analysis | What mysterious liver disease plagues children?


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According to the World Health Organization (WHO), acute hepatitis (inflammation of the liver) caused several children to die and others required liver transplants. Although the cause is still unknown, researchers are studying a family of pathogens called adenoviruses that cause a variety of diseases, including the common cold.

1. When and where did it start?

The case was first confirmed in an Alabama hospital in October 2021, when five children were hospitalized with liver damage of unknown cause. Earlier this year, 10 cases were confirmed in Scotland. As of 10 May, 348 possible cases were found in 20 countries, according to the WHO, with 70 additional cases pending as of 10 May. Most of the 163 likely cases occurred in the UK, according to senior scientist Philippa Easterbrook. from WHO. The Centers for Disease Control and Prevention (CDC) said on May 6 that 109 people were under investigation. Only a handful of other countries, including Spain, Israel and Denmark, had reported more than five as of early May. The first cases in Asia were discovered in late April in Japan and Singapore.

The CDC reports that 5 of 109 US cases have died. Indonesia said in early May that three children had died there. WHO reported at least one death on 23 April. According to the WHO, affected children are between the ages of 1 month and 16 years, and many are under the age of 10. The CDC said 14% of cases under investigation require liver transplantation.

3. What are the common symptoms?

Abdominal pain, diarrhea, and vomiting are followed by jaundice, in which the skin or whites of the eyes turn yellow. Laboratory tests show signs of severe liver inflammation along with markedly high liver enzyme levels. Most children did not have a fever. Other symptoms of hepatitis include fatigue, loss of appetite, dark urine, light-colored stools, and joint pain.

4. What is the cause?

Viral organisms are more likely because cases appear in clusters, according to Tina Tan, a doctor at Chicago’s Lurie Children’s Hospital and a member of the American Society of Infectious Diseases. “The main hypothesis remains that it is related to the adenovirus,” Easterbrook said. But experts are waiting for more data.

• According to Easterbrook, about 70% of the cases tested were positive for adenovirus, with the specific strain F 41 being the most prevalent. (The CDC says about half of suspected U.S. cases are related to adenovirus.) However, this finding is disconcerting because adenoviruses usually resolve on their own and do not cause the severity of the disease in children. An ongoing study in the UK comparing infection rates in different hospitalized children will help determine whether the adenovirus is merely accidental or a causal relationship is possible.

• Some children have also been infected with the coronavirus that causes Covid-19. About 18% of those tested said the potential role of the virus was an “important consideration”. However, U.S. officials have voiced doubts about a link to the coronavirus, stating that all patients in the early Alabama cluster have tested negative at the hospital and have no history of previous infections.

• The WHO report also noted that hypotheses about possible adverse reactions from vaccination were impossible, as “the majority” of affected children were not vaccinated against Covid.

• According to WHO, no common pathogens causing acute viral hepatitis, including hepatitis A, B, C, D and E viruses, have been found in any case.

The WHO said no other risk factors have been identified, including links to international travel. Additional tests for other infections, chemicals and toxins are ongoing in affected countries and enhanced surveillance has begun.

5. What is Adenovirus?

It is a common virus that causes a variety of illnesses, including cold-like symptoms, fever, sore throat, bronchitis, pneumonia, and diarrhea. There are over 50 types that can infect humans. It most commonly causes respiratory symptoms, but can also cause gastroenteritis, conjunctivitis, and bladder infections. Adenovirus type 41 usually causes diarrhea, vomiting, and fever, often accompanied by respiratory symptoms. It is not known to cause hepatitis in healthy children.

6. Is this a new disease?

The WHO says severe hepatitis is rare, but may be the result of a pre-existing adenovirus infection. Adenovirus infections are on the rise recently after falling to low levels during the COVID-19 pandemic, potentially making young children more susceptible. The WHO says the possibility of the emergence of new adenoviruses should also be investigated.

(Updated in sections 1, 2 and 4 with new data from WHO and CDC)

More stories like this can be found here. Bloomberg.com

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