Severe cases of hepatitis A: case series in Curitiba, Paraná, 2023-2024

Describe the epidemiological profile of the hepatitis A outbreak in Curitiba, Paraná, between November 2023 and May 2024, with emphasis on the clinical and laboratory characterization of cases that progressed to death or liver transplantation.

Descriptive case series study based on confirmed cases of hepatitis A. Severe cases, defined by death or liver transplantation, were identified via the Mortality Information System and Hospital Epidemiological Surveillance Centers. Clinical and laboratory data were obtained by reviewing medical records. Proportions, measures of central tendency, and dispersion were calculated.

Among the 281 confirmed cases, the majority were male (74.7%), with a median age of 29 years. Six people (2.1%) progressed to severe forms, of whom three received a diagnosis of fulminant hepatitis. The median age of the severe cases was 43 years, with a male predominance (5/6), and two were homeless individuals. Among the severe cases, five resulted in death, and one in a liver transplant. The most common symptoms and complications were jaundice, acute renal failure, and the need for mechanical ventilation (5/6). Laboratory results indicated hepatic dysfunction (median aspartate aminotransferase of 3,448 U/L; median international normalized ratio of 3) and renal dysfunction (median urea 52 mg/dL and creatinine 3 mg/dL). The median hospitalization length was 11 days.

In this outbreak, there were cases requiring liver transplantation and progressing to death, demonstrating that, although generally self-limiting, the disease can present with a severe course. Timely response and targeted vaccination may be key strategies in outbreak scenarios.