July 13, 2022

expert reaction to two papers looking at children with acute hepatitis of unknown cause

Two papers published in the New England Journal of Medicine (NEJM) look at acute hepatitis cases in children.

Prof Deirdre Kelly, Professor of Paediatric Hepatology at the University of Birmingham; and Liver Unit at the Birmingham Women’s & Children’s Hospital, said:

“There is nothing new here that has not been highlighted already, but it is good to have the clinical symptoms and outcome published, especially from the large study from Birmingham.  A major gap is the lack of SARS-CoV-2 antibody testing (none in the US study and only a fraction in the Birmingham patients).

Is this good quality research?  Are the conclusions backed up by solid data?

“Yes.

How does this work fit with the existing evidence?

“It is similar to a larger data set in the UK held by the UKHSA.

Have the authors accounted for confounders?

“Yes.

Are there important limitations to be aware of?

“This is sample of the reported cases and retrospective, hence not all investigations were done on all children. In view of the emerging problem, but it is acceptable for a retrospective study but highlights the need for full investigation prospectively.

What are the implications in the real world?

“We need to be vigilant about new and emerging infections as the implications of diminished immunity from the isolation associated with the lockdows become apparent.

Is there any overspeculation?

“No.”

Two papers:

‘A Case Series of Children with Acute Hepatitis and Human Adenovirus Infection’ by L. Helena Gutierrez Sanchez et al. was published in the New England Journal of Medicine at 22:00 UK time on Wednesday 13 July 2022.

DOI: 10.1056/NEJMoa2206294

‘Clinical Spectrum of Children with Acute Hepatitis of Unknown Cause’ by Chayarani Kelgeri et al. was published in the New England Journal of Medicine at 22:00 UK time on Wednesday 13 July 2022.

DOI: 10.1056/NEJMoa2206704

Declared interests

No reply to our request for DOIs was received.