Less than a month after alarming Europe, suspected cases of severe acute hepatitis in children were reported in three regions of Brazil. After the first notifications in the South and Southeast, yesterday (9) it was the turn of the Health Department of Pernambuco to inform the record of the disease of unknown origin.
Today, in the country, there are 16 suspected cases under investigation by the Ministry of Health in six states, in addition to the death of a baby.
The folder informed the column that all cases are being investigated and that Cievs (Centers for Strategic Information on Health Surveillance) and the National Hospital Surveillance Network “monitor any change in the epidemiological profile, as well as suspected cases of the disease”.
The ministry directs health professionals to immediately notify suspected cases.
The new manifestation of hepatitis increased the severity of the disease. In Europe, children need a liver transplant in one in ten cases, according to the WHO (World Health Organization).
“We have [nos vírus já conhecidos de hepatite] a case between 1,000 and 10,000 that can progress to a fulminant form. This percentage of one in 10 is large, it indicates a much more serious disease than what we see today”, says professor and hepatologist at the UFC Hospital Complex (Federal University of Ceará) José Milton de Castro Lima.
cases in Pernambuco
In the case reported yesterday, in Pernambuco, the Health Department reported that it is a 1-year-old male child, who lives in Toritama (165 km from Recife), in the wild.
The baby needed to be admitted to Hospital Mestre Vitalino, in Caruaru, on April 27. “The patient, who presented with fever, skin rash [erupções] and abdominal pain with hepatomegaly [fígado aumentado]was followed up by the team, showed clinical improvement and was discharged from hospital on the 6th”, says the text.
The case draws attention because it is a city far from where other cases arose in the country (in the South and Southeast, read below).
The column sought out Toritama City Hall, which was unable to inform whether the child had traveled or had any contact with a traveler recently.
According to the municipality, the case is under evaluation and, as a precaution, the child is in isolation. Starting tomorrow (11), the Regional Health Management will carry out an on-site study and obtain collections to investigate.
After the publication of this report, early on Tuesday night (10), the Pernambuco Health Department reported a new suspected case, this time of a 14-year-old teenager – who will also be investigated. The Ministry of Health was notified, but had not updated the number until 7 pm.
In addition to Pernambuco, suspected cases were reported in five other states.
In Rio, the State Department of Health issued an alert to the 92 municipalities in the state. So far, five suspected cases have been reported to the ministry and are under investigation in the state. An 8-month-old baby, resident of Maricá, died, and the investigation is ongoing.
In São Paulo, the state reported, until yesterday, seven suspected cases notified (one more than the number reported by the Ministry of Health) and they are being investigated.
In Santa Catarina, the Secretary of State for Health detailed that a suspected case was reported on Friday (6) in a 7-year-old child, who was admitted to a hospital in Itajaí on May 4, presenting with acute hepatitis with symptoms of jaundice (yellowing of the skin and eyes), nausea, vomiting, diarrhea and abdominal pain.
History and Mystery
Hepatitis cases were initially reported by the UK and quickly spread across Europe, Israel and the US.
According to the cases already recorded, acute hepatitis has caused gastrointestinal symptoms in children, including abdominal pain, diarrhea and vomiting and increased levels of liver enzymes, in addition to jaundice and absence of fever.
According to virologist Fernando Spilki, who is a professor and researcher at the University Feevale (RS), the causative agent of hepatitis is still unknown, but it is already known that there must be transmission in contact between children.
“Although there are not high levels of confirmation, of what has been mapped in Europe and the United States so far, normally the child has a nexus of contact with other cases”, he explains.
According to investigations in the UK, adenovirus may be associated with transmission. “Among 163 UK cases, 126 were tested for adenovirus, of which 91 had adenovirus detected. [72%]. Among cases, adenovirus was mainly detected in the blood.
However, as it is not present in all patients, the virus is still seen as a hypothesis.
Spilki clarifies that the evidence is beginning to show itself and point to the adenovirus, but he says that it is necessary to have complete genomes and better understand the differentiated behavior of a pathogen already known to science.
If it is, we need to understand why it is an adenovirus different from what we have known for many years. The evidence is strong, but how does a virus that has infected people for so long have such a big change?
Fernando Spilki, virologist
According to him, if it is indeed adenovirus, the pathogen is characterized by environmental transmission. “And that’s what have observed in this case: the infected person had contact with a sick child”, he reports, citing that the case of Pernambuco draws attention due to the distance from other cases reported in the country.
“If it suddenly appears somewhere that no one has noticed, it could be that it was already circulating before, but it is something that has to be investigated”, he points out.
Alert in Latin America
According to PAHO (Pan American Health Organization), countries must remain on alert. On the 5th, Argentina had already confirmed a case, the first officially confirmed case in Latin America.
“The common viruses that cause acute viral hepatitis (hepatitis A, B, C, D and E virus) were not detected in any of these cases. International travel or connections in other countries have not been identified as factors in the disease. is under investigation by the WHO”, he informs.