“In addition, further communication initiatives will be undertaken, with particular regard to the School, based on the consolidation of scientific knowledge and taking into account the epidemiological situation, in accordance with the risk assessments and indications from WHO and Ecdc”. Thus the Undersecretary for Health responding to Mammì (M5S).
06 MAG –
In the case of acute pediatric hepatitis “, a new Ministerial Circular is currently being defined, aimed at standardizing and coordinating public health control measures throughout the national territory. In addition, further communication initiatives will be undertaken, with particular emphasis on with regard to the School, based on the consolidation of scientific knowledge and taking into account the epidemiological situation, in accordance with the risk assessments and indications from WHO and Ecdc “.
“Lastly, with regard to epidemiological surveillance, the ISS is providing daily to integrate the reports received from the Ministry with those received by the Istituto Superiore di Sanità, through the mail dedicated and the network of the special surveillance of acute hepatitis, Seieva (Integrated Epidemiological System of Acute Viral Hepatitis (Seieva), which has been appropriately alerted “.
Thus the Undersecretary of Health, Andrea Costareplying yesterday in the Social Affairs Commission in the Chamber to the question on the subject presented by Stefania Mammì (M5S).
Below is the full reply from Undersecretary Costa.
“The question in question raises a problem of particular importance, which requires a detailed and articulated examination.
But let’s go step by step: an increase in cases of severe acute hepatitis of unknown etiology, among previously healthy children, has been reported by the UK to the World Health Organization (WHO) International Health Regulations (IHR) notification system, the April 5, 2022.
Tests performed excluded viral hepatitis types A, B, C, D and E, as well as other known causes of acute hepatitis.
Following this alert, the United States and several countries of the European Union / European Economic Area (EU / EEA) have reported suspected cases.
The clinical picture is that of severe acute hepatitis, with increased levels of liver enzymes and, in many cases, with jaundice.
In most cases to date, the onset of jaundice has been preceded by gastrointestinal symptoms with vomiting, diarrhea and nausea.
Some patients required admission to the Pediatric Hepatology Unit, and others underwent liver transplantation.
Since the first reports by WHO and ECDC (European Center for Disease Control), the Ministry of Health has shared the information provided at European level with the regions / PAs, encouraging the reporting of cases with similar characteristics possibly observed in the national territory.
On 14 April 2022, the information provided by theEarly Warning and Response System (EWRS), regarding an increase in cases of acute hepatitis of unknown etiology, in previously healthy children under 10 years of age, occurring in the United Kingdom, and regional contact persons were requested to report, urgently, the identification or fewer cases of acute hepatitis of unknown etiology observed in children <16 years of age, with transaminases (aspartate aminotransferase – AST, or alanine aminotransferase – ALT) above 500 IU / L.
On April 15, 2022, the updates received from the United Kingdom and Spain were communicated to the regions / PAs, and to report the scientific work published in the journal Eurosurveillance, concerning the description of the initial investigation on the first Scottish cases.
Furthermore, the provisional case definitions were shared, according to the WHO, divided into “confirmed case”, “possible case” and “epidemiologically related case”; the need to immediately report all cases of acute hepatitis of unknown etiology, and with transaminases (AST or ALT) of over 500 IU / L, observed in children or young people under the age of 16 was reiterated.
On April 16, 2022, the summary of the WHO Report on the cases that occurred in Great Britain and Northern Ireland was transmitted, also reporting the link to the international sites useful for any further information, while on April 18 the further updates received from the ECDC were transmitted to the regions / PA, with the description of the cases in the Netherlands, Spain, Ireland and Denmark and with the diagnostic algorithm recommended in the United Kingdom .
On April 19, the regions / PA were asked to communicate to the Ministry of Health the identification, or not, of cases of acute hepatitis of unknown etiology in children, and on April 20 it was published on the Ministry portal (https://www.salute.gov.it/imgs/C 17 eventiEpidemici 2435 press release itemComunicatoO files itemFilesO fileAzione.pdf) the WHO Bulletin on Outbreaks Abroad: “Acute Hepatitis of Unknown Origin – United Kingdom of Great Britain and Northern Ireland”.
This Document, also transmitted to the regions / PAs, reports the international epidemiological situation, public health activities, clinical response and public health activated throughout the United Kingdom to coordinate case research and investigations into the cause of the disease.
The Document also reports the WHO risk assessment, which considers it very likely the detection of further cases before the identification of the etiology (biological, chemical or other agent) of hepatitis, before the adoption of adequate control and prevention measures. .
WHO recommended that Member States identify, investigate and report potential cases that fit the case definition.
Furthermore, on 20 April, the regions and PAs were updated on the epidemiological situation in the international context, on the new case definitions adopted by the WHO, and on the risk assessment, while on 23 April Circular no. 22809 of the Ministry of Health “Cases of acute hepatitis of unknown etiology in pediatric age”, which reports the international and national epidemiological situation as of April 22, 2022, the definition of the case for surveillance, risk assessment, actions taken at and reporting procedures, as well as recommendations on control measures.
The document can be consulted at the following link: https://www.salute.gov.it/imgs/C 17 news 5889 0 file.pdf. The same April 23 was published on the site web of the Ministry of Health a page dedicated to cases of acute hepatitis of unknown etiology in pediatric age: https://www.salute.gov.it/portale/news/p3 2 1 1.jsp? = lin gua = italian & menu = news & p = dalministe ro & id = 5889.
The next day, a communication from the WHO was sent to the regions / PA which updated the number of cases, and described the activities in progress, proposing a slightly modified case definition, and underlining how the priority was to determine the etiology: https://www.who.int/emergencies/disease-outbreak-news/item/multi-country-acute-severe-hepatitis-of-unknown-origin-in-children.
On April 26, the Ministry released the Bulletin of epidemic events abroad: “Acute hepatitis of unknown origin in children – multiple countries”, reporting the modification of the WHO case definition, the description of the outbreak as of April 21, 2022, the public health activities, the WHO risk assessment, according to which, with the notifications of new cases of recent emergence and with the active search of cases, it is very likely that further cases will be detected before the cause can be confirmed, and more specific control and prevention measures can be implemented, hereinafter link: https://mailweb.sa nita.it/service/home/~/?auth=co&loc=it&id= 103456&part=2).
Furthermore, with the Ministry of Health decree of 27 April 2022, a Crisis Unit was established, composed of representatives of the Ministry of Health, the Regions / PA, the ISS, Agenas, AIFA, the Carabinieri-NAS, as well as Scientific Societies, such as: Italian Society of Pediatrics (SIP), Italian Foundation for Research in Hepatology (FIRE), Italian Association for the Study of the Liver (AISF), Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Italian Society of Hygiene (Sites).
Aware that the situation must be carefully followed and monitored, the definition of a new Ministerial Circular is currently underway, aimed at standardizing and coordinating public health control measures throughout the national territory.
In addition, further communication initiatives will be undertaken, with particular regard to the School, based on the consolidation of scientific knowledge and taking into account the epidemiological situation, in accordance with the risk assessments and indications from the WHO and ECDC.
Lastly, with regard to epidemiological surveillance, the ISS is daily integrating the reports received from the Ministry with those received by the Istituto Superiore di Sanità, through the maildedicated and the network of the special surveillance of acute hepatitis, SEIEVA (Integrated Epidemiological System of Acute Viral Hepatitis (SEIEVA), which has been appropriately alerted “.
Gilda Sportiello (M5S), replying, thanks Undersecretary Costa for having reconstructed the steps in the global spread of severe cases of hepatitis in pediatric age. Due to the delicacy of the situation, it deems it necessary to disseminate all the information necessary in order to avoid excessive alarmism. It therefore evaluates favorably the provision of specific communication campaigns, also in order to counter the spread of hypotheses without scientific basis. He believes that in the presence of a data of absolute gravity, such as that represented by the fact that for about 10 per cent of the subjects concerned it was necessary to carry out a transplant, alongside adequate information it is necessary to strengthen the prevention and monitoring tools. In declaring itself certain that the Ministry of Health will continue to proceed in the direction it has taken, it expresses its ample willingness to support all appropriate initiatives in this regard.
06 maggio 2022
© All rights reserved
Other articles in Government and Parliament
