The Ministry of Health has notified this Thursday the first two deaths in Spain from hepatitis of unknown origin in children, after failing to pass the liver transplant.

According to the Health report published this Thursday, and collected by Europa Press, among the 46 cases detected in Spain, three liver transplants have had to be performed.

It is a 3-year-old girl resident in Aragon with good clinical evolution, a 6-year-old boy from Murcia and a 15-month-old baby in Andalusia.

The 6-year-old boy began symptoms on July 2 and on the 18th he was transferred to a hospital in Madrid for a transplant in serious condition with cerebral edema.

The transplant was performed on July 29 and he died 24 hours after being transplanted.

The other deceased is a 15-month-old baby resident in Andalusia who was admitted at the end of June with acute gastroenteritis with a positive culture for Adenovirus in a critical situation (encephalopathy and severe coagulopathy).

The case required an urgent liver transplant and also died within the next 24 hours.

Spain has already reported 46 cases of this hepatitis of unknown origin, aged between 0 and 16 years with more than 60 percent of girls, according to data as of August 3 from the National Epidemiological Surveillance Network led by the Ministry of Health.

Five cases are under 1 year old, and 3 of them, with onset of symptoms at the end of June, are two neonates aged 3 and 5 days (admitted to the ICU) and a 48-day-old child in whom enterovirus has been detected, in one of them also adenovirus and in another SARS-CoV-2.

The cases have been detected in 10 autonomous communities, with no epidemiological relationship between them and symptoms began between January 2 and July 2, with most of the detections being between March 7 and May 1.

This is how the cases are distributed by Autonomous Community: Andalusia (3), Aragon (1), Balearic Islands (4), Canary Islands (1), Castilla y León (2), Castilla-La Mancha (3), Catalonia (9), Galicia ( 5), Madrid (15) and Murcia (3).

The mean age of the cases under investigation was 5.3 years and the median age was 4 years.

By sex, 29 cases were girls (64.4%) and 16 boys (35.6%), with a higher proportion of girls being observed, especially in the group from 0 to 5 years old.

Among the cases for which information on symptoms is available, the most frequently reported have been malaise (26 cases; 65%), vomiting (26 cases; 59%), fever (23 cases; 58%) and abdominal pain (21 cases; 50%).

Jaundice was reported in 20 cases (50%), diarrhea in 12 cases (29%), respiratory symptoms in 10 cases (25%), and rash in 9 cases (23%).

Microbiological and metagenomic research has been carried out at the National Microbiology Center (CNM) of the Carlos III Health Institute (ISCIII).

7 positive cases for herpes virus have been detected and 10 of the 21 analyzed (47.6%) have been positive for adenovirus, so it continues to be the main suspect behind these cases.

In any case, Health assures that "so far, the number of cases of hepatitis of unknown cause in children and transplants observed in this alert are within those expected according to estimates made with data from previous years."

In fact, Health explains that a comparative analysis between Autonomous Communities has not observed "an increase in cases of severe hepatitis of unknown origin in children aged 0 to 16 years in the period from January to May 2022 compared to the same period of the five previous years, nor in the disaggregation of codes and ages".

"No higher incidence of fulminant hepatitis in pediatric age requiring liver transplantation was detected between January and July 2022 at the national level, compared to the estimated average for the same period between 2012 and 2021," summarizes the Ministry.

At the international level, until July 28, 507 cases have been reported in Europe in 21 countries, 273 in the United Kingdom, Austria (6), Belgium (14), Bulgaria (1), Cyprus (2), Denmark (8), France (9), Greece (12), Ireland (24), Israel (5), Italy (36), Latvia (1), Luxembourg (1), Netherlands (15), Norway (6), Poland (15) , Portugal (20), Moldova (1), Serbia (1) and Sweden (12).

Outside Europe, cases have been detected, especially in the Americas (487 cases), with the majority of cases in the United States (354 cases), followed by the Western Pacific region (77 cases), Southeast Asia (23 cases), and the Eastern Mediterranean. (2 cases).

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