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Severe Acute Hepatitis of Unknown Origin in Children: What Do We Know Today?
María Teresa Pérez-Gracia1, Antonio Tarín-Pelló1, Beatriz Suay-García2
1Área de Microbiología. Departamento de Farmacia, Universidad Cardenal Herrera-CEU. CEU Universities, Alfara del Patriarca (Valencia), Spain.
Insights
Severe acute hepatitis cases in children emerged globally in 2022. Adenovirus was detected in most cases, but the exact cause of this pediatric hepatitis outbreak remains under investigation.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Global Public Health Surveillance
Background:
- An unexplained outbreak of severe acute hepatitis in children was reported globally starting May 2022.
- Over 991 cases were reported worldwide by June 2022, with significant morbidity including liver transplants and fatalities.
Purpose of the Study:
- To summarize the initial global epidemiology and potential etiologies of severe acute hepatitis in children.
- To highlight the ongoing investigation into the cause of this pediatric hepatitis outbreak.
Main Methods:
- Global case reporting and surveillance data compilation.
- Laboratory analysis of clinical samples, including detection of common viral pathogens.
- Review of epidemiological risk factors and hypothesis generation.
Main Results:
- Adenovirus was detected in 62.2% of analyzed pediatric hepatitis cases.
- Common hepatitis viruses (A-E) and COVID-19 vaccines were ruled out as causes.
- A potential link to adenovirus infection following SARS-CoV-2 infection is hypothesized.
Conclusions:
- The etiology of the severe acute hepatitis outbreak in children remains unknown and under active investigation.
- Adenovirus is a significant finding, but its precise role requires further elucidation.
- Further research is crucial to identify the definitive cause and inform public health responses.
Abstract:
In May 2022, the UK International Health Regulations National Focal Point notified World Health Organization of 176 cases of severe acute hepatitis of unknown etiology in children under 10 years of age. From that moment on, cases of severe acute hepatitis of unknown origin in children began to be reported in several countries. As of June 17, 2022, a total of 991 cases had been reported in 35 countries worldwide, 50 children needed a liver transplant and 28 patients died. According to information published by ECDC, 449 cases have been detected in 21 EU countries. The children were between 1 month and 16 years of age. Adenovirus was detected in 62.2% of the analyzed samples. So far, the cause of these cases is unknown and many hypotheses remain open, but hepatitis A-E viruses and COVID-19 vaccines have been ruled out. A possible hypothesis has been published to explain the cause of these cases of severe hepatitis, according to which it could be a consequence of adenovirus infection in the intestine in healthy children previously infected with SARS-CoV-2. No other clear epidemiological risk factors have been identified to date. Thus, at this time, the etiology of the current cases of hepatitis remains under active investigation.
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