After more than 810 days of living with COVID-19, Cuba took a decisive step, which ratifies control over the disease in the country by eliminating the mandatory use of the mask.

Although the pandemic has not left the national territory, the measure responds to the current epidemiological situation, characterized by the decrease in positive cases and deaths, while surveillance of SARS-CoV-2 continues and attention is paid to other health emergencies, such as monkey pox and acute hepatitis in children of unknown cause.

The nation has a confrontation plan against these diseases and the National Health System is alert to both, based on the surveillance of cases with compatible symptoms and epidemiology, and the training of sector personnel, assured José Angel Portal Miranda, minister of Public Health.

He explained that more than 30 children with hepatitis were studied in the territory and none, after carrying out the corresponding tests, was classified as carrier of severe acute hepatitis of unknown cause.

People with skin lesions similar to those caused by monkey pox were also analyzed and, after carrying out the differential diagnoses —clinical, epidemiological and laboratory—, the presence of chickenpox or other diseases was confirmed, he specified.

A NEW TYPE OF HEPATITIS?

Hepatitis is an inflammation of the liver caused by different causes such as an infection or intoxication by drugs or substances, and the most frequent infectious agents are the viruses responsible for hepatitis A, B, C, D and E, according to the Pan American Organization for Health (PAHO).

As for severe acute hepatitis of unknown cause, it refers to inflammation of the liver with elevated transaminase (enzymes that play an important metabolic role), fundamentally, and although there are several hypotheses, its origin has not been determined as they do not coincide with viral hepatitis, detailed Lissette del Rosario López González, head of the National Group of Pediatrics of the Ministry of Public Health (MINSAP).

She added that the World Health Organization (WHO) issued an alert regarding this type of hepatitis due to the increase in the incidence of cases that exceeds the usual figures and because some patients evolve rapidly towards acute liver failure, so they have required a liver transplant, and others have died from this cause.

The doctor pointed out among the theories the implication that the adenovirus (family of viruses that can cause infections in the respiratory tract, eyes and gastrointestinal tract), mainly F41, could have.

However, in some children whose liver has been studied, its presence has not been detected and it is a pathogen that rarely causes such severe liver damage.

The superantigen hypothesis (antigens that cause excessive activation of the immune system) is also considered due to the role that SARS-CoV-2 had as a new virus associated with multi-organ injuries, the liver was one of the affected organs. However, this association remains to be proven, she said.

López González reiterated that Cuba has a national action protocol with a clinical-epidemiological vision, backed by the Pedro Kourí Institute of Tropical Medicine (IPK).

The health personnel, she said, is prepared so that when a patient who meets the criteria for a suspected case presents himself, he is admitted and the protocol is activated with a clinical, laboratory and microbiological follow-up.

The specialist said that it is necessary to go to the health services in the presence of symptoms such as jaundice (yellowing of the skin and mucous membranes), diarrhea, nausea, vomiting, loss of appetite, abdominal pain, choluria (dark urine) and acholic stools (feces clear).

She insisted that parents should not expect their children to get worse at home, as this can cause a torpid evolution of the disease, and it is necessary not to self-medicate, because there are drugs that damage the liver.

MONKEY POX: A RARE DISEASE

Regarding monkey pox, Dr. Francisco Durán García, national director of Epidemiology of the MINSAP, argued that, previously, it had remained endemic in West and Central Africa, but the current outbreak appeared in different countries, such as the United States, Canada and Australia, and especially in Europe.

The condition is endemic in Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, the Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.

Outside the African continent, the largest number of patients had been reported in the United Kingdom, Spain, Portugal, Germany and Canada, while in the Americas region, cases are confirmed in the United States, Canada, Argentina, Mexico and Costa Rica.

Monkey pox is considered a rare disease and constitutes a zoonosis, since it is transmitted mainly from animals to humans, although it can spread from sick person through close contact or from body fluids, skin and mucosal lesions, as well as through contact with articles that have been contaminated, such as personal or bed clothes.

To date there are no specific treatments or vaccines against the infection, but outbreaks can be controlled, added Durán García, who said that vigilance is maintained in the largest of the Antilles, especially for people who come from African countries and the nations where they are reported confirmed cases.

Regarding the health strategy, he stated that, if any contagion is detected, the tests would initially be analyzed in the IPK laboratory and there is also a protocol for its treatment.

What does the WHO/PAHO say?

On April 15, 2022, the WHO published an alert on cases of severe acute hepatitis of unknown cause in children, when the first patients were reported in the United Kingdom, and since then the presence of the disease has increased.

As of May 26, 650 cases had been reported in some 33 countries.

PAHO recommends that parents, in order to protect their children, should be attentive to symptoms, such as diarrhea or vomiting, and especially if there are signs of jaundice, they should seek immediate medical attention.

For prevention, it advises taking basic hygiene measures such as washing your hands and covering your cough or sneeze, which also serves to prevent the transmission of the adenovirus.

As for monkey pox, since the United Kingdom Health Security Agency reported the first case on May 6, the number of infections has increased, which as of May 31 amounted to 606, in 26 countries.

Although the disease has not been detected in Cuba, it is necessary to know how to act against it, and in this sense the WHO calls for limiting contact with people who are suspected or confirmed to have it, wear a mask if you are close to a person infected or when handling their clothing and avoid skin-to-skin contact whenever possible.

Likewise, it insists on the hygiene of hands and contaminated surfaces.

Translated by Linet Acuña Quilez