Tuesday, March 28, 2023

Acute hepatitis and adenovirus infection in pediatric patients in Alabama

A new study published today by the Centers for Disease Control and Prevention (CDC), “Acute Hepatitis and Adenovirus Infection Among Children – Alabama, October 2021-February 2022” adds additional clinical findings from an ongoing investigation involving children in Alabama. and provides epidemiological information. Hepatitis (inflammation of the liver) of unknown cause.

These findings build on previous information shared by the CDC and the Alabama Department of Public Health about a group of nine cases currently under investigation. In the fall of 2021, physicians at a children’s hospital in Alabama identified five patients with severe hepatitis and adenovirus infection, some with acute liver failure. A review of hospital clinical records identified four additional cases, all of whom had liver injury and adenovirus infection. All were previously healthy, about 1 to 6 years of age, and had no significant underlying conditions.

Among the findings in MMWR: two of the pediatric patients in Alabama required liver transplantation, and three developed liver failure, but all have since recovered or are recovering. Before hospitalization, most children experienced vomiting and diarrhea, while some experienced upper respiratory symptoms. During hospitalization, most had pale eyes, pale skin (or jaundice), and an enlarged liver. All nine patients tested positive for adenovirus, and six tested positive for Epstein-Barr virus, but did not have antibodies, meaning no prior, active infection. Laboratory tests showed that some of these children had adenovirus type 41, which commonly causes pediatric acute gastroenteritis. Additionally, some showed a history of other viruses, including enterovirus/rhinovirus, metapneumovirus, respiratory syncytial virus and the human coronavirus OC43.

At this time, we believe that adenovirus may be the cause of these reported cases, but other possible environmental and situational factors are still being investigated. Adenovirus type 41 is not generally known to cause hepatitis in healthy children, and no known epidemiological link or general risk has been found in these children. Some reasons have already been ruled out, including:

    • Hepatitis Viruses A, B, and C
    • SARS-CoV-2 infection
    • autoimmune hepatitis
    • wilson disease

It is important to note that this report is specific to the Alabama investigation, and CDC does not have any updates on any other suspected cases in the US at this time. Vigilantly working with public health officials. and physicians to identify and investigate other possible cases. On April 21, the CDC issued a nationwide Health Alert Network (HAN) advisory asking all physicians to be on the lookout for symptoms and to report any suspected cases of hepatitis of unknown origin to their local and state health departments. said. CDC is working with commercial and state public health laboratories to provide guidance on how to submit the test.

CDC is also aware of a recent increase in cases of pediatric hepatitis with no known cause in Europe, and is in contact with our European counterparts to understand what they are learning. Adenovirus has been confirmed in many European cases, but not in all. Investigators are ruling out other possible causes and identifying other possible contributing factors. As we learn more, we will share additional information and updates.


Centers for Disease Control and Prevention

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