"Unexplained hepatitis" attacks children in many countries. Will your children be infected?

On April 27, the Beijing Municipal Health Commission refuted the rumor that "there are cases of unexplained hepatitis in children in Beijing" and said that it was false news. There have been no cases of unexplained hepatitis in children and no deaths caused by it in the city. At the same time, the Beijing Municipal Health Commission issued a document "Notice on Strengthening the Treatment of Unexplained Hepatitis in Children" to remind relevant medical institutions to be more vigilant.

Which countries around the world have cases of "unexplained childhood hepatitis"? What is going on? NetEase Health's "Health Focus" has sorted out some known facts for everyone, let's take a look.

01 Which countries are facing head-on confrontation with unexplained hepatitis?

Since January 2022, several cases of acute hepatitis in children of unknown causes have been observed in Europe and the United States. The World Health Organization released a report on April 23, stating that as of April 21, 12 countries had reported at least 169 cases of acute hepatitis in children of unknown origin, with patients ranging in age from 1 month to 16 years old, of which 17 (about 10%) required liver transplants and at least one died.

On April 25, Japan reported its first case of hepatitis of unknown cause. The child was not infected with the new coronavirus or adenovirus. On April 26, the Public Health Agency of Canada responded to CBC that there were severe acute hepatitis cases of unknown origin in Canadian children.

So far, according to the latest data from the European Centre for Disease Prevention and Control on April 26, there have been nearly 200 such cases worldwide.

02 Exploring the “culprit” of unexplained hepatitis

Could it be adenovirus?

According to the WHO announcement, among the 169 children attacked by unexplained hepatitis, adenovirus was detected in at least 74 cases (18 of which were identified as adenovirus type 41), new coronavirus was detected in 20 cases, and new coronavirus and adenovirus were detected simultaneously in 19 cases.

In the reported cases, no common viruses that cause infectious hepatitis (hepatitis A, B, C, D, E) were detected, but the patients had symptoms of hepatitis, so it was temporarily called "unexplained hepatitis." In simple terms, the cause of the disease cannot be identified at once with the currently used technology.

Adenoviruses are common pathogens that usually cause self-limiting infections. More than 50 different adenoviruses are known to spread from person to person through droplet, fecal-oral, and close contact, causing human infection, most commonly respiratory disease. For example, infection with adenovirus type 41 usually presents with diarrhea, vomiting, and fever, and may also be accompanied by respiratory symptoms. Depending on the type of adenovirus, it can also cause gastroenteritis, conjunctivitis (pink eye), and cystitis.

The mainstream view currently tends to be that adenovirus is the "culprit" of unexplained hepatitis, because at least 74 of the 169 children were tested positive for adenovirus infection. The World Health Organization stated that adenovirus is considered a hypothesis of the cause, but this cannot fully explain the severity of the clinical symptoms, so the investigation of the causative factor is still ongoing.

The Daily Telegraph quoted Zania Stamataki, a viral immunology researcher at the University of Birmingham, as saying, "We cannot rule out the possibility that the new variant of adenovirus may cause liver damage in children, but we need to know more to be sure."

Could it be a side effect of the new coronavirus vaccine?

The UK Health and Safety Agency, which reported the most patients with "unexplained hepatitis", said that all children in the UK who contracted the disease had not previously been vaccinated with the new coronavirus vaccine and there was no connection between the two.

The WHO said that the hypothesis of side effects of the new crown vaccine is not currently supported because the vast majority of affected children have not been vaccinated against the new crown.

03 What are the main symptoms of sick children?

According to a bulletin released by the World Health Organization on April 15, before the pathogen is identified, more cases of this hepatitis are predicted to occur in the future, and countries are advised to "identify, investigate and report potential cases that meet the case definition."

The so-called "compliance with the definition" includes the following three points:

First, confirmed cases

After January 1, 2022, people aged 10 years and younger with acute hepatitis (not caused by virus infection A, B, C, D or E) and aspartate aminotransferase (AST) or alanine aminotransferase (ALT) exceeding 500U/L.

Second, suspected cases

After January 1, 2022, aged 11-16 years, with acute hepatitis (not caused by virus infection A, B, C, D or E) and AST or ALT exceeding 500U/L.

Third, epidemiologically related cases

After January 1, 2022, you have had acute hepatitis (not caused by virus infection type A, B, C, D or E) and have had close contact with a confirmed case.

The symptoms of children with unexplained hepatitis currently include:

Gastrointestinal symptoms: abdominal pain, diarrhea, and vomiting.

Elevated transaminase level: Transaminase level is an important indicator of liver function. Under healthy conditions, transaminase will play its normal physiological function in cells. When the body causes cell damage due to various reasons, it will be released from the cells and enter the blood. At this time, a blood test can detect the activity of transaminase released from the cells, which is manifested as elevated transaminase. The normal values ​​of ALT and AST are both less than 40U/L, but the transaminase of children can reach 500U/L, and some children even reach 4000U/L.

Jaundice: Yellowing of the skin, sclera (whites of the eyes), etc.

04 Are Chinese children at risk of infection? How to prevent it?

Unexplained childhood hepatitis has spread from Europe, America and other countries to Japan, and seems to be getting closer and closer to China. This has made many Chinese parents nervous, "Could my child be infected?"

At present, there are no cases of unexplained childhood hepatitis in China. In fact, not only viral infections can cause hepatitis. There are many possible causes of hepatitis, such as poisoning, drugs, abnormal immune regulation, and infection with pathogens other than viruses, which can cause serious liver damage and are not necessarily contagious. Lv Fangfang, director of the Department of Hepatology and Infection at the Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine, once said in an interview with the media, "Our country has done a good job in preventing hepatitis. For this new and unclear disease, many medical experts and research institutions are closely observing and studying it. Parents do not need to panic too much. As far as the current situation is concerned, the risk of infection for children in our country is not high."

There is no need to panic, but it is worth being vigilant. WHO advises that normal hygiene measures such as thorough hand washing (including parental supervision of children) can help reduce the spread of many common infections, including adenovirus. If children have symptoms of gastrointestinal infection, including vomiting and diarrhea, they should stay home and not return to school or childcare until 48 hours after the symptoms have stopped.

In short, there is no need to worry before more accurate research results come out. What we ordinary people can do is to strengthen self-protection, and leave the rest to science and time.

References:

[1]https://www.haaretz.com/israel-news/everything-you-need-to-know-about-the-hepatitis-outbreak-among-children-1.10754895

[2]https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON376

[3]https://www.who.int/emergencies/disease-outbreak-news/item/acute-hepatitis-of-unknown-aetiology---the-united-kingdom-of-great-britain-and-northern-ireland