Why has there been an increase of hepatitis in children?

Despite global efforts to eliminate viral hepatitis by 2030, the UK and many other countries have seen a mysterious surge of hepatitis in children throughout 2022. As cases continue to rise, what possible causes are health agencies investigating and what is the advice for concerned parents?

A rise in hepatitis in children

As of 4th July 2022, 263 children under 10 years of age have been diagnosed with hepatitis (inflammation of the liver) in the UK this year1. Thankfully, no children have died, but this unusually high number of hepatitis in children has caused the UK Health Security Agency (UKHSA) to jump into action to figure out the cause of this recent hepatitis outbreak.

There are many types of hepatitis in children, and these have various causes. Depending on the hepatitis type, this liver condition can be very treatable, but it can also sometimes be life-threatening. Most types - hepatitis A, B, C, D, and E - are caused by an infection with a virus. However, according to the UKHSA, these known hepatitis viruses have not been found in the children recently affected2.

Hepatitis in children - the basics

What is hepatitis?

Hepatitis is a condition in which the liver has become inflamed.

  • Acute hepatitis - is a short-lasting illness.
  • Chronic hepatitis - when the illness lasts six months or longer. (Acute hepatitis sometimes becomes chronic. Once chronic, it can cause long-term liver damage.)

Hepatitis symptoms in children

Symptoms of hepatitis in children include:

What causes hepatitis in children?

There are a number of causes for hepatitis in children and adults alike. Different causes correspond to different types of hepatitis, which are treated differently.

  1. Viral hepatitis (most common cause) - hepatitis A, B, C, D, and E viruses and certain other infections can lead to hepatitis. These spread in various ways. For example, hepatitis A and E viruses usually spread through contaminated food or drink, while B, C, and D viruses spread through blood or bodily fluids.
  2. Non-alcoholic fatty liver disease (the most common form of chronic liver disease in children) - a range of conditions caused by a build-up of fat in the liver. Hepatitis is one effect this can have.
  3. Toxins (a rare cause) - toxins are substances harmful to the body. Some medications can trigger toxic reactions in some people. Others store harmful levels of iron (haemochromatosis) or copper (Wilson's disease).
  4. Autoimmune hepatitis ( a rare cause) - a condition where the immune system attacks and damages the liver.

Is hepatitis in children life-threatening?

In short, it very much depends on the type of hepatitis. While some types will heal without any serious consequences, others like hepatitis A can, in very rare cases, lead to severe, life-threatening liver damage (fulminant hepatitis)3 and hepatitis B may turn into fatal primary liver cancer4.

What is causing the recent surge of hepatitis in children?

To cover all bases, healthcare officials are investigating whether these new cases of hepatitis in children could be linked to either a viral or non-viral form of hepatitis.

The UKHSA is currently exploring three main theories:

  1. This could be a new hepatitis-causing virus that hasn't yet been identified.
  2. This could be an existing hepatitis virus, or existing viruses combining, causing new symptoms.
  3. This could be non-viral (eg, hepatitis can be caused by toxins or medications).

This said, the leading theory appears to be that infections of hepatitis in children caused by adenovirus could be to blame.

"Recent studies have found that all patients with unexplained hepatitis had high levels of adenovirus, a common virus that can spread from person to person, causing respiratory symptoms, vomiting and diarrhoea in children," explains Natasha North from British Liver Trust.

Adenovirus can occasionally also cause other serious infections. Over the last two years, the COVID-19 pandemic has meant that children have been mixing less. As this year children are mixing more, certain infections, including adenovirus, are now circulating at a higher rate.

Could there be a link with COVID-19?

The COVID-19 virus is one of the possible infections under scrutiny. Some of the children who have contracted hepatitis have recently been infected with COVID-19, although experts caution that this is to be expected given the high COVID-19 infection rates in this age group.

Experts are also stressing that there is no link between these incidences of hepatitis and the COVID-19 vaccine2. This is because no vaccinations were given to the children who were under 5 years of age - the age group which makes up over 75% of current hepatitis cases.

Hepatitis in children - what is the latest advice for parents?

First and foremost, experts would like parents to know that the risk to public health is minimal. If your child develops the common mild symptoms associated with a viral infection - don't panic! The chance of them developing hepatitis is still extremely low.

They recommend the following precautions:

  • You don't need to contact the NHS unless your child is very unwell. For example, if they have trouble breathing, if they are not eating or drinking, or if they develop jaundice (yellowing of the eyes or skin).
  • If your child's symptoms are rapidly getting worse or you are worried, contact your GP or, if in the UK, call the NHS on 111.
  • Children who are unwell should be kept at home and shouldn't go to school or nursery.
  • Children with gastrointestinal symptoms - including vomiting and diarrhoea - should remain at home until 48 hours after the symptoms have passed unless they have any of the worrying signs above.

Far from a national issue

This as-of-yet undetermined cause extends beyond national borders. In fact, the UK is just one of 34 countries experiencing a rise in unexplained hepatitis in children5. However, we do know that this outbreak is unrelated to the recent hepatitis A cases in the USA - these have been connected to contaminated strawberries that were imported from northern Mexico to California between March and April 2022, leading to 18 confirmed cases as of 5th July.

Further reading

  1. GOV.UK "Hepatitis (liver inflammation) cases in children - latest updates".
  2. UK Health Security Agency (UKHSA) "An increase in Hepatitis Cases in Children".
  3. World Health Organization (WHO) "Hepatitis A".
  4. World Health Organization (WHO) "Hepatitis B".
  5. World Health Organization (WHO) "World Hepatitis Summit 2022 urges action to eliminate viral hepatitis as unexplained hepatitis cases in children rise globally".
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