Santa Catarina has had 12 records of childhood hepatitis of unknown origin until this Monday (27). According to Dive/SC (Directorate of Epidemiological Surveillance), six cases are considered suspicious, four are under laboratory investigation or pending and two have been discarded.
Among the suspects, the state agency reported that all were discharged from hospital and are still under investigation and monitoring by the health teams, with the exception of one who was transferred to Porto Alegre (RS) for evaluation of a liver transplant.
Dive/SC did not provide details on the sex, age and city of suspected cases.
“Laboratory or pending investigation means that we are still awaiting test results and clinical evaluation to verify if they will be classified as a ‘suspected case’”, explains Dive/SC, in a note.
The WHO (World Health Organization), through PAHO (Pan American Health Organization), made new guidelines available to laboratories in the Americas to contribute to investigations into the causes of hepatitis of unknown origin in children.
According to official information, 869 probable cases of the disease have already been reported in healthy children under the age of 16 in 33 countries around the world, between October 1, 2021 and June 16, 2022.
Of these, 368 were in seven countries in the Americas, the majority – 290 – in the United States.
“While this is a serious illness in children and a cause for concern, its occurrence remains infrequent,” said Ruben Mayorga, PAHO’s Head of HIV, Tuberculosis, Hepatitis and Sexually Transmitted Infections.
She stressed, however, that it is important to “continue to monitor the situation and investigate probable cases”.
There are several hypotheses about the cause of these cases, including toxicological/drug, food, immunological, environmental or infectious factors, but none have been proven to date and several of them are being actively investigated.
According to PAHO, knowing the causes will inform public health policies and measures to prevent new cases and treat the disease.
The new PAHO guidelines include a laboratory algorithm designed to rule out the most frequent viral hepatitis (A, B, C, D, and E) and other endemic diseases in the region that can cause liver damage, such as malaria, yellow fever, and leptospirosis.
Human adenovirus — which usually causes mild, self-limiting gastrointestinal or respiratory infections in children — is among the infectious agents investigated.
Therefore, the guidelines incorporate their search as part of the investigation protocol among possible infectious causes.
Once other possibilities have been ruled out, PAHO guidance suggests considering additional tests, such as a respiratory panel, or for Enterobacteriaceae and other less frequent pathogens.
This staggered testing process ensures a rational and cost-effective use of public health laboratory resources.
“These guidelines seek to help gather information to define the most likely cause of this hepatitis,” explained PAHO Regional Adviser for Viral Diseases, Jairo Méndez.
“It could be multifactorial, it could be something triggered in conjunction with other infectious, toxic or metabolic causes, but we don’t know yet, so it’s important to look at probable cases and shed a little more light on the investigation.”
Hepatitis is an inflammation of the liver that can have many causes, which usually range from viral infections to excessive consumption of alcohol, some medications and toxic substances.
The main symptoms recorded in hospitals around the world are jaundice (yellow skin and whites of the eyes) and gastrointestinal manifestations, such as abdominal pain, vomiting, diarrhea and nausea.
The ECDC (European Center for Disease Control) recommends strengthening general good hand hygiene practices and cleaning and disinfecting surfaces. PAHO suggests measures that protect against adenovirus infection, such as the use of a mask.
The best thing is for parents to observe the symptoms of the disease and, when they suspect hepatitis, look for a health service. The relationship between mysterious hepatitis and Covid-19 vaccines has been ruled out.