Department of Health

Acute hepatitis of unknown cause in children

Health advisory

Status:
Active
Advisory number:
220502
Date issued:
01 May 2022
Issued by:
Associate Professor Deborah Friedman, Deputy Chief Health Officer Communicable Diseases
Issued to:
Health professionals

Key messages

  • There has been a significant increase in cases of severe acute hepatitis of unknown cause in children aged 16 years and younger in several countries.
  • No cases have been identified to date in Australia. 
  • Viral hepatitis A, B, C, D and E have been excluded as causes in all of these cases.
  • A high proportion of cases tested positive for adenovirus; however other causes have not been ruled out.
  • Most cases have reported gastrointestinal symptoms including abdominal pain, diarrhoea, and vomiting before developing jaundice. 
  • Clinicians should test for adenovirus in addition to other usual causes of hepatitis in children presenting with acute hepatitis
  • Parents and guardians should be aware of the signs of hepatitis infection in children and seek immediate medical attention. 

What is the issue?

There have been reports of  cases of severe acute hepatitis in children 16 years of age and younger in Europe, the United States, Canada, Japan and Israel, with the United Kingdom reporting the largest number of cases. As of 21 April 2022, at least 169 cases have been reported, with approximately 10% requiring liver transplantation and at least one death has been reported to date.  

Human adenovirus (particularly adenovirus 41) was detected in a high proportion of cases (75% in the United Kingdom) suggesting it may be a causative pathogen, but investigations are ongoing and include  laboratory testing for other infections, chemicals and toxins. A small subset of cases had SARS-CoV-2 coinfection, but the role of this virus in the pathophysiology is unclear. There is no proven link to coronavirus (COVID-19) vaccines. 

Public health authorities in Australia are working closely with national surveillance networks including the Paediatric Active Enhanced Surveillance (PAEDS) OzFoodNet and laboratories to ensure any cases in children are detected without delay.

Who is at risk?

All cases to date have occurred among children 16 years of age or younger.

No particular risk factors have been identified yet, however investigations are ongoing. 

Symptoms and transmission

Most cases reported gastrointestinal symptoms including abdominal pain, diarrhoea and vomiting followed by the onset of jaundice. Most cases did not have a fever. Laboratory testing identified elevated liver enzymes.  Tests for hepatitis A, B, C, D and E have all been negative. 

Recommendations

In children presenting with jaundice following gastroenteritis clinicians should include testing for: 

  • Adenovirus (on blood, stool and respiratory tract samples)
  • Relevant viruses: hepatitis A, B, C, E; cytomegalovirus (CMV), Epstein-Barr virus (EBV), parvovirus; and autoimmune markers. 
  • SARS-CoV2 infection

Samples from suspected cases should be sent to the Victorian Infectious Diseases Reference Laboratory (VIDRL) for further characterisation.

Clinicians should notify the department of cases of acute hepatitis, in which tests have excluded the usual causes of acute hepatitis by calling 1300 651 160.

All staff involved in the care of children with acute hepatitis should use standard IPC precautions with optimal patient placement being in a single room with own ensuite whilst the patient is considered infectious and until resolution of symptoms. 

Parents and guardians should be alert to the signs of hepatitis (including jaundice) and seek immediate medical attention. 

Children with acute hepatitis should be excluded from attending childcare or school for one week after the onset of jaundice and until they are well. Children experiencing gastrointestinal symptoms should not return to childcare or school until 48 hours after their symptoms have resolved. 

Normal hygiene measures such as thorough handwashing (including supervising children) and good thorough respiratory hygiene, help to reduce the spread of many viral infections.

Reviewed 02 May 2022

Health.vic

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