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Grand RJ. Letter to the editor (response to Vajro and colleagues). Virulence 2024; 15:2316714. [PMID: 38388387 PMCID: PMC10885166 DOI: 10.1080/21505594.2024.2316714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Affiliation(s)
- Roger J. Grand
- Institute for Cardiovascular Sciences, The Medical School, University of Birmingham, Birmingham, UK
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2
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Tan CCS, Kelly G, Cregan J, Wilson JD, James T, Chand M, Hopkins S, Swets M, Baillie JK, Jeffery K, Walker AS, Eyre DW, Stoesser N, Matthews PC. Retrospective analysis of hospital electronic health records reveals unseen cases of acute hepatitis with unknown aetiology in adults in Oxfordshire. BMC Public Health 2024; 24:1890. [PMID: 39010057 PMCID: PMC11251388 DOI: 10.1186/s12889-024-19292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/27/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND An outbreak of acute severe hepatitis of unknown aetiology (AS-Hep-UA) in children during 2022 was subsequently linked to infections with adenovirus-associated virus 2 and other 'helper viruses', including human adenovirus. It is possible that evidence of such an outbreak could be identified at a population level based on routine data captured by electronic health records (EHR). METHODS We used anonymised EHR to collate retrospective data for all emergency presentations to Oxford University Hospitals NHS Foundation Trust in the UK, between 2016-2022, for all ages from 18 months and older. We investigated clinical characteristics and temporal distribution of presentations of acute hepatitis and of adenovirus infections based on laboratory data and clinical coding. We relaxed the stringent case definition adopted during the AS-Hep-UA to identify all cases of acute hepatitis with unknown aetiology (termed AHUA). We compared events within the outbreak period (defined as 1st Oct 2021-31 Aug 2022) to the rest of our study period. RESULTS Over the study period, there were 903,433 acute presentations overall, of which 391 (0.04%) were classified as AHUA. AHUA episodes had significantly higher critical care admission rates (p < 0.0001, OR = 41.7, 95% CI:26.3-65.0) and longer inpatient admissions (p < 0.0001) compared with the rest of the patient population. During the outbreak period, significantly more adults (≥ 16 years) were diagnosed with AHUA (p < 0.0001, OR = 3.01, 95% CI: 2.20-4.12), and there were significantly more human adenovirus (HadV) infections in children (p < 0.001, OR = 1.78, 95% CI:1.27-2.47). There were also more HAdV tests performed during the outbreak (p < 0.0001, OR = 1.27, 95% CI:1.17-1.37). Among 3,707 individuals who were tested for HAdV, 179 (4.8%) were positive. However, there was no evidence of more acute hepatitis or increased severity of illness in HadV-positive compared to negative cases. CONCLUSIONS Our results highlight an increase in AHUA in adults coinciding with the period of the outbreak in children, but not linked to documented HAdV infection. Tracking changes in routinely collected clinical data through EHR could be used to support outbreak surveillance.
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Affiliation(s)
- Cedric C S Tan
- The Francis Crick Institute, London, UK
- UCL Genetics Institute, University College London, London, UK
| | - Gavin Kelly
- Bioinformatics and Biostatistics, The Francis Crick Institute, London, UK
| | - Jack Cregan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joseph D Wilson
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Tim James
- Department of Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Meera Chand
- United Kingdom Health Security Agency, Colindale, UK
| | - Susan Hopkins
- NIHR Health Protection Research Unit, Imperial College London, London, UK
| | - Maaike Swets
- Leiden University Medical Center, Leiden, Netherlands
| | | | - Katie Jeffery
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - David W Eyre
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals, Oxford, UK
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicole Stoesser
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals, Oxford, UK
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK.
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- University College London Hospitals NHS Foundation Trust, London, UK.
- University College London, London, UK.
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Caballero-Gómez J, Pereira S, Rivero-Calle I, Perez AB, Viciana I, Casares-Jiménez M, Rios-Muñoz L, Rivero-Juarez A, Aguilera A, Rivero A. Acute Hepatitis in Children Due to Rat Hepatitis E Virus. J Pediatr 2024; 273:114125. [PMID: 38815747 DOI: 10.1016/j.jpeds.2024.114125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
Two of 11 children with acute hepatitis of unknown origin were found to have rat hepatitis E virus infection. This infection should be considered in the differential diagnosis of children with acute hepatitis of unknown origin.
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Affiliation(s)
- Javier Caballero-Gómez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain; Animal Health Department, Universidad de Córdoba, Córdoba, Spain; CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Pereira
- Microbiology Department, Hospital Clínico Universitario & University of Santiago de Compostela (USC)/IDIS, Santiago de Compostela, Spain
| | - Irene Rivero-Calle
- Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Galicia, Spain
| | - Ana B Perez
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Clinical Microbiology Unit, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Isabel Viciana
- Microbiology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - María Casares-Jiménez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain; CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Lucia Rios-Muñoz
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
| | - Antonio Rivero-Juarez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain; CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Antonio Aguilera
- Microbiology Department, Hospital Clínico Universitario & University of Santiago de Compostela (USC)/IDIS, Santiago de Compostela, Spain
| | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain; CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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4
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Shteyer E, Mor O, Waisbourd-Zinman O, Mozer-Glazberg Y, Arnon R, Hecht Sagie L, Mandelboim M, Erster O, Weil M, Dovrat S, Goldberg L, Gozlan Y. The Outbreak of Unexplained Acute Hepatitis in Children: The Role of Viral Infections in View of the COVID-19 Pandemic. Viruses 2024; 16:808. [PMID: 38793689 PMCID: PMC11125843 DOI: 10.3390/v16050808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND AND AIMS An increase in the number of cases of acute hepatitis of unknown origin (HUO) in children was observed in 2021. Adenovirus and adeno-associated virus 2 (AAV2) infections have been suggested as possible triggers. However, the potential etiology is still unclear. We aimed to characterize a cohort of children with HUO in Israel in view of the COVID-19 pandemic. METHOD Demographics, clinical data, and laboratory results on the children compatible with the CDC criteria for HUO were collected by the established registry of the Ministry of Health. Available specimens were sent to the Central Virology Laboratory. RESULTS A total of 39 children were included in the registry. A total of 20 were enrolled prospectively, in which human herpes virus 6 (HHV6) infection or reactivation was identified in 11/19, adenovirus was found in 4/19 of the cases, and AAV2 was detected in 2/16. Past COVID-19 exposure was recorded for 24/39 of the children. A total of 10 children underwent liver biopsy, and 8 were successfully treated with steroids and 2 underwent liver transplantation. CONCLUSIONS The COVID-19 pandemic and the related containment measures combined with reactivation or active infection with other viruses could have been a trigger for the HUO outbreak. In our cohort, HHV6 was the most abundant finding.
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Affiliation(s)
- Eyal Shteyer
- The Juliet Keidan Institute of Pediatric Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Orna Mor
- Centeral Virology Laboratory, Israeli Ministry of Health, Sheba Medical Center, Ramat-Gan 52620000, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
| | - Orith Waisbourd-Zinman
- Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
- Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Petach-Tiqva 4920235, Israel
| | - Yael Mozer-Glazberg
- Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
- Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Petach-Tiqva 4920235, Israel
| | - Ronen Arnon
- Pediatric Gastroenterology Unit, Rambam Medical Center, Haifa 3109601, Israel
| | - Lior Hecht Sagie
- Division of Epidemiology, Israeli Ministry of Health, Jerusalem 9101002, Israel
| | - Michal Mandelboim
- Centeral Virology Laboratory, Israeli Ministry of Health, Sheba Medical Center, Ramat-Gan 52620000, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
| | - Oran Erster
- Centeral Virology Laboratory, Israeli Ministry of Health, Sheba Medical Center, Ramat-Gan 52620000, Israel
| | - Merav Weil
- Centeral Virology Laboratory, Israeli Ministry of Health, Sheba Medical Center, Ramat-Gan 52620000, Israel
| | - Sara Dovrat
- Centeral Virology Laboratory, Israeli Ministry of Health, Sheba Medical Center, Ramat-Gan 52620000, Israel
| | - Lital Goldberg
- Division of Epidemiology, Israeli Ministry of Health, Jerusalem 9101002, Israel
| | - Yael Gozlan
- Centeral Virology Laboratory, Israeli Ministry of Health, Sheba Medical Center, Ramat-Gan 52620000, Israel
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5
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Wang CR. Epidemic characteristics and changing trend of enterovirus infections in the context of prevention and control of COVID-19 epidemic. WORLD CHINESE JOURNAL OF DIGESTOLOGY 2024; 32:254-260. [DOI: 10.11569/wcjd.v32.i4.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
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6
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Dlamini M, Msolo L, Ehi Ebomah K, Nontongana N, Ifeanyi Okoh A. A systematic review on the incidence of influenza viruses in wastewater matrices: Implications for public health. PLoS One 2024; 19:e0291900. [PMID: 38662758 PMCID: PMC11045120 DOI: 10.1371/journal.pone.0291900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
Influenza viruses pose a significant public health threat, necessitating comprehensive surveillance strategies to enhance early detection and preventive measures. This systematic review investigates the incidence of influenza viruses in wastewater matrices, aiming to elucidate the potential implications for public health. The study synthesizes existing literature, employing rigorous inclusion criteria to identify relevant studies conducted globally. The essence of the problem lies in the gaps of traditional surveillance methods, which often rely on clinical data and may underestimate the true prevalence of influenza within communities. Wastewater-based epidemiology offers a novel approach to supplementing these conventional methods, providing a broader and more representative assessment of viral circulation. This review systematically examines the methodologies employed in the selected studies, including virus concentration techniques and molecular detection methods, to establish a standardized framework for future research. Our findings reveal a consistent presence of influenza viruses in diverse wastewater matrices across different geographic locations and seasons. Recommendations for future research include the standardization of sampling protocols, improvement of virus concentration methods, and the integration of wastewater surveillance into existing public health frameworks. In conclusion, this systematic review contributes to the understanding of influenza dynamics in wastewater matrices, offering valuable insights for public health practitioners and policymakers. Implementation of wastewater surveillance alongside traditional methods can enhance the resilience of public health systems and better prepare communities for the challenges posed by influenza outbreaks.
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Affiliation(s)
- Mbasa Dlamini
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Department of Biochemistry and Microbiology, Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
| | - Luyanda Msolo
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Department of Biochemistry and Microbiology, Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
| | - Kingsley Ehi Ebomah
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Department of Biochemistry and Microbiology, Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
| | - Nolonwabo Nontongana
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Department of Biochemistry and Microbiology, Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
| | - Anthony Ifeanyi Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Department of Biochemistry and Microbiology, Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
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7
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Di Maio VC, Gentile L, Scutari R, Colagrossi L, Coltella L, Ranno S, Linardos G, Liccardo D, Basso MS, Pietrobattista A, Landi S, Forqué L, Ciofi Degli Atti M, Ricotta L, Onetti Muda A, Maggiore G, Raponi M, Perno CF, Russo C. Acute Hepatitis of Unknown Origin in Children: Analysis of 17 Cases Admitted to the Bambino Gesù Children's Hospital in Rome. Microorganisms 2024; 12:826. [PMID: 38674772 PMCID: PMC11051986 DOI: 10.3390/microorganisms12040826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
This study described 17 cases of children admitted to the Bambino Gesù Children's Hospital with acute hepatitis of unknown origin between mid-April and November 2022. Following the World Health Organization's working case definition of probable cases, 17 children, with a median age of 2.1 years (interquartile range: 1.0-7.1), presenting with acute hepatitis non-AE, with serum transaminase >500 IU/L, were included in the study. A pre-specified set of microbiological tests was performed on different biological specimens for all pediatric patients. All patients resulted negative for the common hepatotropic viruses. The most common pathogen detected in blood specimens was human-herpes-virus-7 (52.9%). Adenovirus was detected more frequently in stool specimens (62.5%) than in respiratory (20.0%) or blood samples (17.6%). Regarding Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, one child tested positive two days after admission, while antibodies against spike and nucleoprotein were present in 82.3% of patients. A co-pathogen detection was observed in 94.1% of children. Overall, 16 children recovered without clinical complications, while one patient required liver transplantation. In these cases of acute hepatitis of unknown origin, adenovirus was mainly detected in stool samples. A co-pathogen detection was also frequently observed, suggesting that the etiology of this acute hepatitis is most probably multifactorial.
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Affiliation(s)
- Velia Chiara Di Maio
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Leonarda Gentile
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Rossana Scutari
- Multimodal Laboratory Research Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Luna Colagrossi
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Luana Coltella
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Stefania Ranno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Giulia Linardos
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Daniela Liccardo
- Hepatogastroenterology, Rehabilitative Nutrition, Digestive Endoscopy and Liver Transplant Unit, ERN RARE LIVER, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Maria Sole Basso
- Hepatogastroenterology, Rehabilitative Nutrition, Digestive Endoscopy and Liver Transplant Unit, ERN RARE LIVER, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Andrea Pietrobattista
- Hepatogastroenterology, Rehabilitative Nutrition, Digestive Endoscopy and Liver Transplant Unit, ERN RARE LIVER, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Simona Landi
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Lorena Forqué
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Lara Ricotta
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Andrea Onetti Muda
- Scientific Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology, Rehabilitative Nutrition, Digestive Endoscopy and Liver Transplant Unit, ERN RARE LIVER, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Cristina Russo
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
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Luo H, Zhou Q, Feng J, Wu Y, Chen H, Mao M, Qi R. Global Prevalence of Preexisting Antibodies against Human Adenoviruses, Surveyed from 1962 to 2021. Intervirology 2024; 67:19-39. [PMID: 38452738 PMCID: PMC11006277 DOI: 10.1159/000538233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Human adenoviruses (HAdVs) are extensively used as vectors for vaccines development and cancer therapy. People who already have antibodies against HAdVs, on the other hand, would have an impact on the preventative or therapeutic effect. This review focuses primarily on the prevalence of pre-existing antibodies against HAdVs in distinct geographical populations. SUMMARY After screening, 64 studies from 31 countries between 1962 and 2021 were selected, totaling 39,427 samples. The total prevalence of preexisting antibodies to HAdVs varied by country or location, ranging from 2.00 to 95.70%. Southeast Asia had the highest prevalence (54.57%) while Europe had the lowest (18.17%). The prevalence in practically all developing nations was higher than in developed nations. Adults have a greater frequency than children and newborns in most nations. The primary HAdV antibody types varied by country. Adults in China, the USA, the United Kingdom, and Belgium had the lowest prevalence of preexisting antibodies against HAdV55, HAdV37, HAdV8, and HAdV36, respectively. Children in the USA, China, the United Kingdom, and Japan had the lowest rates of HAdV48, HAdV11, HAdV8, and HAdV40. The frequency of antibodies differed significantly between military and civilian groups. KEY MESSAGES Preexisting antibodies against various types of HAdVs differed greatly throughout worldwide populations. Future development of HAdV-vector vaccines and medicines should focus on preexisting antibodies in target groups rather than a "one-size-fits-all" strategy. It might be advantageous in selecting HAdV vectors for studying the prevalence of preexisting antibodies against HAdVs in different locations and people throughout the world.
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Affiliation(s)
- Hui Luo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Qian Zhou
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinqi Feng
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yi Wu
- School of Public Health, Lanzhou University, Lanzhou, China
| | | | - Meihan Mao
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Rui Qi
- School of Public Health, Lanzhou University, Lanzhou, China
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9
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Flynn TG, Olortegui MP, Kosek MN. Viral gastroenteritis. Lancet 2024; 403:862-876. [PMID: 38340741 DOI: 10.1016/s0140-6736(23)02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 02/12/2024]
Abstract
Since the discovery of norovirus in 1972 as a cause of what was contemporarily known as acute infectious non-bacterial gastroenteritis, scientific understanding of the viral gastroenteritides has continued to evolve. It is now recognised that a small number of viruses are the predominant cause of acute gastroenteritis worldwide, in both high-income and low-income settings. Although treatment is still largely restricted to the replacement of fluid and electrolytes, improved diagnostics have allowed attribution of illness, enabling both targeted treatment of individual patients and prioritisation of interventions for populations worldwide. Questions remain regarding specific genetic and immunological factors underlying host susceptibility, and the optimal clinical management of patients who are susceptible to severe or prolonged manifestations of disease. Meanwhile, the worldwide implementation of rotavirus vaccines has led to substantial reductions in morbidity and mortality, and spurred interest in vaccine development to diminish the impact of the most prevalent viruses that are implicated in this syndrome.
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Affiliation(s)
- Thomas G Flynn
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
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10
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Demirbuğa A, Hançerli Törün S, Metin-Akcan Ö, Yücel A, Yahşi A, Bayhan Gİ, Emre I, Öztürk B, Kaba Ö, Kutluk G, Tural-Kara T, Erbaş İC, Özdem-Alataş Ş, Akça M, Özgökçe-Özmen B, Aslan S, Çakici Ö. The Role of Adenovirus in Hepatitis of Unknown Etiology Among Children in Turkey, July 2022 to January 2023. Pediatr Infect Dis J 2024; 43:1-6. [PMID: 37725812 DOI: 10.1097/inf.0000000000004094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND In the first half of 2022, the increase in cases of severe acute hepatitis in children with no epidemiological link and unknown cause has aroused concern worldwide. In this study, we aimed to determine the frequency of adenovirus in children with hepatitis of unknown origin in Turkey. METHODS In this study, which was conducted with the participation of 16 centers from Turkey, between July 2022 and January 2023, 36 pediatric patients under the age of 18 who met the definition of acute hepatitis were included. RESULTS Twenty (55,6%) of patients were female and 16 (44,4%) were male, with a mean age of 41.55 ± 39.22 (3-192) months. The most common symptoms were fever (66.7%), weakness (66.7%), loss of appetite (66.7%), fatigue (61.1%), vomiting (61.1%), and diarrhea (47.2%). Six (16 %) children had acute hepatic failure. Eight of the 15 children (46%) had respiratory viral infections (rhinovirus/enterovirus, n = 4; rhinovirus + parainfluenza, n = 1; parainfluenza, n = 1, SARS-CoV-2 n = 2). Adenovirus was detected in 16 (44%) patients. Adenovirus and coinfections were detected in 7 patients. History of diarrhea and fatigue in the last month was significantly higher in the adenovirus group ( P = 0.023 and 0.018). One child who had both adenovirus and rhinovirus infection required liver transplantation; all others recovered with supportive care. CONCLUSION There were no deaths in our series; however, the number of cases, etiology, and severity of the clinical course may have differed between countries owing to differences in case definitions, laboratory facilities, or regional genetic differences.
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Affiliation(s)
- Asuman Demirbuğa
- From the Department of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selda Hançerli Törün
- From the Department of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Özge Metin-Akcan
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Aylin Yücel
- Department of Pediatrics, Division of Pediatric Gastroenterology Hepatology and Nutrition, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Aysun Yahşi
- Department of Pediatrics, Division of Pediatric Infectious Disease, Medical Faculty of Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Gülsüm İclal Bayhan
- Department of Pediatrics, Division of Pediatric Infectious Disease, Medical Faculty of Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Irmak Emre
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Birol Öztürk
- Department of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özge Kaba
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Başakşehir Çam and Sakura City of Hospital, Istanbul, Turkey
| | - Günsel Kutluk
- Department of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Başakşehir Çam and Sakura City of Hospital, Istanbul, Turkey
| | - Tuğçe Tural-Kara
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - İrem Ceren Erbaş
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Şilem Özdem-Alataş
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Mehtap Akça
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Berfin Özgökçe-Özmen
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Sevgi Aslan
- Department of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Özlem Çakici
- Department of Pediatrics, Division of Pediatric Infectious Disease, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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11
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Grand RJ. Pathogenicity and virulence of human adenovirus F41: Possible links to severe hepatitis in children. Virulence 2023; 14:2242544. [PMID: 37543996 PMCID: PMC10405776 DOI: 10.1080/21505594.2023.2242544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Over 100 human adenoviruses (HAdVs) have been isolated and allocated to seven species, A-G. Species F comprises two members-HAdV-F40 and HAdV-F41. As their primary site of infection is the gastrointestinal tract they have been termed, with species A, enteric adenoviruses. HAdV-F40 and HAdV-F41 are a common cause of gastroenteritis and diarrhoea in children. Partly because of difficulties in propagating the viruses in the laboratory, due to their restrictions on growth in many cell lines, our knowledge of the properties of individual viral proteins is limited. However, the structure of HAdV-F41 has recently been determined by cryo-electron microscopy. The overall structure is similar to those of HAdV-C5 and HAdV-D26 although with some differences. The sequence and arrangement of the hexon hypervariable region 1 (HVR1) and the arrangement of the C-terminal region of protein IX differ. Variations in the penton base and hexon HVR1 may play a role in facilitating infection of intestinal cells by HAdV-F41. A unique feature of HAdV-F40 and F41, among human adenoviruses, is the presence and expression of two fibre genes, giving long and short fibre proteins. This may also contribute to the tropism of these viruses. HAdV-F41 has been linked to a recent outbreak of severe acute hepatitis "of unknown origin" in young children. Further investigation has shown a very high prevalence of adeno-associated virus-2 in the liver and/or plasma of some cohorts of patients. These observations have proved controversial as HAdV-F41 had not been reported to infect the liver and AAV-2 has generally been considered harmless.
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Affiliation(s)
- Roger J. Grand
- Institute for Cancer and Genomic Science, the Medical School, University of Birmingham, Birmingham, UK
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12
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Araujo NM. A dual role for adeno-associated virus in human health. Virol J 2023; 20:228. [PMID: 37817259 PMCID: PMC10563340 DOI: 10.1186/s12985-023-02196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Adeno-associated virus (AAV) differs from most other viruses, as it requires the simultaneous presence of a helper virus for an active infection. Up to 80% of the human population is seropositive for AAV antibodies. AAV has been known to be a non-pathogenic virus and an inhibitor of carcinogenesis caused by coinfecting viruses. However, the recent reports associating AAV infection with hepatocellular carcinoma development and the mysterious cases of acute severe hepatitis in children have challenged the idea that AAV is a harmless virus. Herein, we explore the usefulness of AAV in gene therapy and the importance of AAV as a protector or perpetrator in human carcinogenesis, ultimately reflecting on the dual role of AAV in human health.
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Affiliation(s)
- Natalia M Araujo
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
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13
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Yang MC, Su YT, Chen PH, Tsai CC, Lin TI, Wu JR. Changing patterns of infectious diseases in children during the COVID-19 pandemic. Front Cell Infect Microbiol 2023; 13:1200617. [PMID: 37457965 PMCID: PMC10339349 DOI: 10.3389/fcimb.2023.1200617] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Each infectious disease has had its own epidemic pattern and seasonality for decades. However, public health mitigation measures during the coronavirus disease 2019 (COVID-19) pandemic have resulted in changing epidemic patterns of infectious diseases. Stringent measures resulted in low incidences of various infectious diseases during the outbreak of COVID-19, including influenza, respiratory syncytial virus, pneumococcus, enterovirus, and parainfluenza. Owing to the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and subsequent immunity development, decreasing virulence of SARS-CoV-2, and worldwide immunization against SARS-CoV-2 in children beyond 6 months of age, mitigation measures are lifted country by country. Consequently, the immunity debt to infectious respiratory viruses other than SARS-CoV-2 contributed to the "off-season," "see-saw," and "upsurge" patterns of various infectious diseases in children. Moreover, apart from the persistence of SARS-CoV-2, the coexistence of other circulating viruses or bacterial outbreaks may lead to twindemics or tripledemics during the following years. Therefore, it is necessary to maintain hand hygiene and immunization policies against various pathogens to alleviate the ongoing impact of infectious diseases on children.
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Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Tsun Su
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ping-Hong Chen
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Chung Tsai
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ting-I Lin
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
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14
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Zheng L, Wang L, Lu F. Looking back on the outbreak of acute severe hepatitis with unknown etiology in children in 2022: What do we know now and where do we go from here? J Med Virol 2023; 95:e28890. [PMID: 37334975 DOI: 10.1002/jmv.28890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Liwei Zheng
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Lin Wang
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Fengmin Lu
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
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15
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Săndulescu O, Streinu-Cercel A, Miron VD, Covăcescu SM, Streinu-Cercel A, Craiu M. Liver Transaminases in Pediatric Adenovirus Infection-A Five-Year Study in Two Major Reference Centers from Romania. Microorganisms 2023; 11:microorganisms11020302. [PMID: 36838267 PMCID: PMC9961354 DOI: 10.3390/microorganisms11020302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Human adenovirus causes infections with a very heterogeneous clinical picture, and children are often the most frequently affected group. Interest in adenovirus has increased with the 2022 outbreak of severe acute hepatitis of unknown etiology as human adenovirus was considered as one of the possible etiological agents. We conducted a retrospective study over a 5-year period in two major tertiary hospitals in the Romanian capital with the aim to characterize the clinical picture and the dynamics of liver function tests in children with confirmed adenovirus infection. The study included 1416 children with a median age of 1.1 years (IQR: 0.3, 2.3 years). Digestive symptoms were predominant in 95.2% of children, mainly diarrhea (90.5%) and vomiting (50.5%), and 38.0% had respiratory symptoms. Increased transaminases were identified in 21.5% of patients. Age over 1 year, lethargy, vomiting and dehydration significantly increased the odds of liver cytolysis independent of other risk factors such as chronic conditions or co-infections. Aspartate aminotransferase (AST) was more commonly increased compared to alanine aminotransferase (ALT). Only six children had transaminase increases above 500 U/L, three of which had co-infections with rotavirus, Epstein-Barr virus (EBV), or respiratory syncytial virus (RSV). Liver function tests should be part of routine monitoring for pediatric patients with adenovirus infection. The current study fills a gap in current knowledge related to the frequency and the extent of liver involvement in human adenovirus infection among pediatric patients.
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Affiliation(s)
- Oana Săndulescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Victor Daniel Miron
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania
- Correspondence:
| | - Silvia Mirela Covăcescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania
| | - Adrian Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Mihai Craiu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania
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