Recently, the UK Health Security Agency (UKHSA) surveyed 114 patients with sudden unexplained hepatitis confirmed as of 20 April 2022. Clinical observation and statistics of confirmed cases were carried out, and a detailed report was released - "Increase in hepatitis (liver inflammation) cases in children under investigation".
Study Details:
The patients confirmed in this study were concentrated in the group of children under 5 years of age. Clinical symptoms usually begin with symptoms of gastroenteritis, followed by symptoms associated with jaundice attacks.
To identify the pathogens that cause hepatitis, the researchers tested for adenovirus in 53 of them, 40 of which tested positive for adenovirus, with a detection rate of 75%.
SARS-CoV-2 was detected in 10 of the 60 patients, with a detection rate of 17%. Therefore, there is currently no evidence link between SARS-CoV-2 and this episode of unexplained hepatitis.
The current cause of the disease is most likely adenovirus, and the liver damage from hepatitis is likely to be a symptom of viral infection, or it may be a pathological response under the body's immunity.
Dr Meera Chand, Director of Clinical and Infectious Diseases at UKHSA, said: "Surveys are increasingly suggesting that an increase in sudden hepatitis in children is associated with adenovirus infection. However, we are thoroughly investigating other potential causes. ”
Diagnostic criteria:
Symptoms of hepatitis include jaundice, dark urine, gray-white stools, itchy skin, muscle and joint pain, fever, unusual tiredness, loss of appetite, abdominal pain, and more.
However, it has been reported that the diagnostic criteria for "unexplained hepatitis" have not been harmonized across regions, and in England, Wales and Northern Ireland, the diagnostic criteria for confirmed cases are - 10 years of age and below, the onset of onset from January 1, 2022, acute hepatitis symptoms (non-hep A-E type), serum transaminases > 500 U/l patients.
The diagnostic criteria for suspected cases are age 11 to 16 years, with onset from 1 January 2022. Patients present with symptoms of acute hepatitis (see Nonhep A-E), serum aminotransferase > 500 U/l.
The confirmed cases of unexplained childhood hepatitis in Scotland are defined as children under 10 years of age who have been exposed to suspected or confirmed cases since 1 January 2022, with unexplained serum aminotransferases greater than 500 U/l.
The Scottish region defines a suspected case as a person with jaundice of no known cause, under the age of 10, or a child whose symptoms have been in contact with a suspected or confirmed case since 1 January 2022.
Relevance to COVID-19:
So far, there is no evidence that this unexplained childhood hepatitis is associated with COVID-19. Neither vaccination rates nor the percentage of positive people are sufficient to support this assumption.
(Patient pathogen test results in the report)
Depending on the type of sample reported by the data, adenoviruses are more common in the blood. In the study, 11 cases of adenovirus in the blood have been successfully tested for subtypes to identify the pathogen as adenovirus subtype 14F.
In addition, other subtypes of adenovirus have also been detected in non-blood samples in some cases, and the overall detection rate of adenovirus has exceeded 75% as of April 26, 2022.
Domestic Clinical Program:
On 21 April, the Japanese local government also reported a case of hepatitis to the Ministry of Health, Labor and Welfare, suspected to be the first case of acute hepatitis in an unexplained child in Asia. Many people are starting to worry about whether this type of hepatitis will enter China.
Epidemiologically, outbreaks of acute hepatitis are rare in children. But during the domestic COVID-19 epidemic, the medical industry may have less attention to viral hepatitis diseases, leading to the spread and epidemic of the virus.
Spring is the peak of the adenovirus epidemic. Although some adenovirus diseases are self-limiting, fatal infections may occur in children with low immune function, and the acute hepatitis pattern is not a typical adenovirus infection model, so domestic and foreign medical institutions need to pay attention as soon as possible to do a good job of investigation and reporting.
In addition to this, the current genome-wide adenovirus sequence data available to the public is very limited, and before any definitive conclusions can be drawn, researchers also need to perform genome-wide detection and sequencing of multiple cases to confirm the specific characteristics of the adenovirus subtypes involved.
Finally, the World Health Organization issued a document recommending that countries and regions of health care institutions remain vigilant, strengthen investigations, and issue a warning – "Given the increase in the number of reports in the past month and the expansion of the scope of case searches, more cases may be detected in the coming days." ”
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[1] Acute hepatitis of unknown aetiology–the United Kingdom of Great Britain and Northern Ireland.WHO
[2] Increase in hepatitis (liver inflammation) cases in children under investigation. UKHSA
Source: Health Community