Abdominal pain, diarrhea, and vomiting precede cases of severe acute hepatitis in children

It is recommended to visit the pediatrician if there is yellowing of the skin and eyes, dark urine, or light stools. This is a new agent of unknown etiology about which we have yet to learn.

Abdominal pain, diarrhea, and vomiting precede cases of severe acute hepatitis in children
Hepatitis A virus (HAV) is the most common virus in children and adolescents. This is how it can be transmitted. Photo by Vitolda Klein / Unsplash

Severe acute hepatitis affecting minors is on the rise in the world and there are still no concrete answers as to its origin. "In many cases, it is preceded by abdominal pain, diarrhea, and vomiting, symptoms to which mothers and fathers should be attentive," said Rosa María Wong Chew, head of the Clinical Research Branch of the Faculty of Medicine (FM) of the UNAM.

The specialist recommended taking children to the pediatrician if there are these manifestations -which appear between one and two weeks- as well as jaundice (yellowish color in the skin and eyes) in addition to a darker tone in the urine and lighter in the feces.

During the virtual talk "Severe viral hepatitis in children", organized by this academic entity, she recalled that the first world report from the World Health Organization was on April 5, which revealed 10 cases of severe acute hepatitis of unknown etiology in Scotland, in previously healthy children from 11 months to five years of age. On April 8, there were 74 cases in the United Kingdom, in addition to three cases in Spain. Of the children identified in Europe, six received liver transplants.

On April 21, 169 cases were reported in 11 countries, including the United States. In Mexico, there were the first four cases in Nuevo Leon (only one of unknown origin), while a child from Hidalgo died recently in Mexico City.

The university professor explained: that hepatitis is an inflammation of the liver, which can be of infectious or toxic cause, derived from certain substances. "Normally, viral hepatitis is manifested by yellowing of the skin; the UK patients also had diarrhea, vomiting and abdominal pain".

In turn, Sarbelio Moreno Espinosa, Director of Teaching at the Federico Gómez Children's Hospital of Mexico, warned that we are facing a new hepatitis agent of unknown etiology, about which we still need to learn. "We do not know the exact mechanism, but it is different from the viruses that cause hepatitis A (the most frequent) and B and C (which are more serious).

He suggested being attentive to the symptoms, since if a liver failure occurs, hospitalization is required; maintaining a diet rich in carbohydrates and low in fats and proteins, so as not to make the liver work harder.

The doctors pointed out that adenovirus has been detected in 74 cases (44 percent); SARS-CoV-2 in 20; and 19 with SARS-CoV-2 and adenovirus co-infection. So far, liver inflammation with elevated enzymes and jaundice have attacked children from one month old to 16 years of age.

Possible causes being analyzed for this new viral hepatitis are related to adenovirus 41, low adenovirus circulation during the pandemic and increased susceptibility today, the emergence of new adenoviruses, and conflation with SARS-CoV-2 and adenovirus.

Wong Chew abounded that adenovirus is a DNA virus with 120 different serotypes (which are classified into genotypes from A to G), whose mode of transmission is by contact, droplet, or fecal-oral contact. "This virus causes respiratory, ocular, urinary, gastrointestinal, and hepatitis infections in immunocompromised patients. So far, there is no specific viral treatment for adenovirus."

For the general population, physicians recommended frequent hand washing before and after preparing food, after going to the bathroom or when changing a diaper; covering the nose and mouth when sneezing and coughing (preferably using a handkerchief and discarding it); avoiding sharing food, drinks, cutlery, and dishes; cleaning and disinfecting toys and objects that children put in their mouths, as well as cleaning commonly used surfaces.

Consuming drinking water (boiled, bottled, or filtered); as well as hygienic handling of food and proper disposal of excreta; in addition to completing the basic vaccination schedule.