Revisiting the overlooked role of recycled sewage water in high-income countries in adenoviral outbreaks such as the “2022 pediatric hepatitis’ outbreak”

Background On the 5th of April 2022, cases of adenovirus-induced hepatitis were reported in Scotland and then reached multiple parts of the world. While adenovirus normally presents with diarrhea, vomiting, and fever, these novel cases also resulted in the development of fulminant hepatitis in non-i...

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Published in:The Gazette of the Egyptian Paediatric Association 2022-12, Vol.70 (1), p.22-5, Article 22
Main Authors: AbdelMassih, Antoine, Kamel, Aya, Zaki, Ali Mohamed, Aboudeif, Ayten, Emad, Clara, Ramadan, Dina, Gaber, Hanya, Bastorous, Harvey, Shaker, Mehraiel, Salah, Nancy, Hany, Nourhan, El-Mestkawy, Nur, Sawiris, Rana Adel Naguib, Mamdouh, Rana, Atalla, Sandy, Abozeid, Sara, Ghazi, Sarah Ismail, Youssef, Steven A., ElMaghraby, Youssef, Khudhair, Zainab, Hozaien, Rafeef, El Husseiny, Nadine, El Shershaby, Meryam
Format: Article
Language:English
Subjects:
Adenovirus 41
Adenoviruses
COVID-19
Development and progression
Diarrhea
Disease transmission
Gastroenteritis
Hepatitis
High income
Hygiene
Industrialized nations
Infections
Liver transplants
Medicine
Medicine & Public Health
Pediatrics
Recycled sewage water
Recycling
Review
Unknown hepatitis cases
Viral infections
Viruses
Water treatment
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Summary:Background On the 5th of April 2022, cases of adenovirus-induced hepatitis were reported in Scotland and then reached multiple parts of the world. While adenovirus normally presents with diarrhea, vomiting, and fever, these novel cases also resulted in the development of fulminant hepatitis in non-immunocompromised cases. Main body The responsible pathogen “Adenovirus 41” is an enterovirus. Enteroviruses are spread by the fecal-oral route and are resistant to drying. As such, they predominate in sewage water. Hepatitis is normally restricted to poorer countries, yet this new wave seems to be confined to mostly high-income countries in Europe and the USA. These countries treat and recycle a higher percentage of sewage water. We also propose that the fulminant nature of this strain could be due to either a cross-species mutation or the general decrease in trained immunity post-COVID-19 lockdown. Short conclusion Evidence strongly suggests that the link between these new hepatitis cases is recycled sewage water. This should warrant further investigations on the origin of this outbreak by re-visiting the role of recycled sewage water in causing such outbreak.
ISSN:2090-9942
1110-6638
2090-9942
DOI:10.1186/s43054-022-00113-2