The Health Ministry is examining 12 cases of children who were hospitalized with severe liver inflammation caused by unknown sources over the past few months, following a warning issued by the World Health Organization.
On Tuesday, the ministry instructed hospitals and health maintenance organizations to monitor and report on any similar cases, following the WHO announcement noted that 84 severe cases of acute hepatitis in children were discovered in the United Kingdom since January 1, 2022, with the cause still unknown.
In Israel, the 12 cases came in the last four months; five were hospitalized in Shaare Zedek Medical Center in Jerusalem and seven in Schneider Children’s Medical Center in Petah Tikva. Two of the children in Schneider suffered from liver failure, prompting doctors to carry out liver transplants. The condition of the other children improved quickly after treatment with steroids, and they were released from the hospitals.
Nine similar cases in the United States and three in Spain are also being studied – and more are expected, said the WHO. Three of the children in these cases suffered liver failure and required liver transplants.
Prof. Ronen Arnon, the director of the pediatric liver unit at the Rambam Health Care Campus in Haifa said: “At the moment, the source of the outbreak is not clear.” The cause of the disease is thought to be an unidentified virus, though it is not yet clear whether it's a known or new virus, said Arnon.
“At the same time, other theories are being examined, including reactions to chemicals or toxins that have spread in those areas, or post-Covid related phenomena. Not a lot is known at this stage and the World Health Organization is monitoring the situation,” he added.
Prof. Eyal Shteyer, the director of the pediatric liver unit at Shaare Zedek hospital said that the hospitalized children were all under the age limit for the COVID vaccine, meaning the vaccine is likely not the cause of the inflammation.
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However, 11 out of the 12 children were infected with the coronavirus in the last year. "We know that a severe COVID could damage the liver." Shteyer said. One theory being tested is that liver inflammation is in fact a symptom of long COVID.
Severe hepatitis of an unknown etiology is not something new, said Arnon. In many cases studied by doctors, a clear diagnosis was not found, though he noted that the relative spike in cases in a short period of time requires more attention.
After the Health Ministry joined in the warning from the WHO, Israeli doctors received specific symptoms to look out for, said Arnon, and said that any children under 16 must be taken to hospital for further testing. “Attention should be paid to cases of jaundice, light-colored feces, dark urine, fatigue in children, complaints of not feeling well in general and the rest of the well-known signs of hepatitis,” he added.
The WHO’s working definition for possible cases is the presence of “acute hepatitis (non-hepatitis viruses A-E) with AST or ALT over 500 U/L, in children 11 to 16 years old, whose symptoms appeared after 1 January 2022.”