At least 176 children in the United Kingdom and more than 500 worldwide have been afflicted with a mysterious hepatitis that has been found in at least two dozen children in the United Kingdom.

They can agree.

It is proving difficult to get everyone to agree on how to manage these children.

There are conflicting theories about what is causing healthy young children to suddenly become jaundiced and fall seriously ill. One hypothesis suggests that the damage is being done by adenoviruses, a common childhood infection that causes coldlike symptoms and could be treated with an antiviral drug. The cause is thought to be a rogue immune response to previous infections, which could be treated with steroids. A third hypothesis proposed this week suggests that adenoviruses and SARS-CoV-2 form a destructive partnership that causes the immune system to break down.

With a sick child, do you give steroids? Do you use an antiviral drug? Do you give both?

According to the U.S. Centers for Disease Control and Prevention, 9% of the 180 children in the United States have required a transplant. There have been no deaths in the United Kingdom as of 3 May.

Most cases can be managed with supportive care, but parents should seek medical care for their child if they show a yellow skin and white eyes.

The adenoviruses hypothesis has been elevated by official bodies. In immune-suppressed children, adenoviruses can cause hepatitis, but it's not known to do so in healthy kids. The CDC says adenoviruses have been found in nearly half of the U.S. cases as of 18 May. In the U.K., it was found in 70% of children with the disease. In an announcement updating case numbers last week, the UKHSA pointed out that there was an association with adenoviruses.

The fact that it is in over 70% of cases suggests that it must have a role, according to a group of technical experts.

Some scientists think adenoviruses could be an innocent bystander. How specific is the finding of low amounts of adenoviruses? is the question that is being asked by the University of Geneva's Isabella Eckerle. Would we find it in healthy kids?

The UKHSA wants to answer the question. The methodology for the study is expected to be published today and will compare the prevalence of adenoviruses in children hospitalized with the mysterious hepatitis with that in children hospitalized for other reasons.

Skeptics say that the children's biopsies have failed to find cells with adenoviruses, a sign of adenoviral hepatitis. They say that the agencies are overlooking a more likely culprit.

Major scientific bodies in the U.S. and U.K. are using weak circumstantial evidence to distract the public from the possibility that recent SARS-CoV-2 infections may be driving the increase in.

He and others think that the immune-mediated attack on the liver may be caused by the same thing as the multisystem inflammatory syndrome in children.

In the United Kingdom, 18% of the children have been exposed to the disease. A recent CDC study estimated that 75% of U.S. children have been exposed to the disease. The European Centre for Disease Prevention and Control published a report last week that said there was evidence of prior infections in 14 of 19 children. Most of the cases in Europe have occurred this year during a large Omicron wave. The vaccine for children under 5 years old is not available for the majority of the affected children.

The debate isn't academic. Jalali said in an interview that it has everything to do with whether a patient stays alive or not. The powerful antiviral drug cidofovir could be used in urgent cases if adenoviruses is damaging the liver. Immune-suppressing drugs could be life-saving if the damage is caused by a sustained immune reaction. Jalali says you have better not be wrong.

A hypothesis about knitting the two viruses together was published last week by a doctor.

They point out that 18 of 18 cases tested in the United Kingdom harbored adenoviruses, a strain of adenoviruses that is found in the gut, and that the strain of adenoviruses that is found in the gut is known as SARS-CoV-2. Brodin and Arditi proposed that after adenoviruses enter the gut, they might act as a coconspirator. The immune response to adenoviruses might be stimulated by a small section of the spike protein that has been shown to prompt a broad, nonspecific activation of T cells. There is a mechanism in which a piece of the coronaviruses spike protein causes an immune overreaction.

Brodin encourages clinicians to collect stool samples to confirm the presence of a hyperactivated immune system in children with unexplained hepatitis. Brodin says immunosuppressive therapy would be appropriate if the hypothesis is confirmed.

Jalali is worried by a preprint, not yet peer reviewed, posted on 14 May by scientists at Case Western Reserve University. The paper suggests that the hepatitis cases reported so far are just the tip of a bigger problem. The researchers compared the electronic records of 246,000 children who contracted COVID-19 between March 2020 and March 2022, with those of 556,00 children who contracted other respiratory infections. In the months after the infections, the children with COVID-19 were 2.5 times more likely to have elevated levels of enzymes that indicate liver damage and 3.3 times more likely to have elevated bilirubin. It's a sign of impaired liver function to have elevated levels.

A global health policy expert at the London School of Economics has been closely following the theories of causation after her son was hospitalized with hepatitis earlier this month.

The son of Wenham did not test positive for the disease but did test positive for adenoviruses. He was discharged from the hospital on May 15. He is still not out of the woods.