Israeli study reveals unexplained hepatitis in children Watch again?
Global infection of 700 cases: New Israeli study of unexplained childhood hepatitis suspected COVID-19 sequelae
June 16 news (Editor Shi Zhengcheng)A recent paper by Israeli researchers, published in the Journal of Pediatric Gastroenterology and Nutrition (JPGN), has shifted the global debate over unexplained childhood hepatitis from the "adenovirus hypothesis" to the "COVID-19 sequelae" camp.
The study, conducted by researchers from the Schneider Children's Medical Center, Rabin Medical Center, Rabmbam Medical Center and Tel Aviv University in Israel, is a retrospective study of children in the country who developed hepatitis of unknown cause after contracting COVID-19.
The study focused on five cases of childhood hepatitis admitted to the Schneider Children's Medical Center last year, all of whom had been infected with the Novel Coronavirus prior to the onset of hepatitis symptoms. There were also significant differences in clinical symptoms among the five patients, depending on age, the researchers said.
Specifically, two infants aged 3 to 5 months presented with rapid liver failure and required liver transplantation. Their liver explants showed extensive necrosis, accompanied by bile duct hyperplasia and lymphocytic infiltration. Three other children, two of them 8 years old and the other 13 years old, showed symptoms of hepatitis with cholestasis. Two liver biopsies showed lymphocytic portal vein and substantial inflammation with bile duct hyperplasia.
Case Study: How does pneumonia virus cause hepatitis
The researchers note that although adenovirus infection has been detected in many cases of hepatitis, such adenovirus-induced severe hepatitis is usually present in immunocompromised patients who are healthy infants before the onset of hepatitis symptoms. Further analysis of liver samples from the patients also failed to find adenovirus antigens, or signs that adenovirus causes hepatitis. This is similar to many other studies.
It should be noted that cases of liver damage in adults are also on the rise, but the concern is not as high as "unexplained" hepatitis in children.
Novel coronavirus infection and even post-recovery liver damage may result from a number of mechanisms, including direct viral damage, abnormal immune response, ischemia, increased thrombosis or drug damage. Because none of these patients had previously developed severe COVID-19, the researchers suggested that the liver damage in these children might be due to direct damage caused by the virus via the ACE2 receptor.
Another possible mechanism is related to the immune system, which may overestimate or underestimate the actual infection to cause damage. In previous studies of COVID-19 sequelae, children and young adults have also developed mis-C, which also causes severe liver disease.
A total of 700 cases have been reported in 34 countries, including at least 38 people needing liver transplants, and 10 people have died since childhood hepatitis of unknown cause was reported in the UK in early April. Who and the US CDC also consider adenovirus as a possible cause because of the association with adenovirus 41 reported in several countries.
Us media: Late... We'll decide later
ABC News called the Israeli study a "small study" and quoted Dr. Peter Chin-hong, an infectious disease expert at the University of California, as saying the Israeli study "adds a little fuel to the fire" for understanding the causes of unexplained childhood hepatitis, but the sample size was too small. Not enough to be a conclusion.
Dr Chin-hong further said that the US is at a critical juncture in approving COVID-19 vaccines for children under the age of five. If novel Coronavirus really is the core cause of hepatitis, then we could finally see a decline in related cases.
On Tuesday, the CDC released a new study on childhood hepatitis, noting that there has been no spike in "unexplained hepatitis cases" in the United States, and that the number of severe hepatitis cases observed in the recent past is similar to pre-COVID-19 levels. The CDC is still calling on health systems to monitor the situation.