The Alabama Department of Public Health (ADPH) is investigating an increase in hepatitis in young children across the state.

According to the ADPH, to date, nine children less than 10 years old have been identified as positive for adenovirus, and two have required liver transplants. The affected children were found throughout the state of Alabama, and an epidemiological linkage among them has not been determined. There were no notable underlying health conditions among the group. 

The children were discovered through a collaborative effort of the ADPH, pediatric healthcare providers – including hospitals that treat children– and the Centers for Disease Control and Prevention (CDC). 

The affected children were presented to healthcare providers in different areas of Alabama with symptoms of a gastrointestinal illness and varying degrees of liver injury, including liver failure. Later analyses revealed a possible association of this hepatitis with Adenovirus 41.

The ADPH continues to collaborate with the CDC, Children’s of Alabama and Texas Children’s. The New York State Health Department Wadsworth Center and the Infectious Disease Pathology Branch at the CDC have provided additional testing support. 

Adenoviruses usually cause respiratory illnesses or conjunctivitis (pink eye). Adenoviruses are not a nationally notifiable disease in the United States, meaning clinicians are not required to test for or report cases to health departments or the CDC. Therefore, many outbreaks of adenovirus likely go either undetected or unreported.

Adenoviruses are common viruses that cause a range of illnesses, according to the CDC. They can cause cold-like symptoms, fever, sore throat, bronchitis, pneumonia, diarrhea and pink eye. It's possible to contract an adenovirus infection at any age. People with weakened immune systems or existing respiratory or cardiac disease are more likely than others to get very sick from an adenovirus infection.

According to the CDC, hepatitis occurs when there is inflammation of the liver, usually caused by a virus. In this case, the ADPH is claiming the cases of hepatitis are related to the outbreak of adenovirus.

The CDC is developing a national Health Advisory looking for similar cases with liver injury of unknown etiology or associated with adenovirus infection in other states. The CDC is discussing similar cases of hepatitis potentially associated with adenovirus with international colleagues. 

Adenoviruses are usually spread from an infected person to others through:

  • Close personal contact, such as touching or shaking hands.

  • The air, by coughing and sneezing.

  • Touching an object or surface with adenoviruses on it, then touching your mouth, nose or eyes before washing your hands.

  • Contact with stool, for example, during diaper changing.

According to the ADPH, methods of prevention include handwashing, avoiding touching the eyes or face and avoiding others who are ill. 

Brandon Moseley contributed to this story.

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