HFMD causes child deaths in Cambodia: WHO

English.news.cn 2012-07-12 19:55:37

Xinhua Weibo Facebook Twitter Reddit Diigo Delicious Digg Linkedin MySpace Sina Weibo Kaixin Renren Q-zone Tencent Weibo Sohu Weibo NetEase Weibo

PHNOM PENH, July 12 (Xinhua) -- The severe form of hand, foot and mouth disease (HFMD) was the cause of illnesses and deaths of 54 Cambodian children since April, concluded the findings of a joint investigation on Thursday.
The Ministry of Health, the World Health Organization, the Institut Pasteur du Cambodge and the U.S. Centers for Disease Control and Prevention conducted investigation following reports from Kantha Bopha Children's hospital of unusual numbers of illness and deaths among children hospitalized since April.
The investigation included a thorough review of the hospital records of the patients from Kantha Bopha hospital as well as other hospitals, laboratory tests, active follow-up with the affected families by the local Rapid Response Teams and evaluation of the data from national surveillance system, said a joint statement from the Ministry of Health and the WHO.
Based on the investigation, a total of 78 cases were identified. These included the initial 62 cases reported by Kantha Bopha hospital, and cases reported from other hospitals. Of these the investigation focused on 61 cases who fitted the criteria used ( the case definition), of which 54 had died.
It said that it was not possible to test all the patient as some of them died before appropriate samples could be taken. Samples from a total of 31 patients were obtained and tested for a number of pathogens by Institut Pasteur du Cambodge.
Of these, majority tested positive for Enterovirus 71 (EV-71) which causes hand, foot and mouth disease.
A small proportion of samples also tested positive for other pathogens including Haemophilus Influenzae type B and Streptococcus suis, it said.
The investigation revealed that most of the cases were below 3 years old with some suffering from chronic conditions and malnutrition.
The cases were from 14 different provinces and many of them were given steroids at some point during their illness. Steroid use has been shown to worsen the condition of patients with EV-71.
HFMD virus is contagious and infection in spread from person to person by direct contact with nose or throat discharges, saliva, fluid from blisters, or the stool of infected persons.
Good hygiene practice can prevent HFMD. Presently, there is no specific treatment available for HFMD, said the joint statement. Parents should seek medical advice if their children develop high fever, vomiting, lethargy and limb weakness. http://news.xinhuanet.com/english/health/2012-07/12/c_131711891.htm

HAND, FOOT AND MOUTH DISEASE - VIET NAM (10): (QUANG NAM

Date: Wed 11 Jul 2012
Source: Viet Nam New [edited]
http://vietnamnews.vnagency.com.vn/social-issues/227267/hand-foot-mouth-rises-sharply-in-quang-nam.html


The central province of Quang Nam has recorded nearly 780 hand, foot and mouth disease (HFMD) cases since the start of the year, the provincial Preventive Medicine Centre said yesterday (Tue 10 Jul 2012). It was a sharp increase compared to the same period last year [2011] when only 12 cases were reported. Some 51 out of every 100 000 people in the province have now contracted the disease, patients being mainly children under 3 years of age.

More than 310 children with mumps have also been reported, nearly double the number in the same period last year [2011].

--
Communicated by ProMED-mail
from HealthMap alerts


[It has yet to be established whether human enterovirus 71 is playing a role in this outbreak, similar to that currently observed Cambodia

U.S. Embassy-Update on Illness in Cambodian Children #EV71 #Cambodia

Emergency Messages and Public Announcements

Update on Illness in Cambodian Children

The World Health Organization (WHO) and the Cambodian Ministry of Health (MOH) released an update on Sunday, July 8, on the active investigation of the undiagnosed illness affecting children in Cambodia. The MOH identified 59 hospitalized cases, of which 52 had died. The age of affected children ranged from 3 months to 11 years old, with the majority being under 3 years of age. Based on the latest laboratory results, a number of samples tested positive for enterovirus 71 (EV71). EV71 is recognized as a cause of hand, foot, and mouth disease (HFMD).
 HFMD is a common viral illness that causes frequent outbreaks. It usually affects children and is characterized by fever, blister-like sores in the mouth, and a skin rash. In outbreaks of EV71, most children have typical symptoms of HFMD and recover without health complications. However, a small number of people with this disease develop severe complications (e.g., meningitis or encephalitis) requiring hospitalization or causing death.

How is EV71 transmitted? EV71 spreads from person to person by direct contact with the infectious virus that causes this disease. This virus is found in nose and throat secretions (such as saliva, sputum, or nasal mucus), fluid in blisters, and in the stool of infected persons. The virus may also be spread when infected persons touch objects and surfaces that are then touched by others.
Infected persons are most contagious during the first week of the illness. The virus can remain in the body for weeks after a person’s symptoms have gone away. This means that infected people can still pass the infection to others even though they may appear well. Also, some people who are infected and spreading the virus, including most adults, may have no symptoms.
HFMD is not transmitted to or from pets or other animals.

How do you prevent infection? There is no vaccine to protect against the virus that causes HFMD. A person can lower their risk of being infected by:

• Washing hands often with soap and water, especially after changing diapers and using the toilet.
• Disinfecting dirty surfaces and soiled items, including toys. First wash the items with soap and water; then disinfect them with a solution of chlorine bleach (made by mixing 1 tablespoon of bleach and 4 cups of water).
• Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with HFMD.

If you or your child has a fever, rash, or experiences difficulty in breathing you should contact a healthcare professional.
More information can be found on the CDC’s website: http://www.cdc.gov/hand-foot-mouth/index.html
WHO and partners, including Institut Pasteur du Cambodge, Kantha Bopha hospital, and the U.S. Centers for Disease Control and Prevention, are assisting the MOH with the ongoing investigation.
We encourage you notify us of your presence in Cambodia by enrolling in the Department of State’s Smart Traveler Enrollment Program (STEP).
The American Citizen Services Unit of the U.S. Embassy is located at #1 Street 96, Phnom Penh, Cambodia and can be reached by calling 023-728-000, or by e-mailing ACSPhnomPenh@State.gov.
http://cambodia.usembassy.gov/update_on_illness.html

Treatment played key role in killer Cambodian children's disease

Thursday, 12 July 2012

Bridget Di Certo

The doctor who first alerted the government to Cambodia’s “mystery illness” remains convinced that incorrect treatment in private clinics has played a critical role in the deaths of 64 children....


“Our investigation found that steroids had been used … and there have been studies of the treatment of patients [with EV71] that if you give steroids, those patients die,” Asgari said.

However, Richner, who is awaiting the results of his own toxicology testing being performed in Australia, said that to blame steroids for the deaths of the children was “nonsense”.

“All of the 62 children who died, were treated in private clinics first,” he pointed out. “I think there are wrong [blood transfusions], wrong treatment causing intoxication.

“Lots of medicines in Cambodia are fake or [faulty], and there is no controls over the private clinics buying these medicines,” Richner said. “We still do not know absolutely the reason that these children have died.”  http://www.phnompenhpost.com/index.php/2012071257378/National-news/treatment-played-key-role-in-child-deaths.html

Vietnam's Health Ministry orders quarantine along Cambodia border

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/

8000 ostriches face slaughter after flu outbreak

 12 July, 2012 08:04

About 8000 ostriches in the Western Cape are being slaughtered after a fresh outbreak of avian flu.

Infected ostriches were found on a farm near Albertinia and on two farms near Heidelberg two weeks ago, The Cape Times reported on Thursday
All 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

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

 。 (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.

 。 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

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

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

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.

According to the understanding of the Pioneers, 3 University Medical City Hospital, Trieu An Hospital, FV per day and receiving about 100 patients, including adults and children who are from Cambodia to visit hospitalized and the treatment. However, hospital representatives said, is not receiving any treatment of patients with signs of "unknown disease" as reflected information.

  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

Asean Conference held in the middle of mystery # EV71 Outbreak

OH, My bad.. didn't know they had the ASEAN CONFERENCE IN PHNOM PENH for the next few days.. no wonder it was all cleared up so fast. CNN hasn't mentioned this either and Hillary says nothing about it... 


Thursday, 12 July 2012, 11:53 am
Press Release: US State Department

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

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

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.

Yesterday, the center said the girl and her two brothers, who live in Guangxi, have had fever, headache and neck stiffness since July 1 before traveling to Hong Kong for treatment at Adventist Hospital on July 4.
"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

Vietnamese Markets flooded with smuggled birds from china

with video  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%2Fus.24h.com.vn%2Ftin-tuc-trong-ngay%2Fga-loai-thai-trung-quoc-tran-ngap-thi-truong-viet-nam-c46a468163.html

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

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 ----------------------------------------------------------- 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 ---------------------------------- 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 ----------------------- 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/

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, 2012JASIN, 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. 

http://www.cnn.com/2012/07/10/world/...ase/index.html

Mystery disease is not much of a mystery

Nope. Now it's all good. So it is 3 different diseases, all treated too late or with steroids..
Judging from recent reports, many countries are stringently checking their borders for any sign of a disease that is probably already in their country, namely HFMD..or Dengue Fever..or Strep Suis..

So far Thes countries are checking the borders for sick people from Cambodia. The W.H.O. is about to tell them that is unneccesary some time today. I heard it from CNN.
They didn't tell you what the other countries are doing.

Indo  http://news.xinhuanet.com/english/world/2012-07/09/c_131704362.htm

Vietnam  http://www.nhandan.com.vn/cmlink/nhandandientu/thoisu/doi-song/i-s-ng-tin-chung/ki-m-d-ch-y-t-bien-gi-i-ng-n-ch-n-b-nh-l-vao-vi-t-nam-1.357278

Thailand http://www.bangkokpost.com/news/local/301865/hfmd-in-thailand-is-under-control-says-deputy-minister

Phillipines  http://www.abs-cbnnews.com/nation/07/10/12/cambodian-infection-encephalitis-type-not-hfmd  Tight watch against enterovirus

China The usual

Malaysia http://www.bernama.com/bernama/v6/newsgeneral.php?id=679882



Most of these countries are calling it a strain from Cambodia that they are worried about. Soon I guess, they will say it's regular old HFMD with a few cases of EV71 thrown in and some dengue or pig strep on steroids. I can't help but to think back a couple days where the guy said it was a "Perfect Explanation" for what is happening.



All reports are from the same CNN story, Nothing from the WHO or any other gov't entity. Last nights report from Sanjay said that the Cambodia ministry of health were handling field reports and were not working hand in hand with the WHO. Less than 8 hrs later it is all a big misunderstanding. Just run of the mill diseases on steroids. Maybe the dr was right when he said that the WHO jumped the gun on this, as they overlook the Dengue cases right in front of them. Hopefully that is all it is, cause it is what they are gonna tell us. Oh yeah, it is not contageous..imagine that.  http://www.rappler.com/world/8364-no-need-to-panic,-cambodia-says-on-virus

Mexico-31 farms infected -3.4 mil birds affected -2.5 mil culled #H7N3

 ..As part of health activities in Punjab by avian influenza 148 poultry farms are reviewed and confirmed the presence of the virus in 31 of them, 34 more were negative and the rest is continued with the diagnosis laboratory, reported the National Health Service, Food Safety and Food Quality (SENASICA).
  On the National Emergency Animal Health (DINESA) launched to eradicate H7N3 avian influenza outbreak, originated in the municipalities of Acatic and Tepatitlan, Jalisco, applied in farms and backyards covered, until the day before Monday, a flock of 16.5 million birds, of which 3.4 million have been found affected.
 . The farms remain under quarantine and isolation, as well as maintaining, in accordance with national and regional poultry industry, the control measures to mobilize in order to prevent infected birds, poultry, contaminated poultry offal and could move to other regions without the virus.
  In this universe, the number of birds have been culled as a control and eradication, until Monday, was 2.5 million....    http://translate.google.com/translate?sl=es&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Fyucatan.com.mx%2Fmexico%2Favanza-el-control-de-la-gripe-aviar%2F

China to lend hand in battle with killer virus

Wednesday, 11 July 2012

China yesterday pledged to provide medical experts and funding to assist the investigation and clinical management of a virus that has killed more than 60 Cambodian children.

Eang Sophalleth, personal spokesman for Prime Minister Hun Sen, told reporters the pledge had been made during a meeting between the premier and Chinese Foreign Minister Yang Jiechi yesterday in Phnom Penh.

“There is a mysterious disease that is responsible for killing more than 60 Cambodian children. So China would like to provide experts and funding to assist Cambodia in finding the cause of the disease,” Sophalleth quoted Yang as saying to Hun Sen.

Cambodia’s largest children’s hospital, Kantha Bopha, has reported that 64 children have died from the virus since April.

Tests being conducted by Kantha Bopha and the Ministry of Health and the World Health Organisation have recently identified the disease as enterovirus 71 – a virus associated with hand, foot and mouth disease that can cause severe complications for children.

WHO epidemiologist Dr Nima Asgari said the details of the co-operation with incoming Chinese experts was a matter for the Ministry of Health, but welcomed the additional assistance.

“What I can say is that China does have a lot of experience with clinical management of this virus,” Asgari said.

China has experienced several outbreaks of EV-71, including severe outbreaks in 2008 and 2009 that claimed hundred of lives, according to media reports of the events. During the 2008 outbreaks, the US embassy in Beijing reported that “all the deaths were children less than six years old, and most were under two years of age”.

The commitment of expert assistance and funding was part of Yang’s promise from China to continue providing loans and aid to Cambodia as well as pushing for business and investment and tourists to the Kingdom.

According to Sophalleth, Hun Sen thanked China for its continuing support for Cambodia.http://www.phnompenhpost.com/index.php/2012071157342/National-news/china-to-lend-hand-in-battle-with-killer-virus.html

Mix of pathogens caused mystery illness in Cambodia, doctors say

HAT TIP TETANO

Video

By Dr. Sanjay Gupta and Danielle Dellorto, CNN

July 11, 2012 -- Updated 0936 GMT (1736 HKT)

 

Phnom Penh, Cambodia (CNN)

-- The World Health Organization, in conjunction with the Cambodian Ministry of Health, will conclude that a combination of pathogens is to blame for the mysterious illness that has claimed the lives of more than 60 children in Cambodia, medical doctors familiar with the investigation told CNN on Wednesday.

The pathogens include enterovirus 71, streptococcus suis and dengue, the medical sources said. Additionally, the inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, they said.

The sources did not want to be identified because the results of the health organization's investigation have not yet been made public.

Dr. Beat Richner, head of Kantha Bopha Children's Hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases had been confirmed since last Saturday.

The World Health Organization (WHO) is also 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.

Over the past four months, doctors at Kantha Bopha 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.

In the last hours of their life, the children experienced a "total destruction of the alveola(e) in the lungs," Richner said.

Other hospitals in the country have also reported similar cases, but far fewer than..

http://edition.cnn.com/2012/07/10/world/asia/cambodia-children-disease/index.html

The border medical quarantine, block "unknown disease" in Vietnam

Wednesday, 11/07/2012 (GMT +7)

 On 10-7, Department of Preventive Medicine (Ministry of Health) dispatch center requests the international medical quarantine center of preventive medicine are quarantine border activity immediately deploy the following activities: close monitoring for people on entry, especially for objects suspected carrier of infectious diseases through gate examination and medical treatment facilities for entry, examination and isolation of cases suspected infectious disease.

http://www.nhandan.com.vn/cmlink/nhandandientu/thoisu/doi-song/i-s-ng-tin-chung/ki-m-d-ch-y-t-bien-gi-i-ng-n-ch-n-b-nh-l-vao-vi-t-nam-1.357278

MEXICO SECRETARY OF HEALTH DENIES H7N3 CAN INFECT HUMANS

Or anything else for that matter..

SECRETARY OF HEALTH, CHERTORISKI SOLOMON: Good afternoon everyone, I greet with respect to fellow media, I thank the Secretary Ferrari's invitation to be together, to comprehensively platicarles all sides of this issue we have As always busy.

I would start by saying that the Ministry of Health we have one of the expert groups for influence in the world, recognized worldwide as reiterated today headed by Dr. Pablo Kuri, three messages that I would very timely.
The first influence is a disease that affects several animal species including as we all know and have experienced the human being, yet each of these viruses is limited to the transmission within the same species. In this particular case the H7N3 virus is only transmitted between birds, I want it very clear that no virus among lizards, whales, horses and of course reiterated among humans, but the virus that we are living today in the country today, focusing on the state of Jalisco has no chance of being transmitted to humans. I say this with all punctuality, with precision throughout history has never been a case of transmission of this virus to humans and I think it is very important as we have been doing throughout the week to reiterate this message there is no risk of infection in humans. http://translate.google.com/translate?sl=auto&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Fwww.sagarpa.gob.mx%2Fsaladeprensa%2Fboletines2%2FPaginas%2Fdefault.aspx


..Chertorivski Solomon, owner of Health, noted that "there is no risk of human infection" by bird flu and if they even broke the cordon sanitaire and someone were to eat eggs or chicken infected, your health is no risk.
http://www.jornada.unam.mx/ultimas/2012/07/06/153333235-se-duplicara-cuarta-emergente-de-exportacion-de-huevo



Due to the outbreak of bird flu that has affected A7N3 thousands of birds in the municipalities of Tepatitlán Acatic and Jalisco, the State Government through the Ministry of Health reports that this virus is not transmissible to exotic beings human by any means.

Likewise, this office has ruled out the possibility of avian flu infection who consume eggs and poultry.

Avian influenza is a highly contagious viral disease caused by a virus Type "A" that affects several species of birds of all ages, as wild and domestic turkeys, chickens, ducks, water birds, the latter acting as potential carriers virus.

Dr. Jose Trevino Leo Cardenas Director of Prevention and Disease Control, reported that this disease is only transmitted between birds that have contact with infected feces, secretions, contaminated food and water or improper handling of dead birds.

http://translate.google.com/translate?sl=es&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Fwww.masnoticias.net%2Fnote.cgi%3Fid%3D418307