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Acute Hepatitis in Children Link to Dogs Ruled Out, COVID Association 'Less Likely'

The investigation into sudden onset acute hepatitis in children in the UK has ruled out an association with dogs.

In its May 6 technical briefing, the UKHSA had listed contact with dogs as a possible contributing cause. A review of questionnaires that were circulated to trawl for information revealed that in 70% of 92 cases, families had either owned a dog or been in contact with one recently.

Calum Semple, professor of child health and outbreak medicine at the University of Liverpool, told a briefing hosted by the Science Media Centre: "We've looked very carefully at case-control data, and also those with severe disease and those without severe disease, and there's no difference at all between these children regarding dog contacts." As a result, "that hypothesis has now been removed from their line of investigation by the public health agencies in England and in Scotland".

Prof Semple said a "hierarchy" of hypotheses remained under investigation. "At the bottom of that list was dogs, and the dogs one has been kicked off."

COVID 'Moving Down the List' of Possible Causes

As for a possible association with SARS-CoV-2 infection, he said: "I don't think we're ruling out COVID completely, it's just I'm saying, I think COVID is moving down that list of hierarchies, and that adenovirus and adeno-associated viruses, and other viruses like it, are moving up the list."

In summary, he said: "My inclination is that this doesn't have the feel, based on the data and the epidemiology, that this is a COVID phenomenon."

Will Irving, professor of virology at the University of Nottingham, said it may be difficult to come to any conclusions on whether COVID-19 was a contributory factor, "simply because the background level of SARS-CoV-2 infection has been so high that statistically one would need very large numbers of cases to prove a statistically significant difference between them and the background population".

Multifactorial

The spike in acute hepatitis cases might turn out to have more than one cause, he added. "The adenovirus is the leading contender here, but we do need more data to be convinced – at least I do – that the adenovirus is a primary cause.

"I would also say I strongly suspect this will turn out to be multifactorial; there won't be a single factor here that explains this phenomenon. It will be a coalescence of two, or three, or four aspects that is leading to this increased number of cases."

As of May 10, there had been 176 cases of acute hepatitis in children confirmed in the UK. Of those, 128 were resident in England, 26 in Scotland, 13 in Wales, and 9 in Northern Ireland.

Those affected were mainly under 5 years old, although a small number were aged over 10, the UKHSA said.

As of May 3, 11 of the children had received a liver transplant.

None had died as result of their illness.

An accompanying technical briefing said that typing by partial hexon gene sequencing consistently showed that the adenovirus present in blood samples was type 41F, but that whole genome sequencing had proved difficult because of low viral load in the samples.

Enhanced surveillance, liver tissue tests, and metagenomic sequencing of blood and liver tissue were also in progress, while other strategies were either being planned or were under consideration.

The Agency also said there was no evidence of any link with COVID-19 vaccines because children under the age of 5 were too young to have been vaccinated.

Lead Image Credit: WestEnd 61/Getty Images

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