North Carolina has doubled its total reported hepatitis cases, from four to nine, as mysterious infections continue to pop up across the country.
State health officials reported the updated figures Wednesday night, WRAL reports. North Carolina was one of the first states to report a case of the illness late last month.
In total, the US has recorded 115 confirmed or suspected cases of the condition in 26 states and Puerto Rico. Five children died of the disease and 15 required liver transplants.
Missouri officials also increased the state’s running total of confirmed and suspected hepatitis cases to ten on Wednesday.
Also on Thursday, Irish officials reported the country’s first death from the condition, marking at least 10 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 prime suspect, although so far not all children who have had the disease have tested positive.
Q&A: What is the mysterious global hepatitis outbreak and what’s behind it?
What is hepatitis?
Hepatitis is inflammation of the liver that is usually caused by a viral infection or liver damage from drinking alcohol.
Some cases resolve on their own, with no ongoing problems, but a fraction can be fatal, forcing patients to need liver transplants to survive.
What are the symptoms?
People who have hepatitis usually have fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, and joint pain.
They may also suffer from jaundice, when the skin and the whites of the eyes turn yellow.
Why do the experts care?
Hepatitis is usually rare in children, but experts have already detected more cases in the current outbreak than would normally be expected 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 main theories?
Experts say the cases may be linked to the adenovirus, commonly associated with colds, but further investigation is underway.
This, in combination with covid infections, could be causing the rise in cases.
The adenovirus reported by the WHO has been detected in at least 74 of the cases. At least 20 of the children have tested positive for the coronavirus.
British experts tasked with investigating the onslaught of disease believe the endless cycle of lockdowns may have contributed.
The restrictions may have weakened children’s immunity due to reduced social mixing, leaving them at higher risk of contracting adenoviruses.
This means that even ‘normal’ adenovirus could be causing serious outcomes, because children are not responding as they did in the past.
Other scientists said it may have been the adenovirus that acquired “unusual mutations.”
This would mean that it could be more transmissible or more able to circumvent the natural immunity of children.
New Covid variant
UKHSA officials included ‘a new variant of SARS-CoV-2’ in their working hypotheses.
Covid has caused liver inflammation in very rare cases during the pandemic, although these have been in all ages rather than isolated in children.
The CDC has noted that environmental triggers are still being investigated as possible causes of the illnesses.
These could include contamination 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 has refused to reveal where the five US deaths occurred, citing “confidentiality issues.”
But at least one was in Wisconsin, where the Health Department confirmed last month that it was investigating a fatality related to the disease.
At a news conference last week, the CDC’s deputy director for infectious diseases, Dr. Jay Butler, said most of the youngsters had “completely recovered” after the illness.
He said scientists were still investigating cases to establish a cause, but adenoviruses were “at the top of the list.”
However, Butler added that it was not clear if an adenovirus infection alone was causing the illness or if it was related to an immune reaction to a particular strain or something the children had been exposed to.
However, he stressed that the CDC was not reporting a significantly higher number of hepatitis cases in children than expected for this time of year.
“I think we’re seriously considering whether or not this may be something that’s been going on 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 raised the alarm about a mysterious outbreak in children after detecting more cases in January than would normally be expected.
Other countries quickly followed, with the US reporting its first nine cases in Alabama last month. Each of those children required hospital care.
CDC chiefs admitted they were aware of the cases but initially did not raise an alert because it appeared to be an isolated incident.
They have since issued a health advisory asking states with mystery cases of hepatitis to report them.
However, leading experts fear health officials won’t get to the bottom of what’s behind the outbreak for at least another two months.
Parents are told that despite the spate of cases, there is an “extremely low” risk of their child contracting hepatitis.
They are advised to watch out for the major warning signs, however they have been told that their children are at very low risk of contracting hepatitis.
Jaundice, the 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 to the signs of hepatitis, particularly jaundice, look for a yellow tint to the whites of the eyes, and contact your doctor if you are concerned.
‘Our investigations continue to suggest that there is an association with adenovirus and our studies are now rigorously testing this association.
“We are also investigating other contributors, including earlier SARS-COV-2, and are working closely with the NHS and academic partners to understand the mechanism of liver injury in affected children.”
Most of the cases have been detected in the UK and the US, which have some of the strongest surveillance systems.
The condition of liver inflammation has also been detected in Spain (22), Israel (12), Italy (9), and Denmark (6), among other countries.