Viet Nam - Quang Ngai: Undiagnosed illness, 26 fatalities since April 2011

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://vietnamnews.vnagency.com.vn/Domestic-Press-Highlights/225764/mystery-disease-may-be-arsenic-poisoning.html

Updated June, 07 2012 09:05:48

Mystery disease may be arsenic poisoning

Doctors at the HCM Paediatrics Hospital No 2 speculate that the mystery skin disease afflicting people in Quang Ngai Province may be caused by arsenic or dioxin poisoning.
But a final conclusion awaits the results of tests done on three children admitted there a week ago.

Dr Ho Thi Kim Thoa said the preliminary diagnosis was that the patients were poisoned. Besides causing liver defects, the disease also affected other organs like heart and kidney.

Today the Ministry of Health will organise a conference to discuss the cause of the disease at Hospital C in Da Nang.

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://www.thanhniennews.com/index/pages/20120603-arsenic-found-in-hair-of-central-vietnam-fatal-skin-patient.aspx

Arsenic found in hair of fatal skin patient in central Vietnam
Last Updated: Sunday, June 03, 2012 04:05:00


Pham Van Thach at HCMC Children?s Hospital No.1 before he died May 27. His hair tested postive for high levels of arsenic.


Hair samples of the boy who died of a mysterious skin condition in central Vietnam?s Quang Ngai Province showed elevated levels of arsenic, doctors said.

Tang Chi Thuong, director of Ho Chi Minh City Children?s Hospital No.1 where the boy died May 27, said arsenic can cause skin inflammation, the first and most common symptoms among all patients suffering from the condition so far, according to a Sunday report by news website VnExpress.

However, Thuong said a lot more patients must be tested, and at different laboratories, before an official conclusion should be drawn about the skin condition which has been plaguing Quang Ngai?s Ba To District since April last year.

Thach was transferred to the hospital on May 20 after falling sick in March.

The arsenic level in one of his hair samples was 100 higher than normal while several others showed negative results.

Environmental surveys in 2011 found arsenic in groundwater in many places in northern and central Vietnam, VnExpress said.

The Health Ministry is prepared to conduct more tests on more patients.

At least 214 people from Ba To District have been infected with the unknown skin ailment and 23 have died, including the most recent casualty, a 33-year-old woman who expired on May 30.

Health officials have visited the district many times but remain puzzled as to the cause of the condition, which can quickly turn lethal by causing multiple organs to fail, beginning with the liver.

The World Health Organization said they have not received an official request for help with the situation.

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

A large number of Vietnamese language articles have just come out. A sample:

http://tuoitre.vn/Chinh-tri-xa-hoi/Song-khoe/495535/Benh-%E2%80%9Cla%E2%80%9D-o-Quang-Ngai-dioxin-vao-%E2%80%9Ctam-ngam%E2%80%9D.html

Friday, 06.08.2012, 04:01 (GMT +7) disease "strange" in Quang Ngai: dioxin on the "radar"

TT - Seminar Diagnosis and treatment of dermatitis thick horn hands, feet by the Administration clinics (MOH) held in Da Nang 7-6.

The experts say you should test to find dioxin causes.

Diseases >> "strange" in Quang Ngai
Quang Ngai >> strange disease: still deadlocked



Patients, "stranger" treatment at Health Centers Ba district - Photo: UNION STRENGTH



The latest information is Assoc. Dr. Tran Hau Khang - Director of Central Hospital of Dermatology and chairman of the board of the Ministry of Health professional - 7-6 for light, Asian Association of Dermatology in touch with him, ask if the Assembly will need to experts to help understand the disease "strange". However, by days 6-6 Ministry of Health has worked with the Centers for Disease Control and Disease Prevention (CDC) and the World Health Organization (WHO) does not need to participate.

Mr. Luong Ngoc Khue (Director of Administration medical) that may cause illness or school tomorrow to find out any resistance.

Dioxin can be found in plant protection drugs


Expeditiously at the

At the session of Congress on 7-6 on the economic situation - social, deputies Nguyen Cao Phuc (Quang Ngai) is very frustrating when the treatment regimen as well as the recommendations of the Ministry of Health were local timely implementation but not effective, patients still die. "I would propose to the Government directed the Ministry of Health should use all resources and all organizations that can, promptly invited the World Health Organization in early research to find effective solutions to save lives "- fierce Phuc.

Sues

Experts were aware of the source patient "strange" is due to poisoning. At the same time the experts suggest to put dioxin into the "sights". According to Prof. Kang, in all the tests have not done that a dioxin, and dioxin exposure may be related to the use of plant protection agents in agriculture.

Dr. Pham Due - anti-director of the Center (Bach Mai Hospital) - frank proposal to put dioxin into doubt by factors caused by dioxin has long been overlooked. He also agreed with the conclusions derived high disease from chronic poisoning syndrome lead to liver damage and skin thick horn hands, feet.

"I suspect dioxin-related diseases, but funding is not so large that testing be done. For years we thought dioxin is due to the war but not really, it was found in plant protection drugs "- Dr. Due said.

The same point, Dr. Hoang Van Minh - University Hospital Medical City - also said to focus on determining what toxic substances and so can not remove dioxin.

Administration health care provider about testing for dioxin, the WHO and CDC will monitor the situation and specific plans.

"Need to relocate displaced people will soon"

Mr. Nguyen Xuan Men - deputy director of Quang Ngai Health Department - pressing for that most diarrhea cases "strange" that dialysis will lead to death. He added that leaders of Quang Ngai province awaiting comments from the Ministry of Health. If the water is poisoned by saying the province will build water plants for people. Needed for displaced people in three provinces Fill it would move immediately.

At the workshop, the Ministry of Health has announced plans to reduce mortality by intervention patients, "stranger" in Ba from May to December. Ministry of Health focal implement this plan are 14 hospitals and medical facilities nationwide.

The plan was implemented in two phases. Phase 1 focus on improving the technical capacity for Quang Ngai province and referral treatment of severe cases. The severe cases are transferred and a tertiary treatment such as Hue Central Hospital, Cho Ray Hospital, Bach Mai Hospital, Children's Hospital 1, 2 ... Phase 2 will develop local treatment: the treatment of mild disease in the Medical Center of Ba To district, they taken seriously Hospital of Quang Ngai province.

Answer questions when critically ill patients transferred to hospitals at end of treatment still die, now back to the hospital in Quang Ngai province has nearly as much if not, Assoc. Dr. Tran Hau Khang said briefly: "The Ministry will strengthen the experienced professionals to help treat and train local doctors. With the added manpower, facilities, techniques for Quang Ngai. "

UNION STRENGTH


The first symposium

Calculated from the patients appear "strange" first (19-4-2011), this is the second official conference on the disease organized by the Health Ministry (1st workshop was held in April -2012 in Quang Ngai, with the participation of the Minister of Health Nguyen Thi Kim Tien and Deputy Minister Nguyen Thanh Long). But this is a symposium on treatment for patients with "strange" first.

According to the Ministry of Health, has had two tours of the Central Hospital of Dermatology in 2011, two inter-hospital survey team. 1st from 25 to 28-4 with 35 members and the 2 month 5-2012 with 70 members, not to mention the other sporadic trips.
.

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://vov.vn/Home/Bo-Y-te-van-chua-tim-duoc--nguyen-nhan-benh-la/20126/212215.vov

Health has not found a reason unknown disease
(VNA) - Ba To district, Quang Ngai Province had 215 people with thick horn syndrome dermatitis palms, feet, 43 relapse cases and 23 deaths.
Morning of 7/6, in Da Nang, medical Administration Ministry of Health organized a workshop diagnosis and treatment of skin inflammatory syndrome horns thick palms, feet. Attending the seminar were the leading experts of Dermatology, the Dermatology Hospital, Hue Central Hospital and the provincial departments of Health central city area. Many treatments, consultations, preventing the syndrome has been tabled. But still have not found the cause of gastritis horn syndrome palms feet.

Dr Nguyen Minh Tuyen, Deputy Head of resuscitation, a Children's Hospital, said after being taken from patients in Quang Ngai, the hospital has treated the direction of anti-infective, liver support. The patient improved very well but then relapse and death. The hospital just stop at treating symptoms.



Patients treated strangers.

Central Hospital Dermatology Quy Hoa, Ministry of Health said last year to now, the hospital has treated over 100 patients, all cured, but when returning to the disease relapse rate recurrence up to 76%. Mr Nguyen Thanh Tan, Director of Central Hospital Dermatology Quy Hoa, Ministry of Health stated that the characteristics of this syndrome is very persistent treatment, but progress was slow when there was very unfavorable surprises hospitals should be monitored closely.

Information at the conference, said the health sector have removed many factors that cause diseases such as allergic dermatitis due to the location, exposed to infection by fungal, bacterial, viral, allergic dermatitis drugs, toxic heavy metals. The Health Ministry has also implemented measures to examine the clinical epidemiology and community epidemiology and has removed all these factors. Because no cause is found should lead to health sector reform recommended further environmental screening to enable early detection in order to have timely treatment to people, the same time allocating drugs, vitamins and micronutrients regimen of health.

Associate Professor, Dr. Tran Hau Khang, Director of the Central Hospital of Dermatology, chairman of the dermatology specialist Ministry of Health recommends:

If not, only liver lesions treated with topical anti-inflammatory, anti-horns thick, anti-psoriasis. When the liver has to put up hospitals for treatment, there must be consultation of experienced staff

The experts World Health Organization has arrived in Vietnam, yesterday undertook to work with professional institutes of the Ministry of Health to find out the situation, then the actual survey, find the cause and provide appropriate treatment.

As of today 7/6, in the district of Ba To, Quang Ngai Province had 215 people with dermatitis syndrome horns thick palms, feet, of which, 43 recurrent cases and 23 deaths. Particularly in the last two days, District Health Centers Ba To, Quang Ngai province received 13 cases the presence of thick horn syndrome dermatitis palms, feet.

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

The mention of dioxin in an herbicide here is odd. The herbicide that has been used here is Kanup 480SL, which is glyphosphate, which is used worldwide, including elsewhere in Vietnam, without producing these symptoms and was not used here until after the start of the outbreak. I don't think it even has dioxin in it. Could they have been using a second herbicide that has not been identified? Or is the mention of dioxin a masked attempt to link these illnesses to the war 40 years ago?

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Well, here's where the reports of dioxin seem to be coming from. I don't see anything in this thread to indicate this chemical has anything to do with this outbreak.

While many American and Vietnamese people have had ill effects from exposure to that chemical over the past 40 years, the acute illness in this thread has not preivously been reported.

http://www.tuoitrenews.vn/cmlink/tuoitrenews/society/breakfast-tuoitrenews-june-8-1.75121

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-- Experts have recently demanded that Agent Orange/Dioxin be taken into account when searching for the causes of the unidentified skin disease in the central province of Quang Ngai.

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

I believe the discrepancy between the 12 deaths in Ba To in this article and the 23 deaths elsewhere is the 11 patients who died at home without receiving treatment.

http://www.vietnamplus.vn/Home/Dieu-tri-hoi-chung-viem-da-day-sung-o-Quang-Ngai/20126/143861.vnplus

Treatment of gastritis in Quang Ngai horn
07/06/2012 | 15:43:00

Visiting patients in hard economic Ba Pham Van Dien. (Photo: Dinh Thi Huong / VNA) on 7/6, Workshop on diagnosis and treatment of dermatitis thick horn hands, feet due to medical Administration, Ministry of Health organization, was held in C Da Nang Hospital.

The workshop was attended by leading experts and representatives of the participating hospitals are treating patients with hand dermatitis thick horns, feet in the district of Ba To, Quang Ngai province.

The workshop aims to look back on the past one year of treatment of patients with hand dermatitis thick horns, feet in Quang Ngai and share expertise in treating this disease, thereby reducing mortality Early detection and treatment of patients.

At the workshop, participants agreed on the contents: The name of the disease is taking place in Ba To district (Quang Ngai) in recent times as thick horn syndrome, dermatitis hands, feet. It is caused by chronic poisoning, but not yet identified specific disease-causing toxins. Unified treatment of the Ministry of Health has issued about this treatment, and additional guidance on supportive therapy.

In the future, health care Management Department will work with the Bach Mai Hospital and Central Hospital Dermatology to put some patients with gastritis horn syndrome hands, feet out in Quang Ngai province hospitals to facilitate the work of meeting standards, testing and follow-up. All units in the health sector will give priority to relevant doctors sent to the district under the scheme Ba the Ministry of Health in 1816.

As reported at the workshop and the cumulative number of cases dermatitis thick horn syndrome hands, feet in the district of Ba To, Quang Ngai province since the first cases of disease on [April 19]/2011 to [June 5]/2012 is 215 cases, which were officially recorded 12 deaths and 44 cases of recurrence. This disease is occurring in 5 communes of Ba is Ba Dien District, Ba Amazingly [translation error! - alert], Ba Xa, Ba, Ba Vinh. In particular, concentrated in the village of Ba Dien Commune Moss (accounting for 55.67&#37. The rate of infection highest age group from 15-30 years of age is over 30%, of which 100% of patients from ethnic H 're.

At the workshop, medical Administration has submitted draft plan interventions reduce death from gastritis horn syndrome hands, feet in the Ba district (Quang Ngai) in 2012 to consult specialists in the industry before the official promulgation. /

[Laidback Al]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

The rate of infection highest age group from 15-30 years of age is over 30%, of which 100% of patients from ethnic H 're.

The Hr? are an ethnic group of more than 100,000 people concentrated in Quảng Ng?i and B?nh Định provinces.(link)

The first map below shows the general area of this novel outbreak circled in red. The second maps shows the general location of Hr? ethnic group in the region.





Ethnicity map from http://www.ikap-mmsea.org/images/ethnicmapvietnam.jpg

[Ronan Kelly]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Updated June, 08 2012 10:48:10 EmailPrint
Arsenic may be killer in mystery disease outbreak

...
Dr Nguyen Huy Tien from HCM City-based Paediatrics Hospital No 1 said biopsies on nine-year-old Pham Van Thach, who died on May 27, revealed a chemical could be to blame.
"My check-ups and tests on the patient indicate that arsenic could be involved," he said.
"The patient had dermatitis on his palms hands and feet, while his liver and kidney appear to be poisoned with chemicals," he said.
He said poisoned food, water or pesticides could be responsible, adding that most patients were diagnosed with breathing difficulties and traumas on the liver and kidney, elevated liver enzymes as well as skin peeling off the palms of the hands and feet.
...

http://vietnamnews.vnagency.com.vn/social-issues/225856/arsenic-may-be-killer-in-mystery-disease-outbreak.html

[Ronan Kelly]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Saturday, Jun 09, 2012, Posted at: 14:12(GMT+7)
Dioxin suspected as possible cause of bizarre skin disease
Doctors in the Children Hospital No.2 in Ho Chi Minh City are now suspecting exposure to dioxin as a possible cause of the bizarre skin disease in patients arriving from Ba To District in the central province of Quang Ngai.

More than a week back, the hospital had received three patients suffering from the unidentified skin disease, from Reu Village of Ba Dien Commune in Ba To District. Doctors took a biopsy of skin lesions from all the three patients, Pham Thi Tren, 14, Pham Dinh Hieu, 6, and Pham Quoc Bao, 5.

According to the doctors, the skin disease may be reoccurring due to exposure to toxic and harmful substances like dioxin, which can penetrate air, soil, sediments, food and water.

Dr. Ho Thi Kim Thoa, who is directly treating the above cases, said the children all suffered from severe damage to liver, kidney, heart and hearing, and their condition had not improved, despite blood filtering many times.
...

http://www.saigon-gpdaily.com.vn/Health/2012/6/101606/

[Ronan Kelly]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Change personal habits to eradicate skin disease: WHO
While looking into solutions to eradicate the bizarre and unidentified skin disease plaguing Ba To District in the central province of Quang Ngai, Dr. Babatunde Olowokure, acting head of the World Health Organization in Vietnam, said that it is important that local medical workers focus on bringing about a change in people?s personal habits.

Dr. Olowokure said that so far there has never been any medical record of such a skin disease in any of WHO?s medical journals.

This is a quite a new, bizarre and unknown disease in the world, he said. Hence it will take some time to determine its cause.

...

http://english.vietnamnet.vn/en/society/23575/change-personal-habits-to-eradicate-skin-disease--who.html

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://www.thanhniennews.com/index/pages/20120614-vietnam-yet-to-locate-toxin-of-fatal-skin-disease.aspx

Vietnam yet find toxin causing mysterious, fatal skin disease
Last Updated: Thursday, June 14, 2012 11:30:00

A patient from Quang Ngai Province?s Ba To District being treated for an unidentified skin condition at the Quy Hoa National Leprosy Dermatology Hospital in Binh Dinh Province

Scientists have concluded that the mysterious skin condition that has killed 23 and affected 215 people in Vietnam since last April is caused by chronic poisoning, but they have yet to determine the exact toxin responsible.

At a conference held in the central city of Da Nang on Tuesday, scientists said the disease that has been plaguing Ba To District in the central province of Quang Ngai was caused by some type of environmental contamination, the Vietnamnet news website reported Wednesday.

The condition begins with blisters on the hands and feet and loss of appetite, and may turn fatal due to organ failures, starting with the liver.

Earlier it was believed that the disease was related to local tainted rice and water sources, but even after local agencies cleaned up those areas of contamination, the spread of the disease only increased, the report said.

More than 100 scientists and experts from leading hospitals are rushing to identify the disease, now officially known as hoi chung viem da day sung ban tay ban chan, which translates into English as "the syndrome of dermatitis and horny layer thickening in foot and hand."

In the meantime, Vietnamese health agencies are working to limit the disease's death rate, said Tran Hau Khang, director of the Central Dermatology Hospital.

VnExpress last week quoted Dr. Babatunde Olowokure from the World Health Organization (WHO) in Vietnam as saying that the syndrome has no similarity with any disease or illness that has ever been known in the world.

It will therefore take more time to find the cause than expected, and that in some cases the cause will not be identifiable, the foreign expert said.

The Vietnamese health ministry recently asked for help from the WHO together with the US Centers for Disease Control and Prevention in handling the disease, after being criticized by the public for delaying seeking the support of international organizations.

[Ronan Kelly]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Last update 19/06/2012 12:25:31 PM (GMT+7)


No dioxin, toxic chemicals in soil or water in Ba Dien Commune
Army scientists have ruled out the presence of dioxin or any other toxic chemical substances in the soil or water in Reu Village of Ba Dien Commune in the central province of Quang Ngai, where the bizarre and unidentified skin disease is plaguing local residents.

The Ba To District People?s Committee had earlier sent a document to the Ministry of Defense asking for assistance in finding the cause of the disease. Scientists from the ministry had announced the results after conducting tests of soil and water samples for one month.

According to test results, the stream water that Reu villagers in Ba Dien Commune use for cooking and daily use is heavily polluted from high levels of micro-organisms, said Colonel Dinh Ngoc Tan, president of the Institute of Military Chemical Environment.

Scientists added that other chemicals are still limited, and no traces of dioxin have been found. Content levels of insecticides and heavy metals were also found, but in permissible limits.
...

http://english.vietnamnet.vn/en/society/23794/no-dioxin--toxic-chemicals-in-soil-or-water-in-ba-dien-commune.html

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://english.vietnamnet.vn/en/society/23794/no-dioxin--toxic-chemicals-in-soil-or-water-in-ba-dien-commune.html

Last update 19/06/2012 12:25:31 PM (GMT+7)


No dioxin, toxic chemicals in soil or water in Ba Dien Commune
Army scientists have ruled out the presence of dioxin or any other toxic chemical substances in the soil or water in Reu Village of Ba Dien Commune in the central province of Quang Ngai, where the bizarre and unidentified skin disease is plaguing local residents.

The Ba To District People?s Committee had earlier sent a document to the Ministry of Defense asking for assistance in finding the cause of the disease. Scientists from the ministry had announced the results after conducting tests of soil and water samples for one month.

According to test results, the stream water that Reu villagers in Ba Dien Commune use for cooking and daily use is heavily polluted from high levels of micro-organisms, said Colonel Dinh Ngoc Tan, president of the Institute of Military Chemical Environment.

Scientists added that other chemicals are still limited, and no traces of dioxin have been found. Content levels of insecticides and heavy metals were also found, but in permissible limits.

Accordingly army scientists warned residents in the commune to boil stream water for daily use as well as clean up the surrounding environment. However, recent tests made on water and soil can be used as reference in finding causes of the disease, said Tan.

Meanwhile, Dr. Nguyen Quoc Anh, director of Bach Mai Hospital in Hanoi, said he had examined more than 300 residents of Ba Dien Commune and other patients being treated in Ba To District Medical Center and the General Hospital in Quang Ngai Province.

He concluded that most of the people were suffering from malnutrition and pernicious anemia (few red blood corpuscles or low hemoglobin) which results in a flare up of the disease.

Moreover, disease symptoms in patients vary; some suffer from liver fibrosis, others from liver inflammation, malnutrition, or bleeding in digestive tracts, said Dr. Anh.

According to the latest statistics from the province?s health sector, 239 people have been affected by the disease from April 19, 2011 to June 6, 2012, with 23 fatalities. Currently, 20 people are being treated in hospitals in Quang Ngai Province and the Children Hospital No.2 in Ho Chi Minh City.

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

A rather graphic picture of a victim of the disease is at the link.

http://www.tuoitrenews.vn/cmlink/tuoitrenews/society/dioxin-not-found-in-bizarre-skin-disease-samples-tests-1.76506

Updated : Mon, June 18, 2012,12:31 PM (GMT+0700)

After testing the water and soil samples taken from the Quang Ngai Province’s Ba To District, where 23 people have been killed by an unidentified skin syndrome since last year, experts said dioxin had been not found in them.

Dioxin not found in bizarre skin disease samples: testsThe tests have been carried out by the Military Chemical Environment Institute under the High Command of Chemistry, said Le Han Phong, chairman of the District, where the strange syndrome broke out in April 2011.

Many experts suggested at a seminar held on June 7 in Da Nang City that dioxin should be considered as a possible cause of the strange syndrome that has affected about 200 people in the district.

The syndrome is characterized by thickened skin (keratosis) over the palms and soles, causing stiffness in the limbs and ulcers on victims’ hands and feet that look like burns.

But now experts from the institute have confirmed that dioxin, as well as other chemicals that were used in the Vietnam War before 1975, have been not found in the water and mud samples.

However, the samples were found to be infected with microorganisms at a level that is 1.3-3 times higher than the acceptable limits, said the institute.

The results are identical with those of the tests that were earlier conducted by the Ministry of Science and Technology.

Both agencies have concluded that the water source at Go Khe Mountain has been seriously polluted.

Many residents in Reu, Go Nghenh and Hi Long hamlets of the district’s Ba Dien Commune have taken water from the source for their daily activities, authorities said.

As previously reported, the bizarre disease, which first occurred in the district on April 19, 2011, has so far spread to five communes in the district, including Ba Dien, Ba Ngac, Ba Xa, Ba Vinh and Ba To.

The Health Ministry has yet to identify the cause of the disease.