Jakarta. The doctors association has called on all medical professionals in Indonesia to increase alert for any symptoms of hepatitis in children and adults after three children died of acute hepatitis of unknown etiology last month. 

"All doctors and health workers serving in various types of first-level health facilities, namely public health centers (puskesmas), integrated health centers (posyandu), clinics, independent practice, as well as private practice doctors, need to be aware of any symptoms of hepatitis in children and adults," General Chairperson of the Executive Board of the Indonesian Doctors Association (IDI) M. Adib Khumaidi said in a statement on Tuesday. 

Adib's calls came after the Ministry of Health announced on Monday that three pediatric patients had died of suspected acute hepatitis after receiving treatment at Dr. Cipto Mangunkusumo National Central Public Hospital in Jakarta last month.  

Acute hepatitis, whose cause is still unknown, has symptoms, including the color of urine becoming darker while stool becoming pale. The patients would experience nausea, vomiting, severe diarrhea, fever, jaundice, convulsions, and loss of consciousness.  

Also, tests for the concentration of two enzymes found in the liver, aspartate aminotransferase (AST) and alanine transaminase (ALT), in the patient's blood would result in readings of above more than 500 microliters (μl), indicating liver damage.

Laboratory examinations would not detect the presence of Hepatitis A, B, C, D, and E viruses in acute hepatitis patients. Instead, in some cases, SARS-CoV-2 adenovirus was found.

The World Health Organization (WHO) has declared acute hepatitis an extraordinary event. The organization was first alerted to acute hepatitis of unknown etiology on April 5, concerning ten cases in children aged 11 months to 5 years in Central Scotland, the United Kingdom. 

"Since it was officially published as an outbreak by WHO, the number of case reports has continued to grow, with more than 170 cases reported by more than 12 countries," Adib said. 

IDI and the Indonesian Pediatrician Association (IDAI) appealed to all health workers and the public, especially parents with small children, to strictly adhere to health protocols, especially during this Idul Fitri homecoming period.

More than 85 million Indonesians travel to their hometown across Indonesia to celebrate the Islamic holiday with their extended families this year, providing an ideal condition for a transmissible disease to spread across the country.  

Currently, the Indonesian Ministry of Health is trying to investigate the causes of acute hepatitis through a complete virus panel examination. The Jakarta Provincial Health Department is conducting further epidemiological investigations.

“During the investigation period, we urge the public to remain calm and careful. Take preventive measures such as washing hands, ensuring food is cooked and clean, not changing eating utensils, avoiding contact with sick people, and implementing health protocols," Siti Nadia Tarmizi, the ministry's spokeswoman, said. 

The ministry had asked the provincial and district health departments, port health offices, public health laboratories, and hospitals to monitor and report cases of acute jaundice syndrome to the Early Alert and Response System (SKDR), Indonesia's early disease detection system. 

"We are strengthening surveillance to ensure we take immediate action once acute jaundice syndrome or other hepatitis symptoms are found,"  Nadia said.