#16,724
As is often the case with infectious disease outbreaks, the harder we look, the more cases we find. And over the past 3 weeks we've seen a doubling of acute hepatitis cases of unknown etiology (mostly in children) double in the UK, now that clinicians have been alerted to the condition.
While the UK leads the world in cases, we continue to see rising numbers reported from around the globe. In yesterday's ECDC: Rapid Risk Assessment On Increase in Severe Acute Hepatitis Cases of Unknown Aetiology in Children, that health agency reported:
. . . approximately 55 probable and confirmed cases have been reported from 12 EU/EEA countries. An additional 12 cases have been reported from the United States (US), 12 from Israel, and one from Japan.
These numbers are all likely undercounts, and will likely continue to rise.
The leading theory right now centers around the possibility that a common adenovirus infection (possibly 41F) is causing unusual liver damage in young children. Whether this is due to a change in the virus, or to some other cofactor, isn't known.
The following update from the UKHSA increases the number of confirmed cases in the UK from 111 reported last Monday, to 145 as of yesterday.
News story
Increase in hepatitis (liver inflammation) cases in children under investigation
Regular UKHSA updates on the ongoing investigation into higher than usual rates of liver inflammation (hepatitis) in children across the UK.From:UK Health Security Agency updated 29 April 2022
Latest
The UK Health Security Agency (UKHSA), working with Public Health Scotland, Public Health Wales and the Public Health Agency, are continuing to investigate the cases of sudden onset hepatitis in children aged 10 and under that have been identified since January 2022.
The usual viruses that cause infectious hepatitis (hepatitis A to E) have not been detected. The cases are predominantly in children under 5 years old who showed initial symptoms of gastroenteritis illness (diarrhoea and nausea) followed by the onset of jaundice.
Active case finding investigations have identified a further 34 confirmed cases since the last update on 25 April, bringing the total number of cases to 145. Of the confirmed cases, 108 are resident in England, 17 are in Scotland, 11 are in Wales and 9 are in Northern Ireland.
Of these cases, 10 children have received a liver transplant. No children have died. As part of the investigation, a small number of children over the age of 10 are also being investigated.
Findings continue to suggest that the rise in sudden onset hepatitis in children may be linked to adenovirus infection, but other causes are still being actively investigated.
As it is not typical to see this pattern of symptoms from adenovirus, we are investigating other possible contributing factors, such as another infection – including coronavirus (COVID-19) – or an environmental cause.
We are also exploring whether increased susceptibility due to reduced exposure during the COVID-19 pandemic could be playing a role, or if there has been a change in the genome of the adenovirus.
UKHSA is working with scientists and clinicians across the country to answer these questions as quickly as possible.
Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said:
We know that this may be a concerning time for parents of young children. The likelihood of your child developing hepatitis is extremely low. However, we continue to remind parents to be alert to the signs of hepatitis – particularly jaundice, which is easiest to spot as a yellow tinge in the whites of the eyes – and contact your doctor if you are concerned.
Normal hygiene measures, including thorough handwashing and making sure children wash their hands properly, help to reduce the spread of many common infections.
As always, children experiencing symptoms such as vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped.
