Is hepatitis of unknown cause terrible in children? What should parents do?

Changsha Evening News all-media reporter Yang Weiran correspondent Li Jinqiang

According to Xinhua News Agency, recently, a kind of acute severe hepatitis in children with unknown etiology has attracted close attention from the public health field in Europe and the United States and the World Health Organization. As of 1 May, 228 children with unexplained acute hepatitis have been reported in 20 countries and territories worldwide, and a small number of children require liver transplantation. With the rapid spread of the disease in various countries, it has attracted great attention from medical experts.

As soon as the report came out, many parents of children expressed concern and asked whether there were such cases in the local area. Has the cause been found? Is it related to the coronavirus? What should parents do to prevent hepatitis in children? In response to these hot issues that the public is concerned about, Professor Jiang Fangqing, director and chief physician of the Department of Infectious Diseases of Changsha First Hospital, made relevant interpretations.

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Globally, there are more than 220 cases of hepatitis in children of unknown cause, and 10% of them require liver transplantation

According to reports, on April 5, the United Kingdom was the first to report that healthy children continue to suffer from severe acute unexplained hepatitis. Currently, most of the cases have occurred in the United Kingdom, and since then, the cases have also been detected in 11 other countries, including Spain, Israel, the United States, Denmark, Ireland and so on. To date, most cases have been detected in Europe, but there are also distributions in the Americas, the Western Pacific and South-East Asia.

On 25 April, japan saw its first Asian case. The Ministry of Health of Indonesia reported three deaths from hepatitis in children of unknown etiology on 2 May. In the past month alone, unexplained cases of childhood hepatitis appear to be menacing, with 228 confirmed cases and 50 suspected cases still awaiting confirmation.

Jiang Fangqing introduced that in these cases, the age of children is basically between 1 month and 16 years old, most of them are children under 5 years old, and before diagnosis, they have gastrointestinal symptoms such as abdominal pain, diarrhea and vomiting, as well as symptoms such as jaundice, yellow skin and eyes that may be caused by liver damage. Although most children have recovered after treatment, there are also severe cases.

According to the World Health Organization, as of now, at least 4 cases of hepatitis in children of unknown cause have died, and about 10% of severe cases require liver transplantation.

Analyze the cause

In addition to adenovirus, a variety of non-hepatitis virus infections may also cause liver damage

The World Health Organization reports that none of the common hepatitis viruses A, B, C, D and E have been detected in these affected child cases. Adenovirus was found in a sample of 74 cases, with genetic sequencing further revealing that 18 cases were identified as Adenovirus of subgenus F (Ad41); 20 were found to be infected with COVID-19; and 19 children had a combination of COVID-19 and adenovirus infections.

As a result, many parents are worried that the disease is related to the new crown virus. However, from the research report, although the epidemic period seems to coincide with the spread of the new crown virus, there is no evidence that the disease is directly related to the new crown virus, and no significant association with the new crown virus vaccine has been found.

However, the possibility of indirect impact due to the covid-19 outbreak has not been ruled out, such as more severe symptoms after the co-infection of the new crown virus in children, reduced exposure to the virus due to prolonged isolation measures, and imperfect development of the immune system. Many medical experts say the specific situation is still being studied.

Jiang Fangqing said that viral hepatitis is mostly caused by five viruses A, B, C, D and E, and a variety of non-hepatitis virus infections may also cause liver damage or hepatitis complications, and even liver failure. In addition to adenovirus, rotavirus, measles virus, Epstein-Barr virus, hantavirus and other infections also need further study. Many medical experts have also said that although adenovirus has been found in more cases this time, the World Health Organization is still conducting a number of investigations into the potential cause, and the cause has not yet been identified.

Resolve adenoviruses

It is highly contagious, with a high incidence in schools, childcare institutions and other places

The more suspicious adenovirus of this hepatitis disease is by far the "number one suspect" who is believed to cause acute severe hepatitis in children. How does adenovirus spread? What is pathogenic and contagious?

Jiang Fangqing introduced that the adenovirus population is generally susceptible, and 4% to 10% of children's viral respiratory infections (such as the common cold) are caused by adenoviruses. The source of adenovirus infection is infected people (including asymptomatic invisible infected people), and the transmission route is mainly transmitted by droplets, but also through handshakes, shared towels, door handles, toys, etc., and through the digestive tract through the consumption of contaminated food and water. The respiratory tract, gastrointestinal tract, urethra and bladder, eyes, liver, etc. can be infected by adenovirus.

Adenovirus is highly contagious and occurs mainly in confined, crowded and humid environments such as schools and childcare facilities. Adenoviruses are susceptible at all ages, and infection rates are higher due to the imperfect development of children's immune systems. Even so, infection can usually cause mild, self-limiting flu-like or gastrointestinal disorders without severe acute hepatitis. Unless children are particularly immunocompromised, especially those with some organ transplants, occasional or severe viral hepatitis may occur.

Overall, more evidence is needed to determine an association between adenovirus and this unexplained childhood hepatitis disease, and more attention needs to be paid to the research progress of other cases in subsequent cases. At present, the relevant countries are actively investigating other infectious and non-infectious factors of this hepatitis in order to correctly assess and manage the risks.

Prevention tips

Parents do not need to panic and give their children relevant vaccines in a planned and timely manner

The World Health Organization has urged countries to remain vigilant about any unexplained cases of hepatitis in children and has said that other infectious and non-communicable causes need to be thoroughly investigated. Experts believe that although the number of cases of acute hepatitis in children of unknown origin exceeds 220 cases, a significant increase over previous years, at present, these cases are still mainly sporadic and do not show the characteristics of cluster infection, indicating that the infectivity of the virus is temporarily weak.

Judging from this feature, it will not cause a large-scale and wider epidemic. Medical and health institutions can organize epidemiological investigations and start plans; on the other hand, for adenoviruses reported abroad, they should also make preliminary reserves in terms of detection technology, standardize the knowledge system, and improve the success rate of treatment. Adenovirus vaccine has been studied in China, and has not yet been clinically carried out, and scientific research institutions can strengthen the research and development of vaccines against adenovirus type 41.

Jiang Fangqing said that parents do not need to panic, the number of cases reported by children with unexplained acute hepatitis is still a minority, although some of the reported cases are due to liver failure and need liver transplantation, but clinically unexplained liver failure cases are very rare.

At present, children in mainland China have immunization requirements for hepatitis B and hepatitis A, and the incidence of hepatitis in children is very low in China. As for the unexplained hepatitis disease in children, there are currently no reports of related cases in China. However, as long as it is a contagious disease, parents should give their children a plan and timely vaccination, including hepatitis A virus vaccine and hepatitis B virus vaccine, usually supervise children to wash their hands frequently, pay attention to cleanliness and hygiene, eat cooked food, pay attention to dietary safety, etc. These conventional means are still effective for the prevention of many infectious diseases, including adenovirus.

If the child has diarrhea, abdominal pain, vomiting, nausea, not wanting to eat, discoloration of urine or feces, yellowish skin and white eyeballs (jaundice), fatigue and fatigue, pain in the liver area, bleeding gums when brushing teeth, bruised bruises on the body, itchy skin and other signs, parents should take their child to the doctor immediately, these phenomena may sometimes be a sign of hepatitis.