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Massih AA, Kamel A, Zaki AM, Aboudeif A, Emad C, Ramadan D, Gaber H, Bastorous H, Shaker M, Salah N, Hany N, El-Mestkawy N, Sawiris RAN, Mamdouh R, Atalla S, Abozeid S, Ghazi SI, Youssef SA, ElMaghraby Y, Khudhair Z, Hozaien R, El Husseiny N, El Shershaby M. Revisiting the overlooked role of recycled sewage water in high-income countries in adenoviral outbreaks such as the “2022 pediatric hepatitis’ outbreak”. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [PMCID: PMC9402275 DOI: 10.1186/s43054-022-00113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
On the 5th of April 2022, cases of adenovirus-induced hepatitis were reported in Scotland and then reached multiple parts of the world. While adenovirus normally presents with diarrhea, vomiting, and fever, these novel cases also resulted in the development of fulminant hepatitis in non-immunocompromised cases.
Main body
The responsible pathogen “Adenovirus 41” is an enterovirus. Enteroviruses are spread by the fecal-oral route and are resistant to drying. As such, they predominate in sewage water. Hepatitis is normally restricted to poorer countries, yet this new wave seems to be confined to mostly high-income countries in Europe and the USA. These countries treat and recycle a higher percentage of sewage water. We also propose that the fulminant nature of this strain could be due to either a cross-species mutation or the general decrease in trained immunity post-COVID-19 lockdown.
Short conclusion
Evidence strongly suggests that the link between these new hepatitis cases is recycled sewage water. This should warrant further investigations on the origin of this outbreak by re-visiting the role of recycled sewage water in causing such outbreak.
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Fang Y, Zhang L, Wang Z, Wang R, Liang S. Potential protective benefits of Schisandrin B against severe acute hepatitis in children during the COVID-19 pandemic based on a network pharmacology analysis. Front Pharmacol 2022; 13:969709. [PMID: 36034788 PMCID: PMC9403136 DOI: 10.3389/fphar.2022.969709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
Aims: Reports of hepatitis in children during the coronavirus disease 2019 (COVID-19) pandemic garnered worldwide attention. The most probable culprits are adenovirus and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). At present, the optimal symptomatic treatment consists of a combination of anti-COVID-19 and hepatitis symptom alleviators. Schisandrin B (SchB) has been known to have liver-protective properties for a long time, whereas anti-COVID-19 properties only recently have been discovered. In the case of COVID-19 with hepatitis of unknown origin, we used network pharmacology to explore the symptomatic therapy and protective effects of SchB. Main methods: The most probable protein targets of SchB were predicted in the SwissTargetPrediction database. The GeneCards, National Center for Biotechnology Information, and Online Mendelian Inheritance in Man databases were used to compile information on the diseases hepatitis, adenovirus, and SARS-CoV-2. Following the use of a Venn diagram viewer to identify intersection genes, we constructed a protein-protein interaction network and identified the core genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment, as well as molecular docking, were employed to highlight the mechanisms of SchB on hepatitis. Key findings: SchB contains 27 targets on adenovirus_hepatitis and 16 targets on SARS-CoV-2_hepatitis, with 12 shared genes. Both target populations clustered in viral infection and cancer pathways, as well as in processes such as kinase activity phosphatase, cell adhesion, and ATPase binding. These genes might be closely related to liver damage and membrane binding from adenovirus or SARS-CoV-2 infections. In addition, epidermal growth factor receptor, HSP90AA1, and MAPK1 were among the top five targets of both SchB SARS-CoV-2 hepatitis and SchB adenovirus hepatitis. Significance: SchB may target common protective targets and mechanisms against acute hepatitis caused by adenovirus or by SARS-CoV-2 in children during the COVID-19 pandemic. These findings indicate SchB's potential as a treatment for hepatitis of unknown origin.
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Affiliation(s)
- Yanhua Fang
- The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Lingling Zhang
- The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Zhe Wang
- Oncology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Ruoyu Wang
- The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China,Oncology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China,*Correspondence: Ruoyu Wang, ; Shanshan Liang,
| | - Shanshan Liang
- The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China,*Correspondence: Ruoyu Wang, ; Shanshan Liang,
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53
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Zhu M, Chen L. Hepatitis of unknown etiology in children: What we know and what we can do? Front Microbiol 2022; 13:956887. [PMID: 36003929 PMCID: PMC9393628 DOI: 10.3389/fmicb.2022.956887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022] Open
Abstract
Recently, acute hepatitis of unknown etiology in children has gained great concern since March 2022. The disease was first reported by Public Health Scotland. Cases increased rapidly and are now reported in 33 countries worldwide. All cases are predominantly aged under 5 years old. Most patients presented with jaundice, and remarkably, some cases progress to acute liver failure. Until now, the etiology is not fully elucidated, and the investigations are ongoing. Adenovirus infection seems to be an important factor. Several hypotheses on the etiology have been proposed. This review aims to summarize current research progress and put forward some suggestions.
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54
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Shan S, Jia JD. Adenovirus and severe acute hepatitis of unknown etiology in children: Offender or bystander? Hepatobiliary Pancreat Dis Int 2022; 21:354-355. [PMID: 35680524 DOI: 10.1016/j.hbpd.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Shan Shan
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Ji-Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing 100050, China.
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55
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Romaní Vidal A, Vaughan A, Innocenti F, Colombe S, Nerlander L, Rachwal N, Ciancio BC, Mougkou A, Carvalho C, Delgado E, Mook P, de Muylder G, Peeters M, Tenev T, Golkocheva-Markova E, Vorobieva Solholm Jensen V, Koch A, Figoni J, Brouard C, Nikolopoulou G, Zisouli A, Murphy N, Broderick A, Goldberg L, Rich R, Hecht Sagie L, Tosti ME, Suligoi B, Joosten R, Pijnacker R, Fjeldheim I, Heen E, Stępień M, Polański P, Tato Marinho R, Vieira Martins J, Varela C, Avellón A, Andersson E, Jansson Mörk M, Mandal S, Watson C, Coughlan L, Chand M, Neill C, Bradley DT, Li K, O'Leary M, McInnes N, Williams CJ, Moore C, Gjini A, Duffell E, Pebody R. Hepatitis of unknown aetiology in children - epidemiological overview of cases reported in Europe, 1 January to 16 June 2022. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35929429 PMCID: PMC9358403 DOI: 10.2807/1560-7917.es.2022.27.31.2200483] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Following the report of an excess in paediatric cases of severe acute hepatitis of unknown aetiology by the United Kingdom (UK) on 5 April 2022, 427 cases were reported from 20 countries in the World Health Organization European Region to the European Surveillance System TESSy from 1 January 2022 to 16 June 2022. Here, we analysed demographic, epidemiological, clinical and microbiological data available in TESSy. Of the reported cases, 77.3% were 5 years or younger and 53.5% had a positive test for adenovirus, 10.4% had a positive RT-PCR for SARS-CoV-2 and 10.3% were coinfected with both pathogens. Cases with adenovirus infections were significantly more likely to be admitted to intensive care or high-dependency units (OR = 2.11; 95% CI: 1.18–3.74) and transplanted (OR = 3.36; 95% CI: 1.19–9.55) than cases with a negative test result for adenovirus, but this was no longer observed when looking at this association separately between the UK and other countries. Aetiological studies are needed to ascertain if adenovirus plays a role in this possible emergence of hepatitis cases in children and, if confirmed, the mechanisms that could be involved.
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Affiliation(s)
| | - Aisling Vaughan
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Francesco Innocenti
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Soledad Colombe
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Lina Nerlander
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Natalia Rachwal
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Aikaterini Mougkou
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Carlos Carvalho
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Enrique Delgado
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Piers Mook
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Michael Peeters
- Sciensano, Infectious Diseases in Humans, Viral Diseases, National Reference Centre for Hepatitis Viruses, Brussels, Belgium
| | - Tencho Tenev
- National Reference Laboratory Hepatitis viruses, NCIPD-Virology, Sofia, Bulgaria
| | | | | | - Anders Koch
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Julie Figoni
- Santé Publique France, the National Public Health Agency, Saint-Maurice, France
| | - Cécile Brouard
- Santé Publique France, the National Public Health Agency, Saint-Maurice, France
| | | | | | - Niamh Murphy
- Health Service Executive HPSC surveillance scientist on the National IMT for hepatitis, Dublin, Ireland
| | | | | | - Rivka Rich
- Israel Ministry of Health, Jerusalem, Israel
| | | | - Maria Elena Tosti
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
| | - Barbara Suligoi
- Infectious Disease Department - Istituto Superiore di Sanità, Rome, Italy
| | - Rosa Joosten
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Roan Pijnacker
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Ingvild Fjeldheim
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Eli Heen
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Małgorzata Stępień
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Piotr Polański
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Rui Tato Marinho
- Gastroenterology and Hepatology Department, Hospital S. Maria; Medical School of Lisbon; National Programme for Viral Hepatitis, Portugal Ministry of Health, Lisbon, Portugal
| | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Carmen Varela
- National Centre of Epidemiology, Carlos III Institute of Health, CIBERESP, Madrid, Spain
| | - Ana Avellón
- National Centre of Microbiology, Carlos III Institute of Health, CIBERESP, Madrid, Spain
| | | | | | - Sema Mandal
- United Kingdom Health Security Agency Epidemiology Cell, London, United Kingdom
| | - Conall Watson
- United Kingdom Health Security Agency Epidemiology Cell, London, United Kingdom
| | - Laura Coughlan
- United Kingdom Health Security Agency Epidemiology Cell, London, United Kingdom
| | - Meera Chand
- United Kingdom Health Security Agency Incident Director, London, United Kingdom
| | - Claire Neill
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | | | - Kathy Li
- Regional Virology Laboratory Belfast Health and Social Care Trust, Northern Ireland, Belfast, United Kingdom
| | - Maureen O'Leary
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Neil McInnes
- West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | | | | | - Erika Duffell
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Richard Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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D'Ambrosi F, Di Maso M, Viscardi A, Ossola MW, Soldavini CM, Cetera GE, Erra R, Ferrazzi E. Serum hepatic biomarkers in women with obstetric cholestasis and a concurrent SARS-CoV-2 infection. J Obstet Gynaecol Res 2022; 48:2713-2720. [PMID: 35915565 PMCID: PMC9538249 DOI: 10.1111/jog.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 01/08/2023]
Abstract
Aim The aim of the study was to evaluate the association between SARS‐CoV‐2 infection and serum hepatic biomarker levels among women with obstetric cholestasis. Methods In this prospective study, we recruited all pregnant women admitted in our hospital with obstetric cholestasis. Among those with a concurrent SARS‐CoV‐2 infection, we evaluated the following serum hepatic biomarkers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), and biliar acids (BA). Results Among the 88 women enrolled in the study, 20 presented with a SARS‐CoV‐2 infection while 68 were negative. SARS‐CoV‐2 infected women were younger (mean age 30.5 ± 5.7 vs. 34.3 ± 5.4; p < 0.01) and in a greater percentage of non‐Caucasian ethnicity when compared to noninfected women (60.0% vs. 17.6%; p < 0.01). Regarding levels of hepatic biomarkers, they showed higher levels of AST (111.5 ± 134.1 vs. 37.3 ± 43.4 UI/L; p = 0.02), ALT (132.2 ± 115.7 vs. 50.5 ± 73.173.1 UI/L; p < 0.01), and BA (41.4 ± 46.8 vs. 18.4 ± 13.4 μmol/L; p = 0.04) compared to noninfected patients. No significant differences in maternal or fetal outcomes were found between infected and noninfected women. Conclusion SARS‐CoV‐2 infection was associated with higher levels of liver enzymes in patients with obstetric cholestasis. This could be the result of a possible hepatic involvement in patients with SARS‐CoV‐2 infection.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Anna Viscardi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Manuela W Ossola
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Chiara M Soldavini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Roberta Erra
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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57
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Frediansyah A, Sallam M, Yufika A, Sharun K, Iqhrammullah M, Chandran D, Mamada SS, Sallam DE, Khader Y, Lemu YK, Yusuf F, Kretchy JP, Abdeen Z, Smith Torres-Roman J, Acharya Y, Bondarenko A, Ikram A, Jamil KF, Kotfis K, Koyanagi A, Smith L, Megawati D, Rademaker M, Emran TB, Memish ZA, Vento S, Nainu F, Harapan H. Acute severe hepatitis of unknown etiology in children: A mini-review. NARRA J 2022; 2:e83. [PMID: 38449700 PMCID: PMC10914120 DOI: 10.52225/narra.v2i2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 09/01/2023]
Abstract
The emergence of acute, severe non hepA-E hepatitis of unknown etiology (ASHUE) has attracted global concern owing to the very young age of the patients and its unknown etiology. Although this condition has been linked to several possible causes, including viral infection, drugs and/or toxin exposure, the exact cause remains unknown; this makes treatment recommendation very difficult. In this review, we summarize recent updates on the clinical manifestations, complemented with laboratory results, case numbers with the global distribution and other epidemiological characteristics, and the possible etiologies. We also provide the proposed actions that could be undertaken to control and prevent further spread of this hepatitis. Since many etiological and pathological aspects of the acute non hepA-E hepatitis remain unclear, further research is needed to minimize the severe impact of this disease.
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Affiliation(s)
- Andri Frediansyah
- National Research and Innovation Agency (BRIN), Yogyakarta, Indonesia
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Muhammad Iqhrammullah
- Graduate School of Mathematics and Applied Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Deepak Chandran
- Department of Veterinary Sciences and Animal Husbandry, Amrita School of Agricultural Sciences, Amrita Vishwa Vidyapeetham University, Coimbatore, India
| | - Sukamto S. Mamada
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Dina E. Sallam
- Pediatrics and Pediatric Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yousef Khader
- Jordan University of Science and Technology, Irbid, Jordan
- Eastern Mediterranean Public Health Network, Jordan
| | - Yohannes K. Lemu
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Fauzi Yusuf
- Gastroenterohepatology Division, Internal Medicine Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - James-Paul Kretchy
- Public Health Unit, School of Medicine and Health Sciences, Central University, Accra, Ghana
| | - Ziad Abdeen
- Al-Quds Nutrition and Health Research Institute, Faculty of Medicine, Al-Quds University, Abu Dies, Palestine
| | | | - Yogesh Acharya
- Western Vascular Institute, University Hospital Galway, National University of Ireland Galway, Galway, Ireland
| | - Anastasia Bondarenko
- Pediatric Infectious Disease and Pediatric Immunology Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Kurnia F. Jamil
- Division of Tropical Medicine & Infectious Disease, Department of Internal Medicine Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, ICREA, CIBERSAM, ISCIII, Barcelona, Spain
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Dewi Megawati
- Department of Veterinary Pathobiology, University of Missouri, Columbia, US
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Warmadewa University, Denpasar, Indonesia
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland Medical School, Hamilton, New Zealand
| | - Talha B. Emran
- Department of Pharmacy, BGC Trust University Bangladesh Chittagong, Bangladesh
| | - Ziad A. Memish
- Research & Innovation CentreKing Saud Medical City, Ministry of Health Riyadh, Saudi Arabia
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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58
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Khader S, Foster I, Dagens A, Norton A, Sigfrid L. Severe acute hepatitis of unknown aetiology in children-what is known? BMC Med 2022; 20:280. [PMID: 35906650 PMCID: PMC9336128 DOI: 10.1186/s12916-022-02471-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
The ongoing investigations into clusters of children affected by severe acute hepatitis of unknown aetiology have put our global capacity for a coordinated, effective response to the test. The global health community have rapidly convened to share data and inform the response. In the UK, where most cases were initially identified, a coordinated public health and clinical research response was rapidly initiated. Since then, cases have been reported from other countries, predominantly from higher-income countries. While agencies are keeping an open mind to the cause, the working hypothesis and case notifications raise important questions about our capacity to detect emerging cases in lower-resourced settings with a recognised lack of access to diagnostics even for commonly circulating viruses such as hepatitis A. The limited capability to generate integrated global pathogen surveillance data is a challenge for the outbreak investigations, highlighting an urgent need to strengthen access to diagnostics, with a focus on lower-resourced settings, to improve the capacity to detect emerging diseases to inform care and to improve outcomes and outbreak control.
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Affiliation(s)
- Susan Khader
- GloPID-R, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Isabel Foster
- GloPID-R, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Andrew Dagens
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Alice Norton
- GloPID-R, Pandemic Sciences Institute, University of Oxford, Oxford, UK.
| | - Louise Sigfrid
- GloPID-R, Pandemic Sciences Institute, University of Oxford, Oxford, UK.
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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59
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Li J, Hu W, Zhang JY, Wang FS. Pediatric Acute Severe Hepatitis of Unknown Origin: What is New? J Clin Transl Hepatol 2022; 10:509-514. [PMID: 35836759 PMCID: PMC9240247 DOI: 10.14218/jcth.2022.00247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022] Open
Abstract
Globally, there are emerging cases of acute severe hepatitis of unknown origin in children. These cases have gathered increasing attention, owing to the development of acute liver failure in some cases that resulted in liver transplantation. This review briefly summarizes the outbreak and diagnostic criteria of the disease. We further discuss the possible causes and related mechanisms underlying its occurrence and progression, and analyze the challenges in management. Finally, this review emphasizes patient management in clinical settings and a combination of efforts to unmask the disease.
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Affiliation(s)
- Jing Li
- Peking University 302 Clinical Medical School, Beijing, China
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei Hu
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ji-Yuan Zhang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fu-Sheng Wang
- Peking University 302 Clinical Medical School, Beijing, China
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Correspondence to: Fu-Sheng Wang, Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China. ORCID: https://orcid.org/0000-0002-8043-6685. Tel: +86-10-66933333, Fax: +86-10-66933332, E-mail:
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60
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Zhang LY, Huang LS, Yue YH, Fawaz R, Lim JK, Fan JG. Acute Hepatitis of Unknown Origin in Children: Early Observations from the 2022 Outbreak. J Clin Transl Hepatol 2022; 10:522-530. [PMID: 35836761 PMCID: PMC9240245 DOI: 10.14218/jcth.2022.00281] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022] Open
Abstract
Recent reports of acute hepatitis of unknown origin in previously healthy children have been increasing worldwide. The main characteristics of the affected children were jaundice and gastrointestinal symptoms. Their serum aminotransaminase levels were above 500 IU/L, with negative tests for hepatitis viruses A-E. By 31 May 2022, the outbreak had affected over 800 children under the age of 16 years in more than 40 countries, resulting in acute liver failure in approximately 10%, including at least 21 deaths and 38 patients requiring liver transplantation. There was still no confirmed cause or causes, although there were several different working hypotheses, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), adenovirus serotype 41, or SARS-CoV-2 superantigen-mediated immune cell activation. Here, we review early observations of the 2022 outbreak which may inform diagnosis, treatment, and prevention in the context of an overlapping COVID-19 pandemic.
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Affiliation(s)
- Li-Ya Zhang
- Department of Infectious Disease, Xinhua Children’s Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Su Huang
- Department of Infectious Disease, Xinhua Children’s Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Hang Yue
- Department of Infectious Disease, Xinhua Children’s Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rima Fawaz
- Section of Pediatric Gastroenterology and Hepatology, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph K. Lim
- Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China
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61
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Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review. Pathogens 2022; 11:pathogens11070712. [PMID: 35889958 PMCID: PMC9317240 DOI: 10.3390/pathogens11070712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
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.
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62
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Paraskevis D, Papatheodoridis G, Sypsa V, Sfikakis P, Tsiodras S, Zaoutis T. A Proposed Etiology for an Aberrant Response to Enteric Adenovirus Infection in Previously SARS-CoV-2-Infected Children With Acute Hepatitis. J Pediatric Infect Dis Soc 2022; 11:352-353. [PMID: 35674694 PMCID: PMC9384245 DOI: 10.1093/jpids/piac053] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/03/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Dimitrios Paraskevis
- Corresponding Author: Dimitrios Paraskevis, PhD, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27 Athens, Greece. E-mail:
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theoklis Zaoutis
- National Public Health Organization, Athens, Greece,Second Department of Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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63
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Kambhampati AK, Burke RM, Dietz S, Sheppard M, Almendares O, Baker JM, Cates J, Stein Z, Johns D, Smith AR, Bull-Otterson L, Hofmeister MG, Cobb S, Dale SE, Soetebier KA, Potts CC, Adjemian J, Kite-Powell A, Hartnett KP, Kirking HL, Sugerman D, Parashar UD, Tate JE. Trends in Acute Hepatitis of Unspecified Etiology and Adenovirus Stool Testing Results in Children - United States, 2017-2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:797-802. [PMID: 35709071 DOI: 10.15585/mmwr.mm7124e1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In November 2021, CDC was notified of a cluster of previously healthy children with hepatitis of unknown etiology evaluated at a single U.S. hospital (1). On April 21, 2022, following an investigation of this cluster and reports of similar cases in Europe (2,3), a health advisory* was issued requesting U.S. providers to report pediatric cases† of hepatitis of unknown etiology to public health authorities. In the United States and Europe, many of these patients have also received positive adenovirus test results (1,3). Typed specimens have indicated adenovirus type 41, which typically causes gastroenteritis (1,3). Although adenovirus hepatitis has been reported in immunocompromised persons, adenovirus is not a recognized cause of hepatitis in healthy children (4). Because neither acute hepatitis of unknown etiology nor adenovirus type 41 is reportable in the United States, it is unclear whether either has recently increased above historical levels. Data from four sources were analyzed to assess trends in hepatitis-associated emergency department (ED) visits and hospitalizations, liver transplants, and adenovirus stool testing results among children in the United States. Because of potential changes in health care-seeking behavior during 2020-2021, data from October 2021-March 2022 were compared with a pre-COVID-19 pandemic baseline. These data do not suggest an increase in pediatric hepatitis or adenovirus types 40/41 above baseline levels. Pediatric hepatitis is rare, and the relatively low weekly and monthly counts of associated outcomes limit the ability to interpret small changes in incidence. Ongoing assessment of trends, in addition to enhanced epidemiologic investigations, will help contextualize reported cases of acute hepatitis of unknown etiology in U.S. children.
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64
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Yao KH, Meng QH, Yu D. [The investigation on the acute, severe hepatitis of unknown origin in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:604-613. [PMID: 35652425 PMCID: PMC9250394 DOI: 10.7499/j.issn.1008-8830.2205024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
In April 2022, the United Kingdom notified the World Health Organization (WHO) of an unexpected increase of acute hepatitis of unknown origin in children. Subsequent investigations have found more than 400 cases in more than 20 countries and regions around the world. Although the potential role of adenovirus type 41 in the pathogenesis of these cases is one hypothesis, but it is probably not the only pathogenic factor, and other infectious and non-infectious causes cannot be completely ruled out. For hepatitis caused by non-hepatitis A, B, C, D and E viruses, there is a lack of systematic monitoring and research, and many unknowns still exist. According to the current etiology speculation and epidemiological characteristics of adenovirus in China, cases of acute hepatitis with unknown origin may be found in China in the future. There is also a risk of imported cases. This article systematically sorts out the reports and studies on child acute hepatitis of unknown origin, hoping to attract the attention of pediatric clinicians in China, raise awareness and vigilance, and calmly prepare for possible abnormal situations.
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Affiliation(s)
- Kai-Hu Yao
- National Center for Children's Health/Beijing Children's Hospital, Capital Medical University/Laboratory of Microbiology, Beijing Pediatric Research Institute/National Key Discipline of Pediatrics (Capital Medical University)/Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Qing-Hong Meng
- National Center for Children's Health/Beijing Children's Hospital, Capital Medical University/Laboratory of Microbiology, Beijing Pediatric Research Institute/National Key Discipline of Pediatrics (Capital Medical University)/Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Dan Yu
- National Center for Children's Health/Beijing Children's Hospital, Capital Medical University/Laboratory of Microbiology, Beijing Pediatric Research Institute/National Key Discipline of Pediatrics (Capital Medical University)/Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
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65
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Hepatitis of Unknown Origin and Etiology (Acute Non HepA-E Hepatitis) among Children in 2021/2022: Review of the Current Findings. Healthcare (Basel) 2022; 10:healthcare10060973. [PMID: 35742029 PMCID: PMC9222544 DOI: 10.3390/healthcare10060973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/25/2022] Open
Abstract
Several clusters and individual cases of acute hepatitis have been reported in the US, Europe and recently in Asia and Central America since October 2021. A laboratory investigation of the common viral hepatitis agents (HAV, HBV, HCV, HDV and HEV) yielded negative results prompting the use of the term “acute non HepA-E hepatitis” to describe this condition. The cases were characterized by the manifestations of acute hepatitis (abdominal pain, vomiting, diarrhea, jaundice and very high levels of liver enzymes) affecting children with a median age of 3–4 years. The exact underlying etiology has not been revealed yet; however, a leading hypothesis is that an infectious agent is the culprit, underlying cause or a risk factor for acute non HepA-E hepatitis occurrence. So far, laboratory testing has shown the presence of the group F human adenovirus serotype 41 (HAdV-F41) in about three-fourths of the investigated cases. As of 13 May 2022, more than 450 cases were reported worldwide, the majority of which were in the UK (n = 176), the US (n = 109), 13 European countries (at least 103 cases) and in Argentina, Brazil, Canada, Costa Rica, Indonesia, Israel, Japan, Palestine, Panama, Singapore and South Korea. Vigilant surveillance and epidemiologic investigations to identify further cases are warranted to delineate the features of this emergent public health issue. The possible role of environmental and toxic agents including foodborne toxins should also be considered. Specific guidelines for identification of further cases are necessary, particularly in low-income settings where testing for adenoviruses is not considered routinely. A genetic analysis of HAdV-F41 isolates is recommended to assess the potential changes in the virus genome with subsequent possible altered virus behavior. Immunopathogenesis is another possibility that should be evaluated considering the lack of viral structures in liver biopsies of the affected children in the US.
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66
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Yang S, Tong Y, Chen L, Yu W. Human Identical Sequences, hyaluronan, and hymecromone ─ the new mechanism and management of COVID-19. MOLECULAR BIOMEDICINE 2022; 3:15. [PMID: 35593963 PMCID: PMC9120813 DOI: 10.1186/s43556-022-00077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/04/2022] [Indexed: 02/08/2023] Open
Abstract
COVID-19 caused by SARS-CoV-2 has created formidable damage to public health and market economy. Currently, SARS-CoV-2 variants has exacerbated the transmission from person-to-person. Even after a great deal of investigation on COVID-19, SARS-CoV-2 is still rampaging globally, emphasizing the urgent need to reformulate effective prevention and treatment strategies. Here, we review the latest research progress of COVID-19 and provide distinct perspectives on the mechanism and management of COVID-19. Specially, we highlight the significance of Human Identical Sequences (HIS), hyaluronan, and hymecromone ("Three-H") for the understanding and intervention of COVID-19. Firstly, HIS activate inflammation-related genes to influence COVID-19 progress through NamiRNA-Enhancer network. Accumulation of hyaluronan induced by HIS-mediated HAS2 upregulation is a substantial basis for clinical manifestations of COVID-19, especially in lymphocytopenia and pulmonary ground-glass opacity. Secondly, detection of plasma hyaluronan can be effective for evaluating the progression and severity of COVID-19. Thirdly, spike glycoprotein of SARS-CoV-2 may bind to hyaluronan and further serve as an allergen to stimulate allergic reaction, causing sudden adverse effects after vaccination or the aggravation of COVID-19. Finally, antisense oligonucleotides of HIS or inhibitors of hyaluronan synthesis (hymecromone) or antiallergic agents could be promising therapeutic agents for COVID-19. Collectively, Three-H could hold the key to understand the pathogenic mechanism and create effective therapeutic strategies for COVID-19.
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Affiliation(s)
- Shuai Yang
- Laboratory of RNA Epigenetics, Institutes of Biomedical Sciences & Shanghai Public Health Clinical Center & Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Medical Epigenetics, Shanghai, 200032, People's Republic of China
| | - Ying Tong
- Laboratory of RNA Epigenetics, Institutes of Biomedical Sciences & Shanghai Public Health Clinical Center & Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Medical Epigenetics, Shanghai, 200032, People's Republic of China
| | - Lu Chen
- Laboratory of RNA Epigenetics, Institutes of Biomedical Sciences & Shanghai Public Health Clinical Center & Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Medical Epigenetics, Shanghai, 200032, People's Republic of China
| | - Wenqiang Yu
- Laboratory of RNA Epigenetics, Institutes of Biomedical Sciences & Shanghai Public Health Clinical Center & Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
- Shanghai Key Laboratory of Medical Epigenetics, Shanghai, 200032, People's Republic of China.
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67
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Şahin GÖ, Mondelli MU, Matičič M, Sandulescu O, Irving W. Acute severe hepatitis of unknown aetiology in children: a new non-A-E hepatitis virus on horizon? Clin Microbiol Infect 2022; 28:1300-1301. [PMID: 35595127 DOI: 10.1016/j.cmi.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Gülşen Özkaya Şahin
- Region Skåne, Department of Laboratory Medicine, Section of Clinical Microbiology, Lund, Sweden; Lund University, Department of Translational Medicine, Malmö, Sweden.
| | - Mario U Mondelli
- University of Pavia, Department of Internal Medicine and Therapeutics, Division of Infectious Diseases, Pavia, Italy
| | - Mojca Matičič
- University of Ljubljana, Faculty of Medicine, Institute of Microbiology and Immunology, Ljubljana, Slovakia; University of Ljubljana, Faculty of Medicine, Clinic for Infectious Diseases, Ljubljana, Slovakia
| | - Oana Sandulescu
- Carol Davila University of Medicine and Pharmacy, Department of Infectious Diseases, Bucharest, Romania; National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania
| | - William Irving
- Nottingham University Hospitals NHS Trust, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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68
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Affiliation(s)
- Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Jason Kindrachuk
- Laboratory of Emerging and Re-emerging Viruses, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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69
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Hakim MS. The recent outbreak of acute and severe hepatitis of unknown etiology in children: a possible role of human adenovirus infection? J Med Virol 2022; 94:4065-4068. [PMID: 35577525 DOI: 10.1002/jmv.27856] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/11/2022]
Abstract
The Public Health Scotland (PHS) was notified at the end of March 2022 that five children aged 3-5 years had presented to the Royal Hospital for Children in Glasgow with acute hepatitis of unknown etiology within a three-week period.Keywords This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohamad S Hakim
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Center for Child Health - PRO, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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70
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van Beek J, Fraaij PLA, Giaquinto C, Shingadia D, Horby P, Indolfi G, Koopmans M. Case numbers of acute hepatitis of unknown aetiology among children in 24 countries up to 18 April 2022 compared to the previous 5 years. Euro Surveill 2022; 27:2200370. [PMID: 35551703 PMCID: PMC9101970 DOI: 10.2807/1560-7917.es.2022.27.19.2200370] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
An increase of acute hepatitis of unknown aetiology has been reported among children in multiple countries worldwide. With a rapid online survey among hospitals in and outside of Europe, we describe case numbers recorded from 1 January to 18 April 2022 vs the previous 5 years. Of 24 countries that responded, we identified 5/17 European and 1/7 non-European countries with an elevation in probable cases of unexplained acute hepatitis, and severe cases were elevated in five European countries.
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Affiliation(s)
- Janko van Beek
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter LA Fraaij
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Delane Shingadia
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Peter Horby
- Pandemic Sciences Institute, ISARIC, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Indolfi
- Department Neurofarba, University of Florence, Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Florence, Italy
| | - Marion Koopmans
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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71
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Baker JM, Buchfellner M, Britt W, Sanchez V, Potter JL, Ingram LA, Shiau H, Gutierrez Sanchez LH, Saaybi S, Kelly D, Lu X, Vega EM, Ayers-Millsap S, Willeford WG, Rassaei N, Bullock H, Reagan-Steiner S, Martin A, Moulton EA, Lamson DM, St. George K, Parashar UD, Hall AJ, MacNeil A, Tate JE, Kirking HL. Acute Hepatitis and Adenovirus Infection Among Children - Alabama, October 2021-February 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:638-640. [PMID: 35511732 PMCID: PMC9098244 DOI: 10.15585/mmwr.mm7118e1] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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72
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Acute, Severe Hepatitis of Unknown Origin: Should We Really Be Afraid of Another Obscure Enemy of Our Children? Pediatr Rep 2022; 14:217-219. [PMID: 35645366 PMCID: PMC9149939 DOI: 10.3390/pediatric14020029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 01/27/2023] Open
Abstract
On 31 March 2022, Public Health Scotland was alerted to five children aged 3-5 years, presenting to the Glasgow children's hospital with severe hepatitis of unknown etiology within a 3-week period [...].
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73
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Note from the editors: Acute hepatitis among children, establishing evidence and baselines for comparison. Euro Surveill 2022; 27:220512m. [PMID: 35551706 PMCID: PMC9101971 DOI: 10.2807/1560-7917.es.2022.27.19.220512m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
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74
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Gao SH, Gong MC, Song HM. Acute severe hepatitis of unknown origin in children: considerations from the perspective of immunology. World J Pediatr 2022; 18:529-532. [PMID: 35768757 PMCID: PMC9244185 DOI: 10.1007/s12519-022-00580-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Si-Hao Gao
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Meng-Chun Gong
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Hong-Mei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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75
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Matthews PC, Campbell C, Săndulescu O, Matičič M, Ruta SM, Rivero-Juárez A, van Welzen BJ, Tan BK, Garcia F, Gherlan GS, Çınar G, Hasanoğlu İ, Gmizić I, Nicolini LA, Santos L, Sargsyants N, Velikov P, Habibović S, Fourati S, Židovec-Lepej S, Herder V, Dudman S, Miron VD, Irving W, Şahin GÖ. Acute severe hepatitis outbreak in children: A perfect storm. What do we know, and what questions remain? Front Pharmacol 2022; 13:1062408. [PMID: 36506522 PMCID: PMC9732095 DOI: 10.3389/fphar.2022.1062408] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
During the first half of 2022, the World Health Organization reported an outbreak of acute severe hepatitis of unknown aetiology (AS-Hep-UA) in children, following initial alerts from the United Kingdom (UK) where a cluster of cases was first observed in previously well children aged <6 years. Sporadic cases were then reported across Europe and worldwide, although in most countries incidence did not increase above the expected baseline. There were no consistent epidemiological links between cases, and microbiological investigations ruled out known infectious causes of hepatitis. In this review, we explore the evidence for the role of viral infection, superimposed on a specific host genetic background, as a trigger for liver pathology. This hypothesis is based on a high prevalence of Human Adenovirus (HAdV) 41F in affected children, together with metagenomic evidence of adeno-associated virus (Adeno-associated viruses)-2, which is a putative trigger for an immune-mediated liver injury. Roles for superantigen-mediated pathology have also been explored, with a focus on the potential contribution of SARS-CoV-2 infection. Affected children also had a high frequency of the MHC allele HLA-DRB1*04:01, supporting an immunological predisposition, and may have been vulnerable to viral coinfections due to disruption in normal patterns of exposure and immunity as a result of population lockdowns during the COVID-19 pandemic. We discuss areas of ongoing uncertainty, and highlight the need for ongoing scrutiny to inform clinical and public health interventions for this outbreak and for others that may evolve in future.
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Affiliation(s)
- Philippa C Matthews
- The Francis Crick Institute, London, United Kingdom.,Division of Infection and Immunity, University College London, London, United Kingdom.,Department of Infection, University College London Hospitals, London, United Kingdom
| | - Cori Campbell
- Nuffield Department of Medicine, University of Oxford, Oxford, England
| | - Oana Săndulescu
- Department of Infectious Diseases, National Institute for Infectious Diseases-Prof. Dr. Matei Balş, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mojca Matičič
- Faculty of Medicine, Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Maria Ruta
- Virology Department, Stefan S. Nicolau Institute of Virology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Antonio Rivero-Juárez
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Berend Joost van Welzen
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Boun Kim Tan
- INSERM U1052, Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Federico Garcia
- Microbiology Department, Instituto de Investigacion Ibs.Granada and Ciber de Enfermedades Infecciosas (CIBERINFEC), University Hospital San Cecilio, Granada, Spain
| | - George Sebastian Gherlan
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ivana Gmizić
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia
| | - Laura Ambra Nicolini
- Division of Infectious Diseases , Ospedale Policlinico San Martino, Genova, Italy
| | - Lurdes Santos
- Nephrology and Infectious Diseases R&D, Infectious Diseases Intensive Care Unit, Faculty of Medicine of University of Porto, Centro Hospitalar Universitário São João, I3S - Instituto de Investigação e Inovaçãoem Saúde, University of Porto, Porto, Portugal
| | - Narina Sargsyants
- Ministry of Health, National Centre for Infectious Diseases, National Institute of Health, Yerevan, Armenia
| | - Petar Velikov
- Infectious Diseases Hospital Prof. Ivan Kirov and Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Selma Habibović
- Department of Microbiology, Public Health Institute Novi Pazar, Novi Pazar, Serbia
| | - Slim Fourati
- Department of Virology, INSERM, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Institut Mondor de Recherche Biomédicale, Université Paris-Est, Créteil, France
| | - Snježana Židovec-Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
| | - Vanessa Herder
- Medical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Susanne Dudman
- Department of Microbiology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Victor Daniel Miron
- National Institute for Mother and Child Health "Alessandrescu-Rusescu", Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - William Irving
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Gülşen Özkaya Şahin
- Department of Laboratory Medicine, Section of Clinical Microbiology, Region Skåne, Lund, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
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Chen Y, Lin T, Wang CB, Liang WL, Lian GW, Zanin M, Wong SS, Tian XG, Zhong JY, Zhang YY, Xie JH, Zheng LL, Chen FY, Dang R, Zhao MQ, Yang YY, Zhou R, Zhu B. Human adenovirus (HAdV) infection in children with acute respiratory tract infections in Guangzhou, China, 2010-2021: a molecular epidemiology study. World J Pediatr 2022; 18:545-552. [PMID: 35861938 PMCID: PMC9302229 DOI: 10.1007/s12519-022-00590-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human adenovirus (HAdV) infection can cause a variety of diseases. It is a major pathogen of pediatric acute respiratory tract infections (ARIs) and can be life-threatening in younger children. We described the epidemiology and subtypes shifting of HAdV among children with ARI in Guangzhou, China. METHODS We conducted a retrospective study of 161,079 children diagnosed with acute respiratory illness at the Guangzhou Women and Children's Medical Center between 2010 and 2021. HAdV specimens were detected by real-time PCR and the hexon gene was used for phylogenetic analysis. RESULTS Before the COVID-19 outbreak in Guangzhou, the annual frequency of adenovirus infection detected during this period ranged from 3.92% to 13.58%, with an epidemic peak every four to five years. HAdV demonstrated a clear seasonal distribution, with the lowest positivity in March and peaking during summer (July or August) every year. A significant increase in HAdV cases was recorded for 2018 and 2019, which coincided with a shift in the dominant HAdV subtype from HAdV-3 to HAdV-7. The latter was associated with a more severe disease compared to HAdV-3. The average mortality proportion for children infected with HAdV from 2016 to 2019 was 0.38% but increased to 20% in severe cases. After COVID-19 emerged, HAdV cases dropped to 2.68%, suggesting that non-pharmaceutical interventions probably reduced the transmission of HAdV in the community. CONCLUSION Our study provides the foundation for the understanding of the epidemiology of HAdV and its associated risks in children in Southern China.
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Affiliation(s)
- Yi Chen
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Tao Lin
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Chang-Bing Wang
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Wan-Li Liang
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Guang-Wan Lian
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Mark Zanin
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Sook-San Wong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Xin-Gui Tian
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Jia-Yu Zhong
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Ying-Ying Zhang
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Jia-Hui Xie
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Ling-Ling Zheng
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Fei-Yan Chen
- Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Run Dang
- Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Ming-Qi Zhao
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Yi-Yu Yang
- Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China
| | - Rong Zhou
- Guangzhou Medical University, Guangzhou, 510120, China.
| | - Bing Zhu
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China.
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Diagnosis, treatment, and prevention of severe acute hepatitis of unknown etiology in children. World J Pediatr 2022; 18:538-544. [PMID: 35771382 PMCID: PMC9244883 DOI: 10.1007/s12519-022-00581-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Severe acute hepatitis of unknown etiology in children has recently exhibited a global trend of concentrated occurrence. This review aimed to summarize the current available information regarding the outbreak of severe acute hepatitis and introduce our hospital's previous experiences with the diagnosis and treatment of severe acute hepatitis for reference. DATA SOURCES Websites including the UK Health Security Agency, European Centre for Disease Prevention and Control, CDC, WHO, and databases including PubMed/Medline, Cochrane Library, Embase and Web of Science were searched for articles on severe acute hepatitis in children. RESULTS As of May 26, 2022, a total of 650 cases have been reported in 33 countries; at least 38 (6%) children required liver transplantation, and nine (1%) died. Cases are predominantly aged between 3 and 5 years old, and there are no epidemiological links among them. The common manifestations are jaundice, vomiting and pale stools. Adenovirus tested positive in most cases, and SARS-CoV-2 and other viruses were detected in a few cases, but virus particles were not found in liver tissue. Adenovirus immunohistochemistry showed immunoreactivity in the intrasinusoidal lumen from some liver samples. The hierarchical treatment includes symptomatic and supportive therapy, management of coagulation disorders and hepatic encephalopathy, artificial liver support, and liver transplantation (approximately 6%-10% of cases require liver transplant). CONCLUSIONS The etiology of this severe acute hepatitis in children is not clear. The clinical features are severe acute hepatitis with significantly elevated liver enzymes. Clinicians need to be alert to children with hepatitis.
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