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Children with Acute Hepatitis of Unknown Cause
Children with Acute Hepatitis of Unknown Cause
In the past two years, people all over the world have realized the importance of respiratory health maintenance under COVID-19 pandemic. People have become more and more accepting of washing hands frequently, wearing masks, and using alcohol to keep the surrounding environment clean.
With the implementation of health measures, the global prevalence of respiratory diseases and some viral diseases has gradually decreased. However, there has been a gradual increase in the incidence of unexplained hepatitis across countries, including Europe, the United States, Central and South America, and Asia.
Under analysis, children are the main group with unexplained hepatitis. The British researchers compared the changes before and during the COVID-19 pandemic, and found that the rate of children with unexplained hepatitis with need for liver transplantation was much higher than before.
Excluding other possible causes of hepatitis (eg, viral infection, genetic disease, congenital disease, or metabolic disease), it was found that a large proportion of affected children were infected with adenovirus, SARS-COV-2, rhinovirus or enterovirus. Children with more severe disease are found to have higher viral load of adenovirus, so adenovirus infection has been inferred as a possible cause of unexplained hepatitis in children.
The clinical presentation of unexplained hepatitis include jaundice, vomiting, and diarrhea. Under abdominal ultrasound, thickening of the gallbladder wall, mild hepatomegaly and splenomegaly are noted. Children with more severe initial symptoms (eg, abnormal alanine transaminase and total bilirubin level, abnormal coagulation function) have a higher chance for liver transplantation, but most children can gradually recover with supportive care.
Under COVID-19 pandemic, the different progress of adenovirus infection in children may be related to co-infection with SARS-COV-2 and immune dysregulation due to immune debt. There is currently no adenovirus vaccine available to the general public.
Because adenoviruses is one nonenveloped virus, alcohol cannot be used to destroy adenoviruses. Therefore, washing hands frequently with soap and wearing masks are still effective to prevent adenovirus infection.
References:
1.Kelgeri, Chayarani et al. “Clinical Spectrum of Children with Acute Hepatitis of Unknown Cause.” The New England journal of medicine, 10.1056/NEJMoa2206704. 13 Jul. 2022, doi:10.1056/NEJMoa2206704
2.Internationally important epidemic,Taiwan Centers for Disease Control
https://www.cdc.gov.tw/TravelEpidemic/Index/RzNQU2F5L2RhZmRBd2pzWU5tM0NDQT09