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The Telegraph
The Telegraph
National
Laura Donnelly

Deadly outbreak of children’s hepatitis linked to lockdown

Hepatitis
Hepatitis

Lockdown and social distancing have been linked to a "worrying" surge of hepatitis cases in young children.

Officials said a lack of exposure to common infections during children’s “formative” years, owing to pandemic measures, may be fuelling a global outbreak in cases of the deadly liver disease.

A total of 114 cases of “acute hepatitis of unknown origin” have been reported in Britain, since the first spate of cases was detected in Scotland less than four weeks ago.

UK health officials said they had detected as many cases in the past three months as they would normally expect to see in a year, with the vast majority of cases involving children aged five and under.

Experts have previously raised concerns about the long-term impact of lockdown on children's education and physical and mental health. However, this is the most serious potential health complication to have emerged so far.

They added that three-quarters of cases in the UK had been linked to adenoviruses, a viral infection which usually causes the common cold. If someone's immune system cannot fend off the virus, it can develop into hepatitis.

Number of cases just the 'tip of the iceberg'

Dr Meera Chand - who is heading the UK Health Security Agency's investigation into the rise in cases - said the virus may be hitting young children hardest, because lockdown restrictions meant they were not exposed to it in their early years.

This suggested “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 said.

Speaking at the European Congress of Clinical Microbiology and Infectious Diseases in Lisbon on Monday, she said the “leading hypothesis” would “probably be that we have a normal adenovirus circulating”. 

She added: “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.”

In total, 169 children across 12 countries have been diagnosed since last October, the World Health Organisation has announced.

But liver experts said even these cases may be the “tip of the iceberg”, as some symptoms could be missed.

Across the world, 17 children - including 10 in the UK - have required liver transplants, while one child has died abroad.

In the UK, the average age of children involved is three, with two-thirds of cases involving those aged between three and five. Detailed data for England showed that in 53 per cent of cases, children have recovered.

While rates of adenoviruses fell to almost nothing during lockdowns, between 200 and 300 cases are now being reported weekly, compared with rates of between 50 and 100 per week in a normal year, experts said.

There are also concerns that a common adenovirus could have mutated to become more severe.

Emerging trends 'really worrying'

UK health officials have ruled out the Covid vaccine as a possible cause.

None of the cases in children aged 10 and under in Britain had been vaccinated, officials said.

Scientists say there were no links between the cases, which were not in contact with each other, or with travel.

Officials are also examining whether current or prior infections with Covid could be playing a part. One in six of the children admitted to hospital tested positive on admission, but officials said this was not unexpected at a time when background levels in this group were high.

They have not ruled out other environmental factors such as a poison or environmental exposure, but said this seemed less likely, given the spread of cases across the world.

Aikaterini Mougkou, from the European Centre for Disease Prevention and Control, said the emerging trends were “really worrying”.

The patterns appeared to reflect a rise in cases of adenovirus after restrictions were eased, she said.

“Because of the physical distancing restrictions during the pandemic, there were only a few cases in 2020 and 2021,” she added. “But there was the high circulation in the beginning of 2022, especially in the age group under five.”

Physical distancing restrictions during the coronavirus crisis meant there were fewer cases of adenoviruses, but instances now appear to have risen - Heathcliff O'Malley for The Telegraph
Physical distancing restrictions during the coronavirus crisis meant there were fewer cases of adenoviruses, but instances now appear to have risen - Heathcliff O'Malley for The Telegraph

In total, 13 cases have been detected in Spain, 12 in Israel and 11 in the US, with cases also found in Denmark, Ireland, the Netherlands, Italy, France, Norway, Romania and Belgium.

Prof Deirdre Kelly, an expert in paediatric hepatology at Birmingham Women’s and Children’s Hospital, said the number of cases identified may continue to rise.

She told The Telegraph: "I do think that what we've seen so far may be the tip of the iceberg, because unless they're yellow, it probably doesn't come to medical attention. The other early symptoms are tummy ache, vomiting and diarrhoea - which aren't very specific in children."

While the latest figures are “huge” compared to normal trends, she said it was possible some cases could “fade out” after spring - as there is normally a small rise in hepatitis infections of unknown cause at this time of year.

“We may see it fade out, hopefully as children build up their immunity,” she said. “What will be really interesting is if there's something different about the children who have got it, and that's where the genetic work will come through."

Hepatitis is a term used to describe inflammation of the liver. Usually the result of a viral infection, it can also be caused by exposure to some chemicals, drinking too much alcohol, drugs and certain genetic disorders.

Dr Chand, the UKHSA’s director of clinical and emerging infections, said: “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.

“Parents and guardians should be alert to the signs of hepatitis (including jaundice) and to contact a healthcare professional if they are concerned. Normal hygiene measures such as thorough handwashing (including supervising children) and good thorough respiratory hygiene, help to reduce the spread of many common infections, including adenovirus.

“Children experiencing symptoms of a gastrointestinal infection including vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped.”

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