The Health Ministry has recorded seven suspected deaths linked to acute, severe hepatitis of unknown origin, as well as 17 suspected cases and one probable case as of Friday. Two of the deaths were later determined to be unrelated to the “mystery” hepatitis.

No known comorbidities have been associated with the disease so far, and none of the cases detected in Indonesia to date are confirmed cases of “acute severe hepatitis of unknown origin”, the name of the disease used by the World Health Organization (WHO).

President director Mohammad Syahril of Sulianti Saroso Infectious Diseases Hospital, one of the referral hospitals for testing specimens from suspected cases of acute hepatitis, said it was paramount that parents and caregivers were more vigilant of mild symptoms to prevent death during treatment.

While much remained to be learned about the unknown type of childhood hepatitis, Syahril said the majority of deaths were due to hospitals being unable to do much in treating heavier symptoms.

This was so with the first suspected and fatal cases of the unknown disease detected in three children aged 2, 8 and 11, who were treated for liver inflammation between April 15 to 30 at Cipto Mangunkusumo General Hospital in Jakarta.

The three children, all of whom had been vaccinated against hepatitis and had tested negative for hepatitis types A through E, were referred to Cipto Mangunkusumo from smaller hospitals in East and West Jakarta after they had developed severe symptoms.

Symptoms of acute hepatitis include jaundice (yellowing of the skin), severe diarrhea and loss of consciousness, but health professionals say more attention needed to be given to the onset of milder symptoms like fever, nausea and loss of appetite.

Read also: Govt probes another hepatitis-linked child death as more cases emerge

Parents are urged to bring their children to the nearest hospital or Puskesmas (community health center) as soon as they notice any symptoms, but there is no need to panic. Puskesmas health workers have been equipped with the latest guidelines on testing for and treating acute hepatitis.

“Almost all seven [children] who died were brought to the hospital too late. Some of them had lost consciousness, so the hospitals were unable to provide further treatment," Syahril told a virtual press briefing hosted by the ministry on Friday.

"Do not wait until your children have turned yellow, or for seizures and loss of consciousness before visiting the hospital. Pay attention to lighter symptoms," he stressed.

Although these milder symptoms tended to be mistaken for more common, less deadly ailments, medical professor Tjandra Yoga Aditama from the University of Indonesia said that it was worth overestimating the severity of the underlying disease. It was better to be safe than sorry, he emphasized, since health experts were still gathering more information on the disease.

“We do not yet know the difference between regular fever and hepatitis-related fever. It is safer to bring your child to a hospital the moment they experience discomfort, like a stomachache. This is the precaution we all need to take,” Tjandra told The Jakarta Post on Saturday.

The latest data show that seven out of the 17 suspected cases have now been eliminated, as they had tested positive for other ailments, such as hepatitis A, hepatitis B and dengue.

Read also: Health Ministry investigates mysterious hepatitis that killed three children in Jakarta

Health Ministry spokesperson Siti Nadia Tarmizi said on Friday that the investigation into the remaining suspected cases were continuing to determine whether they were actually hepatitis E.

The origins of this unknown type of acute hepatitis and how it spreads is little understood, but the government is pulling all the stops in raising awareness among health workers and the public on handling suspected cases, with several press events held since late April on the disease.

The ministry has recommended a set of health protocols to prevent the disease’s further spread. These are similar to the COVID-19 health protocols and mainly involve practicing good hygiene, such as regular handwashing with soap and water, mask wearing and social distancing, as well as maintaining good hygiene and sanitation when preparing food.

“Indonesians need to be more alert concerning this matter with regard to detecting symptoms and signs. Parents with children below 16 must especially listen to any complaints of discomfort,” Syahril said.

The ministry said that 90 percent of all suspected cases were detected in children below 16 years, with 5- to 9-year-olds in Jakarta being the most vulnerable population.

Syahril added that the path was still long until vaccines would be available against acute hepatitis of unknown origin, but Indonesian health experts were open to following the United Kingdom’s footsteps in using heart transplants as a possible treatment.