Recently, cases of severe acute hepatitis of unknown origin in children have continued to increase in Europe. Zhang Wenhong, director of the National Medical Center for Infectious Diseases and director of the Department of Infectious Diseases at Huashan Hospital Affiliated to Fudan University, said that children with unexplained hepatitis showed a clustered incidence this year, and the risk of infectious diseases should be considered.
A child watches the St. Patrick’s Day parade in London, England, on March 13. According to Xinhua News Agency
Unexplained hepatitis cases continue to increase in Europe
On April 28 local time, the European Centre for Disease Control and Prevention issued a statement, and on April 5 in the UK As of April 20, 111 cases of 10-year-olds and younger have been identified in the UK, following the first reports of an increase in cases of severe acute hepatitis of unknown etiology in healthy children.
As of April 27, 12 EU/EEA countries have reported around 55 suspected and confirmed cases. The United States has reported 12 cases, Israel has reported 12 and Japan has reported one.
The clinical presentation was severe acute hepatitis requiring hospitalization with jaundice and marked elevation of hepatic transaminases. Information on the outcome of the case is still being collected. To date, most patients for whom information is available have recovered, but some have developed acute liver failure requiring liver transplantation.
The incidence in the EU/EEA is very low, and it is currently impossible to accurately assess risk in the European paediatric population as the causative agent of reported acute hepatitis cases is still unknown and under investigation.
Due to the unknown etiology, effective control measures cannot be identified at this stage. Young children are more likely to be exposed to viruses such as adenovirus through the fecal-oral route. Therefore, the European Centre for Disease Control and Prevention recommends that good hygiene practices be promoted in settings with young children.
What is unexplained hepatitis? What are the symptoms?
According to the etiology, hepatitis can be generally divided into: viral hepatitis, autoimmune liver disease, drug and toxic hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, metabolic disorder liver disease Wait.
In addition, there are some hepatitis whose etiology cannot be determined by the current laboratory examination, histological examination and other diagnostic methods, which is clinically called “unexplained hepatitis”. It has been reported in the literature that the incidence of unexplained hepatitis is about 5% to 30%.
Like other hepatitis, the symptoms of unexplained hepatitis are optional, and the severity of the disease varies. Some even cause liver failure and progress to liver cirrhosis and hepatocellular carcinoma; Acute and chronic; the age of onset and susceptible population are not limited.
WHO said the patient was between 1 month and 16 years old.
According to the UK Health Security Agency, the cases identified so far are mainly children under 5 years old, the average age of confirmed cases is 3 years old, and only “a small number of children over 10 years old are diagnosed”.
The WHO report indicated that the clinical presentation of the case was acute hepatitis with marked elevation of liver enzymes.
Gastrointestinal symptoms, including abdominal pain, diarrhea, and vomiting, as well as elevated liver enzyme levels (AST or ALT greater than 500 IU/L) and jaundice before severe acute hepatitis, have been reported in many cases. Most cases have no fever.
Zhang Wenhong: This year has the characteristics of clustered disease
On April 29, the WeChat public account of “Huashan Infection” issued an article introducing children of unknown causes in the UK and other places The development of hepatitis and its possible causes. The article pointed out that there is an imported risk of unexplained childhood hepatitis, and China should prepare for it early.
Zhang Wenhong, director of the National Medical Center for Infectious Diseases and director of the Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, commented in the article that unexplained hepatitis cases occur every year, often referring to known hepatitis viruses or known causes. liver damage, which is not uncommon in children. However, the unexplained hepatitis that WHO is concerned about has the characteristics of clustered disease, and the incidence rate is higher than in previous years. In this case, it is reasonable to consider the risk of infectious diseases.
Zhang Wenhong said that there is a certain correlation with adenovirus infection. But adenovirus infection is a very common phenomenon that can cause pneumonia or diarrhea. Why are there so many cases of severe hepatitis this year, and only in children? At present, it is speculated that it is a long-term isolation of the new crown. Children have not been exposed to this virus for a long time, and sudden contact will cause relatively serious immune damage. This speculation is consistent with the phenomenon that emerging infectious diseases tend to be heavier in the early stage of disease outbreaks. of.
Zhang Wenhong believes that if it is caused by the long-term isolation of the new crown, rather than a new virus that has not been discovered before, the follow-up effect of this unexplained hepatitis will gradually decline, but we still need to Unknown pathogens remain vigilant, even if the probability of a pandemic of this emerging infectious disease is not high. In addition, the current definition of a confirmed case is constantly being updated as awareness grows.
Cover reporter Yan Lei Intern He Siyi
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