Update on Acute Hepatitis: Tulungagung Case Still in Pending

TEMPO.CO, Jakarta - The Ministry of Health reports on the latest developments in acute hepatitis cases in Indonesia. The latest is the case of a seven-year-old girl in Tulungagung, East Java, who is thought to have died from acute hepatitis.

Spokesperson for the Ministry of Health, Siti Nadia Tarmizi, said that the case in Tulungagung is currently still in the Pending Classification. He said testing at the serology laboratory for this case had begun.

"Yes, but there is still an examination of hepatitis E type which is still under examination," he said when contacted, Sunday, May 8, 2022.

Tulungagung Case

Last Saturday, May 7, 2022, the news of a girl's death was announced by the Head of the Tulungagung District Health Office, Kasil Rokhmat. This child patient had received intensive care at the RSUD dr. Isaac Tulungagung (public hospital).

Its clinical characteristics are identical to those of hepatitis, but what causes it and where it comes from is not yet known. According to Kasil, the laboratory results did not detect any hepatitis A, B, C, D, or E viral infections in the child.

Positive confirmation of mysterious acute hepatitis, he added, had been given in accordance with the criteria of the Ministry of Health and the World Health Organization (WHO). The criteria include symptoms of jaundice, patients under 10 years of age, and no other causes.

Other symptoms that appear are fever, diarrhea, darker colored urine and pale stools. Kasil also said that this case started when the child had a fever and was vomiting for about four days.

First Three Cases

Previously in Tulungagung, there were three cases of acute hepatitis in children. The Ministry of Health first reported it on May 1, 2022 after three pediatric patients died after being treated at RSUPN Dr. Ciptomangunkusumo (National Central General Hospital), at Jakarta, with suspected acute hepatitis whose cause is not yet known.

Finally, on May 5, Siti Nadia Tarmizi, also explained that these three cases could not be classified as acute hepatitis with severe symptoms.

All three are included in the Pending Classification criteria because there are still laboratory tests that must be carried out. Especially the examination of adenovirus and hepatitis E examination which takes time. "Between the next 10 to 14 days," said Nadia.

When confirmed today, Siti Nadia also confirmed that the status of the first three cases had not changed, namely Pending Classification. "Yes (still pending)," he said.

Three Cases Classification

Former Director of Infectious Diseases of the World Health Organization (WHO) Southeast Asia, Tjandra Yoga Aditama, explained the three WHO classifications of severe acute hepatitis cases that are now being reported in various countries.

The first classification is the confirmed cases of which are clearly stated that there is no definition yet. This classification occurs because until now the world does not know for sure what causes hepatitis that is currently spreading.

The second classification is Probable, namely patients who show symptoms of acute hepatitis (without the presence of hepatitis A to E viruses). Then, this patient also had a serum transaminase level >500 IU/L (AST or ALT), who was under 16 years old, occurring since October 2021.

The third classification is Epi-linked or there is an epidemiological relationship. Conditions that fall into this group are someone who shows symptoms of acute hepatitis (without the presence of hepatitis A to E viruses). "Any age, those who have close or direct contact (close contact) with the Probable case," said Tjandra.

In addition to the three classifications above, he said, WHO gives special notes if the patient has symptoms and complaints according to hepatitis. However, the results of the serology laboratory to detect viruses A to E are not yet available and are still being awaited. "So it can be called a Pending Classification," he said regarding cases of acute hepatitis.

Read: IDAI Responds to Issue that Links Acute Hepatitis Cases with Covid-19 Vaccine

FAJAR PEBRIANTO