Number of suspected cases of mysterious childhood hepatitis grows in Brazil

The number of cases under investigation of childhood hepatitis of unknown cause in Brazil rose to 47, which continues to intrigue health authorities.

Just over a week ago, there were 28 registered suspects. Now, the Ministry of Health has already received a total of 58 notifications from 11 states – with 11 cases having already been discarded.

“We are still at the stage of understanding what this hepatitis is. The level of alert is that of vigilance”, he tells the Sheet the executive secretary of the Ministry of Health, Daniel Meirelles Pereira.

Until this Wednesday (18), there were 14 cases under analysis in São Paulo, eight in Minas Gerais, five in Rio Grande do Sul, four in Rio de Janeiro, four in Pernambuco, three in Mato Grosso do Sul, three in Santa Catarina. Catarina, two in Paraná, two in Espírito Santo, one in Maranhão and one in Goiás.

Analysis made from 45 cases monitored by a situation room set up by the ministry shows that children are on average 7 years old. The age of the country’s patients ranges from 8 months to 16 years. 54% are boys and 46% are girls.

Symptoms are fever, jaundice (yellowing of the skin), abdominal pain, vomiting, diarrhea, dark urine, and white stools in children with a healthy history. It would be a typical case of hepatitis, were it not for two reasons: the reason and, according to the president of the Scientific Department of Infectious Diseases of the Brazilian Society of Pediatrics, Marco Aurélio Sáfadi, the greater number of severe cases in relation to the classic cases of childhood hepatitis.

“The occurrence of these cases is intriguing because we are still not sure”, says Sáfadi. “The cases have been exhaustively investigated and they do not find what is usually behind the hepatitis. In other words: it is not the A, B, C, D and E virus, nor are they hepatitis due to intoxication or medication.”

On Friday, the federal government set up a group to closely monitor the increase in cases and guide municipalities. The investigation protocol provides for the collection of blood, feces and nasal secretion samples. The material is being analyzed by the central laboratories, linked to the SUS (Unified Health System).

“We have a structured surveillance system. As this investigation depends a lot on public health laboratories, what we hope is that they will be able to respond”, says Brigina Kemp, technical advisor to the Council of Municipal Health Secretaries of São Paulo. “Health professionals and municipal surveillance need laboratory responses in time.”

The WHO (World Health Organization) has already received 429 notifications of probable cases in 22 countries. Among these cases, 26 children (which is equivalent to 6% of the total) required a liver transplant.

“The vast majority of children recovered, improved and were discharged, but transplantation is a therapeutic resource that you use when you have severe, fulminant hepatitis. Unfortunately, cases [de hepatite misteriosa] have behaved in a more serious way than the classic situations of hepatitis in childhood”, says Sáfadi.

“At the same time, there are less than 500 cases worldwide. We are still talking about a rare occurrence”, he says.

One hypothesis is that mysterious hepatitis is linked to a family of viruses called adenoviruses and a second factor, such as a previous infection with the new coronavirus.

“What drew attention is that, in a relevant part of the cases, they found the adenovirus. It is an old acquaintance of ours, but it has never been associated with hepatitis in healthy children”, says Sáfadi.

“And apparently there was no mutation. It causes respiratory conditions, diarrhea, etc., but not hepatitis. Therefore, the scientific community’s reasoning is that there is a cofactor, another element, in addition to the adenovirus, that is determining the occurrence of the And the most likely cofactor at this point is to imagine that these children were infected by Covid-19 back there”, he continues.

The WHO rules out any link to Covid-19 vaccines. In most of the reported cases, according to the organization, children and adolescents had not been vaccinated against the coronavirus.

The understanding has been followed by the Ministry of Health. “No link to the vaccine [contra a] Covid-19 has been identified”, points out the report of the Ministry of Health Surveillance of the folder on the case.