Per edit: Cheng Peng, Gai Yuanyuan
Since the UK first reported it earlier this month, more than a dozen countries in Europe, North America and Asia have reported cases of unexplained childhood hepatitis. According to Red Star News, the European Centre for Disease Prevention and Control (ECDC) said that as of April 26, local time, nearly 200 cases have been reported worldwide, most of which are concentrated in the European region.
According to foreign media reports on the 27th, at least 6 states in the United States have reported confirmed or found suspected cases of unexplained childhood hepatitis. At the same time, on the afternoon of the 27th local time, the Wisconsin Department of Health Service said that one of the 4 cases under investigation died of a child patient. Once confirmed, it will be the first death in the United States to be linked to unexplained childhood hepatitis.
According to CCTV news, on April 28, local time, The Minister of Health of the Madrid Region of Spain, Escudero, confirmed that as of now, the health authorities of the region have reported 8 cases of unexplained hepatitis infection in children. According to the News Network quoted by Japan's "Yomiuri Shimbun" report, on the 28th, Japan's Ministry of Health, Labor and Welfare said that the country added 2 new cases of acute hepatitis in children of unknown cause. According to the news, 2 patients developed symptoms such as diarrhea and general fatigue. Up to now, Japan has reported a cumulative total of 3 suspected cases of the disease.
↑Distribution map of cases of hepatitis of unknown origin in children as of April 23 Figure according to who
To date, international health officials and experts are still studying the factors that cause hepatitis in unexplained children. The UK Health Security Agency (UKHSA) recently said that the most likely cause of the disease is adenovirus. According to a statement issued by WHO on the 23rd, at least 74 patients were detected to be infected with adenovirus. However, some health experts say the specific reasons have yet to be investigated and that it is "too early" to draw conclusions about this.
On April 29, the "Huashan Infection" WeChat public account published an article on April 29 to introduce the development of hepatitis in children of unknown causes in the United Kingdom and other places and its possible causes. The article pointed out that there is an imported risk of hepatitis in unexplained children, and the mainland should prepare for this early. At the same time, Zhang Wenhong, director of the National Center for Infectious Diseases And director of the Department of Infectious Diseases of Huashan Hospital affiliated to Fudan University, also commented on unexplained childhood hepatitis in the article.
British experts have warned:
Detected cases may be just the tip of the iceberg
On April 28, local time, Escudero, Minister of Health of the Madrid Region of Spain, confirmed that as of now, the health authorities of the region have reported 8 cases of unexplained hepatitis infection in children, of which 5 are from the Madrid region and 3 are from Aragon, Castilla-La Mancha and Galicia.
Escudero said the health authorities in the Madrid region had met with the head of the UK health authority to respond to the unidentified outbreak of childhood hepatitis.
Image source: Photo Network - 400909202
According to CCTV News reported on the 29th, on April 28, local time, the European Center for Disease Control and Prevention issued a statement that after the United Kingdom first reported an increase in cases of severe acute hepatitis of unknown etiology among healthy children on April 5, as of April 20, 111 cases aged 10 and below had been found in the United Kingdom. As of 27 April, 12 countries in the EU/EEA have reported some 55 suspected and confirmed cases.
In addition, recently many states in the United States have also found cases of unexplained childhood hepatitis. According to Red Star News quoted by foreign media reports, as of the 27th, at least 6 states in the United States have confirmed or suspected the detection of unexplained cases of childhood hepatitis. Last week, the CDC issued a national warning saying that Alabama has identified nine unexplained cases of acute hepatitis in children, all ages 1 to 6. Subsequently, 2 cases of acute hepatitis in children were also detected in North Carolina.
Illinois said Monday (25th) that the state has found 3 cases of severe childhood acute hepatitis, one of which requires a liver transplant. A day later, Delaware officials said the state had found a child under 5 with unexplained acute hepatitis and was currently hospitalized.
Wisconsin issued a health alert on the afternoon of the 27th that at least 4 cases similar to hepatitis cases in Alabama are under investigation, one of which has died and another case requires liver transplantation. In addition, New York State health authorities are investigating suspected cases.
Clinical manifestations are severe acute hepatitis requiring hospitalization, with jaundice and a significant increase in hepatic transaminases. Information on the outcome of the case is still being collected. As of now, most patients with access to information have recovered, but some have developed acute liver failure requiring liver transplantation. Due to the unknown cause, it is not possible to determine effective control measures at this stage. Young children are more likely to be exposed to viruses such as adenovirus through the fecal mouth. The European Centre for Disease Control and Prevention therefore recommends strengthening good hygiene practices (including hand hygiene, cleaning and disinfection) in environments with young children.
At a time when cases of hepatitis in unexplained children are spreading in the United States, the number of reported cases worldwide is approaching 200. The European Centre for Disease Control and Prevention said that as of the 26th, about 190 similar cases had been reported worldwide. With the confirmation of the country's first case of unexplained childhood hepatitis on the 25th, the disease has appeared in 13 countries.
At the same time, Canadian public health officials said on the 26th that they are investigating cases of severe acute hepatitis of "unknown origin" in children, but it is not clear whether these cases are related to the recent surge in cases of acute hepatitis in children in Europe and the United States.
The UK has the highest number of confirmed cases. Simon Taylor-Robinson, a liver disease expert at Imperial College London, warned on the 25th that the "mysterious" hepatitis cases in children found so far may be just the "tip of the iceberg", and the actual number of cases is more than the number reported.
According to WHO data, of the 169 confirmed cases as of the 21st, 17 need to receive liver transplantation, accounting for about one-tenth of the confirmed cases. Simon Taylor-Robinson said: "In terms of the cases that have been identified, [17 cases requiring liver transplants] are a fairly high number. But he added that "there is no reason to panic."
Fauci: Attributed to adenovirus infection
Not "completely sure"
WHO said in a statement on the 23rd that according to the cases that have been found, patients infected with such hepatitis mainly have symptoms such as abdominal pain, vomiting, diarrhea and jaundice. Of the 169 cases confirmed as of 21, at least 74 patients have been detected to be infected with adenovirus, of which 18 have been identified as Adenovirus of subgenus F 41 (Ad41). WHO also said that although adenovirus is a possible hypothesis, investigations into the causative factors are still ongoing.
In addition to the association with the COVID-19 vaccine, the UK Health Security Agency has previously said it does not rule out other possible causes such as the new crown virus, other infections or environmental factors. Susan Hopkins, chief medical adviser to the HEALTH Security Agency, said last week that health officials were still studying a range of factors that could lead to hepatitis in unexplained children, but there was a growing likelihood of pointing to adenoviruses.
According to CCTV News, on the 25th local time, the British Health Security Agency said that more and more evidence shows that a common virus is related to rare cases of hepatitis that have occurred in some young children recently. The UK's Health Security Agency said an adenovirus called F41 appeared to be the most likely cause of the disease.
Mila Chand, director of the UK's Clinical and Infectious Diseases Specialty, said information gathered through surveys by relevant departments increasingly suggested that the increase in sudden hepatitis in children was linked to adenovirus infection. In addition, the UK's Health Security Agency says another factor may be age-related. Infants have milder symptoms after infection with the virus, but older children are more likely to develop severe reactions after infection. At present, British scientists have set their sights on a specific adenovirus, namely F41 adenovirus, based on blood sample data, but scientists said that the genetic makeup of the virus needs to be observed before it can be finally confirmed.
Image source: Photo Network - 400107612
Adenoviruses can spread from person to person and cause a range of diseases such as colds, pink eye, gastroenteritis, etc., but few people think that adenoviruses cause severe hepatitis in healthy people. However, adenovirus transmission has intensified in recent months. During the COVID-19 pandemic, there was a sharp drop in recorded cases of adenovirus infection, but now the number of cases has soared. In the UK, the current level of adenovirus infection is higher than before COVID-19.
As for the causative factors, Anthony Fauci, the white house's chief medical adviser and infectious disease expert, said that investigators are still collecting relevant reports, and it is too early to draw conclusions about the causes of this series of cases. "It's still a mystery." Fauci said in an interview, "It seems to be related to adenovirus, but [this conclusion] is not entirely certain." ”
Zhang Wenhong talks about hepatitis in children of unknown cause
The "Huashan Infection" WeChat public account published an article on April 29 to introduce the development of hepatitis in children of unknown causes in the United Kingdom and other places and its possible causes. The article pointed out that there is an imported risk of hepatitis in unexplained children, and the mainland should prepare for this early.
Zhang Wenhong, director of the National Center for Infectious Diseases And director of the Department of Infectious Diseases at Huashan Hospital affiliated to Fudan University, commented in the article that cases of hepatitis of unknown cause occur every year, often referring to liver damage caused by known hepatitis viruses or known causes, which is not uncommon in children. However, hepatitis of unknown cause of concern to WHO this time has the characteristics of cluster incidence, and the incidence rate is higher than in previous years. In this case, it makes sense to consider the risk of infectious diseases.
Zhang Wenhong said that there is a certain correlation with adenovirus infection. But adenovirus infection is a very common phenomenon and can cause pneumonia or diarrhea, so why are there so many cases of severe hepatitis this year, and only in children? At present, it is speculated that it is a long period of new crown isolation, children have not been exposed to this virus for a long time, and sudden contact will produce more serious immune damage, which is consistent with the phenomenon that emerging infectious diseases tend to be heavier in the early stages of disease outbreaks.
Zhang Wenhong believes that if it is caused by a long period of new crown isolation, rather than a new virus that has not been discovered before, the subsequent effects of this unexplained hepatitis will gradually decline, but we also need to be vigilant against unknown pathogens, even if the probability of this emerging infectious disease pandemic is not high. In addition, as awareness continues to deepen, the definition of the current confirmed case is also constantly being updated.
What are the precautionary suggestions?
According to the Beijing News, WHO recommends that normal hygiene measures, such as thorough handwashing (including supervising children's handwashing), can help reduce the spread of many common viral infections, including adenovirus.
Experts from the UK's Health Security Agency and the US Centers for Disease Control and Prevention have advised parents and guardians to be vigilant when children develop symptoms of hepatitis. In addition, maintaining good hand and respiratory hygiene and supervising thorough handwashing in young children can help reduce adenovirus transmission.
Professor Peter Collinion, an Australian infectious disease specialist, believes that the best protection for families with young children in the short term is to keep them away from other sick people and maintain good hygiene practices.
In addition, there are cases of hepatitis of unknown cause in Beijing on the Internet, which have been verified by the Beijing Municipal Health Commission, which is false information. In view of the relevant case information recently reported abroad, in order to prevent the occurrence of the disease and protect the health and life safety of children in the capital region to the greatest extent, the Beijing Municipal Health Commission issued the "Notice on Strengthening the Treatment of Hepatitis Cases of Unexplained Children", with the purpose of prompting relevant medical institutions to increase vigilance, if such cases occur, it is necessary to find out the causes as soon as possible and strengthen treatment.
Edited by | Cheng Peng, Gai Yuanyuan, Du Hengfeng
Proofread | sections
Cover image source: Photo Network - 400909202
Daily Economic News Comprehensive CCTV News, China News Network, Red Star News, Beijing News
Daily economic news