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Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review
Ali A Rabaan1,2,3, Muhammed A Bakhrebah4, Majed S Nassar4
1Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia.
Insights
Unexplained acute liver failure in children was investigated globally. Adenovirus, particularly type 41F, is the suspected cause, prompting hygiene recommendations.
Area of Science:
- Hepatology
- Virology
- Pediatrics
Background:
- An increase in acute, severe pediatric hepatitis of unknown etiology was observed globally starting in late 2021.
- Initial cases in the United States were followed by a cluster in the United Kingdom, prompting international alerts.
Purpose of the Study:
- To investigate the cause of a global outbreak of acute hepatitis in children.
- To identify potential etiological agents and risk factors associated with severe pediatric liver injury.
Main Methods:
- Case identification and epidemiological surveillance across multiple countries.
- Laboratory testing for common viral pathogens, including adenovirus and SARS-CoV-2.
- Clinical data collection on symptoms, liver enzyme levels, and patient outcomes.
Main Results:
- Over 650 cases reported worldwide by May 2022, with a significant number in the UK.
- Common symptoms included vomiting, diarrhea, jaundice, and elevated liver enzymes.
- Adenovirus 41 type F was frequently detected in affected children; no definitive link to SARS-CoV-2 was established.
Conclusions:
- Adenovirus, potentially with genomic variations, is the leading suspected cause of this pediatric hepatitis outbreak.
- While SARS-CoV-2 was ruled out as a direct cause, further research into adenovirus pathogenesis is warranted.
- Standard hygiene measures are recommended to mitigate the spread of adenovirus.
Abstract:
In October 2021, a case of acute hepatic failure without any known cause was identified in the United States of America. Upon further investigation, other children aged 1-6 years were reported to have the same liver failure, and some of them were positive for adenovirus 41 type F. On 21 April 2022, the Centers for Disease Control and Prevention (CDC) released an alert after 74 cases were identified in United Kingdom (UK) between 5 and 8 April in children below 10 years of age, some of whom were also found to be positive for SARS-CoV-2. All the patients showed symptoms such as vomiting, diarrhea, jaundice, and abdominal pain. The patients' liver enzymes were remarkably increased. A total of 650 cases had been reported from 33 countries as of 27 May 2022, among which 222 cases were reported in the UK alone. No connection with SARS-CoV-2 or its vaccine has been found so far. However, the suspected cause is adenovirus, including its genomic variations, because its pathogenesis and laboratory investigations have been positively linked. Until further evidence emerges, hygiene precautions could be helpful to prevent its spread.
