Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in England
Abstract Background During 2022, a new public health threat emerged when cases of paediatric acute hepatitis of unknown aetiology (HUA) were identified in children aged under 16 years old in the United Kingdom (UK). At the time, the epidemiology and extent of cases was based upon limited and non-sta...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-025-23222-0 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849688339729350656 |
|---|---|
| author | Alex J. Elliot Helen E. Hughes Christopher Bennett Thomas C. Hughes Kirsty Challen Conall H. Watson Sema Mandal Gillian E. Smith Daniel Todkill |
| author_facet | Alex J. Elliot Helen E. Hughes Christopher Bennett Thomas C. Hughes Kirsty Challen Conall H. Watson Sema Mandal Gillian E. Smith Daniel Todkill |
| author_sort | Alex J. Elliot |
| collection | DOAJ |
| description | Abstract Background During 2022, a new public health threat emerged when cases of paediatric acute hepatitis of unknown aetiology (HUA) were identified in children aged under 16 years old in the United Kingdom (UK). At the time, the epidemiology and extent of cases was based upon limited and non-standardised reporting from hospitals and liver units. We aimed to adapt existing real-time syndromic surveillance systems to support the epidemiological investigation of cases of HUA presenting to emergency departments (EDs) in England. Methods Syndromic surveillance is generally based on the collection of patient symptoms or chief complaints, which are collected using automated routines in near real-time. Here, we used an existing ED syndromic surveillance system monitoring daily patient attendances across a network of approximately 150 EDs in England. Clinical diagnosis codes related to the potential symptoms associated with the HUA incident were selected and attendance data monitored retrospectively and prospectively during the incident. Results From 2 April 2018 to 31 December 2021, there were small sporadic numbers of daily ED attendances for ‘liver conditions’ in children with no observed secular trends or seasonality across the 1 to 4 and 5 to 14 years age groups. The period 2 April to 29 July was compared across each year included in the analysis. Mean daily HUA attendances during 2018 to 2021 was 0.05 and 0.22 for 1 to 4 and 5 to 14 years respectively, however in 2022 there were 0.26 and 0.42 mean daily attendances. This represented an increase of 377% and 94% in the 1 to 4 and 5 to 14 years age groups, respectively. From June 2022, daily syndromic ‘liver condition’ attendances appeared to decrease and the rate of increase in cumulative attendances slowed. Conclusions We demonstrate how syndromic surveillance provided support to the HUA outbreak using an existing syndromic surveillance framework to develop new indicators based on the newly emerging clinical symptoms. The outputs from the syndromic tool matched clinical and epidemiological findings with respect to trends in other HUA-related data, including clinical and laboratory reports, over time. This work demonstrates the potential for syndromic surveillance supporting the epidemiological surveillance of hepatitis and providing a valuable tool for the real-time management of future unknown health threats. |
| format | Article |
| id | doaj-art-e32ef5b2ae7d41f68a2491f73e015400 |
| institution | DOAJ |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-e32ef5b2ae7d41f68a2491f73e0154002025-08-20T03:22:03ZengBMCBMC Public Health1471-24582025-05-012511710.1186/s12889-025-23222-0Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in EnglandAlex J. Elliot0Helen E. Hughes1Christopher Bennett2Thomas C. Hughes3Kirsty Challen4Conall H. Watson5Sema Mandal6Gillian E. Smith7Daniel Todkill8Real-time Syndromic Surveillance Team, Field Services Division, UK Health Security AgencyReal-time Syndromic Surveillance Team, Field Services Division, UK Health Security AgencyReal-time Syndromic Surveillance Team, Field Services Division, UK Health Security AgencyOxford University Hospitals NHS Foundation TrustLancashire Teaching Hospitals NHS Foundation TrustImmunisation and Vaccine Preventable Diseases Division, UK Health Security AgencyBlood Safety, Hepatitis, STI and HIV Division, UK Health Security AgencyReal-time Syndromic Surveillance Team, Field Services Division, UK Health Security AgencyReal-time Syndromic Surveillance Team, Field Services Division, UK Health Security AgencyAbstract Background During 2022, a new public health threat emerged when cases of paediatric acute hepatitis of unknown aetiology (HUA) were identified in children aged under 16 years old in the United Kingdom (UK). At the time, the epidemiology and extent of cases was based upon limited and non-standardised reporting from hospitals and liver units. We aimed to adapt existing real-time syndromic surveillance systems to support the epidemiological investigation of cases of HUA presenting to emergency departments (EDs) in England. Methods Syndromic surveillance is generally based on the collection of patient symptoms or chief complaints, which are collected using automated routines in near real-time. Here, we used an existing ED syndromic surveillance system monitoring daily patient attendances across a network of approximately 150 EDs in England. Clinical diagnosis codes related to the potential symptoms associated with the HUA incident were selected and attendance data monitored retrospectively and prospectively during the incident. Results From 2 April 2018 to 31 December 2021, there were small sporadic numbers of daily ED attendances for ‘liver conditions’ in children with no observed secular trends or seasonality across the 1 to 4 and 5 to 14 years age groups. The period 2 April to 29 July was compared across each year included in the analysis. Mean daily HUA attendances during 2018 to 2021 was 0.05 and 0.22 for 1 to 4 and 5 to 14 years respectively, however in 2022 there were 0.26 and 0.42 mean daily attendances. This represented an increase of 377% and 94% in the 1 to 4 and 5 to 14 years age groups, respectively. From June 2022, daily syndromic ‘liver condition’ attendances appeared to decrease and the rate of increase in cumulative attendances slowed. Conclusions We demonstrate how syndromic surveillance provided support to the HUA outbreak using an existing syndromic surveillance framework to develop new indicators based on the newly emerging clinical symptoms. The outputs from the syndromic tool matched clinical and epidemiological findings with respect to trends in other HUA-related data, including clinical and laboratory reports, over time. This work demonstrates the potential for syndromic surveillance supporting the epidemiological surveillance of hepatitis and providing a valuable tool for the real-time management of future unknown health threats.https://doi.org/10.1186/s12889-025-23222-0non-HepA–E hepatitisHepatitis of unknown originPaediatric acute hepatitis of unknown aetiologyAcute hepatitisPaediatric hepatitisSyndromic surveillance |
| spellingShingle | Alex J. Elliot Helen E. Hughes Christopher Bennett Thomas C. Hughes Kirsty Challen Conall H. Watson Sema Mandal Gillian E. Smith Daniel Todkill Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in England BMC Public Health non-HepA–E hepatitis Hepatitis of unknown origin Paediatric acute hepatitis of unknown aetiology Acute hepatitis Paediatric hepatitis Syndromic surveillance |
| title | Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in England |
| title_full | Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in England |
| title_fullStr | Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in England |
| title_full_unstemmed | Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in England |
| title_short | Developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in England |
| title_sort | developing a syndromic surveillance tool to support the epidemiological investigation into paediatric acute hepatitis of unknown aetiology in england |
| topic | non-HepA–E hepatitis Hepatitis of unknown origin Paediatric acute hepatitis of unknown aetiology Acute hepatitis Paediatric hepatitis Syndromic surveillance |
| url | https://doi.org/10.1186/s12889-025-23222-0 |
| work_keys_str_mv | AT alexjelliot developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT helenehughes developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT christopherbennett developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT thomaschughes developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT kirstychallen developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT conallhwatson developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT semamandal developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT gillianesmith developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland AT danieltodkill developingasyndromicsurveillancetooltosupporttheepidemiologicalinvestigationintopaediatricacutehepatitisofunknownaetiologyinengland |