SINGAPORE — Two retrospective cases of a three-year-old and an eight-year-old who developed acute hepatitis of unknown causes in October and November last year, respectively, have been identified in Singapore, said the Ministry of Health (MOH) on Tuesday (31 May).
This brings the total number of such cases in the city-state to three, including a 10-month-old male infant who was announced on 30 April to have the infection. All three cases tested negative for hepatitis type A, B, C, and E viruses – the common viruses that cause hepatitis.
The two older cases were discovered after the completion of a lookback investigation, in which MOH asked all local hospitals with paediatric services to review their patient records for those who have a similar presentation to the cases reported by the World Health Organization (WHO).
Both cases did not have a history of COVID-19 infection prior to their acute hepatitis, and continue to undergo regular follow-ups, said MOH.
The other case, the 10-month-old infant, has been discharged and is currently well. He was previously infected with COVID-19 last year, but MOH stressed then that "there is no evidence at this time" that the acute hepatitis was related to the novel coronavirus.
While the cause of hepatitis in all three cases has not been identified, it may not mean that these cases are linked to the pandemic, according to MOH.
Health authorities around the world are probing a mysterious increase in severe cases of hepatitis, or inflammation of the liver, in young children that have caused at least nine deaths.
As of 26 May, 650 probable cases of acute hepatitis of unknown causes in children from 33 countries – the majority of which are in the UK and US – have been reported to WHO. Of them, at least 38 have required transplants. Another 99 such cases are pending classification.
MOH said it will continue to monitor the situation closely and has informed all medical practitioners to be vigilant when they tend to young children presenting with signs and symptoms of hepatitis with unknown causes.
Hepatitis in young children is not uncommon and it is not unusual for the cause of some cases to remain unknown, according to MOH.
"Thus far, MOH has not observed any unusual increase or pattern in the number of children with hepatitis of unknown cause," it said.
US health officials said last week that infection with adenovirus, a common childhood virus, is the leading hypothesis for recent cases of severe hepatitis of unknown origin in children. Hepatitis linked to this type of adenovirus has almost exclusively been associated with immunocompromised children.
WHO has previously dismissed hypotheses that the disease is related to side effects of the COVID-19 vaccines, saying that most affected children had not been vaccinated.
Symptoms of hepatitis include dark urine, pale and grey-coloured faeces as well as yellowing of the white part of the eyes or skin, or jaundice. Other symptoms also can include itchy skin, muscle or joint pain, fatigue, abdominal pain, or loss of appetite.
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