Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022

Abstract

On 31 March 2022, Public Health Scotland was alerted to five children aged 3–5 years admitted to hospital with severe hepatitis of unknown aetiology. Retrospective investigation identified eight additional cases aged 10 years and younger since 1 January 2022. Two pairs of cases have epidemiological links. Common viral hepatitis causes were excluded in those with available results. Five children were adenovirus PCR-positive. Other childhood viruses, including SARS-CoV-2, have been isolated. Investigations are ongoing, with new cases still presenting.

Molecular Phylogeny of human adenovirus type 41 lineages

“…Despite these early studies, the molecular phylogeny of HAdV-F41 has not yet been studied in detail because of its limited clinical significance as a mere gastroenteritis virus. Recently, HAdV-F41 DNAemia was associated with severe hepatitis in young children (Baker et al, 2022;Marsh et al, 2022). Therefore, we sequenced the genomes and analysed the molecular phylogeny of 32 HAdV-F41 clinical isolates from 2011 to 2022, all originating from gastroenteritis cases.…”

“…Despite these early studies, the molecular phylogeny of HAdV-F41 has not yet been studied in detail because of its limited clinical significance as a mere gastroenteritis virus. Recently, HAdV-F41 DNAemia was associated with severe hepatitis in young children (Baker et al, 2022; Marsh et al, 2022).…”

Case numbers of acute hepatitis of unknown aetiology among children in 24 countries up to 18 April 2022 compared to the previous 5 years

“…An increase of acute hepatitis of unknown origin has been reported among children in multiple countries [ 1 , 2 ]. Up to 3 May 2022, 163 cases have been reported from the United Kingdom (UK), of which 11 received a liver transplantation [ 3 ].…”

Acute, Severe Hepatitis of Unknown Origin: Should We Really Be Afraid of Another Obscure Enemy of Our Children?

“…This cluster obviously exceeded the expected number of cases of hepatitis of unknown etiology, fewer than four per year [ 1 ]. A multi-disciplinary expert team reviewed clinical and epidemiological data from the first five children: vomiting in preceding weeks, jaundice, and exceptionally high levels of transaminases, often greater than 2000 international units per liter (IU/L; n.v. <40 IU/L) were the main features [ 2 ].…”