Parents in Northern Ireland are being warned to check their children for signs of hepatitis after nine children here were diagnosed with sudden onset hepatitis.
Yesterday it emerged that a child who was being treated for an acute form of the illness in the Republic of Ireland has died.
Irish health officials also confirmed a second child being treated for hepatitis has received a liver transplant in the UK.
Investigations are ongoing across the UK as to why more than 170 children have now been identified with sudden onset hepatitis, with a rise in the unexplained type of illness also being reported more widely across the globe.
Of the children in the UK, 11 have needed a liver transplant.
The mystery outbreak of hepatitis in children was first identified in the UK in January.
Health officials in Northern Ireland said they are “continuing to work with counterparts in other jurisdictions” as part of the UK-wide investigation being led by the UK Health Security Agency (UKSHA).
The majority of the children affected are under the age of 10 but the UKHSA confirmed a small number of cases in children over the age of 10 are also being investigated.
Hepatitis is an inflammation of the liver tissue and there are a number of different types of the illness, including hepatitis A, B and C.
However, this acute form of hepatitis is of unknown origin, so all possibilities of the cause of this in children recently are being investigated.
Cases are mainly in children under five who have displayed initial symptoms of diarrhoea and nausea followed by jaundice – a condition in which the skin and eyes yellow, which are tell-tale signs the liver is struggling.
The Public Health Agency (PHA) said it is investigating a number of possible causes, including that it is linked to “adenovirus infection”.
Adenoviruses are a family of common viruses that usually cause a range of mild illnesses and most people recover without complications.
According to the PHA, they can cause a range of symptoms, including colds, vomiting and diarrhoea. While they don’t typically cause hepatitis, it is a known rare complication of the virus.
“Work is ongoing to assess a wide range of possible factors. One of the possible causes being investigated is that this is linked to adenovirus infection,” a PHA spokesperson said.
“However, other potential causes are also being thoroughly investigated. There is no link to the Covid-19 vaccine.”
The PHA advised the public the best way to avoid contracting the illness is to observe good hand hygiene along with respiratory hygiene.
“Teach children to cover their nose and mouth when coughing or sneezing and to use a tissue which is disposed of quickly and carefully in a bin,” the spokesperson added.
“Parents are also being reminded to be aware of the symptoms of hepatitis. If you have a child who is showing signs of jaundice where the skin or whites of the eyes have a yellow tinge, then you should contact your GP or other healthcare professional.”
Dr Ciara Martin, the Republic’s Health Service Executive’s (HSE) lead on children, said the cases are more severe than doctors would normally see.
“Generally, hepatitis can be caused by different things – toxin, bacteria and, more commonly, a virus,” Dr Martin said.
She said the common viruses had not been found in the cases in Ireland.
“Hepatitis does not tend to come on fast. It can take a little time for it to show,” she said.
She said there is no apparent link to Covid, although it will take time to see if it is playing any role.