'Mystery hepatitis': See what science already knows about the disease that has the world on high alert

According to the World Health Organization, 348 probable cases of the disease have already been registered in 20 countries around the world; in Brazil, 29 reports and one death are investigated

Archive/Agência Brasil/Agência Brasil

Like the other types of the disease, classified as A, B, C, D and E, acute childhood hepatitis is identified as a lesion in the liver.

This week, the World Health Organization (WHO) reported that 348 probable cases of the popularly called “mystery hepatitis” have already been registered all over the world. The first identifications of the disease, which especially affects children between the ages of 0 and 16, were reported on 5 April, when 10 cases were detected in Scotland in children under ten. Since then, the acute form of liver inflammation has been diagnosed in at least 20 countries, such as the United States, Israel, France, Italy and the United Kingdom, which alone accounts for more than 160 cases of “new hepatitis”, still unknown origin. In addition, according to the WHO, 70 additional records from 13 other countries are pending confirmation tests. Until last Tuesday, 10, six nations had already reported more than five cases of severe liver inflammation in children, including Brazil.

Like the other types of the disease, classified as A, B, C, D and E, the hepatitis Acute childhood illness is identified as a liver injury. However, two particularities differentiate the other forms of injury from the current conditions of the disease: the undetermined cause and the high rate of child patients who need liver transplants, which represents 10% of cases worldwide. In this scenario, considering the similarities, differences, diagnoses, symptoms and prevention and control methods, the Young pan talked to experts to understand: What does science already know about mysterious hepatitis?

‘Mysterious 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 by viruses, such as adenovirus, which causes respiratory and gastrointestinal symptoms, vomiting and diarrhea, the outbreak of acute hepatitis still does not have a causative agent known to science, explains infectious disease specialist Melissa Valentini, from Grupo Pardini. According to her, researchers seek to identify patterns in patients’ biopsies to understand the disease. “To prove causality within a study is quite complicated. Some cases had adenovirus, others did not, some had Covid, one had neither adenovirus nor Covid, but a history of contact with a person infected by the virus. coronavirus. Most likely it’s an infectious cause, but we still can’t beat the hammer.”

In the United States, researchers hypothesize that the origin of liver damage in children is adenovirus 41, after nine patients tested positive for the pathogen. In a statement on acute hepatitis, the Butantan Institute mentions that the adenovirus has been identified in at least 74 cases worldwide, 18 of them in the presence of F type 41 and in 20 patients the Sars-CoV-2, which causes the disease. Covid-19. In addition, 19 patients had coinfection. The entity also mentions that the viruses that cause acute viral hepatitis, responsible for versions A to E of the disease, were not detected in any of the patients analyzed, which reinforces the difference in infections.

What are the symptoms of the disease?

The symptoms of acute hepatitis are similar to other types of the disease and include: diarrhea, vomiting and jaundice, gastrointestinal problems and abdominal pain, without a fever, reported the Pan American Health Organization (PAHO). “This hepatitis has mainly affected children under five years of age. So they have an initial picture of stomach ache, abdominal pain, with nausea, vomiting, diarrhea, and then it progresses to the most characteristic symptoms of hepatitis and liver failure: jaundice, which is the yellow on the skin and eyes, in addition to the darker urine and of lighter stools“, explains pediatrician Marcelo Iampolsky, professor of Medicine at Centro Universitário São Camilo.

Is it related to Covid-19?

Perhaps. As the cause of the current outbreak of acute hepatitis has not yet been confirmed, researchers are evaluating several scenarios, including a possible relationship with the coronavirus infection, which can affect the liver, causing deep damage. “In the last week there have been some important advances with additional research and some refinements of the working hypotheses. Currently, the main hypotheses are those involving adenovirus, and the role of Covid-19“, said Philippa Easterbrook of the WHO global programme.

Pediatrician Marcelo Iampolsky mentions a possible combination of adenovirus and Sars-CoV-2 as a cause of acute hepatitis. “The combination of these two viral proteins causes a very strong immune reaction, so we look like they are super-aggressors. We are going to produce a very strong inflammatory reaction and the liver ends up being the main organ involved. So we have an autoimmune hepatitis triggered by the presence of a virus”, he mentions, noting that the analyzes are being studied.

Is acute hepatitis a reaction to the vaccine?

Not. The current appearance of hepatic lesions in children is not related to the vaccine against Covid-19. The World Health Organization has ruled out any causal link between available immunizations for the pediatric population and acute hepatitis. Likewise, the Butantan Institutewhich is responsible for producing the CoronaVac, in partnership with China’s Sinovac Biotech, reinforced the safety of vaccines. “The majority of children reported with acute hepatitis have not received the Covid-19 vaccine, ruling out a link between the cases and vaccination at this time.”

Is it lethal and/or transmissible?

Yes. The acute form of liver damage can cause death in patients. In the United States, for example, the Centers for Disease Control and Prevention (CDC) are investigating 109 cases of acute hepatitis, including five deaths. According to data cited by the AFP, severe inflammation has been detected in at least 25 US states and territories, in children with an average age of two years. In Indonesia, there were three deaths of children from the disease. “The big problem with this specific hepatitis is that the forms are being very severe, 10% of the children developed liver failure and needed a transplant, which we do not see in other hepatitis, such as A and E”, mentions Melissa Valentini. In the United States, the rate of liver failure caused by an outbreak of acute hepatitis reaches 14%.

As for transmission, due to the lack of knowledge of the agent that causes acute hepatitis, it is still not possible to confirm how transmission occurs and whether it could occur from child to child. However, if related to adenovirus, transmission can occur via the fecal-oral route, which reinforces the importance of maintaining hygiene protocols. “Adenovirus is transmissible by contact, fecal-oral transmission, which is contact with the virus and then with the mucosa, so it is important to continue with hand hygiene”, warns Melissa.

How to protect children?

Pediatrician Marcelo Iampolsky reinforces that the best way to protect children from mysterious hepatitis is to maintain care against viral infections and complete the vaccination schedule. “The vaccine is the only way to protect and reduce our susceptibility”, began the doctor. “Use of masks, avoid agglomeration, hand hygiene. These are the main weapons we have. The possibility of releasing CoronaVac for children under five [pela Anvisa], if this is possible, it would also come at a very favorable time, as these children are the most affected”, he concluded. Likewise, Melissa Valentini reinforced that immunizing agents against hepatitis A and B are already part of the vaccination schedule. “Sick children don’t go to school either. Whenever possible, sanitize your hands and toys too, these are the precautions we should take.”

Mysterious hepatitis in Brazil

THE Ministry of Health monitors the incidence of 29 suspected cases of acute hepatitis in children until 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 Sao Paulo. The São Paulo Health Department informed the Young pan that six patients are hospitalized and the ministry awaits the conclusion of tests for the diagnosis of the liver condition and, therefore, considers “the confirmation of the disease in the State to be hasty”. In Rio de Janeiro, of the six suspected cases, three are residents of the state capital, one was identified in Niterói and one in Araruama, in addition to an 8-month-old baby, a resident of Maricá, who died, and the investigation is also ongoing. “It is important for parents and guardians to be aware of children’s symptoms. If there is any suspicion, they should be immediately taken to a health service so that they can be diagnosed and treated,” said Secretary of State for Health, Alexandre Chieppe. Ceará, Tocantins, Bahia, Rio Grande do Norte, Roraima, Distrito Federal, Pará, Rio Grande do Sul and Amazonas told the report that there are no suspected cases or under investigation.

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