Lockdown cause of childhood hepatitis
Serious hepatitis outbreak in children, immunity was NOT generated as normal in locked down children and now the specific viral cause has just been discovered https://www.hpsc.ie/a-z/hepatitis/acutehepatitisofunknownaetiology/casedefinition/ Since 20th March Children under 16 35 countries UK, 12 liver transplants, Ireland 2 Immunosuppressant drugs for life No single virus had been identified in all cases https://www.hpsc.ie/news/acute-hepatitis-of-unknown-cause-in-children.html Hepatitis viruses A, B, C, E not detected in cases No link to current covid infection status Most / many cases were not covid vaccinated Symptoms of hepatitis Any one of the classic 3 Pale, grey-coloured stools Dark urine Jaundice Other symptoms include muscle and joint pain fever feeling and being sick feeling unusually tired all the time a general sense of feeling unwell loss of appetite tummy pain itchy skin A post lockdown phenomena? Two common viruses, spreading again after pandemic lockdowns infants exposed later than normal https://www.medrxiv.org/content/10.1101/2022.07.19.22277425v1 Detailed investigation, 9 early cases and 58 control subjects Median 3.9 years, 4 boys, 5 girls Preceding subacute history Abdominal pain, diarrhoea and vomiting, between 1 to 11 weeks prior to acute hepatitis Using sequencing and real-time PCR Adeno-associated virus 2 (AAV2), detected in the plasma of 9/9 and liver of 4/4 patients (normally causes no illness, requires a coinfecting "helper" virus) Age-matched healthy controls Adeno-associated virus 2 (AAV2), detected in the plasma of 0/13 Children with adenovirus (HAdV) infection and normal liver function Adeno-associated virus 2 (AAV2), detected in the plasma of 0/12 Children admitted to hospital with hepatitis of other aetiology Adeno-associated virus 2 (AAV2), detected in the plasma of 0/33 AAV2 typically requires a coinfecting ‘helper’ virus to replicate Usually adenovirus (HAdV) or a herpesvirus Adenovirus (HAdV) Detected in 6/9 cases Human herpesvirus 6B (HHV6B) Detected in 3/9 cases Conclusion Acute non-A-E paediatric hepatitis is associated with the presence of Adeno-associated virus 2 (AAV2) infection, which could represent a primary pathogen or a useful biomarker of recent Adenovirus (HAdV) or Herpesvirus (HHV6B) infection. Prof Judith Breuer, University College London and Great Ormond Street Hospital During the lockdown period when children were not mixing, they were not transmitting viruses to each other. They were not building up immunity to the common infections they would normally encounter. When the restrictions were lifted, children began to mix, viruses began to circulate freely - and they suddenly were exposed with this lack of prior immunity to a whole battery of new infections. Prof Emma Thomson, University of Glasgow Larger studies are urgently needed to investigate the role of AAV2 in paediatric hepatitis cases. We also need to understand more about seasonal circulation of AAV2, a virus that is not routinely monitored, it may be that a peak of adenovirus infection has coincided with a peak in AAV2 exposure, leading to an unusual manifestation of hepatitis in susceptible young children Class II HLA-DRB1*04:01 allele Identified in 8/9 cases (89%) (background frequency of 15.6% in Scottish blood donors) Adeno-associated virus 2 (AAV2) mutations May be significant 9 capsid gene mutations over-represented in these cases altered phenotype, including substantial evasion of neutralising antibodies directed against wild-type AAV2, enhanced production yields, increased virion stability. Learn more about your ad choices. Visit megaphone.fm/adchoices
