Top 5 Takeaways

  1. Investigation and Findings: Between October 2021 and February 2022, nine pediatric patients were identified with severe hepatitis of unknown etiology and concomitant adenovirus infection in Alabama.
  2. Clinical Features and Demographics: The affected children, mostly female, were two years and eleven months old on average, displaying symptoms like vomiting, diarrhea, and respiratory issues prior to diagnosis.
  3. Laboratory Tests and Results: All patients tested negative for common hepatitis viruses but positive for adenovirus in blood specimens; adenovirus type 41 was confirmed in five cases.
  4. Treatment and Outcomes: Three children developed acute liver failure, two of whom underwent liver transplantation and recovered. Adenovirus was initially not detectable in plasma but was found in whole blood upon retesting.
  5. Public Health Implications: The cluster of cases suggests adenovirus might be an underrecognized cause of hepatitis in healthy children, and highlights the importance of sensitive testing methods and enhanced surveillance.

Original Article Author and Citation

Corresponding Author

Julia M. Baker, Email:

Suggested Citation

Baker JM, Buchfellner M, Britt W, et al. Acute Hepatitis and Adenovirus Infection Among Children — Alabama, October 2021–February 2022. MMWR Morb Mortal Wkly Rep 2022;71:638–640. DOI: 10.15585/mmwr.mm7118e1.


The report discusses a cluster of severe hepatitis cases linked to adenovirus infection among children in Alabama, highlighting a potential under-recognized pathogenic role of adenovirus in non-immunocompromised children.


Investigation involved reviewing clinical records to identify cases with adenovirus detected via real-time PCR testing, with all other known hepatitis causes ruled out.


The cases suggest adenovirus, particularly type 41, as a contributing factor to severe liver injury. The mixed presence of other viral infections raises questions about co-infection impacts.


Adenovirus type 41 should be considered in differential diagnoses of acute hepatitis in children, with ongoing surveillance essential for understanding and controlling such outbreaks.

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