Pediatric hepatitis: the AD41 virus pathway remains fragile

Cases are increasing but their cause remains a mystery. A total of 228 cases of acute hepatitis were reported to the World Health Organization (WHO), which is still receiving reports in children. In all, 20 countries are involved and about fifty more cases are under investigation. The majority of cases are from Europe, particularly the UK, where 74 cases were identified in early April. At least one death has been reported according to the World Health Organization. Three others are being examined and occurred in Indonesia. The three Indonesian children, aged between two, eight and 11, developed fever, jaundice, seizures and loss of consciousness.

Nine cases were also recorded in the United States, in Alabama, where the Centers for Disease Control (CDC) conducted analyzes on patients. These are, at the moment, the first cases to occur in the world, between November 2021 and February 2022. In their work, the US authorities indicate that these cases of acute hepatitis are caused by a virus, without confirming this course. Medical records from Children’s Hospital of Alabama were reviewed to find patients examined after October 1, 2021, with hepatitis as well as adenovirus infection detected by PCR on blood samples, with no cause for hepatitis identified. A total of nine cases were identified between October 2021 and February 2022, in patients about six years old. Two of them had to undergo a liver transplant. The US authorities indicated that they had found adenovirus type 41 (AD41) in five patients who had undergone PCR.

AD41, Epstein-Barr and other viruses

AD41 is known to cause acute gastroenteritis but not hepatitis. “Adenovirus 41 is a possible factor among others‘,” explains Professor Francois Angolfant, a pediatrician at the Robert Deprey Children’s Hospital in Paris to Science and the future. “AD41 is not found in all children. Moreover, liver damage is not always contagious. There may be toxic causes, such as a drug cause, a metabolic disease, or even a chronic liver disease that has not yet been identified.. “

The CDC has ruled out several other causes: hepatitis A, B and C viruses, as well as Covid-19 infection. In addition, six of the nine patients tested positive for Epstein-Barr virus, at very low levels. The search for antibodies to the disease turned up nothing. The authorities are talking aboutPrevious infection, which could have been reactivated. ” “We know that the Epstein-Barr virus has hepatic embolism. Is this an aid to explain hepatitis? Is it a coincidence? Impossible to say at the moment.“, according to Pr Angoulvant. If a positive PCR usually means that the virus is active, the absence of antibodies rearranges this hypothesis and indicates that the infection is so old that the body is still active in the process of fighting the virus.”Epstein-Barr virus (EBV) is a classic childhood disease. Over 90% of kids have encountered it, mostly when they were kidsThe specialist also insists on the frequency of viral hepatitis in children, especially in developing countries, where the majority of children are infected with hepatitis A, and the problem of the 228 cases identified at the moment is to know their source.

Possible role of the epidemic

Further analyzes on blood samples showed the presence of other viruses, including rhinovirus as well as human coronavirus OC32. The children in the study had no history of infection with the Covid-19 virus. However, the epidemic could have played a role. Some experts speculate that reduced immunity after lockdowns could cause a more severe reaction to the adenovirus. Others hypothesize that the Covid-19 infection would have damaged the immune system, making it more fragile. But none of these leads have been confirmed at this time.

Hepatitis is inflammation of the liver, which is a vital organ that digests nutrients, purifies the blood, and plays an immune role. Most often, hepatitis is caused by a virus. But adenoviruses generally only cause hepatitis in immunocompromised people. However, the Alabama patients were otherwise healthy before they got sick. Adenoviruses could beNot recognized as causes of liver disease in healthy children“According to the CDC, adenoviruses are transmitted via fecal-oral (by putting fecal-contaminated fingers, objects, drinks, or food in the mouth). They live on surfaces and are not disposed of well.” The Academy of Pediatrics.

In France, the authorities are on the lookout. The Directorate General of Health (DGS) has published an urgent letter stating that any acute hepatitis in a child under 18 years of age should lead to a full etiological assessment. Examination includes blood, respiratory, urine and stool samples. If an adenovirus is found, the case is considered probable and should result in a report to Public Health France. At the moment, no excess cases have been identified in France.

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