Department of Health on alert for pediatric cases of acute hepatitis of unknown origin

The Department of Health, together with a team of pediatric gastroenterologists in Puerto Rico, are on alert before the call of the World Health Organization (WHO) to be vigilant to any condition of acute hepatitis of unknown origin that develops in minors, this after it was reported that at least 169 children from 11 countries presented a strange and worrying picture of the disease, to the extent that one of them died and 17 have needed a liver transplant.

At the moment, in Puerto Rico, no suspected or confirmed cases of this rare form of hepatitis of unknown origin have been detected, which until last week had affected patients between one month of birth and 16 years of age in places such as the United Kingdom, Spain , Israel, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania, Belgium and the United States.

However, as explained to First hour the First Medical Officer of the Department of Health, Iris Cardona, As soon as the alert was issued by the WHO and the Centers for Disease Control and Prevention (CDC) detected the first cases in the United States, a national alert was raised urging doctors to be aware of the symptoms of their patients and issue Immediate reports to health agencies.

“In Puerto Rico there is an association of pediatric gastroenterologists, who are specialists in liver diseases, and I contacted the group as soon as this situation arose. They discussed what is happening, which we know is something that is still under investigation, and we are all pending, ”explained the pediatric infectologist.

According to the information provided by the WHO and the CDC, the clinical picture among the cases identified with acute hepatitis (inflammation of the liver) includes fever and gastrointestinal symptoms such as abdominal pain, diarrhea, vomiting, as well as elevated levels of liver enzymes (aspartate transaminase, AST) or alanine aminotransaminase (ALT) greater than 500IU/L.

“But, fundamentally, they have changes in urine because it kind of turns dark, white. And the bowel movements become clearer. In addition, the skin and eyes turn yellow. This occurs because, when the liver stops working, the levels of bilirubin in the blood increase (jaundice) and the mucous membranes of the body are deposited under the skin,” Cardona explained.

The doctor explained that what is rare in the detected cases is that the common viruses that cause acute viral hepatitis (hepatitis A, B, C, D and E viruses) have not been detected in any of the cases. This makes the origin unknown.

In the nine cases identified in the United States until last week, particularly in Alabama, it was determined that all were positive for adenovirus type 41. According to the CDC page, they are boys or girls between the ages of 1 and 6 who they had previously been healthy. None of the minors was in the hospital due to SARS-CoV-2 infection. The first cases were identified in October 2021 at an Alabama hospital, where five minors with significant liver injuries were admitted. Hepatitis A, hepatitis B, and hepatitis C viruses were ruled out in all. No known epidemiologic link or common exposures were found among these pediatric patients.

According to Cardona, adenovirus is a common virus that spreads from person to person and causes respiratory and gastrointestinal symptoms and conjunctivitis.

“In children it is seen quite a bit and it is transmitted just like COVID or Influenza, by drops. There are many types of adenovirus, but type 41 is the one that has been associated with these cases of acute hepatitis. This is what is being investigated, because it has not previously been identified as a virus that causes hepatitis,” explained the pediatric infectious disease specialist, adding that cases of liver inflammation have arisen with other diseases, for example, with patients with mononucleosis, dengue or Monga. “But, usually, they are mild and although the enzymes are altered, they later go down. In these cases that are being reported, we are talking about marked inflammations with values ​​above 500 ″, she added.

He clarified that infectious hepatitis in Puerto Rico is a mandatory reporting disease and constant surveillance is carried out by Health for type A, B and C.

“I know A and B well because we have vaccines against these two types of the disease. And I can tell you that we haven’t had any reports of Hepatitis A or B in children recently. Yes there have been adult cases but not related to outbreaks, ”she commented.

Given the alert picture, the CDC and the Department of Health of Puerto Rico are asking doctors to test pediatric patients with hepatitis of unknown origin for adenoviurs. In addition, they must make the report to the health authorities immediately.

“Pediatricians are vigilant and they know it too. The alert is essential for doctors and citizens are told that if there are symptoms such as vomiting, dehydration and changes in the color of the children’s skin, among other factors that we already mentioned, then they should seek help from their pediatrician and if it is It is more serious to go to an emergency room,” Cardona pointed out.

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