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Hepatitis of unknown aetiology in children – epidemiological overview of cases reported in Europe, 1 January to 16 June 2022
- Adriana Romaní Vidal1 , Aisling Vaughan2 , Francesco Innocenti1,3 , Soledad Colombe2 , Lina Nerlander1 , Natalia Rachwal1 , Bruno Christian Ciancio1 , Aikaterini Mougkou1 , Carlos Carvalho1 , Enrique Delgado1 , Piers Mook2 , Géraldine de Muylder4 , Michael Peeters5 , Tencho Tenev6 , Elitsa Golkocheva-Markova6 , Veronika Vorobieva Solholm Jensen7 , Anders Koch8 , Julie Figoni9 , Cécile Brouard9 , Georgia Nikolopoulou10 , Anastasia Zisouli10 , Niamh Murphy11 , Annemarie Broderick12 , Lital Goldberg13 , Rivka Rich13 , Lior Hecht Sagie13 , Maria Elena Tosti14 , Barbara Suligoi15 , Rosa Joosten16 , Roan Pijnacker16 , Ingvild Fjeldheim17 , Eli Heen17 , Małgorzata Stępień18 , Piotr Polański18 , Rui Tato Marinho19 , João Vieira Martins20 , Carmen Varela21 , Ana Avellón22 , Emmi Andersson23 , Marie Jansson Mörk23 , Sema Mandal24 , Conall Watson24 , Laura Coughlan24 , Meera Chand25 , Claire Neill26 , Declan T Bradley27 , Kathy Li28 , Maureen O’Leary29 , Neil McInnes30 , Christopher J Williams31 , Catherine Moore31 , Ardiana Gjini31 , Erika Duffell1 , Richard Pebody2
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View Affiliations Hide AffiliationsAffiliations: 1 European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 2 World Health Organization Regional Office for Europe, Copenhagen, Denmark 3 Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy 4 Sciensano, Epidemiology of Infectious Diseases, Brussels, Belgium 5 Sciensano, Infectious Diseases in Humans, Viral Diseases, National Reference Centre for Hepatitis Viruses, Brussels, Belgium 6 National Reference Laboratory Hepatitis viruses, NCIPD-Virology, Sofia, Bulgaria 7 Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark 8 Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark 9 Santé Publique France, the National Public Health Agency, Saint-Maurice, France 10 Greek National Public Health Organization (EODY), Athens, Greece 11 Health Service Executive HPSC surveillance scientist on the National IMT for hepatitis, Dublin, Ireland 12 Children’s Health Ireland (CHI), Crumlin, Ireland 13 Israel Ministry of Health, Jerusalem, Israel 14 National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy 15 Infectious Disease Department - Istituto Superiore di Sanità, Rome, Italy 16 National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands 17 Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway 18 Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health NIH – National Research Institute, Warsaw, Poland 19 Gastroenterology and Hepatology Department, Hospital S. Maria; Medical School of Lisbon; National Programme for Viral Hepatitis, Portugal Ministry of Health, Lisbon, Portugal 20 Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal 21 National Centre of Epidemiology, Carlos III Institute of Health, CIBERESP, Madrid, Spain 22 National Centre of Microbiology, Carlos III Institute of Health, CIBERESP, Madrid, Spain 23 Public Health Agency of Sweden, Solna, Sweden 24 United Kingdom Health Security Agency Epidemiology Cell, London, United Kingdom 25 United Kingdom Health Security Agency Incident Director, London, United Kingdom 26 Public Health Agency Northern Ireland, Belfast, United Kingdom 27 Public Health Agency Northern Ireland, Belfast, United Kingdom 28 Regional Virology Laboratory Belfast Health and Social Care Trust, Northern Ireland, Belfast, United Kingdom 29 Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom 30 West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom 31 Public Health Wales, Cardiff, United KingdomAdriana Romaní VidalAdriana.Romani ecdc.europa.eu
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Citation style for this article: Romaní Vidal Adriana, Vaughan Aisling, Innocenti Francesco, Colombe Soledad, Nerlander Lina, Rachwal Natalia, Ciancio Bruno Christian, Mougkou Aikaterini, Carvalho Carlos, Delgado Enrique, Mook Piers, de Muylder Géraldine, Peeters Michael, Tenev Tencho, Golkocheva-Markova Elitsa, Vorobieva Solholm Jensen Veronika, Koch Anders, Figoni Julie, Brouard Cécile, Nikolopoulou Georgia, Zisouli Anastasia, Murphy Niamh, Broderick Annemarie, Goldberg Lital, Rich Rivka, Hecht Sagie Lior, Tosti Maria Elena, Suligoi Barbara, Joosten Rosa, Pijnacker Roan, Fjeldheim Ingvild, Heen Eli, Stępień Małgorzata, Polański Piotr, Tato Marinho Rui, Vieira Martins João, Varela Carmen, Avellón Ana, Andersson Emmi, Jansson Mörk Marie, Mandal Sema, Watson Conall, Coughlan Laura, Chand Meera, Neill Claire, Bradley Declan T, Li Kathy, O’Leary Maureen, McInnes Neil, Williams Christopher J, Moore Catherine, Gjini Ardiana, Duffell Erika, Pebody Richard. Hepatitis of unknown aetiology in children – epidemiological overview of cases reported in Europe, 1 January to 16 June 2022. Euro Surveill. 2022;27(31):pii=2200483. https://doi.org/10.2807/1560-7917.ES.2022.27.31.2200483 Received: 16 Jun 2022; Accepted: 01 Jul 2022
Abstract
Following the report of an excess in paediatric cases of severe acute hepatitis of unknown aetiology by the United Kingdom (UK) on 5 April 2022, 427 cases were reported from 20 countries in the World Health Organization European Region to the European Surveillance System TESSy from 1 January 2022 to 16 June 2022. Here, we analysed demographic, epidemiological, clinical and microbiological data available in TESSy. Of the reported cases, 77.3% were 5 years or younger and 53.5% had a positive test for adenovirus, 10.4% had a positive RT-PCR for SARS-CoV-2 and 10.3% were coinfected with both pathogens. Cases with adenovirus infections were significantly more likely to be admitted to intensive care or high-dependency units (OR = 2.11; 95% CI: 1.18–3.74) and transplanted (OR = 3.36; 95% CI: 1.19–9.55) than cases with a negative test result for adenovirus, but this was no longer observed when looking at this association separately between the UK and other countries. Aetiological studies are needed to ascertain if adenovirus plays a role in this possible emergence of hepatitis cases in children and, if confirmed, the mechanisms that could be involved.
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