World Health Organization. Multi-Country – Acute, severe hepatitis of unknown origin in children. 2022. (accessed 25 April 2022)


02 May 2022
Volume 33 · Issue 5

Increase in hepatitis cases in children under investigation

The UK Health Security Agency (UKHSA), Public Health Scotland, Public Health Wales and the Public Health Agency are continuing to investigate a rise in cases of sudden onset hepatitis – or liver inflammation – in children aged 10 and under since January 2022. The usual viruses that cause infectious hepatitis (hepatitis A to E) have not been detected.

At the time of writing the total number of cases was 111 – of these cases, 10 children have received a liver transplant. The majority of children affected are under the age of 5 years – most of them showed initial symptoms of gastroenteritis followed by the onset of jaundice. None of the cases in the UK have died.

UKHSA stressed that there is no link to the coronavirus (COVID-19) vaccine. None of the currently confirmed cases in the UK is known to have been vaccinated. Since this cluster was identified, cases have been reported in Spain (13 cases), Israel (12), the USA (9), Denmark (6), Ireland (<5), The Netherlands (4), Italy (4), Norway (2), France (2), Romania (1) and Belgium (1) (World Health Organization, 2022).

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, said: ‘We are working with the NHS and public health colleagues in Scotland, Wales and Northern Ireland to swiftly investigate a wide range of possible factors which may be causing children to be admitted to hospital with liver inflammation known as hepatitis. Information gathered through our investigations increasingly suggests that this is linked to adenovirus infection. However, we are thoroughly investigating other potential causes.’

In total, 77% of cases tested were positive for adenovirus. The World Health Organization (2022) state that ‘While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent.’

Severe hepatitis in previously healthy children is rare. Clinicians should notify their local health protection team of suspected cases of certain infectious diseases, including acute infectious hepatitis and diseases that may present a significant risk to human health. Parents should be on the lookout for symptoms of hepatitis (Box 1). Dr Jim McMenamin, Head of Health Protection (Infection Services), Public Health Scotland said: ‘I strongly encourage parents and others taking care of young children to be vigilant about hand and respiratory hygiene. Where possible make sure that young children wash their hands frequently.’

Box 1.Hepatitis symptoms include:

  • Dark urine
  • Pale, grey-coloured poo
  • Itchy skin
  • Yellowing of the eyes and skin (jaundice)
  • Muscle and joint pain
  • A high temperature
  • Feeling and being sick
  • Feeling unusually tired all the time
  • Loss of appetite
  • Tummy pain

HRT shortage causing problems for women across the UK

Hormone replacement therapy (HRT) shortages are affecting women across the UK. Supply issues caused by an increase in demand have mainly affected Oestrogel as well as a handful of other forms of HRT including FemSeven Sequi patches.

The issue was raised by Conservative MP Caroline Nokes in Parliament, who highlighted how the shortages have affected women in her constituency and asked for a debate on access in the House of Commons.

RPS President Professor Claire Anderson said: ‘Difficulties in accessing HRT unfairly impacts women, affects their mental health and worsens health inequalities – this is an area that not only impacts our patients but also the health and care workforce. Pharmacists spend many hours dealing with medicines shortages when we'd rather be talking to patients about their care. One solution would be to enable pharmacists to make minor changes to a prescription when something is out of stock.’

The British Menopause Society suggest ‘prescribers should consider using equivalent preparations to those that their patients are currently using. If an exact match is not possible, prescribers can seek guidance available on the BMS website to clarify equivalent doses’.

This comes after changes to repeat prescription charges for HRT were announced; however, Pharmacy Minister Maria Caulfield recently said the move would not be enacted until April 2023. Chair of RPS in England, Thorrun Govind, said: ‘Women experiencing the menopause need support to stay well and remain in the workplace. For some, HRT prescriptions are an essential part of this, but also a financial drain during a cost-of-living crisis.’

Hundreds of people diagnosed with lung cancer early using mobile health trucks

Around 600 people have been diagnosed with lung cancer earlier through NHS mobile health trucks providing a lung MOT to those at risk of lung cancer. Current and ex-smokers aged between 55 and 74 years are invited to speak to a health professional and – if they have a higher chance of developing lung cancer – are offered an on-the-spot scan of their lungs.

The initiative has seen more than three quarters (77%) of cancers caught at either stage one or two. This compares to less than a third of cancers caught at either stage one or two in 2018.

CT screening can reduce lung cancer mortality

NHS cancer chiefs are urging those most at risk of lung cancer to come forward as soon as they are invited for the life-saving health check, to help even more people benefit from early diagnosis. Currently, only a third of people come forward for their lung check when invited. Previous trials have shown that CT screening reduced lung cancer mortality by 26% in men and between 39% and 61% in women.

Professor Peter Johnson, NHS clinical director for cancer said: ‘Lung cancer can often be hard to detect at an early stage and so these checks, close to people's homes, show how the NHS is taking action to find more people with cancer.’

Targeted checks in areas with the highest death rates

There are currently 23 truck sites and a further 20 sites will go live shortly. NHS lung trucks visit community sites including supermarket carparks, sports and shopping centres, and carry out targeted lung health checks in areas of the country that have some of the highest death rates from lung cancer.

Health and Social Care Secretary Sajid Javid said: ‘I am committed to radically improve outcomes for cancer patients across the UK and our 10-Year Cancer Plan will set out how we will lead the world in cancer care. This community scheme is exactly what we need to ensure hundreds of people get an earlier diagnosis, allowing them to get the treatment they need as soon as possible’.

The trucks have also identified thousands of people with other undiagnosed conditions including respiratory and cardiovascular disease. Advice to help people stop smoking is also provided to those who attend, as smoking causes more than seven in ten lung cancer cases in the UK.

Pushing for a national lung screening programme

Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation, is delighted by the news: ‘For over 30 years, we have been campaigning for lung cancer screening because we know it can save many lives. This is evidence of exactly that. 600 people have been given a better chance to live through lung cancer because of these life saving programmes. This is cause for celebration. But as wonderful as this news is, we must not rest on our laurels. These programmes are only available in selected areas of England so we will continue our push for a national lung cancer screening programme.’