CDC says adenovirus may be behind unexplained childhood hepatitis

Five cases of children with severe hepatitis of unknown origin were first reported in Scotland, United Kingdom, on March 31, 2022. Since then, more than 160 cases of unexplained hepatitis in children ranging from 1 month of age to 16 years have been reported in several countries.

The clinical presentation of this unexplained pediatric hepatitis is acute, and several patients have undergone liver transplantation and there have been deaths. However, the actual cause is unknown, and all patients have been ruled out for hepatitis A, B, C, D, and E. Furthermore, because no patients in the United Kingdom received the COVID-19 vaccine, the cause of that may be ruled out as well.

On April 29, the CDC released a report showing that nine young children in Alabama developed unexplained hepatitis, and they all tested positive for the common pathogen adenovirus 41. In the report, the CDC noted that adenovirus infection may be the cause of this unexplained childhood hepatitis from the current situation, but other potential environmental factors are still under investigation.

Adenovirus 41 infection usually results in gastroenteritis in children and is not usually thought to cause symptoms of hepatitis in healthy children. However, in immunocompromised children, adenovirus 41 infection may cause hepatitis, which may be an under-recognized factor contributing to liver injury in healthy children, but requires further investigation. Available tests have ruled out hepatitis A, B, C, D, and E, as well as autoimmune hepatitis and Wilson's disease (a genetic disorder that causes liver injury).

The nine patients in Alabama occurred between October 2021 and February 2022, three of whom developed acute liver failure, and two of whom had liver transplants. All patients have recovered or are currently recovering, including two liver transplant patients. All 9 patients were monitored positive for adenovirus 41 and 6 tested positive for EB virus (Epstein-Barr virus), which is estimated to be latent in 95% of the population. The 6 individuals infected with EB virus tested positive for the virus, but no antibodies were detected, indicating that the EB virus is in a latent state and is not active.

Most of these nine patients presented with vomiting and diarrhea before hospitalization, and some of them presented with upper respiratory symptoms. During hospitalization, most patients had yellow eyes and skin and enlarged livers.

In addition to the nine pediatric patients in Alabama, four pediatric patients have been reported in Wisconsin, two of whom are in serious condition, one of whom required a liver transplant, and one has died. Cases have also been reported in Illinois and elsewhere.

There are around 50 different varieties of adenovirus, which normally induce cold-like symptoms and can be spread by close contact, respiratory droplets, and objects on surfaces. The CDC has issued a health notice alerting doctors and health departments worldwide to such incidents. Parents and caregivers should also take precautions such as keeping their hands clean, avoiding contact with the ill, covering their mouth and nose while coughing or sneezing, and avoiding contact with their eyes, nose, and mouth.

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