Lisa Schnirring 
Staff
Writer
Jul 12, 2012 (CIDRAP News) – A joint investigation into
dozens of puzzling lethal respiratory illnesses in Cambodian children concluded
that the infections were caused by a severe form of hand, foot, and mouth
disease (HFMD), the World Health Organization (WHO) and Cambodia's health
ministry said today in a statement.
Earlier this week, the agencies said lab analysis of samples from
several of the patients pointed to enterovirus 71 (EV-71), which can cause a
severe form of HFMD in some patients.
In their wrap-up of the investigation, the groups said the
findings include a review of hospital records on children treated at Kantha
Bopha Children's Hospital, which reported unusual numbers of illnesses and
deaths since April, and records from other hospitals.
The probe also included a review of lab tests, follow-up of
affected families by rapid response teams, and analysis of disease data from
Cambodia's surveillance system. The Pasteur Institute in Cambodia and the US
Centers for Disease Control and Prevention (CDC) assisted with the
investigation.
Officials identified 78 cases, including 62 initially
reported from Kantha Bopha Hospital. Investigators focused on 61 cases that fit
the case definition, which included 54 deaths. The Pasteur Institute
tested samples from 31 patients, and most were positive for EV-71. A few were
positive for other pathogens, including Haemophilus influenzae
type B and Streptococcus suis, according to the statement.
Most of the patients were under age 3, and some were affected by
chronic conditions and malnutrition. The children were from 14 different
provinces.
Investigators found that many of the patients had been given
steroids at some point in their illness, which can worsen the condition of
patients with EV-71 infections, the statement said.
In response to the illnesses, Cambodia's health ministry,
with WHO support, has launched enhanced surveillance for neurorespiratory
syndrome, a key feature observed in some patients with severe HFMD caused by
EV-71. Officials have asked health centers to also report patients with
mild HFMD infections. The statement said officials expect to identify occasional
new cases of the severe form of the disease in the months ahead.
Health officials are also developing guidelines and training
courses for managing patients with both mild and severe HFMD.
The statement said HFMD is not a new disease in Cambodia,
but it did not say if illnesses linked to EV-71 had been detected before.
HFMD is common in many Asian countries. A Jun 26 HFMD surveillance
update from the WHO's Western Pacific Region office (WPRO) noted that seven
countries or administrative regions have reported cases this year, most of them
in China, Vietnam, and Singapore.
In other developments, health authorities in the
Philippines on Jul 10 made EV-71 infection a reportable illness, which requires
individuals and health facilities to report infections to public health
officials, Rappler.com, a social news network based near Manila, reported
yesterday. The country's department of health said yesterday that it would soon
release guidelines on reporting EV-71 illnesses.
Philippines health officials said no travel restrictions are
needed for people traveling to and from Cambodia, though officials are screening
in-bound travelers at all points of entry, according to the report.
See also:
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.