Global Mystery Hepatitis Outbreak, Three Children Died in Jakarta

Arfi Bambani
Illustration: A child attending the integrated health post, or Posyandu, in Masawah village in West Java. (Photo: Masawah Village Government)
Illustration: A child attending the integrated health post, or Posyandu, in Masawah village in West Java. (Photo: Masawah Village Government) - The Indonesian Ministry of Health appealed to the Indonesian people to be aware of acute hepatitis after three pediatric patients were treated at the Dr. Ciptomangunkusumo Jakarta with the suspicion of the disease died. In a written statement received in Jakarta, Sunday, the cause of the three children suspected of having acute hepatitis is unknown.

They died in different periods, ranging from the last two weeks to April 31, 2022. These three patients were referrals from hospitals in East Jakarta and West Jakarta. Symptoms found in these patients are nausea, vomiting, severe diarrhea, fever, jaundice, convulsions, and loss of consciousness.

Currently, the Indonesian Ministry of Health is investigating the causes of acute hepatitis through a complete virus panel examination. The Special Capital Region of Jakarta Health Office is conducting further epidemiological investigations.

"During the investigation period, we urge the public to be careful and remain calm. Take precautions such as washing hands, ensuring food is cooked and clean, not changing eating utensils, avoiding contact with sick people, and continuing to implement health protocols," said Ministry of Health Spokesperson Siti Nadia Tarmizi.

If children have symptoms of jaundice, abdominal pain, sudden vomiting and diarrhea, old tea-colored urine, pale stools, seizures, and decreased consciousness, they should immediately check the child to the nearest health service facility, said Nadia. Since it was officially published as an outbreak by WHO, the number of reports has continued to grow, with more than 170 cases reported by more than 12 countries.

WHO first received a report on 5 April 2022 from the United Kingdom regarding 10 cases of Acute Hepatitis of Unknown Etiology in children aged 11 months-5 years in the period January to March 2022 in Central Scotland. The range of cases occurred in children aged 1 month to 16 years. Seventeen of them (10 percent) required a liver transplant, and 1 case died.

Clinical symptoms in the identified cases were acute hepatitis with elevated liver enzymes, acute jaundice (jaundice) syndrome, and gastrointestinal symptoms (abdominal pain, diarrhea, and vomiting). In most cases, there are no symptoms of 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. Adenovirus was detected in 74 cases abroad which after molecular tests were identified as F type 41. SARS-CoV-2 was found in 20 cases, while 19 cases detected co-infection of SARS-CoV-2 and adenovirus.

The Ministry of Health through the Director-General of Disease Prevention and Control issued Circular Letter Number HK.02.02/C/2515/2022 Concerning Precautions for Finding Cases of Acute Hepatitis of Unknown Aetiology dated 27 April 2022. The Circular is intended to increase the support of the Regional Government, health service facilities, the Port Health Office, health human resources (HR), and stakeholders related to early vigilance of the discovery of cases of Acute Hepatitis of Unknown Etiology.

The Ministry of Health asked the Provincial and District/City Health Offices, Port Health Offices, Public Health Laboratories, and Hospitals to, among other things, monitor and report cases of acute jaundice syndrome in the Early Alert and Response System (SKDR), with symptoms marked by discolored skin and sclera. Jaundice or yellow and dark urine that appears suddenly and provides Communication, Information, and Education (IEC) to the community as well as prevention efforts through the implementation of Clean and Healthy Living Behavior.

The Ministry of Health also asks related parties to inform the public to immediately visit the nearest Health Service Facility (Fasyankes) if they have Yellow Disease syndrome, and build and strengthen surveillance networks across programs and sectors. "Of course, we are strengthening surveillance through cross-programs and cross-sectors so that immediate action can be taken if cases of acute jaundice syndrome are found or those with symptoms such as hepatitis symptoms," said dr. Nadia.

The Health Office and Hospitals are also asked to immediately provide notification/ report if there is an increase in cases of acute jaundice syndrome or find cases according to operational definitions to the Director-General of Disease Prevention and Control through Public Health Emergency.

Tag # acute hepatitis # global mystery hepatitis outbreak # hepatitis outbreak in indonesia # hepatitis outbreak in jakarta # indonesia disease # indonesia health issues # disease

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