What is the mystery of hepatitis that affects children around the world?

What is the mystery of hepatitis that affects children around the world?

Scientists are racing to understand the cause of acute hepatitis that has killed at least nine children and infected hundreds more in 20 countries in just over a month.

More than 348 cases of occult hepatitis have been reported, with some children requiring liver transplants. Most of the patients were previously healthy.

Hepatitis is uncommon in children and testing has led to the exclusion of the five known hepatitis viruses. Several hypotheses are being considered – including whether the diseases are linked to Covid-19.

Some progress has been made in improving the investigation in recent weeks, as health experts try to uncover the cause of the cases.

Here’s what scientists know so far and the steps they’re taking to solve the hepatitis conundrum.

The first cases were reported to the World Health Organization (WHO) in early April, after 10 previously healthy children up to five years of age developed acute hepatitis B in central Scotland.

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Soon, an investigation by the World Health Organization revealed other cases in Britain and 11 other countries.

On Tuesday, the health agency said 348 probable cases of acute hepatitis among children had been identified in five regions, mostly in Europe, with 70 suspected infections under investigation.

The WHO tally is a mixture of new cases and retrospective cases. Only six countries have reported more than five infections with the mysterious strain.

Five children have died in the United States, according to the US Centers for Disease Control and Prevention (CDC). The Centers for Disease Control and Prevention said more than 90 percent of the 109 children with the disease were hospitalized and 14 percent needed liver transplants.

In Indonesia, where 14 cases have been reported, four have died.

Symptoms include jaundice, diarrhea, vomiting, and abdominal pain, but often without accompanying fever.

Hepatitis refers to inflammation of the liver, which is usually caused by a viral infection or damage caused by excessive exposure to toxins such as alcohol, prescription drugs, herbs, or industrial chemicals.

The body’s immune system “attack” can also lead to autoimmune hepatitis and liver damage.

The test ruled out the five known types of hepatitis A, B, C, D and E, while Covid-19 and some common adenoviruses – usually responsible for mild colds and flu-like illnesses – were identified in many children.

Scientists are now studying whether these adenoviruses, which are present in about 70 per cent of children with confirmed hepatitis in Britain, were behind the outbreak.

There are more than 50 adenoviruses and some patients have been found to be infected with a specific type called F41.

F41 adenovirus usually causes diarrhea, vomiting, and fever, often with respiratory symptoms. It can cause hepatitis in immunocompromised children but is not a known cause of hepatitis in healthy young adults.

Adenovirus infection is a major contender, but scientists have so far not recommended a definitive connection.

The World Health Organization said improved laboratory testing for adenoviruses, along with increased testing, could indicate a rare result present at previously undetected levels.

Senior scientist Philippa Easterbrook, of the World Health Organization’s Global Hepatitis Program, said more histological examinations of tissue and liver samples had been conducted in the past week.

“It doesn’t show any of these typical features you would expect with hepatitis due to adenovirus. We are waiting for further biopsies,” she said at a media briefing on Tuesday.

A significant increase in adenovirus infections has been observed in Britain, which has also reported the most cases in the world with 163 infections, and scientists are working to find out whether it is a cause of hepatitis or a coincidence.

“Hopefully, during the week there will be data from the UK on this important case study comparing whether the detection rate of adenovirus in children with liver disease differs from that of other children in hospital,” Easterbrook said.

“It will really help to fine-tune whether adenoviruses are just an occasional infection that has been discovered or there is a possible causal or causal link.”

While the main hypotheses involve adenoviruses, scientists are also studying whether Covid-19 may be contributing to the mysterious disease, either through co-infection or from a previous infection.

A total of 18 percent of all children had tested positive for Sars-CoV-2, the virus that causes Covid-19.

Studies in the United States, Brazil and India have reported small numbers of children who required hepatitis treatment after contracting Covid-19, but most of them recovered quickly.

Further testing of blood samples will help scientists learn whether other infected children have previously had Covid-19.

“The big focus over the next week is really looking at serological testing for previous exposure and infection with Covid,” Easterbrook said.

The UK’s Health Security Agency has ruled out a link between cases of hepatitis and Covid-19 vaccines, which do not contain viruses that can grow in the human body.

More than three-quarters of the cases have occurred in children under the age of five – an age group not open to Covid-19 vaccination.

Among the older patients, fewer than five were vaccinated against Covid-19 before contracting hepatitis.

It is difficult to determine effective measures with the cause of hepatitis that has not yet been determined.

WHO has a well-established reporting system in Europe and is building systems with similar data collection tools across other regions.

The General Administration of China Customs Agency has issued a directive aimed at preventing the import of unexplained hepatitis cases from countries that have reported the disease.

The Beijing Health Commission last month issued a notice to hospitals to increase monitoring and treatment of hepatitis in children as a precaution, but the country has not reported a single case so far.

Also read:Indonesia detects 15 cases of acute hepatitis after 3 children died

This article was first published in South China Morning Newspaper.

2022-05-14 05:08:23

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