THE UKHSA have released a new technical briefing today outlining their latest hypotheses for the outbreak of acute hepatitis in kids across Britain.
The following hypotheses are all being actively tested by the investigations in process.
There are increased paediatric acute non-A-E hepatitis presentations due to:
1. A normal adenovirus infection, due to one of:
a. Abnormal susceptibility or host response which allows adenovirus infection to progress more frequently to hepatitis (whether direct or immunopathological), for example from lack of exposure during the coronavirus (COVID-19) pandemic.
b. An exceptionally large wave of normal adenovirus infections, causing a very rare or under-recognised complication to present more frequently.
c. Abnormal susceptibility or host response to adenovirus due to priming by a prior infection with SARS-CoV-2 (including Omicron restricted) or another infection.
d. Abnormal susceptibility or host response to adenovirus due to a coinfection with SARS-CoV-2 or another infection.
e. Abnormal susceptibility or host response to adenovirus due to a toxin, drug or environmental exposure.
2. A novel variant adenovirus, with or without a contribution from a cofactor as listed above.
3. A post-infectious SARS-CoV-2 syndrome (including an Omicron restricted effect).
4. A drug, toxin or environmental exposure.
5. A novel pathogen either acting alone or as a coinfection.
6. A new variant of SARS-CoV-2.
The full technical briefing is republished below, or it can be downloaded from here
To date 163 acute hepatitis (non-A-E) cases have been identified in children under 10 in the UK
• 118 in England 🏴
• 22 in Scotland 🏴
• 13 in Wales 🏴
• 10 in Northern Ireland
11 required liver transplantation
Thankfully zero deaths. pic.twitter.com/r7i64PaFHU
— 🇺🇦 Meaghan Kall (@kallmemeg) May 6, 2022
The CDC is investigating 109 pediatric cases of unexplained severe #hepatitis—acute liver inflammation. 90% of these kids have been hospitalized, several needed liver transplants, and 5 have died to date. Still unclear if Adenovirus 41 or COVID or other.🧵https://t.co/D6uYnZDKNS pic.twitter.com/zPutCC3Lt5
— Eric Feigl-Ding (@DrEricDing) May 6, 2022
Pediatric hepatitis of unknown origin is on the increase also in Sweden.
— Virpi Flyg (@VirpiFlyg) May 6, 2022
UKHSA 2nd report on hepatitis out. US reporting 100 cases with 5 deaths so far: TLDR-
for the UK
– 163 cases so far
-91/126 had adenovirus in blood (but *none* in hepatocytes on liver biopsy)
-low viral load
-18% of cases SARS-CoV-2 positive
-no covid serology results yet pic.twitter.com/YsKnupYtwz
— Dr. Deepti Gurdasani (@dgurdasani1) May 6, 2022
Unknown #Hepatitis in #children: From my point of view as a clinical virologist, there are many aspects that speak against #Adenovirus, with important implications for treatment. Why? Viral loads in the cases reported to be low. Normally viruses causing hepatitis are massively
— Isabella Eckerle (@EckerleIsabella) May 8, 2022
I am a medical virologist as well and I would point out also the lack of viral images in liver biopsy EM, unlikely in any adenovirus infection.
— Roberto Burioni (@RobertoBurioni) May 9, 2022
Indonesia logs 15 cases of acute hepatitis with unknown cause https://t.co/x3Rjwv8ZZU
— Corona Heads Up (@CoronaHeadsUp) May 9, 2022
BREAKING: SickKids hospital reporting 7 cases of severe acute hepatitis, which may be linked to hundreds of other unexplained cases in children around the world. So far it's not clear if this marks a rise in cases of unknown origin at the Toronto facility.https://t.co/0ZwotyXxn2
— Lauren Pelley (@LaurenPelley) May 9, 2022