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The Vietnam's Ministry of
Health has ordered authorities in all border localities along Cambodia to step
up quarantine measures to prevent any spread of the mysterious disease that has
been killing scores of children in Cambodia.
Dr. Nguyen Van Binh, head of the Department of Preventive Medicine, said on July 11 that the unidentified disease in Cambodia is targeting mostly young children and hence local authorities must remain vigilant to stop its spread into Vietnam... http://www.saigon-gpdaily.com.vn/Health/2012/7/102031/ |
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Thursday, July 12, 2012
Vietnam's Health Ministry orders quarantine along Cambodia border
8000 ostriches face slaughter after flu outbreak
12 July, 2012 08:04
Infected ostriches were found on a farm near Albertinia and on two farms near Heidelberg two weeks ago, The Cape Times reported on ThursdayAll birds found on an infected farm had to be killed as part of the government's "stamping out" policy.
The industry had recently stated it had brought the H5N2 disease in the province under control and was a step closer to having its export status re-instated. The European Union had banned all exports since last April... http://www.timeslive.co.za/local/2012/07/12/8000-ostriches-face-slaughter-after-flu-outbreak
Vietnam ups effort to prevent mysterious Cambodia disease
12/07/2012
VietNamNet Bridge – The Vietnamese Health Ministry’s Preventive Health Department has urged authorities in all localities bordering Cambodia to strengthen their health quarantine systems to prevent penetration of the unidentified disease that has killed 56 Cambodian children...
..In order to prevent the disease from spreading to Vietnam, the department requested that the heads of the international health quarantine centers and local health departments, especially those in localities bordering Cambodia, tighten border the health quarantine system to detect the disease.
All concerned agencies must closely supervise people entering Vietnam from Cambodia, and if, or when, a suspect case is found, isolation can be applied to prevent its spread, the department said.
Health units should also coordinate with relevant agencies at border gates in examining animals and animal products that are brought into Vietnam...
http://english.vietnamnet.vn/en/society/24756/vietnam-ups-effort-to-prevent-mysterious-cambodia-disease.html
All concerned agencies must closely supervise people entering Vietnam from Cambodia, and if, or when, a suspect case is found, isolation can be applied to prevent its spread, the department said.
Health units should also coordinate with relevant agencies at border gates in examining animals and animal products that are brought into Vietnam...
http://english.vietnamnet.vn/en/society/24756/vietnam-ups-effort-to-prevent-mysterious-cambodia-disease.html
Wednesday, July 11, 2012
Check carrier this year, the dead bird virus variants Ko Wing-man intends to use the new vaccine for anti-avian
Sing Tao Daily - 3 hours ago
。 So far this year, Hong Kong, a total of eighteen birds or bird carcasses infected with the H5N1 avian influenza, the number of eight higher than the same period last year.。 Department of Agriculture, Fisheries and earlier also the H5N1 avian flu virus found in the Bird Garden in Mong Kok, Kowloon Tong, Yau Yat Chuen, Osmanthus Road seized confirmed with the H5N1 avian influenza virus of House Crows.
。 Food and Health Bureau yesterday Ko Wing-man, to the Legislative Council, said after the peak period of influenza this winter has yet to be seized with the carcasses of dead birds of the avian influenza virus than in the past, the authorities will closely monitor this winter influenza situation will deteriorate .
The first generation of vaccine effectiveness of lowering
。 Ko Wing-man added that, for some experts noted that the current vaccine is not ideal, so the authorities actively introduce two new bird flu vaccine for chickens injected.
"Some experts noted that at present, we use the vaccine because influenza is generally slow to change is the evolution, in fact, is not the best, we are actively seeking to introduce another two closer to the now popular type of avian influenza (for chicken only injection) vaccine. "he added, the Department of Health will strengthen monitoring at ports to detect body temperature to return to Hong Kong residents and other visitors.
。 Infectious Disease Director of the Centre of Hong Kong, Ho Pak-leung said the bird flu virus has evolved to the fourth generation, but we still follow the first-generation avian influenza vaccine so that vaccine effectiveness decreased. Ho also pointed out, Asia-Pacific human cases of avian influenza, have also picked up a year ago, authorities on the introduction of new avian influenza vaccines to reduce the risk of human infection. http://translate.google.com/translate?sl=zh-CN&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Fhk.news.yahoo.com%2F%25E4%25BB%258A%25E5%25B9%25B4%25E6%25AA%25A2%25E5%25B8%25B6%25E8%258F%258C%25E9%259B%2580%25E5%25B1%258D-%25E7%2597%2585%25E6%25AF%2592%25E5%25B7%25B2%25E8%25AE%258A%25E7%25A8%25AE-%25E9%25AB%2598%25E6%25B0%25B8%25E6%2596%2587%25E6%2593%25AC%25E7%2594%25A8%25E9%2598%25B2%25E7%25A6%25BD%25E6%25B5%2581%25E6%2596%25B0%25E7%2596%25AB%25E8%258B%2597-223000416.html
。 (Roundup) (Sing Tao Daily reported) in the seizure of the carcasses of dead birds infected with avian flu virus than in the past and more. 。 Food and Health Bureau, Ko Wing-man said the bird flu vaccine is being used is not ideal, the Government will actively introduce closer to the prevailing type of avian influenza vaccine. 。
Refers to an infectious disease expert, bird flu virus has evolved to the fourth generation, is still used in Hong Kong the first generation of avian flu vaccine, and promoting to accelerate the introduction of new vaccines to reduce the risk of human infection.
。 Food and Health Bureau yesterday Ko Wing-man, to the Legislative Council, said after the peak period of influenza this winter has yet to be seized with the carcasses of dead birds of the avian influenza virus than in the past, the authorities will closely monitor this winter influenza situation will deteriorate .
The first generation of vaccine effectiveness of lowering
。 Ko Wing-man added that, for some experts noted that the current vaccine is not ideal, so the authorities actively introduce two new bird flu vaccine for chickens injected.
"Some experts noted that at present, we use the vaccine because influenza is generally slow to change is the evolution, in fact, is not the best, we are actively seeking to introduce another two closer to the now popular type of avian influenza (for chicken only injection) vaccine. "he added, the Department of Health will strengthen monitoring at ports to detect body temperature to return to Hong Kong residents and other visitors.
。 Infectious Disease Director of the Centre of Hong Kong, Ho Pak-leung said the bird flu virus has evolved to the fourth generation, but we still follow the first-generation avian influenza vaccine so that vaccine effectiveness decreased. Ho also pointed out, Asia-Pacific human cases of avian influenza, have also picked up a year ago, authorities on the introduction of new avian influenza vaccines to reduce the risk of human infection. http://translate.google.com/translate?sl=zh-CN&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Fhk.news.yahoo.com%2F%25E4%25BB%258A%25E5%25B9%25B4%25E6%25AA%25A2%25E5%25B8%25B6%25E8%258F%258C%25E9%259B%2580%25E5%25B1%258D-%25E7%2597%2585%25E6%25AF%2592%25E5%25B7%25B2%25E8%25AE%258A%25E7%25A8%25AE-%25E9%25AB%2598%25E6%25B0%25B8%25E6%2596%2587%25E6%2593%25AC%25E7%2594%25A8%25E9%2598%25B2%25E7%25A6%25BD%25E6%25B5%2581%25E6%2596%25B0%25E7%2596%25AB%25E8%258B%2597-223000416.html
Vietnam-Five provinces PRRS infected pigs
Five provinces PRRS infected pigs
: 07/11/2012 10:02:45
Afternoon 10-7, in Hanoi, the Steering Committee for Disease Prevention and poultry have held briefings to direct stamping solutions PRRS is in danger of spreading.
Deputy Minister of Agriculture and Rural Development Diep Kinh Tan, there are still five provinces including Dien Bien, Quang Ninh, Dong Nai, Binh Duong and Lang Son PRRS infected pigs. In particular, in Dong Nai, delays by the government, the outbreak has spread from one district to four districts. As in Lang Son, the outbreak has spread from one district to district and survival from six months to date 4-2012. ' '
According to the Veterinary Research Institute of the Central Government, in Hanoi recently have not only discovered that blue ear pig disease has appeared both fowl infections, cholera .. very dangerous. Recently, Hanoi has granted 1.3 million doses of vaccine to stamp out cholera.
According to Deputy Minister Diep Kinh Tan, if translated to happen again led Vietnam Institute of Animal Husbandry may be disciplined MARD. http://translate.google.com/translate?sl=vi&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Fwww.baoangiang.com.vn%2Fdefault.aspx
According to Deputy Minister Diep Kinh Tan, if translated to happen again led Vietnam Institute of Animal Husbandry may be disciplined MARD. http://translate.google.com/translate?sl=vi&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Fwww.baoangiang.com.vn%2Fdefault.aspx
Thailand/Cambo border operations on #EV71
Replies in the border area with
Cambodia. The province has had to increase staff at the border crossing
permanently. The relief and trade.Pong Nam Ron district. Soi Dao
district.Preparation and screening of suspects who may have been infected across
the country.
With the medical team. Mobile hospital set up in five business units. Controlling the disease. Bung Health Center in Utrecht, the military and immigration checkpoint at the border area is strictly monitored. If the fever by screening patients with fever over 38 degrees Celsius, has respiratory disorders. Will be held in the area.
If the patient is young Thai border to the highway system of the patient to a hospital for treatment, Chanthaburi owns a hospital emergency immediately. However, the border province of Chanthaburi is also reported that patients with hand, foot and mouth infection from viruses, Sunil Bharti Mittal, Robert 71.
http://translate.google.com/translat...D9550000085127
With the medical team. Mobile hospital set up in five business units. Controlling the disease. Bung Health Center in Utrecht, the military and immigration checkpoint at the border area is strictly monitored. If the fever by screening patients with fever over 38 degrees Celsius, has respiratory disorders. Will be held in the area.
If the patient is young Thai border to the highway system of the patient to a hospital for treatment, Chanthaburi owns a hospital emergency immediately. However, the border province of Chanthaburi is also reported that patients with hand, foot and mouth infection from viruses, Sunil Bharti Mittal, Robert 71.
http://translate.google.com/translat...D9550000085127
Many patients are treated Cambodia in Vietnam
07/11/2012 09:45:24
Since late 2011, sometimes a City Children's Hospital pediatric patients receiving oral questions limbs are moved from Cambodia to treatment
Treatment of cases not reported specific but Khanh said the doctor, from 2011 to now has about 50 medical patients were receiving disease. "There are about 20 cases of hand, foot and mouth with grade 3-4 neurologic complications are we saved" - Dr. Khanh said. "Investigation on the clinical signs showed that they all get hand, foot and mouth" - Dr. Khanh continued.
According to the understanding of the Pioneer, in a recent week Infection - Nervous Children's Hospital 1 has successfully treated two patients for the HI and HK in Siem Reap, Cambodia after a provincial hospital in this transfer to.
However, Dr. Khanh, from April 2 patients who had died when Cambodia was transferred to the hospital, have complications due to nervous causes circulatory and respiratory failure.
Dr. Khanh said the Cambodian patients suffering severe hand, foot and mouth were rescued were transferred through Vietnam from 7-8 hours after turning serious. "Some move through Tay Ninh General Hospital, the first aid then transferred to Children's Hospital No. 1 should be rescued in time."
He said most patients to Vietnam are under 5 years old, the age for hand, foot and mouth disease susceptibility.
The year Pioneer afternoon, Dr. Tran Ngoc Huu-HCMC Pasteur Institute said, according to information that aid is, some samples were tested Pasteur Institute of Cambodia announced that contains Enterovirus Type 71. However, to view the Enterovirus Type 71 in Cambodia and Vietnam, there are clinical signs of how to identify new treatments.
Today, city leaders said the Health Department, has directed the hospital in the City, especially 1-2 Children's Hospital to enhance reception and treatment of hand, foot and mouth. At the same time, ready to receive, treatment for patients in Cambodia.
http://translate.googleusercontent.com/translate_c?hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=vi&tl=en&twu=1&u=http://www.baoangiang.com.vn/newsdetails/1D3FE18E2AF/Nhieu_benh_nhi_Campuchia_dang_duoc_dieu_tri_tai_Viet_Nam_.aspx&usg=ALkJrhiSRQgsLUjl5-VK199C71Q7YhKqgg
Since late 2011, sometimes a City Children's Hospital pediatric patients receiving oral questions limbs are moved from Cambodia to treatment
Treatment of cases not reported specific but Khanh said the doctor, from 2011 to now has about 50 medical patients were receiving disease. "There are about 20 cases of hand, foot and mouth with grade 3-4 neurologic complications are we saved" - Dr. Khanh said. "Investigation on the clinical signs showed that they all get hand, foot and mouth" - Dr. Khanh continued.
According to the understanding of the Pioneer, in a recent week Infection - Nervous Children's Hospital 1 has successfully treated two patients for the HI and HK in Siem Reap, Cambodia after a provincial hospital in this transfer to.
However, Dr. Khanh, from April 2 patients who had died when Cambodia was transferred to the hospital, have complications due to nervous causes circulatory and respiratory failure.
Dr. Khanh said the Cambodian patients suffering severe hand, foot and mouth were rescued were transferred through Vietnam from 7-8 hours after turning serious. "Some move through Tay Ninh General Hospital, the first aid then transferred to Children's Hospital No. 1 should be rescued in time."
He said most patients to Vietnam are under 5 years old, the age for hand, foot and mouth disease susceptibility.
The year Pioneer afternoon, Dr. Tran Ngoc Huu-HCMC Pasteur Institute said, according to information that aid is, some samples were tested Pasteur Institute of Cambodia announced that contains Enterovirus Type 71. However, to view the Enterovirus Type 71 in Cambodia and Vietnam, there are clinical signs of how to identify new treatments.
Today, city leaders said the Health Department, has directed the hospital in the City, especially 1-2 Children's Hospital to enhance reception and treatment of hand, foot and mouth. At the same time, ready to receive, treatment for patients in Cambodia.
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Asean Conference held in the middle of mystery # EV71 Outbreak
Remarks at the U.S.-ASEAN Ministerial Meeting
Remarks
Hillary Rodham Clinton
Secretary of State
Peace Palace
Phnom Penh, Cambodia
July 11, 2012
Thank you very much, Secretary del Rosario, and let me express my pleasure at being here today. This is my fourth U.S.-ASEAN post-ministerial conference. And it gives us the chance to mark 35 years of partnership between ASEAN and the United States and to affirm and strengthen our ties. I want to thank our host, the Government of Cambodia,;;
... Later this week here at ASEAN and at the Regional Forum, I will offer a down payment on APSEI, and in the coming months we’ll be able to talk more about this initiative and its resources.
http://www.scoop.co.nz/stories/WO1207/S00405/remarks-at-the-us-asean-ministerial-meeting.htm
Monitoring prevents the entry 'unknown disease' from Cambodia
. Department of Preventive Medicine, Ministry of Health of Vietnam immediately the deployment requirements for disease control activities at the border.
Specifically, the Center for International Health Quarantine, Center for Preventive Medicine has quarantine border operations closely monitored for the entry, particularly those who are suspected carriers of infectious diseases.
. Conduct inspection and medical treatment facilities for entry, examination and isolation of suspected cases of infection.
The same units are also required to coordinate with the gate forces in supervising the import of animals and animal products across the border.... In addition, the plan should be proactive disease prevention in the summer, preparing sufficient number of drugs, chemicals epidemic ...
http://translate.googleusercontent.com/translate_c?hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=vi&tl=en&twu=1&u=http://vnexpress.net/gl/suc-khoe/2012/07/giam-sat-nguoi-nhap-canh-ngan-benh-la-tu-campuchia/&usg=ALkJrhj9TbAhVfEsKmpvHoBeBdR-sBwAPw
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Vietnam showing the same outbreak as Cambodia
Looks like the same problem right across the border..
Prevent hand, foot and mouth in An Giang
Updated at 02:01, Thursday, 12/07/2012 (GMT +7)
..Although not a local number of cases have hand, foot and mouth (HFMD) the highest nationwide, but the An Giang province is leading the country in the number of deaths with nine cases. So what is the cause of this situation?
..As of mid-July, An Giang province has recorded 1,478 cases of TCM, up seven times over the same period in 2011 (more than 200 cases across the province). All 11 districts, towns and cities have recorded cases of infection. Localities with high child morbidity and mortality...
..According to the Center for Preventive Medicine, all fall into the deaths of children under three age groups and families in rural areas, regions and remote areas, access to health services, especially knowledge of health care, personal hygiene for children is limited.
..On average, each day, An Giang has two or more children with TCM TCM lift incidence in An Giang and weekends from 50 to 70 ca ... Several weeks more than 100 hospitalizations. Meanwhile, an alarming problem that up to 68% of samples tested fall into EV71 bacteria. With the rate of deaths caused by disease in An Giang unusually high compared to other provinces in the country..
..diagnosis in healthcare facilities because access to medical knowledge is weak so many cases has dropped erythema shortcomings positions, because of the atypical cases such as mouth ulcers No, no erythema, pathological findings as a sore throat ... granted, but events quickly disease, severe complications are such as meningitis, pulmonary edema ..., especially in infants under one year, making the treatment faced many difficulties, leading to high mortality rates.http://translate.google.com/translat...giang-1.357425
HERE IS THE MAP ,ON THE LOWER CAMBO BORDER. http://en.wikipedia.org/wiki/File:Lo...namAnGiang.png
Prevent hand, foot and mouth in An Giang
Updated at 02:01, Thursday, 12/07/2012 (GMT +7)
..Although not a local number of cases have hand, foot and mouth (HFMD) the highest nationwide, but the An Giang province is leading the country in the number of deaths with nine cases. So what is the cause of this situation?
..As of mid-July, An Giang province has recorded 1,478 cases of TCM, up seven times over the same period in 2011 (more than 200 cases across the province). All 11 districts, towns and cities have recorded cases of infection. Localities with high child morbidity and mortality...
..According to the Center for Preventive Medicine, all fall into the deaths of children under three age groups and families in rural areas, regions and remote areas, access to health services, especially knowledge of health care, personal hygiene for children is limited.
..On average, each day, An Giang has two or more children with TCM TCM lift incidence in An Giang and weekends from 50 to 70 ca ... Several weeks more than 100 hospitalizations. Meanwhile, an alarming problem that up to 68% of samples tested fall into EV71 bacteria. With the rate of deaths caused by disease in An Giang unusually high compared to other provinces in the country..
..diagnosis in healthcare facilities because access to medical knowledge is weak so many cases has dropped erythema shortcomings positions, because of the atypical cases such as mouth ulcers No, no erythema, pathological findings as a sore throat ... granted, but events quickly disease, severe complications are such as meningitis, pulmonary edema ..., especially in infants under one year, making the treatment faced many difficulties, leading to high mortality rates.http://translate.google.com/translat...giang-1.357425
HERE IS THE MAP ,ON THE LOWER CAMBO BORDER. http://en.wikipedia.org/wiki/File:Lo...namAnGiang.png
Children hit in bad year for severe virus #EV71
Mary Ann Benitez
Thursday, July 12, 2012
Thirteen children have been sickened with severe enteroviral infections this year, a record that follows the pattern seen in the mainland and Cambodia, data shows.
There were eight cases of EV in 2010 and nine last year, the Centre for Health Protection said.
Among the 13 cases, eight are imported, all involving mainland children. Five are local "or not classified," it added.
The imported cases include a five- year-old girl and her two brothers, both seven, who tested positive for enteroviruses - which cause hand, foot mouth disease - but negative for the deadly enterovirus71.
On Tuesday, the Centre for Health Protection announced only that the girl and a 39-day-old baby boy from Shenzhen - admitted to the public Prince of Wales Hospital - were confirmed with severe enterovirus infections.
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"Their clinical diagnoses were meningitis due to EV infection and the three children are now in stable condition," the center said.
The baby boy was infected with the Coxsackie virus, which causes a mild form of hand, foot and mouth disease. The baby had a fever for about 10 days.
EV71 has killed 52 of 59 children during the past three months in Cambodia.
Secretary for Food and Health Ko Wing-man said: "In light of all these outbreaks, including the recent detection of avian influenza H5N1 in Bird Street, I would like to remind the citizens to remain vigilant in terms of food and personal hygiene.
"If we are traveling outside Hong Kong, special precautions must be taken as far as the food that we are going to eat as well as our personal hygiene. People who have returned to Hong Kong with symptoms, particularly fever, should seek medical attention."
So far this year, two severe cases of EV71 infection have been reported out of 39 laboratory-confirmed EV71 cases, also a record high.
http://www.thestandard.com.hk/news_detail.asp?pp_cat=11&art_id=124286&sid=37003249&con_type=1
Source of Bird Flu Virus in girls death is still mysterious
Source of Bird Flu Virus is still mysterious
Wednesday, July 11, 2012 00:01 pm
DEATH KK, 8, a resident of Karachi, West Java, due to the bird flu virus attack, is still a question mark. One was about the source of virus that infects the victim.
"We've studied birds around the victim's home, neighbors, and relatives of victims, all negative exposure to the bird flu virus. In Chicken Market Karachi is referred to as a source of transmission, we also do not have poultry infected with the virus," said Rasim, Head of Disease Control Department of Health and Environmental Diseases Karachi, yesterday.
From the investigation it is believed the victim contracted the bird flu virus from poultry, not humans. He is also suspected to be infected from poultry in Karachi, but it could have been outside the country, because the victim had to Singapore.
"To date in Falkirk still have not found an outbreak of bird flu virus in poultry. Residents do not need to worry," he said. http://www.mediaindonesia.com/read/2012/07/11/332329/76/20/Sumber-Virus-Flu-Burung-masih-Misterius
Wednesday, July 11, 2012 00:01 pm
DEATH KK, 8, a resident of Karachi, West Java, due to the bird flu virus attack, is still a question mark. One was about the source of virus that infects the victim.
"We've studied birds around the victim's home, neighbors, and relatives of victims, all negative exposure to the bird flu virus. In Chicken Market Karachi is referred to as a source of transmission, we also do not have poultry infected with the virus," said Rasim, Head of Disease Control Department of Health and Environmental Diseases Karachi, yesterday.
From the investigation it is believed the victim contracted the bird flu virus from poultry, not humans. He is also suspected to be infected from poultry in Karachi, but it could have been outside the country, because the victim had to Singapore.
"To date in Falkirk still have not found an outbreak of bird flu virus in poultry. Residents do not need to worry," he said. http://www.mediaindonesia.com/read/2012/07/11/332329/76/20/Sumber-Virus-Flu-Burung-masih-Misterius
Panama restricts entry of live animals from #bird flu in Mexico #H7N3
Wednesday, July 11, 2012
Panama strengthened its biosecurity measures at its borders and farms and restricted the entry of live animals from Mexico for the outbreak of bird flu in the Mexican state of Jalisco, authorities said today and producers.
"We are alert to any situation, any product (live animal) coming from Mexico is restricted ', told Notimex director of Animal Health, Ministry of Agriculture, Manuel Gonzalez.
http://www.eldiariodecoahuila.com.mx/notas/2012/7/11/restringe-panama-ingreso-animales-vivos-mexico-gripe-aviar-304519.asp
Panama strengthened its biosecurity measures at its borders and farms and restricted the entry of live animals from Mexico for the outbreak of bird flu in the Mexican state of Jalisco, authorities said today and producers.
"We are alert to any situation, any product (live animal) coming from Mexico is restricted ', told Notimex director of Animal Health, Ministry of Agriculture, Manuel Gonzalez.
http://www.eldiariodecoahuila.com.mx/notas/2012/7/11/restringe-panama-ingreso-animales-vivos-mexico-gripe-aviar-304519.asp
Guatemala maintains emergency avian flu outbreak in Mexico #H7N3
July 11, 2012Guatemala authorities maintain a state of emergency animal disease to prevent spread of bird flu after an outbreak in a region of western Mexico, officials said...
..The decree includes a border fence to prevent the disease from poultry in the country extends north to Guatemala, said a source at the agency, noting that the state of alert is effective until risks are discarded...http://www.radioformula.com.mx/notas.asp?Idn=255900
UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (05): EV71 TREATMENT OPTIONS
Published Date: 2012-07-11 14:48:55
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia (05): EV71 treatment options
Archive Number: 20120711.1197882
UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (05): EV71 TREATMENT OPTIONS
EV71 in the outbreak of fatal illness in Cambodian children
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In previous ProMED postings [listed below] the clinical illness in Cambodia was described as occurring mainly in children under 3, with a male/female ratio of 1.3 to 1. It was noted in 14 south and central provinces of the country. Around 60 children were admitted to Kantha Bopha hospital after having been treated in private clinics and most of these died within 24 hours of a syndrome with encephalitis and pulmonary edema, while platelets, liver function, and renal function appeared normal.
Epidemiology and clinical features
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EV71 has been associated with outbreaks of fatal encephalitis in infants in the 1970s in Hungary and Bulgaria (1, 2) and since 1998 with large outbreaks of hand-foot-mouth disease (HFMD) in Southeast Asia (3). A minority of patients in these outbreaks may develop rhombencephalitis and (neurogenic) autonomic dysregulation leading to pulmonary edema, which can be fatal within 24 hours, while laboratory markers of liver and kidney function usually stay within normal range.
The age distribution and male to female ratio of the children in Kantha Bopha is very similar to what was prospectively observed in Children's Hospital 1 in Ho Chi Minh City, Viet Nam among 4000 children hospitalized with HFMD with a median age of 20 months and a male to female ratio of 1.6 to 1. It was also noted that if children progressed to more severe disease this was within a median of 24 hours of admission.
The case fatality rate was 0.2 percent of all hospitalizations and 6/19 patients with pulmonary edema (TH Khanh, unpublished data).
Myoclonus, particularly of the fingers is often the 1st symptom of central nervous system involvement and is seen in a majority of patients with severe disease (4). Deterioration is hallmarked by autonomic dysregulation, which presents as hypertension and tachycardia in addition to uncontrollable fever and may lead to pulmonary edema and death (3). In Taiwan and Malaysia it was noted that a large fraction (one third to half) of the patients progressing to this severe form of disease do not have a rash (5, 6). On the paediatric ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam among the very severe cases 12/47 had no rash and 28/47 had myoclonic jerks. There is no mention of rash, myoclonus, and hypertension in the children in Cambodia, but this would be very interesting to know.
The laboratory findings from Institute Pasteur and the clinical and epidemiological features are compatible with the severe end of the spectrum of disease caused by EV71. The high case fatality rate is striking, but may be due to an underestimation of the total number of cases because less severe cases are not hospitalized and not reported. The absence of the typical rash of HFMD should not rule EV71 out as a causative agent.
Some notes on treatment
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Guidelines from the Vietnamese ministry of health advice to suppress myoclonus with oral or intravenous phenobarbital, and when suppression is incomplete to instill IVIg at 2g/kg in 2 dosages. Autonomic dysregulation, particularly hypertension, is treated with milrinone (7). Pleconaril, a drug with anti-enteroviral activity, has no activity against EV71 in vitro (11).
Evidence for the use of IVIg comes from treatment of enteroviral meningitis in neonates and agammaglobulinaemic patients, but there is only observational and retrospective case data on its efficacy in HFMD and no evidence for who benefits (8-10). Large randomised controlled trials of all treatment options (IVIg, milrinone, magnesium, fluid regimens, etc) are urgently needed for EV71 HFMD.
http://www.promedmail.org/
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia (05): EV71 treatment options
Archive Number: 20120711.1197882
UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (05): EV71 TREATMENT OPTIONS
HFMD Scare on Sa Kaew Border #EV71 #Cambodia #HFMD
Sa Kaew Provincial Governor Sanit Naksuksri yesterday issued an alert regarding a dangerous strain of hand, foot and mouth disease (HFMD).
He said Cambodian authorities reportedly were unable to get it under control and had called on the World Health Organisation’s help.
Schools were told to keep clean and health services to report any suspicious cases to the surveillance and rapid response team (SRRT) and to the provincial health office immediately.Following news of a dangerous strain of HFMD killing 64 people and leaving 66 children sick, Cambodian vendors at the Rong Kleu border market yesterday took their schoolchildren to the Thai side. Thai border authorities conducted a random health check on the children and handed out leaflets about HFMD.
Sa Kaew Provincial Governor Sanit Naksuksri yesterday issued an alert regarding a dangerous strain of hand foot and mouth disease HFMD.
http://www.nationmultimedia.com/nati...-30185979.html
Sa Kaew watches out against HFMD from
Cambodia
July 11, 2012 5:34 pm
Sa Kaew provincial govonor Sanit Naksuksri Wednesday ordered a war room to watch out for a dangerous strain of hand, foot and mouth disease (HFMD) after the Cambodian authority reportedly, unable to get it under control and called for the World Health Organisation's help.
http://www.nationmultimedia.com/brea...-30185940.html
Panicked Cambodians flee to Sa Kaeo #EV71 #Cambodia #HFMD
Cambodians flee to Sa Kaeo
- 12/07/2012 at 01:31 AM
The hand, foot and mouth disease (HFMD) scare
has resulted in a mass exodus of Cambodian parents with young children into Sa
Kaeo province.
The Aranyaprathet immigration checkpoint was yesterday crowded with Cambodian travellers, most of them with young children, eager to enter Thailand.
The Cambodian parents were mainly workers and vendors at the Rong Kleau border market in Thailand.
Thai disease control officials used a thermal scanner to screen for children with a high fever _ one sign of possible HFMD infection.
One child was stopped and tested but the fever was not overly high.
Won Yom, 32, a Cambodian vendor in Poi Pet market in Cambodia, said the Cambodian public health authorities had announced on radio yesterday that the government needed urgent help from the World Health Organisation to control the spread of the virus that has already killed 64 children. That had added to mounting fears among parents with young children and explained why many wanted to come to Thailand.
A Cambodian mother working in Surin province on Tuesday took her two-year-old boy who had a high fever and was suspected of having HFMD to a local hospital.
The incident triggered panic at Sikhoraphum district hospital, which was crowded with children who were mostly there being treated for dengue fever.
Zalo Ann, 30, the Cambodian mother, said she had learned about the spread of HFMD in her home country from the media and when her son became ill, she feared it could be the same disease.
Upon learning about the Cambodian boy and reports of a number of deaths of children in Cambodia from HFMD, parents whose children were being treated at the hospital panicked.
In Kanchanaburi, three more new HFMD cases were reported yesterday at a municipal daycare centre in Sangkhla Buri district, prompting a temporary shutdown of the centre for disinfection. http://www.bangkokpost.com/news/local/302019/cambodians-flee-to-sa-kaeo
Malysia- EV-71 virus: Controls in place at all borders, says Liow
July 11, 2012
JASIN,
July 11 — The Health Ministry has taken the precautionary measure of beefing up
controls at all entry points to prevent the spread of enterovirus 71 (EV-71)
that was found in Cambodia.Health Minister Datuk Seri Liow Tiong Lai (picture) said the ministry had taken the necessary steps to curb the virus from spreading to Malaysia by sending a medical team as observers to monitor the development in the country.
“According to reports we have received, it has been proven that the virus (EV-71) was found in the country (Cambodia) but some of the deaths that occurred were due to dengue as well,” he told reporters after visiting the Jasin Hospital here today...
http://www.themalaysianinsider.com/malaysia/article/ev-71-virus-controls-in-place-at-all-entry-points-says-liow/
Dr. Beat Richner, Kantha Bopha Children’s Hospitals
Dr. Beat Richner, Kantha Bopha Children’s Hospitals
Phnom Penh / Siem Reap Angkor, 8.7.2012
Urgent message
Since the end of April 2012 in the Kantha Bopha Children’s
Hospitals 66 children
were admitted with just same symptoms and clinical findings. The
children, most
between 2 and 3 years old, suffered from Encephalitis. They
develop in the last
hours of their life a total destruction of the alveolas in the
lungs. Up to now 64 have
died. Only two have survived. The last week from 2
nd to 7th
July there were only two
cases.
On 20
th
June, after having discussed this in Cambodia
new picture of disease since
early May with the Ministry of Health, and after having got no
positive results by
Institut Pasteur, which whom we cooperate since beginning of the
discovery of this
for Cambodia new phenomena in our 5 Hospitals, we wrote a letter
to the Minister
of Health suggesting as causing reason a Enterovirus, or an
intoxication by a
medication outside of our Hospitals, or both. All the 64 cases who
have died were
treated outside by private clinics before they were brought to the
Kantha Bopha
Hospitals.
Yesterday the Institut Pasteur could confirm, that in the majority
of the above
described cases the Enterovirus Type 71 was found. Still we have
now to see what
really is causing the deadly pulmonary complication and see if a
toxic factor is
playing a role too. Why only a very few children infected by
Enterovirus 71 are
doing this awful destruction of the lungs?
Unfortunately WHO has given a declaration on July 2
nd to Reuters without being
clear on the facts being presented on 29
th June
in the Ministry of Health by Kantha
Bopha to all the officials of Health. WHO was telling whole the
world: New mystery
killer disease in Cambodia! This was causing unnecessary panic in
Cambodia.
On the level of public health it is not an alarming issue: The 5
Kantha Bopha
Hospitals are covering 85% of all Cambodian sick children. In case
of the Dengue
Fever Kantha Bopha is covering 92%. In June 75 799 sick children
were treated in
our outpatient stations. 16 517 severely sick children had to be
hospitalized, among
them 5534 severe cases of the Hemorrhagic Dengue Fever. In June
only 34 cases
with this above described “ new” disease were hospitalized. This
declaration by
WHO, which is not at all involved in this matter, to Reuters on
July 2
nd
was neither
professional nor necessary, but causing panic for nothing.
Dr. Beat Richner, Founder and Head of the Kantha Bopha Children’s
Hospitals in
Cambodia.
http://www.beat-richner.ch/pdf/2012/EnterovirusType71_8July.pdf
Mystery illness in Cambodia solved, doctors say #EV71 #Cambodia
Hat tip to Alert
By Dr. Sanjay Gupta and Danielle Dellorto, CNN
updated 11:17 AM EDT, Wed July 11, 2012
Phnom Penh, Cambodia (CNN) -- The cause of a mysterious illness that has claimed the lives of more than 60 Cambodian children has been determined, medical doctors familiar with the investigation told CNN on Wednesday.
A combination of pathogens, disease-causing micro-organisms, is to blame for the illness, the World Health Organization, in conjunction with the Cambodian Ministry of Health, has concluded, the doctors said.
The pathogens include enterovirus 71, which is known to cause neurological disease; streptococcus suis, which can cause infections like bacterial meningitis in people who have close contact with pigs or with pork products; and dengue, which is transmitted by mosquitoes.
The inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, the doctors said. The World Health Organization (WHO) is expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis and breathing difficulties.
While not all the microorganisms were present in each patient, doctors concluded the illness was caused by a combination of them and worsened by steroid use.
The WHO sources did not want to be identified because the results of the health organization's investigation have not yet been made public.
"I'm very confident for the reason of the epidemic," said Dr. Phillipe Buchy, chief of virology at the Institut Pasteur in Cambodia and one of the doctors who cracked the case.
"The first thing that goes through your mind is, is this one of the usual suspects you haven't detected before?" said Dr. Arnaud Tarantola, chief of epidemiology and public health at the Institut Pasteur. "If it is, has it mutated, or changed in a way that it causes more severe disease? Or is it something completely new?"
On the steroids issue, Tarantola said, "When you have a dying child, you try to use what you have at hand, and they were right to try that." But, he acknowledged, "from the cases we reviewed, almost all of the children died, and almost all of them had steroids."
Parents face anxious wait over mystery illness
"I think we can close the case and move ahead asking different questions," Buchy said. "Not what is the illness, but now, how long has the virus been circulating? What is the extent of the circulation of the virus? How many mild diseases are we missing? That's the next step."
Over the past four months, doctors at Kantha Bopha Children's Hospitals in Phnom Penh have been faced with the mysterious syndrome, which kills children so fast that nearly all of those infected with it die within a day or two of being admitted to the hospital.
Dr. Beat Richner, head of the children's hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases of the illness had been confirmed since Saturday.
Other hospitals in the country have reported similar cases, but far fewer than the children's hospitals in the capital, which are the most popular.
In the last hours of their life, the children experienced a "total destruction of the alveola(e) in the lungs," Richner said. Alveolae are the air sacs where oxygen enters the bloodstream.
Most of the children who have contracted the illness have come from the south of the country, though health officials cannot find what is known as a cluster -- a lot of cases coming from one specific area.
By June 29, the WHO had been contacted and Cambodian officials were scrambling to instruct health providers across the country to spread information about the illness as quickly as possible.
Officials search for clues in disease killing Cambodia's children
The WHO and the Cambodian authorities' announcement of the situation drew criticism from Richner, who said they were "causing unnecessary panic."
The WHO said the unexplained nature of the outbreak obliged it to communicate the information.
Over the weekend, lab tests linked enterovirus 71 (EV71) to some of the cases. But the tests didn't solve the whole puzzle and health officials continued their investigations, noting the detection of other elements like streptococcus suis and dengue.
The link to EV71 does not particularly help in the treatment of the illness, as there is no effective antiviral treatment for severe EV71 infections and no vaccine is available.
In milder cases, EV71 can cause coldlike symptoms, diarrhea and sores on the hands, feet and mouth, according to the journal Genetic Vaccines and Therapy. But more severe cases can cause fluid to accumulate on the brain, resulting in polio-like paralysis and death.
Outbreaks of the enterovirus "occur periodically in the Asia-Pacific region," according to the CDC. Brunei had its first major outbreak in 2006. China had an outbreak in 2008.
Adults' well-developed immune systems usually can fend off the virus, but children are vulnerable to it, according to the CDC.
"It looks like (EV71) has emerged strongly, probably because it hadn't circulated with the same intensity in the past years," Tarantola said.
Reported cases of streptococcus suis have risen significantly in recent years, notably in Southeast Asia, according to a paper that appeared last year in Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention in Atlanta.
The rainy season in Cambodia, which lasts from May to October, is a key problem in trying to control diseases like dengue. Because of a lack of indoor plumbing in many homes, people collect rainwater in vats, creating potential breeding grounds for mosquitoes.
In Cambodia, as with many places around the world, parents first try treating their child at home. If that doesn't work, they typically then go to a local clinic. A hospital visit, which often involves a long trip, is a last resort.
By Dr. Sanjay Gupta and Danielle Dellorto, CNN
updated 11:17 AM EDT, Wed July 11, 2012
Phnom Penh, Cambodia (CNN) -- The cause of a mysterious illness that has claimed the lives of more than 60 Cambodian children has been determined, medical doctors familiar with the investigation told CNN on Wednesday.
A combination of pathogens, disease-causing micro-organisms, is to blame for the illness, the World Health Organization, in conjunction with the Cambodian Ministry of Health, has concluded, the doctors said.
The pathogens include enterovirus 71, which is known to cause neurological disease; streptococcus suis, which can cause infections like bacterial meningitis in people who have close contact with pigs or with pork products; and dengue, which is transmitted by mosquitoes.
The inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, the doctors said. The World Health Organization (WHO) is expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis and breathing difficulties.
While not all the microorganisms were present in each patient, doctors concluded the illness was caused by a combination of them and worsened by steroid use.
The WHO sources did not want to be identified because the results of the health organization's investigation have not yet been made public.
"I'm very confident for the reason of the epidemic," said Dr. Phillipe Buchy, chief of virology at the Institut Pasteur in Cambodia and one of the doctors who cracked the case.
"The first thing that goes through your mind is, is this one of the usual suspects you haven't detected before?" said Dr. Arnaud Tarantola, chief of epidemiology and public health at the Institut Pasteur. "If it is, has it mutated, or changed in a way that it causes more severe disease? Or is it something completely new?"
On the steroids issue, Tarantola said, "When you have a dying child, you try to use what you have at hand, and they were right to try that." But, he acknowledged, "from the cases we reviewed, almost all of the children died, and almost all of them had steroids."
Parents face anxious wait over mystery illness
"I think we can close the case and move ahead asking different questions," Buchy said. "Not what is the illness, but now, how long has the virus been circulating? What is the extent of the circulation of the virus? How many mild diseases are we missing? That's the next step."
Over the past four months, doctors at Kantha Bopha Children's Hospitals in Phnom Penh have been faced with the mysterious syndrome, which kills children so fast that nearly all of those infected with it die within a day or two of being admitted to the hospital.
Dr. Beat Richner, head of the children's hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases of the illness had been confirmed since Saturday.
Other hospitals in the country have reported similar cases, but far fewer than the children's hospitals in the capital, which are the most popular.
In the last hours of their life, the children experienced a "total destruction of the alveola(e) in the lungs," Richner said. Alveolae are the air sacs where oxygen enters the bloodstream.
Most of the children who have contracted the illness have come from the south of the country, though health officials cannot find what is known as a cluster -- a lot of cases coming from one specific area.
By June 29, the WHO had been contacted and Cambodian officials were scrambling to instruct health providers across the country to spread information about the illness as quickly as possible.
Officials search for clues in disease killing Cambodia's children
The WHO and the Cambodian authorities' announcement of the situation drew criticism from Richner, who said they were "causing unnecessary panic."
The WHO said the unexplained nature of the outbreak obliged it to communicate the information.
Over the weekend, lab tests linked enterovirus 71 (EV71) to some of the cases. But the tests didn't solve the whole puzzle and health officials continued their investigations, noting the detection of other elements like streptococcus suis and dengue.
The link to EV71 does not particularly help in the treatment of the illness, as there is no effective antiviral treatment for severe EV71 infections and no vaccine is available.
In milder cases, EV71 can cause coldlike symptoms, diarrhea and sores on the hands, feet and mouth, according to the journal Genetic Vaccines and Therapy. But more severe cases can cause fluid to accumulate on the brain, resulting in polio-like paralysis and death.
Outbreaks of the enterovirus "occur periodically in the Asia-Pacific region," according to the CDC. Brunei had its first major outbreak in 2006. China had an outbreak in 2008.
Adults' well-developed immune systems usually can fend off the virus, but children are vulnerable to it, according to the CDC.
"It looks like (EV71) has emerged strongly, probably because it hadn't circulated with the same intensity in the past years," Tarantola said.
Reported cases of streptococcus suis have risen significantly in recent years, notably in Southeast Asia, according to a paper that appeared last year in Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention in Atlanta.
The rainy season in Cambodia, which lasts from May to October, is a key problem in trying to control diseases like dengue. Because of a lack of indoor plumbing in many homes, people collect rainwater in vats, creating potential breeding grounds for mosquitoes.
In Cambodia, as with many places around the world, parents first try treating their child at home. If that doesn't work, they typically then go to a local clinic. A hospital visit, which often involves a long trip, is a last resort.