Acute Hepatitis of Unknown Etiology Among Young Children: Research Agenda by the ESPGHAN Hepatology Committee.
Journal
Journal of pediatric gastroenterology and nutrition
ISSN: 1536-4801
Titre abrégé: J Pediatr Gastroenterol Nutr
Pays: United States
ID NLM: 8211545
Informations de publication
Date de publication:
01 10 2022
01 10 2022
Historique:
pubmed:
19
7
2022
medline:
24
9
2022
entrez:
18
7
2022
Statut:
ppublish
Résumé
In April 2022, an increased incidence of acute hepatitis cases of unknown etiology among previously healthy children across the United Kingdom was described. Since, more than 270 cases from the United Kingdom and hundreds more from all across the world have been reported. The majority of affected children were younger than 6 years of age. The clinical presentation was nonspecific with diarrhea and vomiting usually preceding the appearance of jaundice, abdominal pain, nausea, and malaise. Approximately 5% have required liver transplantation. An infectious etiology has been considered likely given the epidemiological and clinical features of the reported cases. Between 50 and 60% of the children tested were diagnosed with adenovirus infection although a clear etiological connection has still to be demonstrated. No link with SARS-CoV-2 infection and COVID-19 vaccine was found. What is not clear to date is whether the high number of acute hepatitis cases reported is related to a true increase in incidence or heightened awareness following on from the initial reports from the United Kingdom. The Hepatology Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) developed a paper on the current outbreak of acute hepatitis of unknown etiology recognizing its importance and the need of approaching the current situation with a scientifically rigorous approach. The aims of the article are to summarize the current knowledge and to identify the most pertinent issues regarding the diagnosis and management of this condition and the research questions raised.
Identifiants
pubmed: 35848740
doi: 10.1097/MPG.0000000000003567
pii: 00005176-202210000-00030
doi:
Substances chimiques
COVID-19 Vaccines
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
543-548Informations de copyright
Copyright © 2022 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Agency UKHS. Increase in hepatitis (liver inflammation) cases in children under investigation. Available at: https://www.gov.uk/government/news/increase-in-hepatitis-liver-inflammation-cases-in-children-under-investigation . 2022. Accessed August 2022.
Organization WH. Multi-Country—acute, severe hepatitis of unknown origin in children. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/multi-country-acute-severe-hepatitis-of-unknown-origin-in-children . 2022. Accessed August 2022.
Organization WH. Acute hepatitis of unknown aetiology in children—multi-country. Available at: https://www.who.int/emergencies/emergency-events/item/2022-e000081 . 2022. Accessed August 2022.
Marsh K, Tayler R, Pollock L, et al. Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022. Euro Surveill. 2022;27:2200318.
van Beek J, Fraaij P, Giaquinto C, et al. Case numbers of acute hepatitis of unknown aetiology among children in 24 countries up to 18 April 2022 compared to the previous 5 years. Euro Surveill. 2022;27:2200370.
de Kleine RH, Lexmond WS, Buescher G, et al. Severe acute hepatitis and acute liver failure of unknown origin in children: a questionnaire-based study within 34 paediatric liver centres in 22 European countries and Israel, April 2022. Euro Surveill. 2022;27:2200369.
Gutierrez Sanchez LH, Shiau H, Baker JM, et al. A case series of children with acute hepatitis and human adenovirus infection. N Engl J Med Published online July 13, 2022. doi:10.1056/NEJMoa2206294.
doi: 10.1056/NEJMoa2206294
Kelgeri C, Couper M, Gupte GL, et al. Clinical spectrum of children with acute hepatitis of unknown cause. N Engl J Med Published online July 13, 2022. doi:10.1056/NEJMoa2206704.
doi: 10.1056/NEJMoa2206704
Baker JM, Buchfellner M, Britt W, et al. Acute hepatitis and adenovirus infection among children—Alabama, October 2021-February 2022. MMWR Morb Mortal Wkly Rep. 2022;71:638–40.
Agency UHS. Acute hepatitis: technical briefing. Available at: https://www.gov.uk/government/publications/acute-hepatitis-technical-briefing . 2022. Accessed August 2022.
Organization WH. Acute hepatitis of unknown aetiology—the United Kingdom of Great Britain and Northern Ireland. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/acute-hepatitis-of-unknown-aetiology---the-united-kingdom-of-great-britain-and-northern-ireland . 2022. Accessed April 15, 2022.
Control ECfDPa. Update: Hepatitis of unknown origin in children. Available at: https://www.ecdc.europa.eu/en/news-events/update-hepatitis-unknown-origin-children . 2022. Accessed July 29, 2022.
Control ECfDPa. Increase in acute hepatitis of unknown origin among children—United Kingdom. Available at: https://www.ecdc.europa.eu/en/news-events/increase-acute-hepatitis-unknown-origin-among-children-united-kingdom . 2022. Accessed July 29, 2022.
Prevention CfDCa. CDC alerts providers to hepatitis cases of Unknown Origin. Available at: https://www.cdc.gov/media/releases/2022/s0421-hepatitis-alert.html . 2022. Accessed July 29, 2022.
Prevention CfDCa. Recommendations for adenovirus testing and reporting of children with acute hepatitis of unknown etiology. Available at: https://emergency.cdc.gov/han/2022/han00462.asp . 2022. Accessed April 21, 2022.
Prevention CfDCa. Children with hepatitis of unknown cause. Available at: https://www.cdc.gov/ncird/investigation/hepatitis-unknown-cause/overview-what-to-know.html . 2022. Accessed August 2022.
Zellos A, Debray D, Indolfi G, et al. Proceedings of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition Monothematic Conference, 2020: “acute liver failure in children”: treatment and directions for future research. J Pediatr Gastroenterol Nutr. 2022;74:338–47.
Zellos A, Debray D, Indolfi G, et al. Proceedings of ESPGHAN monothematic conference 2020: “acute liver failure in children”: diagnosis and initial management. J Pediatr Gastroenterol Nutr. 2022;74:e45–56.
Agency UKHS. Acute hepatitis: technical briefing. Available at: https://www.gov.uk/government/publications/acute-hepatitis-technical-briefing . 2022. Accessed July 2022.
Control ECfDPa. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Hepatitis of unknown aetiology in children, joint epidemiological overview, 31 May, 2022. Available at: https://www.ecdc.europa.eu/en/hepatitis/joint-weekly-hepatitis-unknown-origin-children-surveillance-bulletin . 2022. Accessed July 2022.
Cevik M, Rasmussen AL, Bogoch II, et al. Acute hepatitis of unknown origin in children. BMJ. 2022;377:o1197.
Hakim MS. The recent outbreak of acute and severe hepatitis of unknown etiology in children: a possible role of human adenovirus infection? J Med Virol. 2022;94:4065–8.
Peled N, Nakar C, Huberman H, et al. Adenovirus infection in hospitalized immunocompetent children. Clin Pediatr (Phila). 2004;43:223–9.
Munoz FM, Piedra PA, Demmler GJ. Disseminated adenovirus disease in immunocompromised and immunocompetent children. Clin Infect Dis. 1998;27:1194–200.
Núñez-Ramos R, Montoro S, Bellusci M, et al. Acute liver failure: outcome and value of pediatric end-stage liver disease score in pediatric cases. Pediatr Emerg Care. 2018;34:409–12.
Matoq A, Salahuddin A. Acute hepatitis and pancytopenia in healthy infant with adenovirus. Case Rep Pediatr. 2016;2016:8648190.
Steiner I, Aebi C, Ridolfi Lüthy A, et al. Fatal adenovirus hepatitis during maintenance therapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2008;50:647–9.
Wallot MA, Dohna-Schwake C, Auth M, et al. Disseminated adenovirus infection with respiratory failure in pediatric liver transplant recipients: impact of intravenous cidofovir and inhaled nitric oxide. Pediatr Transplant. 2006;10:121–7.
Hough R, Chetwood A, Sinfield R, et al. Fatal adenovirus hepatitis during standard chemotherapy for childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2005;27:67–72.
Ronan BA, Agrwal N, Carey EJ, et al. Fulminant hepatitis due to human adenovirus. Infection. 2014;42:105–11.
Alonso EM, Horslen SP, Behrens EM, et al. Pediatric acute liver failure of undetermined cause: a research workshop. Hepatology. 2017;65:1026–37.
Brodin P, Arditi M. Severe acute hepatitis in children: investigate SARS-CoV-2 superantigens. Lancet Gastroenterol Hepatol. 2022;7:594–5.
Maggiore G, Socie G, Sciveres M, et al. Seronegative autoimmune hepatitis in children: spectrum of disorders. Dig Liver Dis. 2016;48:785–91.
Mieli-Vergani G, Vergani D, Baumann U, et al. Diagnosis and management of pediatric autoimmune liver disease: ESPGHAN hepatology committee position statement. J Pediatr Gastroenterol Nutr. 2018;66:345–60.
Verma A, Vimalesvaran S, Lampejo T, et al. Use of cidofovir in recent outbreak of adenovirus-associated acute liver failure in children. Lancet Gastroenterol Hepatol. 2022;7:700–2.
Control ECfDPa. Hepatitis of unknown origin reporting protocol 2022. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/Hepatitis-of-unknown-origin-Reporting-Protocol-v2.1.pdf . Accessed August 2022.
McKenzie RB, Berquist WE, Nadeau KC, et al. Novel protocol including liver biopsy to identify and treat CD8+ T-cell predominant acute hepatitis and liver failure. Pediatr Transplant. 2014;18:503–9.
Rakela J, Mosley JW, Edwards VM, et al. A double-blinded, randomized trial of hydrocortisone in acute hepatic failure. The Acute Hepatic Failure Study Group. Dig Dis Sci. 1991;36:1223–8.
Chapin CA, Horslen SP, Squires JE, et al. Corticosteroid therapy for indeterminate pediatric acute liver failure and aplastic anemia with acute hepatitis. J Pediatr. 2019;208:23–9.