Portugal braces for cases of acute hepatitis in children

DGS || Friday closed with the news that a child was being treated in Porto’s São João Hospital with suspected ‘acute hepatitis’.

This was billed as “the first case so far flagged in Portugal” as elsewhere health systems have described “an unexpected and significant increase in cases of severe, acute hepatitis of unknown origin in young, previously healthy children, all under the age of 10”.

But the media had slightly jumped the gun.

The 21-month-old boy was discovered to have been suffering from Gripe A (a flu strain), not hepatitis, and has since been discharged.

Since then, however, reports have confirmed that two further cases of suspected ‘acute hepatitis’ are pending confirmation – albeit the children involved have developed favourably.

On Tuesday, DGS health director Graça Freitas stressed that the existence of this ‘mystery strain of hepatitis’, which has affected around 200 children in various parts of the Western world, isn’t going to lead to any particular travel restrictions.

According to international media, “common hepatitis viruses have not been detected in any of the children affected”.

Associate Professor Asha Bowen – a clinician at Perth children’s hospital in Australia and an infectious diseases researcher at Telethon Kids Institute – told the UK Guardian that what is “unusual” about this virus is “that it is fulminant hepatitis, which basically means the liver has failed completely in these children. That’s extremely rare in childhood. And it has put us all on high alert.”

The World Health Organisation has registered cases in Europe, the United States, Israel, the Netherlands, Romania and Japan – Canada, too, is investigating an undisclosed number of cases to see if they are linked to the outbreak.

One child has died, and about 10% of cases in UK (meaning 17 children) have required liver transplants.

With no handle yet on the new strain, it is simply being called ‘atypical hepatitis’.

Symptoms include abdominal pain, vomiting, diarrhoea, yellowing of whites of the eyes, and darkened urine.

The only reassuring aspect of the number of children who have required liver transplants is that these have been done through family and friends. Liver transplants do not require donors to be recently deceased – and, therefore, there is less likelihood in children’s cases of transplants not being available. But it is a “worrying” situation, nonetheless – not least because no one can fathom where this virus has come from.

One document in England has suggested the disease is being caused by an adenovirus or possibly as a consequence of Covid-19.

Another idea is that children could be ‘extra vulnerable’ to infections due to their lack of contact with germs as a result of Covid lockdowns and restrictions.

For the time being, it is a question of seeing how things develop and trying to be prepared. Coimbra has a paediatric transplant team “prepared” to step in “at any time”, Rui Tato Marinho, director of the national programme for viral hepatitis, has stressed.