Unknown childhood acute hepatitis: what it is and causes

“I met with representatives of the Italian Federation of Pediatricians this morning. Its network of proximity is essential to protect the health of children and assist their families. These days they are also busy monitoring any case of acute hepatitis in children. Italy can count on its passion and great professionalism at all times. “The Minister of Health, Roberto Speranza, at the end of the meeting with Antonio D’Avino, President of the Italian Federation of Pediatricians, will send the instructions issued today. by the Ministry of Health to activate a state of maximum attention to the risk of disease.Family pediatrics has made immediate availability by activating a surveillance network across the territory of cases of hepatitis that have erupted in the United Kingdom.

According to Andrea Ammon, director of the European Center for Disease Prevention and Control, it would be a link to adenovirus infection. “The most common clinical presentation was jaundice, then yellowing of the skin and eyes, followed by vomiting and gastrointestinal symptoms compatible with adenovirus that some research points out, but then some of these children have had more severe and very severe liver symptoms. failure that required emergency liver transplants “.

To those who venture a correlation with the new coronavirus and the anti-Covid vaccine, Undersecretary of Health Pierpaolo Sileri, on Radio Inblu 2000, clarified that there is no correlation: “It was not the vaccine against Covid-19, there is no For children under 5 years of age, in the UK they are not vaccinated under the age of 10, there is no correlation with the vaccine or the virus. enough to establish a relationship “.

Eleven cases have been reported so far in Abruzzo, Emilia-Romagna, Lazio, Lombardy, Marche, Sicily, Tuscany and Veneto. A patient does not fall within the case definition (admission before January 2022); two cases are being evaluated for possible other etiological causes; four cases can be defined as “suspicious” (exams are ongoing or undefined); two cases defined as “possible” (more than 10 years); two “confirmed” cases. So far, positivity has only been reported for Adenovirus or Sars-CoV-2 in two suspected cases. However, the role of adenoviruses in the etiology of these forms of acute hepatitis, hypothesized by researchers in the United Kingdom, is not definitively confirmed. One “possible” case was a liver transplant. Several regions – Campania, Piedmont, Liguria, Aosta Valley, Calabria, Puglia – have reported that they currently have no case to report.

“At the moment we are not sure about this form of acute hepatitis in children. As in all viral situations, unfortunately already experienced in recent years, when such a situation arises it is necessary to wait for science to take its course. It is useless to try to give answers that at the moment could be inaccurate, useless or even counterproductive, “Paolo Biasci, former president of the Italian Federation of Pediatricians (Fimp), told Adnkronos Salute.

“At the moment we run the risk of giving partial answers which then later go ‘wrong’ and we run the risk of compromising communication aimed at families. We are now at a stage where scientific research is being carried out. and an important surveillance activity.items to deal with an emerging problem.At the moment we do not register many concerns of families but we expect them because, unfortunately, even at the media level, this phenomenon is growing. scientifically and, consequently, more detailed recommendations Our job is to do surveillance activities We do it for everything We now have this alarm bell and our attention will be maximum.Italy has a huge advantage over other countries, to have a pediatric family., that is, a doctor dedicated to the single child in the area, a professional who also has the opportunity to ring the alarm bell against the spread of pathology unexpected gies. It is a tool that not all countries have and that, in this new alarm linked to acute hepatitis, is certainly important. Families need to be assured that in Italy, every child or teenager has their own pediatrician in the area, which is not the case everywhere. Surveillance, therefore, is more effective and timely. “

Massimo Andreoni, head of Infectious Diseases at the Tor Vergata Polyclinic in Rome and scientific director of the Italian Society of Infectious and Tropical Diseases, spoke again to Adnkronos Salute: “On cases of acute hepatitis of unknown origin, we remind you that We are facing few complaints in the world, so we need attention and report any other suspicious cases without creating unmotivated panic in the population.We expect the results of science, research can be laborious and complicated, for now we can not rule out that we We are dealing with a new virus that may have altered the child’s acute hepatitis.There are usually cryptic hepatitis of unknown etiology and specialists are moving on several fronts: viral origin, food poisoning or even Given this distinction, in the cases of viral hepatitis of unknown origin registered so far in the world, we can exclude the scenario of food origin because we do not have a cluster family or restricted to one city, but several cases scattered around the world. Even on the assumption that there may be an immunological or autoimmune origin, the number of cases exceeds expectations. The origin of the infection remains but must be demonstrated, especially that which focuses on adenovirus, since not all confirmed cases today have the presence of adenovirus. Finally, there is also the possibility, however difficult, that there is a mutated adenovirus behind it. If there are any symptoms such as vomiting, fever, abdominal pain or yellow eyes, call your pediatrician. It will be the doctor who will understand if we are dealing with a gastrointestinal condition or something different and will activate the necessary controls “.

“Our first data indicate, as of January 2022 in Italy, 17 cases of acute hepatitis of unknown etiology and only 7 patients are less than six years old. An absolutely congruent figure compared to the previous three years, 2019 2021. These data confirm that no abnormal increase in hepatitis cases has been documented in our country to date, as in the United Kingdom. ”Angelo Di Giorgio, a pediatric hepatologist at the hepatology and transplants at Pope John XXII Hospital in Bergamo, coordinator of the liver-pancreas area of ​​the Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition, a scientific society that launched a survey a few days ago, addressed to pediatric hepatology centers, to check for possible increase in acute hepatitis. “At present, therefore, there are no indications of abnormalities with respect to these hepatitis. This is an expected figure: hepatitis is an inflammation of the liver that can cause many viruses, but most children recover and are well. pathologies we have been facing. since the 1930s, ”he said. The result was also confirmed by the fact that “one of the questions in the survey was whether doctors had the perception of the increase in cases at their center. No one answered yes.” “The survey will close tomorrow. And I hope that some other centers will respond again. Other cases may be reported, but this will not affect the final result much. The 17 respondents represent the answer 24 hours after the survey,” which involved 41 centers, but highly representative because they include all third-level transplant and hepatology centers ”.

There are about 190 reported cases worldwide, forty of them in the European Economic Area. This is the update provided by Andrea Ammon, Director of the European Center for Disease Prevention and Control (ECDC). “The United Kingdom was the first country to sound the alarm in early April and reported more than 100 cases, now more countries have reported them, including 10 EU / US countries, but also Israel and the United States. Many of these children have had severe hepatitis, several have had liver failure and some have required a liver transplant, a sample of the severity of the disease.Investigations are underway in all countries reporting cases but The exact cause of this hepatitis is still unknown. “

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