In this multi-country outbreak of unexplained hepatitis, some cases have been identified as positive for adenovirus ‐41 nucleic acid. However, there is no information on whether adenovirus ‐41 and its whole genome sequence have been detected in the liver of the child. (Visual China/Photo)
The coronavirus has brought a troubling global pandemic, and an as yet unidentified acute hepatitis has quietly targeted children.
On May 3, 2022, local time, the World Health Organization (WHO) held a press conference in Geneva, saying that as of May 1, a total of 228 children in 20 countries and regions had reported unexplained acute hepatitis in 20 countries and regions, and another 50 suspected cases needed further investigation.
"My son is only three years old, and after suffering from unexplained hepatitis at the end of December 2021, he was very weak, underwent a series of tests and treatments in the hospital, and doctors also found respiratory viruses in his secretions." On May 4, the mother of a child with suspected liver disease in the United Kingdom said in an interview with Southern Weekend that it would take about six months for her son's liver to fully recover.
Tricky, there are already deaths. WHO spokesperson Tarik Jasarevic said at the press conference that 1 death has been confirmed among the sick children, 4 suspected cases have died, and 18 children need liver transplants. On 5 May, a spokesman for Indonesia's Ministry of Health announced that three children in the country had died of hepatitis of unknown etiology, aged 11, 8 and 2.
Given that several countries are just beginning to strengthen surveillance for such cases of acute hepatitis in children of unknown origin, the above statistics may be just the tip of the iceberg,
"At present, the cause is not clear, in the case of possible infectious causes, the risk of importation is there, and the main reason for this is that the entry health declaration should be made." On May 5, Professor Xie Youhua, vice president of the Shanghai Institute of Major Infectious Diseases and Biosafety and director of the Department of Pathogenic Biology of the Basic Medical College of Fudan University, told Southern Weekend.
There are no related cases in China
"This time unexplained childhood hepatitis continues to attract attention at home and abroad, the main reason is that in european countries such as the United Kingdom and Denmark, the number of cases of unexplained childhood hepatitis exceeded expectations, indicating that there are new pathogenic factors different from previous years." Xie Youhua told Southern Weekend reporters.
The liver is an important metabolic organ of the human body, and the adult liver weighs about 1200 to 1600 grams, accounting for 1/50 of the adult body weight. Hepatitis is not far away. Hepatitis caused by A, B, C, D, and E viruses is common.
In mid-to-late April 2022, there were rumors on domestic social platforms that there were also cases of unexplained hepatitis in Beijing, and then the Beijing Municipal Health Commission debunked the rumor that "there are cases of unexplained childhood hepatitis in Beijing" as false information.
On April 27, the Beijing Municipal Center for Disease Control and Prevention further disclosed that from January 1 to April 25, 2022, a total of 228 cases of viral hepatitis and 1 death were reported in Beijing. Among the reported cases, there were 20 cases of type A, 42 cases of type B, 23 cases of type C, 1 case of type D, and 142 cases of type E, and no cases of unspecified hepatitis were reported.
"As of now, our city has not received any reports of child cases that meet the who definition of cases of unexplained acute hepatitis in children." At the same time, the Beijing Municipal Center for Disease Control and Prevention also said that the epidemic of gene 41 adenovirus has not yet been monitored, but because the adenovirus is mainly transmitted through the respiratory tract, digestive tract and contact with contaminated objects, measures to prevent the spread of the new crown virus are also applicable to the prevention of adenovirus.
Nevertheless, the Beijing Municipal Health Commission issued the "Notice on Strengthening the Treatment of Cases of Hepatitis in Children of Unknown Cause", reminding relevant medical institutions to be vigilant and pay attention to children with hepatitis caused by unknown causes, and if such cases occur, they should find out the causes and strengthen treatment as soon as possible.
"The current information is released from the WHO or the public health department of the relevant country, and this information is difficult to conduct an in-depth assessment of the current progress." Xie Youhua told the Southern Weekend reporter that with the deepening of follow-up research, there will be more information disclosure, at present, schools and families should pay attention to cultivating children's good hygiene habits, pay attention to hand hygiene and dietary hygiene.
China is a big country with hepatitis epidemics, and viral hepatitis is the class B infectious disease with the highest number of reported cases among china's statutory infectious diseases, of which there are about 90 million hepatitis B virus carriers. In response to this major public health challenge, China has worked to achieve who's goal of eliminating viral hepatitis by 2030 through measures such as neonatal immunization programmes, lowering the price of hepatitis antiviral drugs, and promoting patriotic health campaigns.
Cause or adenovirus
Since WHO received case reports from relevant uk-based agencies on 5 April 2022, cases of unexplained acute hepatitis have been reported in Europe, the Americas and Asia.
Regarding the cause, the UK Health Safety Agency (UKHSA) proposed on 12 April that the sudden increase in hepatitis cases in children may be related to adenovirus, but is also investigating other possible causes of infection, including those related to COVID-19 infection or the environment. Subsequently, the U.S. Centers for Disease Control and Prevention also announced that in the nine children reported in Alabama with unexplained hepatitis, they all tested positive for adenovirus.
On 23 April, the World Health Organization announced that of the 169 children reported as of 21 April 2022, 74 had tested positive for adenovirus, of which 18 were identified as adenovirus type 41. Twenty children were tested for the coronavirus (SARS-CoV-2) and 19 were co-infected with adenovirus and the new coronavirus.
On April 29, the official WeChat account "Huashan Infection" of the Department of Medical Infections affiliated to Fudan University published an article entitled "Outbreaks and Causes of Hepatitis in Children of Unknown Causes in the United Kingdom and Other Places". (Screenshot/photo of "Huashan Infection" WeChat public account)
Adenovirus is a common pathogen first discovered in the 1950s and has been divided into 7 subgenus (A-G) and at least 113 types that can cause diseases including pneumonia, ocular conjunctivitis, cystitis, and gastrointestinal disorders. In cases of pneumonia in children and in cases of viral conjunctivitis, the detection rates of adenovirus are 4% to 10% and 65% to 90%, respectively.
"However, adenoviruses rarely infect the liver and adenovirus hepatitis is rare." "Chinese Journal of Preventive Medicine" released on April 27 "Reflections on the current cases of severe acute hepatitis in unexplained children in some countries around the world", in which xu Wenbo's team of the Chinese Center for Disease Control and Prevention pointed out that adenovirus hepatitis cases usually occur in liver transplant recipients, and studies have shown that the incidence of adenovirus hepatitis in children's liver transplant recipients is only 2% to 4%.
Xu Wenbo's team also said that adenoviruses may have genetic recombination and change the characteristics of the virus, which will trigger a serious outbreak of respiratory infections. Xie Youhua's team at Fudan University also believes that new variants of common viruses such as adenovirus are one of the more likely reasons.
In 2006, there was an adenovirus-55 outbreak in Qishan County, Shaanxi Province, China, when the new virus caused 429 cases and 1 death, and the virus is still circulating in China.
In this multi-country outbreak of unexplained hepatitis, some cases have been identified as positive for adenovirus ‐41 nucleic acid. However, there is no information on whether adenovirus ‐41 and its whole genome sequence have been detected in the liver of the child.
"Whether adenovirus ‐41 is the main pathogen triggering this severe hepatitis outbreak in children requires more etiology, genomics, liver pathology, and immunohistochemical analysis to determine or exclude." Xu Wenbo's team wrote in the article.
Southern Weekend contributing writer Chase Southern Weekend reporter Huang Sizhuo
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