this week , World Health Organization (WHO) It reported 348 probable cases “Mysterious hepatitis” It is already recorded all over the world. The first discoveries of the disease, which mainly affects children aged 0-16, were reported on 5 April, when 10 cases were detected in Scotland in children under the age of 10. Since then, the acute form of hepatitis has been diagnosed in at least 20 countries, such as the United States, Israel, France, Italy and the United Kingdom, which alone account for more than 160 cases of “new hepatitis”, whose origin remains unknown. In addition, according to the World Health Organization, an additional 70 records from 13 other countries are awaiting confirmation tests. As of last Tuesday, 10, six countries have already reported more than five cases of acute hepatitis in children, including Brazil.

Like other types of disease classified as A, B, C, D, and E, Lever Inflammation Acute childhood illness is defined as an injury to the liver. However, there are two characteristics that differentiate the other forms of infection from the current conditions of the disease: the undetermined cause and the high rate of pediatric patients requiring liver transplantation, which accounts for 10% of cases worldwide. In this scenario, taking into account the similarities and differences, diagnosis, symptoms and methods of prevention and control, pan youth Talk to the experts to understand: What does science already know about mysterious hepatitis?

Occult hepatitis: What causes it?

The main question about recent cases of acute hepatitis among children is the cause of the disease. While types A, B, C, D and E are the result of contamination with viruses such as glandularWhich causes respiratory and gastrointestinal symptoms, vomiting and diarrhea, and acute hepatitis outbreaks still do not have a known causative agent to science, explains infectious disease specialist Melissa Valentini, of Grupo Bardini. According to her, researchers seek to identify patterns in patients’ biopsies to understand the disease. “Proving causation within a study is very complex. Some of the cases had adenovirus, some did not, some had Covid, one had neither adenovirus nor Covid, but had a history of contact with someone who had the virus. Corona Virus. Most likely it’s a contagious cause, but we still can’t beat the hammer.”

In the United States, researchers hypothesized that the origin of liver damage in children was adenovirus 41, after nine patients tested positive for the pathogen. In a statement on acute hepatitis, the Butantan Institute stated that adenovirus has been identified in at least 74 cases worldwide, 18 in the presence of F type 41 and in 20 patients with the disease-causing Sars-CoV-2. COVID-19. In addition, 19 patients developed concomitant infections. The entity also states that viruses that cause acute viral hepatitis, which are responsible for the A to E versions of the disease, were not detected in any of the patients analyzed, reinforcing the difference in infection.

What are the symptoms of the disease?

Symptoms of acute hepatitis are similar to other types of the disease and include: diarrhea, vomiting, jaundice, digestive problems and abdominal pain without fever, reports the Pan American Health Organization (PAHO). “This hepatitis has mainly affected children under the age of five. So they have an initial picture of stomach pain, abdominal pain, with nausea, vomiting, and diarrhea, and then they progress to the most characteristic symptom of hepatitis and liver failure: jaundice, which is jaundice. yellow On the skin and eyes, in addition to darker urine Based on lighter stools‘,” explains pediatrician Marcelo Impolski, MD, professor of medicine at Centro Universitário São Camilo.

Is it related to Covid-19?

Probably. Since the cause of the current outbreak of acute hepatitis has yet to be confirmed, researchers are evaluating several scenarios, including a possible relationship with coronavirus infection, which could affect the liver, causing profound damage. “In the past week, there has been some significant progress with additional research and some improvement in the working hypotheses. Currently, the main hypotheses are those involving adenovirus, and the role of COVID-19Philippa Easterbrook of the WHO Global Program said.

Pediatrician Marcelo Impolski cites a possible combination of adenovirus and Sars-CoV-2 as the cause of acute hepatitis B. “The combination of these two viral proteins causes a very strong immune reaction, so we have it as if they are the most aggressive. We will produce a very strong inflammatory reaction and end up with the liver becoming the main organ involved. So we have autoimmune hepatitis caused by the presence of a virus,” as He mentions, remembering that the analyzes are under study.

Is acute hepatitis a reaction to the vaccine?

no. The current appearance of hepatic lesions in children is not associated with Serum Against Covid-19. The World Health Organization has ruled out any causal relationship between childhood vaccinations and acute hepatitis. Similarly, the Putantan Institutewhich is responsible for producing corona, in partnership with China’s Sinovac Biotech, has boosted the safety of vaccines. “The majority of children reported to have acute hepatitis B have not received the Covid-19 vaccine, which rules out a link between cases and vaccination at this time.”

Is it fatal and/or transmissible?

yes. The severe form of liver damage can cause death in patients. In the United States, for example, the Centers for Disease Control and Prevention (CDC) is investigating 109 cases of acute hepatitis, including five deaths. According to data cited by AFP, acute inflammation has been detected in at least 25 US states and territories, in children with an average age of two years. In Indonesia, there have been three child deaths from the disease. “The big problem with this specific type of hepatitis is that the forms are very severe, 10% of the kids had liver failure and needed a transplant, which we don’t see in other hepatitis, like A and E,” Melissa Valentini recalls. In the United States, the rate of liver failure from acute hepatitis outbreaks is 14%.

As for transmission, due to the lack of knowledge of the causative agent of acute hepatitis, it is still not possible to confirm how transmission occurs and whether it can occur from child to child. However, if associated with adenovirus, transmission can occur via the oral-faecal route, reinforcing the importance of maintaining hygiene protocols. “The adenovirus is transmitted by contact, by fecal-oral, which is contact with the virus and then the mucous membrane, so it is important to continue hand hygiene,” Melissa warns.

How do you protect children?

Pediatrician Marcelo Impolski stresses that the best way to protect children from occult hepatitis is to maintain care against the viral infection and complete the vaccination schedule. “A vaccine is the only way to protect and reduce our susceptibility to infection,” the doctor began. “Using masks, avoiding clumps, and hand hygiene. These are the main weapons we have. CoronaVac release potential for children under five years old. [pela Anvisa]He concluded by saying that, if this were possible, it would also come at a very opportune time, because these children are the hardest hit. Similarly, Melissa Valentini emphasized that hepatitis A and B immunization agents are already part of the vaccination schedule. “Sick children don’t go to school either. Whenever possible, sanitize your hands and toys as well, these are the precautions we should take.”

Mysterious hepatitis in Brazil

The Ministry of Health Monitors the occurrence of 29 suspected cases of acute hepatitis in children as of Friday, the 13th. According to the state secretariats, there are two records of the disease in Paraná, three in Pernambuco, four in Minas Gerais, six in Rio de Janeiro, and 14 in São Paulo. The Health Department of Sao Paulo informed pan youth Six patients were transferred to the hospital, and the ministry is awaiting the completion of the tests to diagnose the condition of the liver, and therefore it considers “confirmation of the disease in the country hasty.” In Rio de Janeiro, of the six suspected cases, three are residents of the state capital, one case has been identified in Niteroi and one in Aroma, in addition to an 8-month-old child, a resident of Marica, who died, and an investigation is also underway. . “It is important for parents and guardians to be aware of children’s symptoms. If there is any doubt, they should be taken immediately to a health service so that they can be diagnosed and treated,” said the Minister of State for Health, Alexandre Scheib. And Distrito Federal, Barra, Rio Grande do Sul and Amazonas to report that there are no suspected or under investigation cases.