Health agencies and scientists around the world are working to find the cause of acute hepatitis in children of unknown origin. As of April 21 this year, 169 cases had been registered among children and adolescents aged 1 month to 16 years, according to a report by the World Health Organization (WHO). Most of them were under 5 years old. At least one death has been recorded due to complete inflammation and 17 pediatric patients need liver transplants. Affected children are in Europe and the United States.
Cases were first recorded in the United Kingdom, a country responsible for 114 cases of severe liver disease in children without any known cause. Since then, the outbreak has spread to at least 11 countries, including the United States, Spain and Italy. Most children with acute hepatitis had no sexual intercourse.
What is hepatitis?
Hepatitis is an inflammation of the liver, which can cause many health problems. When organs are severely compromised – important for removing toxins from the blood and controlling clots, among other things – it can lead to death. Hepatitis can have many causes, but the most common are hepatitis A, B, C, D and E viruses. None of the children who had acute hepatitis tested positive for them.
Alcohol consumption, certain medications, and disorders of the immune system can also cause hepatitis. However, the WHO does not yet consider any of these factors as the “main suspects” in explaining the current case of children.
Renato Kafuri, a pediatrician and infectious disease specialist, first secretary of the Brazilian Society of Immunizations (Sbim), noted that complete cases of hepatitis for unknown reasons are not common, especially among young people. “Viral hepatitis, depending on the health condition of the person, requires one transplant for every one in a thousand or tens of thousands,” Kfouri said. “What we are seeing in these reported cases of children is the need for a liver transplant in 10 cases which is very high and worrying. It is noteworthy, however, that other cases of hepatitis may occur without any known cause, but have mild symptoms and are not being diagnosed. In that case, the actual death toll would be much lower, but it’s something we don’t know if it’s actually happening. “
What could be behind the hepatitis in children?
According to the WHO, the main hypothesis is that the inflammation was caused by adenovirus 41F, which was identified in 70 children who had the problem, but investigations are still ongoing. According to Flavio Mello, a pediatrician at Instituto Cândida Vargas (PB), adenovirus 41F, usually responsible for mild gastrointestinal symptoms such as vomiting, diarrhea and mild abdominal pain, does not usually cause hepatitis. “In most people, the adenovirus resolves on its own without any sequelae, so there is a suspicion that there is probably a cofactor that explains why this very common virus is leading to fulminant hepatitis,” he explained.
Among the possible co-factors currently being investigated by scientists are, according to pediatricians: children’s sensitivity, for example, due to lack of previous exposure during an epidemic, which can lead to a weakened immune system; Previous SARS-CoV-2 or other infections; Co-infection with SARS-CoV-2 or other infections; And exposure to certain poisons or drugs.
Although adenovirus 41F is currently the main suspect in hepatitis cases, other possibilities are being evaluated, including: a new variant adenovirus, with or without the contribution of a cofactor; A drug, toxin or environmental exposure; A new pathogen acts alone or as a co-infection; And a new variant of SARS-CoV-2.
According to Kefauri, the only certainty we have today about the mysterious case of hepatitis is that it is not related to the Covid-19 vaccine. “Most children with fulminant hepatitis have not been vaccinated against covid. This can be explained by their age, since most of them are less than five years old, and so they are not within the age for which the immunizer is prescribed. Therefore, any association with the vaccine is ruled out, ”explained the pediatrician.
Can the cases reach Brazil?
So far, there have been no cases of fulminant hepatitis among children in Brazil without an unknown cause, however, following WHO recommendations, the country has declared itself alert to the situation and all suspected cases must be reported. For pediatrician Renato Cofori, the hepatitis outbreak could actually reach the country. “Adenovirus 41F is prevalent in Brazil. If this virus is really involved in pediatric hepatitis, it would not surprise me if we record the cases here, but the fact is that we still have very little evidence to evaluate whether it will occur. You have to be careful and wait, ”he said.
In severe cases of hepatitis, the main symptoms are loss of appetite, yellowing of the skin and eyes, and dark urine. If you identify them, seek medical advice immediately.