A Common Virus May Be Linked to Liver Failure in Healthy Children

Doctors around the world are trying to understand what is causing children to develop severe hepatitis (liver inflammation) that in some cases results in liver failure. These puzzling cases have been linked to a common adenovirus that typically causes colds, conjunctivitis (pinkeye), and stomach cramps and diarrhea.

The number of known cases is very small, according to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). Still, both organizations are asking doctors to report any cases of otherwise healthy children who develop liver disease.

In North Carolina, two school-age children with severe hepatitis and acute liver failure were recently treated at UNC. But both tested negative for adenovirus type 41, the strain suspected of causing hepatitis.

However, nine cases positively linked to adenovirus have been reported in Alabama in children younger than 10, according to the University of Alabama at Birmingham. Two of those patients required liver transplants.

So what’s going on? No one is quite sure yet, but doctors and researchers are working hard to figure it out.

“There’s a lot of guesswork right now concerning the cause,” says Steven Lichtman, MD, a UNC Health pediatric gastroenterologist.

Two Cases of Acute Liver Failure in North Carolina Not Linked to Adenovirus

Dr. Lichtman says the two children hospitalized at UNC, ages 9 and 11, were very ill with acute liver failure.

“These kids were sick enough to be listed for transplant,” he says, “but fortunately they have both recovered without a transplant and gone home.”

While both children lived in the same part of the state, they did not know each other and had no connection.

“They came in a day apart,” Dr. Lichtman says. “This was very unusual. We usually see about one case of liver failure in a child a year, maybe one every two years.”

Dr. Lichtman says he was aware of the cases in Alabama and also a cluster in the United Kingdom, so he ordered testing for adenovirus type 41 and other common viruses known to cause hepatitis, but no cause was found. Tests were done to see if the children had come in contact with a toxic substance, but there was no sign of that either.

No other cases have been reported in North Carolina, he says. However, in the wake of the health advisory from the CDC, the North Carolina Department of Health and Human Services has asked all medical professionals in the state to be on the lookout for acute pediatric hepatitis cases of unknown cause and report any such cases to the state so any spread of the disease can be tracked.

The WHO reports that as of April 21, at least 169 cases of acute hepatitis with an unknown cause have been reported from 11 countries in Europe and in the United States. Of those, 17 children have required liver transplants. These cases are not thought to have any connection to COVID-19.

What Parents Need to Know

While doctors monitor the situation to see if patterns emerge, parents should be aware that if the whites of your child’s eyes start to look yellowish—even a little—you’ll want to contact your pediatrician right away. The doctor can do a blood test to see if your child has hepatitis. In most cases of hepatitis, the liver recovers on its own without treatment.

Vaccines for hepatitis A and B are part of the routine CDC-recommended immunization schedule for children. While these vaccines are important to protect your child against hepatitis A and B, they will not prevent infection with an adenovirus that could affect the liver. Still, make sure your child is up to date on all their vaccines, including hepatitis A and B, to prevent illness caused by those specific viruses.

But parents need not panic, Dr. Lichtman says. So far, there is not evidence of childhood hepatitis spreading throughout the United States. The cases may disappear as mysteriously as they started, he says. But in case they increase in number and affect more children, it’s important for doctors and parents to be aware.

If you notice that the whites of your child’s eyes look yellowish or discolored, see your doctor as soon as you can, or find one near you.