What parents need to know

The Centers for Disease Control and Prevention issued a health advisory about a cluster of nine cases of unusual, severe hepatitis in kids in Alabama on Thursday. Two cases have also been identified in North Carolina and dozens more in Europe, NBC News reported.

The advisory warns of a possible association between cases of inflammation of the liver, also known as hepatitis, and a strain of a virus known as adenovirus 41. Adenoviruses are common viruses that often cause cold-like symptoms, including sore throat, fever pneumonia, and stomach pain or diarrhea.

While there have been previous reports of immunocompromised children with adenovirus 41 developing hepatitis, adenovirus 41 “is not known to be a cause of hepatitis in otherwise healthy children,” the CDC said. The cluster in Alabama “involved previously healthy children,” explained Dr. Michael Fullmer, a pediatrician at Utah Valley Pediatrics in Saratoga Springs, Utah.

The most common type of hepatitis is caused by viruses, typically hepatitis viruses A, B, C, D, and E, with the first three being the most common in the US However, the Alabama cluster of cases and the others are not caused by any of the usual hepatitis viruses.

CDC alert for hepatitis in Alabama kids: What we know so far

All of the nine children in Alabama, between 1 and 6 in age, became ill enough to merit hospitalization, with three developing acute liver failure and two requiring liver transplants. None of the children have died, and none of the nine cases involved children who’d had COVID-19 or received the vaccine, NBC News reported.

“We’ve been watching these cases in the US and throughout parts of Europe with great interest for some time now,” Dr. Andrew Pavia, a pediatric infectious disease epidemiologist at Intermountain Primary Children’s Hospital in Salt Lake City, told TODAY. “It’s only recently that the possible connection between the hepatitis cases and adenovirus 41 has been considered.”

So far, adenovirus 41 has also been found in 77% of the UK hepatitis cases with all nine of the Alabama children testing positive for adenoviruses, as well, according to Dr. Esther Israel, associate unit chief of pediatric gastroenterology and nutrition at Mass General Hospital for Children.

Pavia called the number of reported cases “moderately large,” so “we have to keep an eye on” it, he said. Israel added that because adenoviruses have not commonly caused hepatitis in healthy children before now, “other sources are still being sought” for the cause.

Dr. David Hill, a Wayne County, North Carolina-based pediatrician and the official spokesperson of the American Academy of Pediatrics, agreed.

“Adenovirus 41 is the prime suspect but has not yet been the proven cause of this syndrome,” he said. “The two may be connected, or the cause of these cases may be something entirely new or an evolving kind of infection that we need to identify as quickly as we can.”

Pavia advised concerned parents to keep in mind why the CDC issues advisories like this in the first place: “They aren’t trying to alarm anyone … but it’s important for people to remember that this advisory is meant to help physicians find out how widespread problems are and what could be causing (these new cases).”

Knowing about the possible connection between adenovirus 41 and these severe cases of hepatitis means physicians can broaden their search when diagnosing new cases of hepatitis. “When I treat hepatitis, I don’t typically test bloodwork for adenoviruses,” Hill said. “Because of this advisory, I will be doing so now.”

Dr. Nipunie Rajapakse, a pediatric infectious disease specialist at Mayo Clinic Children’s Center, said the CDC’s health advisory is crucial in determining whether the Alabama cases are widespread or limited to that region alone.

“Reporting of these cases to a central place like the CDC helps to collect more information so that we can learn and share as much information as possible to help identify and provide care for kids with the infection and hopefully help prevent cases as well,” she said. “We also need to understand why some children (with the adenovirus) go on to develop hepatitis and some children do not.”

Rare liver damage in kids: What parents should look for

Parents should be on the lookout for symptoms, as well. While adenoviruses and hepatitis share symptoms, such as diarrhea and nausea, Hill explained that hepatitis is far more concerning with unique symptoms to be aware of.

“Adenoviruses typically run their course without needing medical intervention,” he said. Hepatis, on the other hand, “sometimes leads to hospitalization and may even require a liver transplant.”

Added Rajapakse: “Most of the treatment for hepatitis involves what we call supportive care that supports the body systems until the liver is able to heal and recover from the inflammation.”

There is no specific treatment for adenoviruses.

To differentiate between adenovirus symptoms and hepatitis symptoms, parents should keep an eye on sick children and look out for severe abdominal pain, fever, dark-colored urine or light-colored stools. The most telling symptom to be aware of is jaundice, or a yellow coloring in the skin or in whites of the eyes, Rajapakse said.

Hepatitis and adenovirus: Are these cases contagious?

One of the most important reasons to understand the possible connection between adenoviruses and this cluster of hepatitis cases is, according to Hill, adenoviruses are “much easier to contract than hepatitis.”

As Israel put it, “If indeed adenovirus is the responsible virus, this potentially is contagious.”

Good hygiene can help prevent transmission of either illness.

“At this time, practicing good healthy habits, such as washing or sanitizing hands frequently, staying home when you are ill, and staying away from sick people is the best method for prevention,” Fullmer said. He added that adenoviruses can spread through respiratory droplets (similar to how COVID-19 is transmitted), but it’s “normally spread through direct contact” with other humans or surfaces where the virus is present.

Public health officials still need time to understand the root of these illnesses. “It’s dangerous to speculate too early on,” Pavia advised. “The exact cause and implications of what has happened in Alabama remains to be seen.”

Echoed Israel: “At this stage, it is hard to know how common this will be, but we may very well see more if it is infectious. Parents should be alert to the signs of hepatitis and should contact their healthcare professional if they are concerned.”

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