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HUNTSVILLE, Ala. (WHNT) — The Centers for Disease Control and Prevention (CDC) have identified children across the United States infected with acute cases of hepatitis. In many of the cases, the pediatric patients are hospitalized and some require liver transplants.

The investigation began in Alabama when nine children were diagnosed with hepatitis with no common cause. The CDC issued a nationwide health alert in April.

“Much like detective work, the CDC investigators and our colleagues in the state and local health departments are methodically but as quickly as possible gathering evidence to find clues,” said CDC Deputy Director for Infectious Disease Dr. Jay Butler.

In early May, the CDC’s investigation included 109 children. Now, the number has risen to 180 cases across 36 U.S. states and territories. The cases were identified between October 2021 and February 2022 in patients under the age of 10.

Roughly half of the children identified by the CDC have tested positive for adenovirus 41, which commonly presents with gastrointestinal problems. Investigators are considering this virus as the leading theory behind the cause of the hepatitis outbreak.

“We continue to keep looking for additional causes beyond just adenovirus,” Butler said. “This included whether a path of infection with SARS Coronavirus 2 could be contributing or whether any of the patients under investigation met the criteria for the multi-system inflammatory syndrome in children.”

Because the majority of the children with hepatitis were too young to receive a COVID vaccination, the CDC has ruled it out as a factor in the outbreak. However, the CDC still considers that COVID-19 infection may play a role in the outbreak.

Health officials recommend taking precautions with your children to avoid hepatitis including washing your hands, avoiding people who are sick, and covering your mouth when coughing or sneezing.