The mysterious hepatitis of children, 228 reports and still no why

In just under a month, 228 cases of possible pediatric acute hepatitis of still unknown origin were reported to the world health authorities and over 50 are currently under investigation. An escalation that is frightening due to the speed, gravity, global diffusion and above all because the cause still remains a mystery. It was Tarik Jasarevic of the World Health Organization who took stock of the situation. “From the first report arriving from the UK on 5 April until 1 May 2022 there are now at least 228 probable cases reported from 20 countries and there are over 50 that are now under investigation. Now, therefore, we have cases reported from five regions of the country. ‘WHO, the Eastern Mediterranean, Europe, Pan-America and even the Southeast Asian and Western Pacific region, “he explained.

In the last few hours a case has also been reported in Argentina, it is an eight-year-old boy hospitalized in the Rosario pediatric hospital. To date, one death has been confirmed worldwide from this disease, while four other deaths are being investigated. 18 minors have had to receive a liver transplant.

What worries us is the difficulty in identifying the origin of the pathology. The tests for the viruses that are known to cause the disease have given negative results, the link with Covid is excluded, the relationship with a specific territory or food is also excluded because the cases have a dislocation that does not allow a typing of this kind. In short, a mystery.

“At the moment – reads the latest document released by the Institute of Health (April 29, ed) – none of the theories formulated on the origin has had a confirmation through scientific evidence. Furthermore, every year in Italy, as in other countries, a certain number of hepatitis with unknown cause occurs, and analyzes are underway to establish whether there is actually an excess. Initial hypotheses from the UK investigation team proposed an infectious etiology or possible exposure to toxic substances. Detailed information collected through a questionnaire relating to food, drink, personal habits of the cases did not reveal common exposures. Toxicological investigations are ongoing, but an infectious etiology appears to be more likely based on the epidemiological picture. Microbiological investigations excluded hepatitis A, B, C, D and E viruses in all cases. ‘On the basis of current investigations – writes the ECDC in its Risk Assessment of 28 April – the currently most plausible hypothesis is that a cofactor affecting children who are having an infection with adenovirus, which would be mild under normal circumstances, trigger a more serious infection or immune-mediated liver injury. Other causes are still under investigation and have not been ruled out ‘”.

The focus is on monitoring. For two reasons: because a timely diagnosis increases the chances of cure and recovery and to have an exhaustive picture of the situation. In recent weeks the warning “do not do as for Covid” – that is, do not underestimate the disease – resounds from one end of the globe to the other.

In Italy, due to the increase in pediatric acute hepatitis cases (by decree of 27 April), a crisis unit was set up, which includes the Ministry of Health, the Higher Institute of Health, Regions, Agneas (Agency for regional health services ), Aifa (Italian drug agency), Nas (anti-sophistication carabinieri) and scientific societies. “In the awareness that the situation must be carefully followed and monitored. A new ministerial circular is being defined, aimed at standardizing and coordinating the control and public health measures on the national territory”, explained Andrea Costa, Undersecretary of Health, by replying in the Social Affairs Committee to a parliamentary question presented by the M5S.

The European Center for Disease Prevention and Control then drafted a reporting protocol “to report national data from all countries and areas of the WHO European region, including the 27 countries of the European Union (EU). and the other three countries of the European Economic Area (SEE), at the European level “.

Parents, according to WHO, “should pay attention to hepatitis symptoms, which are an acute onset of diarrhea, vomiting, abdominal pain and jaundice, where the skin and whites of the eyes turn yellow”, while “most of the children do not have a fever “. To prevent children from becoming ill, it is important to “take normal measures that help protect against common viruses,” such as hand washing and respiratory hygiene.

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The mysterious hepatitis of children, 228 reports and still no why

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