Need to Know: New Cases of Hepatitis in Children

On April 21, 2022, the CDC issued a nationwide health alert to notify clinicians and public health authorities about a cluster of children identified with hepatitis of unknown etiology – and to ask all physicians to be on the lookout for symptoms and to report any suspected cases of hepatitis of unknown origin to their local and state health departments.

The North Dakota Department of Health (NDDoH) is working with the Centers for Disease Control and Prevention (CDC) in investigating a child with hepatitis of unknown cause. The child resides in Grand Forks County. The child is recovering at home after a brief hospitalization. North Dakota is among a growing list of states investigating children with hepatitis where usual causes have been ruled out.

“We are encouraging medical providers to review their records back to October 2021 for any patients that warrant further investigation,” said Kirby Kruger, Medical Services Section Chief. “NDDoH is working with the CDC to help identify cases that will aid in understanding the cause of hepatitis in children and to understand how we can prevent these illnesses from happening in the future.”

Parents are encouraged to watch for symptoms of hepatitis, or inflammation of the liver. These symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, and jaundice, or yellow skin or eyes. Talk to your medical provider if your child is experiencing these symptoms.


A link between cases of hepatitis and adenovirus infection has been suggested. Because of this, CDC is asking physicians to consider adenovirus testing. Adenovirus infections are common and occur among persons of all ages. Symptoms may include cold-like symptoms, fever, sore throat, pneumonia, diarrhea, or pink eye.

NDDoH encourages everyday precautions to keep children safe, including washing hands often, staying home when ill, avoiding people who are sick, covering coughs and sneezes, avoiding touching the eyes, nose, or mouth, and staying up-to-date on routinely recommended vaccines.

What is Hepatitis?

Hepatitis is inflammation of the liver that can be caused by viral infections, alcohol use, toxins, medications and certain other medical conditions. In the United States, the most common causes of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C viruses. Signs and symptoms of hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain and jaundice. Treatment of hepatitis depends on the underlying cause or set of causes (etiology).

Viral Hepatitis Key Facts & Prevention
  • There are several different viruses that can cause hepatitis; the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C.
  • Chronic hepatitis B and hepatitis C are leading causes of liver cancer in the United States.
  • Both hepatitis A and hepatitis B are preventable with safe and effective vaccines, and hepatitis C is curable with prescribed treatment.
  • About 66% of people with hepatitis B are unaware of their infection and about 40% of people living with hepatitis C do not know they are infected.
  • Getting tested is the only way to know if you have hepatitis A, hepatitis B or hepatitis C.

What is an Adenovirus?

Adenoviruses (pronounced ad-no-virus) are double-stranded DNA viruses that spread by close personal contact, respiratory droplets and fomites. There are more than 50 types of immunologically distinct adenoviruses that can cause infections in humans. Adenoviruses most commonly cause respiratory illness but depending on the adenovirus type they can cause other illnesses such as gastroenteritis, conjunctivitis, cystitis, and, less commonly, neurological disease. There is no specific treatment for adenovirus infections.

Adenovirus type 41 commonly causes pediatric acute gastroenteritis, which typically presents as diarrhea, vomiting and fever; it can often be accompanied by respiratory symptoms. While there have been case reports of hepatitis in immunocompromised children with adenovirus type 41 infection, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children.

Adenoviruses can cause a wide range of illnesses such as:

  • common cold or flu-like symptoms
  • fever
  • sore throat
  • acute bronchitis (inflammation of the airways of the lungs, sometimes called a “chest cold”)
  • pneumonia (infection of the lungs)
  • pink eye (conjunctivitis)
  • acute gastroenteritis (inflammation of the stomach or intestines causing diarrhea, vomiting, nausea and stomach pain)

Less common symptoms of adenovirus infection include:

  • bladder inflammation or infection
  • neurologic disease (conditions that affect the brain and spinal cord)
How to protect yourself from Adenovirus?

You can protect yourself and others from adenoviruses and other respiratory illnesses by following a few simple steps:

  • Wash your hands often with soap and water for at least 20 seconds (see CDC’s Clean Hands Save Lives!).
  • Avoid touching your eyes, nose or mouth with unwashed hands.
  • Avoid close contact with people who are sick.

If you’re sick you can help protect others:

  • Stay home when you are sick.
  • Cough and sneeze into a tissue or your upper shirt sleeve, not your hands.
  • Avoid sharing cups and eating utensils with others.
  • Refrain from kissing others.
  • Wash your hands often with soap and water for at least 20 seconds, especially after using the bathroom.
  • Frequent handwashing is especially important in childcare settings and health care facilities.
For More Information  

Viral Hepatitis | Department of Health (

Division of Viral Hepatitis | CDC 

Adenovirus | CDC 

Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022 | MMWR (