State and federal officials are investigating an outbreak of non-viral hepatitis traced to “Real Water” brand bottled water. Health officials are warning the public to not drink the water. The company has not initiated a recall.

Five children were hospitalized in late 2020 in Clark County, but all of them have recovered, according to a Southern Nevada Health District investigation report. The water is apparently still being sold. The health district, based in Las Vegas, received initial reports of the five cases of acute non-viral hepatitis in November 2020.

“The patients lived in four different households. Six additional people have reported experiencing less severe symptoms that include vomiting, nausea, loss of appetite, and fatigue. These patients include three adults and three children,” the health district reported.

The U.S. Food and Drug Administration (FDA) is recommending that consumers, restaurants, and retailers discontinue drinking, cooking with, selling, or serving “Real Water” alkaline water to minimize the risk of contracting liver disease.

An investigation updat this afternoon from U.S. Food and Drug Administration (FDA) says the consumption of “Real Water” brand alkaline water is the only common link identified among all of the patients. Real Water Inc., headquartered in Mesa, AZ, owns the “Real Water” brand of alkaline bottled water.

As of this afternoon, the U.S. Centers for Disease Control and Prevention had not posted any information on its work in the outbreak investigation.

The implicated water was distributed in four states in 5-gallon bottles via home delivery subscriptions and nationwide in smaller containers via online sales, according to the FDA.

The 5-gallon containers are delivered to homes in the following areas, according to the firm’s website:

• Honolulu, HI, through Aloha Water
• Orange County, CA, through Paradise Bottling Co.
• St. George, UT, through Real Water Southern Utah
• Tucson, AZ, through Aqua-Pure
• Ventura and Santa Barbara, CA, through Real Water Gold Coast

Additionally, according to the firm’s website, Real Water is sold in 1 gallon, 500 mL, 1 liter, and 1.5-liter plastic bottles and in a 750 ml glass bottle.

The FDA is investigating the company’s facility, according to the updat today. The agency is in the beginning stages of this investigation, and there may be additional products connected to this outbreak.

The Nevada health district is continuing to monitor for cases of acute non-viral hepatitis.

As part of the state investigation, the regional health district has posted an online survey to obtain information to identify possible sources of the pathogen.

“We are administering this brief questionnaire to ask you about you and/or your household member’s possible exposures, symptoms, and other information relating to this investigation,” the survey page states. “If you and/or your household members had acute non-viral hepatitis-related symptoms after consuming alkaline water, please take this survey.” 

Acute non-viral hepatitis is an inflammation of the liver that can be caused by exposure to toxins. Although, hepatitis can have other causes, according to the state update. Symptoms often include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, or yellowing of the skin or eyes. Anyone who is experiencing these symptoms should contact their health care provider.