According to the World Health Organization (WHO), a total of 114 cases of acute hepatitis, or liver inflammation, of unknown origin among children have been reported across the UK in the last four months. The first children to develop this illness were reported from across central Scotland, with one manifesting symptoms in January, while the other nine became sick in March. Since then, outbreaks have been noted across the globe, including 13 cases in Spain, 12 in Israel, nine across the US, six in Denmark and four from The Netherlands. To date, 17 children have required liver transplants as a result of the disease — including 10 in the UK — and one child overseas has died of the condition.
In Britain, the cases are predominantly confined to children under five years of age who developed diarrhoea and nausea as initial symptoms, followed by the onset of jaundice.
According to the UK Health Security Agency (UKHSA), the usual viruses responsible for liver inflammation — that is, hepatitis viruses A, B, C, D and E — have not been detected.
Instead, adenovirus infection seems to be common among young patients, with the WHO reporting that such has been detected in 74 of the 169 cases recorded globally.
Adenoviruses are a broad family of some 50 viruses known to cause a wide variety of illnesses from the common cold, conjunctivitis, gastroenteritis, and bladder infection to life-threatening multi-organ diseases in the clinically vulnerable.
Over the lockdowns implemented to prevent the spread of coronavirus, incidences of adenoviruses fell dramatically — but since such measures were lifted, reported cases have surged to 200–300 each week, compared to just 50–100 in a normal year.
According to the UKHSA’s director of clinical and emerging infections, Dr Meera Chand, the otherwise regular virus may now be hitting young children the hardest because lockdowns prevented them from being exposed to it at an earlier age.
Speaking at the European Congress of Clinical Microbiology and Infectious Diseases in Lisbon yesterday, Dr Chand said there may be “a susceptibility factor — so lack of prior exposure of that particular age group during the formative stages that they’ve gone through during the pandemic”.
UK health officials have ruled out coronavirus vaccines as a possible cause of the illnesses — with none of the cases in Britain having received the jab.
According to some experts, the acute hepatitis cases recorded so far might just be “the tip of the iceberg” — as parents may easily miss the signs unless they involve jaundice.
Paediatric hepatologist Professor Deirdre Kelly of the University of Birmingham told the Telegraph that “unless they’re yellow, it probably doesn’t come to medical attention.
“The other early symptoms are tummy ache, vomiting and diarrhoea — which aren’t very specific in children.”
However, she noted, hepatitis infections of unknown causes are known to rise at this time of year, and so there is hope that the outbreaks will subside as we move into the summer.
Prof Kelly added: “We may see it fade out, hopefully as children build up their immunity.
“What will be really interesting is if there’s something different about the children who have got it, and that’s where the genetic work will come through.”
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Dr Chand added: “Information gathered through our investigations increasingly suggests that this rise in sudden onset hepatitis in children is linked to adenovirus infection.
“However, we are thoroughly investigating other potential causes.
“Parents and guardians should be alert to the signs of hepatitis — including jaundice — and to contact a healthcare professional if they are concerned.
“Normal hygiene measures such as thorough hand washing — including supervising children — and good thorough respiratory hygiene help to reduce the spread of many common infections, including adenovirus.
“Children experiencing symptoms of a gastrointestinal infection including vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped.”