The number of cases under investigation of childhood hepatitis of unknown cause in Brazil has risen to 47, which continues to puzzle health authorities.
Just over a week ago, there were 28 registered suspects. Now, the Department of Health has already received a total of 58 notifications from 11 states – 11 cases having already been dismissed.
“We are still at the stage of understanding what this hepatitis is. The alert level is that of vigilance,” explains the executive secretary of the Ministry of Health, Daniel Meirelles Pereira, to Folha.
Until this Wednesday (18), there were 14 cases being analyzed 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.
The analysis made from 45 cases monitored by a crisis room set up by the ministry shows that the children are on average 7 years old. The age of patients in the country 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, if 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 highest number of serious cases in relation to classic cases of childhood hepatitis.
“The occurrence of these cases is intriguing because we are still not sure,” says Sáfadi. “The cases have been studied exhaustively and they don’t find what usually hides behind hepatitis. In other words, it’s not the A, B, C, D and E virus and it’s not neither is 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 samples of blood, feces and nasal secretions. The material is being analyzed by the central laboratories, linked to the SUS (Unified Health System).
“We have a structured monitoring system. As this investigation depends a lot on public health laboratories, what we hope is that they will be able to answer, ”says Brigina Kemp, technical adviser of the Council of Municipal Secretaries of Health of São Paulo. “Healthcare professionals and municipal oversight need timely laboratory answers.”
The WHO (World Health Organization) has already received 429 notifications of probable cases in 22 countries. Among these cases, 26 children (equivalent to 6% of the total) required a liver transplant.
“The vast majority of children have recovered, improved and been discharged, but the transplant is a therapeutic resource that you use when you have severe, fulminant hepatitis. Unfortunately, the cases [de hepatite misteriosa] behaved in a more serious way than the classic childhood hepatitis situations,” says Sáfadi.
“At the same time, there are less than 500 cases worldwide. We are still talking about a rare event,” he said.
One hypothesis is that the mysterious hepatitis is linked to a family of viruses called adenoviruses and to a second factor, such as previous infection with the new coronavirus.
“What caught their attention was that in a relevant part of the cases they found the adenovirus. It’s an old acquaintance of ours, but it’s never been associated with hepatitis in healthy children,” says Sáfadi.
“And apparently there was no mutation. It causes respiratory problems, diarrhoea, etc., but not hepatitis. Thus, the reasoning of the scientific community is that there is a cofactor, another element, in addition to the adenovirus, which determines the occurrence of cases. And the most likely co-factor at this point is to imagine that these children were infected with Covid-19 at the time.
WHO rules out any link to Covid-19 vaccines. In most reported cases, according to the organization, children and adolescents had not been vaccinated against the coronavirus.
The agreement was monitored by the Ministry of Health. “No link with the vaccine [contra a] The Covid-19 has been identified”, underlines the report of the Ministry of Health Surveillance of the file on the case.
Source: Folha de S. Paulo