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A recent cluster of unexplained hepatitis cases among children in multiple countries has prompted health officials in Minnesota to alert parents for signs of liver inflammation in their kids, especially after bouts with either upper respiratory or stomach-intestinal illnesses.

The Minnesota Department of Health says epidemiologists are investigating three Minnesota children under the age of 3 who had liver inflammation and may be part of a national cluster of hepatitis in children.

Signs of liver inflammation can include yellowing of the eyes or skin, sometimes known as jaundice. Cases are rare among children, however, in about 10% of the seemingly unexplained cases of liver inflammation, it has led to liver failure and need of a transplant.

Earlier Friday, the Centers for Disease and Control provided an update on the cases, which currently stands at 109 suspected cases in 25 states. Five of those cases, all children, died.

Among the national cases, most children have reportedly experienced vomiting and diarrhea, while some experienced upper respiratory symptoms.

The mystery goes back to November, when Alabama health officials began looking into the first of nine cases of severe hepatitis in children in that state. None tested positive for the viruses that commonly cause hepatitis. However, testing was positive for adenovirus.

None of the Alabama children were vaccinated against COVID-19, and the vaccine has since been ruled out as a possible cause, with Dr. Jay Butler of the CDC saying: "We hope this information helps clarify some of the speculation circulating online."

Overall, at least 228 probable cases in 20 countries have been identified, according to the World Health Organization. Most of the cases were found in the United Kingdom, according to the BBC.

Health officials believe the hepatitis may be associated with infection with a type of virus known as adenovirus type 41. Some reports of the illness date back to fall of last year, with it affecting children under the age of 10. There are currently no specific treatments for adenovirus infections, but they are a common virus and the vast majority of those who contract it will not get particularly sick, Bring Me The News reported last week.

However it's believed that some children are reacting more severely to the adenovirus because they've been exposed to it for the first time when they're a little older, owing to periods spent in COVID measures where they were exposed to fewer viruses.

“If your child recently had vomiting and diarrhea or symptoms of a common cold and then develops yellowing of the eyes and skin, it is important to have your child evaluated by a health care provider right away,” said Minnesota Epidemiologist Dr. Ruth Lynfield.

"Other symptoms can include abdominal pain, fatigue, dark urine and clay-colored stools. Getting medical care quickly can help diagnose and treat the condition as needed.”

Among the Minnesota cases, MDH says one child required a liver transplant and has since recovered, while the other two cases recovered without a transplant. The department is aware of at least two other others with possible cases at Minnesota hospitals who are not residents of the state. 

“We’re grateful for the reports we’ve received from clinicians so far and look forward to continuing to work with them in this investigation,” Dr. Lynfield said in a statement. “The more information we can gather, the faster we can help determine how best to protect other children.”

While the investigation on the mysterious illness is still underway, health officials are advising to use general prevention measures. This includes hand washing; avoid touching eyes, nose or mouth with unwashed hands, covering coughs and sneezes; and avoiding close contact with people who are sick.

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