North Carolina health officials have reported seven additional cases of unusual hepatitis in children — bringing the total number of reported cases in the state to nine since March. The children had severe liver inflammation with no known cause.
“All of the children are reported to have recovered and none required transplants,” Bailey Pennington, a spokesperson for North Carolina’s Department of Health and Human Services, said in a statement Friday. “At this time, no cause has been found and no common exposures have been identified.”
The World Health Organization in April reported a global outbreak of hepatitis affecting at least 169 children ages 1 month to 16 years old. Seventeen children required a liver transplant and at least one child died, the WHO said. The Centers for Disease Control and Prevention issued its own alert after a cluster of nine cases was identified in Alabama.
The first two North Carolina cases were brought to officials’ attention in March. It's not clear what part of North Carolina recorded those initial cases, though Mecklenburg County Public Health said in an April statement that it had not received notice of any local cases.
South Carolina as of Friday had not identified any unusual pediatric hepatitis cases. The state’s Department of Health and Environmental Control said in a statement that it “doesn’t routinely track data related to sporadic cases of hepatitis” but said it has requested providers report any unexplained cases to the state.
Hepatitis is inflammation of the liver frequently caused by viruses including hepatitis A, hepatitis B and hepatitis C. It can also be caused by medical conditions like autoimmune disorders and obesity. Hepatitis symptoms, according to the CDC, include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain and yellowing of the skin or eyes. Treatment depends on the cause.
The WHO suggested adenovirus may be a possible cause for the recent global outbreak but cautioned that investigations are still ongoing. Adenovirusesare common viruses that can cause cold-like symptoms. According to the WHO, adenovirus was detected in at least 74 of the cases of children with severe hepatitis but North Carolina health officials said neither of the state's two initial cases tested positive for adenovirus.
Other places that have reported hepatitis in children with no known cause are Belgium, Denmark, France, Ireland, Israel, Italy, The Netherlands, Norway, Romania, Spain and the United Kingdom. The United Kingdom reported the greatest number of cases at 114, according to the WHO.
