Three Illinois children have developed suspected cases of severe hepatitis potentially linked to a strain of adenovirus — joining a string of other kids from across the country with the mysterious illness.

The children in Illinois were all less than 10 years old, with two in suburban Chicago and one in western Illinois, the state health department said Monday in a news release. One child needed a liver transplant because of the illness.

Hepatitis is inflammation of the liver, and is often caused by heavy alcohol use, toxins, some medications or the hepatitis A, hepatitis B or hepatitis C viruses.

The sickness in the Illinois children, however, may be associated with adenovirus 41, a type of virus that typically includes diarrhea, vomiting, fever and respiratory symptoms, but is not known to cause hepatitis in otherwise healthy children. Adenoviruses spread from person to person.

The Illinois announcement came just days after the Centers for Disease Control and Prevention issued a nationwide alert about the illness. In the alert, which went out Thursday, the CDC said that it was working with the Alabama Department of Public Health to investigate nine cases of hepatitis in children ages 1 to 6, who were all previously healthy. The CDC said it believes adenovirus may have caused those cases, but it was still investigating. The children did not go to hospitals for COVID-19.

Europe has also recently reported an increase in cases of pediatric hepatitis without a known cause, and adenovirus has been confirmed in some but not all of those cases, the CDC said.

It is working with state health departments, the CDC said, to see if there are more such cases across the country.

The CDC is urging parents to be on the lookout for symptoms of hepatitis in their children, which include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain and jaundice, and to contact their doctors with any concerns. It’s also encouraging parents to make sure children are up-to-date on their vaccines and to continue taking precautions such as frequent hand washing, avoiding people who are sick, covering coughs and sneezes, and avoiding touching the eyes, nose or mouth. Vaccines are available to protect against hepatitis A and hepatitis B.

The CDC is asking doctors to consider adenovirus testing for children with hepatitis without a known cause.

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