Dive/SC (Santa Catarina Epidemiological Surveillance Authority) published last Friday (9) a note on guidelines and studies on the increase in cases of acute hepatitis in children in Santa Catarina. The origin of the disease remains unknown, but “extensive investigations” are underway, according to the agency.

Symptoms include high levels of liver enzymes, vomiting, diarrhea, abdominal pain, and jaundice.

The board says that most of the reported cases do not appear to be directly related to what the source might be. Many of the symptoms are the same as before confirmation of the disease, but the viruses characteristic of acute hepatitis were not detected in any of the cases.

“The clinical syndrome among the identified cases is acute hepatitis (inflammation of the liver) with a pronounced increase in the activity of liver enzymes. Gastrointestinal symptoms, including abdominal pain, diarrhea and vomiting, have been reported in many cases before the onset of severe acute hepatitis and elevated liver enzymes. In most cases there was no fever.

Although adenovirus is a hypothesis of an underlying cause, the agency says it does not fully explain the severity of the clinical picture. Extensive epidemiological investigations are currently underway to identify common contacts, risk factors or associations between cases.

Other hypotheses are put forward, such as increased susceptibility to adenovirus among young children after the Covid-19 pandemic due to a decrease in the number of pathogens, the emergence of a new adenovirus and a previous infection or co-infection with coronavirus.

It is worth noting that the hypotheses related to the side effects of Covid-19 vaccines are not currently confirmed. Dive reports that the reason for this is that the vast majority of children who have had the disease have not received the Covid vaccine.

WHO confirmed 1,010 cases of hepatitis of unknown origin in July – Photo: Arquivo/Agência Brasil/ND

Dive Orientation

The responsibility for monitoring cases of severe acute hepatitis of unknown etiology in children and adolescents in Santa Catarina is now transferred to Gedic (STI, HIV/AIDS and Chronic Infectious Diseases).

The guiding principle is that all health services pay attention to patients with the following characteristics: “children/adolescents under 17 years of age, with acute hepatitis, with elevated levels of AST (serum aspartate transaminase) and/or ALT (alanine transaminase) transaminase ≥ 500 IU / L, without a reason of non-infectious origin justifying this condition.”

Institutions identifying patients with the characteristics described above should notify Gedic immediately.

Increasing cases

In July, the WHO (World Health Organization) reported that there were at least 1,010 cases in 35 countries. A total of 46 children needed a liver transplant, 22 died.

In Brazil, among the records, three needed a transplant and one child died.