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Hepatitis in children: What’s behind the outbreaks?

BMJ 2022; 377 doi: (Published 26 April 2022) Cite this as: BMJ 2022;377:o1067

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Is toddler herd immunity an issue?

Dear Editor,

My recent experience is of staying with my son and being called in the middle of the night to assess my 15 month old granddaughter who had a pyrexia and was clearly distressed. My concern that she had cold extremities (though no rash) led me to instruct the parents to go straight to Children’s A&E where she quickly received iv support for sepsis and was subsequently found to have Covid19, Adenovirus and Paraflu. She recovered fully over the next 48 hours. I will be forever in debt to colleagues in Bristol.

It is dangerous to generalise from a single case but she had also been attending a nursery and so It is likely that herd immunity in nurseries (and primary schools) is in a post-lockdown low permitting parallel infections of common viruses because serial exposure has so far been denied. The situation is reminiscent of the stories of well meaning missionaries introducing pathogens to indigenous communities.

Not everyone has a GP in the spare bedroom but, in our case my granddaughter received prompt attention without the need for time consuming telephone triage or even waiting for an ambulance. Had she not, though not initially immunocompromised, the functional effect of multiple infections probably had the same impact on her immune system. It is not inconceivable that this could ultimately have led to clinical hepatitis.

It is probably not possible safely to increase toddler herd immunity though, if review of similar cases shows similar results, we might promote the value of teaching parents of young children red flags to which they should quickly respond and report to triage systems, perhaps via nurseries or even TV advertising as children ‘watch with mother’.

Competing interests: No competing interests

30 April 2022
Andrew J Ashworth
GP and Occupational Physician