Infectious Disease Doctor Shares What Parents Need to Know About Hepatitis Cases in Children

Parents and caregivers may have questions following the reports of pediatric cases of severe hepatitis in multiple states. Here's what parents need to know.

The Centers for Disease Control and Prevention has identified and received reports of a cluster of pediatric cases of significant liver injury with positive adenovirus infection since November 2021. The CDC says the cause of hepatitis (inflammation of the liver) impacting the children is not known.

There have been 246 children who are under 10 years old with hepatitis cases of unknown origin included in the CDC's investigation since Oct. 1, 2021. It's not unusual for the cause of hepatitis in children to remain unknown; some estimates suggest 30-50% of all hepatitis cases in children are from unknown causes, the CDC says.

A possible association between these pediatric hepatitis cases and adenovirus infection is currently under investigation. Lab tests showed “adenovirus type 41” infection in several of the cases under investigation. Adenovirus type 41 is primarily spread via the fecal-oral route and predominantly affects the gut, the CDC says. It is a common cause of pediatric acute gastroenteritis typically with diarrhea, vomiting and fever, often accompanied by respiratory symptoms.

There have been no reported deaths since February 2022, and the proportion of patients requiring liver transplants has gone down from 15% to 9% since May 5, the CDC said on May 18.

So what does this news mean for your child? Nicholas Rister, M.D., of the Cook Children's Infectious Disease team shares what parents and caregivers need to know.

It’s important to note that severe hepatitis in children remains rare. However, we encourage parents and caregivers to be aware of the symptoms of hepatitis – particularly jaundice, which is a yellowing of the skin or eyes – and to contact their child’s pediatrician with any concerns.

How concerned should I be as a parent about this cluster of hepatitis cases? Why do some patients need transplants?

These cases remain rare despite adenovirus infection being very common. This is reassuring that the vast majority of children are likely to have no issues. However, in these rare cases, the inflammation in the liver is so severe that the liver is unable to recover and requires a transplant. This is somewhat remarkable since healthy children typically possess a large capacity for their liver to recover on its own after injury.

How is hepatitis spread?

The cause of hepatitis determines how it is spread. Damage to the liver from toxins (alcohol or drugs) or autoimmune disease does not spread between people. Infectious hepatitis depends on the type of infection. Hepatitis A and E are spread through body fluids and contaminated foods/surfaces. Hepatitis B, C, and D are spread through blood (injection drug use) and rarely through sexual contact.

However, most viruses, including adenovirus, can cause some degree of hepatitis and are spread through combinations of close contact and respiratory routes. Adenovirus is typically spread through respiratory droplets and/or contact with bodily fluids.

What are hepatitis A, B, C, D and E? Which is related to this outbreak?

Hepatitis A-E are grouped together because they all primarily cause liver issues but are very different infections otherwise. Hepatitis A is a diarrheal illness. Hepatitis B and C are chronic infections that often go unnoticed for decades following IV drug use (or due to blood transfusions in the past although we screen blood supply now) but eventually lead to liver failure and cancer. Hepatitis D and E are less a consideration in the general population. Hepatitis D can cause problems for folks if they are already infected with other types of hepatitis and hepatitis E is a cause of bad liver disease in pregnant women.

What is adenovirus?

Adenovirus is a common viral cause of febrile illness in children. Many different types lead to different diseases that are all common in children. These include conjunctivitis (pink eye), upper and lower respiratory infections, and diarrhea. The vast majority of adenovirus types have not been linked to this hepatitis outbreak and most children with adenovirus type 41 do not develop severe hepatitis. However, the infection remains suspected and is being investigated in these rare cases.

What can my family do to protect ourselves?

Hepatitis A and B have vaccines that are given to all children as part of the routine vaccine series.

Otherwise, let your pediatrician know immediately if you note yellowing of the eyes or skin consistent with jaundice which can be an early warning sign of liver disease.

Continue healthy habits like hand hygiene, covering coughs and avoiding people who are sick.

What is jaundice?

Jaundice is a buildup of bilirubin in the soft tissues of the skin/eyes. Bilirubin is secreted by your liver into your intestines as a part of bile normally. When the liver is sick, bilirubin can build up in the blood and soft tissues leading to discoloration.

Watch for symptoms of liver inflammation:

• jaundice (yellowing of the skin)
• fever
• fatigue
• loss of appetite
• nausea
• vomiting
• abdominal pain
• dark urine
• light-colored stools (poop)
• joint pain

Keep your child up to date on all their vaccinations.

Help your family prevent disease:

• wash hands often
• avoid people who are sick
• cover coughs and sneezes
• avoid touching the eyes, nose, or mouth