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As the number of cases worldwide increases, researchers compete to solve the puzzle of mysterious hepatitis cases in children.

As the number of cases worldwide increases, researchers compete to solve the puzzle of mysterious hepatitis cases in children.

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About half of these cases are from two countries, the United States and the United Kingdom. On Thursday, investigators from both countries said they were working hard to get an answer.

One of their first tasks was to try to understand whether these cases of sudden and often severe liver damage in children represent a true increase over the past few years. The answer is that it depends on where you are looking.

The UK sees children with liver disease only in three national hospitals, so it has better data on hepatitis cases than many other countries.

“The care for these children is highly centralized,” said Deedre Kelly, a professor of pediatric hepatology at the University of Birmingham, UK, at a press conference hosted by an independent non-profit science media center on Thursday. Said.

& # 39; This is not my kid & # 39 ;: Mysterious hepatitis caused havoc to healthy kid at shocking speed

On average, Kelly says he sees about 20 children who suddenly develop hepatitis without an obvious cause of liver inflammation. This year, they saw 176 such cases, an increase of almost eight times.

This is in contrast to European countries. “There was no increase in the number of acute or severe hepatitis,” Kelly said in a recent study counting cases of hepatitis in children at liver specialist centers across Europe.

Kelly says they are still trying to figure out what that means. “Both Europe are behind us and still need to catch up, or that’s a phenomenon that isn’t happening in Europe,” she said.

In the United States, cases of unexplained hepatitis are not regularly reported to public health authorities, so it is not possible to know if the 180 cases under investigation here are more than what doctors normally see. It Is difficult.

In a call to CDC clinicians on Thursday, Alabama Public Health Department epidemiologist Amandinegram said state investigators were in the emergency department for children suffering from hepatitis, jaundice, and liver failure. He said visits to the state are increasing throughout the state. The month from November 21st to December 25th, 2021. Alabama was the first state to flag a cluster of nine unexplained hepatitis cases in children.

What Parents Should Know About Increasing Unexplained Infernal Hepatitis Cases in Children

Investigators do not have smoking guns. But they were able to narrow down some of what they were looking at.

So far, they are pediatricians and college pediatric health and developmental medicine based on questionnaires collected from cases where contact with dogs could be ruled out as a potential cause of illness. Professor Calum Semple said of Liverpool.

Many of the children under investigation reported that they had pet dogs or had recently come into contact with dogs, so the possibility was initially on the list, but after further investigation, researchers said it was a factor. Says it was excluded as.

“We examined case management data very carefully and data for people with and without severe illness. There is no difference between these children when it comes to contact with dogs,” Semple said. Mr. says.

Covid-19 hasn’t been completely ruled out, but it seems less likely to play a role.

“I don’t think we’re completely eliminating Covid,” Semple said. “I think Covid is moving down the list of possibilities under consideration.” He is moving up the list. “

However, that does not mean that pandemics with changes in social distance, masks, and other behaviors may not be involved in all of this. After nearly two years of exposure to infections, our immune system may behave differently.

Researchers in the United Kingdom are examining the T cell responses of affected children to see if these common infections have abnormal activation of these immune defense factors.

About 70% of children in the UK and more than half of children in the United States test positive for adenovirus 41F in the blood, and this association is difficult to ignore.

But researchers don’t know if they can find as many children of the same age and sex without hepatitis as they have adenovirus in their blood. Hmm. This is called a case-control study, and Will Irving, a professor of virology at the University of Nottingham in the United Kingdom, said the data could be released shortly.

“Adenovirus is the primary candidate here, but at least I’m convinced that we need more data,” Irving said.

Scientists are skeptical because adenovirus 41 is usually not a big player when it comes to viral infections. According to Ingram, it’s not in the top 10 adenoviruses that make people sick every year.

“It’s very difficult to know if this is the cause, and I feel it’s not instinctively, or it’s very difficult to know if it was the trigger for a child who is vulnerable for other reasons. It’s difficult, “Kelly said.

In the case of Alabama, the most sick children (those who eventually needed a liver transplant) had the highest levels of adenovirus in their blood. This suggests a dose response. Caused others or for pure coincidence.

Curiously, many children test positive for adenovirus in their blood, but samples of destroyed liver tissue usually do not detect the virus.

The CDC is investigating more than 100 cases of unexplained hepatitis in children, including 5 deaths.

Researchers say they don’t know what that means, but they say it’s rare. For example, when adenovirus 5 attacks the liver, observe the liver cells under a microscope.

“Hepatocytes are completely packed with new adenovirus particles, so there is no doubt that the virus itself infects and kills hepatocytes, which is not yet relevant,” Irving said. ..

Therefore, there are several factors to consider, Irving said. Perhaps the virus is not acting alone. Or it may be causing a harmful immune response.

In Alabama, 75% of cases (currently 9 out of 12 children identified as having sudden, unexplained hepatitis) detected multiple viruses at the time of their illness.

In addition to adenovirus 41, children are known to cause upper airway infections such as rhinovirus, enterovirus, respiratory syncytial virus (RSV), coronavirus OC43, human metapneumovirus, rotavirus, etc. Tested positive for the virus. No one was positive for the current Covid-19 infection.

A detailed study of Alabama’s children reveals that they were very ill.

Almost all vomited and more than half showed diarrhea and fever. Almost everyone had yellowish white eyes or yellowish-orange skin and had a condition called jaundice. ――――

Encouragingly, at least in the UK, there seems to be no geographical or social connection between the incidents. That is, the children do not know each other or live in the same area. “It’s really sporadic,” says Kelly.

What does it mean if hepatitis is caused by one or more infections but not in children in the same area?

Virgologist Irving believes this means that many children and perhaps adults are also infected, but in most cases these infections do not cause serious liver problems.

“So who raises the question, what’s special about these young children?” According to Irving, those who have been diagnosed with liver problems.

To that end, researchers are looking to genetics to unravel the mystery behind these cases. Several projects are already underway to study the genetic characteristics of affected children and their parents to see if there are any unrecognized risk factors for liver problems.

The puzzles in these cases are fascinating, but researchers say they are trying to keep the affected families at the center of their work.

“Don’t forget that we have 170 families [in the UK] Those who are very afflicted with this mysterious illness that causes such problems in their children, and getting a liver transplant is a life-changing event, “said Temple.

Sources

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2/ https://www.cnn.com/2022/05/20/health/hepatitis-children-cases-rise/index.html

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