Temporal trends and clinical characteristics of acute hepatitis with unknown aetiology and human adenovirus infections in Oxfordshire from 2016 to 2022
Temporal trends and clinical characteristics of acute hepatitis with unknown aetiology and human adenovirus infections in Oxfordshire from 2016 to 2022
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DOI：
10.1101/2023.06.19.23291626
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发表时间：
2023-06
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通讯作者：
C. Tan;Gavin Kelly;Jack Cregan;Joseph D Wilson;T. James;Meera A Chand;Susan Hopkins;Maaike C. Swets;J. Baillie;Katie Jeffery;Sarah Walker;D. Eyre;N. Stoesser;Philippa C. Matthews
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作者：
C. Tan;Gavin Kelly;Jack Cregan;Joseph D Wilson;T. James;Meera A Chand;Susan Hopkins;Maaike C. Swets;J. Baillie;Katie Jeffery;Sarah Walker;D. Eyre;N. Stoesser;Philippa C. Matthews
背景：2022年在儿童中爆发的不明原因的严重急性肝炎（AS-Hep-UA）随后与腺病毒相关病毒2 （AAV2）和其他“辅助病毒”（包括人腺病毒（hav））的感染有关。目的：研究2016-2022年英国牛津郡人群中未知病因急性肝炎（AHUA）和hav感染的临床特征和时间分布。方法：我们使用匿名电子健康记录（EHR）来整理2016-2022年间AHUA和/或hav感染的回顾性数据。我们回顾了牛津大学医院NHS基金会信托基金（OUH； UK）急诊治疗的90万例急性病例的记录，并对病例数和临床特征进行了描述性分析。结果：在整个研究期间，与其他患者相比，编码为AHUA的患者的危重病住院率显著高于其他患者（p<0.0001， OR=41.7, 95% CI:26.3-65.0），住院时间更长（p<0.0001）。将疫情期间（2021年10月1日至2022年8月31日）发生的事件与疫情期间之外发生的事件进行比较，诊断为AHUA的成年人明显更多（p<0.0001， OR=3.01, 95% CI: 2.20-4.12），儿童感染hav的人数明显更多（p<0.001， OR=1.78, 95% CI:1.27-2.47）。在疫情爆发期间，还进行了更多的hav检测（p<0.0001， OR=1.27, 95% CI:1.17-1.37）。没有证据表明，与艾滋病病毒检测阴性的患者相比，艾滋病病毒检测阳性的患者有更多的急性肝炎或疾病严重程度增加。结论：我们的研究结果强调成人AHUA数量的增加与报道的儿童AS-Hep-UA暴发一致，但与记录的hav感染无关。
Background: An outbreak of severe acute hepatitis of unknown aetiology (AS-Hep-UA) in children during 2022 has subsequently been linked to infections by adenovirus-associated virus 2 (AAV2) and other 'helper viruses', including human adenovirus (HAdV). Aim: We investigated clinical characteristics and temporal distribution of acute hepatitis with unknown aetiology (AHUA) and of HAdV infections in Oxfordshire, UK population between 2016-2022. Methods: We used anonymised electronic health records (EHR) to collate retrospective data for presentations of AHUA and/or HAdV infection between 2016-2022. We reviewed records of >900,000 acute presentations to emergency care at Oxford University Hospitals NHS Foundation Trust (OUH; UK) and performed a descriptive analysis of case numbers and clinical characteristics. Results: Over the full study period, patients coded as AHUA had significantly higher critical care admission rates (p<0.0001, OR=41.7, 95% CI:26.3-65.0) and longer inpatient admissions (p<0.0001) compared with the rest of the patient population. Comparing events within the outbreak period (1st Oct 2021 - 31 Aug 2022), to those occurring outside this period, significantly more adults were diagnosed with AHUA (p<0.0001, OR=3.01, 95% CI: 2.20-4.12), and there were significantly more HAdV infections in children (p<0.001, OR=1.78, 95% CI:1.27-2.47). There were also more HAdV tests administered during the outbreak (p<0.0001, OR=1.27, 95% CI:1.17-1.37). There was no evidence of more acute hepatitis or increased severity of illness among patients who tested HAdV-positive compared to those testing HAdV-negative. Conclusion: Our results highlight an increase in the number of AHUA in adults coinciding with the reported AS-Hep-UA outbreak in children, but not linked to documented HAdV infection.