,
  • Yael Mozer-Glazberg,
  • Ronen Arnon,
  • Lior Hecht Sagie,
  • Michal Mandelboim,
  • Oran Erster,
  • Merav Weil,
  • Sara Dovrat,
  • Lital Goldberg,
  • Yael Gozlan

DOI
https://doi.org/10.3390/v16050808
Journal volume & issue
Vol. 16, no. 5
p. 808

Abstract

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Background and Aims: An increase in the number of cases of acute hepatitis of unknown origin (HUO) in children was observed in 2021. Adenovirus and adeno-associated virus 2 (AAV2) infections have been suggested as possible triggers. However, the potential etiology is still unclear. We aimed to characterize a cohort of children with HUO in Israel in view of the COVID-19 pandemic. Method: Demographics, clinical data, and laboratory results on the children compatible with the CDC criteria for HUO were collected by the established registry of the Ministry of Health. Available specimens were sent to the Central Virology Laboratory. Results: A total of 39 children were included in the registry. A total of 20 were enrolled prospectively, in which human herpes virus 6 (HHV6) infection or reactivation was identified in 11/19, adenovirus was found in 4/19 of the cases, and AAV2 was detected in 2/16. Past COVID-19 exposure was recorded for 24/39 of the children. A total of 10 children underwent liver biopsy, and 8 were successfully treated with steroids and 2 underwent liver transplantation. Conclusions: The COVID-19 pandemic and the related containment measures combined with reactivation or active infection with other viruses could have been a trigger for the HUO outbreak. In our cohort, HHV6 was the most abundant finding.

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