The possible cause of the hepatitis outbreak in children could be linked to a common virus, according to health officials.
In an update on Monday, the UK Health Security Agency (UKHSA) said its investigation into the mystery spike of cases "increasingly suggests" the source is a strain of adenovirus called F41.
Adenoviruses are a group of common viruses that cause a range of illnesses and cold-like symptoms.
The agency said the usual viruses that cause infectious hepatitis (hepatitis A to E) have not been detected.
Most of the cases are in children aged five and under who showed initial symptoms of gastroenteritis illness - such as diarrhoea and nausea - followed by the onset of jaundice.
A further three cases have been confirmed by the UKHSA since its update on April 21, bringing the number of cases to 111.
Of the UK cases, 81 are in England, 14 are in Scotland, 11 are in Wales and 5 are in Northern Ireland.
A total of 10 UK cases have received a liver transplant.
The news follows news of the death of one child as confirmed by the World Health Organization (WHO).
There are 169 infections globally and 114 are in all four nations of the UK, according to the WHO's latest update on April 21.
The UKHSA said no UK cases have died and a small number of children over the age of 10 are being investigated.
A link to Covid vaccines has been eliminated. None of the confirmed cases in under 10-year-olds in the UK is known to have been vaccinated.
The surge in cases was first detected in Scotland earlier this month with infections dating back to January.
In an update on April 25, the UKHSA said mounting data suggests that the rise in severe cases of hepatitis may be linked to adenovirus infection, but other causes are still being actively investigated.
Adenovirus was the most common pathogen detected in 40 of 53 (75 percent) confirmed cases tested.
Routine NHS and laboratory data show that common viruses circulating in children are currently higher than in previous years and a marked increase of adenovirus, particularly in the one to four age group.
"Information gathered through our investigations increasingly suggests that this rise in sudden onset hepatitis in children is linked to adenovirus infection. However, we are thoroughly investigating other potential causes," said Dr Meera Chand, Director of Clinical and Emerging Infections at the UKHSA.
Dr Chand also advised adults on the symptoms to recognise.
She said: " Parents and guardians should be alert to the signs of hepatitis (including jaundice) and to contact a healthcare professional if they are concerned.
"Normal hygiene measures such as thorough handwashing (including supervising children ) and good thorough respiratory hygiene, help to reduce the spread of many common infections, including adenovirus.
"Children experiencing symptoms of a gastrointestinal infection including vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped.
"We are working with partners to further investigate the link between adenovirus and these cases."
Symptoms of hepatitis
Hepatitis signs include:
- yellowing of the white part of the eyes or skin (jaundice)
- dark urine
- pale, grey-coloured faeces (poo)
- itchy skin
- muscle and joint pain
- a high temperature
- feeling and being sick
- feeling unusually tired all the time
- loss of appetite
- tummy pain
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