New guidance for the early investigation and management of children with acute non-A-E hepatitis, with and without liver failure

To support paediatricians and the child health workforce we have published a new clinical framework for the investigation, monitoring, transfer and management of children with novel non-A-E acute hepatitis.
Health professionals in scrubs walking down hospital corridor

The UK Health Security Agency (UKHSA) is working with the National Health Service (NHS) and the public health agencies across the UK to investigate the potential cause of an unusually high number of acute hepatitis cases being seen in children in recent weeks. 

As at 16 May 2022, there were approximately 197 cases in the UK, with some cases transferred to specialist children’s liver units, and a small number that have undergone liver transplantation. 

In guidance published in April this year, UKHSA recommended clinicians alert themselves to the situation and be vigilant to children presenting with signs and symptoms which may potentially attribute to hepatitis. They stated the most common symptoms experienced by children affected are jaundice and vomiting with other symptoms including pruritus, arthralgia/myalgia, pyrexia and lethargy and/or loss of appetite. 

While no direct cause has yet been identified, there is evidence of a possible link between infections with adenovirus infections and the increase of acute hepatitis cases. 

To support paediatricians and the child health workforce with early investigation and management of children with acute non-A-E hepatitis, with and without liver failure, this clinical guidance has been published.

This new guidance is based on a clinician consensus and provides an outline of investigation, monitoring and management and pathways. It is intended to provide a structure for the investigation, transfer and management of children with novel non-A-E acute hepatitis in the context of an emergence of a novel disease.

Whilst the guidance provides general principles of care for this condition, each case should be treated in an individual and nuanced way. 

Furthermore, the recommendations within the guidance are based on existing principles of management of acute hepatitis and acute liver failure and on expert consensus opinion in the absence of high quality evidence around this novel condition. 

For more information click through to the clinical guideline and see UKHSA technical briefings for children here.