Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey.
College of Medicine and Health Science, Abrar University, Mogadishu, Somalia.
BMC Infect Dis. 2021 Aug 30;21(1):890. doi: 10.1186/s12879-021-06594-7.
Hepatitis A is one of the most common infectious causes of acute hepatitis, and currently, a neglected global public health problem necessitating an urgent response in Somalia. Hepatitis A infection and its rare complication of acute liver failure in children are largely based on very limited data. The aim of the study was therefore to investigate the Hepatitis A infection and its rare complication of acute liver failure in children in Somalia.
This retrospective study was conducted on children aged 0-18 years who were admitted to the pediatric departments of the Somalia Mogadishu-Turkey Training and Research Hospital, Somali, from June 2019 and December 2019. Patients who were tested for hepatitis A infection during the study period and had complete data were included. Children with chronic disease, primary or secondary immunodeficiency, blood transfusion history, and missing data were excluded. Abstracted data including patients' demographics, clinical presentation, laboratory results, ultrasonographic findings, length of hospital stay, clinical course and outcome were retrieved from the hospital database system.
Of the 13,047 children, 219 were analyzed. Of the 219 Hepatitis A cases, 25 (11%) were diagnosed with pediatric acute liver failure (PALF). The mean age of children with Hepatitis A was 6.7 years. The majority of cases were reported in the 5-9 (39.7%) year age range. Hepatic encephalopathy, length of hospital stay, levels of albumin, and values of PT, aPPT, and INR were significantly higher in children with acute live failure. The presence of cholecystitis and cholecystitis with ascites in the sonographic evaluation were poor prognostic markers for acute liver failure.
This study revealed hepatitis A virus infection and its related acute liver failure among hospitalized children in Somalia of which 11% had PALF. Hence, the introduction of Hepatitis A vaccination, which is the main public health tool, into the national immunization program, the improvement of hygiene conditions, raising awareness of the disease, and increasing health literacy are necessary to prevent the consequence of the Hepatitis A virus in children.
甲型肝炎是急性肝炎最常见的感染原因之一，目前是一个被忽视的全球公共卫生问题，在索马里急需采取应对措施。甲型肝炎感染及其在儿童中罕见的急性肝衰竭并发症主要基于非常有限的数据。因此，本研究旨在调查索马里儿童甲型肝炎感染及其罕见的急性肝衰竭并发症。
本回顾性研究纳入了 2019 年 6 月至 2019 年 12 月期间在索马里摩加迪沙-土耳其培训和研究医院儿科就诊的 0-18 岁儿童。研究期间接受甲型肝炎感染检测且资料完整的患儿纳入本研究。排除患有慢性疾病、原发性或继发性免疫缺陷、输血史以及资料缺失的患儿。从医院数据库系统中提取患者人口统计学、临床表现、实验室结果、超声检查结果、住院时间、临床病程和结局等资料。
在 13047 名儿童中，219 名进行了分析。在 219 例甲型肝炎病例中，25 例（11%）被诊断为儿童急性肝衰竭（PALF）。甲型肝炎患儿的平均年龄为 6.7 岁。大多数病例发生在 5-9 岁（39.7%）年龄组。肝性脑病、住院时间、白蛋白水平以及 PT、aPPT 和 INR 值在急性肝衰竭患儿中显著升高。超声评估中胆囊炎和胆囊炎合并腹水是急性肝衰竭不良预后的标志物。
本研究揭示了甲型肝炎病毒感染及其相关的急性肝衰竭在索马里住院儿童中较为常见，其中 11%的患儿发生 PALF。因此，有必要将甲型肝炎疫苗接种（主要的公共卫生工具）纳入国家免疫计划，改善卫生条件，提高对该病的认识，增强健康素养，以预防甲型肝炎病毒对儿童的影响。
