The number of investigated cases of hepatitis among children under 10 has risen to 111 up to April 20, health officials have confirmed.

Most of the cases of liver inflammation were in children under five, though a small number of cases in children over 11 are also being examined, the UK Health Security Agency (UKHSA) said.

Of the confirmed cases, 81 live in England, 14 are in Scotland, 11 are in Wales and five are in Northern Ireland.

The number of children who have required a liver transplant has risen to 10 in the UK. There have been no deaths, the UKHSA added.

The cases have not been caused by the usual viruses that cause hepatitis A – E and data gathered has “increasingly” suggested that the rise in severe cases of hepatitis may be linked to a group of viruses called adenoviruses, the agency said.

Of 53 cases tested, 40 (75%) showed that adenovirus was the most common pathogen detected.

A total of 16% of cases, meanwhile, were positive for Covid-19, which was not unexpected due to the high rates of the virus during January to April this year.

The agency said there is no link to the coronavirus vaccine as none of the currently confirmed cases in under 10s in the UK is known to have been vaccinated.

• Muscle and joint pain
• High temperature
• Feeling and being sick
• Feeling unusually tired all the time
• A general sense of feeling unwell
• A loss of apetite
• Stomach pain
• Dark urine
• Pale grey poo
• Itchy skin
• Yellowing of the eyes or skin (jaundice)

Dr Meera Chand, director of clinical and emerging infections at UKHSA, said: “Information gathered through our investigations increasingly suggests that this rise in sudden onset hepatitis in children is linked to adenovirus infection. However, we are thoroughly investigating other potential causes.

“Parents and guardians should be alert to the signs of hepatitis, including jaundice, and to contact a healthcare professional if they are concerned. Normal hygiene measures such as thorough hand washing, including supervising children, and good thorough respiratory hygiene help to reduce the spread of many common infections, including adenovirus.

“Children experiencing symptoms of a gastrointestinal infection including vomiting and diarrhoea should stay at home and not return to school or nursery until 48 hours after the symptoms have stopped.”