Pandemic linked to childhood liver disease found in British study

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(Bloomberg) β€” Health authorities are investigating a possible link between the pandemic and an outbreak of mysterious acute hepatitis that has infected children in the UK, US and elsewhere.

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The UK has detected adenovirus, a family of pathogens that cause a range of illnesses including the common cold, in three-quarters of cases of liver inflammation, officials said on Monday. They are now investigating whether a lack of prior exposure to adenoviruses during pandemic restrictions or previous exposure to SARS-CoV-2 or another virus could be related.

Researchers have analyzed 111 cases identified in the UK as of April 20, including 81 cases in England, according to government data. Ten patients underwent liver transplantation. The UK has not reported any deaths and a small number of children over the age of 10 are under investigation, according to an emailed statement.

The investigation “increasingly suggests that this increase in sudden onset hepatitis in children is associated with adenovirus infection,” Mira Chand, director of clinical and emerging infections at the UK Health Agency, said in a statement. “However, we are thoroughly investigating other possible causes.”

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There is no link between the cases themselves or travel, Andrea Ammon, director of the European Center for Disease Prevention and Control, said at a press conference on Tuesday. The organization is set to release a quick risk assessment on Thursday. Ammon said she couldn’t provide case numbers.

On April 5, the World Health Organization was notified of 10 cases in central Scotland among previously healthy children with diarrhea, vomiting, abdominal pain and jaundice, a liver-related disease. Three days later, 74 cases were identified in the UK.

As of April 21, the UK cases were followed by 13 in Spain, 12 in Israel, nine in the US and another 21 in Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania and Belgium.

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Symptoms include inflammation of the liver with markedly high levels of liver enzymes and jaundice preceded by abdominal pain, diarrhea, and vomiting. According to the WHO, the common viruses that cause acute hepatitis were not detected in any of the cases.

According to WHO, of the samples that underwent molecular testing, 18 were identified as adenovirus F type 41. Nineteen children were found to be simultaneously infected with SARS-CoV-2 and adenovirus.

What we know about the mysterious liver disease that affects children around the world

(Bloomberg) β€” An outbreak of acute hepatitis in children has killed one child and required liver transplants for at least 17 other children, according to the World Health Organization. While the cause has yet to be identified, researchers are studying adenovirus, a family of viruses that cause a range of illnesses, including the common cold.

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1. When was it first reported and how many people have been affected so far?

The first cases in the US were identified in an Alabama hospital in October 2021, when five children were hospitalized with liver damage for an unknown reason. The World Health Organization was notified April 5 of 10 cases in previously healthy children in Scotland. Three days later, 74 cases were identified in the UK.

Most of the 169 cases were detected in the UK – 114 cases as of 21 April, followed by 13 cases in Spain, 12 cases in Israel, nine cases in the US and another 21 cases scattered across Denmark, Ireland, the Netherlands, Italy, Norway , France. , Romania and Belgium, according to WHO. On April 25, Japan’s health ministry said it had found one probable case, raising concerns that the disease is spreading outside of Europe and the US.

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With a more thorough search, β€œit is highly likely that more cases will be found before the cause is confirmed and more specific control and prevention measures can be implemented,” the WHO said in a statement.

2. What are the general symptoms?

Abdominal pain, diarrhea, and vomiting are replaced by jaundice, when the skin or whites of the eyes turn yellow. Laboratory tests show signs of severe liver inflammation with markedly high levels of liver enzymes. Most of the children did not have a temperature. Other symptoms of hepatitis include fatigue, loss of appetite, dark urine, light-colored stools, and joint pain.

The affected children ranged from one month old to 16 years old, many of them were 10 years old or younger. About 10%, or 17 children, needed a liver transplant. At least one death has been reported, according to the WHO.

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3. What causes the disease?

The reason is not yet known. Health authorities and experts are investigating potential triggers, including infection with a known adenovirus that has been found in 74 children. Some have also been infected with Covid, although the role of the viruses is not clear.

According to WHO, common pathogens that cause acute viral hepatitis, including hepatitis A, B, C, D and E viruses, were not detected in any of the cases. No other risk factors, including links to international travel, were identified. Affected countries are conducting additional testing for other infections, chemicals and toxins, which have also begun enhanced surveillance activities.

The WHO has said that it is possible that severe hepatitis is an ongoing, albeit rare, result of adenovirus infection, which is now being detected more frequently due to increased testing. Recently, there has been a rise in adenovirus infections after dropping to low levels during the Covid pandemic, potentially making young children more susceptible. The WHO said the potential emergence of a new adenovirus also needs to be explored.

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4. What is adenovirus?

According to the U.S. Centers for Disease Control and Prevention, adenoviruses are common viruses that cause a range of illnesses, including cold symptoms, fever, sore throat, bronchitis, pneumonia, and diarrhea. According to the WHO, there are more than 50 types of adenoviruses that can cause infections in humans. Although they most commonly cause respiratory symptoms, they can also lead to gastroenteritis, conjunctivitis, and bladder infections.

According to WHO, adenovirus was detected in more than 40% of cases. Among the samples subjected to molecular testing, 18 were identified as adenovirus F type 41. However, the results are puzzling because adenoviruses usually resolve on their own and do not cause the severity of disease seen in children. Adenovirus type 41 typically causes diarrhea, vomiting, and fever, often accompanied by respiratory symptoms. It is not known to cause hepatitis in healthy children.

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