April 26, 2022

expert reaction to technical briefing and update from the UKHSA on acute hepatitis of unknown aetiology in children in England

The UK Health Security Agency (UKHSA) has issued an update, including a technical briefing document, on the ongoing investigation into higher than usual rates of liver inflammation (hepatitis) in children across the UK.

Prof Thomas Baumert, a hepatologist and virologist at Inserm and the University of Strasbourg, said:

“These cases of acute liver failures in children are indeed a major concern.  The association with gastrointestinal symptoms point to an infectious, likely viral origin different than the known viruses causing liver disease.  Research is needed to quickly uncover the causative agent for prevention and treatment.  This new challenge subsequent to the Covid-19 pandemic again underlines the importance of being prepared for emerging infectious diseases.”

Prof Will Irving, Professor of Virology, University of Nottingham, said:

“The UKHSA technical report provides considerable detail on the epidemiology and ongoing investigations into the recent rise in the number of cases of sudden onset hepatitis in children.  The link with adenovirus infection remains tantalising – a definite possibility but not yet proven.  There are very few case reports in the global literature of adenovirus infection being associated with hepatitis in immunocompetent children (or adults) – so if it transpires that adenoviral infection is involved in causing this disease outbreak, there will be a need to explain why the natural history of adenovirus infection has changed so dramatically in 2022.”

Prof Deirdre Kelly, Professor of Paediatric Hepatology at the University of Birmingham; and Liver Unit at the Birmingham Women’s & Children’s Hospital, said:

What does the evidence suggest so far; what evidence and data do we still need to see?

“We still need to see evidence of a relationship with previous Covid infection, and whether the affected children are genetically or immunologically different from others especially in relation to the adenovirus which may be a trigger rather than the causative factor.

“We need to know what the explanted livers at transplant showed.

Is hepatitis sometimes a known but very rare manifestation of adenovirus infection?

“In the past only in immunocompromised children.

Is it possible we are seeing a rare outcome of a common infection, and the increased numbers are because of an increase in adenovirus infections?

“It is possible.

Have most children with this recovered well?

“Yes.

Does hepatitis always have a cause?

“No but it does in 80%.

Would we expect the number of reported cases to rise once an issue has been raised and clinicians have been asked to be alert to possible cases?

“Yes we have seen this already.

Is this a worrying situation — should parents be panicking?

“No only a small number of children affected, but now in China and Japan too.

Is it good that the authorities are monitoring this and that countries worldwide are actively looking for cases?

“Definitely.”

UKHSA technical briefing: https://www.gov.uk/government/publications/acute-hepatitis-technical-briefing; https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1071102/acute-hepatitis-technical-briefing-1.pdf

UKHSA press release: https://www.gov.uk/government/news/increase-in-hepatitis-liver-inflammation-cases-in-children-under-investigation

Comments sent out 13/04/2022 and 21/04/2022 on hepatitis in children.

Declared interests

Prof Will Irving: “I currently chair the National Strategy Group for Viral Hepatitis (a multi-agency group with a number of remits including overseeing plans to eliminate hepatitis B and C virus infections as a public health concern).  I have received research funding and consultancy fees from a number of pharmaceutical and diagnostic companies (I can supply details if required).”

For all other experts, no reply to our request for declarations of interest was received.