While the cause of the multi-national outbreak of acute hepatitis in small children remains unknown, many scientists continue to focus on an adenovirus link, as more than half of known cases have tested positive for this common respiratory/gastrointestinal virus.
Last week's 49-page Technical Briefing from the UK included the following working hypothesis:
Late yesterday the UK released an update, adding another confirmed 13 cases, bringing their total to 176. The UK continues to lead the world in probable or confirmed cases, although this may be due to less rigorous surveillance and reporting in many countries around the world.
I'll have more on the U.S. response after the break.
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 Last updated 12 May 2022 — See all updates
The UK Health Security Agency (UKHSA), working with Public Health Scotland, Public Health Wales and the Public Health Agency, are continuing to investigate 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 13 confirmed cases since the last update on 6 May, bringing the total number of cases in the UK to 176, as of 10 May. Of the confirmed cases, 128 are resident in England, 26 are in Scotland, 13 are in Wales and 9 are in Northern Ireland. No children have died. As part of the investigation, a small number of children over the age of 10 are also being investigated.
UKHSA continues to investigate possible causes and will regularly publish technical updates. The investigation continues to suggest an association with adenovirus. Adenovirus is the most frequently detected virus in samples tested and a formal epidemiological study is continuing. Research studies of the immune system are also being undertaken to determine if changes in susceptibility or the effect of prior or concurrent infections could be contributing factors.
Normal hygiene measures, including thorough handwashing and making sure children wash their hands properly, help to reduce the spread of many common infections, including adenovirus.
Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said:
It’s important that parents know the likelihood of their child developing hepatitis is extremely low. We continue to remind everyone to be alert to the signs of hepatitis – particularly jaundice, look for a yellow tinge in the whites of the eyes – and contact your doctor if you are concerned.
Our investigations continue to suggest that there is an association with adenovirus and our studies are now testing this association rigorously.
We are working closely with the NHS and academic partners to actively investigate the role of other contributors, including prior SARS-CoV-2 and other infections.
A week ago the CDC held a Telebriefing on the U.S. response, and on Wednesday they released an updated HAN: Updated Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology.
As of two days ago, the CDC had confirmed 109 cases across 24 states (and Puerto Rico) - and 5 deaths - although there are likely more cases yet to be reported.
Next week (May 19th, 2:00 PM – 3:00 PM ET) the CDC will hold a COCA Call for clinicians, on how to test and report suspected cases.
Clinical Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology
Free Continuing Education
The Centers for Disease Control and Prevention (CDC) is investigating a cluster of children identified with hepatitis and adenovirus infection. CDC has recommended that U.S. clinicians who encounter pediatric patients with hepatitis of unknown etiology to consider adenovirus testing and to report such cases to state public health authorities and CDC. While there have been case reports of hepatitis in immunocompromised children with adenovirus type 41 infection in the past, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children. More common causes for hepatitis have been ruled out. During this COCA Call, presenters will discuss the unknown etiology of patients under investigation, progress of the investigation, and how clinicians can continue to support these efforts through testing and reporting.
L. Amanda Ingram, MPH
Infectious Diseases & Outbreaks Division
Alabama Department of Public Health
Jacqueline Tate, PhD
Epidemiology Team Lead, Viral Gastroenteritis Branch
Division of Viral Diseases
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Helena Gutierrez, MD
Medical Director, Pediatric Liver Transplant Program
Assistant Professor, Division of Pediatric Gastroenterology, Hepatology, and Nutrition
The University of Alabama at Birmingham
Elizabeth A. Moulton, MD, PhD
Assistant Professor of Pediatrics
Transplant Infectious Diseases
Baylor College of Medicine
Texas Children’s Hospital
Thursday, May 19, 2022,
2:00 PM – 3:00 PM ET
Passcode: 854934As always, If you are unable to attend the live presentation, these (and past) webinars are archived and available for later viewing at this LINK.
US: +1 669 254 5252
or +1 646 828 7666
or +1 669 216 1590
or +1 551 285 1373
US: +16692545252,,1611321885#,,,,*854934# or +16468287666,,1611321885#,,,,*854934#
Webinar ID: 161 132 1885