Unexplained childhood hepatitis discovered abroad! How to understand it correctly?

Recently, acute hepatitis in children of unknown causes has occurred in the UK and other places. The Ministry of Health, Labor and Welfare of Japan announced on April 25 that the first case of a child who may have this acute hepatitis has appeared in Japan. According to the Japan Broadcasting Association (NHK), unlike most cases in Europe and the United States, this patient did not detect adenovirus.

My personal opinion is to be cautious, that is, to identify the pathogen first. Because the data from the UK currently looks like adenovirus, the data from Israel looks like COVID-19, but the data from Japan looks like neither, so we can only wait for further data.

So what is the current situation and what warnings can it bring to us? Let’s talk about it today!

01. Hepatitis is just a descriptive term

First, hepatitis is a descriptive word.

Hepatitis is a general term for liver inflammation, so factors that can cause liver inflammation must be taken into consideration. The factors that generally cause hepatitis are:

1. Viruses, such as the familiar AB, C, D, and E viruses.

2. Bacteria, parasites, chemical poisons, drugs, alcohol, autoimmunity, etc.

These factors can also cause hepatitis. In fact, as long as the liver shows signs of inflammation, it is called hepatitis, and the inflammatory response is the most basic response of the human body. After all, immunity is one of the foundations of the human body.

Because of this, one should not assume a preconceived cause of hepatitis.

Secondly, there is insufficient research on the affected population. At present, the research statistics on the affected population are adenovirus and new coronavirus.

However, neither of these was found in the Japanese case.

02. What needs to be done now

In view of the above situation, what needs to be done now is:

1. More detailed case investigation

Identify these children, their age, gender, family hygiene, genetic diseases, treatment received, and their experiences before the onset of the disease such as diet and activity venues.

These are all important processes in finding out the cause of the disease, especially as the current trend is showing that the population is expanding. It is necessary to find out whether it is due to infectious factors or other factors.

Even, a very serious question: did it not exist before, or was it classified as a regular disease?

2. Pathogenic microorganism sequencing technology.

This technology is relatively mature at present. When the new coronavirus was discovered in Wuhan, this technology was used to quickly screen the pathogen (it only took about 2 days), while traditional culture technology takes too long.

Therefore, we use the latest metagenomic technology to test samples collected from each sick child to see if we can find common factors.

If found, it may be confirmed that it is caused by microorganisms, and then we need to consider how to prevent and control microbial infections.

Therefore, at this moment, do not rush to draw conclusions.

However, from a personal perspective, I still hope that it is not a sequelae caused by the new coronavirus, although previous studies have explored the relationship between the new coronavirus and hepatitis.

If that happens, it will be adding insult to injury.

03. COVID-19? Adenovirus 41?

Although many people are worried about the new coronavirus, I personally think more evidence is needed. From a global perspective, only 20 of the 169 children tested positive for the new coronavirus, and 19 of them were infected with both the new coronavirus and adenovirus.

But there are differences in different countries.

Israel is the most obvious, with 11 of the 12 cases having been infected with the coronavirus within a year. The UK has reported 114 cases so far, but overall the proportion that can be explained by the coronavirus is not high.

Japan has reported 1 case so far, no adenovirus, no COVID-19.

Adenovirus has been detected in at least 74 cases, and of the number of cases with information on molecular testing, 18 have been identified as F type 41. SARS-CoV-2 was identified in 20 cases of those that were tested. Furthermore, 19 were detected with a SARS-CoV-2 and adenovirus co-infection.

Let me share my personal views on the adenovirus, which is currently very popular.

First, adenoviruses currently do not explain the majority of infections.

169 people were infected, 74 of them were infected with adenovirus, which is two-fifths. What about the remaining three-fifths?

Among these 74 people infected with adenovirus, the highest proportion was adenovirus type 41, with 18 cases, accounting for only about one-fifth.

Secondly, there are not many reports on adenovirus and hepatitis

Of course, it can also be understood as a new adenovirus variant. But overall, there is insufficient scientific evidence to explain the current situation with adenovirus 41.

04. Possible Situations

At present, one possibility is that it is caused by children’s low immunity combined with other factors.

Another possibility is that it existed before, but it was caused by insufficient testing methods. The WHO also mentioned this in its original words, saying that it was only because of the strengthening of laboratory testing that it was observed.

Nevertheless, due to enhanced laboratory testing for adenovirus, this could represent the identification of an existing rare outcome occurring at levels not previously detected that is now being recognized due to increased testing.

But no matter what, at present, taking good protection may be the only thing everyone can do.

The above data is based on information publicly available before April 26, 2022.