What Is Causing Mystery Liver Damage in Alabama Children?

The Centers for Disease Control and Prevention (CDC) has notified clinicians and public health authorities to be alert for children with liver damage due to unknown causes. The alert comes after a cluster of children in Alabama were identified with hepatitis and adenovirus infection.

In a statement issued via the CDC Health Alert Network, the agency wrote: "In November 2021, clinicians at a large children's hospital in Alabama notified CDC of five pediatric patients with significant liver injury, including three with acute liver failure, who also tested positive for adenovirus.

"All children were previously healthy. None had COVID-19. Case-finding efforts at this hospital identified four additional pediatric patients with hepatitis and adenovirus infection for a total of nine patients admitted from October 2021 through February 2022."

The CDC added that while none of the patients died, two required liver transplants. The CDC says hepatitis is inflammation of the liver that can be caused by viral infections, alcohol use, toxins, medications, and certain other medical conditions.

Symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice.

Dr. Aaron Milstone is a professor of pediatrics at the Johns Hopkins University School of Medicine who specializes in treating infectious diseases in children. He told Newsweek: "It is unknown at this time what is causing liver damage in children in Alabama. Some children have tested positive for a common childhood virus called adenovirus."

What Is Adenovirus and How Does it Cause Liver Damage?

There are 50 distinct types of adenoviruses that can cause infection in humans. They spread via close personal contact such as touching or shaking hands, in the air as a result of coughing and sneezing, or touching objects or surfaces with adenoviruses on them and then touching the mouth, nose, or eyes.

Milstone explains: "Adenovirus is a common virus we often see in children that can cause vomiting, diarrhea, respiratory symptoms, and pink eye. It can cause hepatitis—liver inflammation—but this is a rare presentation in healthy children."

The Johns Hopkins University School of Medicine doctor added that like other viruses, adenovirus can also inflame the liver by invading liver cells directly.

The most common causes of viral hepatitis are the hepatitis A, hepatitis B, and hepatitis C viruses. These viruses were not present in the children in question, Milstone said.

He continued: "Sometimes we see live inflammation after infection when the body attacks itself."

The CDC cannot rule out whether these cases of liver damage in Alabama are related to COVID, with Milstone saying: "It's unknown at this time. COVID can cause symptoms in the acute phase but also in a post-infectious period.

"We have not previously seen liver failure alone as a common complication of COVID, but as the virus changes, we may see new presentations or manifestations of the virus."

The cases of pediatric hepatitis reported in Alabama reflect 10 similar cases reported in the United Kingdom earlier this month. As with the nine U.S. cases, the World Health Organization (WHO) reported that the children in question tested negative for hepatitis A, B, and C.

A further 64 cases were identified in the U.K. following further investigation. WHO wrote in a press statement: "Some cases have required transfer to specialist children's liver units and six children have undergone liver transplantation. As of 11 April, no death has been reported among these cases and one epidemiologically linked case has been detected.

"The United Kingdom has recently observed an increase in adenovirus activity, which is co-circulating with SARS-CoV-2, though the role of these viruses in the pathogenesis—the mechanism by which disease develops—is not yet clear."

Newsweek previously reported that similar cases have been identified in Ireland and Spain. WHO added that it is closely monitoring the situation.

What to look out for in your Children. Signs and Symptoms.

Adenoviruses usually cause respiratory illness, but they can also lead to other illnesses like gastroenteritis, conjunctivitis, cystitis, and in rare cases neurological disease.

This means symptoms to look out for are common cold or flu-like symptoms, fever, sore throat, inflation of the airways of the lungs, pneumonia, pink eye, or inflammation of the stomach or intestines causing diarrhea, vomiting, nausea, and stomach pain.

Adenoviruses can result in mild to severe illness, but severe sickness is less common.

Milstone offered advice to parents concerned about these cases of hepatitis and adenoviruses and liver damage in children. He said: "This is uncommon. Parents can protect their kids using the same prevention measures they use to prevent COVID.

"Hand washing is especially important to prevent adenovirus transmission—wash your hands before you eat or put something in your mouth."

Child with saline drip
A stock image of a child in hospital. Two of the children with liver damage required transplants with one doctor telling Newsweek the cause is "unknown at this time." Golfcuk/GETTY