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Acute hepatitis in children, cause identified. Always viral

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Acute hepatitis in children, cause identified.  Always viral

In the world, the probable cases of acute hepatitis of unknown origin have for some time exceeded one thousand. But there are important updates on the case: in fact, the cause of the hepatitis that has been affecting children in different parts of the world, especially in Europe (in the United Kingdom in particular) and in the Americas, may have been identified. Two studies, being published and still to be considered preliminary, point the finger at an adeno-associated virus, at the same time exonerating coronavirus infections but not entirely those from adenovirus, indeed, long considered one of the most likely responsible. The – provisional – conclusions in fact indicate a co-infection of adenovirus (or herpesvirus) with adeno-associated virus in susceptible children as a probable reason for the origin of hepatitis.

Acute hepatitis in children, half of European cases in Great Britain

by our correspondent Elvira Naselli


Suspected adenovirus

Acute hepatitis of unknown origin in children – in some cases even serious, requiring hospitalization in intensive care, transplantation and death, 22 according to what is reported in the latest update available from the World Health Organization – have kept researchers busy for months . And some circumstances, such as the high spread of the coronavirus but also a recent surge in adenovirus infections, had led clinicians and scientists to look in this direction, also imagining the contribution of multiple factors. And more factors would have actually been identified, but would not include the coronavirus.

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Not one, but two viruses

The studies just presented and arriving from the United Kingdom show that in over 90% of children with acute hepatitis there is the presence of an adeno-associated virus (AAV2), a virus that needs another virus to replicate, such as an adenovirus or herpesvirus. The researchers who took part in the studies analyzed in detail the liver samples (when available) or blood samples of children with acute hepatitis of unknown origin, and compared them to those of other children, healthy, with other hepatitis, with infections. from adenovirus or immunocompromised. The results showed the presence of AAV2 in the liver and blood of children with acute hepatitis, present only very rarely or absent in the various controls. Also present an adenovirus or a herpesvirus in the samples of children with acute hepatitis (including those coming from the liver), although in some cases at low levels. On the contrary, the coronavirus was not found in the liver samples analyzed, and even the previous infections found in children had a prevalence comparable to that observed in children not affected by hepatitis.

If these researches add valuable information to the case of hepatitis of unknown origin they do not completely resolve the question (especially since there are only 37 cases of acute hepatitis analyzed), and studies in the field will continue. Also to try to understand why it could have happened. For now, the hypotheses at stake call into question the lockdown and the reduced exposure of children to adenovirus infections, as already suggested in the past.

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In essence, the reduction in contact between children during the pandemic, and therefore in the circulation of viruses, would have reduced immunity against adenoviruses and AAVs, the researchers write. But we also need to focus on viruses associated with adenoviruses, such as AAV2, as Emma Thomson of the MRC-University of Glasgow Center for Virus Research, head of one of the studies, commented: “AAV2 can cause disease on its own or can be a useful biomarker for recent adenovirus infections which may be the underlying pathogen, but which is more difficult to identify – explained in a note from the University of Glasgow – There are many questions that remain unanswered and larger studies are needed to study the role. AAV2 in pediatric hepatitis cases. We also need to understand more about the seasonal circulation of AAV2, a virus that is not routinely monitored – it may be that a spike in adenovirus infections coincided with a spike in AAV2 exposure. leading to unusual manifestations of hepatitis in susceptible children “.

Acute hepatitis in children: stable cases in Italy, hypotheses on the causes


The other information that emerges from the studies is in fact that in children with acute hepatitis genetic variants are more often found in some genes (such as HLA, Human Leukocyte Antigen) involved in the functioning of the immune system.

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