The Ministry of Health stated that it monitors 7 cases of hepatitis of unknown cause in children in Brazil. Four patients are in Rio de Janeiro and three in Paraná. Acute liver inflammation is similar to what has been described by health authorities in Europe and the United States.
A few weeks ago, on April 15, the World Health Organization (WHO) issued an alert about an outbreak of cases of acute childhood hepatitis of unknown cause.
The first ten cases were identified by the United Kingdom in children under ten years old, without pre-existing conditions, and were reported to the entity in early April.
So far, about 200 cases have been reported in other European countries, the United States and Asia, and since then, scientists around the world have been trying to find out what is causing the disease. But what exactly is childhood hepatitis?
“Hepatitis is the name given to an inflammatory process of the liver, which usually occurs as a result of infectious conditions”, explains pediatric infectious disease specialist Alfredo Elias Gilio, coordinator of the Immunization Clinic at Hospital Israelita Albert Einstein and professor at the USP School of Medicine. .
The main causes of hepatitis are viruses (A, B, C, D, E), but the disease can also be triggered by excessive use of some medications, an autoimmune disease, alcohol and drug use.
In children, hepatitis usually manifests as abdominal pain, diarrhea, vomiting, nausea, and loss of appetite. In most cases it develops into jaundice – which is that yellowish color in the skin and whites of the eyes. Other signs of hepatitis are dark urine and whitish stools.
“There are cases in which the child will not have jaundice, but, in general, it is this yellowish color in the eyes that draws the attention of parents. That’s when they usually look for a doctor”, warns Gilio.
How is the diagnosis?
In general, in the face of these symptoms and after a detailed anamnesis of the child’s condition and clinical history, the doctor orders some tests of liver enzymes in the blood to confirm the diagnosis – when there is inflammation in the liver, the amount of these enzymes in the bloodstream increases. .
Once the diagnosis is confirmed, it is necessary to know the cause/origin of hepatitis. “In children, most of the time, the most common cause is hepatitis A. In general, it does not require hospitalization, is not usually serious, and most cases progress well. There is no specific remedy for the treatment, we take care of the symptoms and the body itself recovers”, explains Gilio.
Hepatitis A transmission occurs by fecal-oral contagion, by ingestion of contaminated food and/or water and in places with poor sanitation conditions. A less common form of transmission is through sexual intercourse.
Professor Giglio points out that as there is a vaccine for hepatitis A and B in the National Vaccination Calendar, the number of cases of viral hepatitis in children is decreasing in Brazil.
3 Cards_Gallery_of_Photos (5)Hepatitis is inflammation of the liver. It can be caused by viruses, bacteria, overuse of medication, or alcohol consumption. There are five types of hepatitis: A, B, C, D and E. However, in Brazil, types A, B and C are the most common. Getty Images
*****Picture-person-holding-exam-in-hands.jpgHepatitis A is caused by a virus that can be transmitted through sexual intercourse or through consumption of contaminated food and water. The diagnosis is made through clinical and laboratory tests. TEK IMAGE/SCIENCE PHOTO LIBRARY/Getty Images
*****Picture-person-sitting-on-floor-with-hand-on-head.jpgThere is no specific treatment for hepatitis A, so self-medication should be avoided. Despite this, there is an effective vaccine against the disease. Among the main symptoms of this typing are: nausea for no apparent reason, low fever, loss of appetite, abdominal pain and fatigue.Glasshouse Images/ Getty Images
*****Picture-person-making-tattoo.jpgHepatitis B is also caused by a virus and can be transmitted by sharing personal objects, performing tattoos and surgical procedures without proper hygiene, during sexual intercourse, among others. Among the main symptoms are: yellowing of the eyes, abdominal pain and dark urineJeffrey Coolidge/Getty Images
*****Illustration-of-a-liver-with-hepatitis.jpgIn hepatitis B, the liver may present a persistent inflammation and there is a risk of the disease progressing to liver cirrhosis. It can be identified through laboratory tests. In most cases, it can be treated with antiviral drugs that stop the virus from multiplying and slow down or improve the course of the disease.KATERYNA KON/SCIENCE PHOTO LIBRARY/Getty Images
*****Picture-eye-yellow.jpgHepatitis C, also caused by a virus, has a similar means of transmission to hepatitis B. However, hepatitis C is curable in more than 95% of cases and treatment is available with oral medication. Symptoms include fatigue, loss of appetite, nausea, yellowing of the eyes or skin. MediaProduction/Getty Images
*****Photo-person-performing-dental-procedure.jpgHepatitis D, also known as hepatitis Delta, is caused by the HDV virus (RNA Virus, which needs the hepatitis B virus for infection to occur). It is present in the blood and secretions and can be transmitted as in the case of hepatitis B and C. Luis Alvarez/Getty Images
*****Picture-person-with-hands-on-tummy.jpgHepatitis D can cause abdominal pain, tiredness and nausea. The diagnosis of the disease must be made through clinical and epidemiological examinations.boonchai wedmakawand/ Getty Images
*****Picture-plate-with-food-2.jpgHepatitis E, caused by the HEV virus, is transmitted via the fecal-oral route, that is, through the consumption of contaminated water or food. In most cases, this version of the disease is curable. Symptoms include lack of appetite, nausea and yellowing of the skin. In rare cases, the disease can progress to acute liver failure. Ekaterina Smirnova/Getty Images
*****Picture-person-washing-the-hands.jpgRegardless of the vaccine, indicated for all cases, some recommendations are essential for the prevention of viral hepatitis. These are: washing hands after using the toilets, washing food with treated, chlorinated or boiled water, cooking food well and not bathing in untreated water or near sewers.Solskin/Getty Images
****Foto-instrumentos-cirurgicos.jpgIn addition, using condoms, not sharing syringes or personal materials, and making sure biosafety protocols are followed before undergoing tattoos, piercings, dental treatments, and surgical procedures can help prevent illness.Aja Koska/Getty Images
****Illustration-person-with-yellow-liver.jpgIn addition to these, there is also alcoholic hepatitis, caused by abusive and prolonged consumption of alcohol. Drug hepatitis, which causes inflammation in the liver after indiscriminate use of drugs, and Steatohepatitis, for example, which arises due to the accumulation of fat in the liverSEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARY/Getty Images
*****Illustration-drug-viral.jpgIn milder cases, the disease may go away on its own. But in certain types it is necessary to use antiviral drugs or other specific careOsakaWayne Studios/ Getty Images
*****Photo-child-lying-with-thermometer-in-mouthRecently, several children aged between one month and 16 years were diagnosed with acute hepatitis in European countries and the USA. The severity of the disease led 17 children to undergo liver transplants and one of them died.Pixabay
****Foto-ilustracao-virus.jpgThe mysterious cases of severe liver inflammation still have no clear cause, but evidence points to adenovirus 41F infection.photography/ Getty Images
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Cases of unknown origin
What caught authorities’ attention in the UK cases was the unknown origin of the outbreak in the children – all under 16, most under 10, all healthy. Types A, B, C, D and E viruses, which are the most common causes of the disease, were ruled out. After carrying out a series of tests, the scientists realized that most cases had the presence of adenovirus 41F.
According to Gilio, there are more than 50 adenovirus subtypes and, in general, they cause mild cases of respiratory and non-gastrointestinal problems. But it is still not possible to say that this subtype is the cause of acute cases of childhood hepatitis, since it was not found in all samples.
“The cause of this outbreak is still an assumption, an observation. We need more robust data to answer the questions: are these cases related to the child’s previous Covid-19 infection? Does Covid-19 alter children’s immune response? Is it really the adenovirus that is causing the hepatitis? Could it be that the genome of this adenovirus has changed and has it become more aggressive? There are countless questions that we still don’t know how to answer”, said Gilio.
“One thing we already know is that the cases have nothing to do with the coronavirus vaccine, mainly because they happened in children in an age group that was not vaccinated. [abaixo de 5 anos]. This needs to be reinforced”, continued the professor.
There are still no answers about the origin of the outbreak, but according to Gilio, there is no reason for parents to panic. The orientation is to look for a doctor if the child presents any of the symptoms related to the disease. (Source: Einstein Agency)
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