China issues guidance on acute severe hepatitis of unknown causes in children for early recognition

Photo: IC

Photo: IC

The Chinese National Health Commission on Tuesday issued diagnosis and treatment guidelines for the acute severe hepatitis of unknown etiology in children for early recognition, as cases have been reported since March in multiple countries and regions with a high percentage of severe cases, despite the fact that there are no Current evidence is that it is a contagious disease.

While there are currently no cases of acute severe hepatitis of unknown etiology in children reported in China, preparation for advance medical treatment, including early recognition and standardized diagnosis and treatment of the disease, is reinforced and suggested by the guidelines based on relevant reports and literature, combined with hepatitis diagnosis and treatment.

According to World Health Organization (WHO) statistics, more than 700 possible cases have been reported so far this year, including 112 cases under investigation. Of the approximately 700 children affected worldwide, at least 38 have required a liver transplant and 10 have died. Currently, researchers in the US and European Union countries are still investigating the cause of the hepatitis outbreak, which first made headlines in April.

The current existing evidence does not indicate that it is an infectious disease as most of the reported cases appear to be unrelated and extensive epidemiological studies are underway to identify common exposures, risk factors or associations between cases.

Long-term COVID may be the cause of unexplained cases of hepatitis in children around the world in recent months, Israeli researchers found in a study recently published in the peer-reviewed Journal of Pediatric Gastroenterology and Nutrition.

The new Israeli study analyzed the cases of five patients hospitalized at Schneider Children’s Medical Center last year for liver damage. All five patients had tested positive for COVID-19 before showing symptoms.

Adenovirus has been considered the most suspected cause of the unexplained cases of childhood hepatitis in other studies around the world. However, some patients in this study tested positive for adenovirus, while others tested negative. So the Israeli researchers think that adenovirus may not be the cause of liver problems, despite the fact that adenovirus usually causes severe hepatitis in immunocompromised patients, and these patients were healthy before they got hepatitis.

At the moment there is no definitive conclusion from the medical circle about the causes of hepatitis in children of unknown etiology in many places in the world. According to WHO, laboratory tests have ruled out hepatitis AE viruses in these children, but COVID-19 and/or adenovirus have been detected in a number of cases, although data reported to WHO is incomplete.

The WHO rates the risk at a global level as moderate given the unknown etiology of this severe acute hepatitis, limited epidemiological, laboratory, histopathological and clinical information currently available, and unknown source and mode of transmission.

At this stage, the WHO recommends collecting blood, urine, feces, and respiratory samples (liver biopsy samples as needed) from suspected patients for screening for pathogens, including adenovirus, novel coronavirus, cytomegalovirus, Epstein-Barr virus, chickenpox virus, and herpes simplex virus.

Xu Wenbo, head of the National Institute for Viral Disease Control and Prevention at the China CDC, said China has mature technical reserves for pathogen detection, reliable nucleic acid testing and screening capabilities for the suspected cases of acute severe hepatitis of unknown etiology in children. . a press conference on June 9.

Symptoms of the disease include fatigue and poor appetite, nausea, vomiting, diarrhea, abdominal pain, and other gastrointestinal symptoms, which are followed by yellow colors of urine, skin, and sclera. Some children may have white stools and suffer from liver enlargement, fever and respiratory symptoms. A small number of cases can progress to acute hepatic failure in a short time, with progressive worsening of jaundice and hepatic encephalopathy, according to the guideline.

While there are no treatment recommendations from WHO due to the unknown cause, Chinese health authorities guidelines have suggested comprehensive treatment measures involving symptomatic treatment in combination with supportive treatment. Complications should be avoided by closely observing changes in circumstances, assessing mental status and monitoring laboratory indicators. Patients with liver failure should be immediately transferred to hospitals with treatment capacity.

Global times

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