Could there be a Covid connection behind hepatitis outbreak in kids?

The global outbreak of hepatitis in children is a real worry, ­especially among parents and grandparents, raising the ­spectre of another Covid.

There have been 650 suspected cases globally and more than 250 of those were in the UK. So far no precise cause has been found for this liver inflammation – but research is giving us some clues.

Worldwide, at least 38 children have required liver transplants, and 10 deaths have been reported. Cases in the UK involve children aged between one month and 16 years, but three-­quarters were under five. A dozen have so far required liver ­transplants here after developing symptoms.

Muge Cevik, a lecturer in infectious diseases at St Andrews University said in the BMJ that gastro symptoms are common, including vomiting, pale stools, ­diarrhoea and jaundice. Fever and respiratory symptoms have been reported less often.

We know it’s not down to the usual suspects – hepatitis viruses A to E – but the UK Health Security Agency has reported finding another common virus, adenovirus, in 91 of the 126 ­children tested. Active Covid infection was confirmed in 24 of 132 affected children in the UK.

Many other viruses are in the frame, including Epstein-Barr virus (which causes glandular fever), enterovirus, cytomegalovirus, and respiratory syncytial virus.

Also human herpes viruses 6 and 7 have been identified in UK patients, though less often.

So it’s a puzzle with no unifying causative factor, but it’s still worth looking at adenovirus more closely. This virus affects adults and ­children and usually causes symptoms ­resembling a cold or flu, which get better in a short time.

While adenovirus is hardly ever seen with liver failure in healthy children, other factors may increase a child to be vulnerable, such as a susceptibility because of a previous infection with another virus – even Covid.

India has seen a kind of hepatitis in 37 children two to six weeks after Covid infection during an outbreak of the Delta variant.

But it was different. Liver function was unaffected, there was no jaundice, none had liver failure, and there were no deaths.

Non-infectious or toxic causes haven’t been identified but can’t be ruled out just yet. Previous Covid infection causing a major immune response that leads to more severe adenovirus infection is also being considered and investigated.

This seemingly rare but severe condition is likely to have a complex background and cause. As with Covid, what’s needed is global collaboration ­and ­information sharing to get on top of this worrying outbreak.