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On Sunday (24), the World Health Organization (WHO) confirmed at least 169 cases of acute hepatitis of unknown origin. Most notifications involve babies, children and teenagers between one month and 16 years old. Of the total, 17 (equivalent to about 10%) required liver transplantation and one death was recorded.
Through a note, the State Health Department (SES) reported that the state government “is attentive and monitoring the occurrence of the disease around the world”.
Second largest lethal infectious disease in the world, behind only tuberculosis, hepatitis is inflammation of the liver. The main causes are viruses (A, B, C, D and E). Some medications, excessive consumption of alcohol and other drugs and autoimmune, metabolic and genetic diseases can also trigger it.
The alert from the Center for Strategic Information on Health Surveillance of Pernambuco (Cievs-PE) was issued on Monday (25). The document is intended for public and private health units.
Notifications of suspected cases must be made by email [email protected] or by telephone (81) 3184-0191 and 99488-4267 (for health professionals).
Also according to the state government, information has been passed on by the WHO. The world body said, according to the secretariat, that “additional tests have been carried out for other infections, chemicals and toxins”.
“Investigations are ongoing in all countries reporting cases. They are: United Kingdom, Northern Ireland, Spain, Denmark, Netherlands, Italy, Norway, France, Romania, Belgium, Israel and United States.
Alert number 01/22 from the Center for Strategic Information on Health Surveillance (Cievs) in Pernambuco pointed out that the first infections occurred in Scotland, and were soon diagnosed in other parts of the United Kingdom.
“In total, around 80 patients were registered by the UK Health and Safety Agency. The age of the cases ranged from 22 months to 13 years,” Cievs said in the text.
Also according to the report, the European Center for Disease Prevention and Control reported cases in Spain, Denmark and the Netherlands.
The Cievs also stated that “the adenovirus has been confirmed in several European cases, but not in all”. He also stated that “no known epidemiological links or common exposures were found among these children.”
According to the alert made in Pernambuco, the cases in the United Kingdom presented clinically with severe acute hepatitis, with high levels of liver enzymes, and many cases had jaundice.
Some of the cases have reported gastrointestinal symptoms including abdominal pain, diarrhea and vomiting in the previous weeks. Most patients did not have a fever.
Adenoviruses spread from person to person and most commonly cause respiratory illness, but depending on the type, they can also cause other illnesses such as gastroenteritis (inflammation of the stomach or intestines), conjunctivitis (pink eye), and cystitis (bladder infection). ).
Adenovirus type 41 usually presents as diarrhea, vomiting, and fever, often accompanied by respiratory symptoms. Although there are case reports of hepatitis in immunocompromised children with this infection, adenovirus type 41 is not known to be a cause of hepatitis in healthy children.
The Cievs of Pernambuco also said that the laboratory tests carried out excluded the hepatitis A, B, C, D and E viruses: “The Covid-19 hypothesis, however, has not been sustained, as several of the affected children do not had the disease.”
Health teams, especially pediatrics, should be attentive to children and adolescents aged 16 years or younger, especially with reports of passing through the affected areas, who have jaundice or symptoms compatible with non-AE acute hepatitis.
Every year, according to the WHO, viral hepatitis causes 1.7 million deaths worldwide. In Brazil, between 1999 and 2018, 632,814 cases of the disease were recorded. Of this total, 167,108 (26.4%) were type A, 233,027 (36.8%) were type B, 228,695 (36.1%) were type C and 3,984 (0.7%) were type D (or Delta).
The data are contained in the Epidemiological Bulletin of Viral Hepatitis 2019, released this week by the Ministry of Health.
In 2018, according to the Ministry of Health, 2,149 cases of hepatitis A were reported in Brazil, which is equivalent to a detection rate of 1 case per 100,000 inhabitants. In 2008, it was 6.2 per 100,000 inhabitants.
Transmission occurs through fecal-oral contagion, through ingestion of contaminated food and/or water, especially in places with poor sanitation. Another way, which is less common, is through oral-anal sexual practice, by contacting the mucosa of the mouth with the anus of the infected person.
Hepatitis A does not always present symptoms, only in acute cases. Among the main ones are abdominal pain, diarrhea, nausea, vomiting, intolerance to smells, yellow skin and eyes, dark urine, pale stools, malaise and body pain.
In most cases, the disease heals on its own, within a week or two, and the person acquires immunity, that is, they do not have a new infection. The treatment of this type of hepatitis is symptomatic and also includes rest and diet, in addition to avoiding alcohol consumption.
The most effective way to prevent it is with the vaccine, available free of charge for children aged 15 months to 5 years old (4 years, 11 months and 29 days) in basic health units. For risk groups, immunization takes place at the Reference Centers for Special Immunobiologicals.
This group includes people of any age who have chronic liver diseases, coagulopathies, hemoglobinopathies, HIV, immunosuppressive and storage diseases, cystic fibrosis and trisomies, organ transplant candidates and organ donors registered in transplant programs.
For other individuals, immunization is available at private clinics and laboratories. In addition, it is important to wash food well before consuming it, not to buy it anywhere, just drink clean water, pay attention to the water you will use for cooking and take care of personal hygiene.
Last year, 13,992 cases of hepatitis B were registered in the country, which represents 6.9 cases per 100,000 inhabitants.
In this variation, transmission occurs through contact with contaminated blood, through the sharing of syringes, needles, razor blades, nail pliers and other objects that pierce or cut, materials that have not been properly sterilized, unprotected sex and from mother to child. (vertical transmission) at birth.
It presents both acute forms, that is, when there are symptoms (about 10% of the occurrences, having the same clinical manifestations of hepatitis A), and chronic forms (when the virus persists in the body for more than six months).
The disease has treatment, offered by the Unified Health System (SUS), and control, so that it does not progress to cirrhosis and liver cancer. It is done with the administration of antiviral drugs.
The Ministry of Health also provides vaccine. For children, there are four doses (at birth, 2, 4 and 6 months) and, for adults, three doses, depending on the vaccination status. People who have some type of immunosuppression or the HIV virus need a special regimen, with a double dose.
According to data from the Epidemiological Bulletin of Viral Hepatitis 2019, last year 26,167 cases of hepatitis C were reported in Brazil, with a detection rate of 13 per 100,000 inhabitants. This type of disease is the deadliest. From 2000 to 2017, there were 53,715 deaths associated with it.
The Ministry of Health reported that, currently, more than 500 thousand people live with the virus and do not know it, since it is a disease, usually silent, until it reaches greater severity.
The chronic form is common in 80% of patients and, of these, 20% can progress to liver cirrhosis and 1% to 5% to liver cancer.
The pathology is transmitted in the same way as B, through contact with contaminated blood, unprotected sex and from mother to child at the time of delivery.
The treatment, free of charge by the SUS, involves the use of oral antivirals, determined according to the genotype of the virus and the involvement of the liver. It is performed from three months to a year and has excellent chances of cure, passing 95%.
As there is no vaccine against hepatitis C, the best way to prevent it is not to share personal objects and sharps or piercings, use condoms and, when undergoing any procedure, make sure that the materials used are sterilized and disposables are not being reused.
Last year, in the country, there were 145 cases of hepatitis D. This type of disease depends on the presence of the B virus to contaminate a person.
In the same way as the other variations, the patient hardly presents symptoms, which are also the same. The mode of transmission is through sexual intercourse without a condom with an infected person, from the sick mother to the child during childbirth, and through the sharing of sharp objects.
The infection can be both acute and chronic and has treatment (lasting from three months to a year) and control, preventing progression to cirrhosis and cancer. The best way to prevent and not contract hepatitis B is through the vaccine.
This type of hepatitis has a low prevalence in Brazil, so much so that it is not even listed in the Epidemiological Bulletin of Viral Hepatitis 2019. The contagion is the same as that of A: due to poor conditions of basic sanitation, contaminated water and food and lack of personal hygiene.
Patients also have almost no symptoms, but when they do appear, they are basically the same as those of other types of hepatitis: tiredness, nausea, vomiting, fever, abdominal pain, pale stools, dark urine, and yellow skin and eyes.
In most cases, it does not require treatment, being indicated only rest and not drinking alcohol. There is a risk of becoming chronic in immunosuppressed and transplanted people.
As there is no vaccine, the best way to prevent it is to wash your hands well after going to the bathroom and before eating, wash your food well and not have contact with water from ditches, streams, fountains, floods and sewage.