CDC Issues Nationwide Health Alert for Hepatitis Cases With Unknown Origin

The first cases were identified in October 2021 at a children’s hospital in Alabama that admitted 5 children with significant liver injury, including some with acute liver failure.

The CDC has issued a nationwide health alert regarding a cluster of children diagnosed with hepatitis and adenovirus infection and has asked health care providers to be on the lookout for symptoms.

CDC officials are currently working with the Alabama Department of Public Health to investigate a cluster of 9 cases of hepatitis of unknown origin in children ranging in age from 1 to 6 years, all of whom were previously healthy. None of the children were at the hospital due to a current SARS-CoV-2 infection.

The first cases were identified in October 2021 at a children’s hospital in Alabama that admitted 5 children with significant liver injury, including some with acute liver failure, without a known cause. The children also tested positive for adenovirus, but hepatitis A, B, and C viruses were ruled out.

Upon investigation, a review of hospital records identified 4 additional cases, all of whom had liver injury and adenovirus infection. Laboratory tests found that some of the children had adenovirus type 41, which more commonly causes pediatric acute gastroenteritis. No known epidemiological link or common exposures were found among the children and a statewide alert to elicit additional cases on February 1, 2022, has not found any further reports.

In a press release, CDC officials said they are aware of an increase in cases of pediatric hepatitis without a known cause recently reported in Europe and have been in contact with European counterparts to share information. Adenovirus has been confirmed in several of the European cases but not all.

Symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice, and can be caused by viruses.

Adenoviruses spread from person to person and most commonly cause respiratory illness, but can also cause other illnesses such as gastroenteritis, conjunctivitis, and cystitis. Adenovirus type 41 typically presents as diarrhea, vomiting, and fever, and is often accompanied with respiratory symptoms. Although there have been case reports of hepatitis in immunocompromised children with adenovirus infection, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children.

The CDC is working with state health departments to identify any additional cases in the United States as well as potential causes. At this time, they believe adenovirus may be the cause for the reported cases, but they are learning more. So far, other common causes of viral hepatitis have been ruled out.

In the press release, the CDC asked physicians to consider adenovirus testing for pediatric patients with hepatitis of unknown etiology, and to report any possible cases of hepatitis of unknown origin to the CDC and state public health authorities. Patients and caregivers are also encouraged to be aware of the symptoms of hepatitis, and to contact their health care provider with any concerns. Routine vaccinations and preventive actions are also recommended, including frequent hand washing, avoiding individuals who are sick, and covering coughs and sneezes.

REFERENCE

CDC Alerts Providers to Hepatitis Cases of Unknown Origin. News release. CDC; April 21, 2022. Accessed April 22, 2022. https://www.cdc.gov/media/releases/2022/s0421-hepatitis-alert.html