A further 36 children have fallen ill in the mysterious hepatitis outbreak, health chiefs revealed on Wednesday – after six deaths were linked to the disease.
This brings the number of children affected by liver inflammation to 216 in 37 states, with Mississippi and Utah being the latest to be added to the growing list.
No new deaths or liver transplants have been reported in the past seven days, the Centers for Disease Control and Prevention (CDC) revealed in their weekly update, with the totals remaining at 14 and six respectively.
The agency did not disclose where the deaths occurred due to “confidentiality issues,” but at least one was recorded in Wisconsin health chiefs in the state.
Globally, the United States has had the most deaths and suspected cases of any country – although that may be due to tighter surveillance here.
Indonesia has reported five deaths in the outbreak, while Palestine and Israel have recorded one each.
Scientists say it will still be weeks before the cause of the cases is revealed, although the CDC continues to consider an adenovirus infection – which can trigger the common cold – as the most likely cause.
The outbreak may also be the result of weakened immunity due to lockdowns that have damaged people’s immunity, experts warn.
The CDC now publishes weekly outbreaks on the number of suspected cases, liver transplants and reported deaths.
Many cases are “historic”, having occurred in the seven months since October 2021, but are only beginning to come to light as doctors search for samples taken from sick children in post.
The CDC said last week that there were no signs that cases were increasing in recent months.
A total of 37 states have now reported outbreak cases of hepatitis. They are: Arkansas, Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas and Virginia, Washington and Wisconsin.
The territory of Puerto Rico has also recorded at least one case of mysterious hepatitis.
Experts warn the shutdowns mean the United States could now be entering a time when it’s unclear what to expect from infectious diseases.
Dr Marion Koopmans, head of the department of virosciences at Erasmus Medical Center in Rotterdam, the Netherlands, warned New statistics and said it was because of less recent immunity.
She said blood tests on the children showed they had been through something of an ‘infectious honeymoon’ with few antibodies present against normal illnesses.
She added: “You really see that the children in the second year of the pandemic have much less antibodies against a set of common respiratory viruses.
“They’re just less exposed.”
The CDC said last week that an adenovirus infection – which can cause the common cold – was their main hypothesis for the cause of the disease, although they were also still investigating the role of Covid infections.
They all but ruled out theories suggesting that a mutation in the virus could be causing the disease, or that it could be due to exposure to pet dogs. There is no evidence that the Covid vaccine triggers hepatitis.
The usual causes – hepatitis A, B, C, D and E viruses – have all been ruled out.
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.
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.
Around three quarters of UK cases have tested positive for the virus.
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.
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