“Unknown cause” Adenovirus is related to acute hepatitis symptoms in children?

Nowadays, there are a series of reports of acute hepatitis in "children" overseas such as the United Kingdom. The

cause is not clear yet, but some children need liver transplantation.

Three cases of this possible hepatitis have been reported in Japan as well.

Acute hepatitis in children of unknown cause confirmed in Japan

▽ What kind of symptoms do you get?

▽ How far has the cause been investigated?

▽ What is the response required of us?

I have summarized what I have learned so far.

Acute hepatitis in "children" Confirmed in Japan

On April 25, the Ministry of Health, Labor and Welfare revealed that a child under the age of 16 had been hospitalized for unexplained hepatitis.

This is the first time that a patient with unexplained acute hepatitis reported in Europe and the United States has been confirmed in Japan.

"Unknown cause" is because five types of hepatitis viruses from type A to type E are not detected, but the child has hepatitis. We are asking you to go back and report to any children up to the age of 16 who had high liver enzyme levels on test.

After that, two people were reported on April 28, and the total number of patients with this possible hepatitis is three.

1. What is acute hepatitis?

What kind of illness is acute hepatitis?

The liver plays a wide range of roles, such as making proteins necessary for the body to store nutrients, detoxifying harmful substances, and making bile necessary for digesting food.

Acute

hepatitis is

a

disease that affects children and adults. Generally, it is caused by a virus, and the liver function deteriorates

. Causes the symptoms of.

According to the website of the National Center for Global Health and Medicine, about 1% to 2% of patients get worse rapidly, and some may need a liver transplant.

If you have children ...

According to Dr. Hitoshi Tajiri of Kinki University School of Medicine, who is familiar with liver disease in children, even children may have hepatitis due to decreased liver function during so-called "tummy cold". is.

However, especially in infants, symptoms often do not appear so often, and if the cause is not clear, symptomatic treatment such as administration of vitamins is used, and most of them improve liver function in a short period of time.

Usually, there are few cases of deterioration, and when "Oudan" worsens, brain damage may occur, and when liver function deteriorates extremely, it becomes impossible to make protein to stop bleeding, and liver transplantation is extremely rare. It means that you may need it.

This acute hepatitis of unknown cause has relatively severe symptoms even in children, and its characteristics are slightly different from those of normal hepatitis.

2. What are the symptoms if a child is affected?

What are the symptoms of unexplained hepatitis?

According to WHO = World Health Organization,

▽ liver enzyme levels are high,

▽ urine color becomes darker,

stool color becomes lighter, and

▽ skin becomes yellow. And, while symptoms such as

▽ diarrhea,

▽ vomiting,

▽ abdominal pain,

▽ joint pain and muscle pain occur, few children have a fever.

Detailed case reports in the United Kingdom and the United States have reported that many patients have vomiting, diarrhea, and urticaria, and that severely ill children require liver transplants.

About 10% of children with symptoms will receive a liver transplant

According to WHO, as of April 29, about 170 people in 16 countries, including the United Kingdom and the United States, have reported symptoms.

It is said that children from 1 month to 16 years old have symptoms.

About 10% of these, 16 people, received liver transplants and one died.

The majority of patients are under the age of 10, and about half are between the ages of 3 and 5.

3. What is the cause?

How far do you know the cause?

WHO experts have not found any of the five hepatitis viruses from type A to type E, bacteria, poisons, drugs, etc. that are usually thought to be the cause, from children with symptoms. It is said that.

According to the WHO, hepatitis in children of unknown cause occurs in several cases each year in many countries, but it is apparently increasing in some countries, and we request case reports. At the same time, we are planning to investigate the cause together with research institutes in each country.

Is it caused by adenovirus?

What is the relationship with the new coronavirus?

Among these, the one that has been pointed out is the "adenovirus" that causes sore throat and diarrhea.

According to WHO, adenovirus was detected in at least 74 children with symptoms, and 18 of the adenoviruses were infected with a virus called type 41.

In addition, 19 people were infected with the new corona along with adenovirus.

In general, adenovirus is transmitted through contact and flying, and mainly causes respiratory symptoms such as sore throat, but adenovirus type 41 causes symptoms such as diarrhea and vomiting along with respiratory symptoms.

However, although there are reports that children with weakened immunity develop hepatitis when infected with this virus, there are no reports that healthy children develop hepatitis symptoms.

WHO will investigate the possibility of new types of adenovirus, such as the fact that it is easier to be infected with adenovirus because the infection of new corona has decreased since the infection of the new corona has spread worldwide. It is said that it is necessary.

On the other hand, the majority of children with symptoms have not been vaccinated with the new corona, so it is unlikely that this is a side reaction to the vaccine.

British health authorities "The most common element is'adenovirus'"

Also, according to a report released on April 25 by the UK health authorities, 111 patients under the age of 16 have been reported in the UK since January, but various viruses have been tested. The most common factor is that "adenovirus" has emerged.

Adenovirus was detected in 40 of the 53 people tested.

In addition, a new type of coronavirus has been detected in 10 out of 61 people.

On the other hand, none of the reported children were vaccinated against the new corona.

The British health authorities hypothesized that ▽ "association with adenovirus" was the most promising, ▽ "due to co-infection of adenovirus with new coronavirus and other pathogens", ▽ "causes severe hepatitis". He says he is also investigating the possibility of a "new adenovirus."

In addition, the US CDC Centers for Disease Control and Prevention released a report on nine patients in southern Alabama on April 29, which detected adenovirus in all of them, while no one was infected with the new coronavirus. did not.

The CDC says, "Adenovirus may be the cause, but we will also investigate other environmental factors."

4. Japanese expert “Adenovirus cannot be asserted at this stage”

How do Japanese experts view adenovirus, which has been pointed out to be involved in hepatitis?

According to Dr. Hitoshi Tajiri, who is familiar with liver disease in children, there have been only 12 cases in the world of severe hepatitis associated with adenovirus in children, of which there are no underlying diseases. Is that there were two cases.

According to Dr. Tajiri, in normal medical care, if hepatitis in a child is found, hepatitis A to C viruses are tested, but further tests are rare, and the cause is often unclear. about it.

On the other hand, adenovirus is sometimes used to carry a gene to a target location during gene therapy, and it is known that if it enters a blood vessel at this time, it collects in the liver.

However, the types of adenovirus used in gene therapy and the adenovirus detected this time are different.

National Institute of Infectious Diseases "The number of infected people is not increasing rapidly"

As of April 25, the National Institute of Infectious Diseases said, "There is no sign that the number of cases has increased significantly in the reported countries, it is easy to infect around the patient, and the number of infected people seems to increase rapidly. It's not a situation. "

On top of that, "There are no signs that severe hepatitis in children is increasing in Japan, and there are no signs that adenovirus, which is cited as one of the possible causes, is more prevalent in Japan than normally expected. ", And now it is in the stage of investigating whether there are any cases.

5. What are we careful about?

Professor Sotaro Mushiaki of the Department of Pediatrics, Kinki University Nara Hospital, who is the chairman of the Steering Committee of the Japan Pediatric Liver Study Group, says that there are about 20 cases of severe hepatitis in children annually, and about half of them do not know the cause.

He added, "I don't have the impression that acute hepatitis in children has increased in the last few years. A national survey seeking reports according to the standards advocated by WHO should be watched carefully. It may apply to patients with a wide range of symptoms. We would like to investigate in detail whether severe hepatitis of unknown cause is increasing in children. "

In addition, Dr. Tajiri said, "WHO is disseminating information, so it is important to check the situation. However, I do not know if there will be a series of cases reported in Europe and the United States in Japan, so I am not so scared. I want you to see the situation. "

On top of that, is there anything I should be careful about?

"Go to a medical institution as soon as you have symptoms" "Wash your hands well"

Ryo Sumazaki, Honorary Director of Ibaraki Prefectural Children's Hospital, who is familiar with childhood liver disease, said, "In children, hepatitis A to E does not fall under this category, and acute hepatitis of unknown cause often occurs, so the number of cases has actually increased. It is necessary for the national government and experts to carefully investigate whether or not there is a disease, but at this point, it seems that ordinary parents do not have to worry too much. " If you have symptoms, vomiting or diarrhea and you are not feeling well and cannot get rid of water, please see a medical institution immediately. Adenovirus is a common virus, so it is said that it is the cause immediately. I don't think it can be determined, but it often spreads not only through flying but also by contact infection, so I want you to wash your hands thoroughly. "