CDC says adenovirus may contribute to liver damage in healthy children

Nine children in Alabama with severe acute hepatitis, three of whom had liver failure, all tested positive for adenovirus, and none had a history of Covid-19 infection, according to the Centers for Disease Control and Prevention.

The CDC on Friday released its most detailed data on children since issuing a nationwide health alert last week. It states that adenovirus infection may be an underestimated cause of liver damage in healthy children, but further research is needed.

While hepatitis is not uncommon in children, the Alabama cluster of cases surprised doctors because previously healthy children had severe symptoms and did not test positive for hepatitis viruses.

Public health authorities in the US and Europe are closely monitoring cases of severe hepatitis in children after the UK alerted the World Health Organization earlier this month about a cluster of cases there. To date, WHO has identified 169 cases worldwide, the vast majority of them in the UK.

All nine children in the United States were Alabama Children’s Hospital patients between the ages of 2 and 6, according to the CDC. Three patients suffered from liver failure, two required a liver transplant. All of them have either recovered or are recovering.

Symptoms in children prior to hospitalization included vomiting, diarrhea, and upper respiratory symptoms. Eight patients had scleral icterus, yellowing of the white of the eye. Seven people had an enlarged liver, six had jaundice, and one had encephalopathy (a broad term for brain disease).

All of the children tested positive for adenovirus, a common infection that can cause respiratory problems, indigestion, conjunctivitis and bladder inflammation, or, more rarely, neurological disease. Adenovirus is a known cause of hepatitis in children with weak immune systems, but all patients in Alabama had normal immune systems and no serious illness, according to the CDC.

Although six of the children also tested positive for Epstein-Barr virus, the CDC does not believe these were acute infections because they tested negative for antibodies. All of the children tested negative for hepatitis A, B, and C, according to the CDC. None of them had a history of Covid-19 infection.

Doctors in Alabama identified the first five cases last fall. The CDC and the Alabama Department of Public Health launched an investigation in November. They identified four more cases in Alabama through February of this year. No additional cases have been identified in Alabama since February.

The CDC said it is closely monitoring the situation to better understand the cause of severe hepatitis in children and find ways to prevent the disease. The Public Health Agency told doctors that whole blood tests, rather than plasma, can better detect the presence of adenovirus.