Jakarta (Indonesia Window) – The Indonesian Health Ministry has increased its vigilance since recent days after the World Health Organization (WHO) declared an extraordinary event in the case of acute hepatitis that affects children in Europe, America and Asia as the cause has not been known since April 15, 2022.

The vigilance increased after three children who were treated at the Dr. Cipto Mangunkusumo hospital in Jakarta with suspected acute hepatitis have died in a different time period until April 30, 2022, according to an official statement from the Health Ministry recently.

The three patients were referred by hospitals in East Jakarta and West Jakarta, the ministry said, adding that the symptoms found in these patients were nausea, vomiting, severe diarrhea, fever, jaundice, seizures and decreased consciousness.

Since it was officially published as an outbreak by WHO, the number of reports has continued to grow, and currently more than 170 cases have been reported by more than 12 countries.

WHO first received a report on April 5, 2022 from the United Kingdom regarding 10 cases of acute hepatitis of unknown etiology in children aged in the range between 11 months and five years in the January-March period 2022 in Central Scotland.

Clinical symptoms in the identified cases were acute hepatitis with elevated liver enzymes, acute jaundice syndrome, and gastrointestinal symptoms (abdominal pain, diarrhea and vomiting), and most cases did not have fever.

The cause of the disease is still unknown. Laboratory tests abroad have been carried out and hepatitis A, B, C, D and E viruses were not found to be the cause of the disease.

The government through the Health Ministry and the Jakarta Health Office has conducted a contact investigation to determine the risk factors for the three cases of acute hepatitis in children, the Health Ministry’s Spokesperson Siti Nadia Tarmizi said in a press statement in Jakarta on Thursday (May 5).

''Based on the results of the contact investigation of the death cases, the three patients came to a health facility in an advanced stage, so health workers only had a little time to take rescue actions,'' Nadia said.

In the three cases, the two-year-old child has received hepatitis vaccination, the eight-year-old child has received a COVID-19 vaccination once and a complete hepatitis vaccine, and the 11-year-old child has received a complete COVID-19 and hepatitis vaccinations, and all the three were negative for COVID-19.

Based on the results of the investigation, it was also found that one case had co-morbidities.

"Until now, we cannot classify these three cases as acute hepatitis with severe symptoms, but they are included in the pending classification criteria because there are still laboratory tests that must be carried out, especially adenovirus examination and hepatitis E examination which takes between 10 to 14 days,'' Nadia said.

In addition, there were no history of hepatitis from other family members of the three children, and no other family members who had the same symptoms were found, she said, explaining that the main complaints were of the gastrointestinal tract, nausea, vomiting, and severe diarrhea.

The Health Ministry also revealed that there was no link between COVID-19 vaccination and acute hepatitis whose cause was unknown in children, the lead scientist for this case, Prof. dr. Hanifah Oswari, said at a press statement in Jakarta on Thursday (May 5).

"This is not true that the cases are related to the COVID-19 vaccine, because at this time there is no evidence that they are related to the COVID-19 vaccination," Hanifah stressed.

Reporting by Bambang Purwanto