What Are the Signs of Hepatitis in Children?

Following a CDC alert about a cluster of rare hepatitis cases in children, a Stanford Medicine Children’s Health pediatric hepatologist provides guidance for parents.

Global health officials are tracking a mysterious outbreak of hepatitis cases in otherwise healthy children in the United States and Europe. At this time, it’s unknown what is causing the hepatitis outbreak.

Between October 2021 and February 2022, nine children in Alabama were admitted to hospitals there with sudden-onset hepatitis. Now, the CDC is investigating 109 cases of severe and unexplained hepatitis in children, including five deaths, across the country. Fourteen percent needed liver transplants and nearly all of them – 90 percent – required hospitalization. More than half of the patients tested positive for adenovirus infection.

Hepatitis is inflammation of the liver, and in children it can occur due to many reasons. 

“Pediatricians and pediatric gastroenterologists have known that adenovirus infection can cause short-lived liver inflammation,” says Leina Alrabadi, MD, a pediatric transplant hepatologist at Stanford Medicine Children’s Health. “But what’s concerning and new is that some healthy children are becoming very ill with adenovirus and, in some cases, progressing to acute liver failure.”

Adenovirus infections are common and usually mild. They can cause cold-like symptoms, fever, sore throat, bronchitis, pneumonia, diarrhea, and pink eye. Dr. Alrabadi says that in most cases, hepatitis can make a child feel sick, but it rarely gets to the point of liver failure.

If your child has the following symptoms of acute hepatitis, contact your pediatrician for further evaluation:

• Nausea
• Vomiting
• Abdominal pain
• Yellowing of the eyes or skin (jaundice)
• Bruising
• Light-colored or white stools
• Dark urine

How can parents protect their children?

Although the cause of these hepatitis cases is still unknown, Dr. Alrabadi says that good hygiene is most important. The hepatitis A and B vaccines, which are included in childhood vaccinations, are important and prevent children from developing severe forms of hepatitis; however, those vaccines don’t prevent adenovirus infections. Adenoviruses usually spread from infected people to others through the air by coughing and sneezing, close personal contact, or touching objects or surfaces with the virus on them.

“In general, avoiding touching one’s face and continuing to practice proper handwashing, as we’ve done a lot of during the pandemic, is essential in preventing transmission of disease,” Dr. Alrabadi says.

Physicians want to stress to parents that this news is not cause for alarm.

“Please remember that severe acute hepatitis in children is rare,” Dr. Alrabadi says. “The recent cluster of cases is puzzling, but health officials are continuing to investigate this. If you are concerned or have questions, reach out to your child’s pediatrician.”