Sri Lanka: 10 children die from undiagnosed respiratory illness - adenovirus, H1N1 suspected

[alert]

Published Date: 2018-05-18 11:56:15
Subject: PRO/SOAS> Undiagnosed viral infection - Sri Lanka (02): (Galle) pediatric, nosocomial, fatal
Archive Number: 20180518.5802882
UNKNOWN VIRAL INFECTION - SRI LANKA (02): (GALLE) PEDIATRIC, NOSOCOMIAL, FATAL
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[1] Date: Thu 17 May 2018
Source: EpiCore Global Surveillance Project [edited]


The clinical features of this mystery virus are apparently similar to influenza. Testing should soon reveal whether it is influenza in fact, but it is likely to be another respiratory virus.

--
Communicated by:
EpiCore Global Surveillance Project


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[2] Date: Thu 17 May 2018
Source: EpiCore Global Surveillance Project [edited]


The epidemic is now spreading to the adjacent district of Matara. Although some adults have also been affected, [their illness is not] as severe as that of the children. Many children in the pediatric ward at Karapitiya hospital are on oxygen.

The MRI [Medical Research Institute] virologists appear to be quite satisfied that it is just an adenovirus. This is the impression I got when I spoke to those who did the assays.
--
Communicated by:
EpiCore Global Surveillance Project


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[3] Date: Thu 17 May 2018
Source: EpiCore Global Surveillance Project [edited]


Apparently it is some sort of adenovirus. However, the question is whether the usual adenoviruses cause such virulent epidemics as this. I have a feeling that we are looking at something other than the usual adenovirus. All children have bad viral pneumonitis and are on oxygen. The ones who died developed respiratory failure.

Now the death toll is 10.

--
Communicated by:
EpiCore Global Surveillance Project


[ProMED thanks the EpiCore members who submitted important information regarding the undiagnosed viral illness in Sri Lanka.

In summary, adenovirus is likely the causative agent resulting in severe respiratory disease with up to 10 fatal cases so far. Further identification of the adenovirus types may be helpful in understanding the severity of disease and adverse outcome.

The immune status of the affected children is also an important consideration, since disease may be more severe in such patients. Obviously these children were already hospitalized and had other health issues and therefore the possibility of concomitant infection with another viral or bacterial pathogens should be ruled out as well.

Acute respiratory disease (ARD) -- predominantly adenovirus types 1, 2, 4, 5, and 6; occasionally, 3 and 7
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As with many other viral syndromes, ARD is more common in spring and winter months. Approximately half of adenovirus respiratory infections do not cause symptoms. Adenoviruses account for 10 percent of all childhood lower respiratory tract infections. Lower respiratory tract infections, including tracheobronchitis, bronchiolitis, and pneumonia, may mimic respiratory syncytial virus infection or influenza. Notably, conjunctivitis in the presence of bronchitis suggests adenoviral infection. Fatal pneumonia is uncommon but is more likely in neonates and has been associated with serotypes 3, 7, 14, 21, and 30 (https://emedicine.medscape.com/article/211738-clinical).

Currently, specific therapy for adenovirus infection, other than supportive and symptomatic treatment, remains a matter of debate. Fortunately, most infections are self-limited in the setting of a normal immune response and do not warrant specific therapy.

In immunocompromised patients, several drugs, such as cidofovir, ribavirin, ganciclovir, and vidarabine, have been used to treat adenovirus infections. Most of these agents are virostatic, may induce drug resistance, and have significant risks of toxicities, as well as risks to healthcare staff, depending on mode of delivery (such as, aerosolized ribavirin). - Mod.UBA

HealthMap/ProMED-mail map
Galle, Southern, Sri Lanka: http://healthmap.org/promed/p/12673]

See Also

Undiagnosed viral infection - Sri Lanka: (Galle) pediatric, nosocomial, fatal, RFI 20180517.5799922
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[alert]

Earlier post:

http://www.promedmail.org/post/20180517.5799922 Published Date: 2018-05-17 12:01:32
Subject: PRO/SOAS> Undiagnosed viral infection - Sri Lanka: (Galle) pediatric, nosocomial, fatal, RFI
Archive Number: 20180517.5799922
UNDIAGNOSED VIRAL INFECTION - SRI LANKA: (GALLE) REQUEST FOR INFORMATION
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Wed 16 May 2018
From: Mohamed Rafeek Rukshan Ahamed [edited]


An unidentified virus has resulted in the deaths of 5 children in the pediatric ward of the Teaching Hospital in Karapitiya, Galle (Southern province) Sri Lanka over the last few days. According to hospital sources, several more children are currently suffering in the ward.

Director of the Teaching Hospital Karapitiya, Galle, Dr Jayampathy Senanayake, has confirmed the deaths of the 5 children. At first, doctors thought it was a bacterial infection, but now they have confirmed that it is a viral infection. However, they have not been able to identify the virus. Dr Senanayake also confirmed that there were other children infected with the same virus in the ward and many are getting admitted with the similar type of infection. Blood samples were sent to Medical Research Institute (MRI) Colombo for further investigation.

--
Mohamed Rafeek Rukshan Ahamed
University of Peradeniya
Sri Lanka


[ProMED-SoAs thanks Mohamed Rafeek Rukshan Ahamed for this report on a series of fatal cases in a pediatric ward in Sri Lanka.

The report does not provide much information on the clinical picture of the cases and their presentation that could help guide inference to a possible etiological agent. Any further information on the etiology from fatal or new suspected cases, the results of any diagnostic tests, consultation with any referral facility, contact tracing, etc., on cases under evaluation/treatment would be quite helpful. - Mod.UBA

[Ronan Kelly]

http://www.hirunews.lk/191093/fever-in-south-death-toll-risen-to-13

[tetano]

Preschools closed in Influenza hit Southern province

The Southern Provincial Education Minister said that he instructed to close all Preschools in the province due to the spread of Influenza, from today until May 23.

The Provincial Minister said that he gave these instructions after consulting medical specialists who reported that hospital wards are already overflowing with children and several children had died due to the H1N1 virus.

Accordingly pre-schools in Matara, Mulatiyana, Akurassa, Tengalle, Walasmulla and Galle will be closed.

Medical Specialist urged to refrain from sending children to school who are contaminated with fever, cold or cough.

The Specialists also advised to avoid exposing children to where older people exists.

http://www.dailynews.lk/2018/05/21/local/151570/preschools-closed-influenza-hit-southern-province

[Pathfinder]

Pre- and primary schools in Southern Province closed due to viral flu

Tue, May 22, 2018, 12:04 pm SL Time, ColomboPage News Desk, Sri Lanka.

May 22, Colombo: The Southern Province Education Ministry says, as a precaution to a viral fever spreading in the Southern Province, Primary Schools and the primary section of secondary schools in six Education Zones will be closed today and tomorrow.
...
A viral flu epidemic is spreading across the Southern Province mostly affecting infants and children. Several children under one year of age and elderly people who were infected with the viral disease have died while at present around 600 people are receiving treatment

According to the Director of the Karapitiya Teaching Hospital in Galle, 37 children are presently receiving treatment for influenza in the hospital.
...

http://www.colombopage.com/archive_18A/May22_1526970875CH.php

[Ronan Kelly]

14 children die from viral flu in Sri Lanka
Source: Xinhua 2018-05-31 18:09:50
COLOMBO, May 31 (Xinhua) -- Sri Lanka's health officials on Thursday said 14 children had died from a viral fever which was spreading in southern Sri Lanka and urged the public to take safety health measures to prevent its spread.

Director of the Karapitiya Teaching Hospital in southern Sri Lanka, Dr. Jayampathi Senanayake told Xinhua that out of the 14 deaths, 13 were reported in Karapitiya while one was reported in Colombo.

All children who had died were below 2 years of age. According to doctors, the symptoms of the virus include fever, cough, cold and headache. The patients then develop breathing problems which leads to pneumonia.
...

http://www.xinhuanet.com/english/2018-05/31/c_137220724.htm

[tetano]

Killer virus identified as Influenza A

COLOMBO (News 1^st) ? Health authorities say the viral fever that is rapidly spreading across the Southern Province has been attributed to a strain of the Influenza A virus. Over the past three weeks, 13 lives, mainly those of small children, have been lost to the disease.
Since the viral fever began spreading rapidly across the Southern Province, many have questioned whether this could spread to other parts of the country causing a national epidemic. 1,068 patients had contracted this viral fever in the Galle district alone between the 21^st and 30^th of May. 744 cases were reported from the Matara district while about 500 cases have been reported from the Hambantota district.
Dr. Jude Jayamaha, Consultant Medical Virologist of the National Influenza Centre stated that since last month they have received about 159 samples from small children, especially from the Karapitiya hospital to the Medical Research Institute. He stated that they have identified it as the Influenza A virus and cannot say that it is a new virus. He added that it appears that it is the same Influenza virus that has afflicted the population over the past several years.

https://visitsrilanka.com/news/killer-virus-identified-as-influenza-a/