On May 3, local time, the World Health Organization said that as of May 1, 20 countries had reported at least 228 suspected cases of hepatitis in children of unknown etiology, and more than 50 cases were under investigation.
As of now, however, the exact cause is still under investigation. There are concerns that such unknown hepatitis may be related to the new crown.
On May 3, a reporter from the Beijing News contacted Auris Wiseborough Zinman. /Screenshot of EarthWire video
In this regard, on May 3, Orith Waisbourd-Zinman, director of the pediatric liver disease department of the Schneider Children's Medical Center in Israel, said in an exclusive interview with the Beijing News reporter that there is potential evidence that although it is very rare, patients may be more susceptible to hepatitis of unknown cause at a certain time after being infected with the new crown virus.
Jaundice occurred in all cases at Schneider Children's Medical Center
Earthwire 丨Endoor hepatitis experts: There were already cases of hepatitis in children of unknown etiology in February last year. / The Beijing News knows that the video is produced
Beijing News: A few days ago, the Israeli Ministry of Health announced that the country recently found 12 cases of hepatitis in children of unknown etiology, of which 7 cases were reported by the Schneider Children's Medical Center. Have there been any new confirmed cases at Schneider Children's Medical Center so far? Is the number of cases on the rise?
Auris Wiesburg Zinman: Previously, Schneider Children's Medical Center reported 7 cases of hepatitis in children of unknown etiology to the Israeli Ministry of Health. Following the report of 7 cases, 2 additional cases were identified, bringing a total of 9 cases to a total of 9 cases. The severity of each child's condition varied, with some symptoms being milder and some being severe, with 4 developing liver failure and 2 requiring liver transplantation.
Schneider Children's Medical Center is investigating more cases to confirm if they are linked to this hepatitis. After the media reported, the Israeli Ministry of Health is collecting more case data at our center. Last week we also noticed a case of mild condition that, after referral to Schneider Children's Medical Center, improved spontaneously without any treatment. However, his condition meets who defines a case of hepatitis in children of unknown etiology, so this is perhaps the tenth child case of hepatitis of unknown etiology that we have received.
Beijing News: When will Schneider Children's Medical Center receive the first case of hepatitis in children of unknown etiology? What are the main clinical symptoms?
Auris Wiesburg Zinman: Schneider Children's Medical Center received its first case in February 2021. The main clinical symptoms of all children are jaundice, and the main reason for their visit is jaundice or poor mental status. After the visit, all children were hospitalized, some received routine blood tests and found elevated enzyme levels, and some worsened during hospitalization.
Beijing News: What is the current progress in the treatment of these children?
Auris Wiesburg Zinman: Some children have been treated with steroids, respond well to medications, and are recovering well. Two very young children developed very severe symptoms and their condition deteriorated rapidly and required a liver transplant. However, the two children who received liver transplants are recovering well and are accompanied by their parents, one of whom just celebrated his first birthday last week, and his parents sent us photos of the birthday party. In addition to these two cases, the other children have recovered after receiving treatment.
Speculation about hepatitis in children of unknown etiology and COVID-19 infection remains cautious
Earthwire 丨Endoor hepatitis experts: Potential evidence suggests that hepatitis in children of unknown etiology may be related to the new crown virus. / The Beijing News knows that the video is produced
Beijing News: According to a previous report by Israel's Haaretz newspaper, 11 of the 12 cases found in Israel have been infected with the new crown virus in one year, which new coronavirus strain are they infected with?
Ollis Wiesburg Zinman: During the COVID-19 pandemic, these cases of childhood hepatitis of unknown etiology that we received had previously been infected with COVID-19, mainly delta and Omikeron variants.
Beijing News: Does this show that there is some connection between unknown hepatitis and new crown? What are the current types of speculation or judgment about this connection? Will prolonged isolation of COVID-19 lead to a decrease in human immunity?
Ollis Wiseborough Zinman: We believe that there is a link between hepatitis in children of these unknown causes and COVID-19 infection, but I must point out that there is no evidence of a link between the two at this time, and this speculation needs to be treated with caution. After liver biopsies of all patients, we found that these cases did not qualify for any known strains of hepatitis virus, but noted that the liver biopsy graphs in these cases looked very similar. And it took us a year to notice that. We can now determine that there may be some correlation between these cases.
However, there is still no definitive answer. Children suffering from such unidentified hepatitis may be due to the long period of isolation during the COVID-19 epidemic, or it may be some immune disorder caused by the new crown virus, resulting in an abnormal immune response to adenovirus. If it were not for the above causes, this virus may not cause severe liver damage.
In addition, while I have no way of knowing whether the adenovirus detected in cases of childhood hepatitis of unknown etiology in Israel is the same as the adenovirus reported in the UK or elsewhere, I need to point out that adenovirus does not cause serious symptoms and cannot simply be blamed on adenovirus.
I think that this unknown cause of hepatitis may be related to the effects of infection with the new crown virus, which is indeed a hypothesis, but it can also be explained from a physiological point of view, that is, it is possible for a patient to be infected with adenovirus or other viruses at a specific time after infection with the new crown virus, and not just adenovirus infection. Of course, more data is needed to support it.
Beijing News: Relevant health departments and experts believe that hepatitis in children of unknown etiology may be related to adenovirus. Can the unknown cause of hepatitis now be confirmed to be caused by adenovirus? What more evidence is needed?
Aolis Wiseburg Zinman: To understand whether there is a link between hepatitis and adenovirus in children with such unknown etiology, we need liver biopsy to detect whether adenovirus replicates itself in the liver, including PCR (polymerase chain reaction) testing and special staining tests for adenovirus. Previously, we observed that a patient with hepatitis of unknown etiology who had previously had COVID-19 tested positive for adenovirus, but this patient tested for adenovirus accurately to the liver and turned negative. We failed to detect adenovirus in the liver, so we cannot conclude that this hepatitis is caused by an adenovirus infection.
To investigate this problem further, we need to collect more liver samples and do more molecular tests.
Beijing News: What speculations or conclusions can be drawn at present?
Olris Wiesburg Zinman: Once we start discussing rare cases, it takes time to come to definitive conclusions, and those conclusions have to be approached with caution. But I think there is potential evidence that, although very rare, it is possible that patients may be more susceptible to this unknown hepatitis at a specific time after contracting the new crown virus.
However, I still think that parents do not need to feel pressured to do something about it, and it is not recommended to routinely check patients who have been infected with the new crown virus. Overall, we should not make the general population nervous, but should get the attention of medical professionals.
Some cases are still expected to remain undetected
EarthWire 丨Endoor hepatitis experts: There is no need to be overly nervous about ordinary people with "unexplained hepatitis in children". / The Beijing News knows that the video is produced
Beijing News: Compared with the previous hepatitis, what is the difference between hepatitis in children of unknown etiology this time?
Olris Wiseborough Zinman: This hepatitis differs from previous hepatitis in that the patient's bilirubin has increased, and the response of these bilirubin to steroids is very obvious.
From the results of liver biopsy, there are inflammatory cells in the liver entrance area, called interfacial hepatitis, which has similarities with ordinary hepatitis. However, care is still needed to avoid misdiagnosing interfacial hepatitis as autoimmune hepatitis, which is also similar on laboratory biopsies.
At the same time, interfacial hepatitis also has similarities with hepatitis caused by EBV (herpes virus). For example, there are some features of interfacial hepatitis that are mixed with certain features of hepatitis caused by EBV, and they look pathologically similar.
These key findings are also unique to the pediatric hepatitis community of unknown etiology.
Beijing News: At present, do the cases in Israel have in common with the cases of the United States, the United Kingdom and other countries?
Aolis Wiesburg Zinman: My colleagues in the U.S. say that similar cases have been found in the U.S. Once hepatitis of unknown etiology comes to the attention of the people, doctors will begin to trace the case back. Now we need more data, and I believe we will get it soon.
Beijing News: Is there a scientific research plan for this unknown cause of hepatitis in the next step?
Ollis Wiseborough Zinman: We're trying to reanalyze liver biopsies, do more molecular testing on biopsy specimens, and proactively perform PCR (polymerase chain reaction) testing. What's more, there may be more cases in the future, and we should do some preparation for this, cryopreserving some serum and liver fragments for more analysis.
Reporter | Yao Yuan Zhu Yuehong
Edit | Zhang