At least 228 probable cases of severe hepatitis in children have been reported across 20 countries worldwide, according to the World Health Organization on May 4. In the United States, the Center for Disease Control and Prevention (CDC) is investigating 109 cases of pediatric hepatitis of an unknown cause. As clinicians, epidemiologists, and other experts search for answers on what is causing serious liver inflammation in affected kids and how to prevent it, it might help to start with what can be ruled out.

Researchers agree that hepatitis A, B, C, D, or E — viruses that more commonly cause acute hepatitis — are not to blame in these cases. Nor are these cases definitively linked to SARS-CoV-2 infection, at least not so far, and there is also no evidence that the COVID-19 vaccination is to blame.

For example, in a study published in Morbidity and Mortality Weekly Report (MMWR), CDC investigators found no connection between COVID-19 and nine cases of hepatitis targeting children in Alabama. In a May 6 CDC media briefing, officials said they were not aware of any cases with documented COVID-19 infection; however, they are looking to see if any cases have antibodies pointing to previous infection.

Adenovirus is one possible cause of these new cases. In a report published on May 6, the UK Health Security agency said that of 163 reported pediatric hepatitis cases in the United Kingdom, 126 were tested for adenovirus, and 72% tested positive. More than half of cases being investigated in the United States have also tested positive for adenovirus, the CDC said. In the nine Alabama cases, each child was previously healthy but had both severe hepatitis and adenovirus infection.

There are about 50 adenoviruses that infect people, including ones that cause the common cold, conjunctivitis, and gastrointestinal distress. Laboratory testing of about 40% of children so far were positive for adenovirus, “F type 41,” according to the WHO.

The investigation remains ongoing, the CDC notes. “At this time, we believe adenovirus may be the cause for these reported cases, but other potential environmental and situational factors are still being investigated,” the agency wrote in the April 29 report.

If, in fact, an adenovirus is to blame, spread may occur through close personal contact and respiratory droplets. In addition to 109 cases identified in the United States as of May 6, severe cases of acute hepatitis in kids have also been reported in the United Kingdom, Europe, Asia, and Indonesia. Given the global mystery, WHO is also on the case, following its April 15 alert regarding acute hepatitis in children first reported in the United Kingdom. Cases are reported in children as old as 17 years and as young as 1 month old.

Read the entire WHO report here.

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  • The material in these reviews is from various public open access sources, meant for educational and informational purposes only
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