Unexplained hepatitis has been reported in many countries! 169 cases have been found, causing the new crown virus?

Lola, a 3-year-old British girl, contracted unexplained hepatitis in March 2022.

Doctors informed her parents that Lola was suffering from acute liver failure and needed to urgently find a matching donor to survive.

"When the doctor told me that my daughter needed a liver transplant, she might die. This is completely unexpected, and it is not something that any father can accept." Eventually, half of Lola's father's liver was transplanted into his daughter, and Lola's condition began to improve.

According to Xinhua News Agency, 34 cases of childhood hepatitis of unknown etiology have been found in the United Kingdom, bringing the total number of similar cases in the United Kingdom to 108, of which 8 people have received liver transplants due to their serious illness.

At the same time, Spain, Denmark, Ireland, the Netherlands and other countries have also reported related cases.

At least 169 unexplained cases of acute hepatitis in children have been reported in 11 countries in the WHO European Region and 1 country in the Region of the Americas.

All cases ranged in age from 1 month to 16 years. Seventeen children (about 10 percent) needed a liver transplant and at least one died.

Some European experts pointed out when talking about the patient's condition that although mild hepatitis in children is quite common, the situation is obviously different this time, and some patients in the UK are even serious enough to need a liver transplant.

"Adenovirus rarely causes severe hepatitis in healthy people. It happens in children who don't have serious underlying health problems and are very rare." Some industry insiders analyzed.

When most people were confused, the "culprit" slowly surfaced.

The World Health Organization issued a notification on 23 April that adenovirus had been detected in 74 of these cases of unexplained hepatitis. Of these, 20 were infected with the new crown virus and 19 were infected with both the new crown virus and the adenovirus.

Does early COVID-19 infection make children more susceptible to adenovirus infection? Will severe hepatitis be a long-term sequelae of COVID-19 infection? Or is it a new virus? A series of issues to be solved have sparked heated discussions.

Unexplained hepatitis caused by adenovirus?

Mild childhood hepatitis is not unusual, but the patients reported this time are so sick that they are so severe that they have been given a liver transplant, which has caused alarm.

The survey found that the age of these children was concentrated in 1-16 years old, most of them under 10 years old. Just a week before the onset of illness, the children were healthy, and clinical records indicate that they did not have any significant past medical history, such as underlying immunodeficiency or treatment with immunosuppressants.

According to information provided by parents, two of the children had close contact with two other COVID-19 cases in the family or other setting.

According to the World Health Organization (WHO), the first children were all located in the UK and were found while hospitalized, with the earliest case being in January 2022.

Cases in the United States were admitted to hospital earlier, with cases of unexplained hepatitis reported as early as November 2021, according to the latest notification from the U.S. Centers for Disease Control and Prevention (CDC).

From the current infection situation, the clinical syndrome of these cases is acute hepatitis with a significant increase in liver enzymes. The vast majority of patients develop gastrointestinal symptoms such as diarrhea, abdominal pain, and vomiting, but most do not develop symptoms of fever.

Hepatitis A, B, C and E virus infections were ruled out after experts tested for several typical hepatitis viruses in children in the UK and Spain.

Because most children do not have fever, or abnormal markers of blood inflammation, C-reactive protein, and elevated white blood cell counts. Therefore, only a small number of children were examined bacteriologically and there were no abnormalities.

In desperation, scientists have tried to further expand the detection range of viruses to those that are not within the scope of routine detection of hepatitis.

Eventually, after a series of tests, the scientists found that 5 of the 13 Scottish children tested positive for adenovirus. The findings were also confirmed by officials from the U.S. Department of Public Health in Alabama, who said five of the nine sick children in the area were positive for adenovirus-41.

Meanwhile, UK Health Security Agency data shows that 77% of cases test positive for adenovirus. As a result, a growing body of data points to this episode of unexplained hepatitis to adenovirus infection.

Public information shows that as a seasonally transmitted virus, February to April is the peak of the adenovirus epidemic. The virus is transmitted mainly through respiratory droplets through the respiratory tract or contact, and infection can cause cold symptoms, conjunctivitis, vomiting, and diarrhea, but rarely hepatitis. The adenovirus-41 type, which appeared in the Alabama case, also mainly caused gastroenteritis in children.

However, of the known hazards of adenoviruses, the virus is not deadly enough.

Researchers in Scotland believe that if these severe hepatitis are really caused by adenovirus infection, it could be a completely new variant with unique clinical symptoms. Another possibility is that this is a routinely circulating variant of adenovirus, although the effects of infection on children are more severe.

From all current investigations, it is not possible to determine that adenovirus is the direct cause of this hepatitis.

Who is to blame for unexplained hepatitis?

Compared with adenovirus, another cause that can cause unknown hepatitis is more disturbing.

Of the 114 cases of hepatitis in children in the UK, a total of 74 were positive for adenovirus; 20 were detected for COVID-19; and 19 were detected for COVID-19 and adenovirus.

There are also professionals who suspect that unknown hepatitis may also be related to the side effects of the vaccine. However, according to the survey, none of these children have been vaccinated against COVID-19, so this speculation can be ruled out.

The most acceptable trigger right now is that the youngest children may have become immunologically vulnerable during the COVID-19 lockdown in the UK. The prolonged blockade has prevented these children from contacting many viruses, including adenovirus, and the current high incidence of adenovirus is currently in the early childhood.

The World Health Organization proposes that the priority now is to determine the cause of the disease to guide the next step of clinical and public health action.

Until the events are inconclusive, speculation is rife. The discovery of an intersection with the coronavirus also raised speculations about whether hepatitis was related to the sequelae of COVID-19.

How terrible are the after-effects of COVID-19?

At present, there are several more common types of COVID-19 sequelae: temporary changes in smell and taste or even disappearance; cerebellar atrophy; dyspnea; sexual dysfunction.

A British study showed that 13% of people lose their sense of smell or taste after being infected with the Aumechjong strain. In contrast, in pre-mutation outbreaks, the proportion was as high as 34 percent.

Therefore, from this data, the lethality of Aumechjong is declining. Thankfully, most people's sense of smell and taste will recover quickly.

When children are infected with the new crown virus, they develop "multisystem inflammation syndrome (MIS-C)". Data from the outbreak in Omiljung, Hong Kong, show that children with "multisystem inflammatory syndrome" will have symptoms such as high fever, rash and diarrhea within two to five weeks of recovery.

In The new crown variant strain Delta before Omicron, its mild patients basically do not have sequelae, and moderately ill patients or severe patients may have such as itchy throat, dry cough, lung discomfort, poor sleep, and easy insomnia. A small number of people experience chest tightness, shortness of breath, and difficulty breathing.

The latest "Delta Kerkjong", WHO's new crown technology leader and U.S. infectious disease epidemiologist Maria Van Kerkhove said that so far, more research on the Delta Kerong variant is underway, and no change in severity has been seen.

In summary, it is also impossible to determine that the acute hepatitis in children that has swept the West is related to the sequelae of the new crown.

According to Reuters, the Director General of Public Health Scotland said work was currently underway to determine whether the adenovirus involved had mutated. Causes a more serious illness, or whether it may be "tandem" with another virus, such as the coronavirus.

Through actual cases, the current sequelae caused by Omicron are not so terrible.

In this regard, the health community has also contacted patients who recovered after infection with the new crown during the Changchun epidemic some time ago. The patient, from Jiutai District, Changchun City, tested positive for nucleic acid during the isolation of the hotel during the epidemic period, and was later judged to be mild and admitted to the Fang Cabin Hospital.

According to the patient's own report, he developed symptoms such as high fever, diarrhea, and inability to speak after his infection. However, the nucleic acid test turned negative in about four days after being admitted to the fang cabin hospital. After being discharged from the hospital, she continued to cough for more than ten days, coughing until she could not sleep, but there was no abnormality in the sense of smell and taste mentioned in the previous report, and after recovery, it was no different from before the disease.

"Many of us were mildly ill, and at that time, 'Great White' said that Omicron was not harmful, that is, it spread faster." Said the above patient.

Dr. Hu Bijie, director of the Department of Infectious Diseases and Infection Management at Zhongshan Hospital affiliated to Fudan University, has previously debunked rumors that "Aomi Kerong has more than 200 sequelae", saying that Aomi Kerong is mainly limited to the upper respiratory tract compared with the original type of new coronavirus that often violates the lower respiratory tract two years ago. As long as the patient's immune function is normal, sequelae rarely appear, and basically can be completely recovered.

How far are we from unexplained hepatitis?

How far from the mainland is the unknown hepatitis that caused panic in Europe? What do we need to pay attention to?

Professor Lu Hongzhou, head of the first public health expert group on epidemic prevention and control in Shenzhen and president of shenzhen third people's hospital, pointed out in an interview that the pathogenicity of the unexplained disease still needs to be studied in basic and clinical research. The virus is also transmitted through the respiratory tract, but European and American countries do not require the mandatory wearing of masks because of the liberalization of epidemic prevention and control policies, so it will lead to the spread of the virus

"But the mainland is different, at present, everyone still wears a mask when they go out every day, so the possibility of transmission through the respiratory tract is relatively small, and it should not be too nervous at present." Lu Hongzhou stressed.

According to Lu Hongzhou, the prevention measures for adenovirus infection are similar to the prevention of infectious diseases in the respiratory and digestive tracts:

Mainly wash hands frequently, disinfect frequently, avoid contact with patients and their respiratory droplets; usually drink more water, eat more vegetables and fruits, pay attention to exercise; indoor ventilation, keep the indoor environment clean; try to go to crowded public places as little as possible during the winter and spring epidemic seasons, wear masks when going out, and avoid contact with patients to prevent infection.

Once the symptoms of acute fever, sore throat and conjunctivitis occur, it is necessary to go to the hospital as soon as possible, isolate early, and treat early. During the adenovirus epidemic season, young children with upper respiratory tract infections should go home and rest in isolation to avoid spreading the epidemic. After illness, try to see a nearby hospital and avoid infusion in the observation room of a large hospital with a large concentration of patients to prevent cross-infection. Severe cough and dyspnea are mostly severe cases, and you should go to the hospital in time to avoid delaying the condition.

Mainland China has immunization requirements for children's hepatitis B and hepatitis A, and the incidence of hepatitis in children is very low in China.

Lu Hongzhou also said that the current domestic vaccination against the new crown adenovirus vector vaccine is to use the modified harmless adenovirus as a carrier, loaded with the S protein gene of the new crown virus, made into an adenovirus vector vaccine, to stimulate the body to produce antibodies.

"Although the adenovirus used in the adenovirus vector vaccine is not the same as the adenovirus, it should also have a certain immune cross-protection effect." Lu Hongzhou said.

Health Community Exhibits

Written by | Wang Dandan

Editor-in-charge| Zhao Yang