Natalie Grover and Jennifer Rigby

LONDON (Reuters) – Health authorities around the world are investigating a mysterious increase in severe cases of hepatitis – inflammation of the liver – in young children.

Here is an overview of the facts about this outbreak.

WHAT’S HAPPENED?

There have been more than 190 confirmed cases, the majority of which are in Britain. Britain has already reported 111 cases from January.

Others countries, including Spain, Israel, Denmark and Ireland have reported smaller cases.

WHY IS THIS A CONCERNING THING?

It is possible to get mild paediatric hepatitis. However, the first cases were reported in Scotland on April 6. Children had been very sick. One child died, and several others required liver transplants.

The other concern was that the cases were not linked to the typical viruses usually linked to the condition – hepatitis A, B, C, D and E.

Maria Buti from Barcelona, an hepatology professor and chair of the European Association of the Study of the Liver’s public health committee said that although there are still very few cases of the disease, the most concerning thing about the situation is the severeness of the spread. She has closely followed the ECDC’s response to the epidemic.

What CAUSES IT?

The leading theory is viral infection, probably with an adenovirus – a common family of viruses that can cause the common cold, among other conditions.

Type 41 is a type of adenovirus that causes severe gastroenteritis. It has been reported to cause hepatitis in children with immunocompromised, but not in children who are healthy.

Jim McMenamin from Public Health Scotland said that work is underway to determine if the adenovirus in question has mutated and caused more severe diseases, or if they could have been causing problems with other viruses, such as SARS-CoV-2 which can cause COVID-19.

75% of the British affected children tested positive for adenovirus.

Scientists say that although it is possible for a new pathogen or toxin to be responsible, the geographical spread of cases indicates infection.

As the majority of COVID-19 cases are found in Britain, any link has been eliminated.

Others suggested that lowered immunity due to reduced social interaction during the pandemic might be an explanation.

Simon Taylor-Robinson (a consultant hepatologist, professor of translational medicine at Imperial College London) said that this could be an over-response for stimulation to the immune.

Some others cautioned against the possibility of adenovirus infection due to their widespread spread at this time.

What are Public Health AUTHORITIES Advising?

In the United States, public health warnings have been issued asking physicians to look out for the disease and for children to be tested for it if possible.

Dark urine, yellowing skin and eyes (jaundice), fever, fatigue, loss appetite, nausea and vomiting are all symptoms.

Although there is not a cure for hepatitis, drugs may be used to treat inflammation.

It is being advised that parents be aware of symptoms and contact their health professionals if they become concerned.

British Health Security Agency advised handwashing in order to stop further spreading.

Although experts said the increase in cases was relatively gradual, they cautioned against expecting more.

Buti said, “If you pay attention a thing you see more of that,”