Acute Hepatitis with Unknown Etiology in Children – April 22


Acute Hepatitis with Unknown Etiology in Children

April 22, 2022

Dear Colleague:

We would like to make you aware of CDC’s April 21 Health Alert Network (HAN) advisory, Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology.

  • A cluster of nine children with hepatitis and adenovirus infection has been identified in Alabama since November 2021. All children were previously healthy; two patients required liver transplant and none died.  A possible association between pediatric hepatitis and adenovirus infection is currently under investigation.
  • VDH has started surveillance for potential cases among children in Virginia; to date, no cases have been reported.
  • Healthcare providers caring for pediatric patients with hepatitis of unknown etiology should consider adenovirus testing, preferably with a nucleic acid amplification test (e.g., PCR). Depending on the laboratory, testing may be performed on respiratory specimens, stool or rectal swabs, or blood.
  • Per the Virginia Regulations for Disease Reporting and Control, 12 VAC 5-90-80, subsection A, ‘Unusual occurrence of disease of public health concern’, providers should immediately report any suspected cases to their local health department (not the CDC):
    • Children <10 years of age with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) (>500 U/L) who have an unknown etiology for hepatitis (with or without any adenovirus testing results, independent of the results) since October 1, 2021.
  • After the provider reports a suspected case, the Virginia Department of Health (VDH) will work with the provider to facilitate shipment of specimens to the Division of Consolidated Laboratory Services (DCLS) for public health testing, if needed. VDH will also collect information about the patient’s illness, laboratory results, and possible exposures and report these to CDC.

Thank you for your attention and cooperation on this emerging situation.


Colin M. Greene, MD, MPH
State Health Commissioner