Since the publication of this update, a new case definition and course of action are available. To consult them, click here.
Pediatric acute hepatitis cases: actions initiated as soon as the United Kingdom reports
On April 8, 2022, Public Health France was alerted to the occurrence in the United Kingdom of an abnormally high number of cases of severe acute hepatitis in children of no identified origin, in particular without being carriers of the hepatitis A, B, C, D and E.
Upon receipt of this signal, Public Health France contacted its partners in the national public health network: French-speaking resuscitation and pediatric emergency group, French Society of Pediatrics, French Society of Hepatology, National Reference Centers for Hepatitis B/C / delta, Hepatitis A/E, gastroenteritis viruses and respiratory infection viruses.
In addition, Public Health France also conducted an analysis:
- emergency room visit data from the OSCOUR® network for a selection of diagnostic codes compatible with acute hepatitis of unknown etiology (notably excluding viral hepatitis A to E) in children aged 0 to 17 between 2018 and April 24, 2022 , in order to identify a possible unusual increase in these cases over the recent period;
- hospitalization data (PMSI) between 2018 and January 2022 to detect a possible increase over the recent period in the number of hospital stays compatible with acute hepatitis of unknown etiology.
At this stage, no excess of emergency visits or hospital stays has been identified on national territory since January 1, 2022 compared to previous years (2018-2021).
Two cases of acute hepatitis (in children under 10 years old) whose origin is still undetermined have been reported by the Lyon University Hospital. Explorations of acute hepatitis of unknown origin are complex (infectious, toxic, metabolic, autoimmune causes, etc.) and therefore sometimes long; for the two patients, the investigations are still in progress by the medical teams, in conjunction with Public Health France. It is not possible, at present, to know if they are linked to the signal observed in the United Kingdom.
Establishment of a reporting circuit for possible cases
A circuit for reporting and investigating possible cases has now been formalized, in conjunction with the Ministry in charge of Health, with the aim of detecting a possible signal in the territory similar to that observed in the United Kingdom.
It relies on a network of clinicians and laboratories including the 4 liver transplant centers (Necker, Bicêtre, Marseille, Lyon) and pediatric intensive care units, and allows standardized feedback.
In the absence of confirmation in France to date of a signal similar to that reported by the United Kingdom, the system is based on a more specific case definition than that of the United Kingdom. It was developed in collaboration with the hepato-paediatricians and the 3 CNRs involved (viral hepatitis B/C/Delta, gastroenteritis viruses and respiratory infection viruses). Finally, a course of action in the event of severe acute hepatitis in children under 18 has been drawn up and distributed by the Ministry responsible for Health to the professionals concerned.
Cases of acute pediatric hepatitis: update on 04/29/22 in France and abroad
In France :
Two patients meeting the case definition developed by the United Kingdom have been reported by the Lyon University Hospital and are still being investigated by medical teams, in conjunction with Public Health France.
Internationally :
As of April 28, 2022, according to Rapid risk assessment (RRA) from the ECDC, 166 cases of acute hepatitis of unknown etiology in children aged 1 month to 16 years have been reported in 12 European countries (55 cases) and the United Kingdom (111 cases) and are under investigation in order to search for an infectious, toxicological or environmental origin. This RRA mentions that 4 countries have reported a number of cases of severe acute hepatitis of unknown etiology in children which is higher than expected over the period from October 1, 2021 to April 21, 2022: the United Kingdom, the -Netherlands, Ireland and Denmark.
