Unexplained children with acute hepatitis "doubtful"
Recently, the sporadic acute hepatitis of unknown etiology in children in the past has shown a trend of concentrated attacks.
Acute hepatitis in children reported in many countries was initially discovered in Europe and the United States and other countries, and later appeared in many countries in Asia.
This has aroused the high vigilance of relevant domestic researchers.
"Unexplained acute hepatitis is very damaging to children's liver function." Ning Qin, director of the Department of Infectious Diseases at the National Medical Center for Major Public Health Events and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (hereinafter referred to as Tongji Hospital), told Science and Technology Daily on May 13 Reporter, in addition to the great harm, another important reason for the incident to attract attention is that it happened intensively in a short period of time.
In the past, this kind of unexplained childhood hepatitis was sporadic, and the number of cases was small, but this time the number of reported cases is large in a short period of time, which may cause infection.
But what makes people puzzling is that if it is an infectious disease, there is no time-space intersection between children in different countries or regions, and theoretically it is impossible to infect each other.
Suspects are "heavy", and many causes are "mismatched"
As of May 3, 20 countries and regions around the world had reported about 228 cases of acute hepatitis of unknown cause in children, of which at least 20 were liver transplants, accounting for about 8.8%, and 4 died.
"Children have common characteristics, such as jaundice and elevated transaminase levels." Professor Luo Xiaoping, director of the Department of Pediatrics of Tongji Hospital, said that in such cases, the hospital will follow routine procedures to screen for viral hepatitis, non-hepatotropic virus infection, Autoimmune hepatitis, metabolic liver disease, drug-induced infection, etc., determine the cause according to the results.
The World Health Organization has ruled out hepatitis virus infection such as A, B, B, and B after investigating acute hepatitis cases of unknown cause. So what is the cause?
Some scholars speculate that it may be T-cell-dominated autoimmune hepatitis caused by the new crown mRNA vaccine.
However, further investigation found that most of the children were not vaccinated with the new crown mRNA vaccine, and this possibility was ruled out.
Through molecular biology testing, it was found that there is a human adenovirus (HAdV) type 41 in the serum samples of some patients, and it has become the biggest "suspect" at present.
But the problem is, according to past experience, human adenovirus is not so destructive.
"People's research on human adenoviruses is relatively in-depth, from molecular structure to pathogenicity, to different tissue orientations and different toxicity." Ning Qin said that most human adenoviruses invade the respiratory tract, and a few cause gastroenteritis, Conjunctivitis, which leads to liver failure, is even rarer.
Infection with a new variant of the new coronavirus is one of the possible reasons
At present, the industry believes that in addition to human adenovirus infection, there are other possibilities, such as a new type of hepatotropic virus that has not yet been identified, a new variant of human adenovirus, drugs, toxins or environmental exposure and other factors. A new variant of the new coronavirus is also considered one of the possibilities.
"Although some cases tested positive for the new coronavirus and (or) human adenovirus, genetic identification of the virus is still needed to determine the relationship between the two." Ning Qin said that whether it is a new virus requires further in-depth research Research.
In addition, it may be that during the epidemic of new coronary pneumonia, the increased susceptibility of young children led to the increased virulence of the virus, and blood, serum, urine, stool and respiratory samples and even liver biopsy samples should be tested.
"In fact, it is still unclear whether the unexplained childhood hepatitis in various countries is caused by the same cause." Ning Qin said that there is currently no evidence that the cases in various countries are caused by the same cause. Therefore, international efforts should be strengthened. Communication and cooperation, such as sharing the results of gene sequencing in the international academic community, can solve the mystery earlier.
No related cases have been found in my country, but we need to be vigilant
Similar cases have not been found or reported in my country, but due to their great harm and the possibility of infectious diseases, high vigilance is required.
The article "Highly Concerned about the Characteristics and Development Trends of Severe Acute Hepatitis in Children of Unexplained Causes in Many Countries in the World" published in the Chinese Medical Journal by the Department of Infectious Diseases and Pediatrics of Tongji Hospital emphasized the above point of view.
"Fast and accurate identification of the cause is the basis for the diagnosis and treatment of emerging infectious diseases and epidemic prevention and control. The basis for the rapid identification of the cause is rapid discovery." The article calls for physicians in pediatrics, infectious diseases and related departments to be highly vigilant against unknown causes of liver function For abnormal children and adult patients, carefully inquire about the contact history, the history of new coronavirus infection, etc.
There are many current pathogen identification technologies, such as metagenomic sequencing technology, technologies based on antigen-antibody reaction, and biosensors, which can achieve rapid locking of pathogens.
Ning Qin reminded that patients with acute hepatitis of unknown cause who have been excluded from common pathogens should be actively subjected to metagenomic sequencing, and medical units should obtain blood or other body fluid samples after obtaining the patient's consent for further identification of pathogens.
Once a case is found, it should be actively reported to the disease control department.
Our reporter Zhang Jiaxing