Portugal has an “anti-hepatitis brigade available 24 hours a day”
Dsince the UK launched the alert that 10 children will have all been hospitalized with hepatitis and unknown, on April 5, that the cases are multiplying little by little. In Portugal, contingencies were identified before the first suspected case was identified, through the creation of a ‘monitoring task force’. With new cases under analysis, Rui Tato Marinho, director of the National Program for Viral Hepatitis, guarantees that the country has all the tools “so that things don’t go wrong, if a child doesn’t need us”.
in conversation with the News by the Minute, the director of Gastroenterology and Hepatology at the Centro Hospitalar Universitário Lisboa Norte (CHULN) advances the “known” outbreak, announced by the World Health Organization (WHO) on April 15, presents, in its genesis, gastrointestinal symptoms – such as abdominal pain , diarrhea and vomiting – as well as the extent of liver enzymes. If in some cases the ‘culprit’ may be an adenovirus, in others the coronavirus seems to be the ‘mystery agent’. The fact is that “there are no certainties at this point”.
The latest data released by the European Center for Disease Prevention and Control (ECDC), which created a Crisis Group to monitor the disease, report the existence of at least 450 cases of acute childhood hepatitis around the world, which has already caused the death of 11 children. However, the professor at the Faculty of Medicine of the University of Lisbon (FMUL) assures that this is not “an explosive focus”, reiterating that Portugal has “an anti-hepatitis brigade 24 hours a day” at its side.
Even before the first case appears in Portugal, that it is already seen on the defense to attack it
What could be behind this outbreak of acute or atypical hepatitis? What do you already know?
We have some evidence. It manifests itself in small children, with an average age of three years, and has a higher severity rate than we are used to, in which 10% may need a transplant. There were also some cases from one region, the UK and neighboring countries. In a certain percentage of cases, adenovirus – a form called F41 – was found, and some also had SARS-Cov-2 infection, which may have had a facilitating effect, with the two viruses in common.
Another characteristic is that the cause is not yet known, but there are some clues. What is a fact, there is a high frequency of children with acute hepatitis, with a high concentration – which is not very common – which is not usual. Even today I spoke to a pediatrician at the Hospital de Santa Maria, who said he hadn’t seen hepatitis for I don’t know how many years.
Why did ECDC decide to recover until October to locate possible suspects?
We are talking about an unknown hepatitis, a ‘criminal’ who doesn’t know who he is, and who may have started acting a few months ago. It is interesting to look with new eyes at the eyes of rare hepatitis than some other hepatitis a few months ago, knowing that there is an unknown entity, or that all information about children under 16 years old who had their probability in the last six months has increased. Until it leads to the discovery of a dozen more cases.
1. Interesting update on #Pediatric Hepatitis from @ECDC_EU + @WHO_Europe. It contains the first epicurve I’ve seen, which is very useful because the reported cases include current and past cases found through record searches. The 1st case here dates from September 2021. pic.twitter.com/16rST1K7F5
— Helen Branswell 🇺🇦 (@HelenBranswell) May 13, 2022
Case mentioned the presence of SARS-CoV-2 in some; the disease must be released, it may be due to an infectious cause, until Covid-19 may have had an influence on it. Do you share the same opinion?
Yes. When a cause is not known with absolute certainty, we must put several working hypotheses, more likely than others. In six months, probably with more cases, with more laboratory and clinical investigation, a more effective conclusion can be reached. What is the most certain conclusion? It’s a hepatitis of unknown cause, so I have to put several hypotheses and follow these clues that can operate.
At this point, what do these “clues” indicate?
In some cases it may be the adenovirus, others the coronavirus, in others it may not be the cause. There are no certainties at this point. In fact, in Portugal there are no confirmed cases – we have probable cases and are under investigation.
To prevent this, a very simple measure has been talked about everywhere, which is to wash your hands. It’s a little like us on the street and protect ourselves from the rain or a floor
Bearing in mind that it is only children who are also known, since the disease has already manifested itself in adolescents aged 16, how is it possible to prevent it?
From the data I have seen from the various countries, the vast majority are children under five. If my grandson, who is five years old, appears with a fever and in pain, there may be an alarm, because he is in the highest risk group. If my 16-year-old nephew appears with these symptoms, I will be more relaxed. To prevent this, a very simple measure has been talked about everywhere, which is to wash your hands. In the meantime, wash your hands if up to 10, and respiratory hygiene if it’s a virus, which we’re not sure yet. It’s a bit like walking on the street and protecting yourself from the rain or walking.
What signs should parents be aware of?
They should be aware if the child is sick, with fever, vomiting, diarrhea, prostration, lack of appetite. In addition, if you present the typical sign of the liver, which is the yellow color in the eyes – the so-called jaundice -, which implies a more serious situation, in which the person must go to the hospital. In most cases they go well, but they involve doing the live look.
We are prepared for whatever it takes, with an anti-hepatitis brigade available 24 hours a day
What treatment options are available once a cause has not yet been determined?
There is no treatment. If by a virus, you can start trying different antiviral drugs. There are not many examples of antivirals, but they even cure hepatitis C, per. But since I don’t know what the problem is, I’ll treat the consequences of the infection. If the child gets another infection, which can happen when it starts to fail, I’ll take care of it. If you start bleeding, same thing. It is a global treatment and not a specific one. If failure fails, there is the option of transplantation – it is not the most frequent, but it can happen. Now, in 10 children, there is a need to do something, which is much more frequent than what we are used to in this type of hepatitis.
For now, Portugal remains unconfirmed, despite having new suspicions. What contingencies do we have prepared in case this happens?
Portugal is very well prepared. We created a ‘task force’, which is the anti-hepatitis intervention body, made up of 13 elements from various aspects – doctors, nurses, public health specialists, and journalists. Even before the first case appeared in Portugal, it was already possible to observe the defense to attack whatever it was. We have periodically met, communicated the opinions of all colleagues abroad, communicated with the World Health Organization (WHO), and with structures.
We are prepared for everything that comes and, in addition, we have an excellent pediatrics, with more than two thousand pediatricians in the. Great mothers, great children, wonderful children – a few careful, but let’s take care a little more like concerned people. We have an excellent team to do liver transplants, already well oiled. I think we have everything to make sure things don’t go wrong if a child needs us.
Given the circumstances they take into account, do I consider there to be cause for alarm?
Clearly not. It’s not an epidemic, it’s not a pandemic, it’s not an explosive outbreak. It is something that confuses us, that bothers us in some way by the unknown, but we are not panicked. We are prepared for whatever it takes, with an anti-hepatitis brigade available 24 hours a day.
From the point of view until the diseases of knowledge, it is an opportunity for the healthy people that exist, that is a vital, and that can suffer from the people who suffer like diseases.
If an outbreak is confirmed in our country, what consequences in terms of health or health literacy could this have for our society?
A more or less good thing can be an opportunity for health literature, and to promote access to medical contact. Here, from the point of even liver disease, it is an opportunity for people to know that fas exists, that it is a vital organ, and that it can suffer from sight. Also that Portugal has one of the best vaccines for hepatitis B in children, which it managed to get rid of, and that we have treatments for hepatitis C and an excellent liver transplant.
Do you consider that this hepatitis could jeopardize the goal established with the WHO to eradicate hepatitis as 2030?
It has nothing to do. On the contrary, because, perhaps, it has given more voice to the National Program for Viral Hepatitis, and this can help raise awareness of HIP, which turns out to be ‘free advertising’ for a good cause. We’ve saved a few lives like this, [através da comunicação social]. Playing a little with the words, it’s ‘putting the liver in people’s heads’. What exists is a very silent organ, it is a adored monster. In fact, recommend that the estimated values stop at least once in hepatitis B and estimate and see each time the transaminase values are evaluated. If you change, drink less alcohol or reduce your risk of death.
Also read: Hepatitis Outbreak. Warning Signs Parents Should Never Ignore
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