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

[Shiloh]

Source: https://www.northwestgeorgianews.co...cle_06bfad86-ec26-11ec-a465-dfce3412be64.html

Georgia Department of Public Health updates on mysterious hepatitis, monkeypox outbreaks
Rebecca Grapevine Capitol Beat News Service 30 min ago

ATLANTA -- Fewer than 10 children in Georgia have been diagnosed with pediatric hepatitis, State Epidemiologist Cherie L. Drenzek said at the state Board of Public Health’s monthly meeting Tuesday.

The pediatric hepatitis outbreak began in Alabama in October 2021.

So, far 245 children in the United States have had the mysterious disease. Most needed to be hospitalized and nine have died.

It’s unclear what causes the disease. None of the children diagnosed so far had hepatitis viruses, but 45% did test positive for adenovirus type 41, a common childhood infection that is usually mild and causes gastrointestinal upset.

“(The federal Centers for Disease Control and Prevention) is casting a really wide net to look at what potentially could be involved, other cofactors, previous infections,” Drenzek said.

Some staff members at Atlanta children’s hospitals are helping with the studies, Drenzek added.

Prior to this outbreak, public health officials did not closely track hepatitis in children, so it’s hard to determine whether the recently identified cases are much higher than typical rates, Drenzek said.

She emphasized that the disease remains very rare...

 

[Shiloh]

Source: https://www.cdc.gov/mmwr/volumes/71/wr/mm7124e1.htm

Trends in Acute Hepatitis of Unspecified Etiology and Adenovirus Stool Testing Results in Children — United States, 2017–2022


Early Release / June 14, 2022 / 71


Anita K. Kambhampati, MPH[SUP]1[/SUP]; Rachel M. Burke, PhD[SUP]1[/SUP]; Stephanie Dietz, PhD[SUP]2[/SUP]; Michael Sheppard, MS[SUP]2[/SUP]; Olivia Almendares, MSPH[SUP]1[/SUP]; Julia M. Baker, PhD[SUP]1[/SUP][SUP],3[/SUP]; Jordan Cates, PhD[SUP]1[/SUP]; Zachary Stein, MPH[SUP]2[/SUP][SUP],4[/SUP]; Dylan Johns, MS[SUP]2[/SUP][SUP],4[/SUP]; Amanda R. Smith, PhD[SUP]2[/SUP][SUP],3[/SUP]; Lara Bull-Otterson, PhD[SUP]2[/SUP]; Megan G. Hofmeister, MD[SUP]5[/SUP]; Stacy Cobb, PhD[SUP]2[/SUP][SUP],6[/SUP]; Suzanne E. Dale, PhD[SUP]7[/SUP]; Karl A. Soetebier, MAPW[SUP]2[/SUP]; Caelin C. Potts, PhD[SUP]1[/SUP]; Jennifer Adjemian, PhD[SUP]2[/SUP]; Aaron Kite-Powell, MS[SUP]2[/SUP]; Kathleen P. Hartnett, PhD[SUP]2[/SUP]; Hannah L. Kirking, MD[SUP]1[/SUP]; David Sugerman, MD[SUP]1[/SUP]; Umesh D. Parashar, MD, MBBS[SUP]1[/SUP]; Jacqueline E. Tate, PhD[SUP]1[/SUP] (View author affiliations)



Summary

What is already known about this topic?
Following identification of pediatric hepatitis cases of unknown etiology in the United States and the United Kingdom, CDC issued a request in April 2022 for U.S. providers to report additional cases. Many reported cases had test results positive for adenovirus, which is not known to cause hepatitis in immunocompetent children.
What is added by this report?
Analyses of four data sources did not indicate recent increases in hepatitis-associated emergency department visits or hospitalizations, liver transplants, or adenovirus types 40/41 percent positivity among U.S. children compared with pre–COVID-19 pandemic levels.
What are the implications for public health practice?
Current data do not suggest an increase in pediatric hepatitis or adenovirus types 40/41 above pre–COVID-19 pandemic baseline levels; continued surveillance is important to monitor changes over time...

 

[sharon sanders]

bump this

 

[Shiloh]

Source: https://www.statnews.com/2022/06/17...-to-seeming-surge-of-hepatitis-cases-in-kids/

A CDC study seeks to provide clues to seeming surge of hepatitis cases in kids
By Helen Branswell June 17, 2022

When previously healthy little kids started showing up in hospitals with failing livers last fall and this spring, startled doctors and public health authorities didn’t know what was behind what they were seeing. They also didn’t know if what they were seeing was new.

There have always been cases of hepatitis in children for which a cause cannot be found — such cases are labeled pediatric hepatitis of unknown etiology. But these cases occur in very low numbers and they aren’t well-studied or tracked. So when doctors in Alabama and Scotland reported seeing more of these cases over a few weeks then they would normally see in a year, they didn’t have reliable statistics against which to compare the seeming surge.

Now scientists at the Centers for Disease Control and Prevention have come up with some estimates for the normal rate of this condition, at least in the United States. Their findings, published earlier this week in the online journal Morbidity and Mortality Weekly Report, may come as a surprise.

Their research suggests there has not been an increase in cases of pediatric hepatitis of unknown origin, at least in the United States. Nor has there been a rise in the number of pediatric liver transplants, which a portion of these children have needed. Likewise, the rate of detections of infections caused by adenovirus 41 — a stomach bug virus that has been implicated as a potential trigger of these hepatitis cases — has not changed over time, the CDC scientists reported.

(They note that authorities in the United Kingdom believe they may have seen a small increase in pediatric hepatitis cases, but the report they point to says the lack of pre-pandemic data there makes it hard to be certain.)

The CDC findings don’t identify what is causing the cases of pediatric hepatitis of unknown origin, 290 of which are under investigation in this country. Elsewhere, about three dozen countries have detected cases since the United Kingdom raised the alarm in early April. As of June 6, the World Health Organization had been notified of over 800 probable and suspected cases.

But the CDC findings may help to rule some things out. With rates unchanged since before the Covid-19 pandemic, a theory espoused by scientists from Israel — that this is some sort of post-Covid condition — becomes harder to argue.

“It doesn’t mean that Covid still can’t have some collateral role with all of this. But I think these kind of data helps support that that’s probably not the cause,” explained veteran epidemiologist Michael Osterholm, who was not involved in the CDC work....

 

[Shiloh]

Source: https://www.euractiv.com/section/di...erious-hepatitis-among-children-very-unusual/


The severity of mysterious hepatitis among children “very unusual”
By Esther Snippe and Giedre Peseckyte | EURACTIV.com
6:38 (updated: 8:23)

Cases of hepatitis of unknown origin among children have now been recorded in 20 countries in Europe. While hepatitis of unknown origin is reported every year, the severity of cases this time is “very unusual”, medical experts say.

The news about unknown hepatitis first came from the UK, when an increase in acute hepatitis cases of unknown aetiology was reported on 5 April.

As of 9 June 2022, 402 cases of acute hepatitis of unknown origin in children aged 16 years and below have been reported from across Europe. The vast majority are seen among children who are five years old or younger.

The UK has the highest incidence, with 224 cases. In the EU, Spain and Italy recorded the highest number of cases, each more than 30.

So far 87 children have been admitted to an intensive care unit and 17 have received a liver transplant. On 12 May, public health authorities in Ireland announced one death associated with hepatitis of unknown origin in a child under 12 years of age.

Cases of hepatitis of unknown origin among children have now been recorded in 20 countries in Europe. While hepatitis of unknown origin is reported every year, the severity of cases this time is “very unusual”, medical experts say.

The news about unknown hepatitis first came from the UK, when an increase in acute hepatitis cases of unknown aetiology was reported on 5 April.

As of 9 June 2022, 402 cases of acute hepatitis of unknown origin in children aged 16 years and below have been reported from across Europe. The vast majority are seen among children who are five years old or younger.

The UK has the highest incidence, with 224 cases. In the EU, Spain and Italy recorded the highest number of cases, each more than 30.

So far 87 children have been admitted to an intensive care unit and 17 have received a liver transplant. On 12 May, public health authorities in Ireland announced one death associated with hepatitis of unknown origin in a child under 12 years of age...

 

[Shiloh]

Source: https://metro.co.uk/2022/06/23/seven-more-hepatitis-cases-confirmed-in-uk-children-16879819/


Mystery spike in hepatitis among children continues with more cases confirmed
Sean SeddonThursday 23 Jun 2022 2:04 pm


A further seven cases of hepatitis have been identified in young children in the UK.

It takes the total confirmed so far up to 258 after a mystery surge in incidences of the illness since January.

Of the verified cases, 183 are resident in England, 35 are in Scotland, 18 are in Wales and 22 are in Northern Ireland.

The cases are primarily being found in children under the age of five, according the UK Health Security Agency (UKHSA).

A link between the rise and the adenovirus, a common illness which causes flu-like fevers, remains under investigation...

 

[Pathfinder]

Translation Google


Acute infantile hepatitis: "It must be said, no one sees clearly", according to virologist Bruno Lina

Published on 07/03/2022 at 16:14

The essential - In an interview with Le Parisien, Bruno Lina, virologist at the Hospices Civils de Lyon, talks about this global epidemic of acute hepatitis which affects children. Three months after the first cases, its origins remain unclear and may never be known.

"It is possible that we will never find the cause" In an interview with the daily Le Parisien , Bruno Lina, virologist at the Hospices Civiles de Lyon, talks about the epidemic of severe acute hepatitis which has affected children since last April. A total of 920 probable cases have been reported to Public Health France, according to their latest report dated June 28 . 33 countries are affected.

"These hepatitis show an increase in transaminases (enzymes present inside cells in particular the liver, editor's note), explains the virologist. They also have yellow eyes, inflammation of the liver, even destruction, which may require a transplantation." The majority of cases affect children under the age of five .

Countries affected differently

"But the number is different depending on the country and that's what questions us," recognizes the scientist. In France, probably eight cases have been identified, "which is stable compared to last year", and four are still under investigation. While at the same time, Britain records almost half of the 450 European cases. Across the Atlantic, the United States has identified more than 300 cases.

An origin linked to covid?

“ At first we thought that the Covid could be the cause , except that only 10% of the 313 sick children identified and tested had been contaminated”, affirms Bruno Lina. Another explanation: an adenovirus of types 40 and 41. "It is a family of viruses which causes angina in the vast majority of cases, and in a small number of diarrhea. They were found in 52.4% of children suffering, in proportion, it is more than in the general population", he explains.

Before I qualify, first of all, screening is not done on every symptom, so scientists don’t know the level of circulation. Then, the cases of hepatitis with these types of adenovirus are very exceptional in children: they mainly affect very immunocompromised children. Finally, the traces of this virus are perceptible for a very long time in the stool. In conclusion, "it is possible that there are several associated toxicological, environmental and infectious factors which, by their combination, cause this acute hepatitis".

“It is possible that we will never find”

The origin and source of this epidemic therefore remain a mystery, according to the virologist. "It may never be found! The signal is fading, the cases are decreasing, so our chances of identifying the cause are diminishing over time." According to the latest WHO report dated June 22 , eighteen deaths have been reported. 45 children required a transplant.

https://www.ladepeche.fr/2022/07/03...r-dapres-le-virologue-bruno-lina-10412641.php

 

[Shiloh]

Source: https://www.gov.uk/government/news/...atest-updates#full-publication-update-history

Latest


The UK Health Security Agency (UKHSA) is continuing to investigate and confirm cases of sudden onset hepatitis in children aged 10 and under that have been identified since January 2022.

Working alongside Public Health Scotland, Public Health Wales and the Public Health Agency, active investigations have identified a further 5 confirmed cases since the last update on 23 June, bringing the total number of confirmed cases in the UK to 263, as of 4 July.

Of the confirmed cases, 186 are resident in England, 36 are in Scotland, 19 are in Wales and 22 are in Northern Ireland. 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.

As part of the investigation, a small number of children over the age of 10 are also being investigated as possible cases.

No children have died.

 

[Emily]

https://brownstone.org/articles/what-weakened-immune-systems-have-wrought-for-children/
What Weakened Immune Systems Have Wrought for Children


By Carla Peeters July 12, 2022 Public Health
n the report of June 24, 2022, the WHO noted a further rise from 450 cases to 920 cases of acute hepatitis in children worldwide from May 26 to June 24, mostly (78%) in children under the age of 6 years. Unfortunately, forty-five children required liver transplants and 18 children died. Most children have been diagnosed in the UK (367), US (305), Japan (58), Mexico (58), Italy (34) and Spain (39).

Out of 100 probable cases with available clinical data the most commonly reported symptoms were nausea or vomiting (54%), jaundice (49%), general weakness (45%) and abdominal pain (45%).

Researchers and medical doctors are still investigating the origin of the mysterious rise in hepatitis with a focus on a possible viral origin. In 45% of the cases in the US a positive PCR test for adenovirus was found, with 75% of the cases in the UK and in more than 50% of the cases in Europe. A positive PCR test for SARS-CoV-2-virus was found in 15% of the cases in Europe and 10% in the US.

Although the PCR test for the adenovirus was run with two probes, Ct values for a positive test were almost all above 30, indicating most of the cases had a low infection risk. Furthermore, histological findings were non-specific and not consistent with known viral causes of hepatitis.

Analysis by Liquid Chromatography/High Resolution Mass Spectrometry detected several therapeutic moieties including antibiotics, ursodeoxycholic acid, vitamins, paracetamol, and fluconazole. Some have been administered in hospital as part of the case management.

Paracetamol, fluconazole and mycotoxins (foodborne toxins) are thought to be highly unlikely. Though, Salmon and Palmer argue that the spread in age of cases is a possibility of food contaminated with mycotoxins. They refer to a Salmonella outbreak in Canada and the US that was recently linked to peanut butter.

Both the CDC and the WHO have ruled out Covid-19 vaccine as a causative agent, as most of the children did not receive the vaccine prior to hepatitis. Based on preliminary reports the WHO still considers the adenovirus as the most possible causative pathogen.

Seeking Illness

Since the start of the pandemic the focus of seeking the cause of illnesses has been a screening on viral infections. Unfortunately, a positive PCR test is not able to distinguish between a piece of dead material (RNA, DNA) or a virus able to cause an infection. How long a piece of RNA or DNA may remain in the body that can result in a positive PCR test is not known. The preliminary reports do not write about an infectious virus that has been cultured.

More observations on children’s health are alarming. Health experts in the US are seeing children in the middle of the summer testing positive for as much as seven common viruses-adenovirus, rhinovirus, respiratory syncytial virus, human metapneumovirus, influenza and parainfluenza as well as coronavirus, with most of them having two or three combined. ..

 

[Shiloh]

Source: https://www.cdc.gov/ncird/investigation/hepatitis-unknown-cause/updates.html



Persons Under Investigation

Children with Acute Hepatitis of Unknown Etiology

While rare, children can still have serious hepatitis, and we don’t always know the cause. That’s why investigators continue to look at possible causes and investigate.
Numbers of persons under investigation (PUI): 355

PUI does not mean this person is a confirmed case. The states and CDC are looking broadly (including hepatitis cases of unknown origin in children under 10 years of age, since October, 2021), so this number may go up or down as CDC and states review medical charts and learn more.
States and Jurisdictions Reporting at Least One Person Under Investigation (42)* as of July 20, 2022

*These may not be recent cases of hepatitis being reported.
To protect patient privacy, numbers for each state will not be released.


These data were posted on July 20, 2022 and reflect data from October 1, 2021. Reported PUIs are preliminary and subject to change as more data become available. Data will be updated weekly...

 

[Emily]

If there is something going on, they should look at the vaccination status of other household members, particularly adenovirus vectored vaccines.

https://www.sciencedirect.com/science/article/pii/S0264410X16302250#bib0445

Richard C. Condit, Anna-Lise Williamson, Rebecca Sheets, Stephen J. Seligman, Thomas P. Monath, Jean-Louis Excler, Marc Gurwith, Karin Bok, James S. Robertson, Denny Kim, R. Michael Hendry, Vidisha Singh, Lisa M. Mac, Robert T. Chen,
Unique safety issues associated with virus-vectored vaccines: Potential for and theoretical consequences of recombination with wild type virus strains,
Vaccine,
Volume 34, Issue 51,
2016,
Pages 6610-6616,
ISSN 0264-410X,
https://doi.org/10.1016/j.vaccine.2016.04.060.
(https://www.sciencedirect.com/science/article/pii/S0264410X16302250)
Abstract: In 2003 and 2013, the World Health Organization convened informal consultations on characterization and quality aspects of vaccines based on live virus vectors. In the resulting reports, one of several issues raised for future study was the potential for recombination of virus-vectored vaccines with wild type pathogenic virus strains. This paper presents an assessment of this issue formulated by the Brighton Collaboration. To provide an appropriate context for understanding the potential for recombination of virus-vectored vaccines, we review briefly the current status of virus-vectored vaccines, mechanisms of recombination between viruses, experience with recombination involving live attenuated vaccines in the field, and concerns raised previously in the literature regarding recombination of virus-vectored vaccines with wild type virus strains. We then present a discussion of the major variables that could influence recombination between a virus-vectored vaccine and circulating wild type virus and the consequences of such recombination, including intrinsic recombination properties of the parent virus used as a vector; sequence relatedness of vector and wild virus; virus host range, pathogenesis and transmission; replication competency of vector in target host; mechanism of vector attenuation; additional factors potentially affecting virulence; and circulation of multiple recombinant vectors in the same target population. Finally, we present some guiding principles for vector design and testing intended to anticipate and mitigate the potential for and consequences of recombination of virus-vectored vaccines with wild type pathogenic virus strains.
Keywords: Live viral vaccines; Vaccines; Vaccine safety; Potential for recombination; Virus recombination; Vaccine manufacturing; Brighton Collaboration

 

[Shiloh]

Source: https://www.bbc.com/news/health-61269586

Likely cause of mystery child hepatitis outbreak found
By Michelle Roberts
Published 2 hours ago

UK experts believe they have identified the cause of the recent spate of mysterious liver problems affecting young children around the world.

Investigations suggest two common viruses made a comeback after pandemic lockdowns ended - and triggered the rare but very serious hepatitis cases.

More than 1,000 children - many under the age of five - in 35 countries are thought to have been affected.

Some, including 12 in the UK, have needed a lifesaving liver transplant.

The two teams of researchers, from London and Glasgow, say infants exposed later than normal - because of Covid restrictions - missed out on some early immunity to:

adenovirus, which normally causes colds and stomach upsets
adeno-associated virus two, which normally causes no illness and requires a coinfecting "helper" virus - such as adenovirus - to replicate

That could explain why some developed the unusual and worrying liver complications...

 

[Shiloh]

Source: https://www.statnews.com/2022/07/25...-on-cause-of-unusual-hepatitis-cases-in-kids/

New studies offer theory on cause of unusual hepatitis cases in kids
By Helen Branswell July 25, 2022

There is a new theory about what may be causing puzzling cases of pediatric hepatitis of unknown origin — and it is complex.

Two new and as-yet-unpublished studies from scientists in the United Kingdom theorize that children who have developed the hepatitis cases may have been co-infected with two different viruses and had a genetic predisposition to have an over-exuberant immune response when that happened.

Previously the leading hypothesis was that adenovirus 41, which had been found in a number of the infected children, was causing the liver damage. Adenovirus 41 has been known to trigger liver damage in immunocompromised children, but had never been seen to do so in children with intact immune systems.

But the new studies report finding the presence of something called adeno-associated virus 2 — AAV2 for short — in the blood and in liver tissues from a number of affected children. They also found the children were infected with adenoviruses or herpes viruses...

 

[Mary Wilson]

First published: 25 July 2022

The University of Glasgow
UNIVERSITY NEWS

HEPATITIS CASES IN CHILDREN LINKED TO ADENO-ASSOCIATED VIRUS AAV2

Recent acute hepatitis cases of unknown origin in children have now been linked to the virus AAV2 in two new UK studies, with no evidence of a direct link to SARS-CoV-2 infection.

Submitted to MedRxiv as pre-prints, both studies found that the common virus AAV2 (adeno-associated virus 2) was present at high levels in all samples from patients with confirmed cases of unexplained hepatitis. The virus, which is not known to normally cause disease and often accompanies infection with adenoviruses, has now been found by scientists to be associated with the development of acute hepatitis in a small number of young children.

The two studies were led independently and simultaneously. One, examining cases from Scotland by the MRC-University of Glasgow Centre for Virus Research (CVR) and the Royal Hospital for Children in Glasgow, in partnership with Public Health Scotland and ISARIC (International Severe Acute Respiratory and emerging Infections Consortium) WHO Clinical Characterisation Protocol UK (CCP-UK); and a second studying cases from across all four UK nations at Great Ormond Street Hospital and the UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), in partnership with the UK Health Security Agency.

... Researchers across two teams found that AAV2 (which cannot replicate without a ‘helper’ virus such as an adenovirus or herpesvirus) was present in 96% cases of unknown hepatitis examined across both studies.

Therefore, the researchers believe that coinfection with two viruses – AAV2 and an adenovirus, or less often the herpes virus HHV6 (which has also been found in sample from some patients) – may offer the best explanation for the onset of severe liver disease in affected children.

The Glasgow research and patient genetics

The Scottish study carried out a detailed investigation of nine cases and 58 control subjects. Using next-generation sequencing and real-time PCR, the research team compared samples and were able to confirm the presence of AAV2 in the plasma and liver of all nine cases. There was no AAV2 in any of the subjects in the control groups, which were made up of age-matched healthy controls, children with adenovirus but normal liver function and children admitted to hospital with known causes of hepatitis. The Scottish study also examined the genetics of the patients with unknown hepatitis, alongside the pathogen genomics, to find out whether any of the children may be more susceptible to this type of acute hepatitis. Using detailed genomic testing of the patients, researchers were able to identify differences in the Human Leukocyte Antigen gene, that were not commonly found in the control groups of healthy children, or in the genes of children with other forms of hepatitis. The team believe these genetic sequences may offer another part of the answer as to why some children have become seriously unwell.

The London research, sequencing and immunocompromised patients

With expertise in metagenomics and adenovirus sequencing, the London team studied 28 cases, including liver samples from five children that required a transplant and blood samples from the remaining children who did not – residual samples were sufficient to test 17 cases for AAV2, 16 of which tested positive. RNA sequencing of liver samples confirmed the presence of AAV2 replication in the liver of children with unknown hepatitis. Patient samples were compared with 132 controls from immunocompromised and immunocompetent patients. The London study showed that AAV2 was present only very rarely in the children who did not have hepatitis (6 out of 100) and at much lower levels, even for immunocompromised children (11 out of 32).

Unknown hepatitis and SARS-CoV-2

Both studies were able to rule out the likelihood of recent or prior SARS-CoV-2 infection as a direct cause for the acute hepatitis. Researchers found no SARS-CoV-2 in the liver of patients, while tests conducted by the team in Glasgow to find out

whether the children had previously had COVID-19 found that only two thirds of the patients had antibodies to the infection, similar to SARS-CoV-2 antibody prevalence in Scottish children at the time. Further, the peak in cases occurred well after the peak in COVID-19 cases in Scotland but only shortly after a peak in adenovirus infections.

Researchers still cannot be certain why this is happening now, but both teams have highlighted the possibility that a peak in adenovirus infections in the general population after a period of lockdown may have contributed to this, through lowered immunity in children to certain viruses and changes in patterns of virus circulation.

... AAV2 is not an adenovirus but a member of the AAV2 is not an adenovirus but a member of the parvovirus family. Researchers found the virus at very high levels in the blood and liver of patients sampled, and it was also found to be replicating in the liver. ...

https://www.gla.ac.uk/news/headline_863600_en.html

 

[Pathfinder]

Translation Google

Severe pediatric acute hepatitis of unknown origin: update on July 26, 2022

Update on 07/26/22 following the cases of acute pediatric hepatitis reported in France and internationally. A case definition for healthcare professionals and guidelines are available on our website.

Posted on July 26, 2022
...

Cases of pediatric acute hepatitis: update on 07/26/2022 in France and abroad

In France :

Nine possible cases have been reported and one is being investigated by the medical teams in charge of patients, in conjunction with Public Health France. The occurrence of these cases is not unexpected and does not reflect, at this stage, an excess of cases in France.

'The data on emergency visits for hepatitis of unknown etiology from the OSCOUR® network are stable and do not show an excess of cases. Analysis of PMSI data over the first 16 weeks of 2022 shows a number of hospital stays that remains within the usual values ​​for the 2018-2021 period, regardless of the age group considered.

Internationally :

1. As of June 30, 2022, 200 cases of acute hepatitis of unknown origin in children aged 16 or younger have been reported from 19 European countries .
2. As of 4 July 2022, 263 cases of acute hepatitis of unknown etiology have been identified in children aged 10 years or younger in the UK .
3. As of July 8, 2022, a total of 1,010 probable cases have been reported by 35 countries in five WHO regions , without it being possible at this time to know whether they represent an excess of cases or whether they are This is the usual number of cases in most countries.

This update will be updated in the event of a significant change in the situation in France.
​

...

https://www.santepubliquefrance.fr/...nconnue-point-de-situation-au-26-juillet-2022

 

[Pathfinder]

Translation Google

Severe acute non-A-E hepatitis of unknown cause in
children under 16 years.

Situation in Spain.

October 5, 2022

Summary of the situation and conclusions

 On April 5, 2022, the United Kingdom (UK) notified the WHO of an alert following the detection of
10 cases of severe acute hepatitis of unknown cause in children. In Spain it started
the surveillance of this entity from that moment.

 In 2022, until August 31 in Spain, the National Network of
Epidemiological Surveillance 48 cases, with a mean age of 5 years (between 0 and 16 years), 62.5%
of girls. The cases were detected in 11 Autonomous Communities, with no epidemiological relationship between them and
symptoms began between January 2 and August 12, with most of the
detections between weeks 10 and 17 (March 7 to May 1).

 The clinical evolution has been favorable in all cases except three, which required
liver transplant. Two of these cases were transplanted in a critical situation and
they died 24 hours after transplantation.

 At the National Center for Microbiology, research has been carried out
microbiology and metagenomics. 8 positive cases for herpes virus have been detected
and 14 of the 32 analyzed (47.3%) have been positive for adenovirus.

 So far, the number of cases of hepatitis of unknown cause in children and
transplants observed in this alert are within those expected according to the
estimates made with data from previous years.

 As of September 29, 555 cases have been reported in Europe in 22 countries: 278 in
UK, 23 of which, 7.5%, required liver transplantation.

 The main causal hypothesis is around infection by Adenovirus,
having been associated in a very significant way to the cases of the UK and to a percentage
important part of the cases detected in the rest of the world.

 Spain is collaborating with the European Center for the Prevention and Control of
Diseases (ECDC) and the World Health Organization (WHO) and will continue to monitor and
studying the microbiological characteristics of these cases.
...
https://www.sanidad.gob.es/en/profe...tual/docs/20221005_InformeAlertaHepatitis.pdf