Investigations of a spike in hepatitis cases in children continue to point to adenovirus infection, but COVID-19 has not been ruled out as a contributing factor

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Health officials have identified a further 34 cases of sudden onset hepatitis in children, bringing the total number of cases in the UK to 108.

All those affected were aged 10 and under and were diagnosed after being admitted to hospital between January and April 12, 2022, the UK Health Security Agency (UKHSA) said.

Of the confirmed cases of non-A to E hepatitis, 79 were in England, 14 in Scotland, and the remainder in Wales and Northern Ireland.

Of the cases, eight children have received a liver transplant.

Investigation continues into causes

Earlier this month the UKHSA said it was investigating a number of possible causes for the spike in cases, including adenoviruses, and infection with the SARS-CoV-2 virus.

In an update, the UKHSA said its investigation, involving patient samples and surveillance systems, ‘continues to point’ to a link between adenovirus infection, with 77% of cases tested being positive for adenovirus.

Due to the unusual pattern of disease, it is also looking into other factors, including a past history of COVID-19, another infection, or environmental causes, such as chemicals and toxins. Another line of inquiry was whether the adenovirus had undergone genetic changes. There was no link to COVID-19 vaccines, the UKHSA stressed.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said: ‘We are working with the NHS and public health colleagues in Scotland, Wales, and Northern Ireland to swiftly investigate a wide range of possible factors which may be causing children to be admitted to hospital with liver inflammation, known as hepatitis.

‘Information gathered through our investigations increasingly suggests that this is linked to adenovirus infection. However, we are thoroughly investigating other potential causes.’

Dr Zania Stamataki, Associate Professor of Viral Immunology at the Centre for Liver and Gastrointestinal Research, University of Birmingham, said: ‘The rising incidence of children with sudden onset hepatitis is unusual and worrying.  If an adenovirus is to blame, this could be a new variant of adenovirus that may cause liver injury in children with naïve/immature immune systems. But we need to know more to be sure. Alternatively, if adenovirus is the culprit for hepatitis in children that are otherwise well, we ought to look for other infections and environmental causes that could exacerbate adenoviral inflammation.’

Symptoms alert

The Agency said parents and guardians should be alert to symptoms of hepatitis, including jaundice, and to contact health services if they are concerned.

Hepatitis symptoms include:

  • dark urine
  • pale, grey-coloured faeces
  • itchy skin
  • jaundice
  • muscle and joint pain
  • a high temperature
  • nausea and vomiting
  • fatigue
  • loss of appetite
  • stomach ache.

Although adenoviruses do not usually cause hepatitis, it is known as a rare complication.

Normal hygiene measures, such as handwashing, can help prevent the virus spreading, the UKHSA said.

World Health Organization alerted

Investigators in Scotland first identified the outbreak on 31 March, when Public Health Scotland was alerted to a cluster of 3- to 5-year olds admitted to the Royal Hospital for Children in Glasgow with severe hepatitis of unknown aetiology within a 3-week period. The spike in cases drew attention because Scotland would normally see fewer than four cases over a whole year.

The World Health Organization was alerted on April 5, with the UK Government reporting further cases in England, Wales, and Northern Ireland on April 12.

Additional cases have also been reported in France, Denmark, Ireland, Spain, and Alabama, the European Centre for Disease Control said on Tuesday.

The Israeli Health Ministry also announced on Tuesday that they had detected the virus in 12 children under age 5 years. All children have been released from hospital.

This article was originally published on Medscape, part of the Medscape Professional Network.

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