Acute liver inflammation (hepatitis) of unknown origin in children: Cross-survey of the European Reference Network ERN RARE-LIVER

There has been concern regarding the frequency of unexplained cases of acute liver inflammation in children, especially in the United Kingdom (UK). In response, the European Reference Network on Hepatological Diseases (ERN RARE-LIVER) decided to conduct a thorough investigation. Conclusions from a survey conducted over 34 paediatric specialist liver centers from 22 European countries do not confirm the alarming observations from the UK in other European countries.

The World Health Organisation (WHO) has recently reported that there has been increased incidence of unexplained acute liver inflammation in children since January 2022. Several children required emergency liver transplantation. Scientific discussion centered around adenovirus as a possible cause.

To address these concerns about a true rise in cases, the ERN RARE-LIVER conducted a survey in collaboration with the working group on acute liver failure. While clinicians have raised awareness about the possibility of hepatitis of unknown origin, results indicate that only a minority of patients carry an actual infection with adenovirus within the whole group of children with acute hepatitis. Collectively, the alarming observations from the United Kingdom could not be confirmed.

“The initial figures put our minds at ease, but it is important to keep an eye on further developments,” said Dr. Dominic Lenz from the Centre for Paediatric and Adolescent Medicine at the Heidelberg University Hospital, and leader of the ERN RARE-LIVER working group for acute liver failure. A similar statement was provided by Dr. Ruben de Kleine, from the Section for Surgery, Hepatobiliary Surgery and Liver Transplantation at the University Medical Center Groningen in the Netherlands. He is leading this project within the working group of acute liver failure. “We have a very limited number of children with a possible role for the adenovirus in a much larger group of children with acute liver failure. We recognize this clinical entity of acute liver failure from the previous years and we know how to deal with it. We should monitor carefully whether the numbers increase and look more closely into the cases that we have documented.”

ERN RARE-LIVER Coordinator, Prof. Ansgar W. Lohse, Clinic Director of the I. Department of Medicine at the University Medical Centre Hamburg-Eppendorf adds, “It is likely that lockdown and other pandemic restrictions implemented internationally have led to changes in children’s immune systems and their ability to defend against common viruses. There are isolated and rare cases where there has been a disturbance in the balance between the immune system and a virus like the adenovirus. However, these cases seem to be extremely rare and there is currently no evidence indicating that a new and dangerous form of hepatitis is spreading.”