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Scientists search for cause of hepatitis cases in children

BMJ 2022; 377 doi: (Published 14 April 2022) Cite this as: BMJ 2022;377:o982

Rapid Response:

Re: Scientists search for cause of hepatitis cases in children

Dear Editor,

I am a Registered Nurse in the USA, specializing in high-risk neonatal intensive care (BSN RNC-NIC). I am also a dual British/US citizen.

I read with interest this article regarding hepatitis of unknown origin in children scattered across Europe, with multiple cases identified in the UK. It reminded me of some remarkably similar reports last year in the US, linked by the FDA to an alkaline water product. Seemingly random pediatric non-viral hepatitis, occurring in Southern Nevada, USA [1], back in November of 2020 [2] and again in May 2021 [2], were traced to a brand of improperly formulated alkaline water, sold regionally. Although a specific contaminant was not isolated in laboratory studies [2], the FDA concluded this unexpected source was the only known causal link between cases.[3]

The FDA, in conjunction with the CDC investigated reports from the Southern Nevada Health District, the conclusions of which are published on the FDA website with case counts [2].

The outbreak was contained, the offending alkaline water product was recalled and the public were warned.[2]

I submit this information for consideration as a possible chemically based cause for the current cases. If one factory can improperly formulate, so can others regardless of location.

The families of affected children should be asked if they purchase alkaline bottled water products for their homes. A test of whatever their water source is might prove to be a previously unexplored link, in light of the incidents in Nevada.

Thank you for your consideration. I am providing links to relevant FDA information


1. Turney, A. (2021). FDA In Brief: Viral Hepatitis Cases Possibly Linked to Bottled Alkaline Water. FDA News- Events.

2. Food and Drug Administration (2021). Investigation of Acute Non-viral Hepatitis Illnesses – “Real Water” Brand Alkaline Water.

3. Food and Drug Administration. (2021). Nevada-Based Bottled Water Manufacturer Agrees to Stop Production for Failure to Comply with Manufacturing Requirements.

Competing interests: No competing interests

20 April 2022
Pauline A Myers
Registered Nurse (BSN RNC-NIC)
New Jersey, USA.