The United States is investigating the deaths of three people in Indonesia

Indonesian authorities confirmed on Monday that two children had died of acute hepatitis 2 from an unknown source, a disease that has already been reported to the World Health Organization (WHO) by about 20 countries. Wisconsin in the United States is also investigating a death. As of April 21, there were at least 169 cases in the world, according to the latest bulletin published by Global Entity.

At the time, only one death was reported, but no details of the victim’s history were recorded in the British health system. In addition to the United Kingdom and Northern Ireland, cases have been reported in Spain, Israel, the United States, Denmark, Ireland, the Netherlands, Italy, Norway, the Netherlands, France, Romania, and Belgium. And now in Indonesia and Singapore too. To date, seventeen children (about 1% of cases) have needed a liver transplant, according to the WHO.

In the case of Indonesia, victims have died in Jakarta in the past two weeks with symptoms such as nausea, vomiting, diarrhea, jaundice and fever, according to authorities who confirmed the cause of death on Sunday, 1.6. “The public should be alert after the death of three pediatric patients with acute hepatitis,” said the Indonesian Ministry of Health.

On Saturday, 30th, the authorities in Singapore announced the admission of a minor to hospital with acute hepatitis of unknown origin.

According to the WHO, hepatitis is an inflammation that affects the liver due to a variety of infectious viruses (viral hepatitis) and non-infectious agents. Infection can lead to a number of health problems, which can be fatal. Common viruses that cause acute viral hepatitis (hepatitis A, B, C, D, and E viruses) have not been detected in any of these cases.

Although the syndrome affects patients up to 16 years of age, in most cases it is 2 to 5 years old. The picture of European children is one of acute infection. Many have jaundice, which is sometimes preceded by gastrointestinal symptoms – including abdominal pain, diarrhea and vomiting – especially in children under 10 years of age. In most cases there was no fever.

In case of doubt, blood tests (in the initial experience that whole blood is more sensitive than serum), serum, urine, stool and respiratory samples, as well as liver biopsy samples (when available) are recommended. , Including more features of the virus, including sequencing.

It is worth emphasizing that common preventive measures for adenovirus and other common infections include regular hand washing and respiratory hygiene.

Experts believe that the causative agent of the disease is an adenovirus that is transmitted by contact or by air. Although it is currently assumed to be an underlying cause, it does not fully explain the severity of the clinical picture. Infection with adenovirus type 41, the type of adenovirus involved, has not previously been associated with such a clinical presentation.

Adenoviruses are common pathogens – organisms capable of infecting a host – that usually cause self-limiting infections. They spread from person to person and usually cause respiratory illness, but depending on the type, they can cause other illnesses such as gastroenteritis (inflammation of the stomach or intestines), conjunctivitis (pink eyes) and cystitis (bladder infection).

According to the WHO, there are more than 50 immunologically distinct types of adenoviruses that can cause infections in humans. Adenovirus type 41 is commonly presented as diarrhea, vomiting, and fever, often accompanied by symptoms of shortness of breath. The possible emergence of a new adenovirus is still being investigated. Another hypothesis is that there is some connection with the new coronavirus. The possibility of adverse effects of the vaccine against Covid-19 was ruled out, as most British patients did not receive immunizations.

What are the symptoms of hepatitis in children?

The US Centers for Disease Control and Prevention issued a warning to doctors across the country late last month, alerting them to a cluster of unexplained, severe hepatitis in their healthy young children.

Between October 2021 and February 2022, nine children aged 1 to 6 were hospitalized in Alabama with acute hepatitis. Two levers were needed.

Similar incidents have occurred in North Carolina as well as in Europe. The UK Health Safety Agency has reported more than 100 cases of sudden hepatitis in children under the age of 10 since January 2022, ten of which require a liver transplant.

What is hepatitis?

Hepatitis is a broad term used to describe inflammation of the liver, an organ that performs hundreds of essential functions every day, from aiding digestion to removing toxins from the blood. When the liver is swollen or damaged, it is unable to perform many of these tasks.

Acute hepatitis refers to inflammation that occurs relatively quickly and does not last more than six months. This can be serious and can lead to liver failure, as in the case of several children in Alabama. But hepatitis can be relatively mild.

Alexander Weiman, director of the Liver Center at National Children’s Hospital in Columbus, Ohio, explains that “it is not uncommon for patients – especially children – to develop inflammation of the liver during a simple, complex viral illness.”

What symptoms should parents be aware of?

The symptoms of hepatitis are widespread and overlap with many common illnesses. A child with hepatitis may have fever (more or less), fatigue, joint or muscle pain, loss of appetite or nausea, diarrhea and vomiting.

“Babies can also have abdominal pain or tenderness, especially in the upper right abdomen, where the liver is located,” Weiman said. It is important to seek emergency medical advice whenever a child shows signs of severe pain when touching the abdomen.

Doctors may consider other possible causes of abdominal pain, such as appendicitis. Some babies may have dark urine or pale or earthy stools. Jaundice or yellowing of the skin and eyes is a characteristic sign of hepatitis – although significant inflammation of the liver and symptoms of jaundice may not be seen.

“The first change is in the eyes: the white part starts to look yellow,” Weiman said. He noted that jaundice may be more difficult to detect in children with darker skin, so parents should take subtle changes in tone seriously. “Usually, you don’t see ‘dramatic’ jaundice until the inflammation or dysfunction of the liver has progressed enough,” the doctor said.

What is the cause of the recent cluster of hepatitis?

Hepatitis can have many causes, ranging from autoimmune diseases to side effects of certain medications. It is most often caused by five hepatitis viruses (hepatitis A, B, C, D, and E). Depending on the type, viral hepatitis can be spread by contact with blood and other body fluids or by eating raw or undercooked meat. But viral hepatitis has been ruled out in recent pediatric groups in the United States and abroad.

Instead, the CDC suspects the adenovirus is causing the current case, although health officials have warned that an investigation is ongoing. There are more than 50 types of adenoviruses, which can cause mild illnesses such as colds and fevers, conjunctivitis or vomiting, and diarrhea.

In Alabama, all nine children tested positive for adenovirus. And of the five cases that were genetically sequenced, all had adenovirus type 41, which usually causes vomiting and diarrhea. Most, though not all, infected children in Britain have tested positive for the adenovirus.

“It’s interesting that we only see this in children under the age of 10, which means that most people over the age of 10 have adenovirus immunity, which is why this hepatitis is seen in young children.” Jennifer Lighter, a pediatric infectious disease specialist in New York and a public health researcher at the hospital.

However, doctors and health officials know that adenovirus infections can cause inflammation in the liver. This is not new. It is not uncommon for healthy young children to suddenly become ill, which is why public health officials are investigating other possible underlying causes.

What can parents do?

Although health officials are not sure if adenovirus is causing recent clusters of hepatitis, parents can take steps to prevent the infection. The adenovirus is spread from person to person through a drop of breath or by touching a surface with adenovirus.

Children should be encouraged to wash their hands frequently and to avoid touching their face and mouth as much as possible – many of the same measures that help stop the spread of Covid-19.

Parents should also keep in mind that the CDC is not a warning or an alarm call. The overall risk of a healthy child developing sudden hepatitis is extremely low.

Authorities only want to warn pediatricians and other healthcare professionals who may be able to care for young hepatitis patients who now need to be tested for adenovirus. Treatment varies depending on the type of hepatitis in the baby.

“For some types of viral hepatitis, there are drugs that can suppress or eliminate the virus,” Weiman said. “But in most cases – such as when a child develops inflammation of the liver and adenovirus – doctors focus on preventing or managing complications. This is usually sufficient, because the liver itself is very good at healing,” he added. / The New York Times, AFP and EFE

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