What do we know about the global hepatitis outbreak?
Scientists have been left puzzled by a global outbreak of hepatitis that has caused one death and 17 liver transplants.
The inflammatory liver condition has been spotted in at least 169 children aged between one month and 16 years old.
None of the cases have been caused by any of the five typical strains of the virus — hepatitis A, B, C, D and E.
What is hepatitis?
Hepatitis is inflammation of the liver that is usually caused by a viral infection or liver damage from drinking alcohol.
Hepatitis often has no noticeable symptoms — but they can include dark urine, pale grey-coloured faeces, itchy skin and the yellowing of the eyes and skin.
Infected people can also suffer muscle and joint pain, a high temperature, feeling and being sick and being unusually tired all of the time.
When hepatitis is spread by a virus, it’s usually caused by consuming food and drink contaminated with the faeces of an infected person or blood-to-blood or sexual contact.
How many countries have cases been recorded in?
UK
Spain
US*
Israel
Denmark
Ireland
The Netherlands
Italy
France
Norway
Romania
Belgium
Japan*
Canada*
114
13
14
12
Six
Fewer than five
Four
Four
Two
Two
One
One
One
Unspecified number
*cases in Canada, Japan and Illinois, US, are still yet to be confirmed
Do we know what is behind the outbreak?
Co-infection
Experts say the cases may be linked to a virus commonly associated with colds, but further research is ongoing.
This, in combination with Covid infections, could be causing the spike in cases.
‘While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent,’ WHO said,
It noted that the virus has been detected in at least 74 of the cases. At least 20 of the children tested positive for the coronavirus.
Weakened immunity
British experts tasked with investigating the spate of illnesses believe the endless cycle of lockdowns may have played a contributing role.
Restrictions may have weakened children’s immunity, leaving them at heightened risk of adenovirus.
Writing in the journal Eurosurveillance, the team — led by Public Health Scotland epidemiologist Dr Kimberly Marsh — said more children could be ‘immunologically naive’ to the virus because of restrictions.
They said: ‘The leading hypotheses centre around adenovirus — either a new variant with a distinct clinical syndrome or a routinely circulating variant that is more severely impacting younger children who are immunologically naive.
‘The latter scenario may be the result of restricted social mixing during the pandemic.’
Adenovirus mutation
Other scientists said it may have been a virus that has acquired ‘unusual mutations’.
A virology specialist at Imperial College London told The Telegraph it is ‘very unusual and rare’ for children to suffer severe hepatitis, especially to the extent that they require a liver transplant.
The expert, who wished to remain anonymous, said: ‘The number of cases is exceptional.
‘It makes people think there is something unusual going on — such as a virus that has mutated or some other cause. It has sent alarm bells ringing.’
New Covid variant
UKHSA officials included ‘a new variant of SARS-CoV-2’ in their working hypotheses, when discussing the variant at the European Congress of Clinical Microbiology & Infectious Diseases in Lisbon.
Other theories
The UKHSA has noted Covid as well as other infections and environmental triggers are still being probed as possible causes of the illnesses.
The agency ruled out the Covid vaccine as a possible cause, with none of the British cases so far having been vaccinated because of their age.
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