Problem

In late 2020, CDPH received reports from the state of Nevada of multiple children with acute liver disease from non-viral hepatitis. Nevada determined that these illnesses were linked to the “Real Water” brand of alkaline water. Real Water had been distributed throughout the country, including in California.

Investigation

CDPH and federal agencies issued public health advisories to inform clinicians, local health departments, and the public about the outbreak of ​​acute non-viral hepatitis linked to drinking Real Water.

CDPH investigated reports of potential cases from clinicians in California. CDPH worked with local health departments to conduct surveys of the patients, collect samples of Real Water products, and review patient medical records. Three patients in California were identified as probable cases.

Outcomes and impact

Real Water alkaline water products were recalled, and no further illnesses were reported.​

Resources

• ​Notes from the Field: Acute Nonviral Hepatitis Linked to a Brand of Alkaline Bottled Water — Clark County, Nevada and California, 2020 (CDC, 2020)
  
• Investigation of Acute Non-viral Hepatitis Illnesses – “Real Water” Brand Alkaline Water (FDA, 2021)​