PAHO Investigates Causes of Acute Childhood Hepatitis

The Pan American Health Organization (PAHO) published new guidelines to help identify the causes of the recent acute childhood hepatitis cases, which have emerged in various countries including Mexico. 

“Although it is a severe disease in children and of concern, its occurrence remains rare,” said Rubén Mayorga, Head of Tuberculosis, HIV, Hepatitis and Sexually Transmitted Infections, PAHO. However, he highlighted the importance of keeping up with protective measures to control the disease “we must continue to monitor the situation and investigate probable cases.”

Many propositions have emerged to determine the origin of these cases. Some avenues of research include toxicology, dietary, immunological, environmental and infectious factors but the disease’s origins have not been determined. A test to verify the origin of these cases is necessary to create public health policies and measurements to prevent new cases. 

There have been at least 869 new cases between Oct. 1, 2021, and until June 16, 2022, all of them in children and teenagers under 16 years of age and with no previous health issues that could be related. Although there have been cases in 33 countries around the world, 368 of them have been in the American continent and the vast majority of them (290 cases) were detected in the US. 

In Mexico, the first cases were detected in Nuevo Leon in the first two weeks of May. “We are aware of the patients that have been diagnosed with hepatitis in both private and public institutions. They are children from different ages. We are monitoring them to evaluate how they develop and will share with you the complete information,” said Nuevo Leon’s Ministry of Health, as reported by MBN. 

PAHO’s new guidelines evaluate the most viable causes of this disease and introduce a laboratory algorithm to rule out the most frequent causes of viral hepatitis (A, B, C, D and E) and other diseases that can cause similar symptoms, such as malaria, yellow fever and leptospirosis. 

“There have been rare cases, however, of severe adenovirus infections that have caused hepatitis in immunocompromised–or transplant patients, for example. However, these children do not match that description–they were previously healthy,” said Leandro Soares, Advisor for Hepatitis Prevention and Control, PAHO.

The human adenovirus is generally responsible for mild and self-limited gastrointestinal or respiratory infections in children. After discarding this possibility, the PAHO guideline recommends additional test in the respiratory panel, enterobacteria and for the less frequent pathogens. Jairo Méndez, Regional Advisor, PAHO, explained that “these guidelines are intended to help gather information to define the most likely cause of this hepatitis” while also explaining the different outcomes that this investigation can have. The cause “may be multifactorial, it may be something that is triggered in conjunction with other infectious, toxic or metabolic causes, but we still do not know, so it is important to analyze the probable cases and shed a little more light on the research,” said Méndez.