Mysterious hepatitis progression among children in Europe and warns Brazilian doctors – 04/27/2022

The World Health Organization (WHO) has issued a warning about a new type of hepatitis that affects children and has resulted in the need for one in ten liver transplants.

The lawsuits have appeared in the UK and are spreading across Europe. As of April 21, 158 children had been infected in ten countries on the old continent. There have been nine cases in the United States and 12 in Israel. One death has been reported – where the WHO has not specified. To date, 17 patients have needed a transplant.

The new revelation raises the severity of the disease to unprecedented levels, and experts in Brazil are concerned. They suggest that health services prepare themselves and pay attention to suspected cases of hepatitis without confirmation of already known infectious agents.

“Investigations are underway for an effective agent,” said a note from the WHO on the 23rd, classifying the disease as “acute hepatitis of unknown etiology”. To help other countries, the UK Health Protection Agency has issued guidelines to affected countries to assist in the investigation of suspected cases.

Cases reported worldwide as of April 21:

  • United Kingdom – 114
  • Spain – 13
  • Israel – 12
  • USA – 9
  • Denmark-6
  • Ireland – 5
  • Holland and Italy – 4
  • Norway and France – 2
  • Romania and Belgium – 1

The WHO Information Board shows countries that have already reported cases

Photo: Reproduction / WHO

Extreme caution in Brazil

News of the case warns infectious experts who assess the likelihood of the disease emerging in Brazil.

“It’s very worrying because it’s spreading so fast. We’re assuming that [o número de casos] Will increase, even more so now travel is increasing as the epidemic becomes more controlled. The chances of coming to Brazil are great, “said Marcelo Simao, a professor at UFU (Federal University of Uberlandia) and former president of the SBI (Brazilian Society of Infectious Diseases) between 2010 and 2014.

According to the WHO, the main suspect so far may be an infection caused by adenovirus type 41.

“Type 41 adenovirus usually presents as diarrhea, vomiting, and fever, often accompanied by symptoms of shortness of breath, although there are reports of hepatitis in children. Immunocompromised With adenovirus infection, adenovirus type 41 is not known to cause hepatitis in healthy children, “the statement said.

The WHO recommends countries that include blood, serum, urine, stool and respiratory samples of patients, as well as liver biopsy samples (when available), with more features of the virus, including sequencing. “Other infectious and non-infectious factors need to be thoroughly investigated,” he said.

Marcelo Simao says the main suspected agent, adenovirus, is already well-known in medicine and causes outbreaks in various countries, but only in cases of diarrhea and the common cold. “It can change and become more contagious and aggressive,” he said.

If the adenovirus is confirmed to be effective, Sima also fears that the spread of the infection will spread worldwide.

The virus is transmitted through food or from one child to another, so the WHO is concerned. We have started to notice these cases and in two, three weeks they have already spread. This is very worrying and we will have to wait for more research.
Marcelo Simao, Infectious Diseases Specialist

If it is a new agent, he said, science must run to get a vaccine as soon as possible to protect children, as was the case with the coronavirus. “Acute hepatitis known today is controlled by vaccination and treatment. But it is new, we don’t even know it is the peak of an epidemic and it will disappear. If it stays, we must protect our children,” he said.

The replacement rate is 100 times higher

Jos Milton de Castro Lima, a professor and hepatologist at the UFC Hospital Complex (Federal University of Sierra), explains that hepatitis is still a mystery because it does not fit into any of the five known types of medicine.

“We have viruses known as hepatotropics. They produce hepatitis A, B, C, D and E. These do not meet any of the requirements for reporting,” he explained.

According to Lima, fulminant hepatitis is very rare in the case of known viruses. “We have a case between 1,000 and 10,000 that could progress to a full-fledged level. This percentage of one in 10 is new and has attracted attention. This is a large number, indicating a much more serious disease than what we see today.” He said

The professor says a full-blown hepatitis leads a person to an urgent need for a liver transplant, as has happened with 17 children, according to the WHO.

“It happens when aggression is so severe that the person begins to have difficulty or loses the ability to make substances. [produzidas pelo fígado] Needed for freezing. And then comes encephalopathy, which causes mental confusion, the person starts to urinate “, he said. You have substances produced in your blood, most of them in the liver, it can develop a very large clotting process, die of bleeding.

We need to pay attention to hepatitis and get tested for adenovirus. This is a precaution that I make for all pediatricians
Jos মিল Milton de Castro Lima, Hepatologist

Hepatitis C virus image - BSIP / Contributor Getty Images - BSIP / Contributor Getty Images

Pictures of the hepatitis C virus

Photo: BSIP / Contributor Getty Images

Unknown and mysterious agent

The adenovirus has so far been found in 74 samples from sick children, according to the WHO report. Effective agents of SARS-CoV-2, covid-19 were also found in 20 samples.

Fernando Spielki, a virologist at Fival University (RS), says it’s not yet known, but he believes our “third cause” may be responsible for the illness.

“It’s not a common manifestation, not even adenovirus or SARS-CoV-2,” he explained. “The adenovirus is transmitted through water, especially in places where you have poor sanitation. It is relatively frequent as a cause of gastroenteritis outbreaks in both adults and children, but we do not see this strong link to hepatitis,” it said.

Regarding adenovirus, the WHO recalls that it was “not previously associated with such a clinical presentation”. “Although adenovirus is currently thought to be an underlying cause, it does not fully explain the severity of the clinical picture,” the WHO said.

For Spilky, it’s “weird” that the cause is adenovirus, but it’s not impossible. “Some additions, or even hypotheses of a virus related to mutated adenovirus 41, or some kind of mutation, alter this pathogenicity and induce a new clinical manifestation,” he said.

It is noteworthy that these persistent outbreaks are observed in different countries with similar characteristics, either by an agent that is already known, but has probably changed, or even a virus or other microorganisms that are still unknown.
Fernando Spilky, virologist

WHO logo at its headquarters in Geneva - Dennis Balibaus / Reuters - Dennis Balibaus / Reuters

WHO logo at the entity’s headquarters in Geneva

Photo: Dennis Balibaus / Reuters

Vera Magalhayes, a professor and professor of Tropical Diseases at UFPE (Federal University of Pernambuco), said there was a suspicion that the causative agent would be an unknown infectious agent or chemical.

“It is thought to be an infectious agent because it occurs in people who have contact with others and these children have not traveled. Sick children also had no history of taking the drug,” he explained.

The patients in these cases are mainly 10-year-old children, whose symptoms include jaundice, vomiting, diarrhea and abdominal pain, he said.

For Magalhays, it is too early to dismiss Covid-19 as one of the culprits. “The Omicron variant of its BA.2 lineage was detected in the samples; it was not even known if the virus changed the immune system of these children to the point of more aggressive response to adenovirus and other respiratory viruses – which were also identified in some patients.” Does.

In a column, the Ministry of Health reported today that the Center for Health Surveillance Strategic Information Center (CIEVS) monitors the National Hospital Surveillance Network’s (RENAVEH) hospital epidemiology centers, with no changes in the epidemiological profile, as well as serious acute hepatitis in children.

“The folder directs the National Network of Health Professionals and the Unified Health System (VigiAR-SUS) Public Health Monitoring, Alert and Response to emergencies, and suspicions are immediately notified”, completing the folder, noting that no case has yet been registered.

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