North Carolina has doubled its total number of reported hepatitis cases, raising its total from four to nine cases, as mystery infections continue to pop up across the country.
State health officials reported the updated numbers late Wednesday, WRAL reports. North Carolina was among the first states to report a case of the disease late last month.
In total, the United States has recorded 115 confirmed or suspected cases of the disease in 26 states and Puerto Rico. Five children died from the disease and 15 required liver transplants.
Missouri officials also increased the state’s cumulative total of confirmed and suspected hepatitis cases to ten on Wednesday as well.
Also on Thursday, Irish officials reported the country’s first death from the disease, marking at least ten deaths worldwide from the mysterious liver disease.
The exact cause of the mysterious hepatitis is currently unknown. Adenovirus – which is often associated with the common cold – is the main suspect, although not all children who have had the disease so far have tested positive.
Q&A: What is the mysterious global hepatitis epidemic and what is behind it?
What is hepatitis?
Hepatitis is an inflammation of the liver that is usually caused by a viral infection or liver damage caused by alcohol consumption.
Some cases resolve on their own with no lingering problems, but a fraction can be fatal, requiring patients to need liver transplants to survive.
What are the symptoms?
People with hepatitis typically experience fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, pale stools, and joint pain.
They can also suffer from jaundice – when the skin and the whites of the eyes turn yellow.
Why are experts concerned?
Hepatitis is generally rare in children, but experts have already spotted more cases in the current outbreak than they would normally expect in a year.
The cases are of “unknown origin” and are also serious, according to the World Health Organization. It has caused up to two deaths and 18 liver transplants.
What are the best theories?
Experts say the cases may be linked to adenovirus, commonly associated with the common cold, but more research is ongoing.
This, in combination with Covid infections, could be behind the spike in cases.
Adenovirus reported by WHO was detected in at least 74 of the cases. At least 20 of the children have tested positive for coronavirus.
British experts investigating the wave of illness believe the endless cycle of lockdowns may have played a contributing role.
The restrictions may have weakened children’s immunity due to reduced social mixing, leaving them at increased risk of adenovirus.
This means that even the “normal” adenovirus could be the cause of the serious consequences, because children do not react to it as they did in the past.
Other scientists said it may have been the adenovirus that had acquired “unusual mutations”.
This would mean that it might be more transmissible or better able to circumvent children’s natural immunity.
New Covid Variant
UKHSA officials included “a new variant of SARS-CoV-2” in their working hypotheses.
Covid has caused inflammation of the liver in very rare cases during the pandemic, although these have been in all ages rather than isolated in children.
The CDC noted that environmental triggers are still being researched as possible causes of illnesses.
These could include pollution or exposure to particular drugs or toxins.
Cases of the mysterious hepatitis have been detected in 26 states, including: Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota , Nebraska, New York, Ohio, Pennsylvania, Tennessee, Texas, Washington and Wisconsin.
At least one case has also been reported in the territory of Puerto Rico.
The CDC declined to reveal where the five American deaths occurred, citing “confidentiality concerns”.
But at least one was in Wisconsin, where the Department of Health confirmed last month that it was investigating a death related to the disease.
At a press conference last week, CDC Deputy Director for Infectious Diseases Dr. Jay Butler said most of the youngsters had “fully recovered” from the illness.
He said scientists were still probing cases to establish a cause, but adenoviruses were “top of the list”.
However, Butler added that it was unclear if an adenovirus infection alone caused the disease or if it was linked to an immune reaction to a particular strain or something the children had been exposed to.
He pointed out, however, that the CDC was not seeing a significantly higher number of childhood hepatitis cases than expected for this time of year.
“I think we’re seriously looking at whether this might be something that happened at a low level for a number of years, and we just haven’t documented it,” he said.
Last week, the World Health Organization said it was investigating 50 possible causes of the disease.
Hepatitis is normally rare in children, but earlier this year the UK sounded the alarm over a mysterious outbreak in children after spotting more cases in January than it normally thought.
Other countries quickly followed, with the United States reporting its first nine cases in Alabama last month. Each of these children had to be hospitalized.
CDC chiefs admitted they were aware of the cases but did not initially raise an alert because it appeared to be an isolated incident.
They have since issued a health advisory asking all states with mysterious hepatitis cases to report them.
However, top experts fear health officials will find out what is behind the outbreak for at least two months.
Parents are told that despite the surge in cases, there is an ‘extremely low’ risk of their child contracting hepatitis.
They are advised to keep an eye out for the main warning signs, but are told that their children are at very low risk of contracting hepatitis.
Jaundice – yellowing of the skin and whites of the eyes – is the most common sign, followed by vomiting and pale stools.
Dr Meera Chand, director of emerging infections at the UK Health Security Agency, said: “It is important for parents to know that the chance of their child developing hepatitis is extremely low.”
“However, we continue to remind everyone to be alert for signs of hepatitis – especially jaundice, to look for a yellow tint to the whites of the eyes – and to contact your doctor if you are concerned.
“Our investigations continue to suggest that there is an association with adenovirus and our studies are currently testing this association rigorously.
“We are also investigating other contributors, including the former SARS-COV-2, and working closely with NHS and academic partners to understand the mechanism of liver damage in affected children.”
Most cases have been detected in the UK and US, which have some of the strongest surveillance systems.
The condition of liver inflammation has also been spotted in Spain (22), Israel (12), Italy (9), and Denmark (6), among other countries.