Acute hepatitis in children, Maggiore (Bambino Gesù): 'Jaundice a wake-up call'

By Cristiano Antonino On Apr 29, 2022

Acute hepatitis: the first symptom is jaundice, but consult the paediatrician even if the child is very dejected and has other symptoms

Jaundice “alarm bell” for acute hepatitis

Jaundice is certainly an alarm bell, but if we find ourselves in front of a child who, although not jaundiced, “is no longer himself”, that is, we see him particularly dejected and has non-specific symptoms such as abdominal pain, diarrhoea or vomiting, then it is a good idea to consult the paediatrician who will be able to assess the situation.

Parents are very important sensors, for better or for worse”.

This was said by Giuseppe Maggiore, head of Hepato-Gastro-Enterology and Nutrition at the Bambino Gesù in Rome, during a Facebook live broadcast organised by the paediatric hospital to answer questions from families about acute hepatitis of unknown origin, which has been affecting children for several weeks.

However, the expert reassured that if in England the phenomenon seems to be expanding ‘at the moment in Italy there is no evidence that there is an increased frequency of this type of hepatitis’.

In fact, today the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition (Sigenp) published the results of a survey conducted in 71 national centres: 20 total cases of acute hepatitis of unknown aetiology (not A-not E) have been found in Italy since January.

“This is a number that overlaps with that of the previous three-year period (2019-2021),” explains Sigenp.

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However, hepatitis of unknown origin is nothing new for hepatologists

50% of acute and severe hepatitis has an unknown cause,” explains Maggiore. “The peculiarity of this disease in England is that it mainly affects an age group limited to the first five years of life, something we are not used to.

Generally, ‘severe/ fulminant hepatitis does not have a specific age group,’ explains the expert, ‘because there can be many causes.

We do not know the cause of the hepatitis we have been talking about for the last few weeks, and the prevailing hypothesis is an infectious one,” continues Maggiore, “but we are still in the field of hypotheses, without much evidence.

In England, the Adenovirus has been identified in three out of four patients, and this is an important element,” says the expert, “even though this is a virus that, to date, has only given rise to hepatitis in a few cases, but in banal cases, not with serious organ dysfunction.

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So we have to imagine that there is a virus that triggers these acute hepatitis or that the concomitance with other viruses can lead to more serious damage, but these are all hypotheses.

And speaking of hypotheses, we cannot imagine how it is transmitted, we can reason on the viral hypothesis, but no clusters have been identified.

With regard to Sars-CoV-2, Maggiore points out that ‘it has only been found in a few patients, and then,’ he says, ‘Covid is so widespread that it can be a confounding factor, and there is no evidence that in the two years of the pandemic it has caused major hepatitis on its own.

Acute hepatitis, but there is one certainty

We can exclude the possibility of a correlation with the Covid vaccine,” explains Maggiore, “also because the age group most affected is the one in which children have not been vaccinated, particularly in England.

Finally, to those who ask if it is better to avoid travelling to the United Kingdom at the moment, Maggiore replies that “even though it is at the centre of this new entity, the numbers recorded in the country are still small compared to the total number of children present, so,” he concludes, “at the moment I don’t think there is anything to advise against travelling there for this specific reason.