The European Centre for Disease Prevention and Control (ECDC) has been informed of an increase in acute hepatitis cases among children in recent weeks in the UK. It is sharing this information internationally to increase awareness among clinicians working with children and to determine whether there are any similar cases in other countries.

The clinical syndrome in identified cases involves severe acute hepatitis with markedly elevated transaminases, often presenting with jaundice and sometimes preceded by gastrointestinal symptoms, including vomiting as a prominent feature in children up to the age of 16 years.

Clinicians are encouraged to report cases of acute hepatitis in children up to the age of 16 years with a serum transaminase >500 IU/L, in which hepatitis A to E has been excluded, to their national public health institutes. EU member states can also share information about any suspected cases on the ECDC EpiPulse platform to facilitate further investigation.

According to the ECDC, around 60 cases are currently under investigation in England, with the majority of these occurring in children aged between two and five years. Some cases have progressed to acute liver failure and a small number of children have undergone liver transplantation as a result.

In Scotland, 10 cases that required hospital admission occurred in children aged between one and five and are currently under investigation. Most of these presented from March 2022 onwards.

While there are currently no known cases in Wales, a small number of cases from earlier this year had similar clinical presentations.

There are currently no confirmed cases in Northern Ireland.

The cause of hepatitis in these cases is unknown. The common viruses that can cause hepatitis (hepatitis viruses A, B, C, D and E) have not been detected in any of the cases.

Some of the children hospitalised in England did test positive for SARS-CoV-2 and others for adenovirus, however there is currently no clear connection between the reported cases and there is no known association with travel.

Investigations are underway across the UK to investigate the potential cause. The UK Health Security Agency has published a guidance for clinicians, including advice on how children should be investigated. It can be viewed here.