Brazil sees rise in hepatitis A cases after a decade of decline

Brazil has again seen a worrying rise in hepatitis A cases after a ten-year decline, according to the Viral Hepatitis Epidemiological Bulletin released in July by the Ministry of Health. The national incidence rate of the disease rose 54.5% from 2023 to 2024, rising from an average of 1.1 to 1.7 cases per 100,000 inhabitants, according to data from the Notifiable Diseases Information System (SINAN).

Historically, the problem was concentrated in the North and Northeast regions (with 24.5% and 29.2% of cumulative cases, respectively). However, the survey points to a new pattern, with outbreaks in large cities, which until then had been less affected. This occurred primarily in the South, Southeast, and Central-West regions. The latter showed the greatest proportional variation, with a 350% increase in just one year.

The capitals of these regions lead the rankings. Curitiba is the most extreme case, with 31.3 cases per 100,000 inhabitants—almost 20 times higher than the national average. This discrepancy between the incidence in the country and in the capitals suggests that the recent outbreak is urban and may be related to population density and inequalities in access to basic sanitation and vaccination.

Silent threat

Caused by the hepatitis A virus (HAV), the disease is transmitted primarily through the fecal-oral route, that is, through the ingestion of contaminated food or water. Therefore, it is associated with factors such as poor sewage systems, poor personal hygiene, and the consumption of unsafe water or poorly sanitized food.

Infection can also be transmitted through anal sex. This is why immunization campaigns by the Unified Health System (SUS) in São Paulo and the Federal District, for example, have begun targeting specific groups, such as cisgender homosexual men.

"This virus has an incubation period that varies from 15 to 50 days. Therefore, it's possible that many individuals don't even know they're infected and transmit the infection to their partners," warns infectious disease specialist David Salomão Lewi, from Einstein Hospital Israelita.

When they do occur, typical symptoms include fatigue, fever, malaise, nausea, abdominal pain, and jaundice (yellowing of the mucous membranes, dark urine, and white stools). In more severe cases, the condition can progress to acute liver failure.

"Hepatitis A usually presents in childhood as a benign, self-limiting infection. However, in adulthood, it often presents in a more complex manner, with a higher risk of becoming fulminant hepatitis, which can require a liver transplant and be life-threatening," explains infectious disease specialist and hepatologist Thor Dantas, a professor at the Federal University of Acre (UFAC) and a member of the Brazilian Society of Hepatology.

And it is precisely the elderly who have been most affected by the disease. The Ministry of Health bulletin indicates that in 2014, the incidence of hepatitis A among young people aged 20 to 29 was two cases per 100,000 inhabitants; ten years later, that number rose to four cases per 100,000. This same trend can be seen in the 30- to 39-year-old age group, which had one case per 100,000 in 2014 and rose to almost four cases per 100,000 in 2024.

Conversely, among both children under 5 and those aged 5 to 9, there was a 99.9% reduction in the incidence of hepatitis A over these ten years. This is primarily due to the introduction of vaccination against the disease through the Unified Health System (SUS) in 2014.

Is there treatment?

There is no specific antiviral to treat hepatitis A. "Care in these cases is symptomatic, meaning that if the patient experiences nausea, an antiemetic is given; if they experience abdominal pain, an analgesic is recommended," Lewi emphasizes. "In general, the best way to aid recovery is relative rest—the person doesn't need to lie down all the time, but they should avoid unnecessary exertion, such as physical exercise, and maintain a balanced diet without excess fat or sugar."

Contact isolation of the infected individual may also be recommended. Therefore, while recovering from the infection, it is important not to share personal hygiene items, such as toothbrushes, razors, and towels. Respiratory isolation is not necessary.

"The liver has a great capacity for recovery, so treatment for hepatitis A is considered supportive. The exception is for patients who develop fulminant hepatitis," Dantas notes. "In these cases, because massive organ destruction occurs, these patients need to be admitted to specialized centers for intensive therapy and close medical monitoring."

Besides improvements in basic sanitation, the main preventive method against hepatitis is the vaccine. Developed from the inactive HAV virus, it is highly effective, with a long-lasting and perennial effect, meaning it does not require booster doses throughout life.

For those unsure whether they have been vaccinated, a serological test can be performed to check for the presence of antibodies. If none are found, vaccination is recommended. At SUS health centers, the vaccine is distributed free of charge to children aged 12 months to under 5 years (4 years, 11 months, and 29 days). It is scheduled for 15 months in the childhood vaccination schedule.

Furthermore, the public health system offers the vaccine in a two-dose schedule, with a minimum interval of six months, for children, adolescents and adults with chronic liver disease or other conditions that lead to immunosuppression, such as HIV infection.

Source: Einstein Agency

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