As of 21 April 2022, 12 countries have reported cases of hepatitis of unknown cause in children, with a total of 169 cases and 74 adenovirus tested, as of 21 April 2022.
On 25 April, Japan also reported the first case of unexplained hepatitis.
Of these, 114 were from the UK, resulting in at least one child fatality. The impact of the COVID-19 vaccine can be basically ruled out.
Figure | CCTV
What causes hepatitis in children of current unknown origin? What are the developments in the research? Baidu Health Medicine Code invites authoritative experts to bring interpretations to everyone.
Which countries are currently available
Reported unexplained hepatitis?
As of 21 April, 114 cases have been reported in the United Kingdom, 13 in Spain, 12 in Israel, 9 in the United States, 6 in Denmark, less than 5 in Ireland, 4 in the Netherlands and Italy, 2 in Norway and France, and 1 each in Romania and Belgium, WHO said.
On 25 April, Japan also reported the first case of unexplained hepatitis.
Figure | Resources
Analysis of the current situation of cases in various countries
United Kingdom
On April 25, UK time, the UK released an investigation report on sudden hepatitis cases in children as of April 20, 2022 [2], which provided data and findings on cases in residents of England.
The UK report mainly suggests that the effects may be caused by adenovirus.
Key 1: What are the clinical features of UK cases?
As of 20 April 2022, there were 111 children with unexplained hepatitis in the UK, 81 in England, 14 in Scotland, 11 in Wales and 5 in Northern Ireland, of whom 10 children required liver transplants.
None of these cases have been vaccinated against COVID-19. [3]
The study analysed the clinical situation of 81 children in England.
Most of them were between the ages of 3 and 5 (53, or 65.4%), with a median age of 3 years and 54.3% of women. According to the information available, the majority were white (49 out of 56, or 87.5 per cent).
According to available data, the most common symptom was jaundice (60/81: 74.1%), followed by vomiting (59/81: 72.8%); gastrointestinal symptoms were often the cause of medical visits, including diarrhea (49.4%) and nausea (39.5%).
In addition, common symptoms include lighter stool color (58.0%), drowsiness (55.6%), fever (29.6%), and less common respiratory symptoms (19.8%).
Seven of the 81 cases required transplantation, and the clinical results are shown in the following table:
Figure | Resources
Key 2: What are the etiological test results?
The UK health department tested and no hepatitis A to E virus was detected.
Of the 53 cases detected, adenovirus was the most common pathogen (a common cold virus, accounting for 40 cases).
Grading was done in blood samples from 11 of these cases, all of which were type 41F, but other adenoviruses were found in some non-blood samples of the cases.
Adenovirus DNA levels in blood/serum samples from liver transplant patients are approximately 12 times higher than in patients who have not received liver transplants, although the timing of taking these samples varies depending on the time of onset and exacerbation of the patient.
Of the 61 cases in which test data are available, 10 tested positive for SARS-CoV-2 (16%) upon admission. Seven of them also tested positive within 6 weeks prior to admission, and 3 cases of adenovirus co-infection with SARS-CoV-2.
Key 3: Do adenoviruses and COVID-19 cause liver damage?
Whether it is adenovirus or new coronavirus, liver injuries after infection are rare events.
In the 21 years from 1995 to 2016, there were only 12 cases of adenovirus-related hepatitis in the pathology database of Stanford University Medical Center in the United States, and all of them occurred in immunocompromised people, such as hematopoietic stem cell transplantation, solid organ transplantation, human immunodeficiency virus infection, chemotherapy and congenital immunodeficiency syndrome. [4]
According to the International Consortium for Severe Acute Respiratory and Emerging Infections (ISARIC) [2], of the 8,883 children admitted to hospital for SARS-CoV-2 infection between February 2020 and March 2022, 2171 (24%) who were at risk of liver function impairment through clinical assessment were tested for liver enzyme ALT at admission, and only 13 ALT were greater than 500 IU/ml. (This value is one of the diagnostic criteria for unexplained hepatitis recommended by WHO).
So do the two interact with each other, leading to an increased risk of liver damage? The UK also investigated trends in adenovirus infections during the COVID-19 pandemic.
The data shows that between October 2020 and March 2022, the number of adenovirus prodromal, co-infected and secondary infections increased among children under the age of 10 who were infected with the new crown virus.
There has been a similar rise in other childhood infections. That is, during the COVID-19 pandemic, the number of children infected with adenovirus and other pathogens in the UK has increased.
Figure | Resources
Dr Meera Chand, Director of Clinical and Emerging Infections at the UK Health Security Agency (UKHSA), said: "The information gathered through surveys is increasingly suggesting that an increase in sudden hepatitis in children is associated with adenovirus infection. However, we are thoroughly investigating other potential causes. ”
Israel
Israel also released information on the information[5], Israel Schneider Hospital found a total of 12 children with hepatitis, 7 hospitalized (4 with liver failure, 2 of whom needed transplants).
All but one of the other 11 children have been diagnosed with COVID-19 and are all under the age of 5.
Five of them also suffered from "post-COVID-19 syndrome", and it should be noted that the Israeli Ministry of Health has now determined that the hepatitis of these 5 children is post-COVID-19 syndrome.
Their view is that the outbreak in Israel cannot be considered at this time.
The Israeli Ministry of Health is currently investigating the incident, and it is unclear whether it is a known virus or a new virus.
At the same time, they are testing other hypotheses, such as reactions to chemicals or toxins, and the possibility of phenomena associated with post-COVID-19 syndrome.
As can be seen from the patient base information released in Israel, the proportion of COVID-19 patients among children with unexplained hepatitis is very high.
Japan
There is currently less information about unexplained hepatitis in children in Japan.
The known patient is under 16 years of age, is negative for adenovirus, coronavirus, and hepatitis A to E virus, and is hospitalized, but has not undergone a liver transplant. [6]
Will it develop into a global infectious disease?
It can be seen that the specific cause of hepatitis of unknown origin is not clear.
It may be a combination of adenoviruses and the new crown virus, or it may be other pathogens (viruses, bacteria, or fungi), so there is also a lack of targeted protection recommendations.
Since there are currently few cases found, mainly concentrated in Europe, we do not need to panic too much for the time being, but we also need to maintain attention and vigilance.
How can parents do a good job of daily protection?
Parents and guardians should pay more attention to hepatitis, and when children appear jaundice, nausea, vomiting, diarrhea and other symptoms, they should seek medical attention in time.
Normal hygiene measures help reduce the spread of many common infections, including adenovirus. For example:
Let your child wash their hands frequently, especially after returning home from a public place;
Let your child wear a mask outside;
Instruct your child to cover his mouth and nose when sneezing/coughing, etc.;
Dr. Meera Chand recommends that children with symptoms of gastrointestinal infections, including vomiting and diarrhoea, stay home or seek medical attention until 48 hours after symptoms have stopped before returning to school or nursery.
bibliography
[1] WHO. Multi-Country – Acute, severe hepatitis of unknown origin in children
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON376
[2] UKHSA. Investigation into acute hepatitis of unknown aetiology in children in England, Technical briefing.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1071198/acute-hepatitis-technical-briefing-1_4_.pdf
[3] Increase in hepatitis (liver inflammation) cases in children under investigation
https://www.gov.uk/government/news/increase-in-hepatitis-liver-inflammation-cases-in-children-under-investigation
[4] Schaberg KB, Kambham N, Sibley RK, et al. Adenovirus Hepatitis: Clinicopathologic Analysis of 12 Consecutive Cases From a Single Institution. Am J Surg Pathol. 2017; 41(6):810-819.
[5]https://news.walla.co.il/item/3501712
[6] Japan's new year 闻. First confirmed cases of acute hepatitis in children with unknown cause in Japan One after another report in Europe and the United States
https://news.yahoo.co.jp/articles/532442933b8126212f799329e504e323729e5e4c
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