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Increase in acute hepatitis of unknown origin among children in the UK

21 April 2022

The European Centre for Disease Prevention and Control (ECDC) has been informed of an increase in acute hepatitis cases in children during the past few weeks in the United Kingdom (UK) and is sharing this information internationally to increase awareness among clinicians taking care of children, to determine whether there are any similar cases in other countries. EASL partners with the ECDC on public health issues and will follow this closely to update our community.

The clinical syndrome in identified cases is of severe acute hepatitis with markedly elevated transaminases, often presenting with jaundice, sometimes preceded by gastrointestinal symptoms including vomiting as a prominent feature, in children up to the age of 16 years.

Clinicians are encouraged to report cases of acute hepatitis in children up to the age of 16 years with a serum transaminase >500 IU/L, in which hepatitis A to E has been excluded, to National Public Health Institutes. EU/EEA Member States can share information about any such suspected cases on the ECDC EpiPulse platform to facilitate the investigation.

In England, there are approximately 60 cases under investigation, with most cases in children between 2 and 5 years old. Some cases progressed to acute liver failure and have required transfer to specialist children’s liver units. A small number of children have undergone liver transplantation.

In Scotland, 10 cases that required hospital admission were in children aged between 1 and 5 years of age and are under investigation. Most of the cases in Scotland presented from March 2022 onwards.

As of 12 April, In Wales, there were no known cases under investigation, but a very small number of cases from early 2022 had similar clinical presentations. In Northern Ireland, there were currently no confirmed cases reported.

At present, the cause of hepatitis in these cases is unknown. The common viruses that can cause hepatitis (hepatitis viruses A, B, C, D and E) have not been detected in any of the cases. Some of the children hospitalised in England did test positive for SARS-CoV-2 and others for adenovirus. There is currently no clear connection between the reported cases. There is no known association with travel.

Investigations are underway across the UK to investigate the potential cause and information has been distributed to healthcare professionals and the public to raise awareness.

The UK Health Security Agency has published a guidance for clinicians including advice on how children should be investigated.

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