Recently, a mysterious child acute hepatitis has appeared in many parts of the world, which has aroused concern. As the country investigates, more details emerge. The US Centers for Disease Control and Prevention released a report on the 29th, which seems to exclude the role of the new crown virus and highlight the role of adenovirus.
Mysterious disease
Recently, a mysterious child acute hepatitis has appeared in many parts of the world, which has aroused concern due to unknown etiology, sporadic situation and serious impact.
Richard Pebodi, an infectious disease expert at the World Health Organization's Regional Office for Europe, said on the 28th that the organization has recorded about 170 such cases, distributed in 16 countries, most of which are concentrated in Europe. Patients aged between 1 month and 16 years of age require liver transplantation in about 10% of cases and at least 1 death.
In Europe, most cases are concentrated in the UK. According to British media reports, the number of local cases has risen to 145, but most have recovered and there have been no deaths. Dirdrie Kelly, a British paediatric hepatologist, believes that the number of cases in the UK is much higher than in other European countries, possibly because of the country's more timely surveillance reports.
According to US media reports, at least 18 related cases have been reported in at least 4 local states. In Wisconsin, two suspected cases were in serious condition, one requiring liver transplantation and one fatal.
In addition, there have been cases in Israel and Japan, where symptoms are mainly manifested as the initial symptoms of gastroenteritis (diarrhea, nausea, etc.), as well as jaundice.
Coincidentally, the disease appears to have emerged in many parts of the globe last fall and this spring. In the US state of Alabama, five cases began in October last year and four cases in February this year. Similarly, two cases reported from Cyprus became ill in November last year and March this year, respectively.
Accounts differ and opinions vary
There are many opinions about the cause of this mysterious disease.
One is "common hepatitis virus infection". However, WHO recently said that after laboratory analysis, the possibility that these cases were caused by hepatitis A, B, C, D and E has been ruled out, and the new crown virus or adenovirus has been detected from some case samples.
WHO said last week that one adenovirus was detected in at least 74 cases, of which 18 were confirmed to be infected with adenovirus type 41; the new coronavirus was detected in 20 cases; and both adenovirus and the new coronavirus were detected in 19 cases.
The second is the "new crown virus theory". Bloomberg said that because the new crown virus may cause damage to organs such as the liver, it is also seen as one of the potential causes.
Experts such as Kelly believe that the current increase in acute hepatitis cases in children may be related to the new crown virus pandemic. According to a medical report in 1924, cases of hepatitis in children increased after the 1918 influenza pandemic.
However, the UK Health Security Agency said that as the new crown virus is still raging locally, it is not surprising that there are new coronavirus cases in related hepatitis cases. The department also said these cases of hepatitis were not linked to the COVID-19 vaccine because the vaccine has not yet been rolled out on a large scale among children.
Third, the "adenovirus theory", especially the "type 41 adenovirus theory" has aroused concern. Although most of the dozens of known adenoviruses are associated with cold symptoms, fever, sore throat, etc., they do not match the symptoms of current mysterious hepatitis. However, adenovirus type 41 is usually associated with diarrhea, vomiting, fever, and often respiratory symptoms.
According to the UK Health Security Agency, the level of transmission of common viruses among children is currently higher than in previous years, with a significant increase in cases of adenovirus infection, particularly in children aged 1 to 4 years. In current cases, approximately 77% of adenovirus test positive.
According to WHO, this may be due to lower levels of transmission of adenovirus during the COVID-19 pandemic, leading to increased susceptibility in children.
Alastair Sakliff, a professor of pediatrics at University College London, bluntly said the phenomenon was "too coincidental". He believes that either the children's immunity to adenovirus has declined, or that adenovirus and the new crown virus have worked together to cause this mysterious hepatitis. In any case, "there is a covid-19 pandemic in this." ”
However, the "adenovirus theory" is also questionable. Although there have been previous cases of adenovirus-induced hepatitis in children, it is more common in immunocompromised children, and most of the current patients do not have underlying disease.
According to WHO, the possibility of a new type of adenovirus and the possibility of adenovirus working together with the new coronavirus to cause mysterious hepatitis needs further study.
Other speculations include non-contagious causes, such as food poisoning, exposure to certain drugs or metal substances.
Investigation progress
As the country investigates, more details emerge. The US Centers for Disease Control and Prevention released an investigation report on the 29th, which seems to exclude the role of the new crown virus and highlight the role of adenovirus.
The investigation is based on nine cases in Alabama, including 7 girls and 2 boys. Their average age was 2 years, each from different parts of the state, and there was no epidemiological link.
Prior to the onset of illness, these patients were generally in good health and had no record of confirmed COVID-19. Like most patients, the symptoms of these nine cases before admission were mainly diarrhea and nausea, accompanied by jaundice, and some patients also developed upper respiratory tract symptoms. As the condition progressed, 3 people developed acute liver failure and 2 people had undergone liver transplant surgery and are currently recovering or are in the process of recovering.
In terms of viral testing, the common hepatitis virus tests of these 9 people were all negative, but the adenovirus test results were all positive, and 5 of them tested positive for adenovirus type 41. Six others tested positive for Epstein-Barr virus. However, because the antibody test is negative, it is estimated that it is not a recent infection. Some patients have a history of other viral infections, including human coronavirus OC43, etc.
Researchers around the world are still learning more, and the global picture of this mysterious disease is unclear. The European Center for Disease Control and Prevention believes that although systematic monitoring has not yet been carried out, the current incidence rate seems to be "very low". However, due to unclear causes and trends and the severity of some children, it is not possible to accurately estimate the health risks of the disease to the European population.
It is reported that there is currently no adenovirus vaccine for children. WHO believes that it is imperative to identify the cause and strengthen surveillance and hygiene measures, including frequent hand washing and respiratory hygiene, to prevent common viral infections such as adenovirus.
Mila Chandler, the Health Safety Agency's official in charge of clinical and emerging infections, also cautioned that parents and guardians should be vigilant when children develop symptoms of hepatitis and contact professionals in a timely manner if suspicious symptoms are found.
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Column Editor-in-Chief: Yang Liqun Text Editor: Yang Liqun Title Image Source: Figure Worm Image Editor: Shao Jing
Source: Author: Lu Yifei