Elias Mosialos quotes data from a report of the British health authorities regarding the cases of acute hepatitis in children.
Through a Facebook post, the professor refers to the latest epidemiological data and the main findings of a research conducted in Britain.
Continuing to analyze what may be the possible causes of hepatitis in children.
The text of Elias Mosialos in detail
As of January 1, 2022, 114 cases of acute hepatitis of unknown etiology have been recorded, detected in children under 16 years of age. Yesterday, a report by the British health authorities was published regarding the progress and developments of the investigation of the unexplained etiology – acute hepatitis in children.
I will quote the epidemiological data and some key results and conclusions from the report.
– Patients are mainly 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
10 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.
– 7 of these children were also positively diagnosed with coronavirus at some point in the previous 6 weeks, before being hospitalized.
– 40 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.
Health care providers process coronavirus and other microorganism infection data and investigate interactions to determine if adenovirus infection in the general pediatric population has preceded coronavirus infection, if present in 27 or if present, 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).
It should also be mentioned here that in Israel the temporal association of hepatitis and coronavirus infection in children is investigated. It has been reported that a large percentage of children who developed acute hepatitis had been infected with the 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), Italy (2). ) and in Spain (1).
In conclusion, the working hypotheses of the British researchers according to the report (in order from the most probable to the 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 may 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. dual / concomitant infection eg 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
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 hope for corresponding detailed history and disease data from other countries that have also identified cases of hepatitis in children.
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