H5N1

Joint ECDC-WHO Regional Office for Europe Weekly Hepatitis of Unknown Origin in Children Surveillance Bulletin

Via ECDC: Joint ECDC-WHO Regional Office for Europe Weekly Hepatitis of Unknown Origin in Children Surveillance Bulletin. The summary:

This report provides an overview of the cases of hepatitis of unknown origin in children aged 16 years and below reported to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy) hosted at ECDC.

As of 30 June 2022, 473 cases of acute hepatitis of unknown aetiology have been reported by 21 countries: (Austria (three), Belgium (14), Bulgaria (one), Cyprus (two), Denmark (seven), France (seven), Greece (11), Ireland (16), Israel (five), Italy (35), Latvia (one), Luxembourg (one), the Netherlands (15), Norway (five), Poland (10), Portugal (19), Republic of Moldova (one), Serbia (one), Spain (40), Sweden (11), and the United Kingdom (268)).

Since the last surveillance bulletin, which used data as of 17 June 2022, 27 new cases have been reported from 10 countries (France (one), Greece (two), Ireland (two), Italy (two), Luxembourg (one), Poland (two), Portugal (four), Spain (three), Sweden (two), and the United Kingdom (eight)). Two cases (France (one), and Sweden (one)) previously classified as probable were subsequently discarded. One case (Sweden) previously discarded was reclassified as probable. Two cases (United Kingdom) previously reported were not included in the latest data update.

The epicurve shows cases by date of onset when available (294 cases), and date of hospitalisation (159 cases), or date used for statistics when the former two are not available (20 cases). The number of cases reported increased sharply starting in week 12 and remained stable between 26 and 39 cases per week up to and including week 18. As severe hepatitis can take some time to develop following the initial symptoms, and since investigations are required to rule out known causes, there is an expected reporting delay. The recent decrease in cases is therefore challenging to interpret.

The majority (76.1%) of cases are five years old or younger.

Of the 473 probable cases, 302 have information available on clinical outcome. Of these, 221 have recovered, 80 remain under medical care, and one death has been associated with this disease.

Of 295 cases with available information, 87 (29.5%) required admission to an intensive care unit. Of the 242 cases for which this information is available, 20 (8.3%) have received a liver transplant.
Overall, 364 cases were tested for adenovirus by any specimen type and had a valid positive or negative result. Of these, 192 (52.7%) tested positive. The positivity rate was the highest in whole blood specimens (53.7%). Typing data are only available for eight cases: type 31 (n = 1), type 40 (n = 1), type 41 (n = 3), and type other (n = 3).

Of the 322 cases PCR tested for SARS-CoV-2, 35 (10.9%) were positive. Serology results for SARS-CoV-2 are only available for 61 cases, of which 39 (63.9%) resulted positive. Of the 113 cases with data on COVID-19 vaccination, 97 (85.8%) were unvaccinated.

Interim analysis of acute hepatitis of unknown etiology in children aged 10 years — United States, October 2021–June 2022

Via MMWR: Interim Analysis of Acute Hepatitis of Unknown Etiology in Children Aged 10 Years — United States, October 2021–June 2022. The summary:

What is already known about this topic?  

During October 2021–February 2022, a cluster of children with hepatitis of unknown etiology and adenovirus infection was identified in the United States. On April 21, after reports of similar cases in other countries, CDC advised clinicians to report patients aged <10 years with hepatitis of unknown etiology to public health authorities.  

What is added by this report?  

During October 1, 2021–June 15, 2022, a total of 296 U.S. pediatric patients received a diagnosis of hepatitis of unknown etiology, with adenovirus detected among 45%. Preliminary analyses have not identified common exposures (e.g., travel or toxicants).  

What are the implications for public health practice?  

The investigation is ongoing; further clinical data are needed to understand the cause of these cases and to assess the potential association with adenovirus.

Joint ECDC-WHO Regional Office for Europe weekly hepatitis of unknown origin in children surveillance bulletin

Via ECDC: Joint ECDC-WHO Regional Office for Europe Weekly Hepatitis of Unknown Origin in Children Surveillance Bulletin. The summary:

This report provides an overview of the cases of hepatitis of unknown origin in children aged 16 years and below reported to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy) hosted at ECDC.

 

As of 16 June 2022, 449 cases of acute hepatitis of unknown aetiology have been reported by 20 countries: (Austria (three), Belgium (14), Bulgaria (one), Cyprus (two), Denmark (seven), France (seven), Greece (nine), Ireland (14), Israel (five), Italy (33), Latvia (one), the Netherlands (15), Norway (five), Poland (eight), Portugal (15), Republic of Moldova (one), Serbia (one), Spain (37), Sweden (nine), and the United Kingdom (262)).

 

Since the last surveillance bulletin, which used data as of 17 June 2022, 48 new cases have been reported from eight countries (Austria (one), Greece (three), Ireland (one), Italy (two), the Netherlands (one), Spain (one), Sweden (one), and the United Kingdom (38)). One case (Sweden) previously classified as probable or epi-linked was subsequently discarded.

 

The epicurve shows cases by date of onset when available (276 cases), and date of hospitalisation (155 cases), or date used for statistics when the former two are not available (18 cases). The number of cases reported increased sharply starting in week 12 and remained stable between 26 and 39 cases per week up to and including week 18. As severe hepatitis can take some time to develop following the initial symptoms, and since investigations are required to rule out known causes, there is an expected reporting delay. The recent decrease in cases is therefore challenging to interpret.

 

The majority (76.6%) of cases are five years old or younger.

 

Of the 449 probable cases, 276 have information available on clinical outcome. Of these, 201 have recovered, while 74 remain under medical care.

 

Of 279 cases with available information, 87 (31.2%) required admission to an intensive care unit. Of the 227 cases for which this information is available, 19 (8.4%) have received a liver transplant. There has been one death associated with the disease.

 

Overall, 313 cases were tested for adenovirus by any specimen type and had a valid positive or negative result. Of these, 164 (52.4%) tested positive. The positivity rate was the highest in whole blood specimens (53.9%). Typing data are only available for four cases: type 40 (n = 1), type 41 (n = 2), and type other (n = 1).

 

Of the 292 cases PCR tested for SARS-CoV-2, 31 (10.6%) were positive. Serology results for SARS-CoV-2 are only available for 52 cases, of which 33 (63.5%) resulted positive. Of the 99 cases with data on COVID-19 vaccination, 85 (85.9%) were unvaccinated.

Ebola in Mbandaka: Death of a 4th confirmed case

Via Radio Okapi: Ebola in Mbandaka: death of a 4th confirmed case. The Google translation, with my bolding:

The fourth confirmed case of the Ebola virus disease died on Friday May 20 in Mbandaka. This is the fourth recorded since the outbreak of the epidemic on April 21. He was discovered on Thursday in the Maman Balako health area, Wangata health zone and commune.  

Only 24 hours after his discovery, the patient died, after having dragged around the community for a long time without proper care.  

Medical sources claim that the victim was a 12-year-old child in the Maman Balako health area. Since May 14, he had been developing symptoms of Ebola, including fever, fatigue, blackish vomit.  

For five days, he was cared for at home, until Thursday, May 19; date on which he was taken to a medical center in the Mbandaka II district. The results of the analysis of the samples taken on the same day from the child were found to be positive for the Ebola virus disease.  

But the family resisted and brought the child home on Thursday evening, where he passed away on Friday morning.  

Sources add that another 9-year-old child died with the same symptoms, in the same neighborhood, on May 6 and buried, without post-mortem collection or a dignified and secure burial. This raises fears of a multiplication of cases.  

The response teams are preparing for the decontamination of different places, through which the deceased child passed. They seek the cooperation of the populations around the case and in the health area concerned.  

They also invite the inhabitants to appropriate all the preventive measures recently enacted by the provincial authority, in order to avoid a large-scale spread of the disease. Among these measures, there is a compulsory post-mortem sample before any burial of bodies in the city.

Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin

ECDC and WHO have published Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin. The surveillance summary:

This report provides an overview of the cases of hepatitis of unknown origin in children aged 16 years and below reported to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy) hosted at ECDC.  

As of 13 May 2022, 232 cases of acute hepatitis of unknown aetiology in children aged 16 years or below have been reported, of which 229 were classified as probable and three as epidemiologically linked, by 14 countries (Belgium (12), Cyprus (two), Denmark (six), Greece (two), Ireland (six), Italy (24), the Netherlands (six), Norway (five), Poland (one), Serbia (one), Slovenia (one), Spain (26), Sweden (nine), and the United Kingdom (131)).  

Of the 229 probable cases, 122 have recovered, while 18 remain under medical care.  

The epicurve shows cases by the date of onset of first symptoms of disease. An increase in the number of cases has occurred from week 9. As severe hepatitis can take some time to develop after the onset of the first symptoms and as investigations take time, there may be a delay in the reporting of cases. The recent decrease in cases is therefore challenging to interpret.  

The majority (75.9%) of cases are <5 years of age.  

Of 143 cases with information, 22 (15.4%) were admitted to an intensive care unit. Of the 98 cases for which this information was available, six (6.1%) have received a liver transplant. There has been one death associated with this disease.  

Overall, 151 cases were tested for adenovirus by any specimen type, of which 90 (59.6%) tested positive. The positivity rate was the highest in whole blood specimens (68.9%).  

Of the 173 cases PCR tested for SARS-CoV-2, 20 (11.6%) tested positive. Serology results for SARS-CoV-2 were only available for 19 cases, of which 14 (73.7%) had a positive finding. Of the 56 cases with data on COVID-19 vaccination, 47 (83.9%) were unvaccinated.

ECDC epidemiological update: Hepatitis of unknown aetiology in children

ECDC has published Epidemiological update: Hepatitis of unknown aetiology in children. Excerpt:

Since the first alert launched by the United Kingdom (UK) on 5 April 2022, probable cases of hepatitis of unknown aetiology in children have been reported from several countries worldwide. It is not yet clear whether the cases identified following the alert are part of a true increase compared to the baseline rate of hepatitis of unknown aetiology in children.  

The aetiology and pathogenetic mechanisms of disease are still under investigation. A possible association with current adenovirus infection has been found in cases in the UK in particular but other hypotheses and possible co-factors are under investigation. Most cases continue to be reported as sporadic un-linked cases.  

This report presents an update of probable cases identified in the European Union/European Economic Area (EU/EEA) and worldwide. Whereas cases detected in the EU/EEA have been reported according to the ECDC/WHO case definition, worldwide cases are collected through screening of official websites and media sources and therefore different case definitions could have been used. 

Case definition used in EU/EEA: 

• Confirmed: N/A 

• Probable: A person presenting with an acute hepatitis (non-hepatitis viruses A, B, C, D and E*) with aspartate transaminase (AST) or alanine transaminase (ALT) over 500 IU/L, who is 16 years old or younger, since 1 October 2021.  

• Epi-linked: A person presenting with an acute hepatitis (non-hepatitis viruses A, B, C, D and E*) of any age who is a close contact of a probable case since 1 October 2021.  

Cases of hepatitis with known aetiology such those due to specific infectious diseases, drug toxicity, and metabolic hereditary, or autoimmune disorders should not be reported under this protocol.    

In EU/EEA countries, approximately 106 cases have been identified in 14 EU/EEA countries as of 10 May 2022. 

Worldwide update

United Kingdom: As of 3 May 2022, the UKHSA has identified a total of 163 children, aged under 16 years, with acute hepatitis of unknown aetiology. Of these cases, 11 children have received a liver transplant. A second detailed technical briefing on the investigations among the UK cases was published by the UKHSA on 6 May 2022. 

Outside of EU/EEA and the United Kingdom: as of 10 May 2022, there are at least 181 cases of acute hepatitis among children. Cases have been reported by Argentina [8], Brazil [16], Canada [7], Costa Rica [2], Indonesia [15], Israel [12], Japan [7], Panama [1], Palestine* [1], Serbia [1], Singapore [1], South Korea [1] and the United States [at least 109].  

The total number of cases reported worldwide is approximately 450, including 11 deaths reported from Indonesia [5], Palestine [1], and the United States [5].  

On 3 May 2022, the media quoting public health authorities reported a death of an eight-year-old child with acute hepatitis of unknown aetiology in Palestine*. It is currently unclear whether this is the same child who was diagnosed in the previous week. Confirmation of this case is pending.

Jakarta health agency talks of mysterious acute hepatitis

Via Tempo, an Indonesian news site: Jakarta Health Agency Talks of Mysterious Acute Hepatitis. Excerpt:

Jakarta Health Agency Head Widyastuti said the agency is still studying the clinical criteria and epidemiology of the mysterious acute hepatitis or liver inflammation. She said the government has not yet dared to conclude the pattern of the disease.  

“It is a mysterious [disease] that surely needs investigation. We are not in haste to conclude what it is,” she said at City Hall, Central Jakarta, Monday, May 9, 2022.  

Previously reported, the Health Ministry stated that three child patients at Dr. Cipto Mangunkusumo Central National Hospital (RSCM) died of suspected mysterious hepatitis. They were treated for two weeks starting April 30, 2022. The cause remains unknown.  

Widyastuti said hepatitis was not a new disease as there have been hepatitis types A-E. Thus, early vigilance has been practiced from the beginning. “So of course, we all must stay vigilant,” she remarked.

ECDC update: Hepatitis of unknown origin in children

Via ECDC: Update: Hepatitis of unknown origin in children. Click or tap through for the epidemiological summary. Excerpt: 

Following the reports of cases of acute hepatitis of unknown origin by the UK Health Security Agency, additional cases in children have been reported in Denmark, Ireland, the Netherlands, and Spain.  

In addition, nine cases of acute hepatitis among children between 1 and 6 years old in the state of Alabama in the United States who also tested positive for adenovirus have been reported.  

Investigations are ongoing in all countries reporting cases. At present, the exact cause of hepatitis in these children remains unknown. The incident team in the United Kingdom, where most of the cases have occurred to date, consider that an infective cause is most likely based on the clinical and epidemiological features of the cases under investigation.  

ECDC is working with teams in each of the countries reporting cases, along with WHO and other key partners to support the ongoing investigations. ECDC facilitates the sharing of information as it becomes available, as well as tools for investigations.  

Over the past weekend, the agency continued sharing all available information with countries through its Hepatitis Network and with the clinical organisations the European Association for the Study of the Liver and the European Society of Clinical Microbiology and Infectious Diseases ESCMID.  

ECDC will continue to monitor this event through its epidemic intelligence activities and liaise with Member States and international partners.

Kwilu: 286 children died in 3 months from an unknown disease

Kwilu province, DR Congo. Gungu is in the south-central part of the province. Google Maps.

Thanks to @BojoBodean for alerting me to this Radio Okapi report: Kwilu: 286 children died in 3 months from an unknown disease. The Google translation:

The head of the provincial health division of Kwilu, Dr Jean-Pierre Basake, told Radio Okapi on Monday, November 8 that two hundred and forty-six children whose age varies between 0 and 5 years had died since the end of the month. of August 2021 of an illness of unknown origin, in the health zone of Mukedi, in the territory of Gungu, in the province of Kwilu.  

According to him, this figure was drawn from the cumulative amount of 4,881 cases including 286 registered deaths. "The cases are still there. Children have a fever with abdominal pain, vomiting, some lead to a picture of anemia. We are at 4,481 cases and 286 cumulative deaths," said Dr Basake.  

He also said that the province and some partners had provided material and financial support to strengthen the response:  

"We brought in medical, material and technical support. The drugs we used did not have the right active principle. We nevertheless obtained the support of the provincial government on the recommendation of the provincial assembly, five million francs. Congolese (US $ 2,450) taken out of the provincial fund and drugs. The partners also made available antimalarials, therefore ACTs and inputs of nearly US $28 to 29,000. From the weekend to this day, this 'was $33 to 34,000 USD. Drugs and inputs. We have with us here a biologist technician who takes the samples, we will send nationally to the INRB."

Vietnam: Ho Chi Minh City starts vaccinating school children against COVID-19

Via VietnamPlus: HCM City starts vaccinating school children against COVID-19. Excerpt:

HCM City (VNA) – Ho Chi Minh City on October 27 morning started giving COVID-19 vaccines to school children in the district of Cu Chi.  

According to Chairwoman of the People’s Committee of Cu Chi Pham Thi Thanh Hien, the vaccination is being piloted at one site initially, with about 1,500 students aging from 16-17 to receive the shots.  

Doctor Nguyen Thanh Danh, head of the Health Care Division of Cu Chi said that the vaccination will only be carried out with agreement from their parents. The students are receiving Pfizer COVID-19 vaccine, he added. 

Duong Anh Duc, Vice Chairman of the HCM City People’s Committee said that Cu Chi district, together with District 1, are the first localities in the city chosen for the vaccination of children.  

Duc noted that so far, the city has administered nearly 13 million doses of COVID-19 vaccines to locals with utmost safety. The city has also made careful preparations to give the vaccines to children, he said, adding that the city will be the first locality in the country to conduct a massive vaccination campaign on children starting from November.