The Directorate-General for Health is following an alert from the European Center for Disease Control and the World Health Organization following a series of unspecified cases of acute hepatitis in infants, first in Scotland but also in the United States. , Spain, the Netherlands and Denmark. The origin of acute hepatitis is still unknown, but several countries are now reporting a similar phenomenon, so part of what appears to be more prevalent than a strictly local phenomenon has been intrigue and alarming physicians who have noticed an increase in more serious disease. diagnosis.
First, because in children, unusual clinical conditions were not associated with hepatitis viruses, which would be the first hypothesis. However, it is known that various infections can affect the liver. With the pandemic still high and the coronavirus virus being routinely tested, it appears that some children had become infected with SARS-CoV-2 – one of the possible manifestations of covid-19 – but not everyone had this condition.
The second suspicion, currently the strongest, is against adenovirus, which has been diagnosed in some of the children in hospital. It is a respiratory virus that usually circulates seasonally, more in winter than in summer, but does not normally cause liver damage, leaving open whether it is a more aggressive variant or the result of younger children. there is less defense after two years of less social contact during a pandemic.
Portugal without cases
To iThe Directorate-General for Health announced on Monday that it was monitoring the alerts and that no notifications had been received so far. Rui Tato Marinho, Director of Gastroenterology and Hepatology at Hospital de Centro Hospitalar Lisboa Norte and Director of the National Viral Hepatitis Program at DGS, says i that monitoring of the situation began in recent weeks with reports of an increase in these cases in children. Late last week, when ECDC and WHO alerts were issued and the first cases were reported in Spain, the doctor added that the program alerted the Portuguese Pediatric Association so that paediatricians could also be awake.
“There is no need to worry, but to step up surveillance and be prepared to act if cases arise in the country,” emphasizes Rui Tato Marinho, explaining that at this stage it is too early to be sure of the cause of these hepatitis. . They are atypical because acute hepatitis in children is rare, and more worrying because liver transplants are needed in the most severe cases. Rui Tato Marinho also admits that in this return to school after the Easter holidays, this is an additional reason to maintain school hygiene and contacts with young children and that strengthening the guidelines may be necessary. In the UK, public health has already recommended that adenovirus is one of the suspects in hand hygiene, and parents have urged their children to wash them in addition to the breath label. When it comes to symptoms to look out for, jaundice (yellowing of the skin) is most important.
what is known
Despite the fact that international alerts were only heard last week, atypical numbers of cases of acute hepatitis in children began to be verified in March. An article published in Eurosurveillancand last week she looked at the situation in Glasgow, Scotland: 13 children are in hospital in these conditions until 12 April – the first on 11 January. Their average age is 3.9 years and the symptoms were jaundice, abdominal pain, nausea, diarrhea, vomiting and drowsiness, and according to the authors, doctors in the Scottish capital, none of the children were aware of any previous illnesses.
After hospitalization, they had a negative test for hepatitis A, B, C, and E viruses. Five had a recent SARS-CoV-2 infection and five had a positive adenovirus infection that returned this year. pandemic circulation, but it is not routinely tested, so it may go unnoticed.
The team noted that in addition to the high number of cases in a short period of time – four cases of hepatitis of unclear etiology per year are generally expected in Scotland – doctors particularly noted the severity of clinical symptoms.
By the time the article appeared, one child had already needed a liver transplant and two others had been evaluated. They write that the original hypotheses suggested that there could be a case of poisoning, such as food, which they rule out because there are, however, more confirmed cases in the United Kingdom and the United States. “At the time of this publication, the main hypothesis focuses on adenovirus – either a new variant with a clear clinical syndrome, or a variant that routinely circulates but affects children who are immunologically naive the most. This latter scenario may be due to social contact limitations during the covid-19 pandemic.” , they acknowledge, but do not rule out, the possibility that another source of infection, such as a recent infection with Omicron BA.2, which has controlled Variant 2 or a new virus, they also pointed out that none of the children had been vaccinated against the Covid-19 virus.
More than 70 cases have now been reported in the UK. In Spain, three children (22 months and 13 years old) were reported, and one of them also needed a liver transplant. In the United States, the alert was heard in Alabama, where the Department of Public Health said all children (nine) were under the age of ten and tested positive for a particular variant of adenovirus (adenovirus 41) associated with severe cases of diarrhea. When the number of cases reported in recent days is added, there are already about a hundred. The World Health Organization considers it more likely that more can be detected before tracing the origin, acknowledging that it may be biological or chemical, and appropriate control and prevention measures. So far, the measures available and recommended during the pandemic are generalized measures that are the basis for the prevention of many infections: wash your hands often, do not cough or sneeze at others, precautions will be intensified, especially among children.