Acute infantile hepatitis scares pediatricians of the Ats vademecum

The head physician of San Matteo, Marseglia: “Known disease, but the causes are still unknown”


Report all cases of children with symptoms of acute childhood hepatitis: liver disease still to be framed under the lens of regional health surveillance. Which now raises the threshold of attention, asking pediatricians and hospitals to report on the infectious disease portal all cases of children and young people under 16 with out-of-scale liver values ​​and acute hepatitis that excludes viral strains A and E.

There are already 11 cases of this disease in Italy (as of April 22) with two small patients hospitalized in the province of Bergamo, one of them undergoing a transplant. About forty infections in the EU, about a hundred in the United Kingdom.

The regional initiative shared with Ats, paediatricians from Pavia and hospitals follows the request of the Ministry of Health to track and report cases in a timely manner, and is also addressed to the Asst and scientific hospitalization institutes. Like the San Matteo polyclinic: «We are ready to handle any cases that, I hope, do not occur. At the moment there has been no diagnosis in the ward ». This was explained by Gian Luigi Marseglia, head of pediatrics at the Pavia polyclinic. Which reassures: «The symptoms do not seem different from other known hepatitis: they are clearly recognizable. This gives us a great advantage because we are prepared to face it ». On the territory, the guard is high: «The relationship is very close between the hospital and the family pediatricians – continues Marseglia – and we are in direct dialogue with the professionals of the area to tighten the shirts and report the cases immediately. The symptoms are clear and the pediatricians know them very well ».

What is striking about this still unknown form is the incidence: compared to other more widespread diseases, viral hepatitis affects about two hundred patients a year, with a downward trend for the forms counteracted by the vaccine. The total cases reported in Lombardy are 42 in 2021. According to Epicentro, the Italian incidence last year among patients under 14 years old was zero for some viral strains. Like hepatitis B, with zero cases for every 100,000 children under the age of fourteen.

This is one of the reasons that makes the cases reported so far among children relevant: eleven as of April 22, two of which in Lombardy. They aroused attention and activated surveillance: “Also thanks to vaccines, there are not many cases involving children – explains Claudio Cravidi, pediatrician from Stradella and professor at the University of Pavia -. There is no need to be afraid but we must monitor the phenomenon, it is the phrase that I repeat also to the parents who have raised their doubts. What is striking, reading the cases of which we have news, is the aggressiveness of this pathology, with very high liver enzyme values ​​and I would say fulminant symptoms ».

The horizon is that of hypotheses. Among these could be a mutated adenovirus: pathogenic which, as noted by the Ministry of Health, “does not commonly cause hepatitis, which is a rare complication known among immunocompromised individuals”. It is still early to define the cause: «It is not clear to us whether it is a new virus or a pathogen already studied, which has acquired a particular aggressiveness due to a mutation: a phenomenon that can occur in particular contexts or in predisposed subjects. There is no link between the cause of the disease and its effects, which are known. The causes are not yet, but they will soon be ». The Region has set for April 26 a meeting with the hospital directors, the Ats, the representatives of the departments concerned, pediatricians and family doctors. –

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