Because children are vulnerable to acute hepatitis

The president of EODY and professor of Pediatrics of EKPA talks about the possible symptoms that parents should be aware of

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EODY is on full alert for the mysterious cases of acute hepatitis in children, assures the president of the Organization and professor of Pediatrics of EKPA Theoklis Zaoutis in an interview with "Vima", adding that the underlying cause remains currently unknown. Asked about the suspicion that children have become more vulnerable due to restrictive measures, he emphasizes that "the scenario is not considered the most likely». Referring to the pandemic, he insists that the emergence of a new mutation can not be predicted while analyzing the plan for the treatment of nosocomial infections.

 Cases of acute hepatitis around the world in young children have taken a toll, causing a new wave of anxiety. How prepared is our country? What are the instructions given by EODY to the scientific community?

"In our country so far no increase in cases of hepatitis in children has been reported. However, clinicians are called upon to be vigilant for the early diagnosis of children up to 16 years of age who present with symptoms of acute hepatitis without a clear reason, and for the immediate reporting of cases to the EODY.

On April 22, 2022, the definition of a possible case of acute hepatitis was posted on the EODY website, as well as the definition of contact with a possible case, along with accompanying instructions to health professionals for the collection of biological material from possible cases. The management of the biological material samples will be carried out by the Central Laboratory of Public Health (KEDY).

EODY is on the alert and closely monitoring the situation, is in regular contact with the European Public Health Agency, the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) and has already informed all the Health Regions of the country, the Panhellenic Medical Association as well as the relevant Scientific Societies ".

Even if it turns out that the "culprit" for these cases is an adenovirus, is it estimated that the SARS-CoV-2 pandemic has contributed?

"From the laboratory test that has been carried out so far in order to find the cause of these cases of acute hepatitis, the classic hepatitis viruses (A to E) have been excluded, while in some cases SARS-CoV-2 virus or even the adenovirus has been detected. , but it is not yet possible to determine the clear role of the above infections in cases of acute hepatitis. Therefore, the underlying cause of hepatitis cases remains, at present, unknown. Further laboratory investigation of the cases for the presence of pathogens, chemical agents and toxins is in progress. There is a suspicion that children have become more vulnerable due to the restrictive measures implemented in the context of dealing with the pandemic COVID-19, as during the quarantine period they were not exposed to common infectious agents. "Nevertheless, this scenario is not considered the most likely to explain the incidence of acute hepatitis in children."

How do you explain the fact that acute hepatitis usually occurs in younger children, aged 3-5 years?

"This may be due to the 'immature' immune system at these ages and in combination with other factors that have not yet been clarified, makes children vulnerable to the disease."

Is it time for children to get out of the "sterile" environment? Or should parents be even more careful?

"Children should return to their normal social activity, always according to the instructions of EODY. At the same time, however, parents should be aware of the possible symptoms of acute hepatitis, which include the following: jaundice, discoloration of urine and feces, fatigue, loss of appetite, nausea, vomiting and abdominal pain. In case of the above symptoms, they should immediately seek pediatric care ".

But at the same time there is the risk of SARS-CoV-2 and long Covid…

"It should be emphasized that long COVID does not appear to be associated with an exacerbation of acute hepatitis in children. The de-escalation of the pandemic indicators at the moment has allowed the relaxation of the restrictive measures in our country, while the pandemic is entering a phase of coexistence with the virus. In any case, we remain vigilant with the current epidemiological data as our guide ".

How likely is it that a new mutation will be detected in the coming summer months, as happened in the summer of 2021 with Delta?

"The possibility of a new variant emerging can not be predicted with certainty. According to the strategic preparedness plan published by the WHO on March 30, 2022, there are three possible scenarios for the future of the pandemic: the most likely (base case), the most favorable (best case) and the worst (worst case) scenario, which will must be taken into account so that each country's health system has the preparedness and flexibility to be able to cope with each of these scenarios.

Based on existing experience and knowledge, the most likely scenario (base case) is that the SARS-CoV-2 virus will continue to evolve, but the severity of the disease will become milder over time, as immunity will increases through vaccination or through natural disease. "In this case, the virus will cause less severe waves with periodic outbreaks in the phases of reduced population immunity, possibly following a similar seasonality pattern to the influenza virus."

Do you think that the 4th dose will be necessary in the general population? Respectively, will healthy children undergo a third dose?

"The completion of the basic vaccination of the entire adult population with the three vaccine doses is of primary importance. COVID-19. The 4th dose of vaccine is currently only recommended for people over 60 years of age. The benefit is maximized for people over 70 years as well as for those who are over 60 years old and suffer from concomitant chronic diseases. Regarding the 3rd dose in the pediatric population, it is currently recommended for children 12-17 years old who are at increased risk for serious disease from COVID-19. The data for the 4th dose in the general population or the 3rd dose in the pediatric population may change depending on the current epidemiological data ".

You recently re-referred to the underwriting of deaths due COVID-19 in the rest of Ancient Epirus in relation to Greece. In fact, you referred to a study in the "Lancet", according to which the excessive mortality in our country is at lower levels than that of other European countries. So, will their recording change immediately?

"The recording of deaths due COVID-19 in our country from the beginning of the pandemic until today is based on the definition of the World Health Organization (WHO) and will continue based on the same definition. Excessive mortality is an indicator that allows us to compare mortality between different countries, which may follow different definitions of deaths due to COVID-19 in relation to Greece ".

Finally, the Microbiological Laboratories of the public hospitals of the country are trying to comply with the European directives EUCAST, concerning the identification of pathogenic microorganisms and the control of their susceptibility to antibiotics, directives to which we are obliged by the European Union from 2018 to we follow so that we all speak the same language in relation to the resistance of germs within Greece and Europe ".