The Wisconsin Department of Health Services is investigating at least four cases in children, including one who needed a liver transplant and one who died. The four children also tested positive for adenovirus, according to DHS. “Hepatitis can be very serious,” said Dr. Greg DeMouri, a professor at the University of Wisconsin School of Medicine and Public Health. Specializes in pediatric infections. “Hepatitis is a liver infection or inflammation of the liver and is usually caused by a virus.” SIGN UP TODAY: Receive daily headlines, breaking news emails from FOX6 News Doctors know this. What they do not know is why they see more hepatitis in children that may be related to adenovirus. DeMuri described the adenovirus as a common cold. The specific type that is potentially associated with recent cases of hepatitis, adenovirus 41, often causes gastrointestinal problems. He said it has been known to cause hepatitis in the past. “It’s just a really rare thing and I’ve only seen a few cases,” he said, adding that it is usually in children with weakened immune systems. “The new part of it really is that it infects healthy kids and they seem to be taller than we expected.” According to a health warning from DHS in Wisconsin, the agency began its own investigation after learning of a group of nine children in Alabama with significant liver damage who also tested positive for adenovirus. Three ended up with acute liver failure and two required liver transplants. All the children were previously healthy. As of April 21, the World Health Organization reported 169 cases of acute hepatitis in children from 12 countries of unknown origin. The WHO reports that in 10% of cases, the children needed liver transplants. FREE DOWNLOAD: Receive breaking news notifications in the FOX6 News app for iOS or Android. “Not everyone with hepatitis would normally have an adenovirus test, but now clinicians need to know how to do it,” DeMuri said. DHS has issued a health network alert so clinicians can test and report. DeMuri said some of his colleagues at the university are also considering how to go deeper than normal blood tests to get to the cause. “We need to know: Is this a mutated virus, a variant, if you will, that is more contagious and more likely to cause liver infection or is it just a coincidence?” said DeMuri. “These do not appear to be hepatitis A, B or C – some of the other hepatitis B viruses in letters as we call them have been ruled out. Hepatitis A cases are well known and something we can treat. There is a vaccine for them, but this is not related to any of these viruses. “ Wisconsin Department of Health Services DHS Demuri said at the moment, most of the concern comes from the unknown. “If you’re the average parent in Wisconsin, I would say do some smart things to make sure your kids are healthy, but I do not think you should put so much on your radar for things that concern you. ” he said. While monitoring children for symptoms of hepatitis, such as jaundice, fever, fatigue and intestinal problems, Demuri said it was important to inform children about hepatitis A and B vaccines. The Milwaukee City Health Department said it expects more information from the state as it learns more.