Guillermo D. Rueda / [email protected]
Is the situation to worry about, or is it that we are all very susceptible to what has happened in the last two years due to the pandemic?
The question falls from mature, from the alert – last April 15 – from the World Health Organization (WHO) about cases of severe acute hepatitis of unknown cause in children in the United Kingdom.
Until this Wednesday the 11th, when The new one. spoke with Dr. Kohler, a member of the Argentine Society of Pediatrics and the Argentine Society of Vaccinology and Epidemiology, the cases in minor patients —in more than 20 countries in the world— had reached 300.
In Argentina, as reported the day before by the Minister of Health of the Nation, Carla Vizzotti, there are 8 cases of minors with severe liver failure, without specifying the origin of the condition, as well as confirmed the liver transplant a 8-year-old boy from Santa Fe, held last Saturday 7.
“Early diagnosis must be extreme and, depending on the evolution, determine the steps to follow according to the protocol,” Kohler said.
“A type of adenovirus has been identified, which is unusual for the liver to be interested in,” Dr. Kohler said.
“We are going back to the beginning; to the sources. We are learning from this hepatitis, just as we did with COVID. As it is a new entity, we must determine the how and why, in order to specify what type of prevention and / or treatment will be carried out, ”he added.
Kohler recalled that these hepatitis have appeared in a surprising way from the increase in cases that do not respond to the usual diagnoses.
“They do not belong to the hepatitis that go from A to E and that are basically identified by laboratory monitoring,” he said.
“To this day, it is not certain what they obey. A type of adenovirus has been identified, which is not usually of interest to the liver. However, the F-41 adenovirus would affect it,” he commented.
The pediatrician also said that the adenovirus usually affects the respiratory system and, in some cases, the digestive system.
“But it seems that the F-41 did some kind of modification to its structure. And from here several hypotheses can be established, ”he explained.
“It also influences, and it is in general for other diseases, the little movement of the population due to the pandemic,” he said.
“This caused that there is no circulation of viruses, nor of people who infect. For this reason, at the time of the opening of different activities, such as schools, work and others, circulation is renewed. Thus, adenoviruses, in a context where influenza is also included, will find susceptible people who, for example, have not been vaccinated for several years. This also happens with measles, with rubella and with mumps, in the cases of unvaccinated children because they have been confined to their homes”, he indicated.
He recalled that, last October, there were reports of hepatitis with symptoms similar to the current ones in the United States, but that they did not have the current monitoring and alert.
—Dr. Kohler, do these cases have any connection to COVID?
—The works that have been done so far, which are many although none are conclusive, estimate that it has nothing to do with COVID, although it does indirectly. That is, the low circulation of the population compared to today.
“It is about determining if the disease has influenced the liver to react in another way or if there was a co-infection, which, in fact, there has been, between COVID and this hepatitis.
“Possible toxins or cofactors are also being investigated.”
—How long will it take to determine the origin?
“Depends on the research labs. They are not few and, many of them, of the highest quality.
“The country is also working fast in this regard, because when you look at the follow-up of the boys and the presentation of hepatitis, if the diagnosis leads to liver failure, it goes directly to a transplant, which is the case of the boy from Santa Fe.
“More cases are also appreciated because the complaints are numerous. As there was an alert, certain hepatitis that sometimes went unnoticed, because the evolution was good, were not classified as ‘unknown’.
—Is the experience already gone through with COVID useful?
“We can use it. Those who have comorbidities or immunosuppression also have impaired liver function. When the cause is found, the forms of prevention and treatment will be seen so as not to reach an emergency situation.”
What is there to do?
“The important thing is the initial diagnosis and following the protocols made by scientific societies to quickly refer the patient, if the evolution algorithm determines that it is a potentially complicated case,” said Dr. Kohler.
“You have to be attentive to the classic symptoms of hepatitis: dark urine, pale fecal material, yellowish color of the skin and eye conjunctiva.
“The diagnosis is simple. Clearly, there is a protocol to follow because the first thing to find out is which hepatitis it corresponds to: A, B, C, D or E.
“Dismissed that, we can think of a hepatitis of unknown origin, but that does not have such a high or common incidence either. You have to be vigilant. Nothing more”.
—Can it end in something similar to a pandemic?
-For now it seems that it does not have the contagiousness of other types of virus, since otherwise the cases would have increased faster.
“That is why the key here is to certify that it is an adenovirus and, from there, determine what causes some to become infected and others not.”
—Is Bahía Blanca prepared in that sense?
—Yes, it is an important and very good medical center. Of that there is no doubt; there are excellent professionals and infectologists”.
—“Apropos of these cases, it is good to remember that the vaccines against hepatitis A and B, which are the most common among children and adults, have highly efficient prevention and generate lasting immunity.”
—“The hepatitis A vaccine was implemented in 2000 and is applied at one year of age. It has a prolonged immunity over time. Since then, the disease has diminished —importantly— and liver transplants practically disappeared; so much so that, in 2004, there were 173 cases per 100,000. And in 2007 they were less than 10 per 100,000. And there were no more transplants.”
—“Now is a good time to review the vaccination schedule for boys and get vaccinated against hepatitis A, beyond what is happening, but because it corresponds and because we will avoid contagion from someone who is not vaccinated or from a group of susceptible”.
—“The hepatitis B vaccine was incorporated in 2000 in newborns; in 2003, 11-year-old boys were added and, in 2012, it was implemented for the entire population free of charge and without medical indication. Hepatitis B vaccination has also reduced the incidence of liver cancer and cirrhosis.”
—“The application of hepatitis B vaccines at 11 years of age and in adults is aimed at a strategy of covering the entire population. It has been done this way in other countries, such as Australia, where it has been drastically controlled.”