A mysterious liver disease affecting children that was first reported in the UK has now spread to Europe and the US.
More than 70 children under 10 have become sick with hepatitis, or liver inflammation, in the UK since January.
All of the 74 cases – 49 in England, 13 in Scotland and 12 across Wales and Northern Ireland – have been admitted to hospital.
Some have required specialist care at liver units and a few have needed a liver transplant.
Nine cases of the disease have been identified in children aged one to six in Alabama in the US and now also four European countries.
The European Centre for Disease Prevention and Control said on Tuesday, that additional cases of hepatitis had been identified in Denmark, Ireland, the Netherlands and Spain.
The authority did not specify exactly how many cases have been found in the countries and said the ‘exact cause’ of the outbreak ‘remains unknown’.
The usual viruses that cause infectious hepatitis have not been seen in the cases leaving scientists and doctors unsure as to what could be causing the illness.
As a result, experts are considering other possible sources, including Covid-19, other viruses, and environmental factors.
Simon Taylor-Robinson, a professor of hepatology at Imperial College London said while it ‘might seem unusual’ that doctors don’t know what was causing the hepatitis outbreak, news of the infections was evidence of alert systems working.
‘What is happening is that the World Health Organisation, the British Medical Association and European authorities are putting alerts out there to general medical practitioners,’ he said.
He said the alerts meant medics were on the lookout for cases of hepatitis in children and could provide the best care if patients presented with the illness.
UK scientists previously said one of the possible causes they were investigating were adenoviruses, a family of common viruses usually responsible for conditions like a sore throat or diarrhoea.
US authorities said the nine children with acute hepatitis in Alabama tested positive for adenovirus.
On Wednesday, health officials in the US issued an alert warning doctors to be on the lookout for symptoms of hepatitis in children linked with an adenovirus infection.
But some doctors have said adenoviruses are so common in children that finding them in those with hepatitis does not necessarily mean the viruses are responsible for the outbreak.
The WHO noted that although there has been an increase in adenovirus in Britain, which is spreading at the same time as Covid-19, the potential role of those viruses in triggering hepatitis is unclear.
Prof Taylor-Robinson said it was quite common to get adenoviruses circulating in the population in the spring.
But added that one possible reason children are falling ill may be because they have not been exposed to lots of viruses during the pandemic, so their immune systems are less equipped to handle them.
‘We are living in this post-Covid era which means that perhaps children have not been exposed to so many viruses as normal and haven’t built up the immunity to viruses that they would normally do,’ he said.
British public health officials have also ruled out any links to Covid-19 vaccines, saying none of the children who have fallen ill has been vaccinated.
Some of the children with hepatitis have tested positive for coronavirus, but the WHO said genetic analysis of the virus was needed to determine if there were any connections between the cases.
It said no other links had been found between the children in the UK and none had recently travelled internationally.
Lab tests are also underway to determine if a chemical or toxin might be the cause.
The WHO said there were fewer than five possible cases in Ireland and three confirmed cases in Spain, in children aged 22 months to 13 years.
The UN health agency said that given the jump in cases and heightened surveillance, it is ‘very likely’ more cases will be detected before the cause of the outbreak is identified.
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