Deadly hepatitis in Australia: 'Plausibility is increasing'
Fears over the mysterious hepatitis outbreak are growing as the illness edges closer to home.
So far, almost 200 young children worldwide have fallen ill with a gastroenteritis type illness, many with acute liver failure or inflammation.
The majority of cases have been in the UK, but the World Health Organisation (WHO) has recorded cases in Europe, America, Isreal and most recently Japan.
Although experts don't know a lot just yet, including the exact cause or how it's spread, the chances of it reaching Australia is increasing, according to an Australian-based researcher.
"The plausibility is increasing as the global case numbers appear to rise but there’s plenty still to be resolved about the cause and the mode of transition if it is a virus," Professor Andrew Lloyd from UNSW told Yahoo News Australia.
"If it’s droplet transmission person to person, like SARS, for example, the probability is much higher than what we’d call fecal-oral, which is person-to-person contact with contaminated hands for instance."
It's not yet possible to predict whether the illness will occur in Australia until the cause and the pattern of spread have been identified.
But the fact it occurred initially in England and then in Europe suggests that it can spread between countries and the increasing numbers "definitely raises concern".
What is the cause and how is it spread?
Professor Lloyd, an infectious diseases physician and hepatitis researcher, says experts know "relatively little" about the outbreak at this stage except that it's affecting young children.
"The most plausible explanation for the cause is indeed a strain of adenovirus, type 41" he said.
"If this is in fact adenovirus, it’s recognised to be spread by that fecal-oral route, it's what we call fecal contamination of hands or potentially a food or water source."
All of the known causes of hepatitis, ranging from viruses to drugs and toxins, are being considered, but many have already been ruled out.
"There’s definitely what you call a clear association [with adenovirus 41]," he explained. Although, that’s not necessarily the same as causation.
"It just mainly says that most of the cases [we've seen so far] seem to have [that virus strain], whether or not it’s the cause of the illness still needs further study."
Tracking transmission can also be challenging because for every person who gets sick from hepatitis, often there’ll be many more who have been infected but have no significant illness, he said.
What do we know about the current strain?
There are dozens of adenoviruses, of which, 49 are knowns to infect humans - and adenovirus 41 is just one of them.
The strains are often associated with common illnesses including pink eye or conjunctivitis or common cold-like symptoms.
Adenoviruses 41 however is "clearly implicated as the cause of gastroenteric illness".
But Professor Llyod said there are lots of uncertainties at the moment, particularly in relation to whether or not the virus is only occurring in some genetically vulnerable group of kids
Why does it only affect children?
So far, only children have been affected by this particular outbreak and that's to do with their compromised immune systems, which is "not a surprise" said Professor Llyod.
"As we get exposed to the many different Adenovirus strains that exist, we progressively acquire immunity from a young age to protect ourselves against them," he said.
"Adenovirus in general only affects symptomatic illness in young children and in people who are significantly immunocompromised, particularly transplant recipients."
What should parents look out for and what are the symptoms?
In almost all cases diarrhoea will be the first sign of sickness. Nausea or vomiting could also be present.
Typically, a gastro-related virus will last between one and three days, which "looks like it’s the beginning " of hepatitis.
"If there’s a gastroenteric episode in a young kid that doesn’t seem to settle down after 2-3 days, those are the marks of the beginning of the potential liver inflammation illness," Professor Llyod warned.
Other signs include having dark urine, feeling nauseated and jaundice or yellowing of the eyes.
The health expert said being vigilant about hand hygiene is a sure-fire way to help avoid infection - especially for households or settings where there are international travellers.
"Using disinfectants we, fortunately, have widespread at the moment for Covid, that would be a sensible starting point," he advised.
What is the treatment?
There is currently no treatment for adenovirus 41 partly because the cause is not yet known.
But hospital-based treatment would include supportive care for patients with hepatitis.
This means symptomatic treatments to manage nausea or pain and supportive care for the liver.
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