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Scientific clinical analysis on rise in acute hepatitis in children

Member of the National Assembly Tshilidzi Bethuel Munyai, speaking after members of the parliamentary health portfolio committee. Image: Itumeleng English/African News Agency(ANA)

Member of the National Assembly Tshilidzi Bethuel Munyai, speaking after members of the parliamentary health portfolio committee. Image: Itumeleng English/African News Agency(ANA)

Published Jul 7, 2022

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By Tshilidzi Munyai, MP

The World Health Director General’s (WHO) opening remarks at the World Hepatitis Summit under the theme “achieving the elimination of viral hepatitis within the evolving health systems on 07 June 2022 assert that: “hepatitis is one of most devastating diseases on earth, but it’s also one the most preventable and treatable, with services that can be delivered easily and cheaply at the primary health care level”.

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In this the irony is true, due to the fact that the aetiology of this disease is still unknown, and hinders the prevention and control of spread of the diseases.

The link of SARS-CoV-2 infection, followed by adenovirus or other viruses cannot be ruled out at this stage.

World Hepatitis Day on 28 July 2022, coincides with President Nelson Mandela’s United Nations month. Inspired and encouraged by Madiba’s legacy on health care to children, at the current conjuncture, the core related fundamental plight of a “new variant of a known virus causing acute hepatitis in children” demands from global humanity practical and urgent collective action!

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After the outbreak of COVID-19, acute hepatitis of unknown aetiology swept across Europe and America.

In April 2022, the United Kingdom informed WHO that more than a dozen children with unexplained severe hepatitis had been found in Scotland. On 15 April 2022, WHO issued a document advising countries to identify, investigate and report cases of unexplained acute hepatitis in children that meet the definition.

Since then, France, Israel, the United States, Japan, Spain and other places have reported that acute hepatitis in children with unknown causes has gradually spread.

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On 27 May 2022, WHO said that 650 suspected cases of unexplained acute hepatitis in children had been reported in 33 countries and regions.

It is noteworthy that compared with the previous reports of unexplained acute hepatitis in children, the clinical symptoms of those cases were more serious and the proportion of acute liver failure was higher.

At present, health departments in various countries are actively studying the causes of the disease. At present, there are the following conjectures:

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Firstly, a new variant of a known virus caused acute hepatitis in children.

It may be adenovirus, but the possibility of other pathogens cannot be ruled out, such as variants of coronavirus, rhinovirus, enterovirus and parainfluenza virus.

The British health and safety authority listed adenovirus as the first hypothesis for children with unexplained acute hepatitis because, through the aetiological investigation of British cases, it was found that many patients were positive for adenovirus.

At present, the data show that 68% of the testers are positive, the main sample comes from blood, and the most common one is type 41F. However, adenovirus infection is usually self-limiting leading to only minor diseases or symptoms.

Acute hepatitis caused by adenovirus infection is uncommon, especially in children with normal immune function.

Secondly, epidemic prevention and control during the epidemic of coronavirus disease in 2019 may reduce the contact between some young children and common pathogens, resulting in the development of their immune system different from that of children of the same age before the epidemic of coronavirus disease in 2019.

When children are subsequently infected with common pathogens such as adenovirus, they have different immune responses or disease manifestations from their peers in the past.

It is also possible that SARS-CoV-2 infection is followed by adenovirus or other viruses, or SARS-CoV-2 co-infection with adenovirus or other viruses produces an unusual immune response or disease manifestations.

On 10 June 2022, researchers in the paediatrics intensive care unit of King's College Hospital London (KCH) published an article in Intensive Care Medicine with the title "Outbreak of hepatitis in children: clinical course of children with acute liver failure admitted to the intensive care unit", the article mentioned that among eight children with severe hepatitis of unknown cause, six cases had been infected with COVID-19 and there was no adenovirus in their liver.

On the same day, JPGN, an international journal of gastroatric enterology and hepatology, published a study on hepatitis on acute hepatitis of unknown aetiology from Israel.

After a thorough examination, the study excluded other known causes, classified children's cases with common clinical, radiological and histopathological features, and report two distinct patterns of potentially long COVID-19 liver manifestations in children, suggesting the relationship between children's acute hepatitis and COVID-19.

Academic and clinical analysis shows that Covid-19 plays an important role in children's acute hepatitis. To suppress the occurrence of acute hepatitis in children, we must first stop the spread of the COVID-19 epidemic at the source.

At present, in the international community, there are two completely different ways to deal with the COVID-19 epidemic. One is a group immunisation strategy led by European and American countries, which forms immunity to viruses through the popularization of vaccines and natural infection.

However, many variations in Covid-19, insufficient vaccination rate and other factors make the traditional group immunization strategy ineffective, and the number of confirmed cases of COVID-19 in Europe and America is still high. Since the outbreak of COVID-19, more than one million Americans have lost their lives, 200 000 children have become ‘COVID-19 orphans’, and countless American families have been fragmented.

The root cause of this human tragedy is that the epidemic prevention and control in the United States have always served ‘capital and political self-interest first’. Faced with the failure of the anti-epidemic, California took the lead in February 2022 to announce that it had entered the stage of ‘coexistence with the virus’. In March 2022, all states in the United States lifted the mask order, which led to a sharp increase in the number of confirmed and hospitalised cases of COVID-19.

America's ‘lying down' anti-epidemic is essentially the extreme disregard for life and the inaction of policymakers.

On the other hand, in China, although there are occasional outbreaks due to virus mutation, the Chinese government has always adhered to the principle of ‘people first, life first’ and ‘dynamic clearing’, and found and put out an epidemic, so as to prevent the epidemic from rebounding on a large scale.

The purpose is to achieve the maximum prevention and control effect at the lowest cost and to maximise the protection of people's life and health and normal production and living order.

Compared with the group immunisation strategy of the United States, the number of infected people, the number of deaths and the trend of virus mutation in COVID-19 have decreased.

Based on this strict anti-epidemic measure, China's economy has been rapidly rejuvenated, the resumption of work and production has been steadily advanced, effectively filling the global supply and demand gap, stabilising the global industrial chain, and making its own contribution to the international community.

Going forward other countries must draw lessons from China’s solid anti-epidemic policy

Thirdly, there is a new pathogen that has not yet been discovered or non-infectious factors, such as environmental toxins and drugs.

Although no cases of acute hepatitis in children have been reported in South Africa, in view of the current situation, we still need to take precautions.

South Africa as a leading expertise country on communicable disease surveillance, through The National Institute For Communicable Diseases Of South Africa should take measures to detect and respond to public health threats in order to prevent communicable and non-communicable disease outbreaks. As per the protocol, they will report to the Minister of health and other policymakers and notify the WHO, as the multilateral body concerned .

Residents who need to leave the country in the near future should consider avoiding going to places where there are still large numbers of cases, prevent children going to crowded public places with poor air circulation, cutting off droplet contact and faecal transmission, ensuring children's adequate sleep and nutrition, regularly cleaning children's clothes and articles that are often in contact, washing hands frequently, wearing masks, and keeping social distance.

If children have hepatitis symptoms such as jaundice and digestive tract symptoms, they should seek medical attention in time.

*Tshilidzi Munyai, is a Member of Parliament and Whip for the African National Congress on the Portfolio Committee of Health.

**Tshilidzi Munyai :writes in in his personal capacity taking forward the plight of “a new variant of a known virus causing acute hepatitis in children” to contribute to the Nelson Mandela month towards the World Hepatitis Day on 28 July 2022

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