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No cases have been reported in Quebec, but the World Health Organization says about 200 cases of acute liver disease “of unknown origin” have been found in children in a dozen countries.
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Jesse Faith • Montreal Gazette “It’s not the usual suspects that cause this,” said Dr Jesse Papenberg, a pediatric infectious disease specialist at Montreal Children’s Hospital, about the recent outbreak of hepatitis in children around the world. Photo: Alan McInnis / The Montreal Gazette Dossiers
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Although it is said that it is too early for people to worry, Montreal pediatricians are monitoring all cases of severe and unexplained forms of hepatitis affecting children around the world.
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According to the World Health Organization, about 200 cases of acute liver disease “of unknown origin” have been found in children in a dozen countries.
The Canadian Public Health Agency says it is investigating “potential cases” in Canada to see if they are related to those found in the United Kingdom and the United States.
In interviews this week, doctors at Montreal’s two main children’s hospitals said they still did not believe parents should be panicked by the outbreak.
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 disturbing?” Yes, because we haven’t actually determined the cause, and that’s always a concern, “said Dr. Jesse Papenberg, a pediatric infectious disease specialist at Montreal Children’s Hospital.
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“But should families worry about their children at this time?” I would say no. ”
The WHO first reported the outbreak in mid-April. His latest calculation shows that the number of cases is just over 220 worldwide, most of which are reported in the United Kingdom.
Hepatitis is an inflammation of the liver that can be caused by various medical conditions or intoxication with drugs or other substances. It is most often caused by a virus.
The cases in question have been described as mysterious, as the viruses that usually cause acute hepatitis have not been found in any of them. Approximately 10% of affected children required a liver transplant and one death was reported.
Given the pandemic, a link to a previous COVID-19 infection has been studied, but not all children affected have tested positive for SARS-CoV-2.
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The WHO says a link to the COVID-19 vaccine is ruled out because most children have not received the vaccine.
Regarding the outbreak, the Quebec Ministry of Health said no cases had yet been reported in the province.
“Instructions for reporting cases of severe acute hepatitis of unknown origin will soon be widely disseminated to various clinicians,” an e-mail spokesman said, “allowing these cases to be documented.”
One of the reasons being investigated in the outbreak is a possible link to adenoviral infection. A common virus that usually causes respiratory symptoms or gastrointestinal problems, adenovirus has been found in at least 74 of the cases so far, the WHO said.
Dr Fernando Alvarez, a hepatologist and director of the liver transplant program at Ste-Justine Hospital in Montreal, said another theory worth pursuing was whether the outbreak was in any way related to the blocking measures observed in during the COVID-19 pandemic.
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“For two years, schools were closed and children were kept at home. And during this time we are seeing a decrease in the circulation of many viruses, including adenovirus, “explained Alvarez.
“This means that children, especially young children, are not immune to these viruses,” he continued. “One possible hypothesis is that adenovirus recycling is now attacking children who have not been prepared (to face) these types of infections.”
Alvarez said that acute hepatitis is not unheard of in children, but the numbers coming from the United Kingdom (114 as of the last update) are “surprisingly higher” than usual.
By comparison, he said, Quebec usually sees one to three cases of unexplained hepatitis in children a year. And about one child needs a liver transplant for hepatitis every two to three years in Quebec, he added.
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Alvarez said it would be crucial to detect all cases locally and report to federal authorities to determine the incidence in Canada.
Papenburg agreed. “We need to monitor these cases and systematically investigate them for all possible etiologies,” he said. “Because so far we have some suspicions, but not the usual suspects cause that.”
Papenburg also said that parents need to know what to look out for in their children.
Early symptoms of hepatitis may include lethargy, loss of appetite, and abdominal pain. But this should be considered a red flag, he added, when they are accompanied by jaundice, dark urine or pale stools.
jfeith@postmedia.com
twiiter.com/jessefeith
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