Alabama is not the only part of the world to see an outbreak of liver disease in young children.

The World Health Organization (WHO) announced that it was investigating worldwide instances of hepatitis in young children. 

According to the WHO, as of April 21, 2022, at least 169 cases of acute hepatitis of unknown origin have been reported from 11 countries in the WHO European Region and one country in the WHO Region of the Americas. Cases were reported in the United Kingdom (114), Spain (13), Israel (12), the United States (9), Denmark (6), Ireland (5), The Netherlands (4), Italy (4), Norway (2), France (2), Romania (1), and Belgium (1).

Seventeen children – approximately 10% – have required liver transplants, and at least one death has been reported.

Adenovirus was detected in at least 74 of the worldwide hepatitis cases.

“The United Kingdom, where the majority of cases have been reported to date, has recently observed a significant increase in adenovirus infections in the community (particularly detected in fecal samples in children) following low levels of circulation earlier in the COVID-19 pandemic,” the WHO said. “The Netherlands also reported concurrent increasing community adenovirus circulation.”

On April 15, the Alabama Department of Public Health (ADPH) announced it was investigating an increase in hepatitis in young children across the state. All of the cases were positive for adenovirus.

According to the ADPH, two of the children 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. 

None of the health organizations reporting on this rise in liver disease have given any theories why the spike is occurring. 

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.

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