Health Times reporter Zhang He Tan Qixin
According to the latest WHO report, as of 21 April, 169 cases of unexplained acute hepatitis in children have been reported in 12 countries around the world, including the United Kingdom, Spain, Israel and the United States, ranging in age from 1 month to 16 years of age, of which 17 patients have undergone liver transplantation and at least 1 case of death.
Since the UK first reported five cases of unexplained hepatitis in children on 31 March, less than a month has passed since the united kingdom first reported cases of unexplained hepatitis in children. What are the possible causes of unexplained hepatitis in children? Is the mainland at risk of importation? How should I prevent it?
As of 23 April, cases of acute severe hepatitis of unknown cause were distributed across countries.
The causative factors are unclear, and the possibility of a new adenovirus needs to be concerned
"In general, acute severe hepatitis in children is rare and its etiology has so far been inconclusive. Although current etiological analysis is the first to promote the possibility of adenovirus infection, more investigations and studies are needed to confirm it. Zhuang Hui's research team from the Department of Pathogenic Biology and the Center for Infectious Diseases Research at Peking University School of Basic Medical Sciences wrote an article.
WHO reports that no common virus causing acute viral hepatitis (hepatitis A, B, C, D and E) has been detected in all 169 confirmed cases and that adenovirus has been detected in at least 74 cases. In addition, the novel coronavirus was detected in 20 tested cases and 19 people were infected with both the novel coronavirus and the adenovirus.
Adenovirus is a common virus that usually causes mild, self-limiting influenza-like illness or gastrointestinal disorders. "The information we collect from our investigations increasingly suggests that an increase in sudden hepatitis cases in children is associated with adenovirus infection. But we are still investigating other potential causes. The HEALTH SECURITY also ruled out a link between the disease and the COVID-19 vaccine in its investigation, and no one has been vaccinated against COVID-19 in confirmed cases under the age of 10 in the UK.
However, Zhuang Hui's research team proposed that although some children in this outbreak have detected adenoviruses, adenovirus infection generally causes the onset of immunocompromised people, and acute severe hepatitis in immunocompetent children is rare.
"It is imperative to determine the cause of these cases to further refine controls and preventive measures. Although adenovirus is currently a hypothesis of a potential cause, it does not fully explain the severity of the current clinical situation. "WHO notes that investigations need to focus on factors such as whether decreased adenovirus circulation levels during the COVID-19 pandemic lead to increased susceptibility in young children, the possibility of the presence of novel adenoviruses, and co-infection of the novel coronavirus with adenovirus.
The mainland should be vigilant, but there is no need to panic
"We also need to be vigilant against unknown pathogens, even if the probability of such an emerging infectious pandemic is not high." On April 29, Zhang Wenhong, director of the Department of Infectious Diseases at Huashan Hospital affiliated to Fudan University, commented on the "Huashan Infection" WeChat public account.
Zhang Wenhong pointed out that the unexplained hepatitis that WHO is concerned about this time has the characteristics of cluster incidence, and the incidence rate exceeds that of previous years, in this case, it is reasonable to consider the risk of infectious diseases. The current speculation is related to the prolonged isolation of the new crown, the fact that children have not been exposed to the virus for a long time, and that 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.
"If it is caused by this cause, rather than a new virus that has not been detected before, the subsequent effects of this unexplained hepatitis will gradually decline." Zhang Wenhong said.
In fact, hepatitis in children can be caused by a variety of causes, according to the information released by the Stanford Children's Health Center, the causes of hepatitis in addition to the common hepatitis virus, cytomegalovirus, herpes simplex virus, chickenpox, adenovirus, etc. may lead to the occurrence of liver inflammation in children.
On April 27, the Beijing Municipal Health Commission issued the Notice on Strengthening the Treatment of Cases of Hepatitis in Children of Unknown Cause, with the purpose of reminding relevant medical institutions to be vigilant and pay attention to children with hepatitis caused by unknown causes.
"Parents do not need to panic, the number of cases reported by this outbreak is still a minority, although there are individual cases reported this time that require liver transplantation due to liver failure, but clinically unexplained liver failure is not uncommon." Zhu Zhijun, director of the Liver Transplant Center of Beijing Friendship Hospital, said in an interview with a Health Times reporter.
Qingdao Municipal Disease Control and Prevention an expert who did not want to be named pointed out in an interview with the Health Times reporter that the mainland currently has immunization program vaccination requirements for children hepatitis B and hepatitis A, and the incidence of hepatitis in children is very low in China, as for hepatitis of unknown cause, I have not heard of relevant cases in China, but as long as it is an infectious disease, routine means such as washing hands frequently and paying attention to respiratory cleanliness and hygiene are still effective for preventing infection.
bibliography:
1.WHO：Multi-Country – Acute, severe hepatitis of unknown origin in children.2022-04-23 https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON376
2.UKSHA: 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#full-publication-update-history
