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Doctors are investigating a mysterious outbreak of liver disease in young children in the UK. So far, there have been 60 cases in England and 11 in Scotland of unexplained hepatitis, or liver inflammation, since the start of the year, most of them in children who are 2 to 5 years old. Case numbers in Wales and Northern Ireland haven’t been released.

Although no child has died, a “small number” have needed a liver transplant, . This means they will have to take drugs that suppress the immune system for the rest of their lives, which will leave them at risk of infections.

Hepatitis is often associated with specific pathogens, such as the hepatitis C virus, but it can be triggered by many other things. There have previously been small clusters of cases caused by the hepatitis A virus, which can be spread by faecal contamination of food or water. The hepatitis viruses A to E have all been ruled out in the current outbreak, though.

Finding the cause will require carefully investigating every case to see if they have factors in common, says , an infectious disease specialist at Imperial College London.

The outbreak might have been caused by a rare delayed reaction to covid-19 infection, or by a different infection spreading after pandemic-related lockdown restrictions were lifted.

“There is probably a group of children who won’t have been exposed to all those viruses they would normally be exposed to in early life,” says Cooke. “With the easing of restrictions, a lot of other viruses are circulating that weren’t able to circulate before.

The covid-19 vaccine can’t be the cause, because it isn’t being offered to children under the age of 5 in the UK.

Family doctors have been asked to watch out for children aged 16 and under who have symptoms of hepatitis, which include a yellow tinge to the skin known as jaundice, discoloured urine or faeces, itchy skin, fever, nausea and abdominal pain.

If the cause of hepatitis is unknown, those affected would receive general supportive care, and if necessary, treatments to stand in for the poorly functioning liver, such as vitamin K, which helps in blood clotting.

“If you’re not treating a specific cause, you’re just trying to minimise the damage from the liver, and support the various organ functions if someone does become sick,” says Cooke.

Hospital doctors have been told to have a “low threshold for seeking expert support” from the UK’s three specialist centres for children with liver disease.

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