Dogs linked to hepatitis outbreak in children – but expert says there may be simple reason

This Morning: Dr Ellie on link between dogs and hepatitis

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As of last week, the UK Health Security Agency (UKHSA) has reported a total of 176 cases of acute hepatitis, or liver inflammation, in UK children mostly under the age of 10. To date, the majority of cases — 128 — came from England, with 26 reported from Scotland, 13 in Wales and nine from Northern Island. The usual viruses responsible for liver inflammation — that is, hepatitis viruses A, B, C, D and E — have not been detected in these cases, although the World Health Organisation (WHO) has reported that many of the global cases appear to have an adenovirus infection. Adenoviruses are a broad family of some 50 viruses known to cause a wide variety of illnesses from the common cold, conjunctivitis, gastroenteritis, and bladder infection to life-threatening multi-organ diseases in the clinically vulnerable.

The UKHSA has said that they are continuing “to investigate possible causes and will regularly publish technical updates”.

In a recent briefing paper, the UKHSA noted that there were “relatively high numbers of dog-owning families or other dog exposures in cases”.

Specifically, affected children were exposed to dogs in 70 percent of cases studied.

The UKHSA added: “The significance of this finding is being explored.

“Pet dog ownership is common in the UK.”

According to comparative immunologist Professor Mick Bailey of the University of Bristol, this latter fact is very likely not a cause for concern.

As he wrote in the Conversation: “33 percent of households in the UK own dogs.

“Many more children from non-dog-owning households will be exposed to dogs when they visit or play with their friends.

“70 percent exposure to dogs may be completely normal.”

Prof Bailey added: “To suggest a link, it’s important to show not only that exposure to dogs in patients is high, but that it’s higher than in unaffected children.

“Until that’s checked in what’s known as a case-control study, any link is nothing more than a suggestion.”

The immunologist explained that it is very easy to find spurious associations in retrospective analyses — and that future studies will be required to assess whether the link continues to hold as further data is collected from new cases.

Scientists have proposed other causes for the recent outbreak — with one theory, for example, suggesting that social distancing during the pandemic has reduced our children’s exposure to various diseases, leaving their immune systems underprepared.

On the opposite end of the spectrum, enhanced hygiene measures brought in to combat Covid — such as more thorough hand washing and the sterilisation of surfaces — may, Prof. Bailey explained, have predisposed children to over-reactive immune responses.

Alternatively, yet another hypothesis has suggested that it is infection with SARS-CoV-2, the virus which causes COVID-19, that has predisposed children to severe hepatitis infections.

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Prof Bailey concluded: “All of these are no more than theories at the moment, and the available data is insufficient to prioritise any of them or to use them to suggest control measures.

“Fortunately, the incidence is still extremely low, and until there is better data parents should probably concentrate more on keeping an eye out for any symptoms in their children than on reducing their exposure to dogs.”

Symptoms of acute hepatitis initially typically manifest as persistent diarrhoea, stomach aches and nausea followed by the onset of jaundice, which is a yellowing of the skin, mucous membranes and whites of the eyes.

In a smaller subset of cases, children have also presented with headaches, sore throats and a fever.

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