Rise of Hepatitis Cases in Children: What Parents Need To Know

If you’re a parent who is worried about the sudden—and unusually high—number of acute hepatitis cases in children, you’re not alone. But medical experts say there is no need for panic. Instead, they recommend that physicians and parents educate themselves on what to watch out for. 

Hepatitis, or inflammation of the liver, is extremely rare in children. Yet more than 100 cases of severe hepatitis—in otherwise healthy children—have been reported in 25 states and territories in recent months. And there have been at least another 100 cases in 19 other countries. While most children fully recover from hepatitis, 14% of the cases in the U.S. required liver transplant and five children have died, according to the Centers for Disease Control and Prevention (CDC). 

Scientists are still searching for a definitive cause, but adenoviruses are a possible culprit because it, too, has been found in more than one-third of the reported cases globally. Adenoviruses are a group of common viruses that cause a range of illnesses, from cold-like symptoms to gastroenteritis, or “a stomach bug.” 

“Although adenoviruses can cause hepatitis, it is uncommon in adenovirus type 41, which was found in a cluster of children with hepatitis in Alabama,” says Rima Fawaz, MD, a Yale Medicine pediatric transplant hepatologist. 

Likewise, neither COVID-19 nor the vaccine appear to be linked to the cases, health officials say. “Most of the cases have occurred in children under age 5, who have not received vaccination,” Dr. Fawaz says. 

In April, the CDC issued a health alert to physicians to keep an eye out for hepatitis in children. We talked more with Dr. Fawaz about signs and symptoms, and what else is known about these cases so far. 

Simply put, hepatitis is inflammation of the liver that can be caused by infections, toxins (such as alcohol), drugs, or certain medical conditions. In adults, hepatitis is most commonly caused by the hepatitis A, B, C, and E viruses. 

The liver is a vital organ that processes nutrients, filters blood, and fights infection. If it’s damaged or inflamed, its functions may be affected.

Sometimes, people with hepatitis do not have any symptoms. But with these recent cases in children, symptoms have included vomiting, abdominal pain and diarrhea, dehydration, and jaundice—a yellowing of the skin or eyes. They also had abnormally high levels of liver enzymes in their blood, which indicates liver inflammation or damage. Other signs of liver damage include dark urine and light-colored stool. 

Gastrointestinal symptoms are common in children and should not on their own make one suspect hepatitis, but signs of jaundice are more indicative of a liver problem, Dr. Fawaz says. 

“When a person’s skin or eyes turn yellow, medical attention should be sought out, as this is indicative of a liver problem. In addition, any child with persistent vomiting, diarrhea, and concerns for inadequate hydration should also seek medical evaluation,” she adds.  

It began in October 2021, when five pediatric cases of severe hepatitis with unknown cause were identified in children at an Alabama hospital, the CDC reports. The children had significant liver illness, including some with liver failure. All tested negative for hepatitis A, B, and C, but positive for adenovirus. 

The children, who ranged in age from 1 to 6, were previously healthy and came from different parts of the state with no known contact or common exposures. Furthermore, none of the children in Alabama—which later grew to nine reported cases—had any signs of COVID-19 infection prior to or during hospitalization.

Since then, more cases of pediatric hepatitis with unknown origin have been reported in other states and around the world. Adenovirus has been detected in some of these patients, but not all. In the cases in the U.S. so far, 50% had adenovirus, the CDC says. Investigators around the world are looking into other possible causes and contributing factors. 

For now, the CDC recommends that doctors who treat children with unexplained hepatitis consider testing them for adenovirus. 

Typically, adenoviruses cause mild illness. They can affect adults or children any time of year. In these recent incidents of pediatric hepatitis, symptoms have mainly involved the gastrointestinal tract, including vomiting and diarrhea, Dr. Fawaz says. 

These viruses usually spread through close personal contact (touching or shaking hands), through the air (coughing or sneezing), or by touching contaminated surfaces. 

“For the average child, adenoviruses are treated with supportive care, including proper rest and hydration,” Dr. Fawaz says. 

In addition to being on the lookout for symptoms of hepatitis, proper handwashing is key when it comes to preventing all infections, including adenoviruses, Dr. Fawaz says.  

Other steps the CDC recommends include keeping children up to date on all vaccinations, avoiding contact with people who are sick, covering coughs and sneezes, and reminding children to not touch the eyes, nose, or mouth.