WHO confirmed on the 23rd that at least 12 countries have reported cases of suspected unexplained young children's hepatitis, and 1 child has been reported to have died. As of 21 April, the United Kingdom, the United States, Spain, Israel, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania and Belgium have reported a cumulative total of 169 cases of hepatitis in children of unknown etiology, of which 114 are from the United Kingdom.
Global confirmed figures as of the evening of 21 April 2022
Unexplained childhood hepatitis has been reported in many parts of Europe and the United States
On 5 April, the UK health department informed WHO of 10 cases of severe acute hepatitis in infants and young children of unknown etiology detected in central Scotland. The patients were between 11 months and 5 years of age and had no history of previous illness.
The earliest case developed symptoms in January 2022, the remaining nine were detected in March, and all 10 cases were detected while hospitalized.
Ireland has also reported 5 cases following notification in the UK, which are currently under further investigation. In addition, Spain has also reported 3 confirmed cases of acute hepatitis of unknown etiology. The Spanish newspaper El País reported that one of the children needed a liver transplant.
Agence France-Presse reported on the 19th that the University Hospital of Lyon in France has received two children under the age of 10 who are suspected of suffering from rare unexplained acute hepatitis and are currently under investigation.
The European Center for Disease Control and Prevention reported on the 19th that more and more children have recently been infected with hepatitis of unknown cause, following the 74 cases earlier reported by the United Kingdom, Denmark, Ireland, the Netherlands and Spain and other countries have also found cases, but there is no specific number.
On the same day, according to the Associated Press, similar cases also occurred in the United States, and the southeastern state of Alabama reported that 9 children had similar cases.
Kristen Nordlund, a spokeswoman for the U.S. Centers for Disease Control and Prevention, said the nine cases of childhood hepatitis ranged in age from 1 to 6 years old, with the earliest being detected in October 2021.
Helena Gutierrez, medical director of the Pediatric Liver Transplant Program at the University of Alabama at Birmingham, said that like some patients in the United Kingdom, nine children in the United States are very sick. "From severe hepatitis to acute liver failure, we've seen a full range of reports." She said.
WHO strongly recommends the identification of potential cases
WHO spokesman Tarik Jasarevic said WHO had learned of suspected cases in countries such as the United Kingdom, Spain, Ireland, Denmark, the Netherlands, Sweden and the United States through the IHR mechanism and media coverage. WHO is communicating with Member States to verify these reports and to identify possible causes, clinical courses and further information on management for sharing with other Member States.
In these cases, laboratory tests have ruled out hepatitis A, B, C, D and E viruses, while in some cases, COVID-19 and adenovirus have been detected, WHO said. The role of these viruses in pathogenesis is unclear. Overall, the etiology of these cases of hepatitis is still unknown and investigations are ongoing.
Screenshot of the official social media of the World Health Organization
WHO recommends that the priority now be to determine the etiology of these cases to guide further clinical and public health action, and strongly encourage Member States to identify, investigate and report potential cases that meet the case definition.
The so-called "conformity to the definition" includes 3 aspects:
First, confirmed cases: After 1 January 2022, 10 years of age and below, with acute hepatitis (not caused by A, B, C, D or E virus infection) and aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 500U/L.
Second, suspected cases: after 1 January 2022, aged 11-16 years, with acute hepatitis (not caused by A, B, C, D, or E virus infection) and AST or ALT > 500U/L.
Third, epidemiologically related cases: after 1 January 2022, there was acute hepatitis (not caused by A, B, C, D or E virus infection) and had close contact with the confirmed case.
Given the increase in reported cases over the past month and the intensification of case search activities, WHO expects to report more cases in the coming days. Based on the information currently available, WHO does not recommend any restrictions on travel and trade with the UK or any other country where cases have been found.
77% of test cases test positive for adenovirus
What exactly is causing this series of cases of acute hepatitis in children? The UK health department said one of the many potential causes it was investigating was a virus known as adenovirus-41, with 77 percent of testing cases positive for adenovirus.
A research article published by the European Center for Disease Control and Prevention on the 14th said that in the 13 British children tracked, 5 of them tested positive for adenovirus. According to the UK Health Security Agency, "one of the potential causes may be adenovirus infection." ”
The U.S. Department of Disease Control also confirmed that the 9 children reported in the United States have all reported positive adenovirus test results, of which 5 have been confirmed to be positive for adenovirus-41.
Screenshot of CCTV News
Adenovirus is a common virus that causes viral pneumonia and usually causes a range of mild illnesses, including colds, vomiting, and diarrhea, and usually does not cause hepatitis.
Adenovirus was discovered and successfully isolated as early as the 1950s, and has since spread around the world at different ages. In recent years, adenovirus has become more and more active, and there have been more reports of severe adenovirus pneumonia cases and deaths. In November 2018, an adenovirus outbreak hit New Jersey, USA, infecting 23 children and killing 11 people. In 2019, Wuming Hospital and Wuming Maternal and Child Health Hospital affiliated to Guangxi Medical University reported as many as 101 cases of adenovirus infection from July 20 to August 2. According to domestic surveys, children under the age of 6 are at high risk of adenovirus infection, of which 50% are infants and young children under the age of 2.
The adenovirus incubation period is generally 2-21 days, with an average of 3-8 days. Symptoms of adenovirus infection are very common, unless they are very experienced doctors, are generally difficult to detect in the early stages, and are often misdiagnosed as a common cold or flu. The most common symptom of adenovirus is a sudden high fever (above 39 ° C), which can be accompanied by cough, sputum production, pharyngeal redness, sore throat and other upper respiratory symptoms, but it is quite different from the unknown hepatitis symptoms this time.
Experts point out that the most effective way to reduce adenovirus transmission is to maintain good hand and respiratory hygiene and to supervise young children to wash their hands thoroughly.
Upstream News Comprehensive Surging News, CCTV, Beijing Daily-Beijing Daily, Qianjiang Evening News, China Center for Disease Control and Prevention