Public Health Experts Concerned Over Severe Liver Inflammation Found in Children

MONTGOMERY, Ala. — The Alabama Department of Public Health sent notifications to the public and providers recently to warn that nine children under the age of 10 were identified as testing positive for adenovirus, a common virus that typically causes cold-like symptoms but is now causing abnormally severe liver inflammation in the children identified.

“We are looking into the epidemiological links, and how to increase provider knowledge across the nation for cases that have gone unreported … At this point we have no epidemiological link to any of these cases,” said Wes Stubblefield, district medical officer at Alabama Department of Public Health, during a phone call with The Well News.

According to Stubblefield, in late October of last year, the U.S. Centers for Disease Control and Prevention contacted the Alabama Department of Public Health reporting a few children that presented with liver injury and positive adenovirus.

The department has now discovered a total of nine cases. Two of those children went on to receive liver transplants due to severe infection and five of the infections were identified as specifically adenovirus type 41, whereas the four other infections could not be specifically typed, according to Stubblefield.

The last case of the adenovirus was reported in February of this year and since then the Department of Public Health has not received any additional reports.

Still, Stubblefield said that last week the department was made aware that similar infections are occurring in children in Europe.

“These children presented for hepatitis, but the adenovirus is causing hepatitis,” said Stubblefield.

“None of the children had COVID, and none had been vaccinated [against COVID],” added Stubblefield.

So far, researchers have been able to determine the adenovirus is not caused by viral hepatitis, which includes hepatitis A, B, C, D, and E.

The bigger concern is that while type 41 adenovirus is commonly known, this particular type has not previously caused liver injury in the ways seen in these recent cases.

“We sent out a health alert network with a weblink to allow providers to input potential cases in a secure fashion, and reviewed five submissions, none of which [matched] the criteria for the adenovirus,” said Stubblefield.

Stubblefield said, so far, they have not been able to ascertain why these cases are happening in Alabama.

“The only thing we can do is send messaging out, and see what other cases are out there,” said Stubblefield.

The messaging provided to physicians included summarizing the cases of the nine children and ensuring that providers screen everyone, including adults, who present with symptoms of hepatitis—such as an enlarged liver, or dark-colored urine.

Stubblefield said the department has submitted news releases to media organizations and the general public, and will send out a second health alert work message as soon as CDC submits information on that.

“We don’t know how far this extends beyond these nine patients. If other people got this infection and didn’t get this liver injury, it may have been something seasonal, but we don’t know the answer to those questions,” said Stubblefield.

The cases reported in Alabama have received attention from individuals working on eliminating hepatitis.

“We haven’t seen something like this in 40 to 50 years,” said Chari Cohen, senior vice president of the Hepatitis B Foundation, during a phone call with The Well News.

“It looks like in all cases viral hepatitis has been ruled out. That’s what really makes it unusual …You don’t typically see liver damage or disease to the point where they would need a liver transplant,” continued Cohen.

According to Cohen, when it comes to viral hepatitis, like hepatitis B, most children who are infected with hepatitis B at birth would have a silent infection for decades and never see such a severe impact on the liver.

More commonly known viral forms of hepatitis, like chronic hepatitis B and C, tend to live in people’s liver for a long time before causing damage.

According to Cohen, this is because the liver regularly tries to regenerate itself which is why it could take years before liver damage is seen.

Viral forms of hepatitis can be transmitted from a pregnant woman who is positive with infection to a child through childbirth, which is why screening for hepatitis is currently recommended for all pregnant women in the country.

“We do a pretty good job of screening women [for hepatitis], it’s somewhere around 95-97% of new moms screened, but we have to link the mom who tests positive with appropriate care and make sure the vaccine is available in the delivery room,” said Cohen.

To increase screening and vaccination for hepatitis, Cohen said that the CDC recently came out with a draft implementation for ending hepatitis by 2030. For the first time, the CDC has also recommended hepatitis B vaccination for adults.

“Hepatitis B is one of those universal childhood vaccines, but it has not been universally recommended for U.S. adults,” said Cohen.

“You have a situation in the U.S. where only 25-30% of adults are protected against hepatitis B,” continued Cohen.

During the pandemic, CDC evidence showed that in general, in the U.S. and worldwide, there has been a decrease in infant, childhood and adult vaccinations.

The CDC’s draft guidance for universal HBV screening is currently open for public comment though July. The CDC has also issued updated updated recommendations for adult HBV vaccination.

Cohen said that by July, the Hepatitis B Foundation will release updated guidance for primary care providers on screening and vaccination for hepatitis.

“We are working on an implementation plan to try to make sure that primary care providers around the country know how to do that and have the resources to do that,” said Cohen.

Alexa can be reached at [email protected]