Lockdown may be one of the factors behind a growing hepatitis outbreak among children that has left scientists puzzled.
The number of infected youngsters in the UK had risen to 114 a few days ago, the World Health Organisation (WHO) said. They are mainly under 10.
But the outbreak of the unknown strain has also hit Europe and North America, with almost 10% needing liver transplants. One patient has died, though their nationality and identity has not been revealed.
There have been no deaths here, the UK Health Security Agency (UKHSA) say, but 10 children have had transplants.
Experts say the patients do not have any of the known strands of hepatitis (from A to E) but children are initially showing symptoms of diarrhoea and nausea followed by jaundice, an emergency presentation at the European Congress of Clinical Microbiology and Infectious Diseases yesterday heard.
Such cases are extremely rare, Dr Meera Chand, the UKHSA’s director of clinical and emerging infections, suggested, adding that Scottish doctors who first detected the outbreak would normally only see four to five unknown hepatitis cases in a year.
But the mystery may be explained by Covid restrictions, which have meant younger children have not been exposed to as many illnesses as previous generations.
A link to the coronavirus vaccine has been ruled out, however, since none of the confirmed UK cases in under 10s are known to have been vaccinated. Experts also discounted the idea that international travel or paracetamol could be factors.
A number of other theories are being considered, most notably a link to adenovirus, a family of common viruses that usually cause a range of mild illnesses – including colds, vomiting and diarrhoea.
Most people recover without complications, but hepatitis is a rare complication.
Now Dr Chand has suggested the ‘leading hypothesis’ is that adenovirus could be hitting younger children hard after they spent their ‘formative stages’ under Covid lockdowns and wearing face masks.
Explaining that adenovirus was found in 75 percent of the UK patients, Dr Chand said rates of those viruses had plunged in the early stages of the pandemic, but spiked far above previous levels after measures were lifted.
Other possibilities include a prior infection to Covid or another illness, a co-infection with Covid or another illness and toxin, drug or environmental exposure.
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A novel variant of adenovirus may also be to blame.
The UKHSA says data ‘increasingly’ suggests that adenoviruses – which have shot up among children aged one to four – are playing a major role.
The illness is commonly passed from person to person and by touching contaminated surfaces, as well as through the ‘respiratory route’.
Meanwhile, a total of 16% of the UK hepatitis cases were positive for Covid-19 – but that was expected due to current high rates of that virus.
Most of the cases of liver inflammation were in children under five, though a small number of cases in children over 11 are also being examined, the UKHSA added.
Of the confirmed UK cases, 81 live in England, 14 are in Scotland, 11 are in Wales and five are in Northern Ireland. The WHO later detected three more UK cases.
According to the global organisation, as of April 21, 169 cases of acute hepatitis of unknown origin have been reported from 11 countries in Europe and America.
But there may be more patients who have gone undetected with less severe symptoms.
The outbreak, first detected in Scotland, involves patients aged one month to 16 years old. Seventeen have required liver transplants.
The liver processes nutrients, filters the blood and fights infections, meaning hepatitis can be life-threatening if left untreated.
Maria Buti, a Barcelona pathologist who chairs the European Association for the Study of the Liver (EASL), said the ‘main concern’ is the strain’s severity.
The UKHSA’s 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.’
She called for thorough handwashing and good respiratory hygiene, as well as parents looking out for symptoms, including jaundice.
Officials in the USA said earlier this month that they were investigating a cluster of otherwise unexplained hepatitis cases diagnosed in nine Alabama children who also tested positive for adenovirus.
They are exploring a link to one of the dozens of versions of the virus — adenovirus 41 — which is normally associated with gut inflammation.
Get in touch with our news team by emailing us at [email protected].
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