São Paulo investigates seven suspected cases of mysterious hepatitis in three cities

The São Paulo State Health Department is investigating seven suspected cases of the mysterious hepatitis that affects especially children. The cases were identified in São José dos Campos, Fernandópolis and in the capital.

According to the secretary, until last Friday (7), 2 of the 7 patients were hospitalized. The state agency says it awaits completion of diagnostic tests to confirm the relationship with the disease.

Adding the suspected cases in São Paulo, the number of occurrences under investigation in the country rises to 16. The others disclosed so far are in Rio de Janeiro (6) and Paraná (2). Hepatitis is a notifiable disease in Brazil — states and municipalities must report occurrences and suspicions to the Ministry of Health.

At least 300 cases have already been confirmed in at least 25 countries, most of them within the European Union, according to the most recent bulletin from the ECDC (European Center for Disease Prevention and Control).

Hepatitis is an inflammation of the liver that can be caused by viral infections and even excessive alcohol consumption, as well as some drugs and toxic substances. There are five known viruses that cause hepatitis: A, B, C, D and E. In addition to these five, there is autoimmune hepatitis, in which the body’s own immune system attacks the liver.

Occurrence in healthy children is considered uncommon by health agencies and experts. This is because none of the viruses that cause the disease were detected in the patients.​

So far, three children have died from the disease in Indonesia. The US investigates five suspicious deaths and one death is under investigation in Palestine.

Only 10% of confirmed cases so far in the world have progressed to liver inflammation, causing the need for organ transplantation. The children who needed to undergo the procedure recovered well, according to information from the WHO (World Health Organization)

Possible cause

According to the UK Health Safety Agency (UKHSA), the association of this hepatitis with adenovirus remains the main suspect for the cause of the disease. “Adenovirus is the virus most frequently detected in the samples tested”, says the British agency’s bulletin issued on May 6.

The investigation seeks to understand whether the disease could be caused by a change in the adenovirus genome. Other viruses are also being investigated, including Sars-CoV-2. Authorities are also assessing whether children’s lower exposure to viruses caused by isolation during the pandemic may have increased their susceptibility.

Adenovirus 41, one of the investigated types, causes colds, respiratory problems, conjunctivitis and even digestive problems in children. Most people are infected before the age of five, precisely the age range with the highest incidence of mysterious acute hepatitis in the United Kingdom, the country most affected so far.

Of the 163 cases recorded to date in the country, 126 were tested for adenovirus infection and its presence was confirmed in 72% of patients. Sars-CoV-2 was detected in 24 of the 132 cases tested, about 18%, and for this reason it is still not possible to rule out, according to the document, a possible relationship between the virus that causes covid and mysterious hepatitis.

There is no evidence that cases of acute hepatitis with no known origin have anything to do with Covid-19 vaccines.