An outbreak of a mysterious liver disease prompted the Centers for Disease Control and Prevention (CDC) last month to issue a Health Alert Network (HAN) Health Advisory warning public health officials of a cluster of children identified with hepatitis and adenovirus infection. The advisory led to at least three U.S. states reporting similar cases, but the first reported cases of the illness originated in Alabama.
Between October 2021 and February 2022, nine children were admitted to Children's of Alabama with significant liver injury without known cause (including some with acute liver failure), who also tested positive for adenovirus.
Children's Hospitals Today spoke with Helena Gutierrez, M.D., a pediatric gastroenterologist at Children's of Alabama in Birmingham. She shared her experience with the rare illness and offered insight for pediatric health care providers who may encounter patients showing the same symptoms.
What are you seeing around this hepatitis outbreak?
It all began for us in October of last year. We had five cases within a month, which is very unusual—we really don't see episodes of severe hepatitis or acute liver failure in this age group with this frequency. To put that into perspective, we typically see four cases in a year at most. The fact that we were getting them one after the other was concerning.
Our first case was positive for adenovirus, which was also strange because you don't typically see that in an otherwise healthy patient. The other thing that was very unusual with these cases—and what made their parents seek medical attention—was the development of jaundice.
So, when we saw the second and third cases were also positive for adenovirus, we became concerned and decided to reach out to our public health department and the CDC to make them aware that something out of the ordinary was happening.
With this cluster of cases presenting around the same time and all with adenovirus, do you suspect these cases were related to each other?
No, but it is still the question we haven't answered. There is a correlation, but we're not talking causation at this time—we're just saying there are common links among them.
We looked to see if perhaps they were coming from the same community, but they came from different areas in Alabama. Our state health department also looked at these from an epidemiologic standpoint and couldn't find any epidemiological link that could tie them all together.
With cases now being reported in other areas around the country, what kind of advice would you give pediatric care providers who may be seeing these symptoms for the first time?
I would say to keep in mind what we all know as pediatricians: kids routinely get viral illnesses, and they recover on their own with just supportive measures. Everybody should be aware that this is a rare presentation of a common virus, and if you have a patient with vomiting, diarrhea and fever, it could still be bread-and-butter gastroenteritis.
Of course, you'll want to make sure they stay hydrated. But if they develop other signs that point toward liver involvement—jaundice or scleral icterus—parents should bring these patients to their pediatricians to assess liver function.
I've been trying to stress to everybody to not be alarmed, but just to be aware of the signs of liver involvement. Kids are kids. Just being at school, they're going to be exposed to different viruses and get sick. Enforcing good hand hygiene remains as important as ever.