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Acute Hepatitis in Children Cases Rise Again

A further 34 cases of sudden onset hepatitis in children have been identified in the UK as an investigation by the health authorities continued to identify adenovirus as the most likely trigger for the outbreak.

The total number of confirmed cases of acute non-A-E hepatitis with serum transaminases greater than 500 IU/l stood at 197 as of May 16, the UK Health Security Agency (UKHSA) said. Of those, 180 required hospitalisations, and 11 had received a liver transplant. No cases resident in the UK had died, the Agency said.

All the children affected presented to health services since January this year. Those affected were mainly under 5 years, although a small number were aged over 10.

A breakdown of the cases to date showed 144 were in England, 26 in Scotland, 15 in Wales, and 12 in Northern Ireland.

The UKHSA said it was currently unable to predict how case rates for sudden onset acute hepatitis would evolve, but that the data indicated that the current rate was more consistent with plateauing than exponential growth.

Latest details of the investigation came in a technical briefing – the first issued by the Agency since May 6.

It said while the "leading hypotheses remain those which involve adenovirus", public health officials "continue to investigate the potential role of SARS-CoV-2 and to work on ruling out any toxicological component".

Adenovirus

Adenovirus remained the most frequently detected potential pathogen amongst samples tested, with a 68% detection rate Typing by partial hexon gene sequencing identified adenovirus type 41F (ADV F41) in 77% of the 35 cases where a result was available.

Whole genome sequencing of adenovirus continued to elude scientists because of low viral load in the blood samples, the UKHSA said.

"Our investigations continue to suggest that there is an association with adenovirus infection, but investigations continue to unpick the exact reason for the rise in cases," said Dr Renu Bindra, senior medical advisor at the UKHSA.

The possibility of a novel variant adenovirus had not been ruled out, the Agency said.

COVID-19

SARS-CoV-2 was found in 15% of PCR or lateral flow samples taken at or around the time of hospital admission. Serological testing of cases involving prior infection with SARS-CoV-2 was ongoing but proving to be "challenging" because of the high prevalence of the virus in the background population.

The possibility that cases might be linked to a new variant of SARS-CoV-2 had not been ruled out, although this was placed at the bottom of the list of hypotheses under investigation.

As previously reported by the Agency, no evidence of a link with the COVID-19 vaccine had been found.

A range of other possible pathogens, including adenovirus-associated virus and human herpes virus 6, were detected in a low proportion of cases, with some of those still under investigation.

Toxicology and Environmental Factors

Results from toxicology investigations had focused on paracetamol and fluconazole because of their association with liver injury, but since both drugs could have been administered after hospital admission, follow-up analysis was being conducted to ascertain timing and dosage.

Further testing was also ongoing to establish whether mycotoxins could be associated with cases of acute hepatitis.

But the Agency was able to strike an association with dogs off its list of working hypotheses. Results from 'trawling questionnaires' carried out by public health specialists among affected families had indicated that around 70% of children had been in recent contact with pet dogs.

However, further analysis found "no difference between children with dog contact and those without dog contact in either the patterns of illness or virological detections" and that there was "nothing to indicate a role of dogs in the hepatic syndrome". There was "no public health concerns regarding dog contact", the briefing stated.

Lead Image Credit: EyeEm/Getty Images

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