Theories emerge in mysterious cases of childhood hepatitis in Alabama

As researchers work to unravel the mystery behind dozens of hepatitis cases in children in Alabama and elsewhere around the world, a few theories have emerged about a possible connection to a common stomach virus.

Alabama officials have reported nine hepatitis cases among previously healthy children – the most in the United States. The United Kingdom reported 111 cases as of April 20. Doctors have ruled out the five viruses that usually cause liver disease and poisoning by acetaminophen (Tylenol) which can cause damage to the organ.

On Monday, the UK Health Security Agency released a document outlining several working theories about the cause of the unusual cases. Adenovirus, a common virus that usually causes a range of mild childhood illnesses, has emerged as the leading contender after most patients tested positive. But experts do not know why it suddenly causes such severe liver disease in healthy children.

It could be a result of limited exposure to viruses during the pandemic or maybe of COVID itself. The document said the leading theory is that adenovirus is worse than normal either because children had no prior exposure to build up their body’s defenses due to isolation. Or it could be due to a child’s prior infection with COVID-19, including omicron variants. They have not ruled out toxins or environmental exposures that could be unrelated to adenoviruses and COVID-19 or a new variant of adenovirus.

Most of the children in the report tested positive for adenovirus. Only 16 percent tested positive for COVID-19 at the time of admission to the hospital. None of the patients in Alabama or the UK had received the COVID vaccine before they became ill.

Doctors in Alabama have told parents and pediatricians to be aware of the symptoms of hepatitis to identify more cases and help pinpoint the causes. They have said parents should not panic about hepatitis, which remains rare among healthy children. Although two children in Alabama needed liver transplants, all nine have recovered. Seven children in the UK needed transplants.

The technical bulletin only covered cases in the UK. Dr. Karen Landers, area health officer for the Alabama Department of Public Health, said it’s unclear how cases in Alabama might be connected to those appearing in other states.

“At this time, ADPH cannot conclusively link what is occurring in other parts of the world with hepatitis cases in children to what happened in Alabama,” Landers said. “While adenovirus testing was positive in nine cases in our state, it is still too early to conclude that this virus is the etiologic agent. More research, discussion, and surveillance is necessary. ”

Although researchers have been cautious about linking the cases, some similarities exist between the clusters in Alabama and the UK. The Alabama cases all occurred in children younger than six. Most of the cases in the UK also happened in very young children.

Doctors in Alabama have not identified any new patients since February. At least 169 cases have been reported in 11 countries, according to the World Health Organization.

Adenoviruses can cause fever, nausea, vomiting and other symptoms. Health experts recommend frequent hand washing for at least 20 seconds with soap and warm water. The virus often spreads in child care settings where children are in close contact.

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