Although they say it’s too early for people to be concerned, Montreal pediatricians are on the lookout for any severe, unexplained form of hepatitis affecting children around the world.
According to the World Health Organization, about 200 cases of acute liver disease of “unknown origin” have been found in children in twelve countries.
Public Health Canada says it is investigating “possible cases” in Canada to see if they are linked to those in the UK and US.
In interviews this week, doctors at two major children’s hospitals in Montreal said they don’t think parents should panic about the outbreak just yet.
But they stressed the importance of doctors looking for cases and reporting them to public health authorities to better understand what is happening.
“Is it worrying? “Yes, because we haven’t really identified the cause, and that’s always a concern,” said Dr. Jesse Papenberg, a pediatric infectious disease specialist at Children’s Hospital Montreal.
But should families take care of their children at this point? I will say no. “
The World Health Organization first reported the outbreak in mid-April. The latest tally put the number of cases at more than 220 worldwide, the bulk of which were reported in the United Kingdom.
Hepatitis is inflammation of the liver that can result from various medical conditions or poisoning with drugs or other substances. It is most commonly caused by a virus.
The cases in question have been described as mysterious because the viruses that cause acute hepatitis usually have not been detected in any of them. Approximately 10 percent of affected children required a liver transplant and one death was reported.
Due to the pandemic, a link to a previous infection with COVID-19 is being verified, but not all children have been tested for SARS-CoV-2.
The World Health Organization says the link to the COVID-19 vaccine has been ruled out, because most children have not received the vaccine.
When contacted about the outbreak, the Quebec Department of Health said it had not yet been notified of any cases in the province.
“Instructions for reporting cases of severe acute hepatitis of unknown origin will soon be distributed widely to various clinicians,” a company spokesperson wrote in an email response, “allowing these cases to be documented.”
One reason being investigated during an outbreak is a possible association with adenovirus infection. The World Health Organization says it is a common virus that usually causes respiratory symptoms or digestive problems, and the adenovirus has been detected in at least 74 cases so far.
Another theory worth pursuing is whether the outbreak is somehow linked to the lockdown measures seen throughout the COVID-19 pandemic, said Dr. Fernando Alvarez, a hepatologist and liver transplant program director at Ste-Justine Hospital in Montreal.
“For parts of two years, schools were closed and children were kept at home. Alvarez explained that during that period we saw a decrease in the circulation of many viruses, including adenoviruses.
He continued, “This means that children, especially young children, have not been immunized against those viruses.” “One possible hypothesis is that recycled adenoviruses are now attacking children who were not prepared (to confront) these types of infections.”
Alvarez said acute hepatitis was unheard of in children, but figures from the UK (114 as of the last update) were “surprisingly higher” than normal.
By comparison, he said, Quebec typically sees one to three cases of unexplained hepatitis in children each year. He added that about one child needs a liver transplant because of hepatitis every two to three years in Quebec.
Alvarez said it would be necessary to move forward to detect any cases locally and report them to federal authorities for proof of infection in Canada.
Papenburg agreed. “We need to systematically monitor and investigate these cases, in terms of all possible etiologies,” he said. “Because so far we have some suspicions, but it’s not the usual suspects who caused it.”
Papenburg also said that parents should know what to look for in their children.
Early symptoms of hepatitis can include lethargy, loss of appetite and abdominal pain. But he added that it should be considered a red flag when accompanied by jaundice, dark urine or pale stools.
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