Recent news stories have reported on a virus that is causing severe liver damage, or hepatitis, in children. The first cases were seen in Alabama, but then grew around the United States and the world. 

These cases share a few key features:

  • The children affected have never had a liver problem before.
  • They have extremely high liver inflammation. 
  • The liver can have sudden failure that requires a liver transplant.

Here are the answers to some of the frequently asked questions about this infection.

What is hepatitis?

Hepatitis means there is inflammation in the liver. When there is inflammation in any part of the body, we end the word in “-itis.” For example, Inflammation in the appendix is “appendicitis;” in the tonsils is “tonsilitis;” and in the liver is “hepatitis.” 

Causes of hepatitis

There are many things that can cause hepatitis. Those include:

  • infections
  • medications
  • extra body fat
  • autoimmune problems 
  • genetics/family history
  • viruses

Viral hepatitis

Different viruses can cause hepatitis. The most common viruses that cause hepatitis are Hepatitis A, B and C. Other common viruses are Epstein Barr Virus, which also causes mononucleosis, and Cytomegalovirus (CMV). 

Adenovirus is a common virus that usually causes colds or mild gastrointestinal infections – the dreaded “24-hour GI bug.” It does not usually cause hepatitis. However, many of the new cases of hepatitis are linked to Adenovirus type 41, but not all these children have tested positive for Adenovirus 41. 

Signs and symptoms of hepatitis

Hepatitis can be hard to identify. The symptoms are vague, so concerns should be discussed with a pediatrician or other health care provider.

Some signs and symptoms to watch for include:

  • fever
  • fatigue
  • abdominal pain
  • nausea and vomiting
  • diarrhea
  • skin and eyes turning yellow (jaundice)
  • dark urine (like tea or cola) 
  • pale or light-colored stool
  • bruising or bleeding more easily than normal
  • large liver or spleen
  • swelling in the belly or legs that is new

What is the liver and how does hepatitis affect it?

The liver does many things for our body. It is responsible for several functions, including: 

  • processing nutrients from our food
  • making proteins that help the blood to clot 
  • scanning the body for infection
  • clearing toxins from the body 

The virus causes the liver cells to die. The liver is exceptionally good at healing itself and usually can recover from this damage. Sometimes the liver cannot recover and that is when a liver transplant would be needed.

Is hepatitis common in children?

Hepatitis from a virus infection is rare. We don’t know the exact number of cases because most children do not have their blood checked during an infection and the inflammation heals on its own. 

How is hepatitis treated?

Most cases of hepatitis will resolve on their own. Sometimes children will need support like intravenous hydration, anti-nausea medication or pain medication to help them until their bodies recover. 

If the liver starts to fail, additional support may include:

  • vitamin supplementation
  • products that help the blood clot 
  • replacement of proteins
  • nutrition
  • medications that help to remove extra fluid from the body

In rare cases if the liver stops working a liver transplant may be necessary. 

Can hepatitis be prevented?

Viruses are spread through contact with an infected person. The best way to avoid any virus infection is to wash your hands before eating or putting anything in your mouth and after returning home. Also, be sure to: 

  • cover your nose and mouth when sneezing
  • try not to touch your eyes, nose, and mouth frequently
  • avoid spending time with people who are sick with a cold

Is there a link between the increased cases of hepatitis and COVID-19?

There is no link between these new cases of hepatitis and COVID-19. Many of the children were tested for COVID-19 and were negative. COVID-19 can cause a hepatitis, but it is usually not as severe as these new cases. To date, COVID-19 has not led to liver transplant in a patient who did not already have liver disease.

If your child is showing signs of hepatitis, be sure to contact your child’s primary care provider, or make an appointment with our Children's Center for Liver Disease at Hasbro Children's Hospital. 

Vania L. Kasper, MD

Vania L. Kasper, MD

Dr. Vania Kasper is director of the Children's Center for Liver Disease in the Division of Pediatric Gastroenterology, Nutrition and Liver Diseases at Hasbro Children's Hospital. She is certified in pediatric gastroenterology and nutrition.