U.S., U.K. investigating unusual cases of hepatitis in young children - April 15, 2022+

[Shiloh]

Source: https://www.statnews.com/2022/04/14...unusual-cases-of-hepatitis-in-young-children/

U.S., U.K. investigating unusual cases of hepatitis in young children
By Helen Branswell April 14, 2022

Public health officials in the United States and the United Kingdom are investigating a number of unusual cases of serious hepatitis in young children, the cause or causes of which are currently unknown.

Evidence from the U.K. and from Alabama — where nine cases have been recorded since last fall — points to the possible involvement of an adenovirus. Adenoviruses generally attack the respiratory tract, causing cold-like illnesses. But they have been linked to bladder inflammation and infection, and occasionally to hepatitis, though rarely in children who are not immunocompromised.

In a statement issued late Thursday, the Centers for Disease Control and Prevention said it is working with Alabama on its investigation into the cases, and is working with other state health departments to see if there are other cases elsewhere. In an alert to doctors the Alabama public health department issued in early February, it mentioned being aware of a case in another state, but it did not give details...

 

[Shiloh]

Source: https://www.who.int/emergencies/dis...kingdom-of-great-britain-and-northern-ireland


Acute hepatitis of unknown aetiology – the United Kingdom of Great Britain and Northern Ireland

15 April 2022


Situation at a glance:
On 5 April 2022, WHO was notified of 10 cases of severe acute hepatitis of unknown aetiology in children under the age of 10 years, across central Scotland. By 8 April, 74 cases had been identified in the United Kingdom. Hepatitis viruses (A, B, C, E, and D where applicable) have been excluded after laboratory testing while further investigations are ongoing to understand the aetiology of these cases. Given the increase in cases reported over the past one month and enhanced case search activities, more cases are likely to be reported in the coming days.

Description of cases:

On 5 April 2022, the International Health Regulations (IHR) National Focal Point (NFP) for the United Kingdom notified WHO of 10 cases of severe acute hepatitis of unknown aetiology in previously healthy young children (age range: 11 months to five-year-old) across central Scotland. Of these 10 cases, nine had onset of symptoms in March 2022 while one case had an onset of symptoms in January 2022. Symptoms included jaundice, diarrhoea, vomiting and abdominal pain. All 10 cases were detected when hospitalised.

As of 8 April 2022, further investigations across the United Kingdom have identified a total of 74 cases (including the 10 cases) fulfilling the case definition[SUP]1.[/SUP] The clinical syndrome in identified cases is of acute hepatitis with markedly elevated liver enzymes, often with jaundice, sometimes preceded by gastrointestinal symptoms, in children principally up to 10 years old. Some cases have required transfer to specialist children’s liver units and six children have undergone liver transplantation. As of 11 April, no death has been reported among these cases and one epidemiologically linked case has been detected.

Laboratory testing has excluded hepatitis type A, B, C, and E viruses (and D where applicable) in these cases while Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and/or adenovirus have been detected in several cases. The United Kingdom has recently observed an increase in adenovirus activity, which is co-circulating with SARS-CoV-2, though the role of these viruses in the pathogenesis (mechanism by which disease develops) is not yet clear. No other epidemiological risk factors have been identified to date, including recent international travel. Overall, the aetiology of the current hepatitis cases is still considered unknown and remains under active investigation. Laboratory testing for additional infections, chemicals and toxins is underway for the identified cases.

Following the notification from the UK, less than five cases (confirmed or possible) have been reported in Ireland, further investigations into these are ongoing. Additionally, three confirmed cases of acute hepatitis of unknown aetiology have been reported in children (age range 22-month-old to 13-year-old) in Spain. The national authorities are currently investigating these cases.





Public health response

Clinical and public health response has been implemented across the United Kingdom to coordinate case finding with investigation into the cause of illness in these cases.

Further investigations by the national authorities are ongoing to include more detailed exposure history, toxicology testing, and additional virological/microbiological tests. Guidance has been issued to experts to support a thorough investigation of suspected cases.

Further investigations and a clinical and public health response to the cases reported are also being undertaken in Ireland and Spain.

WHO risk assessment


The United Kingdom has reported a recent unexpected significant increase in cases of severe acute hepatitis of unknown aetiology in young children. Although the potential role of adenovirus and/or SARS-CoV-2 in the pathogenesis of these cases is one hypothesis, other infectious and non-infectious factors need to be fully investigated to properly assess and manage the risk.

As there is an on-going increasing trend in cases in the United Kingdom over the past month together with more extensive case searching, it is very likely that more cases will be detected before the aetiology has been found (either biological, chemical or other agent(s)) and corresponding appropriate control and prevention measures have been taken.

WHO is closely monitoring the situation with other Member States and the United Kingdom and partners for cases with similar profiles.


WHO advice

Further work is required to identify cases both inside the United Kingdom and internationally. The priority is to determine the aetiology of these cases to guide further clinical and public health actions. Any epidemiological links between or among the cases might provide indications for tracking the source of illness. Temporal and geographical information of the cases, as well as their contacts should be reviewed for potential risk factors.

While some cases tested positive for SARS-CoV-2 and/or adenovirus, genetic characterization of viruses should be undertaken to determine any potential associations between cases.

Member States are strongly encouraged to identify, investigate and report potential cases fitting the case definition.

International travel and trade: WHO does not recommend any restriction on travel and/or trade with the United Kingdom, or any other country where cases are identified, based on the currently available information.

 

[Emily]

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.15.2200318
Marsh Kimberly, Tayler Rachel, Pollock Louisa, Roy Kirsty, Lakha Fatim, Ho Antonia, Henderson David, Divala Titus, Currie Sandra, Yirrell David, Lockhart Michael, Rossi Maria K., Phin Nick. Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022. Euro Surveill. 2022;27(15)ii=2200318. https://doi.org/10.2807/1560-7917.ES.2022.27.15.2200318 Received: 12 Apr 2022; Accepted: 14 Apr 2022
....

Initial hypotheses about the aetiological nature of the severe hepatitis included either an infectious pathogen or a toxic exposure to food, drinks or toys favoured by younger children. Toxicology analyses are ongoing among cases from across the UK, although responses to the enhanced investigation questionnaire about food, drink and personal care habits have not yet identified any common exposures.

An infectious aetiology is now considered more likely given the epidemiological and clinical features, and taking into account the additional cases from across the UK and the US cluster. At the time of publication, the leading hypotheses centre around adenovirus—either a new variant with a distinct clinical syndrome or a routinely circulating variant that is more severely impacting younger children who are immunologically naïve. The latter scenario may be the result of restricted social mixing during the COVID-19 pandemic. Adenovirus infection as a cause of severe hepatitis is rare in immunocompetent children but has been reported in case reports and series [9-11].

Other infectious causes still being explored include increased severity of disease following infection with Omicron BA.2 (the dominant SARS-CoV-2 virus circulating in Scotland) or infection by an as yet uncharacterised SARS-CoV-2 variant. Of note, none of the children were vaccinated for SARS-CoV-2. A novel or yet undetected virus also cannot be ruled out at this time...

 

[Emily]

https://www.alabamapublichealth.gov/blog/2022/04/nr15.html
FOR IMMEDIATE RELEASE

CONTACT: Wes Stubblefield, M.D., (256) 340-2113

Since November 2021, the Alabama Department of Public Health (ADPH), in collaboration with pediatric healthcare providers including hospitals who treat children and the Centers for Disease Control and Prevention (CDC), has been investigating an increase in hepatitis in young children. These children presented to providers in different areas of Alabama with symptoms of a gastrointestinal illness and varying degrees of liver injury including liver failure. Later analyses have revealed a possible association of this hepatitis with Adenovirus 41.

To date, nine children less than 10 years old have been identified as positive for adenovirus and two have required liver transplants. The affected children were from throughout the state of Alabama, and an epidemiological linkage among them has not been determined. None of these children has had any underlying health conditions of note.

ADPH issued a Health Alert Network (HAN) notification on February 1, 2022, to elicit additional cases, and ADPH is updating the HAN for redistribution. ADPH continues to collaborate with the CDC. Other entities working with ADPH include Children's of Alabama and Texas Children's. New York State Health Department Wadsworth Center and the Infectious Disease Pathology Branch at CDC have been performing the testing on the specimens in these cases.

CDC is developing a national Health Advisory looking for clinically similar cases with liver injury of unknown etiology or associated with adenovirus infection in other states and is discussing similar cases of hepatitis potentially associated with adenovirus with international colleagues.

Adenoviruses are common viruses that typically cause a mild, self-limiting flu-like or gastrointestinal illness. Rarely, in otherwise healthy individuals, do these viruses cause an illness so severe that they need to be hospitalized and may die.

Adenoviruses are usually spread from an infected person to others through:

• Close personal contact, such as touching or shaking hands
• The air by coughing and sneezing
• Touching an object or surface with adenoviruses on it, then touching your mouth, nose or eyes before washing your hands
• Contact with stool, for example, during diaper changing

Adenoviruses are often resistant to common disinfectants and can remain infectious for long periods of time on surfaces and objects. Basic steps individuals can take to protect themselves from getting sick are as follows:

• Wash your hands often with soap and water for at least 20 seconds, and help young children do the same.
• Avoid touching your eyes, nose or mouth with unwashed hands.
• Avoid close contact with people who are sick.

-30-

4/15/22

 

[sharon sanders]

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[Pathfinder]

Update: Hepatitis of unknown origin in children

News story
19 Apr 2022

Following the reports of cases of acute hepatitis of unknown origin by the UK Health Security Agency, additional cases in children have been reported in Denmark, Ireland, the Netherlands, and Spain.

In addition, nine cases of acute hepatitis among children between 1 and 6 years old in the state of Alabama in the United States who also tested positive for adenovirus have been reported.

Investigations are ongoing in all countries reporting cases. At present, the exact cause of hepatitis in these children remains unknown. The incident team in the United Kingdom, where most of the cases have occurred to date, consider that an infective cause is most likely based on the clinical and epidemiological features of the cases under investigation.

ECDC is working with teams in each of the countries reporting cases, along with WHO and other key partners to support the ongoing investigations. ECDC facilitates the sharing of information as it becomes available, as well as tools for investigations.

Over the past weekend, the agency continued sharing all available information with countries through its Hepatitis Network and with the clinical organisations the European Association for the Study of the Liver and the European Society of Clinical Microbiology and Infectious Diseases ESCMID.

ECDC will continue to monitor this event through its epidemic intelligence activities and liaise with Member States and international partners.

Epidemiological summary


On 5 April 2022, the United Kingdom reported an increase in acute hepatitis cases of unknown aetiology among previously healthy children aged under 10 years from Scotland.

On 12 April, the United Kingdom reported that in addition to the cases in Scotland there were approximately 61 further cases under investigation in England, Wales and Northern Ireland, with most of these cases aged between 2 and 5 years.

On 14 April, Scotland reported that of the 13 cases under investigation two pairs of cases were epidemiologically linked.

The cases in the United Kingdom presented clinically with severe acute hepatitis, with increased levels of liver enzymes (aspartate transaminase (AST) or Alanine aminotransaminase (ALT) greater than 500 IU/L) and many cases were jaundiced. Some of the cases reported gastrointestinal symptoms, including abdominal pain, diarrhoea and vomiting in the preceding weeks.

Most cases did not have a fever. Some of the cases required care at specialist children’s liver units and a few had undergone liver transplantation.

Initial hypotheses by the incident team in the United Kingdom around the aetiological origin of the cases centred around an infectious agent or a possible toxic exposure. No link to the COVID-19 vaccine was identified and detailed information collected through a questionnaire to cases about food, drink and personal habits failed to identify any common exposure.

Toxicological investigations are ongoing but an infectious aetiology is considered more likely given the epidemiological picture and the clinical features of the cases.

Laboratory investigations of the cases excluded viral hepatitis types A, B, C, D and E in all cases. Of the 13 cases reported by Scotland for which detailed information is available regarding testing, three tested positive for SARS-CoV-2 infection, five tested negative and two were documented to have had an infection in the three months before presentation. Eleven of these 13 cases had results for adenovirus testing and five tested positive.


https://www.ecdc.europa.eu/en/news-events/update-hepatitis-unknown-origin-children

 

[sharon sanders]

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[Pathfinder]

Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology

Distributed via the CDC Health Alert Network
Thursday, April 21, 2022, 11:00 AM ET
CDCHAN-00462

Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of a cluster of children identified with hepatitis and adenovirus infection. In November 2021, clinicians at a large children’s hospital in Alabama notified CDC of five pediatric patients with significant liver injury, including three with acute liver failure, who also tested positive for adenovirus. All children were previously healthy. None had COVID-19. Case-finding efforts at this hospital identified four additional pediatric patients with hepatitis and adenovirus infection for a total of nine patients admitted from October 2021 through February 2022; all five that were sequenced had adenovirus type 41 infection identified. In two patients, plasma samples were negative for adenovirus by quantitative polymerase chain reaction (qPCR), but both patients were positive when retested using whole blood. Two patients required liver transplant; no patients died. A possible association between pediatric hepatitis and adenovirus infection is currently under investigation. Cases of pediatric hepatitis in children who tested negative for hepatitis viruses A, B, C, D, and E were reported earlier this month in the United Kingdom, including some with adenovirus infection [1].

This Health Advisory serves to notify US clinicians who may encounter pediatric patients with hepatitis of unknown etiology to consider adenovirus testing and to elicit reporting of such cases to state public health authorities and to CDC. Nucleic acid amplification testing (NAAT, e.g. PCR) is preferred for adenovirus detection and may be performed on respiratory specimens, stool or rectal swabs, or blood.

Background
Hepatitis is inflammation of the liver that can be caused by viral infections, alcohol use, toxins, medications, and certain other medical conditions. In the United States, the most common causes of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C viruses [2]. Signs and symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice [2]. Treatment of hepatitis depends on the underlying etiology.

Adenoviruses are doubled-stranded DNA viruses that spread by close personal contact, respiratory droplets, and fomites [3]. There are more than 50 types of immunologically distinct adenoviruses that can cause infections in humans. Adenoviruses most commonly cause respiratory illness but depending on the adenovirus type they can cause other illnesses such as gastroenteritis, conjunctivitis, cystitis, and, less commonly, neurological disease [3]. There is no specific treatment for adenovirus infections.

Adenovirus type 41 commonly causes pediatric acute gastroenteritis, which typically presents as diarrhea, vomiting, and fever; it can often be accompanied by respiratory symptoms [4]. While there have been case reports of hepatitis in immunocompromised children with adenovirus type 41 infection, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children [5, 6].

Recommendations

1. Clinicians should consider adenovirus testing in pediatric patients with hepatitis of unknown etiology. NAAT (e.g. PCR) is preferable and may be done on respiratory specimens, stool or rectal swabs, or blood.
2. Anecdotal reports suggest that testing whole blood by PCR may be more sensitive than testing plasma by PCR; therefore, testing of whole blood could be considered in those without an etiology who tested negative for adenovirus in plasma samples.

Request for Notification of Possible Cases
CDC is requesting notification from clinicians or state public health authorities of children <10 years of age with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) (>500 U/L) who have an unknown etiology for their hepatitis (with or without any adenovirus testing results, independent of the results) since October 1, 2021.

Please email CDC at ncirddvdgast@cdc.gov to notify of any cases meeting the above criteria or with any related questions.

If patients are still under medical care or have residual specimens available, please save and freeze them for possible additional testing and contact CDC at ncirddvdgast@cdc.gov for additional instructions.

For More Information
Division of Viral Hepatitis | CDC
Adenovirus | CDC

References
[1] World Health Organization. Acute hepatitis of unknown aetiology – the United Kingdom of Great Britain and Northern Ireland. Disease Outbreak News [Internet]. 2022 Apr 15; Available from: https://www.who.int/emergencies/disease-outbreak-news/item/acute-hepatitis-of-unknown-aetiology—the-united-kingdom-of-great-britain-and-northern-irelandexternal icon
[2] Hepatitis Webpage. Centers for Disease Control and Prevention. Available from:
https://www.cdc.gov/hepatitis/abc/index.htm
[3] Adenoviruses Webpage. Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/adenovirus/index.html
[4] Kang G. Viral Diarrhea. International Encyclopedia of Public Health [Internet]. Elsevier; 2017. P. 260-7. Available from https://www.sciencedirect.com/referencework/9780128037089/international-encyclopedia-of-public-healthexternal icon
[5] Munoz FM, Piedra PA, Demmler GJ. Disseminated Adenovirus Disease in Immunocompromised and Immunocompetent Children. CLIN INFECT DIS. 1998. Nov;27(5):1194-200. https://doi.org/10.1086/514978external icon
[6] Peled N, Nakar C, Huberman H, Scherf E, Samra Z, Finkelstein Y, et al. Adenovirus Infection in Hospitalized Immunocompetent Children. Clin Pediatr (Phila). 2004 Apr;43(3):223–9. https://doi.org/10.1177/000992280404300303external icon


https://emergency.cdc.gov/han/2022/...ntrol,with hepatitis and adenovirus infection.

 

[Pathfinder]

Increase in hepatitis (liver inflammation) cases in children under investigation


Regular updates by the UK Health Security Agency on the ongoing investigation into higher than usual rates of liver inflammation (hepatitis) in children across the UK.


From: UK Health Security Agency Published 6 April 2022
Last updated 21 April 2022 — See all updates

​

Latest


The UK Health Security Agency (UKHSA), Public Health Scotland, Public Health Wales and the Public Health Agency are continuing to investigate a rise in cases of sudden onset hepatitis (liver inflammation) in children aged 10 and under since January 2022, where the usual viruses that cause infectious hepatitis (hepatitis A to E) have not been detected.

Our active case finding investigations have identified a further 34 cases since our last update, bringing the total number of cases to 108. All the children affected presented to health services between January 2022 and 12 April 2022.

Of the confirmed cases, 79 are in England, 14 are in Scotland and the remainder are in Wales and Northern Ireland.

Of these cases, 8 children have received a liver transplant.

There is no link to the coronavirus (COVID-19) vaccine. None of the currently confirmed cases in the UK is known to have been vaccinated.

The investigation, including information from patient samples and surveillance systems, continues to point towards a link to adenovirus infection. Seventy-seven per cent of cases tested were positive for adenovirus. However, as it is not usual to see this pattern of disease from adenovirus, we are actively investigating other possible contributing factors, such as another infection (including COVID-19) or an environmental cause.

We are also investigating whether there has been a change in the genome of the adenovirus. UKHSA is working with scientists and clinicians across the country to answer these questions as quickly as possible.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said:

We are working with the NHS and public health colleagues in Scotland, Wales and Northern Ireland to swiftly investigate a wide range of possible factors which may be causing children to be admitted to hospital with liver inflammation known as hepatitis.

Information gathered through our investigations increasingly suggests that this is linked to adenovirus infection. However, we are thoroughly investigating other potential causes.

Normal hygiene measures such as thorough handwashing (including supervising children) and good thorough respiratory hygiene, help to reduce the spread of many common infections, including adenovirus.

We are also calling on parents and guardians, to be alert to the signs of hepatitis (including jaundice) and to contact a healthcare professional if they are concerned.

...
https://www.gov.uk/government/news/i...-investigation​

 

[sharon sanders]

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[Pathfinder]

Translation Google

Coordination Centre for Alerts and
Health Emergencies

SECRETARY-GENERAL OF SANITY
DIRECTORATE-GENERAL OF
PUBLIC HEALTH

Severe acute non-AE hepatitis alert
unknown in children under 10 in the UK.

Situation in Spain.

22 April 2022
...

Situation in Spain

Between 1 January 2022 and 22 April 2022, 13 cases of severe non-born hepatitis in people between 0 and 16 years: 8 cases that meet the criteria of confirmed case to initiate investigation as defined by U.K., and 5 cases were classified as likely.

The 8 confirmed cases (3 boys and 5 girls aged between 18 months and 7 years) started symptoms between January 2 and March 24, 2022 and have their residence in the Community of Madrid, Catalonia (2 of them), Galicia (2), Andalusia, Castilla-La Mancha and Aragon, are not related to each other, one has travel history to the U.K. and. in one case was obtained positive test for adenovirus. Developments have been favourable, except in one required liver transplant. Two of them may have another cause that justified the picture clinician.

The 5 probable cases (2 boys, 2 girls and 1 of unknown sex, ages 12-16) and FIS between 30 December 2021 and 1 April 2022, have their residence in Catalonia (3), Andalusia (1) and Murcia (1).
...
Nonfiliate liver failure in children in Spain, according to data available in the CMBD (Minimum Basic Data Set) between 2016 and 2020, would range from 4 to 10 cases per year. Adding other related diagnostic categories would reach 88-138 cases per year (Annex 2). According to the categories studied by the coding of the CMBD, in children between 0 and 9 years, calculating the annual average and its proportional share in the first four months of the year, we would expect to find from January 1 to April 20, 2022, an average of 18 cases (range 12.7-21.4) including the 4 categories (B17.9, B19.9, K72.0 and K72.9) and an average of 7.8 cases (range 5.1 to 10.2) if only categories K72.0 and K72.9 are included where no cause is indicated virus. According to the information received so far, so far we have not observed an increase in cases of acute insufficiency or expected severe acute hepatitis in pediatric age in Spain.

Conclusion:

As a follow-up to the alert issued by the UK in Spain, in coordination with all the Autonomous Communities and with ISCIII, has proceeded to study cases of severe acute hepatitis in children who are producing since January 2022 in research, but probably related to a increased incidence of adenovirus infection in the U.K. Epidemiology services are by applying a comprehensive questionnaire to all cases identified to date, without a common cause has been found. It is being assessed whether the cases detected in Spain represents an unusual increase in cases of unfriendly hepatitis compared to those detected in previous years or if they present some differential characteristics with the cases that are identified usually. So far, and according to the first scans of the encoded data such as acute non-filiate hepatitis in children admitted to hospitals, the number of cases detected is lower than we would expect in the first 4 months of the year.

The entire public health and care system has been activated quickly to give a coordinated response to the need for information related to this alert launched by the UK.

...
https://www.sanidad.gob.es/profesio...tual/docs/20220422_InformeAlertaHepatitis.pdf

 

[Mary Wilson]

Multi-Country – Acute, severe hepatitis of unknown origin in children - WHO

23 April 2022

Outbreak at a glance:

Since the WHO Disease Outbreak News on Acute hepatitis of unknown aetiology – the United Kingdom of Great Britain and Northern Ireland was published on 15 April 2022, there have been continuing further reports of cases of acute hepatitis of unknown origin among young children. It is not yet clear if there has been an increase in hepatitis cases, or an increase in awareness of hepatitis cases that occur at the expected rate but go undetected. While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent.

Outbreak overview

As of 21 April 2022, at least 169 cases of acute hepatitis of unknown origin have been reported from 11 countries in the WHO European Region and one country in the WHO Region of the Americas (Figure 1). Cases have been reported in the United Kingdom of Great Britain and Northern Ireland (the United Kingdom) (114), Spain (13), Israel (12), the United States of America (9), Denmark (6), Ireland (<5), The Netherlands (4), Italy (4), Norway (2), France (2), Romania (1), and Belgium (1). ...

Public health response

Further investigations are ongoing in countries that have identified cases and include more detailed clinical and exposure histories, toxicology testing (i.e. environmental and food toxicity testing), and additional virological/microbiological tests. Affected countries have also initiated enhanced surveillance activities. ...

[SUP]1[/SUP]WHO working case definition:

• Confirmed: N/A at present
• Probable: A person presenting with an acute hepatitis (non hepA-E*) with serum transaminase >500 IU/L (AST or ALT), who is 16 years and younger, since 1 January 2021
• Epi-linked: A person presenting with an acute hepatitis (non hepA-E*) of any age who is a close contact of a confirmed case, since 1 January 2021. ...

https://www.who.int/emergencies/dis...evere-hepatitis-of-unknown-origin-in-children

 

[Shiloh]

Source: https://www.niagara-gazette.com/new...cle_c9e03f49-88f3-56c6-9bce-a22d8ab8f760.html

WHO: Child has died in mystery liver disease outbreak
36 min ago

BERLIN — The World Health Organization says at least one death has been reported in connection with a mysterious liver disease outbreak affecting children in Europe and the United States.

The U.N. health agency said late Saturday that it has so far received reports of at least 169 cases of “acute hepatitis of unknown origin” from a dozen countries.

The cases were reported in children aged one month to 16 years old, and 17 of those who fell ill required liver transplants. WHO didn't say in which country the death occurred.

The first cases were recorded in Britain, where 114 children have been sickened...

 

[Pathfinder]

Increase in hepatitis (liver inflammation) cases in children under investigation


Regular UKHSA updates on the ongoing investigation into higher than usual rates of liver inflammation (hepatitis) in children across the UK.

From: UK Health Security Agency

Published 6 April 2022
Last updated 25 April 2022 — See all updates

Latest


Today, the UK Heath Security Agency (UKHSA) published a detailed technical briefing on the investigations into a rise in cases of sudden onset hepatitis (liver inflammation) in children, with data and findings on cases resident in England, up to 20 April 2022.

UKHSA, working with Public Health Scotland, Public Health Wales and the Public Health Agency, are continuing to investigate the cases in children aged 10 and under that have occurred since January 2022. The usual viruses that cause infectious hepatitis (hepatitis A to E) have not been detected. The cases are predominantly in children under 5 years old who showed initial symptoms of gastroenteritis illness (diarrhoea and nausea) followed by the onset of jaundice.

Active case finding investigations have identified a further 3 confirmed cases since the last update on 21 April, bringing the total number of cases to 111. Of the confirmed cases, 81 are resident in England, 14 are in Scotland, 11 are in Wales and 5 are in Northern Ireland.

Of these cases, 10 children have received a liver transplant. No UK cases have died. A small number of children over the age of 10 are being investigated.

There is no link to the coronavirus (COVID-19) vaccine. None of the currently confirmed cases in under 10 year olds in the UK is known to have been vaccinated.

Information gathered through the investigations increasingly suggests that the rise in severe cases of hepatitis may be linked to adenovirus infection but other causes are still being actively investigated. Adenovirus was the most common pathogen detected in 40 of 53 (75%) confirmed cases tested. Sixteen per cent of cases were positive for SARS-CoV-2 at admission between January and April but there was a high background rate of COVID-19 during the investigation period, so this is not unexpected.

Routine NHS and laboratory data show that common viruses circulating in children are currently higher than in previous years and there is a marked increase of adenovirus, particular in the 1 to 4 age group.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said:

Information gathered through our investigations increasingly suggests that this rise in sudden onset hepatitis in children is linked to adenovirus infection. However, we are thoroughly investigating other potential causes.

Parents and guardians should be alert to the signs of hepatitis (including jaundice) and to contact a healthcare professional if they are concerned. Normal hygiene measures such as thorough handwashing (including supervising children) and good thorough respiratory hygiene, help to reduce the spread of many common infections, including adenovirus.

Children experiencing symptoms of a gastrointestinal infection including vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped.​

We are working with partners to further investigate the link between adenovirus and these cases.

Hepatitis symptoms include:

• yellowing of the white part of the eyes or skin (jaundice)
• dark urine
• pale, grey-coloured faeces (poo)
• itchy skin
• muscle and joint pain
• a high temperature
• feeling and being sick
• feeling unusually tired all the time
• loss of appetite
• tummy pain

...
https://www.gov.uk/government/news/i...update-history

 

[sharon sanders]

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[Pathfinder]

Global mystery hepatitis outbreak spreads to Asia and Canada
...
Guardian staff
Tue 26 Apr 2022 22.08 EDT

A mysterious liver disease that has infected children in a dozen countries around the world has reached Asia, with a case reported in Japan.

The case in Japan of acute hepatitis – or inflammation of the liver – of unknown origin was flagged by local authorities on 21 April in a child who had tested negative for adenovirus – a possible cause being investigated worldwide – and Covid-19.

The patient had not had a liver transplant, the health ministry said on Monday, without giving further details.

Canada’s Public Health Agency said on Tuesday it was investigating reports of severe acute hepatitis of unknown origin in young children. It did not reveal the number of cases or their location.

So far across the world, 190 mystery cases of acute hepatitis in children have been reported, with 140 of them in Europe, mostly in the UK (110 cases). Further cases have been found in Israel and in the United States. Seventeen children became so sick they needed liver transplants.
...

https://www.theguardian.com/technol...hepatitis-outbreak-spreads-to-asia-and-canada

 

[sharon sanders]

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[Pathfinder]

Increase in severe acute hepatitis cases of unknown aetiology in children

Risk assessment
28 Apr 2022

An increase in severe acute hepatitis cases of unknown aetiology among previously healthy children was first reported by the United Kingdom (UK) to the World Health Organization’s International Health Regulations (IHR) notification system on 5 April 2022 (testing had excluded viral hepatitis types A, B, C, D and E and other known causes of acute hepatitis). Following this alert, the United States and several European Union, European Economic Area (EU/EEA) and other countries have reported suspected cases.

Executive summary


As of 20 April 2022, 111 cases had been reported from the UK, and as of 27 April 2022 approximately 55 probable and confirmed cases have been reported from 12 EU/EEA countries. An additional 12 cases have been reported from the United States (US), 12 from Israel, and one from Japan. The clinical picture is of severe acute hepatitis requiring hospitalisation with jaundice and markedly elevated liver transaminases. In most cases to date, the onset of jaundice was preceded by a gastrointestinal illness with vomiting, diarrhoea, and nausea. Information on the outcome of the cases is still being collected. So far, most patients for whom information is available have recovered, but a number have progressed to acute liver failure and required liver transplantation.

Detailed epidemiological and laboratory investigations of the cases are still ongoing to help determine the underlying aetiology. Cases have been tested for a range of different infectious causes, and the most common pathogens found were adenovirus and SARS-CoV-2. In England and Scotland, 75.5% and 50% of cases respectively tested positive for adenovirus. Subtyping of 11 cases from the UK investigation found that these were all type 41F, which is the same subtype identified among several of the cases reported from the US. Other adenoviruses were also found in some non-blood samples among the UK cases investigated. Information on testing in the EU/EEA is incomplete, but among cases reported 10 tested positive for adenovirus. Statistical exceedance compared to positive tests in previous years in the detection of many viruses in the community has been reported by the UK, including a marked recent exceedance in adenovirus detections in faecal samples among children aged 1-4 years.

Early epidemiological investigations of cases from the UK based on trawling questionnaires have failed to identify a common exposure of note (including food, medicines, or toxins). Toxicological analysis of specimens collected from cases as part of the UK investigation is ongoing. Although epidemiological links were reported from the Scottish investigation for two pairs of cases, no other clusters have been reported. Across all reporting countries, the majority of cases to date have not had significant past medical history.

Based on these investigations, the current leading hypothesis is that a cofactor affecting young children having an adenovirus infection, which would be mild in normal circumstances, triggers a more severe infection or immune-mediated liver damage. Other aetiologies (e.g. other infectious or toxic agents) are still under investigation and have not been excluded but are considered less plausible. The disease pathogenesis and routes of transmission are also still unknown. The disease is quite rare and evidence around human-to-human transmission remains unclear; cases in the EU/EEA are sporadic with an unclear trend. As a result, the risk for the European paediatric population cannot be accurately assessed. However, considering the reported cases with acute liver failure, with some cases requiring liver transplantation, the potential impact for the affected paediatric population is considered high. Access to highly specialised paediatric intensive care and transplantation services may further impact outcomes. Considering the unknown aetiology, the affected paediatric population, and the potential severe outcome, this currently constitutes a public health event of concern.

It is essential to establish surveillance at the national level for EU/EEA countries as soon as possible to collect detailed epidemiological, clinical, virological, and other information, including toxicological analyses, on cases. Additional information for hypothesis testing should be collected in the context of analytical studies looking at other factors and potential co-factors such as recent infections, personal and environmental determinants. Specific studies should be designed to identify risk factors for infection and for severe illness, to investigate routes of potential transmission, to describe the full clinical spectrum, and to ascertain whether the same aetiological agent causes different clinical presentations depending on age and other conditions. ECDC will provide guidance and coordination to EU/EEA countries planning to set up such studies.

Further investigations include an assessment of the underlying level of acute viral infections circulating in the community, in particular adenoviruses, by age, and whether this is above what would normally be expected.

Public health authorities should communicate with paediatricians, general practitioners and other medical specialists to inform about the need for active case finding and reporting of new cases.

Testing appropriate samples from symptomatic children for adenoviruses as well as for other viruses that can cause hepatitis should be performed early after symptom onset. ECDC recommends an extensive set of tests to help identify the causative agent or co-factors.

Cases fulfilling the case definition should be reported to The European Surveillance System (TESSy) as soon as possible. Case records can be updated as more test results become available.

As the aetiology remains unknown, effective control measures cannot be defined at this stage. Faecal-oral exposure to viruses such as adenoviruses is more likely for young children. We therefore recommend reinforcing general good hygienic practices (including careful hand hygiene, cleaning and disinfection of surfaces) in settings attended by young children.

https://www.ecdc.europa.eu/en/public...ology-children

 

[Shiloh]

Source: https://www.reportdoor.com/wisconsin-probes-4-mystery-child-hepatitis-cases/


Wisconsin probes 4 mystery child hepatitis cases
April 28, 2022 by James Thompson

Wisconsin health authorities are investigating four cases of childhood hepatitis, including one young patient who died after suffering severe liver damage – potentially marking the first fatality related to the illness in the US.

The state was the fourth to report a mysterious outbreak of the disease, following Alabama, North Carolina and Illinois.

In a health alert, state health authorities asked local doctors to be on the lookout for symptoms of the rare liver disease in children and to report them to the agency...

 

[sharon sanders]

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