No abstract

Organization (WHO) received reports of 1,010 probable cases of severe acute hepatitis of unknown etiology (SAHUE) in young children from 35 countries (1). Many cases resulted in severe clinical outcomes; ≈5% of patients required liver transplants, and 22 died. Most (48%) cases were reported from the WHO European Region, and 484 cases were reported in previously healthy children from 21 countries (1). Ireland reported 28 probable cases of SAHUE in non-A-E hepatitis, including 2 patients who received liver transplants and 1 who died but did not receive a transplant (2).The causes of SAHUE remain unclear. A possible connection with SARS-CoV-2 has been suggested (3), but SARS-CoV-2 RNA was detected in only 16% of SAHUE cases reported in the WHO European Region (1). Recent studies suggest a possible association between SAHUE and human adenovirus (HAdV) species F type 41 (HAdV-F41) and adeno-associated virus 2 (AAV2) infections (4,5; A. Ho et al., unpub. data,

Soft fruits are at particular risk of contamination with enteric viruses such as Hepatitis A virus (HAV), Hepatitis E Virus (HEV), Norovirus (NoV), Human Adenovirus (HAdV) and Sapovirus (SaV). The aim of this study was to investigate, for the first time, the presence of these biological agents in ready to eat (RTE) berries at point of retail in Ireland. A sampling strategy was designed in which RTE fresh and frozen strawberries and raspberries were purchased from five retailers between May and October 2018. Reverse Transcriptase Polymerase Chain Reaction (RT-qPCR) assays for HEV RNA, Nov RNA, SaV RNA, and human Adenovirus species F DNA (HAdV-F) were performed on 239 samples (25g portions). Viral nucleic acid was present in 6.7% (n = 16) of samples tested as follows: HAV RNA (n = 5), HAdV-F DNA (n = 5), HEV RNA (n = 3) and NoV GII RNA (n = 3). Sapovirus RNA was not detected in any product. No significant differences were found between berry type, fresh/frozen status, or supermarket source. This study suggests a risk that exists across all retail outlets however only low levels of nucleic acid ranging from 0 to 16 genome copies/g were present. Although these findings may reflect non-viable/non-infectious virus the continued provision of risk mitigation advice to consumers is warranted and further work is required to ensure control measures to reduce contamination are implemented and enforced.

The results are reassuring in that definite iatrogenic hepatitis virus transmission has not been found in this cohort, despite long-term treatment with a wide range of immunoglobulin products. The source of infection of the single patient infected with HGV remains as uncertain as the pathogenic potential of this virus. However, as long as the risk of immunoglobulin-associated viral transmission continues, a strict monitoring programme such as ours should continue to facilitate prompt detection of cases with abnormal liver function. Liver dysfunction in this group requires full investigation and we cannot exclude infection with hitherto unidentified blood-borne viruses.

We report here the first near-complete genome sequence (7,463 nucleotides) of a human sapovirus GI.2 variant from Dublin, Ireland, detected in an adult with gastroenteritis in 2016.