The Ministry of Health has notified this Thursday the first two deaths in Spain from hepatitis of unknown origin in children, after failing to pass the liver transplant. According to the report from the Center for the Coordination of Health Alerts and Emergencies (CCAES), among the 46 cases detected in Spain, three liver transplants have had to be performed. Two of the three minors subjected to the intervention have died.
The 6-year-old boy began with symptoms on July 2 and on the 18th he was transferred to a hospital in Madrid for a transplant in serious condition with cerebral edema. The transplant was performed on July 29, but he died 24 hours after the operation.
The other deceased is a 15-month-old baby from Andalusia, who was admitted at the end of June with acute gastroenteritis with a positive culture for adenovirus in a critical situation (encephalopathy and severe coagulopathy). The case required an urgent liver transplant, but died within 24 hours. Given the seriousness, the CCAES has included in the report that has updated this Thursday the case of this child who is under investigation retrospectively.
There is also a third girl who has required a transplant, a child under 3 years of age from Aragón, but who now has "good clinical evolution".
Spain has already reported 46 cases of this childhood hepatitis of unknown origin, aged between 0 and 16 years, of which 38 were less than 10 years old. By communities, Madrid reflects the highest figure with 15; they are followed by Catalonia (9); Galicia (5); Balearic Islands (4); Castile-La Mancha and Murcia (3); Castilla y León and Andalucía (2, in both communities, not counting the child who died in the last one incorporated now) and Aragón and Canarias, both with 1.
Thus, since the last report “Serious acute non-AE hepatitis of unknown cause in children under 10 years of age. Situation in Spain” of June 17, Spain has added nine more cases, but the CCAES makes it clear in its update this Thursday that both the number of cases and the number of “observed transplants are within those expected according to estimates made with data from previous years.
“No increase in cases of severe hepatitis of unknown origin is observed in children aged 0 to 16 years in the period from January to May 2022 compared to the same period of the previous five years”, nor is there a “higher incidence of fulminant hepatitis in children requiring liver transplantation” compared to the estimated average for the same period between 2012 and 2021.
Last year, and the same in 2020, 8 children under the age of 16 needed a new liver; in 2019 there were six and in 2018 and 2017 there were three in both cases. The most frequently reported symptoms are malaise (26 cases; 65%), vomiting (26 cases; 59%), fever (23 cases; 58%) and abdominal pain (21 cases; 50%). Jaundice was reported in 20 cases (50%), diarrhea in 12 cases (29%), respiratory symptoms in 10 cases (25%), and rash in 9 cases (23%).
In this way, “the main causal hypothesis is around infection by Adenovirus, having been associated in a very significant way with the cases in the United Kingdom —where the first ones were detected in early April— and with a significant percentage of the cases detected in the rest of the world".
the hepatologist María Buti, one of the most renowned in Spain, last June he gave elDiario.es a message of “calm, but also alert” in the face of this disease. “Progress is being made, but studies require time. It has already been identified that in some cases there is infection by adenovirus and it is a hypothesis that is being considered; in others, they have been seen to have had COVID-19 infection; and in others, the two factors together,” he noted at the time.
He also stressed that molecular biology tests are being carried out to catalog the type of adenovirus. “These investigations are not done overnight. Possible effects of foods or other frequently transmitted viruses have been ruled out and epidemiological surveys are being carried out, ”she said.
Most common disease in girls
The first of the children began symptoms on January 2 and the last reported case on July 2. The mean age of the cases is 5.3 years and the median is 4 years. Most of them (29, 64.4%) are girls and the rest, 16 boys (35.6%), “observing a higher proportion of girls, especially in the group from 0 to 5 years old.
Five are under 1 year of age, and 3 of them, who began their symptoms at the end of June, are two neonates aged 3 and 5 days who were admitted to the ICU and a 48-day-old child in whom enterovirus has been detected, in one of them also adenovirus and in another SARS-CoV-2.