The Centers for Disease Control and Prevention (CDC) have now investigated 180 cases of a mysterious form of hepatitis, spanning 35 states, with every illness involving children under 10 years old.
Scientists are reportedly "puzzled" by the root cause of the outbreak, but CDC officials say that adenoviruses — which can cause the common cold — cover nearly half of patients testing positive for hepatitis.
Adenoviruses can be transmitted by touching feces-contaminated surfaces.
There have been a total of five American fatalities since the onset of the illness — including one child in Wisconsin — and 12 worldwide deaths.
The United States has reported the most child hepatitis cases since this outbreak was first detected, with the United Kingdom ranking second (163 cases).
Among the states reporting a hepatitis outbreak over the last two weeks: Arkansas, Hawaii, Kentucky, Maryland, Massachusetts, Nevada, New Jersey, Oklahoma, Rhode Island, South Dakota, and Virginia.
And prior to that, 24 states reported virus detections: 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.
On Wednesday, the CDC reported 71 hepatitis cases among children (bringing the total to 180). Within that figure, one child required a liver transplant.
"It's important to note that severe hepatitis in children remains rare," says the CDC. "However, we encourage parents and caregivers to be aware of the symptoms of hepatitis — particularly jaundice, which is a yellowing of the skin or eyes — and to contact their child's healthcare provider with any concerns."
Last week, Dr. Matthew Binnicker, the director of clinical virology at the Mayo Clinic in Minnesota, told The Daily Mail the hepatitis outbreak would likely continue "throughout the summer," because it's not a seasonal virus.
Binnicker also said that schools and daycare centers are potentially harmful areas for spreading the virus.
When speaking with The Daily Mail, Binnicker said: 'I would not be comfortable saying this outbreak has peaked. I'd say cases will continue to emerge throughout the summer period because we will continue to see children in day care where there is higher transmission.
"This type of adenovirus we don't tend to think of as seasonal, we will continue to see cases throughout the year."
The adenovirus children with hepatitis are most likely to have tested positive for is scientifically named "type 41."
This type of illness typically affects the gastric system, and sometimes leads to diarrhea and vomiting.
"Type 41" is spread via the fecal-oral route. The worst action occurs when a child unwittingly touches a surface contaminated with feces, prior to touching their own mouth.
"Hepatitis can occur on a sliding scale of causing an individual to be hospitalized to the other end where it is much more mild. In [the mild] cases, it may not prompt parents to take their child for investigation, or to the hospital," said Binnicker.
"Many of these children will experience gastroenteritis symptoms such as vomiting, diarrhea and nausea, with some also facing an upper respiratory illness so a cough or sore throat that's preceding hepatitis."
Binnicker added: "Those who then develop hepatitis will see changes in skin color, so some develop symptoms of jaundice or yellowing of the skin ... ranging from very, very noticeable to very, very subtle changes. A yellowing white of the eye is also something that is very apparent and parents get very shocked some times, but other times it is very, very subtle and may not be noticed."
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