The Directorate General of Health is following up on the alert issued by the European Center for Disease Control and the World Health Organization after several cases of acute hepatitis in young children, of undetermined origin, were reported, first in Scotland but in the meantime also in the United States, Spain, the Netherlands and Denmark. The origin of acute hepatitis is still unknown, but with a similar phenomenon now reported in many countries, parts of what appear to be more general and not strictly a local phenomenon, which has been of concern to clinicians who have noted an increase in severe cases. diagnoses.
First of all, because the clinical cases, which are unusual in children, were not related to the hepatitis virus, which would be the first hypothesis. However, it is known that various infections can affect the liver. As the epidemic continues to spread with high levels of virus transmission and coronavirus testing is done routinely, some children appear to have contracted SARS-CoV-2 – a possible manifestation of covid-19 – but not all of them have the condition.
Another suspicion, at the moment the strongest, falls on the adenovirus, which was diagnosed in some children in the hospital. It is a respiratory virus that is more seasonal in winter than in summer, but it does not usually cause liver damage, leaving it open whether it is a more aggressive variant or as a result of younger children. They have fewer defenses after two years to reduce social contact during an epidemic.
Portugal without issues
to me meOn Monday, the Directorate General of Health indicated that it is monitoring alerts and that so far there are no notifications in the country. Rui Tato Marinho, Director of the Gastroenterology and Hepatology Service at De Centro Hospital Lisbon Norte and Director of the National Viral Hepatitis Program at the Directorate General of Surgery (DGS). me The situation began to be monitored in recent weeks when reports began to show an increase in these cases in children’s age. Last weekend, 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 Society so that pediatricians could also be alert.
Rui Tato Marinho stresses that “there is no cause for concern, but to strengthen monitoring and readiness to act in the event of cases emerging in the country,” explaining that at this stage it is too early to ascertain what explains this hepatitis. It is atypical because it is uncommon to have acute hepatitis in children and more concerning because in severe cases a liver transplant has been needed. Rui Tato Marinho also acknowledges that in this back-to-school after the Easter break, this is all the more reason to keep health care in schools and in contact with younger children and that it may be necessary to strengthen the guidelines. In the UK, Public Health has already recommended, with adenovirus being one of the suspects, the promotion of hand hygiene, with parents encouraging their children to wash it, in addition to respiratory etiquette. As for the symptoms to watch out for, jaundice (yellow skin) is the main cause.
What is known
Despite the fact that international alerts have sounded only last week, verification of the unusual number of cases of acute hepatitis in children began in March. Article published in EurosurveillancAnd last week he reviewed the state of cases in Glasgow, Scotland: There are 13 children who have been hospitalized under these conditions as of April 12 – the first on January 11. Their average lifespan is 3.9 years and symptoms include jaundice, abdominal pain, nausea, diarrhea, vomiting and lethargy, and according to the study authors, doctors in the Scottish capital, none of the children had any knowledge of pre-existing illnesses.
After they were admitted to hospital, they tested negative for hepatitis A, B, C and E. Five of them had a recent history of SARS-CoV-2 and five tested positive for adenovirus, which this year resumed their prior levels. The epidemic has spread but has not been routinely tested, so it may go unnoticed.
The team concluded that in addition to the high concentration of cases in a short period of time – four cases of hepatitis of unspecified etiology are normally expected in Scotland each year – clinicians noted the severity of the clinical manifestations in particular.
When the article was published, one of the children actually needed a liver transplant and two other children underwent evaluation. They wrote that initial hypotheses included that it could have been a case of poisoning, for example food, which they rule out because there are, however, more confirmed cases in the UK and US. “At the time of this publication, the main hypothesis focuses on adenovirus – either a novel variant with a distinct clinical syndrome or a variant that is routinely prevalent but severely affects immunologically naive children. This latter scenario may be the result of limitations in social contacts during the covid-19 epidemic. ”, they admit, without excluding that there may be another infectious source, for example recent infection with the BA.2 variant of Omicron, which has dominated the spread of the coronavirus, may increase vulnerability; Or it is the result of another uncharacteristic variant of SARS-Cov-2 or a new virus. They also noted that none of the children had been vaccinated against Covid-19.
In the UK, there are now more than 70 reported cases. In Spain, three children (ages 22 months to 13 years) were reported and one of them also required a liver transplant. In the US, the alert went off in Alabama, where the Department of Public Health said all (nine) children were under 10 years old and had tested positive for a specific variant of adenovirus (adenovirus 41) associated with severe diarrheal cases. Adding up the cases reported in the past few days, there are already about a hundred cases. The World Health Organization considers that more is likely to be discovered before the origin is determined, recognizing that it could be biological or chemical, and appropriate control and prevention measures. At the moment, the measures available and recommended are those that have been circulated during the epidemic and that are the basis for preventing many infections: wash your hands frequently and do not cough or sneeze at others, precautions that must be reinforced especially among children.
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