As if Covid was not enough!

According to WHO (World Health Organisation), as of May 16, 2022, Portugal had the highest rate of COVID-19 cases reported in the previous seven days in Europe, at 1,282 cases per 100,000 population.

The United Kingdom currently has the highest number of deaths in Western Europe, and has recorded 176,412 coronavirus deaths as of May 8.

The number of new cases worldwide is fluctuating as the COVID-19 pandemic continues to impact countries around the world, with the emergence of virus variants causing further waves of infection.

Despite the large number of COVID-19 cases currently in Europe, high population immunity, largely resulting from successful vaccination programmes, has helped to keep hospitalisation and death rates down.

Hundreds of thousands of lives are known to have been saved as a result of the vaccination campaigns but, even with vaccines, it remains important for the public to stay vigilant, continue to follow safety precautions and adhere to rules and regulations.

Getting fully vaccinated against COVID-19 and taking a booster dose when recommended is vitally important, particularly for people who are older, have underlying health conditions or are immunocompromised, because the virus is still circulating at high levels and lives are still being lost unnecessarily.

And now there is “something” else!

WHO Disease Outbreak News on April 15, 2022 has reported a number of cases of acute severe hepatitis of unknown origin, in children, in several countries including the United Kingdom, Northern Ireland, Portugal, Spain and the United States of America. Since then, there have been further reports of cases.

The term Acute Hepatitis is used to describe an acute inflammation of the liver that can be due to a range of infectious and non-infectious causes. More commonly, three main types of acute viral hepatitis, hepatitis A, B and C, are responsible.

But this outbreak is unusual, as severe acute hepatitis is unusual in young children. The initial report of a possible increase in cases came from Scotland. This then led to alerts being raised elsewhere in the United Kingdom and globally, with people looking for, and finding, more cases.

WHO reports that cases increased to 429, most of them in Europe. In each four children affected, three were less than five years old.

In Portugal, up to May 17, 12 suspected cases were reported.

What we know is that the common viruses that cause acute viral hepatitis have not been detected in these patients. Also, international travel or links to other countries, based on the currently available information, have not been identified as important factors.

Though these are rare events, this should be taken seriously. The priority is to determine the cause of the illness, to be able to further refine control and prevention actions.

One of the leading hypotheses for the cause is adenovirus, which is a group of common viruses that spread from person to person causing respiratory symptoms, vomiting and diarrhoea in children, but it does not fully explain the severity of the clinical picture.

The potential emergence of a novel adenovirus following a lower level of circulation of adenovirus during the COVID-19 pandemic, as well as SARS-CoV-2 co-infection have been suggested by the United Kingdom team as possible factors.

The United Kingdom, where the majority of cases have been reported to date, has recently observed a significant increase in adenovirus infections in the community following low levels of circulation earlier in the COVID-19 pandemic. The Netherlands also reported concurrent increasing community adenovirus circulation.

Since most of the affected children have not received a COVID-19 vaccine, there is also no evidence that the presentation is linked to vaccination.

It is important to stress that this is not a common disease.

Nevertheless, in younger children, parents should be alert to the symptoms of acute hepatitis, which are an acute onset of diarrhoea, vomiting, abdominal pain and jaundice, meaning skin and whites of the eyes turn yellow. Most children do not have a fever.

According to The Lancet, 72% of the children tested in the UK with acute hepatitis had been infected with adenovirus and, in most, a specific subtype was found.

Once more, the normal measures that help protect against common viruses must be promoted to keep children from getting sick, so good handwashing should be supervised as well as good respiratory hygiene, such as covering up a cough or sneeze.

Taken together, these measures can help reduce the spread, not just for this infection but for many others…

And one more … Monkeypox

The first case was reported by the UK Health Security Agency (UKHSA) on May 7 and is believed to be imported. On May 14, 2022, two more cases were identified in the UK, with no recent history of travel and no contact with the case reported on May 7. A further four cases were confirmed on May 16 that were not contacts of the cases reported on May 7 and 14.

On May 18, Portugal reported five confirmed cases of monkeypox, and more than 20 suspected cases. All cases were young men, and all in the Lisbon area. Spain has also reported eight suspected cases.

Monkeypox is another viral disease and is considered to have moderate transmissibility among humans. It can occur through contact with an infected animal or human, or with human bodily material containing the virus.

Transmission between humans mostly occurs through large respiratory droplets. As droplets cannot travel far, prolonged face-to-face contact is needed. The virus can also enter the body through bodily fluids, lesion material, or indirect contact with lesion material.

Symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash typically develops that usually begins on the face, spreading to other parts of the body including the genitals.

Transmission between sexual partners due to intimate contact, during sex, with infectious skin lesions, seems the likely mode of transmission. Transmission between individuals without close contact is considered low.

These new viral threats are not as frightening as Covid, but be reasonable, for your own safety and for the safety of all others around you!

Best healthy wishes,
Dra. Maria Alice Pestana Serrano e Silva

Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service. Administration Assessor – Grupo Hospital Particular do Algarve