Since the World Health Organization (WHO) issued an alert on cases of fulminant hepatitis of unknown origin and which mainly affected children last month, experts are trying to decipher what is triggering the disease, which caused one death and caused 17 patients to need a liver transplant. WHO works with the line that the problem was caused by adenovirus infections, which cause gastrointestinal and respiratory diseasebut investigates foods, toxic substances and environmental agents.
Hepatitis is an inflammation that affects the liver and, in most episodes, is caused by a virus, but it can be related to the use of toxic substances, including drugs, alcohol consumption, hereditary diseases and autoimmune disorders. The main symptoms are jaundice (yellow color of the skin or eyes), diarrhea, abdominal pain and vomiting. In the case of children affected in these episodes, the disease is not explained by the types of hepatitis – A, B, C, E and D (when applicable) – or other viral diseases.
So far, according to the latest WHO survey, around 170 records are being monitored in 11 countries, including the United Kingdom, Spain, Israel, the United States, Denmark and Italy.
With records of the disease in the United States, researchers have been questioning whether cases can be recorded in other locations. For André Ibrahim David, a reference in liver transplants who is a professor at the Faculty of Medicine of the Federal University of São Paulo (Unifesp) and a digestive system surgeon, it is possible that this occurs and that there are reports of cases in Brazil.
“It will end up being, we are part of the world and the flow from Europe to Brazil and the United States to Brazil is very large. I believe it will arrive in Brazil and we have to be prepared”, he said in an interview with LOOK. Read the main excerpts below.
– The WHO is investigating the possibility of a relationship between the cases of this mysterious hepatitis with adenovirus. What is already known about this?
What we have information is what is being released by the WHO, because there is no published scientific work. It must be related to a viral infectious agent. It is a condition with elevation of liver enzymes, jaundice, very similar to hepatitis A, which is transmitted orally. If it’s adenovirus, it’s not normal, it’s subtype 41 (associated with episodes of gastroenteritis).
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– Could it have any connection with Covid-19?
Of the cases analyzed, 74 were adenovirus, but 20 had Covid-19. And another 19 were from coinfection, adenovirus and Covid-19. Chances are, when the cause is discovered, it will be a viral agent. The important thing is to point out that it has nothing to do with vaccines against Covid-19, because most children had not been vaccinated.
– Do you believe that cases will be registered in Brazil?
Someone brought this virus to the United States without having many symptoms, it could have been an adult who transmitted it. The adult has an immunological history and the virus ends up doing nothing. So, eventually, we are part of the world and the flow from Europe to Brazil and the United States to Brazil is very large. I believe it will arrive in Brazil and we have to be prepared.
– But does Brazil have the structure to deal with these cases?
Brazil has conditions, because we do a lot of transplants. The problem is the volume, it’s a situation that looks like an epidemic, with 10% of patients needing a liver transplant. It is possible to carry out the living transplant in many children, the father or mother donate, but it needs a pediatric team and there are few teams in Brazil. It would be an overload in large centers.
– Without knowing the cause, what can you do to prevent the disease?
It is important to provide support for not having fulminant hepatitis and to maintain care measures, such as having a healthy diet, sleeping well, having adequate personal hygiene. As the transmission (of adenovirus) is oro-fecal, you have to redouble hygiene care and guide children, schools and parks on the subject.
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