More Unusual Child Hepatitis Cases In Malaysia Possible

Unusual Child Hepatitis Cases in Malaysia: Potential Rise Amid Global Increase

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The rise in mystery severe hepatitis in the UK and US means more cases are conceivable in Malaysia, which has confirmed one case.


Dr. Amar-Singh HSS, a senior consultant paediatrician and researcher, told CodeBlue that while it is difficult to speculate the potential spread of the serious liver disease due to its unknown cause, the significant increase in cases in the UK and the US suggests that many "more cases are possible" in Malaysia.

The World Health Organization (WHO) revealed on May 10 that over 348 probable instances of acute hepatitis in children have been documented in 21 countries, with 26 requiring liver transplants. 15 countries have five or fewer cases. Malaysia isn't on the WHO's probable case list.

On May 6, the MOH reported severe hepatitis in a 4-year-old boy in Sabah who had no underlying condition save Covid-19 infection. Investigations are ongoing to ascertain if this is a case of acute hepatitis of "unknown origin" reported globally.


The 4-year, 11-month-old Malaysian youngster with liver inflammation had jaundice, fever, lack of appetite, nausea, and vomiting. He sought care in Sabah last March and had a liver transplant on March 30 in the Klang Valley as his health deteriorated. On April 21, he was discharged healthy.

The liver transplant team at UMMC and Dr. Alvin Khoh from Gleneagles Hospital in Kota Kinabalu later linked their patient's severe acute hepatitis to Covid-19 infection problems.

Severe acute hepatitis in children is rare, although experts disagree on the disease's link between Covid-19 and adenovirus, a common organism that causes respiratory sickness. The WHO has confirmed adenovirus in at least 74 instances as of April 21, 2022.


Dr. Amar said attributing severe hepatitis of unknown origin to adenovirus doesn't explain the severity of the clinical presentation.

He emphasised that adenovirus-related severe hepatitis usually affects immunocompromised children, not healthy ones. Dr. Amar added 75% of the children suspected of having acute, severe hepatitis are young and healthy.

Covid-19 vaccinations can be ruled out as a cause of these acute paediatric hepatitis cases, but Dr. Amar said it's still possible they played a role.


Dr. Amar mentioned a recent study by Japanese experts that looked at the association between accumulated Omicron instances and severe child hepatitis cases.

"They propose we explore 'the potential that Omicron infection is linked to severe hepatitis in infants.'" It's too early to speculate on a reason or several causes, Dr. Amar said.

Pantai Hospital Ampang's Dr. Chieng Jin Yu disagrees. Dr. Chieng informed CodeBlue that Covid-19 children seldom had severe hepatitis, making the notion improbable.


"Covid-19 infection is 'hot' nowadays. These hepatitis cases aren't linked to Covid-19. Only 16% of UK cases had an ongoing Covid-19 infection, Dr. Chieng stated.

Dr. Chieng also denied any ties between child hepatitis disease and the Covid-19 immunisation.

Some Covid-19 vaccines, which are adenoviral, use a modified variant of adenovirus 26 or ChAdOx1, which may cause the common cold. This viral strain is distinct from the one discovered in young children, Dr. Chieng noted.


Oxford and AstraZeneca produced the ChAdOx1-S recombinant Covid-19 vaccination. Johnson & Johnson's Janssen Covid-19 Vaccine is an Ad26-vectored vaccine.

Convidecia is CanSino Biologics' modified Ad5 vaccination. Gamaleya Institute's Sputnik V vaccination uses Ad5 and another adenovirus.

In England and Scotland, 75% and 50% of patients tested positive for adenovirus, with type 41 found in several cases.


Adenovirus causes respiratory (cough, runny nose, sore throat) and GI symptoms (vomiting and diarrhoea). Dr. Chieng said they're usually short-lived and seldom become serious.

"Adenovirus hasn't been verified as the cause of this unusual severe acute hepatitis," Dr. Chieng said.

Dr. Chieng is also investigating whether Covid-19 lockdowns impaired children's immunity by reducing pathogen exposure. More research and data are needed to confirm.

Dr. Chieng expects the MOH to monitor the unexplained sickness in the country and work closely with WHO, despite insufficient worldwide knowledge.

He urged daily hand washing and respiratory hygiene to prevent adenovirus and other illnesses.

Dr. Amar added the MOH and public should be vigilant about hepatitis signs and seek early medical care.

Dr. Amar advised protecting children against Covid-19 infection while the reason is unknown.

180 paediatric instances of acute hepatitis of unknown origin were reported to the CDC by May 18.

The CDC said adenovirus has been discovered in nearly half of the children and "remains a strong lead." Further lab tests are being undertaken to check the virus genome and other possible infections, such as Covid-19.

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