South Dakota is now investigating a case of childhood hepatitis, becoming the 12th state to report the disease, after a child in Wisconsin died of the disease.
State health chiefs said the patient was under 10 years old and lived in Brown County, which borders North Dakota.
It brings the US total to at least 32 confirmed or suspected cases of unexplained hepatitis, including five liver transplants and one death.
Four children are believed to have died from the disease worldwide, after Indonesia said it was investigating three deaths.
To date, more than 220 cases have been detected, the majority in the UK, and 18 liver transplants have been carried out, but experts warn this could be just the “tip of the iceberg”.
Scientists are puzzled by the spate of cases because none of the affected children have tested positive for the normal viruses that cause hepatitis.
They have linked many to the adenovirus, which can trigger the common cold, and have even suggested that lockdowns or a previous covid infection could be to blame.
The map above shows the states that have confirmed cases of hepatitis (red) and those that have suspected cases (yellow). The state numbers correspond to their number in the table on the right side, which contains the case numbers.
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.
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 UKHSA 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.
South Dakota epidemiologist Dr. Josh Clayton has asked doctors in the state to look for cases of hepatitis.
He said they were now working closely with the CDC to pinpoint the cause of the condition.
A total of 11 other states have also reported cases of the disease so far. These are Alabama, Delaware, Louisiana, Tennessee, North Carolina, Wisconsin, California, and Minnesota.
New York, Illinois and Georgia say they are investigating suspected cases of the disease.
On Tuesday, the World Health Organization stated that at least 228 probable cases of hepatitis in children had been reported in 20 countries.
He said there were more than 50 other cases under investigation.
Most of the cases were from the UK, 145, and the US, 20, they said, which have some of the strongest surveillance systems.
The agency did not disclose which countries reported additional cases, but other health agencies revealed that Austria, Germany, Poland, Japan and Canada have detected cases, while Singapore is investigating a possible case in a 10-month-old baby.
Indonesia said yesterday that three children had died from suspected hepatitis of unknown cause.
Children affected by hepatitis in the United States were generally less than 10 years old.
Those with the condition suffered from vomiting, diarrhea and jaundice, where the skin and whites of the eyes turn yellow, the CDC said.
More than half also suffered from a fever due to the condition.
Cases have been recorded since October, when the first were detected in Alabama.
But at least one patient is still in the hospital in Minnesota awaiting a liver transplant.
Most of the children sampled have tested positive for adenoviruses, fueling theories that this could be behind the onslaught of illnesses.
But some are not convinced, pointing out that it is not uncommon to be infected with this virus.
The director of clinical and emerging infections at the British health agency UKHSA, Dr. Meera Chand, has told parents that the chance of their child developing hepatitis is “extremely low”.
She said: “However, we continue to remind parents to be vigilant for signs of hepatitis, particularly jaundice, which is most easily detected as a yellow tinge to the whites of the eyes, and to contact their doctor if they are worried,” he said. saying.
Dr Chand added: ‘Normal hygiene measures, including thorough handwashing and making sure children wash their hands properly, help reduce the spread of many common infections.
“As always, children experiencing symptoms such as vomiting and diarrhea should stay home and not return to school or daycare until 48 hours after symptoms have resolved.”
Hepatitis is usually rare in children, but experts have already detected more cases in the UK, at the center of the outbreak, since January than would normally be expected in a year.
Scientists have previously suggested that the cases could just be the ‘tip of the iceberg’, with more likely to be out there than has been seen so far.
Searching for an unknown cause is especially difficult because cases can have multiple factors behind them that are not consistent across diseases.