Number of unexplained hepatitis cases in children continues to grow – ECDC

Investigations ongoing into cases in Ireland, UK, Denmark, Netherlands and Spain

The number of unexplained hepatitis infections in children continues to grow, with cases now reported in Ireland and at least five other countries, according to the European Centre for Disease Control (ECDC).

Nine cases of acute hepatitis among children aged between one and six years have been newly reported in the US state of Alabama, the ECDC said on Tuesday. All also tested positive for adenovirus.

With investigations continuing into cases in Ireland, the UK, Denmark, the Netherlands and Spain, the exact cause of hepatitis in affected children remains unknown, according to the ECDC.

“The incident team in the UK, where most of the cases have occurred to date, consider that an infective cause is most likely based on the clinical and epidemiological features of the cases under investigation.”

The organisation said it was working with teams in each of the countries reporting cases, as well as the World Health Organisation and other partners, to support ongoing investigations.

In Ireland, the Health Service Executive (HSE) has said "less than five" cases of hepatitis of unknown origin have been identified recently among children in Ireland.

“This is more than would usually be expected over a six week period. The children affected have no links to the other children involved,” a HSE spokesman said. “To date no single virus has been identified in the cases. Investigations are currently ongoing to identify the cause of these illnesses. ”

The cases were first reported among previously healthy children in Scotland on April 5th. The number of UK cases has since increased to 61.

The children in the UK involved had increased levels of liver enzymes and many were jaundiced. Some reported gastro-intestinal symptoms such as abdominal pain, diarrhoea and vomiting, in the previous weeks.

Most cases did not have a fever. Some required care at a specialised liver units and a few required liver transplantation.

Initial hypotheses by the incident team in the UK into the origin of the cases centred around an infectious agent or a possible toxic exposure. No link to the Covid-19 vaccine was identified and detailed information collected through a questionnaire to cases about food, drink and personal habits failed to identify any common exposure.

Laboratory investigations of the cases excluded viral hepatitis types A, B, C, D and E in all cases. Of the 13 cases reported by Scotland, three tested positive for SARS-CoV-2 infection, five tested negative and two were documented to have had an infection in the three months before presentation. Eleven of these 13 cases had results for adenovirus testing and five tested positive.

The HSE has said it and the Department of Health continue to keep the cases under review and issued precautionary information to GPs and paediatric consultants in this speciality.

Parents are advised to be aware of symptoms of hepatitis and to go to their GP if their child develops jaundice (discolouration of the white of the eye, dark urine and/or pale stools). The GP will assess the child and refer on for further assessment as indicated.

“If your child is unwell with respiratory or diarrhoeal or hepatitis symptoms keep your child at home and do not send to crèche/preschool/school until they are better,” the HSE advised.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times