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.

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.

Migration and outbreaks of vaccine-preventable disease in Europe: A systematic review

Via The Lancet Infectious Diseases: Migration and outbreaks of vaccine-preventable disease in Europe: a systematic review. The summary:

Migrant populations are one of several underimmunised groups in the EU or European Economic Area (EU/EEA), yet little is known about their involvement in outbreaks of vaccine-preventable diseases. This information is vital to develop targeted strategies to improve the health of diverse migrant communities. 

We did a systematic review (PROSPERO CRD42019157473; Jan 1, 2000, to May 22, 2020) adhering to PRISMA guidelines, to identify studies on vaccine-preventable disease outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, varicella, Neisseria meningitidis, and Haemophilus influenzae) involving migrants residing in the EU/EEA and Switzerland. 

We identified 45 studies, reporting on 47 distinct vaccine-preventable disease outbreaks across 13 countries. Most reported outbreaks involving migrants were of measles (n=24; 6496 cases), followed by varicella (n=11; 505 cases), hepatitis A (n=7; 1356 cases), rubella (n=3; 487 cases), and mumps (n=2; 293 cases). 19 (40%) outbreaks, predominantly varicella and measles, were reported in temporary refugee camps or shelters. Of 11 varicella outbreaks, nine (82%) were associated with adult migrants. Half of measles outbreaks (n=11) were associated with migrants from eastern European countries. 

In conclusion, migrants are involved in vaccine-preventable disease outbreaks in Europe, with adult and child refugees residing in shelters or temporary camps at particular risk, alongside specific nationality groups. Vulnerability varies by disease, setting, and demographics, highlighting the importance of tailoring catch-up vaccination interventions to specific groups in order to meet regional and global vaccination targets as recommended by the new Immunisation Agenda 2030 framework for action. 

A better understanding of vaccine access and intent in migrant groups and a greater focus on co-designing interventions is urgently needed, with direct implications for COVID-19 vaccine delivery.

Far from Ebola, other diseases continue to kill in the DRC

Via mediacongo.net: Health: far from Ebola, other diseases continue to kill in the DRC. The Google translation:

The second largest epidemic in the history of Ebola is the one reported in eastern Democratic Republic of Congo since August 1, 2018. The National Multisectoral Response Committee reported 3,000 cases including 2000 dead since the beginning of the epidemic. 

This epidemic has caught the attention of the international community since the World Health Organization declared it "global emergency" to forget other diseases that, moreover continue to kill populations. 

Measles more deadly than Ebola and cholera combined 

Measles has killed more people in seven months than Ebola in one year, according to Médecins Sans Frontières (MSF). According to this organization, the measles epidemic has caused more than 2700 deaths in the DRC between January and early August. 

"The measles epidemic declared last June 10 is the deadliest that the DRC has known since 2011-2012," the organization wrote in a report in June, stating that it had infected more than 145,000 people. leading to being more deadly than Ebola and cholera combined. 

18,000 people died of malaria 

Malaria had killed more than 18,000 people in 18 million cases registered in 2018 according to a report by the national health ministry published on April 25, 2019. If the key intervention in the fight remains the distribution of long-lasting insecticide-treated mosquito nets, for the collective of civil society organizations for health and the fight against malaria, this is not enough.

Cholera killed 112 people in seven weeks  

In a report in February this year, the Congolese Ministry of Health said in a statement that the country had registered 4,716 cholera cases from January 1 to February 17, 2019 including 112 deaths.  

In 2018, this disease had made 900 deaths against 1190 for the year 2017 on 55,000 cases for that year. While the epidemic is rife in almost all provinces of the country, Upper Katanga, Upper Lomami, Tanganyika and South Kivu are the most affected provinces. 

Other diseases such as hepatitis B, HIV/AIDS, diabetes, cancer of the uterus and breast continue to kill in the country.  

From this table, it appears that the DRC is experiencing enormous health difficulties and that efforts in this area must be provided in order to clean up the environment in which the Congolese population lives.

Increasing childhood vaccination coverage of the refugee and migrant population in Greece through the European programme PHILOS, April 2017 to April 2018

Via Eurosurveillance: Increasing childhood vaccination coverage of the refugee and migrant population in Greece through the European programme PHILOS, April 2017 to April 2018. The abstract:

After the 2016 Balkan route border closures, vaccination of refugee children in Greece was mainly performed by non-governmental organisations. Activities varied between camps, resulting in heterogeneity of vaccination coverage (VC). 

In April 2017, the European programme ‘PHILOS - Emergency health response to refugee crisis’ took over vaccination coordination. Interventions were planned for the first time for refugee children in the community and unaccompanied minors at safe zones. From April 2017–April 2018, 57,615 vaccinations were performed against measles-mumps-rubella (MMR) (21,031), diphtheria-tetanus-pertussis (7,341), poliomyelitis (7,652), pneumococcal disease (5,938), Haemophilus influenzae type b (7,179) and hepatitis B (8,474). 

In April 2018, the vaccination status of children at camps (reception and identification centres and community facilities such as hostels/hotels were excluded) was recorded and VC for each disease, stratified by dose, nationality and camp size, was calculated. 

More than 80% of the children received the first MMR dose, with VC dropping to 45% for the second dose. For all other vaccines, VC was < 50% for the first dose in children aged 0–4 years and < 25% for the second dose. Despite challenges, PHILOS improved planning and monitoring of vaccination activities; however, further efforts towards improving VC in refugee children are needed.