170: Hepatitis Alert

Dr. Scott Harris, Alabama’s State Health Officer, discusses how states and territories are on alert for cases of hepatitis and adenovirus in children; Dr. Jose Romero, Arkansas’ Secretary of Health, is worried about increasing cases of...

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Dr. Scott Harris, Alabama’s State Health Officer, discusses how states and territories are on alert for cases of hepatitis and adenovirus in children; Dr. Jose Romero, Arkansas’ Secretary of Health, is worried about increasing cases of tuberculosis, especially among children; ASTHO has a new blog article on state responses to the growing problem of tick-borne diseases; and ASTHO invites public health officials to attend a webinar featuring a simulation planning tool that helps agencies simulate vaccination, triage and screening during public health emergencies.

ASTHO Blog Article: Public Health Confronts the Tick

ASTHO Webinar Registration: Public Health Preparedness - POD SimPLER

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This is Public Health Review Morning Edition for Tuesday May 3, 2022. I’m Robert Johnson.

Now, today’s news from the Association of State and Territorial Health Officials.


States and territories are on alert for cases of hepatitis and adenovirus in children after several kids in Alabama suffered liver failure.

Dr. Scott Harris is Alabama’s state health officer. He’s tracking the mysterious outbreak and talks about it in today’s morning conversation.

In recent weeks, children in a few states—including Alabama—have been diagnosed with hepatitis; and in some cases, the patients have had to get liver transplants. Can you tell us what’s going on?



We first became aware of this in November of 2021. Our state’s largest children’s hospital notified us and CDC that they had seen four cases of acute hepatitis in pediatric patients—the age range was between one year and five years—and had not really been able to determine a cause. They had searched for the usual causes of hepatitis, had not really identified anything at that point.

So, we began working with them and ultimately identified a fifth case as well, and then eventually put out a call for cases to providers in the state; and we actually now have identified a total of nine cases that all occurred between October of 2020 and February of this year—no new cases since February that we’re aware of yet.

The normal causes were ruled out, but it was noticed that all of these kids had evidence of infection with adenovirus, and a few of them in particular had a specific strain of adenovirus called adenovirus 41, which is not normally known to cause hepatitis.

Some adenoviruses can cause hepatitis in immunocompromised patients, but none of these kids seem to have any immunologic abnormalities—they were just normal kids. They also didn't seem to have anything else in common: they were from all different parts of the state, they didn't have any obvious risk factors. And so, it was really somewhat of a mystery.


Are you worried at all about the situation based on what you know and what you don't know?


Well, certainly, we do have concerns because we want to try to understand what's going on.

As I said, we've seen in at least half of these cases some connection to a particular strain of adenovirus. This has started showing up in other parts of the world, as I'm sure you're aware—I think as of last count, I heard that there are about 11 countries including the U.S. that have identified some cases. Now, there have been maybe half a dozen states in the United States that have identified cases. I know the state of Wisconsin reported a death, which would be the first death that we know of to be associated from the syndrome. So, there's still a lot to figure out.

Again, the normal things have sort of been ruled out. Obviously, because we're in a pandemic, we've looked carefully at COVID status, and this does not appear to be associated with COVID in any way nor with COVID vaccination—none of the Alabama kids had even undergone COVID vaccination.

So, there's still a lot of work to do. We work closely with CDC on this, and we're continuing to try to identify an underlying cause.


For your colleagues in other states where they haven't seen this yet, what would you recommend to them so they can maybe bump up their surveillance? Get ahead of it, make sure they know what's going on there?


Yeah, we certainly just want to make sure that they have awareness in this situation. CDC has put out a National Health Alert Network message about a week ago. And so, obviously, health departments and all should be looking for this. It's just important for other state health officials to communicate with their provider groups, with their hospital systems, other healthcare providers, just to make sure that people are aware to look for this.

Again, in Alabama, you know, we had four cases that came from different parts of the state, you know, out of a population of a million kids in Alabama. And so you can see, it might have been, you know, easy to miss that, except for the, you know, serendipitous event that all these kids were referred to the same tertiary care referral center in one location, and that's how it was picked up.

So, we want providers to be aware of it so that if they see an unusual case of hepatitis, they notify public health and look and see if that case is going to meet the case definition.



Nearby in Arkansas, secretary of health Dr. Jose Romero is worried about increasing cases of tuberculosis, especially those reported among children.


I think children are very high risk, in part because—as the old adage goes—if you see a case of TB in the children, then you know it's widespread in the community.

Because kids are, if you will, the sentinel chickens of tuberculosis in our community—they're very susceptible to it, it tends to spread quickly within themselves, they can develop TB disease very quickly, they have a hard time bringing it under control.

So, I really want to draw emphasis on children being high-risk group in this upsurge


Hear the full conversation with Dr. Romero in a new episode of the Public Health Review Podcast, coming soon everywhere you stream audio


Tick-borne diseases are becoming a year-round public health problem due to warmer weather in many parts of the country. ASTHO reports on state policy responses in a new blog article now online. You can read it using the link in the show notes.


Finally, a simulation planning tool that helps agencies better manage vaccination triage, screening, and other activities during a public health emergency will be demonstrated during two webinars this week.

The first review of the POD simPLER tool is today, May 3rd, at 3 p.m. Eastern Time. The second is Thursday, May 5th at 7 p.m. Eastern Time. Sign up using the link in the show notes.


Before we go, we want to remind you to follow the show on your podcast app. And if you're on Twitter, Instagram, Facebook or LinkedIn, we'd love a shout out.

That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Jose Romero MD

Secretary of Health, Arkansas Department of Health

Scott Harris MD, MPH, FACP, FIDSA

State Health Officer, Alabama Department of Public Health