When five-year-old Hélio Tenório sees other children on the street, it is difficult for him to hide a smile. According to his mother, Thaís Sêco, having spent most of the last two years outside of face-to-face classes and without personally playing with classmates of the same age, he, who is naturally sociable, is ecstatic when he finds someone who can become his friend. .
The isolation of the little one was not for nothing. Hélio has been taking an immunosuppressive medication since his first year of life, as he was diagnosed with AVB (bile duct atresia) shortly after birth and, at six months, he had to undergo a liver transplant.
According to the SBP (Brazilian Society of Pediatrics), the disease is the most common reason for liver transplantation in children, and its cause is not completely known. In the case of Hélio, the yellowish color of the skin that did not disappear after sunbathing and the yellow stools like egg yolk were signs that helped in the diagnosis.
In an organism with the condition, there is inflammation and obstruction of the bile ducts, responsible for transporting bile, a liquid that helps in the digestion of fats and carries some substances to be eliminated by the intestine. Bile is retained in the liver, quickly causing organ damage, which can progress to cirrhosis and death if the patient is not treated early.
For many children, the solution is to have a procedure known as ‘Kasai surgery’, which aims to connect the small intestine to the site of greatest accumulation of bile in the liver and can delay the need for a liver transplant by more than one of each. In Hélio’s case, the surgery was not successful, which made him need to receive a piece of his father’s liver.
‘I rely on science since he was born’
The liver is the only organ capable of regenerating itself, which allowed his father, Thiago Duque, to continue living healthily after donating 30% of the organ to his son.
“The volume was still much higher than the size of a baby, so the doctors reduced it even more. It was an extremely delicate surgery that took 13 hours. So that he could live, I count on science since he was born. Now, with the vaccine would be no different”, says Thaís, who is 36 years old and is a professor in the Law Department at UFLA (Federal University of Lavras) and is licensed to dedicate herself to doctoral research.
For different health complications, up to a year and a half, Hélio underwent seven surgical procedures. Afterwards, the boy grew up and led a life like any other child, with the help of an immunosuppressant that prevents the body from rejecting the transplanted organ.
But as the name suggests, the drug has the effect of weakening the immune system. “These patients are at greater risk of contracting any type of infection, as well as developing more severe forms of them”, explains Lucas Fadel, pediatrician and coordinator of the Pediatric and Neonatal ICU at Santa Casa de São José dos Campos (SP).
That’s why Hélio’s family kept him at home during most of the pandemic, afraid that he might have contact with Sars-CoV-2.
‘Does this coronavirus ever go away, Mom?’
The question was asked by Hélio in December 2021. Like most Brazilians, he was eager to resume “normal” life, without the dangers posed by Covid-19. Hearing from his mother that the scientists were producing the immunizer, he returned to the room a few minutes later with his own lego version of the vaccine in hand. The scene made the mother laugh and yearn even more for a real vaccine.
“He can take most vaccines. Although he will have a lower response rate, it’s still worth a lot to strengthen his immune system. But his protection also depends a lot on community immunity, so I urge other parents also vaccinate their children”, says Thais.
Currently, the family lives in Bicas, Minas Gerais, about 40 kilometers away from Juiz de Fora. In the city, vaccination has not yet started. “In Juiz de Fora it has already started, but there is no mention of immunosuppressed patients. Here, a sound car goes by warning. I am anxious to hear the announcement”, says the mother.
Understand what is considered comorbidity
The vaccination order established by the Ministry of Health starts with children aged 5 to 11 years with permanent disabilities or with comorbidities, then indigenous and quilombola children, followed by those who live in homes with people at high risk for severe evolution of Covid-19. After these groups come children without comorbidities, starting from the oldest to the youngest.
However, each state (and in some cases, municipalities) may have differences in vaccination logistics. See more details here.
In addition to immunosuppressed children for any reason, the following are considered comorbidities for children by the Ministry of Health: diabetes mellitus; severe chronic lung diseases; resistant or stage 3 hypertension; arterial hypertension stages 1 and 2 as target organ damage; cardiac insufficiency; cor-pulmonale and pulmonary hypertension; hypertensive heart disease; coronary syndromes; valvular heart disease; cardiomyopathies and pericardiopathies; diseases of the aorta, great vessels and arteriovenous fistulas; cardiac arrhythmias; congenital heart disease in adults; prosthetic valves and implanted cardiac devices; chronic neurological diseases; chronic kidney disease; severe hemoglobinopathies; morbid obesity; Down’s syndrome; and liver cirrhosis.
First in line for the vaccine
Accompanied by his mother, Enzo Cronemberger de Azevedo, 9 years old, was the first to arrive at the health center located in Vila Anastácio, a neighborhood in the west of São Paulo, to receive the vaccine in a pediatric dose on the 17th.
Milene cries when talking about her vaccinated son. “It’s something that we waited too long. We followed the approvals step by step. Having the vaccine, for us, is a hope. He was anxious, he even said he would make a cake to celebrate the day of the vaccine”, says the mother, adding that he had no adverse reaction to the immunizer.
The boy could be seen because he was part of the children with comorbidities and immunosuppressed. In the first few months of his life, he was diagnosed with diabetes and hypothyroidism. Soon after, he had a kidney disorder that caused his body to eliminate excess protein in his urine. The condition, uncommon in children, led the doctors who accompanied him to suspect a rare syndrome.
Enzo was then diagnosed with the autoimmune disease IPEX, a rare hereditary condition that causes dysfunction of several endocrine glands and inflammation of the intestine. Since then, he has been using an immunosuppressive drug continuously, and with that, he has maintained good health.
When the pandemic started, Milene, who is a project manager, already started working remotely. “For the first few months, we didn’t leave the house at all. His contact is with the family — my mother, my sister, his father and the brothers on his father’s side”, she explains, now she lives with her son and husband, Enzo’s stepfather.
The little one spent almost two years without going to school in person. In November 2021, with the care indicated by the doctors, he returned to study in the same room as other colleagues for a month, before the holidays and the new wave caused by the omicron variant began.
Even taking regular care, Milene was infected by Sars-CoV-2 twice, but on both occasions she managed to protect her son, leaving him at his father’s house.
“He understands the current situation and is very aware of his immunity, his medications, and he remained calm in isolation. But before going back to school he was already reaching a stage where being so reclusive was bad for him. with him for the parties, he stopped playing with other children and doing physical activity, since swimming lessons were no longer possible”, says the mother.
“I talked to his immunologist, who gave me a certificate for him to take the vaccine. I was scared, but the doctors said: it’s much better for him to take the vaccine.”
Myths get in the way of vaccination
“Doubts about the vaccine should be clarified with the child’s pediatrician”, advises the doctor Lucas Fadel so that families do not fall for false news. Below, the expert clarifies topics that are often used to discourage the vaccine, but which are not true:
– The vaccine does not interact with cellular DNA and does not cause genetic changes. It works as a ready-made “prescription” so that the immune system can produce antibodies and be ready to fight a possible infection.
– The mRNA (or messenger RNA), used in the Pfizer vaccine, will not stay in the cells it entered indefinitely. After fulfilling its role, it is inactivated (like all mRNA that the human body produces). The coronavirus spike proteins will also be inactivated by the body, as will all proteins recognized as invaders.
– Myocarditis, pericarditis and other vaccine events are extremely rare. “Just look at the number of vaccinated, which are millions, and the number of events, just a few dozen”, points out Fadel.
The most worrisome vaccine events are even more unlikely and all showed a benign course. “Furthermore, the risk of developing myocarditis from the coronavirus infection is more than ten times greater than from the vaccine.”
Recent diagnosis made Lívia join the priority group
The parents of Lívia Martins Pinto, 7 years old, are also looking forward to their daughter’s turn to receive the immunizer, which should take place in the next few days in the city of Indaiatuba (SP). After having mono in 2021, the girl’s fever didn’t stop for 15 days straight. The worrying symptom was the beginning of the parents’ struggle for a diagnosis. The signs that appeared next were joint pain and retching, which led Lívia not to eat and to lose weight.
Another 15 days passed, with the child hospitalized, before the multidisciplinary team of doctors who examined him discovered the problem. After an extensive battery of examinations and tests, the parents received news that she had systemic juvenile idiopathic arthritis.
“The disease causes antibodies that should protect the immune system to attack the body itself. It inflames the joints, causing pain, swelling and difficulty in movement. Lívia has the most severe subtype (systemic), which causes fever and In addition, she also had macrophage activation syndrome, which causes excessive proliferation of macrophages (immune system cells), and can be fatal”, explains pediatric rheumatologist Maria Teresa Terreri, a professor at Unifesp (Federal University of São Paulo), and part of the NGO Acredita, where he met Lívia.
During the year, Lívia had to be hospitalized six times and now, using three immunosuppressive drugs, her health is stable. “I’m afraid she will catch anything, but especially Covid-19. We only go out with PFF2 masks, we still take our clothes off before entering the house and I don’t let anyone get too close to her”, says her mother, Shirlei, who has 52 years old and is an elementary school teacher.
In order to have more security, Terreri explains that it is not only safe, but also extremely recommended, that immunosuppressed patients receive the vaccine.
“I hope that the immunizer can allow her to do more things. She is a very special girl, brilliant at school, who even has a good understanding of what happens to her, but who still wants to play and visit her friends”, says the mother.