Jakarta: Three children 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 US to Asia to at least four.

The children, hospitalised in the capital Jakarta, had symptoms including nausea, vomiting, heavy diarrhoea, fever, jaundice, seizures and loss of consciousness, the ministry said in a statement on 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.

Over the weekend, Singapore also confirmed a case of acute hepatitis in a 10-month-old baby and is investigating whether it has a similar presentation to other cases reported worldwide.

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 Organisation. 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.

Cases were first identified at an Alabama hospital in October 2021, when five children were admitted with liver damage from an unknown cause. Early this year, 10 cases were identified in Scotland. As of April 21, 169 cases had been detected, the WHO said.

Most of them - 114 - were in the UK, with cases also found in Spain, Israel, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania and Belgium. The US Centres for Disease Control and Prevention issued a nationwide health alert, and as of April 28 at least five more US states had confirmed or suspected cases. On April 28, Japan’s health ministry said it found two more probable cases, taking the nation’s tally to three.

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But US health officials have cast doubt on Covid-19 as a potential cause of the disease, while adding weight to the possibility it’s caused by a more common virus linked to stomach ailments.