The number of cases of hepatitis due to the mysterious cause is increasing. More and more countries are reporting children with symptoms that lead to the idea that they may have such a condition. A significant number need a liver transplant.
Researchers are working to find out what causes this hepatitis as soon as possible. Genomic and transcriptome analyzes are performed on continuous fire, as in the case of SARS-CoV-2.
Dr. Marius Geantă, president of the Center for Innovation in Medicine, explained in an interview for Ziare.com the state of research on the cause of atypical hepatitis but also how we can avoid other types of hepatitis whose causes we already know.
“What attracts the most attention is this 10% of cases that need a liver transplant. Which obviously shows us that in addition to the causative agents that can be pathogenic, there may be a virus or a combination of these. There is also the other component, the way the body reacts to something that is not its own, in this case to a pathogen or a toxic substance “, the specialist explained.
What are the tests that could lead to the cause of the mysterious hepatitis?
Because some children have symptoms of this condition of unknown origin after a previous infection with the new coronavirusscientists are doing research on both adenovirus and SARS-CoV-2.
“The analyzes used are very detailed on both adenovirus and SARS-Cov-2, on the one hand, including genomic analysis, ie the viral structure and transcriptome-type analysis, ie those relating to other components of the genetic material. .
There are in-depth tests that are done especially in cases that need a liver transplant and here are, in addition to the analysis of the genome and the human transcriptome this time, there are also tests that show the type of reaction in the immune system.
It is quite likely that the massive destruction of the liver that needs transplantation is not caused directly by the virus, by the agent that produces hepatitis but, as we have seen in COVID cases, the effect of an exaggeratedly abnormal immune reaction. In the case of COVID-19, there was talk about that cytokine storm “, says Dr. Marius Geantă.
What results do researchers expect?
“It is important and probably that from these analyzes we will better understand the risk profile for this type of hepatitis due to an unknown cause, a risk that belongs to us, to people, to children in this case.
Why is this important? Because we need to find a way to prevent it as effectively as possible, and in order to do that, we need to understand the causative agent as well as possible, but also who the people at risk are. Just as we were talking about the severe forms of COVID-19, we are now talking about the severe forms of this hepatitis of unknown origin. These analyzes take some time and I think it is a bit early to have these results, but if we think about what is happening now, things are going in this direction “, the specialist also explained.
It goes on a diagnosis of exclusion
Two-way research is currently underway.
“Let’s see which are the individual risk factors, which can be genetic, biological and on the other hand which are the factors that determine and / or trigger the disease.
What needs to be kept in mind is that we are talking about a diagnosis of exclusion. The other five viral causes that can cause hepatitis must be ruled out, autoimmune hepatitis must be ruled out, and possible toxic causes, such as medicines, must be ruled out.
One relevant thing is that the clinical picture is not much different in this hepatitis compared to the others. For this reason the children presented themselves at hospital having symptoms encountered in all types of hepatitis and for this reason it is important that the other causes are excluded first “, the doctor added.
Liver transplantation in children is done with a compatible part of the parent’s liver
The health expert also states that, “from a therapeutic point of view, there are quite a few options”.
“We are talking about options for supporting liver function. The liver has two main categories of functions: it removes toxins from the body and this function can be taken over by a dialysis that can be temporary.
The second function of the liver is to produce enzymes, proteins and other substances necessary for the body to function and if it is destroyed it is clear that an external supply with such substances administered by infusions is needed. Unfortunately, there are not many options “, explained Dr. Marius Geantă.
Those who need a transplant can get a part of the liver from one of the parents, who is compatible.
“The good part, if we call it that, is that if you need a liver transplant in your baby, you only need a part of the parent’s liver that is largely compatible.
There is no need to transfer another liver from another child. And from this point of view we can say that we are a little better than in the case of liver transplantation in adults “, the president of the Center for Innovation in Medicine also specified.
How to prevent known hepatitis and what vaccine options we have on the market
Until the cause and the specific treatment are found, specialists recommend that we try to prevent the disease.
“If we talk about prevention, the means are the same for all types of hepatitis and we are talking about keeping hands clean, washing fruits, vegetables eaten fresh.
These are valid for hepatitis A and hepatitis D, and for hepatitis B, C, and E, the main routes of transmission are for E and D: the sexual route, C is generally transmitted by transfusions, by medical or non-medical instruments infected with in a person suffering from this type of hepatitis, and this instrument has not been sterilized. Such a pathway exists for hepatitis B as well as for D “, the doctor also explained.
On the other hand, for hepatitis due to causes we already know, there is a vaccine, and Romania has a high vaccination rate.
“There is a vaccine for hepatitis B that is given from the first day of life. The good news is that in Romania, approximately 93% of newborns, in 2019, received the first dose of hepatitis B vaccine on the first day of life.
Three doses of vaccine are given. The second dose is given at one month, the third dose is given at the age of six months. In our country, hepatitis B vaccination started somewhere in the 90’s and Romania was among the first countries to introduce this vaccine in the mandatory vaccination schedule. There have been two years, 2017-2018, when vaccination with the first dose has been slightly lower, but things have improved.
There is also a vaccine against hepatitis A. It can be given with one of the doses of hepatitis B vaccine. There is no vaccine for hepatitis C, but there is a very effective treatment that treats 98% of the cases and exist only if the person has previously been infected with hepatitis B, those who are vaccinated against hepatitis B are also protected from D.
Hepatitis E cases are rare, they occur in certain regions of the globe but there is also a vaccine for this type of hepatitis “, explained Dr. Marius Geantă.
We are not as good at vaccinating for other serious diseases.
“There is a big gap between vaccination for hepatitis B vaccination and cervical cancer vaccination, for example.
Data from the European Cancer Organization show that in Eastern Europe, at the level of 2019, girls are vaccinated in proportion of less than 5% and in terms of vaccination in boys, it can not even be the percentage is 0%. And it turns out that we have certain data that HPV vaccination protects against the onset of cervical cancer which has a very high mortality rate and also protects against the occurrence of some forms of head and neck cancer.
However, there is a difference, HPV vaccination is not included in the national vaccination program, we know controversies related to previous campaigns so it is a different situation.
Another discrepancy is compared to the anti-COVID vaccination which is not mandatory but is carried out in pandemic conditions when the threat to public health is very high and yet the number of those vaccinated in Romania is below the European average and much below the European average in terms of booster dose vaccination “, the doctor also explained.
Two more suspicions of atypical hepatitis in Romania
On Thursday, April 28, the Ministry of Health reported that an 8-year-old and a 10-year-old child have symptoms of atypical hepatitis. They are in the hospital and the specialists are waiting for the results of the tests to see if there is an identifiable cause.
The 5-year-old girl confirmed with this form of acute hepatitis is still in hospital, under treatment. If it does not work, doctors consider a liver transplant. The girl did not have COVID-19 and the adenovirus tests were negative.
Approximately 200 cases of mysterious hepatitis have been reported worldwide.
–
