Adenovirus F41, the main 'suspect' in cases of childhood hepatitis

• Pediatrics Clues about the origin of rare childhood hepatitis: "Several hypotheses are considered: toxicological and adenovirus"

• ECDC Europe confirms new cases of childhood hepatitis of unknown origin in Denmark, Ireland, the Netherlands and the USA

• Origin No, cases of childhood hepatitis are not due to Covid-19 vaccines

• Health The strange cases of childhood hepatitis that have been detected in Spain: symptoms and possible causes

The investigation continues into the cases of childhood hepatitis of unknown origin that

.

According to data from the World Health Organization,

have been confirmed so far , all in the northern hemisphere.

The United Kingdom, the first country to sound the alarm on the 5th, has recorded 114 cases to date;

;

Israel, with 12;

United States, with 9;

Denmark with 6;

Ireland, which has reported less than 5;

Holland, with 4;

Italy, also with 4;

Norway and France with 2 respectively and Romania and Belgium with two cases.

Although the health authorities are still trying to find out the origins of these hepatitis that

people (10% of the cases), there are still few certainties about the possible causes and mechanisms. of the illness.

According to the data presented this Monday at the Congress of the European Society for Clinical Microbiology and Infectious Diseases (ECCMID), which is being held these days in Lisbon (Portugal), one of the main suspects is the

.

Although "at the moment all hypotheses remain open", as Aikaterini Mougkou, a researcher at the European Center for Disease Control (ECDC), pointed out at the meeting, this subtype of adenovirus is postulated as one of the possible causes .

An adenovirus infection was detected in 74 of the cases, and the

could be identified in 18 of them .

According to Raúl Rivas, Professor of Microbiology at the University of Salamanca, adenoviruses are very common pathogens in humans and can cause different types of infections in the respiratory tract, eyes, intestine, liver, urinary tract or adenoids.

What are the symptoms caused by this adenovirus?

Specifically, adenovirus species F serotypes 40/41

.

These conditions can be serious and require hospitalization, especially in children under two years of age.

"Some previous works had already pointed to other adenoviruses as a possible cause of liver failure in children," says Rivas, although it is a rare association that has mainly been reported in immunocompromised patients.

How is this pathogen transmitted between children?

These are microorganisms that are transmitted from one person to another with great ease, through secretions or contaminated objects.

," he clarifies.

For Jesús Rodríguez-Baño, head of the Infectious Diseases service at the Virgen Macarena University Hospital in Seville and former president of ECCMID, right now "

", although the specialist suggests that it could be a new variant with a more hepatotropic profile, that is, with a greater capacity to cause liver damage.

There are many issues that still need to be cleared up, underlines the specialist.

"We also don't know if all the cases are serious or what we are seeing is the tip of the iceberg that hides many other milder cases underneath," he says.

More circulation of adenovirus

At the aforementioned congress, Meera Chand, director of clinical and emerging infections of the United Kingdom Health Security Agency, pointed out that a

has also been observed in the country in recent weeks.

The increase contrasts with the low transmission previously detected, during the peak months of the pandemic.

In this sense, although

, it is being investigated that hepatitis is related to a greater susceptibility to exposure to adenovirus.

The authorities, he clarified, are also working to identify whether new variants of adenoviruses or other pathogens of interest are circulating, as well as whether previous infection by SARS-CoV-2 or other viruses may favor greater vulnerability.

Adenovirus and SARS-CoV-2 coinfection has been detected in 19 of the patients.

The health authorities completely rule out any relationship with the vaccine against Covid-19 since the vast majority of those affected had not been vaccinated.

Spain, how is the profile of detected children?

At the moment, the cases have been diagnosed in children between one month and 16 years of age, although most of those affected were under 5 years of age.

According to data from the Ministry of Health, the ages of the cases registered in Spain (confirmed and probable) range between 18 months (one case) and 16 years.

Only one of those affected, the little one who needed to undergo a transplant, has tested positive for adenovirus.

One of the affected Spanish minors has a history of recent travel to the United Kingdom and another had previously undergone

for acute lymphoblastic leukemia.

Patients present with acute hepatitis, with a high level of transaminases (more than 500 IU/L).

Many of the children suffer from jaundice and gastrointestinal symptoms, such as abdominal pain, vomiting and diarrhoea.

The analyzes carried out rule out that the picture is due to the hepatitis A, B, C, D or E viruses, which commonly cause hepatitis in children.

In a suspicious case, Rodríguez Baño emphasizes, it is important that in addition to an exhaustive evaluation, taking into account their medical history and possible exposure to toxic substances, the samples obtained are sent and evaluated to reference laboratories that have the necessary molecular techniques to detect better the possible causes of the disease.

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