Three children died of acute hepatitis in Indonesia last month

Three pediatric patients in Indonesia died from acute hepatitis in April, the country’s health ministry said, boosting the global death toll from the mysterious liver ailment affecting children from the U.S. to Asia to at least four.

The children, hospitalized in the capital Jakarta, had symptoms including nausea, vomiting, heavy diarrhea, fever, jaundice, seizures and loss of consciousness, the ministry said in a statement Monday. It is urging parents to immediately bring children who exhibit these symptoms to the hospital.

The ministry is running a full panel of tests to determine the cause of the disease and has issued a circular to step up nationwide surveillance for the illness, it said.

Earlier, Singapore confirmed a case of acute hepatitis in a 10-month old baby and is investigating to see if it has a similar presentation to other cases reported around the world.

Laboratory testing has determined the case to be negative for the common viruses that cause hepatitis — type A, B, C and E viruses — the city state’s Ministry of Health said in an emailed statement. The baby has a previous history of COVID-19 in December, although there’s no current evidence that the acute hepatitis is related to coronavirus.

At least one other child has died from acute hepatitis, and more than a dozen others globally have undergone liver transplants after coming down with the disease, according to the World Health Organization. While the cause of the sickness is yet to be determined, investigators are studying a family of pathogens called adenoviruses that cause a range of illnesses including the common cold.

As of April 21, 169 cases had been detected, the WHO has said. Most of them were in the U.K., as well as some in countries including Spain, Israel, the U.S. and other nations in Europe. Japan also has said it found some probable cases last week.

U.S. health officials have cast doubt on COVID-19 as a potential cause of the severe hepatitis cases, while adding weight to the possibility that they may be caused by the more common virus linked to stomach ailments.