What is hepatitis and why are cases spiking in children?

Lockdowns could have had an impact too, experts have said.

Prof Deirdre Kelly, professor of Pediatric Hepatology at the Birmingham Women’s & Children’s Hospital, added: “We think it must be related to the pandemic, either because Covid has changed these children’s immunity in some way, or because they weren’t exposed to their normal childhood viruses because of isolation at different stages.”

She added, though, that the cases may be caused by another virus or infectious agent that is yet to be identified.

Environmental factors could also be linked, scientists said, and investigators are quizzing parents about issues including their child’s diet and where they buy food.

Could this be related to Covid vaccinations?

A side effect from coronavirus vaccines has also been ruled out, as none of the children affected in the UK have received a jab. Most of the children are also under five, so not yet eligible to receive a vaccine in the UK.

What are the symptoms?

Parents are being urged to be alert to the signs of hepatitis, especially jaundice – or yellowing of the skin. Other symptoms may include:

  • dark urine
  • pale, grey-coloured poo
  • itchy skin
  • yellowing of the eyes and skin (jaundice)
  • muscle and joint pain
  • at high temperature
  • nausea and vomiting
  • feeling unusually tired all the time
  • loss of appetite
  • tummy pain

What are parents being advised to do?

The UKHSA recommends normal hygiene measures such as thorough hand washing and thorough respiratory hygiene to help reduce the spread of many common infections, including adenoviruses.

Parents and guardians should contact a GP if they are concerned.

When was the alarm first raised?

The alarm was first raised in Glasgow in late March, after five young children were admitted to hospital with severe hepatitis. Usually, it is rare to see this many cases in a year.

These children – aged between three and five – had spent weeks vomiting, their skin was jaundiced yellow and they had “exceptionally high” levels of an enzyme called alanine aminotransferase in their systems, a sign of liver damage, according to a Eurosurveillance report.

Where else have cases been detected?

Alongside cases in the UK, children have also been diagnosed with the “hepatitis of unknown aetiology” in Israel, Denmark, Ireland, the Netherlands, Spain, Italy and the United States.

What does treatment involve?

Antiviral agents can be used when there is a treatable viral cause like Herpes virus, or other viruses like Hepatitis B or C, or adenovirus, Prof Anil Dhawan of Pediatric Hepatology at King’s College London said.

Prof Simon Taylor-Robinson, Hepatologist at Imperial College London, said: “Treatment is usually supportive – with hydration and management of temperature – because the problem normally resolves. The liver has an amazing ability to regenerate itself after an insult – generally within a few days or weeks things settle back down with this supportive treatment.”

If the liver involvement is severe, a patient may need urgent liver transplantation.

What is a liver transplant and how long does recovery take?

A liver transplant is an operation to remove the liver and replace it with a healthy one from a donor. It is recommended when the liver has stopped working properly and other treatments cannot help.

A liver transplant operation in a child generally takes around six hours. Prof Kelly said that, for an unplanned liver transplant, the success rate is usually between 70 and 80 per cent, and the children can go on to live almost a normal life.

A child is likely to spend at least two days in intensive care after the operation, and on average another three weeks in hospital before they can be discharged.

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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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