Children up to 16 years of age with symptoms of acute hepatitis should be seen urgently in the hospital. See what these symptoms are

Department of Health-General warns with symptoms like nausea, anorexia, nausea or jaundice or non-specific symptoms like abdominal pain and diarrhea

All children up to 16 years of age with clinical manifestations of acute hepatitis, such as nausea, anorexia, vomiting or jaundice, or with nonspecific symptoms such as abdominal pain and diarrhea, should be seen in the hospital urgently.

In suspected cases of acute hepatitis of unknown etiology at pediatric age, with more than a week of evolution, indeterminate manifestations such as abdominal pain, nausea and vomiting, diarrhea, according to guidelines published this Tuesday by the Directorate-General for Health (DGS). And severe bowing can coexist with symptoms of shortness of breath and fever.

In terms of hospital care, in the presence of a child with the above-mentioned clinical manifestations and which raises suspicion of hepatitis, laboratory investigation should be started, along with other analyzes, complete blood count, coagulation study (INR), in the area. Indicators such as biochemistry, blood glucose, urea, creatinine, ionogram, total and direct bilirubin should be analyzed, as well as blood culture in case of fever.

Since the results of ongoing investigations are still limited in the reported countries, where enteric adenoviruses have been identified as a potential agent involved, the DGS community recommends strengthening protective measures, such as hand hygiene (supervision). In young children) and respiratory etiquette, ventilation and / or ventilation of internal spaces, frequent cleaning and / or disinfection of surfaces in case of acute gastroenteritis or respiratory infections.

In health facilities, it is recommended to take precautionary measures in case of suspected or possible contact with respiratory symptoms, “adhere to established rules for infection control by programs for prevention and control of infections and add antimicrobial resistance (PPCIRA)”. DGS.

To promote the identification of suspected cases and to ensure their investigation, the DGS defines potential cases that refer to children 16 years of age or younger with susceptible symptoms to acute hepatitis and not confirmed as hepatitis A and E and with serum aminotransferase values ​​1 Oct. More than 500 IU / L (aspartate aminotransferase (AST) or alanine aminotransferase (ALT)) by 2021.

Since October 1, 2021, there has been an epidemic link between people of any age with acute hepatitis (not Hepatitis AE), and those who are in close contact with a potential case will also be identified as potential cases.

If the laboratory of the hospital where the child is receiving health care cannot perform any of these analyzes, the samples should be sent to Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA) along with the relevant request and term of office. DGS.

In the presence of a potential case, “health professionals in the health system must report the case to the regionally appropriate health authority”, selecting the disease “Hepatitis of unknown etiology in childhood” through Synavemed (National Epidemiological Surveillance System). , DGS emphasizes.

Following the notification, the investigation into the epidemic will be conducted by the regionally competent health authority, according to the guidelines, and the probable case or linked case of an epidemic will be reported by the DGS to the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO). ” Contribute to ongoing international research “.

The DGS also said that health professionals should “inform parents about the rarity of this condition”, clarifying the need to investigate, the clinical manifestations that will lead to the search for health care, as well as where to go.

On May 31, 2022, the ECDC and WHO Europe published an epidemic bulletin reporting that the WHO reported 305 cases of acute hepatitis of unknown etiology in children aged 16 and under in 17 European countries, 15 of which were reported in Portugal.

According to the DGS, 15 suspicious cases have been reported in Portugal as of June 3, 2022, among children aged four months to 16 years, between November 2021 and May 31, 2022. The clinical picture of these children has been favorably developed

Other WHO European countries that reported cases in late May were: United Kingdom (155), Italy (29), Spain (34), Netherlands (14), Belgium (14), Sweden (9), Ireland (8), Denmark (7), Greece (5), Norway (5), Poland (3), Cyprus (2), France (2), Austria (2), Bulgaria (1), Republic of Moldova (1), Serbia (1) ).

The total number of reported cases worldwide was 621, with 14 deaths reported in Indonesia (6), the United States (5), Ireland (1), Mexico (1) and Palestine (1).


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