Today, the UK Heath Security Agency (UKHSA) published a detailed technical briefing on the investigations into a rise in cases of sudden onset hepatitis (liver inflammation) in children, with data and findings on cases resident in England, up to 20 April 2022.
The head of the investigation has suggested the rise in cases may be due to infants’ lack of exposure throughout lockdown restrictions in 2020 and 2021.
UKHSA, working with Public Health Scotland, Public Health Wales and the Public Health Agency, are continuing to investigate the cases in children aged 10 and under that have occurred 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 3 confirmed cases since the last update on 21 April, bringing the total number of cases to 111. Of the confirmed cases, 81 are resident in England, 14 are in Scotland, 11 are in Wales and 5 are in Northern Ireland.
Of these cases, 10 children have received a liver transplant. No UK cases have died. A small number of children over the age of 10 are being investigated.
The government have stressed that there is no link to the coronavirus vaccine. None of the currently confirmed cases in under 10 year olds in the UK is known to have been vaccinated.
Information gathered through the investigations increasingly suggests that the rise in severe cases of hepatitis may be linked to adenovirus infection but other causes are still being actively investigated. Adenovirus was the most common pathogen detected in 40 of 53 confirmed cases tested. Sixteen per cent of cases were positive for SARS-CoV-2 at admission between January and April but there was a high background rate of COVID-19 during the investigation period, so this is not unexpected.
Routine NHS and laboratory data show that common viruses circulating in children are currently higher than in previous years and there is a marked increase of adenovirus, particular in the 1 to 4 age group.
Dr Meera Chand, head of the UKHSA’s investigation into the spike in cases – told Monday’s meeting of the European Congress of Clinical Microbiology and Infectious Diseases in Lisbon that the infection may be rising in young children due to their lack of exposure during lockdown restrictions.
It pointed toward “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”, she argued.
She said the “leading hypothesis” is “probably… that we have a normal adenovirus circulating”.
However she went on to say that: “We may not have seen as much of it as we have for the past couple of years. But we have a co-factor affecting a particular age group of young children, which is either rendering that infection more severe or causing it to trigger some kind of an immunopathology.”
