Ten UK children require transplant amid surge in hepatitis cases

There have been ten children in the UK who have required a transplant due to a recent surge in severe hepatitis cases among young children.

A lack of exposure to common adenoviruses due to Covid restrictions over the past two years combined with a recent spike in adenoviruses is the most likely explanation.

Common cold-like symptoms can be caused by a number of common viruses, including adenoviruses. They don't usually cause hepatitis, but this can be a very rare complication of some types of adenoviruses.

At the European Congress of Clinical Microbiology and Infectious Diseases in Lisbon on Monday, Dr Meera Chand, incident director for UKHSA's investigation into the hepatitis surge, said that of 81 cases reported in England so far, 43 children had fully recovered. There were seven transplant cases in England.

She said that the cases in England are not known to be connected to each other.

The majority of the cases have involved children under the age of six, and have occurred in the past three to five weeks. None of the children have died.

Many children have had less exposure to common viruses than normal because of restrictions, and this has resulted in an inadequate immune response when confronted with infections as society opens back up.

It is a prime suspect that adenoviruses are spread through close personal contact, coughing or sneezing, and touching contaminated surfaces.

There are 53 children with hepatitis in England who have been tested so far and 40 of them have positive results. There have been no other times in the past five years when the infections among one- to four-year-olds in England have been at their highest level.

I think our leading hypothesis is that we probably have a normal adenoviruses circulating, but we have a co-factor affecting a particular age group of young children which is either rendering that infection more severe.

The fact that children have been involved may be the reason for the cases, according to Prof Kelly.

In the same time period this year, the centre saw about 40 unexplained hepatitis cases in children.

There is a possibility that the recent Covid infection could suppress the immune system, making children more vulnerable to serious side-effects from normally fairly innocuous viruses; or that a new, more virulent strain of adenoviruses is in circulation, although initial genotyping has found no evidence for this.

Adenovirus 41F is the most common cause of infections, usually causing vomiting, abdominal pain and a high temperature.

There have been at least 169 cases of severe hepatitis among young children reported to the World Health Organization so far. Most of the reported cases have been in the UK, followed by Spain and Israel. Cases have been reported in the US, Ireland, the Netherlands, Italy, France, Norway, and Belgium.