Researchers believe that an unrecognized COVID-19 infection in children could have led to cases of severe hepatitis.  In general, children with COVID-19 are at much higher risk than adults when it comes to experiencing liver dysfunction, according to a medRxiv report.  At the same time, cases of COVID-19 are less likely to be reported.  In fact, in the majority of the cases analyzed for the current study, children were found to be infected with the adenovirus 41F, which tends to mimic coronavirus symptoms (i.e., fever and respiratory distress), followed by diarrhea and jaundice.“Some adenoviruses can spread through an infected person’s stool, for example, during diaper changing,” the Centers for Disease Control and Prevention (CDC) warns. “Adenovirus can also spread through the water, such as swimming pools, but this is less common.”

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The report from the UKHSA surmises “Seventy-five percent of the children with severe hepatitis also had adenovirus” and researchers believe looking to whether the children actually contracted the coronavirus would be worthwhile.  They further suggest, “Preliminary typing of the adenovirus has been consistent with type 41F where data is available from blood samples.  However, other adenovirus types have also been identified in non-blood samples.”Since many of the children who developed hepatitis were too young to be vaccinated, “it is possible that they had mild or asymptomatic COVID infections that went unnoticed,” a separate team of researchers suggested in The Lancet Gastroenterology and Hepatology. “If that were true, then lingering particles of the coronavirus in the gastrointestinal tract in these children could be priming the immune system to over-react to adenovirus 41F with high amounts of inflammatory proteins that ultimately damage the liver.”In 2021, a study in The Pediatric Infectious Disease Journal found, “Among the wide spectrum of manifestations of COVID-19, liver injury is garnering increasing attention.  Liver test abnormalities are estimated to occur in ~15% of adult patients and those with severe COVID-19 seem to have higher rates of liver dysfunction.”Thus, COVID can cause liver damage at any age.  Authors of the 2021 paper provide a case study of a child who was admitted into the emergency room after his mother had tested positive for the coronavirus.  While the boy was not ultimately tested for, or found to be infected with, the virus, they believe it could have been present.  The boy suffered liver damage as a result, and the authors conclude, “Our case suggests an unreported association between acute SARs-CoV-2 infection and acute hepatitis in children, thus supporting the notion that evaluation of liver enzymes during hospitalization for SARs-CoV-2 infection is also indicated in pediatric age…We suggest that children with acute hepatitis be investigated for SARS-CoV-2 persistence in stool and for other signals that the liver damage is happening because the spike protein of the coronavirus is a ‘superantigen’ that over-sensitizes the immune system.”In general, there is evidence of a link between COVID-19 and liver issues and severe hepatitis in young children as well as in adults.  Now that a vaccine is available for those between the ages of 5 and 12, the CDC is encouraging parents to consider vaccinating the whole family to fend off long-term complications.  The current recommendation is that those 5 and older should receive initial round, and those 12 and older should also receive a booster.

Sources:

SARS-CoV-2 Could Be at Root of Mysterious Hepatitis in KidsSARS-CoV-2 Infection May Present as Acute Hepatitis in ChildrenElevated liver enzymes and bilirubin following SARS-CoV-2 infection in children under 10COVID Vaccine for Children - Official CDC Site for COVID