Three children in Indonesia have died from a mysterious hepatitis that, if confirmed, would raise the global death toll to at least four.
The country’s health ministry said the victims died of “suspected acute hepatitis” last month and were all located in the capital of Jakarta.
His symptoms included nausea, vomiting, severe diarrhea, fever, jaundice, seizures and loss of consciousness, all telltale signs of the deadly liver disease.
Tests are underway to confirm the cause of his death. Indonesia has not officially recorded any cases of hepatitis since the outbreak began.
The children’s ages have not been released and it is unclear if they had underlying health conditions.
More than 200 cases of childhood hepatitis of unknown origin have been confirmed worldwide in the mysterious outbreak, which experts say is just the “tip of the iceberg.”
Most of the cases have been detected in the UK and US, which have some of the strongest surveillance systems.
The World Health Organization has confirmed one death, although it did not disclose the location. One death in the US is being investigated, along with the three in Indonesia. At least 18 of the young people have required liver transplants.
None of the cases tested positive for the normal viruses that cause hepatitis, which has left scientists puzzled over the origins of the disease.
A virus that normally causes the common cold, known as adenovirus, is thought to be involved.
But there are a number of theories as to why the normally harmless virus is causing critical illness in previously healthy young children.
More than 200 children have been sickened by the condition worldwide in as many as 14 countries since last October *cases in Canada, Japan, and Wisconsin, Illinois, and New York have yet to be confirmed.
The Indonesian Ministry of Health urged parents to be vigilant for symptoms of the disease, which include jaundice (yellowing of the skin and whites of the eyes), as well as abdominal pain, vomiting, diarrhea and dark-colored urine. .
It has instructed people to seek medical attention if their child develops symptoms and encouraged its population to practice good hand hygiene, make sure food is clean and well cooked, and avoid contact with sick people.
Q&A: What is the mysterious global hepatitis outbreak and what’s behind it?
What is hepatitis?
Hepatitis is inflammation of the liver that is usually caused by a viral infection or liver damage from drinking alcohol.
Some cases resolve on their own, with no ongoing problems, but a fraction can be fatal, forcing patients to need liver transplants to survive.
Why do the experts care?
Hepatitis is usually rare in children, but experts have already detected more cases in the current outbreak than would normally be expected in a year.
The cases are of “unknown origin” and are also serious, according to the World Health Organization. It has caused at least one death and 18 liver transplants.
How widespread are the cases?
The inflammatory condition of the liver has been detected in more than 200 children between the ages of one month and 16 years.
less than five
*no cases have yet been confirmed in Canada, Japan, and Illinois, Wisconsin, and New York
What could be triggering?
None of the cases have been caused by any of the five typical strains of the virus (hepatitis A, B, C, D and E), leaving experts baffled by the outbreak.
Some children have tested positive for adenovirus, which usually causes a cold, while others have been infected with covid, but no clear issue has emerged.
The UKHSA has ruled out the Covid vaccine as a possible cause, and none of the British cases so far have been vaccinated due to their age.
What are the symptoms?
Hepatitis often has no noticeable symptoms, but they can include dark urine, pale gray stools, itchy skin, and yellowing of the eyes and skin.
Infected people may also experience muscle and joint pain, high fever, nausea, and be unusually tired all the time.
How is it treated?
Treatment depends on severity, and some patients can fight the disease on their own.
In more dangerous cases where the liver fails, children can go into induced comas to deal with brain swelling caused by ammonia buildup.
A liver transplant may be necessary if the liver has been damaged to repair itself, although this is incredibly rare.
Authorities are investigating the cause and analyzing the epidemiology of the outbreak, the ministry said.
UK health chiefs believe adenovirus may be behind cases of sudden-onset hepatitis.
The 145 affected children in Britain, most of whom were five years old or younger, initially suffered from diarrhea and nausea, followed by jaundice.
But the UK Health Security Agency (UKHSA) said it is not typical to see this pattern of symptoms in adenovirus, so it is still investigating other causes, including Covid itself.
He also noted that the lockdowns may have weakened the children’s immunity and made them more susceptible to the virus, or it may be a mutated version of the adenovirus.
The UK agency is working with scientists and doctors across the country to “answer these questions as quickly as possible”.
Indonesia did not impose a nationwide lockdown, but instead implemented local restrictions that forced people to work from home, attend school online, and not dine in restaurants.
Experts are also investigating whether a new coronavirus variant is responsible or whether it could be a case of previous or concurrent Covid infection.
Dr Meera Chand, UKHSA’s director of clinical and emerging infections, said parents may be concerned, but the chance of their child developing hepatitis is “extremely low”.
“However, we continue to remind parents to watch for signs of hepatitis, particularly jaundice, which is most easily detected as a yellow tint to the whites of the eyes, and to contact their doctor if they are concerned. “, said.
Dr. Chand added: “Normal hygiene measures, including thorough handwashing and making sure children wash their hands properly, help reduce the spread of many common infections.”
“As always, children experiencing symptoms such as vomiting and diarrhea should stay home and not return to school or daycare until 48 hours after symptoms have resolved.”
Hepatitis is usually rare in children, but experts have already detected more cases in the UK since January than would normally be expected in a year.
The cases are of “unknown origin” and are also serious, according to the World Health Organization.
Scientists have previously suggested that the cases could just be the ‘tip of the iceberg’, with more likely to be out there than has been seen so far.
Professor Alastair Sutcliffe, a leading pediatrician at University College London, told MailOnline that health chiefs may not know the cause until later this summer.
He said: “With modern methods, informatics, advanced computing, real-time PCR and whole-genome screening, I think it will take three months to find the cause with reasonable reliability.”
Professor Sutcliffe said discovering the cause could be slowed down by bureaucracy across international borders, with difficulties in transporting biomaterials between countries.
Parental consent, data protection and laws regulating the use of human tissue in the UK could act to delay research, it said.
Searching for an unknown cause is especially difficult because cases can have multiple factors behind them that are not consistent across diseases.
UK health officials have ruled out the Covid vaccine as a possible cause, and none of the sick British children have been vaccinated due to their young age.
Liver experts described the spate of cases as “worrying” but said parents should not worry about the disease affecting their children.
An official from the European Center for Disease Prevention and Control (ECDC) said the disease was “quite rare” but considered the risk to children “high” due to the potential impact.
The risk to European children cannot be accurately assessed as evidence of human-to-human transmission was unclear and cases in the European Union were “sporadic with an unclear trend,” it said.
But given the unknown causes of the illness and the potential severity of the illness caused, the ECDC said the outbreak “constitutes a public health event of concern.”
The rise in hepatitis cases was first recorded in Scotland on March 31, with a child hospitalized in January with the condition. The Scottish case dates back to January.
WHAT IS CAUSING HEPATITIS CASES?
Experts say the cases may be linked to the adenovirus, commonly associated with colds, but further investigation is underway.
This, in combination with covid infections, could be causing the rise in cases.
The adenovirus reported by the WHO has been detected in at least 74 of the cases. At least 20 of the children have tested positive for the coronavirus.
British experts tasked with investigating the onslaught of disease believe the endless cycle of lockdowns may have contributed.
The restrictions may have weakened children’s immunity due to reduced social mixing, leaving them at higher risk of contracting adenoviruses.
This means that even ‘normal’ adenovirus could be causing serious outcomes, because children are not responding as they did in the past.
Other scientists said it may have been the adenovirus that acquired “unusual mutations.”
This would mean that it could be more transmissible or more able to circumvent the natural immunity of children.
New Covid variant
UKHSA officials included ‘a new variant of SARS-CoV-2’ in their working hypotheses.
Covid has caused liver inflammation in very rare cases during the pandemic, although these have been in all ages rather than isolated in children.
The UKHSA has noted that environmental triggers are still being investigated as possible causes of the illnesses.
These could include contamination or exposure to particular drugs or toxins.