What are the symptoms of hepatitis amid warning over increase in cases in children?

Health officials have been left puzzled by the rise in cases of hepatitis in children in the UK as all of the normal causes of liver inflammation have been ruled out.

The number of investigated cases of hepatitis among children under 10 has increased to 111 up to 20 April, the UK Health Security Agency (UKHSA) said on Monday.

It comes amid global concerns about the spread of hepatitis, the term used to describe inflammation of the liver.

The number of children who have required a liver transplant has risen to 10 in the UK.

There have been no deaths in the UK, but the World Health Organization (WHO) said on Sunday that one child has died elsewhere, although it did not identify the country.

Health experts are now investigating the possibility that the increase in cases in children is linked to a common virus, as well as the coronavirus lockdown.

They have ruled out both COVID-19 and the COVID vaccines as a cause.

What are the symptoms of acute hepatitis?

Short-term, or acute, hepatitis often has no noticeable symptoms, according to the NHS.

However, if symptoms do develop, they can include muscle and joint pain, a high temperature, feeling and being sick, feeling unusually tired all the time, loss of appetite, stomach pain, dark urine, pale grey-coloured poo, itchy skin and yellowing of the eyes and skin/jaundice.

Most of the children affected recently in the UK have also had symptoms of gastroenteritis illness, such as diarrhoea and nausea.

What is the situation in the UK?

Since January 2022, there have been 111 cases of hepatitis in children in the UK, the UKHSA said.

Most of the cases of liver inflammation were in children under five, though a small number of cases in children over 11 are also being examined.

Watch: Number of hepatitis cases rises among UK children

Of the confirmed cases, 81 live in England, 14 are in Scotland, 11 are in Wales and five are in Northern Ireland.

The number of children who have required a liver transplant has risen to 10 in the UK.

There have been no deaths.

What can parents/carers do?

People have been asked to see their GP if their child shows symptoms of hepatitis, including yellowing of the eyes and skin, or jaundice.

To help prevent the spread, health officials advise supervising young children when they are washing their hands.

What is causing the spread of hepatitis?

The recent cases have not been caused by the usual viruses that cause hepatitis A – E and data gathered has “increasingly” suggested that the rise in severe cases of hepatitis may be linked to a group of viruses called adenoviruses, the UKHSA said.

Of 53 cases tested in the UK, 40 (75%) showed that adenovirus was the most common pathogen detected.

What is adenovirus?

Adenovirus is a family of common viruses that usually cause a range of mild illnesses – including colds, vomiting and diarrhoea – and most people recover without complications.

While they do not typically cause hepatitis, it is a known rare complication of the virus.

Read more: How many people in the UK haven't had COVID?

Adenoviruses are commonly passed from person to person and by touching contaminated surfaces, as well as through the “respiratory route”.

NHS and laboratory data show that common viruses circulating in children are currently higher than in previous years and there is a marked increase of adenovirus, particular in the one to four age group.

Is the coronavirus pandemic to blame?

Of the 53 child hepatitis cases tested in the UK, 16% were positive for COVID-19, but health officials said this was not unexpected because of the high coronavirus infection rates between January and April this year.

The UKHSA said there is no link to the coronavirus vaccine as none of the currently confirmed cases in under 10s in the UK are known to have been vaccinated.

One theory being considered is that children have become more susceptible to adenovirus because of a lack of exposure to it during the COVID-19 pandemic.

What does the government say?

Dr Meera Chand, director of clinical and emerging infections at UKHSA, 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 hand washing, 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.”

What is the worldwide picture?

According to the WHO, as of 21 April, 169 cases of acute hepatitis of unknown origin have been reported from 11 countries in Europe and America, while one person has died.

The global cases involve people aged one month to 16 years old and 17 children (about 10%) have required liver transplants.