What?
In the UK currently, there is a surge of sudden-onset hepatitis cases in children (under 16 years old). The figure stands at 108 children being investigated, with more as yet unreported. As of now, at least eight children have required a liver transplant as a result of hepatitis.
Hepatitis is any inflammation of the liver. In UK adults, hepatitis is most commonly caused by a fatty liver or alcohol. In children however, hepatitis is mostly caused by viruses. This can either be one of the five types of hepatitis virus (A, B, C, D or E), or other viruses, such as cytomegalovirus (CMV), Epstein-Barr virus (EBV) or adenovirus, amongst others.
Why?
This outbreak has become newsworthy as the number of children being diagnosed with hepatitis has far exceeded normal case numbers for children in the UK.
There are a number of theories that have been put forward to explain this rise in cases by UK health agencies and the World Health Organization (WHO). These include environmental or chemical factors that are, as yet, unknown to scientists. The common hepatitis viruses (A, B, C, D and E) have been ruled out following negative tests for these in affected children.
However, a curiously large proportion of those children with sudden-onset hepatitis have tested positive for adenovirus and/or SARSCoV2 (COVID-19 virus). These two viruses are said to be ‘co-circulating’ or being transmitted together.
Adenovirus is a common childhood virus that causes colds, fevers and other illnesses in children. Symptoms are often mild, however it does have the potential to cause severe illness. One example of this is hepatitis. During the pandemic, due to social isolation, many children have had reduced exposure to viruses for children of their age. This, it has been theorised, will cause a child exposed at a later age to produce a more vigorous immune response – in turn leading to collateral organ damage such as hepatitis. It’s important to note that this is just a theory at present.
In rare cases, severe COVID-19 infection can cause brief rises in liver enzymes, indicating liver damage, in adults. And it is much less commonly linked to hepatitis in children. So COVID-19 (alone) is less likely to be a cause for childhood hepatitis, but it still remains under investigation.
How (does it affect you)?
Currently, sudden-onset hepatitis in children is an uncommon but significant issue for those affected. It will understandably cause worry to parents, and there are signs that they should be on the lookout for. These include tummy pain, yellowing of the skin or eyes, or dark urine. A longer list can be found here. If your child is affected by these symptoms, request urgent medical attention by ringing 111 or by attending A&E.
However, there are approximately 3.8 million children in the UK, meaning the that 108 children currently affected is still a very small proportion of the total number. Cases are being reported outside of the UK, in Ireland and Spain, which may suggest a growing issue. However, there is no suggestion that adenovirus is going to cause a pandemic similar to coronavirus. Additionally, there is no current suggestion that this is related to any of the COVID vaccines, as no affected children had received them. Current guidance therefore maintains that the COVID vaccine is safe.
Sudden-onset hepatitis in children remains rare, and it is unlikely to represent a population level health event. It does however highlight possible risks of late exposure to viruses in children, and unintended consequences of social isolation. Many viruses are transmitted by mouth, reinforcing the need for continued good hand hygiene, especially when caring for children – people frequently touch their mouths without noticing, and we all know that children will put anything in their mouths!
As always, best wishes from myHSN!
