• Authorities across the globe are investigating a rise in severe hepatitis cases in formerly healthy children.
  • Many of the children tested positive for adenovirus.
  • Adenoviruses are very common and often result in relatively mild symptoms that resolve without medical intervention.
  • In some cases, children with weakened immune systems developed hepatitis after contracting an adenovirus.

Authorities in multiple countries are investigating dozens of cases of hepatitis in children. At least 169 cases have been reported so far, according to the World Health Organization.

The Centers for Disease Control and Prevention issued a health alert this month advising clinicians and public health authorities to keep watch for children experiencing hepatitis-like symptoms after the Alabama health department reported nine cases, and two were reported in North Carolina.

Both UK and US officials are investigating if the hepatitis cases occurred after the children developed possibly a strain of adenovirus.

Adenoviruses are common viruses that cause traditional cold-like symptoms that many people get every year.

Adenovirus symptoms typically appear between 2 and 14 days after the initial exposure.

Symptoms of adenovirus infection can include cough, sore throat, bronchitis, diarrhea, pneumonia, and pinkeye. With a healthy immune system, these symptoms are usually mild and pass quickly.

“The adenovirus is typically associated with respiratory infections, as well as gastrointestinal infections,” said Dr. Helena Gutierrez, medical director of the University of Alabama at Birmingham and Children’s Pediatric Liver Transplant Program.

Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, agrees that adenovirus is quite common and is mostly responsible for outbreaks of pinkeye.

“However, there are also a number of papers that show adenovirus, once it gets into a unit that takes care of immunocompromised patients, can cause more serious outbreaks,” Schaffner said. “They frequently result in pneumonia, and in this case, a number of deaths.”

Despite this recent increase in cases of hepatitis, Schaffner doesn’t believe the general public (or those with a healthy immune system) should be overly concerned. Many cases are mild.

The UK has reported the highest number of these mysterious hepatitis cases, with 111 known cases.

In a report this week, the UK Health Security Agency said that of 53 children who tested for adenovirus, 40 tested positive.

Their theory is that this adenovirus then led or contributed to severe hepatitis in the children.

In the hepatitis cases out of Alabama, all children have been discovered to have a strain of the virus known as adenovirus 41.

Of the nine children in Alabama, all have required hospitalization, and two have needed a liver transplant.

In the past, children with weakened immune systems were at risk for hepatitis if they developed adenovirus. But that was not a known risk factor for children with healthy immune systems.

Experts are still unclear why so many seemingly healthy children developed hepatitis after an adenovirus infection.

Hepatitis is a broad term that describes inflammation or complication with the liver. It is commonly associated with specific viruses labeled hepatitis A, B, C, D, and E – but none of these viruses have been found in these recent cases.

This possible connection between hepatitis and adenovirus was discovered in children’s hospitals in Alabama through routine testing.

“We were able to uncover the possible association with the adenovirus-41 strain because it is our standard practice to screen patients diagnosed with hepatitis for adenovirus,” said Dr. Markus Buchfellner, pediatric infectious disease physician at UAB and Children’s Hospital.

The adenovirus is spread by close personal contact with others, like shaking hands or touching. Coughing, sneezing, or touching an object or surface that has the virus and then touching your mouth, nose, or eyes can also transmit the virus.

When the symptoms of the adenovirus are mild, many cases don’t require diagnostic testing from urine, blood, or swabs.

Schaffner says that hand hygiene, appropriate recognition and diagnosis, isolation of patients, and refraining healthcare personnel who are ill with respiratory illnesses from working can help limit the impact of this virus.

Most cases of adenovirus are mild and don’t require any medical care. However, worsening or severe symptoms require prompt medical treatment.

For people who need medical care, healthcare providers will provide symptomatic treatment as the main course of action.

Symptoms of the adenovirus can be similar to the common cold. But symptoms of hepatitis or serious illness can include severe abdominal pain, prolonged fever, jaundice, or yellowing of the skin and eyes, and increased lethargy.

These may indicate that you should reach out to a healthcare professional.

There is no widely available vaccine for adenovirus in the U.S.

There’s an oral vaccine against two strains of the adenovirus, but it’s reserved for U.S. military personnel between the ages of 17 and 50 who may be at high risk of infection, and it doesn’t protect against adenovirus 41.

Health experts still advise people to wash their hands with antimicrobial soap and water. Frequent handwashing is advised, especially for those working in child or healthcare settings.

Experts also recommend staying home when you’re sick. Avoid sharing cups and eating utensils and kissing or close contact with others until your symptoms pass.

Experts are investigating potential causes of mysterious hepatitis cases in formerly healthy children. One current hypothesis is that the children developed an adenovirus infection before developing hepatitis.

Health experts say that this is not a reason to panic or cause for alarm and that these are very rare cases.

Dr. Rajiv Bahl, is an emergency medicine physician, board member of the Florida College of Emergency Physicians, and health writer. You can find him at RajivBahlMD.com.