Five U.S. children have died of an unexplained type of hepatitis that has sickened more than 100 kids across 25 states and territories, according to the U.S. Centers for Disease Control and Prevention (CDC).
Most of the children have fully recovered, but nearly all of them were hospitalized and 14 kids needed liver transplants, Jay Butler, MD, deputy director for infectious diseases at the CDC, said in a May 6 statement. More than half of these children tested positive for adenovirus infections, Dr. Butler said.
“What we don’t know yet — but investigators both here and across the globe are hard at work to determine — [what] is the cause,” Butler said. “Adenovirus has been detected in some of the children, but we do not know if it is the cause of these illnesses.”
Hepatitis is inflammation of the liver, which is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Most often, hepatitis is caused by a virus.
Adenoviruses are a common type of virus spread from person to person that can cause a range of mild to more severe illnesses, but they’re only rarely reported as a cause of severe hepatitis in healthy individuals.
Investigations Started in Alabama
The CDC last month issued a nationwide public health alert about unexplained hepatitis cases in children after public health officials in Alabama identified nine children — ranging in age from 1 to 6 years old — who have been diagnosed with hepatitis and who also tested positive for adenovirus since October 2021. Butler said that several of these patients had adenovirus type 41.
These children, who came from different areas of the state, experienced symptoms of a gastrointestinal illness and varying degrees of liver injury including liver failure, the Alabama Department of Public Health said in a statement. Two of these nine children needed liver transplants.
None of the children had underlying health conditions that could explain the hepatitis cases, and investigators haven’t determined a connection between their cases, Alabama health officials said in the statement.
Adenoviruses are quite common, and typically cause flu-like symptoms or gastrointestinal illnesses, Alabama health officials said. It’s rare for otherwise healthy people to develop symptoms so severe that they require hospitalization, but this can happen and these cases can prove fatal.
The CDC is now investigating cases in Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska, New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington, and Wisconsin.
How Adenoviruses Spread and How to Avoid Them
It’s easy for infected individuals to spread adenoviruses to others. There are several ways adenoviruses can spread, according to the CDC, including:
- Close personal contact, like shaking hands
- Coughing and sneezing
- Touching surfaces with adenovirus on it then touching your mouth, nose, or eyes
- Contact with stool, for example, while changing diapers
Adenoviruses are often resistant to common disinfectants and can remain infectious for long periods of time on surfaces and objects, Alabama public health officials note. The CDC recommends these measures to prevent the spread of adenoviruses:
- Wash your hands often with soap and water for at least 20 seconds.
- Avoid touching your eyes, nose, or mouth with unwashed hands.
- Avoid close contact with people who are sick.
Children Stricken in the United Kingdom, Europe
Scientists are also investigating 169 unexplained hepatitis cases in young children in 12 countries, many of which have been linked to adenoviruses, the World Health Organization (WHO) said in an April 23 statement. Seventeen children required liver transplants and at least one died.
As of April 21, the majority of these cases — 114 — were in Great Britain and Northern Ireland, WHO said. Cases were also reported in Spain, Israel, Denmark, Ireland, The Netherlands, Italy, Norway, France, Romania, and Belgium. The total reported by WHO also included nine cases in the United States.
Lab tests have excluded several different types of hepatitis viruses as the cause of these cases, WHO said.
“It is not yet clear if there has been an increase in hepatitis cases, or an increase in awareness of hepatitis cases that occur at the expected rate but go undetected,” WHO said. “While adenovirus is a possible hypothesis, investigations are ongoing for the causative agent.”