Mysterious hepatitis in children: Indonesia reports three deaths, US investigates death

The Indonesian authorities confirmed this Monday, 2, the death of three children as a result of acute hepatitis of unknown origin, a disease already reported to the World Health Organization (WHO) by almost twenty countries. Wisconsin, in the United States, is also investigating a death. Until April 21, there were at least 169 cases in the world, according to the latest bulletin released by the global entity.

At the time, only one death had been reported, but no details on the victim’s history, which was recorded in the British health system. In addition to the United Kingdom and Northern Ireland, cases have been reported in Spain, Israel, the United States, Denmark, Ireland, the Netherlands, Italy, Norway, the Netherlands, France, Romania and Belgium. And now also in Indonesia and Singapore. To date, seventeen children (approximately 1% of cases) have required liver transplantation, according to the WHO.

Regarding the cases in Indonesia, the victims died in the last two weeks in Jakarta, with symptoms such as nausea, vomiting, diarrhea, jaundice and fever, according to the authorities, who confirmed the cause of death on Sunday, 1.º. “The public should be on alert after the death of three childhood patients with acute hepatitis,” said the Indonesian Ministry of Health.

On Saturday, the 30th, the Singaporean authorities announced the hospitalization of a minor with acute hepatitis of unknown origin.

According to the WHO, hepatitis is an inflammation that affects the liver caused by a variety of infectious viruses (viral hepatitis) and non-infectious agents. The infection can lead to a number of health problems, which can be fatal. The common viruses that cause acute viral hepatitis (hepatitis A, B, C, D, and E viruses) were not detected in any of these cases.

Although the syndrome affects patients up to 16 years of age, the most cases are in the 2 to 5 year range. The picture of European children is one of acute infection. Many have jaundice, which is sometimes preceded by gastrointestinal symptoms – including abdominal pain, diarrhea and vomiting -, especially in children up to 10 years of age. Most cases did not have fever.

In case of suspicion, blood tests (with initial experience that whole blood is more sensitive than serum), serum, urine, stool and respiratory samples, as well as liver biopsy samples (when available) are recommended. , with further characterization of the virus, including sequencing.

It is worth emphasizing that simple preventive measures for adenoviruses and other common infections involve regular hand washing and respiratory hygiene.

Experts believe that the causative agent of the disease is an adenovirus that is transmitted by contact or through the air. Although it is currently hypothesized as an underlying cause, it does not fully explain the severity of the clinical picture. Infection with adenovirus type 41, the type of adenovirus implicated, has not previously been associated with such a clinical presentation.

Adenoviruses are pathogens – organisms that are capable of causing disease in a host – common that often cause self-limiting infections. They spread from person to person and most commonly cause respiratory illnesses, but depending on the type, they can also cause other illnesses such as gastroenteritis (inflammation of the stomach or intestines), conjunctivitis (pink eye) and cystitis (bladder infection).

According to the WHO, there are more than 50 immunologically distinct types of adenoviruses that can cause infections in humans. Adenovirus type 41 usually presents as diarrhea, vomiting, and fever, often accompanied by respiratory symptoms. The potential emergence of a new adenovirus is still being investigated. Another hypothesis is that there is some relationship with the new coronavirus. The possibility of being an adverse effect of the vaccine against covid-19, however, was ruled out, since most British patients had not taken the immunizer.

What are the symptoms of hepatitis in children like?

The US Centers for Disease Control and Prevention issued an alert late last month to doctors across the country, notifying them of a cluster of unexplained, severe hepatitis in healthy young children.

Between October 2021 and February 2022, nine children aged 1 to 6 years in Alabama were admitted to the hospital with acute hepatitis. Two liver transplants were needed.

Similar cases have also emerged in North Carolina as well as Europe. The UK Health Safety Agency has reported over 100 cases of sudden-onset hepatitis in children under the age of 10 since January 2022, ten of whom required liver transplants.

What is hepatitis?

Hepatitis is a broad term used to describe inflammation of the liver, an organ that performs hundreds of essential functions every day, from aiding digestion to removing toxins from the blood. When the liver is inflamed or damaged, it is unable to perform many of these tasks.

Acute hepatitis refers to inflammation that occurs relatively quickly and does not last longer than six months. It can be serious and lead to liver failure, as was the case with several children in Alabama. But hepatitis can also be relatively mild.

“It is not uncommon for patients – particularly children – to have liver inflammation in the course of a simple, uncomplicated viral illness,” explained Alexander Weymann, director of the Liver Center at National Children’s Hospital in Columbus, Ohio.

What symptoms should parents watch out for?

The symptoms of hepatitis are broad and overlap with many common illnesses. A child with hepatitis may have a fever (low or more severe), fatigue, joint or muscle pain, loss of appetite or nausea, diarrhea, and vomiting.

“Children can also have abdominal pain or tenderness, particularly in the upper right abdomen, which is where the liver is located,” Weymann said. It is important to seek urgent medical attention whenever a child shows signs of severe pain when their abdomen is touched.

Doctors may consider other possible causes of abdominal pain, such as appendicitis. Some children may have darker urine or pale or clay-colored stools. Jaundice or yellowing of the skin and eyes is a hallmark sign of hepatitis – although it is possible to have significant inflammation of the liver and not show signs of jaundice.

“The first change is in the eyes: the white part starts to look yellow,” said Weymann. He noted that jaundice can be more difficult to detect in children who have darker skin, so parents should take subtle changes in tone seriously. “Typically, you won’t see ‘dramatic’ jaundice until the liver inflammation or dysfunction has progressed far enough,” the doctor said.

What is causing the recent clusters of hepatitis?

Hepatitis can have many causes, from autoimmune diseases to side effects of certain medications. It is most often caused by one of the five hepatitis viruses (hepatitis A, B, C, D, and E). Depending on the type, viral hepatitis can be spread through contact with blood and other body fluids or fecal matter, or through consumption of raw or undercooked meats. But viral hepatitis has been ruled out in recent pediatric groups in the United States and abroad.

Instead, the CDC suspects the adenovirus is causing the current cases, although health officials warn that the investigation is ongoing. There are over 50 types of adenoviruses, which tend to cause mild illnesses such as colds and fevers, conjunctivitis or vomiting and diarrhea.

In Alabama, all nine children tested positive for adenovirus. And of the five cases that were genetically sequenced, all had adenovirus type 41, which normally causes vomiting and diarrhea. Most, though not all, affected children in Britain have also tested positive for adenovirus.

“It’s interesting that we’re only seeing this in children under the age of 10, which means that most people over the age of 10 have adenovirus immunity, which could be why this hepatitis is showing up in young children,” he said. Jennifer Lighter, a pediatric infectious disease specialist and hospital public health researcher in New York.

However, doctors and health officials know that adenovirus infection can cause inflammation in the liver. This is not new. What is unusual is for healthy young children to become so suddenly sick, which is why public health officials continue to investigate other possible underlying causes.

What can parents do?

While health officials are not sure that adenovirus is causing the recent clusters of hepatitis, parents can take steps to prevent transmission. Adenovirus spreads from person to person through respiratory droplets or by touching a surface with adenovirus.

Children should be encouraged to wash their hands frequently and avoid touching their face and mouth as much as possible – many of the same measures that help stop the spread of Covid-19.

Parents should also remember that the CDC alert is not a call to action or alarm. The overall risk of a healthy child suddenly developing severe hepatitis remains extremely low.

Authorities simply want to alert pediatricians and other healthcare professionals who might be able to care for young hepatitis patients who must now screen for adenovirus. Treatment varies depending on the type of hepatitis the child has.

“For some types of viral hepatitis, there are drugs that can suppress or eliminate the virus,” Weymann said. “But for the vast majority of cases – like when a child comes in with inflammation of the liver and adenovirus – doctors focus on preventing or managing complications. That’s usually enough, as the liver is very good at healing itself,” he added. /The New York Times, AFP and EFE

About Jenni Smith

She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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