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They discover what could cause acute childhood hepatitis, registered in 35 countries

Since April, the World Health Organization (WHO) has recorded 1,010 suspected cases in 35 countries, including 22 deaths, and 46 liver transplants have been carried out.

A group of doctors in the United Kingdom revealed that the recent increase in cases of Hepatitis in children can be caused by the presence of two infectious agents, the adeno-associated virus 2 (AAV2) and the adenovirus (HAdV), so the probability of a SARS-CoV-2 infection is ruled out, reported this Monday the University of Glasgow (Scotland).

According to those responsible for the investigation, published by the MedRxiv preprint service, an outbreak of acute childhood hepatitis of unknown origin was detected in Scotland last April. Since then, the World Health Organization (WHO) has accounted for 1,010 suspected cases in 35 countries, including 22 deaths, and 46 liver transplants have been performed.

The majority of the 268 cases reported in the United Kingdom were minor children of five years. Also, of the 189 patients who were hospitalized, 74 required admission to the intensive care unit, and 12 needed a liver transplant. Health officials previously believed that the increase in infections was caused by an adenovirus, as it was found in samples from children affected by liver disease.

Given this situation, Two studies were carried out independently and simultaneously by researchers from scientific institutions in Scotland and England in order to find the causes of the infection. The Scottish team performed next-generation sequencing as well as real-time polymerase chain reaction (PCR) analysis. During the study, they discovered the presence of AAV2, which is a member of the parvovirus family, in both the blood and liver of nine infected children. In the case of the control group, which consisted of 58 patients, no evidence of AAV2 was found.

At the same time, English scientists studied liver and blood samples from 28 minors with hepatitis, identifying AAV2 in 16 of these. The samples were compared with 132 controls from immunocompromised (low immune system) and immunocompetent (normal immune system) patients. Furthermore, RNA sequencing confirmed that AAV2 was replicating in the liver of the hepatitis patients. In both studies, it was ruled out that SARS-cov-2 is responsible for causing liver disease.

Discovering how the AAV2 works

Because the AAV2 cannot e replicated without an “auxiliary” virus, specialists determined that the appearance of the disease in children is caused by the existence of two viruses. In this case, AAV2 together with an adenovirus. Less frequently, AAV2 may be associated with the herpes virus HHV6.

“The presence of the AAV2 virus is associated with unexplained hepatitis in children”, commented the professor at the University of Glasgow, Emma Thomson, who assured that “this virus can only appear infrequently in the presence of another virus (usually an adenovirus).”

“There are many unanswered questions and larger studies are urgently needed to investigate the role of AAV2 in pediatric hepatitis,” he said. Thomson, adding that “more needs to be understood about the seasonal circulation of AAV2, a virus that is not routinely monitored, and it may be that a peak in adenovirus infection has coincided with a peak in AAV2 exposure, which leads to an unusual manifestation of hepatitis in susceptible young children”.

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