In the latest incident data acute hepatitis to children in United Kingdom and the possible causes are mentioned by Elias Mosialos, Professor of Health Policy at LSE, by posting it on facebook. As of January 1, 2022 have been recorded 114 cases of acute hepatitis of unexplained etiology, found in children of age under 16 years. Mr. Mosialos cites a report by the British Health Authority regarding the progress and developments of the investigation of the unexplained etiology of acute hepatitis in children.
Epidemiological data and conclusions from the report
– Patients are -mostly- under 5 years old.
– Children are -mainly- aged between 3 and 5 years (53: 65.4%), with a median age of 3 years and 54.3% are girls.
The clinical picture often begins with gastroenteritis-type symptoms, often followed by jaundice.
– From the data available, in England, 43 of the children have recovered and 38 continue to be treated.
– The cases are not related to each other.
Geographical dispersion is not limited to one area but covers the whole of the United Kingdom.
– Ten children needed a transplant.
No deaths have been reported between these cases in the United Kingdom.
In addition, regarding the possible causes of hepatitis
– Coronavirus has been detected in 10 of the 60 patients currently screened.
– Seven of these children were also positively diagnosed with coronavirus at some point in the previous 6 weeks, before being hospitalized.
Forty of the 53 children tested for adenovirus tested positive.
Preliminary analysis of the adenovirus shows that type 41F is common (11 cases have been identified successfully) but sequencing of the entire genome from multiple cases is necessary before the type of virus can be confirmed.
Adenovirus DNA levels in blood / serum samples in children who underwent liver transplantation were approximately 12-fold higher than those who did not undergo liver transplantation (although the timing of sampling varies in the onset and worsening of symptoms).
– Thorough questionnaires on the history of the disease have not revealed obvious causes of common exposure to toxins or other environmental factors.
According to Mr. Mosialos, health professionals process data on coronavirus infection and other microorganisms and investigate interactions to understand whether adenovirus infection in the general pediatric population has preceded coronavirus infection, if it was coronavirus, if 27 days or delayed secondary infection up to 59 days after coronavirus infection. The current data show that between October 2020 and March 2022 there was an increase in both previous and secondary infections in children under 10 years of age. (Similar increases have also been observed for other childhood infections).
The teacher adds that in Israel is being investigated temporal association of hepatitis and coronavirus infection to the children. It has been reported that a large proportion of children who developed acute hepatitis had been diagnosed with coronavirus 3.5 months earlier.
Also, although the majority of reported cases are in the United Kingdom, liver transplants in children with acute hepatitis of unknown etiology have currently been reported in the Netherlands (3), the Americas (2), and Italy ( 2) and in Spain (1).
In conclusion, the working cases of British researchersaccording to the report (in order from most probable to least probable) with the current data, are the following:
1. A factor – still unclear – that affects young children, that either makes the adenovirus infections more serious than usual or causes the immunopathology in question. This booster can be:
A. Sensitivity, for example, due to lack of prior exposure to the pathogen during a pandemic.
B. Previous coronavirus infection or other infection.
C. Double / simultaneous infection e.g. with coronavirus.
D. Exposure to toxin (s), drugs or other environmental agents.
A new variant of adenovirus with or without the contribution of a booster agent.
3. A new pathogen that either acts alone or as a concomitant infection
4. A new variant of the coronavirus.
We expect new ones soon and we hope for corresponding detailed data of history and disease from other countries that have also identified cases of hepatitis in children, concludes Mr. Mosialos.
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