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Spain reported its first two deaths in children from acute hepatitis, or inflammation of the liver – an illness that has unknown causes and is being monitored by world health authorities.

Spain has reported 46 cases of the illness, three requiring liver transplants, Spain’s health ministry said.

Of the three transplant patients, two died — a 15-month-old baby in June and a 6-year-old baby in July.

A woman and her 7-month-old son are waiting for a liver transplant.

A woman and her 7-month-old son are waiting for a liver transplant.
(Juancho Torres/Anadolu Agency via Getty Images)

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The ministry said in a statement on Thursday that 21 countries in Europe had reported 507 cases as of July 28, of which 273 were in Britain.

The pediatrician vaccinates the child with the 6-way combination vaccine against diphtheria, tetanus (tetanus), polio, pertussis, Haemophilus influenza type B (Hib) and hepatitis B.

The pediatrician vaccinates the child with the 6-way combination vaccine against diphtheria, tetanus (tetanus), polio, pertussis, Haemophilus influenza type B (Hib) and hepatitis B.
(Julian Stratenschulte/dpa (Photo by Julian Stratenschulte/Image alliance via Getty Images))

At least 180 cases and six deaths have been reported in the United States.

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Health officials are puzzled by the causes of hepatitis and say the best available evidence points to a stomach bug that can cause liver problems in otherwise healthy children.

Spain said it had begun closely monitoring the situation after Britain alerted the World Health Organization following a surge in cases.

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The ministry said so far it has not observed an increase in the number of cases of this type of hepatitis compared to estimates made with previous years’ data.