A mysterious hepatitis outbreak in children has spread across the northern hemisphere, with six probable cases of the illness identified in Ireland over the past ten weeks in children aged one to 12 years.
Hepatitis is inflammation of the liver, and although it can have many causes, what has baffled experts is none of the children who have the mystery strain have tested positive for viruses known to cause the illness.
The strain has proven to be deadly, with the HSE confirming on Thursday that a child being treated for an acute form of hepatitis has died, and a second has received a liver transplant.
READ MORE: Irish child being treated for mystery form of hepatitis dies and second receives liver transplant
Since the first case was reported on April 15, there have been continuing further reports of cases of acute hepatitis of unknown origin among young children.
According to WHO, as of April 21, at least 169 cases of acute hepatitis of unknown origin in children have been reported from 11 countries in the WHO European Region and one country in the WHO Region of the Americas.
The cases have been recorded in children aged between one month to 16 years old.
Of those 169 cases, 17 children (approximately 10%) have required liver transplantation, and at least six deaths have been reported.
The clinical syndrome, among identified cases, is acute hepatitis (liver inflammation) with markedly elevated liver enzymes.
Many cases reported gastrointestinal symptoms, including abdominal pain, diarrhoea and vomiting before presentation with severe acute hepatitis and increased levels of liver enzymes and jaundice.
Most cases did not have a fever.
The common viruses that cause acute viral hepatitis (hepatitis viruses A, B, C, D and E) have not been detected in any of these cases.
Based on the currently available information, international travel or links to other countries have not been identified as factors.
Adenovirus - a family of double-stranded DNA viruses originally identified in human adenoid tissue, causing infections of the respiratory system, conjunctiva, and gastrointestinal tract - has been detected in at least 74 of the cases.
The United Kingdom, where the majority of cases have been reported to date (114), observed a significant increase in adenovirus infections in the community following low levels of circulation earlier in the Covid-19 pandemic.
The Netherlands also reported concurrent increasing community adenovirus circulation.
Each country where a case has been identified is researching what is causing the illness with the support of the WHO.
However, in the meantime, parents and guardians should be aware of the symptoms to watch out for.
Advice for parents on symptoms of hepatitis
Symptoms of hepatitis can include:
- muscle and joint pain
- a high temperature
- feeling and being sick
- feeling unusually tired all the time
- a general sense of feeling unwell
- loss of appetite
- tummy pain
- dark urine
- pale, grey-coloured poo
- itchy skin
- yellowing of the eyes and skin (jaundice)
Parents are advised to go to their GP if their child develops symptoms of hepatitis. The GP will assess the child and refer on for further assessment as indicated.
If your child is unwell with respiratory or diarrheal or hepatitis symptoms, keep them at home and do not send them to crèche/preschool/school until they are better.
Good respiratory and hand hygiene, including supervising hand washing in young children, should be carried out as this can help prevent adenovirus and other infections that can cause hepatitis.
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