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Acute childhood hepatitis: 10 doubts resolved by a medical specialist

2022-05-26T04:01:25.465Z


Roberto Vázquez Campuzano, academic from the Faculty of Medicine at UNAM, gives recommendations to families about the new disease of unknown origin


Acute childhood hepatitis has caused nervousness in dozens of countries.

The main reason is in the name of the disease: it affects children and adolescents.

Added to that is its unknown origin.

It is not conclusively known what spreads it or how and, therefore, there are still no specific measures to stop it.

After two years of the pandemic, the World Health Organization issued an international alert to redouble international efforts to detect this new disease.

Until this week there are about 600 reported cases in the world, while in Mexico there are between 20 and 30 known cases, according to health authorities.

"We are in a time that had not been experienced since the influenza pandemic of 1918", explains Roberto Vázquez Campuzano, professor at the Faculty of Medicine of the National Autonomous University of Mexico.

"This confinement, this need to be apart, has generated stress in people and fear of new infections, but in reality you have to be vigilant and, above all, calm," he says.

The researcher refers in an interview that around 30 new diseases are discovered each year and "most of them do not cause many problems."

Vázquez Campuzano answers the most common questions and gives his recommendations to prevent childhood hepatitis.

1. Beyond its unknown origin, what is acute childhood hepatitis and how is it different from other types?

The symptoms are a little different and it has only occurred in children under 16 years of age.

That is the main feature.

Among the symptoms we are going to have the classic ones of hepatitis: fatigue, malaise, fever, jaundice, dark urine and grayish stool.

But nausea, vomiting and diarrhea can also occur, something that is not seen in other types.

Hepatitis A virus is the virus most frequently associated with infection in children.

And for this case, it is said that the younger the age at which the infection is acquired, the fewer symptoms there will be.

Children who are infected with hepatitis A and are under the age of six develop virtually no symptoms.

It is a very mild disease that usually goes unnoticed.

The rest of the viruses associated with hepatitis can also cause infection in children, but these are rarer cases.

2. What happens in our bodies when we get some type of hepatitis?

Hepatitis is an inflammation of the liver and has different causes that produce it.

We can have alcoholic hepatitis, toxic or drug hepatitis and infectious hepatitis.

In the case of infectious hepatitis, there are viruses that grow inside the liver called hepatocytes and produce interleukin release.

And this is associated with inflammation.

It is the same response of our organism against an infection.

The set of symptoms has to do with the functions of the liver.

One of the processes it performs, for example, is to metabolize bilirubin, a pigment that comes from the hemoglobin in our red blood cells.

Being unable to transform it, it accumulates.

And this pigment, that bilirubin, is what accumulates in the skin and gives us that yellow tint [the so-called jaundice].

Since bilirubin cannot pass into the excretion system, it also accumulates in the urine and therefore appears darker.

It is also not eliminated in the fecal matter and that is what makes it appear whitish.

All the symptoms that are observed in hepatitis have to do with this inflammatory process.

3. How many types of hepatitis are known?

There are about 20 viruses that have the liver as their target organ, which are hepatotropic viruses.

The most common are five: the hepatitis A virus, hepatitis B, C, D and E, but there are others.

We have the hepatitis G virus or the hepatitis DD virus, for example, which is transmitted by transfusion.

There are many, but the prevalence is very low for some types and for others we do not know.

For this reason, we say that there are basically five viruses that can cause infectious hepatitis.

Most of the time they are viral, but they are not necessarily produced exclusively by viruses.

4. What can parents and children do to prevent childhood hepatitis?

Covid taught us that good hygiene habits serve to prevent infectious diseases.

In this case, basically the same applies, such as washing hands frequently and using disinfectant gel.

Something that is very important is to disinfect toys and all objects that children can put in their mouths to avoid contagion.

It is good to wash food, eat it well cooked and be careful to consume drinking water.

As soon as you notice that the child has any of the manifestations that are most associated with hepatitis, that yellowish tint to the skin and eyes, it is advisable to seek medical attention.

5. What turns a mild condition into a serious case that may require a transplant or cause the death of the patient?

It is very difficult to answer that question, because the cause of this hepatitis is not yet known.

It is assumed that it may be an infectious or a toxic hepatitis, but the real cause has not yet been identified.

Until then, the evolution will not be known or why there are patients who are infected in a more or less severe way.

It is also not yet known what is the reason that there have been no cases in adults.

A publication from the CDC [the United States health authorities] indicates that they have not seen an increase in the number of hepatitis cases nor in the demand for liver transplants compared to previous years.

So, another theory is that it may be something that was already happening, but no one had noticed.

6. Do known hepatitis vaccines help prevent this new type?

No. There is a vaccine against the hepatitis A virus and another against the hepatitis B virus. But they are specifically against those two types.

There is no vaccine that has shown protection so far.

7. What are the main hypotheses about the causes of acute childhood hepatitis?

There are many theories.

The first is that it is an infection with adenovirus 41 or 40, a family of viruses that is often associated with respiratory and gastrointestinal problems.

They are the two viruses that have been found in a percentage of infected children.

It could also be that it was a toxic hepatitis, as a result of the consumption of a medication.

Some drugs that have been associated with hepatitis are already being investigated.

For example, paracetamol, which has now been widely used during the pandemic.

That could be another possibility.

It has not been ruled out that it is an infection after a covid infection.

The journal

The Lancet

just published a document a few days ago stating that after people are infected with covid, an inflammatory response remains in the intestine, which is known as a cytokine storm.

The arrival of these new adenoviruses triggers a stronger response, a hyperreactivity.

A large number of toxins are produced and precisely because of this, serious disease occurs in these patients.

These are the theories that are being handled so far.

8. Is there any relationship with anticovid vaccines?

No. That's ruled out.

It's fake news.

What you have to see is if there is a possibility that they have been infected with covid.

It must be remembered that most of the cases in the world are in children who did not have the vaccine.

In addition, many of them had not presented symptoms of covid or it is possible that they were asymptomatic.

9. Should the number of cases that have occurred in Mexico concern us or is it within what is expected?

We must be alert, but not worry.

Surely, we will observe cases.

We have around twenty cases described, but none have been confirmed.

They are all probable cases.

If we were already clearly convinced that adenovirus 41 is the cause of this hepatitis, then we look for this virus and if it is found, it means that it is this type of hepatitis.

Unfortunately, since we don't know what the biological agent is, I can search for 20 different viruses and maybe two or three come up.

So we don't know if those are actually the cause of the disease.

We cannot speak of "confirmation" because there is still no etiology.

The samples that are sent to the Indre [Institute of Epidemiological Diagnosis and Reference] are not very complicated, but they are many.

That makes the analysis take time.

Specialists have to test for hepatitis A, B, C and E, and each test takes about two hours to get a result.

In addition, molecular biology tests are being carried out to detect other viruses, for example, from the herpes family, which have normally been associated with hepatitis

and adenoviruses.

It is a long process, it is not something that can be done in a short time.

10. What can be expected for the next days and weeks?

The outlook is still uncertain.

Hard research is being done to identify the cause, but so far it has not been possible to know why the disease occurs.

There are many theories and they all need to be confirmed.

In Europe, work is being done on the infectious part.

In the United Kingdom the toxicological part is studied.

We are exchanging samples between several countries to be able to identify the presence of an agent by sequencing.

A result is expected soon.

Are cases going to continue?

Definitely yes.

Are we going to have complications?

Probably.

Deaths?

We do not know.

It's a posibility.

So, we have to continue investigating, preparing ourselves and being very vigilant in prevention.

To identify the cases and to be able to give the best attention to the children, particularly to prevent them from getting complicated and from having any serious problems in the future.

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Source: elparis

All news articles on 2022-05-26

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