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World J Clin Cases. Dec 16, 2022; 10(35): 12837-12843
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12837
Hepatitis of unknown etiology in children: Current evidence and association
Rui Zhong, Feng Yi, Fen Xiang, Yan-Fang Qiu, Lei Zhu, Yan-Hui Zou, Wei Wang, Qiong Zhang
Rui Zhong, Wei Wang, Department of Medical Oncology, Digestive and Urinary Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
Feng Yi, Fen Xiang, Qiong Zhang, Department of Emergency, Yueyang Central Hospital, Yueyang 414100, Hunan Province, China
Yan-Fang Qiu, Department of Radiation Therapy Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
Lei Zhu, School of Nursing, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
Yan-Hui Zou, Health Service Centre, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
Author contributions: Zhong R and Zhang Q wrote the paper; Zou YH designed and wrote the paper; Wang W and Yi F checked and proofread the paper; Xiang F, Qiu YF and Zhu L searched the related literature and information for the paper; and all authors have read and approved the final manuscript.
Supported by Hunan Provincial Bureau of Science and Technology, No. 2021ZK4076 and No. 2021ZK4078; and The Changsha Science and Technology Bureau in China, No. kq1901085.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiong Zhang, MSN, Chief Nurse, Department of Emergency, Yueyang Central Hospital, No 39 Dongmaoling Road, Yueyanglou District, Yueyang 414100, Hunan Province, China. 534551036@qq.com
Received: August 2, 2022
Peer-review started: August 2, 2022
First decision: October 5, 2022
Revised: October 13, 2022
Accepted: November 18, 2022
Article in press: November 18, 2022
Published online: December 16, 2022
Abstract

Two years after the coronavirus disease 2019 (COVID-19) pandemic, acute hepatitis of unknown etiology in children (AHUCD) began to be reported worldwide. The novel coronavirus and adenovirus were found in pathogen and antibody tests in AHUCD cases reported by the World Health Organization. Children are not exposed to the viruses that children are generally exposed to owing to COVID-19 infection preventive measures such as isolation and wearing masks; therefore, some researchers have speculated that this disease is related to reduced exposure to pathogens. Some scientists have also speculated that the disease is related to liver injury and adenoviral hepatitis, which are the sequelae of COVID-19. Some evidence also suggests a weak association between the disease and COVID-19 vaccination. Therefore, further research and investigation of the pathogenesis, preventive measures, and early treatment of hepatitis of unknown etiology are required. This study aimed to synthesize available evidence to further elucidate this disease in order to treat and prevent it effectively.

Keywords: Acute hepatitis of unknown etiology, Coronavirus disease, Adenovirus, Immune system, Vaccine, Multi-system inflammatory syndrome in children

Core Tip: In this review, we summarize the existing evidence related to the outbreak of acute hepatitis of unknown etiology in children (AHUCD). Some scholars believe that the outbreak of AHUCD caused by the coronavirus disease 2019 (COVID-19) pandemic is caused by immune dysfunction and liver injury after COVID-19, and children with reduced exposure to pathogens and increased physical susceptibility due to isolation and mask wearing. Secondly, human adenovirus or other pathogens can interact with each other, leading to the outbreak of AHUCD. However, the relationship between COVID-19, adenovirus hepatitis and AHUCD is still unclear. Future studies should focus on the etiology and mechanism of AHUCD.