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

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  • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky

    Aflatoxin suspected, once again....

    http://www.saigon-gpdaily.com.vn/Health/2013/3/104322/

    Thursday, Mar 07, 2013, Posted at: 12:40(GMT+7)

    Health Ministry suggests replacing toxic rice with fresh stock

    A doctor examines a patient suffering mystery skin disease
    After tests showed toxic mushrooms in rice samples consumed by people in Ba Dien Commune in Ba To District in the central province of Quang Ngai, the Ministry of Health proposed replacing their traditional rice stock with high quality rice.

    Nguyen Van Binh, head of the Department of Preventive Medicine under the Ministry of Health, said they have requested the Chairman of the People’s Committee in Quang Ngai Province and the Minister of Agriculture and Rural Development, to replace the traditional rice stock of residents with high quality rice, as the former contains toxic mushrooms.

    In addition, related agencies should instruct people to eliminate mildew from rice baskets as well as improve personal hygiene and clean surrounding areas.

    According to a report from the Quy Hoa National Leprosy Dermatology Hospital in the central province of Binh Dinh and Pasteur Institute in Nha Trang, the bizarre disease reoccurred in the province via six persons, including Pham Thi Ngai, 73, from Reu Village in Ba Dien Commune; Pham Thi Vin, 27; Pham Van Toan, 9, and Pha Va Un, 33, from Nuoc Ne Village in Ba Vinh Commune. All of them had eaten the traditional rice.

    The mystery skin disease that first occurred in the district on April 19, 2011 erupts as thickening of the skin (keratosis) on palms and soles, stiffness in limbs and ulcers on hands and feet that look like burns.

    Comment


    • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky

      Machine translation of original article:


      "Disagreement about the causes of the strange

      10/03/2013 3:10
      On 9.3, the delegation of the Ministry of Agriculture and Rural Development of Ba Dien Ba district (Quang Ngai), local outbreaks of dermatitis syndrome thick horn hand - foot (strange disease), to examine the quality rice and water.

      Through the survey, the delegation said that the majority the rice hut of people follow practices to preserve the standard improper rice. Thus, insects and pests such as rats, cockroaches can invade, affect food quality. Water sources that people use Ba Dien mainly water vessels near the fields and streams should also not hygienic. Nguyen Thi Xuan Thu, Vice Minister of Agriculture and Rural Development, said it will assign the unit of the drying system support for quality people to ensure a dry, moldy, rice quality. In the short term, to immediately deploy water works.

      By the afternoon of 9.3, Ba district health centers recorded 14 in Ba Dien and Ba Vinh strange disease, including 5 cases of recurrence and nine new cases. According to medical experts, not exclude the possibility of re-use by patients brewed rice so strange disease recurrence. Department of Preventive Health (MOH) reported test results that people in rice samples Ba Dien use some kind of poisonous mushrooms. Meanwhile, Ba leaders voiced root cause of the disease is due to people eating rice silage, moldy rice. "



      "What information consumes is rather obvious: it consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention, and a need to allocate that attention efficiently among the overabundance of information sources that might consume it." - Herbert Simon

      "The benefits of education and of useful knowledge, generally diffused through a community, are essential to the preservation of a free government." - Sam Houston

      Comment


      • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky

        This is a new fatal case.

        The total count here is not correct; this is either the 25th or 29th fatality.

        http://news.xinhuanet.com/english/he..._132228028.htm

        Mystery skin disease infects 17, kills 1 in central Vietnam

        English.news.cn 2013-03-12 15:51:28

        HANOI, March 12 (Xinhua) -- An unidentified mystery skin disease have infected 17 people from Vietnam's central Quang Ngai province, killing one, so far this year, local health official said Tuesday.

        Le Huy, an official from Quang Ngai health department, told local Vietnam News that 13 people from Ba To and Son Ha districts have been diagnosed with infections of dermatitis, while three others are being kept in health centers for further diagnosis.

        One patient, who previously believed to be suffering the disease, died of septicemia (a blood infection) at Da Nang general hospital Monday. He is 17 years old and from Son Ha district.

        Huy said 13 patients had undeniably suffered from dermatitis, while another three are being treated under existing methods by the Health Ministry.

        All patients have had oilment applied to their affected skin and taken medicine to ease the pain.

        The strange disease, which caused people's skin to peel off their feet and palms, was first reported in 2011, and it was believed to be controlled last August. However, it reoccurred on Feb. 19 this year.

        So far, the disease affected a total of 215 people, mainly from Ba To district of central Quang Ngai province, about 730 km south of capital Hanoi, of whom 23 people died, said the report.

        Comment


        • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky, 1 in Son Ha

          Published Date: 2013-03-12 14:02:00
          Subject: PRO/EDR> Undiagnosed illness - Viet Nam (01): (QG) resurgence
          Archive Number: 20130312.1583058

          UNDIAGNOSED ILLNESS - VIET NAM (01): (QUANG NGAI) RESURGENCE
          ************************************************** **********
          A ProMED-mail post
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          [1]Date: Thu 28 Feb 2013
          Source: Quang Ngai province Information and Communications Department [edited]
          http://www.quangngai.gov.vn/eng/Page...qnpsite-1.html


          After discovering 2 cases of the "strange disease" in Son Ba commune (Son Ha mountainous district), the Malaria Parasite-Insect Central in coordination with the Quang Ngai provincial General Hospital organized screening for the H're [an ethnic group] living in the commune.

          During 23-24 Feb 2013, the doctor mission of the health sector conducted examination and screening tests for 341 cases, blood tests for 38 cases. Through test examination activities, 9 cases were discovered to [have] high liver enzymes, mainly concentrating in the 2 villages of Ka Khu and Ba.

          In the morning of 27 Feb 2013, the provincial Preventive Medicine Center sprayed chemicals for disinfection and sterilization with chloramine B at a concentration of 2 per cent in the aforesaid villages with the ratio of 20 mg/100 sq m to prevent the disease epidemic.

          [byline: Dai Kiet]

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          ******
          [2]
          Date: Mon 4 Mar 2013
          Source: Thanh Nien News [edited]
          http://www.thanhniennews.com/index/p...er-hiatus.aspx


          Fatal skin disease returns to central Viet Nam after 3 month hiatus
          -------------------------------------------------------------------
          A fatal skin disease believed to have first appeared in Viet Nam has recurred in the central province of Quang Ngai, local authorities reported on Sunday [3 Mar 2013]. The mysterious disease has killed 24 of 240 people affected with it since first appearing in 2011. Since the end of last month [February 2013], after about 3 months of no reported cases, 6 people have been admitted to local hospitals in Ba To and Son Ha districts with the disease.

          The new patients were diagnosed as having the illness that begins with blisters on the hands and feet and the loss of appetite, and can turn fatal due to organ failure, starting with the liver. It is officially known as the syndrome of dermatitis and horny layer thickening in foot and hand in Viet Nam.

          Local and foreign experts, including those from the World Health Organization have yet to find the cause of the syndrome that has been mostly recorded in Ba To District, or come up with an effective treatment method. Speaking to Thanh Nien, Le Han Phong, chairman of Ba To District People's Committee, said 4 of the latest patients are from one family in Ba Dien Commune -- the disease's focal point with 124 cases of infection and 16 deaths from it so far. The youngest victim was 7 years old and the eldest was 75, Phong said.

          Two others are from Son Ha District's Son Ba Commune, where authorities also detected 9 cases in which patients had slightly increased liver enzyme levels, one of the symptoms associated with the disease. All patients suspected of having the disease have been placed under close observation by local health workers.

          Dinh Van Nun, head of a Ka Khu Village in Son Ba Commune, said people are "very scared" because they have heard that the disease killed many in Ba To District last year [2012].

          In the meantime, the Quang Ngai Center for Preventive Health has sent teams to sterilize the environment, and take samples of the water and soil in Ba To. More health officials have also been sent to the locality to control the situation. The same measures have been launched in Son Ba.

          Since the disease first broke out in April 2011, scientists from various fields have undertaken inspections and conducted tests to find its cause. They have concluded that it is caused by chronic poisoning, but have so far failed to identify the toxin responsible.

          In an interview with the online newspaper VnExpress, Dr Babatunde Olowokure from the World Health Organization (WHO) in Viet Nam said the disease is not similar to any disease or illness that has ever been known in the world. He warned that it will therefore take more time to find the cause than expected, and that in some cases the cause may not be identifiable.

          [byline: Hien Cu]

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          ******
          [3]
          Date: Mon 11 Mar 2013
          Source: VietNamNet Bridge [edited]
          http://english.vietnamnet.vn/fms/soc...uang-ngai.html


          People in the area of the strange skin disease are anxious about their fate while the Ministry of Health is struggling to "decode" the disease. The disease that has killed 23 people in Quang Ngai is raging violently.

          In 2012, [a woman] was infected with the disease. She was well again after 2 months of treatment. But the disease has recurred. The "strange" disease, which is called by the Ministry of Health as dermatitis syndrome on hands and feet, in the central province of Quang Ngai has recently returned with new cases, while the specific cause of the disease is still vague. Since late February 2013, the bizarre skin disease has come back in the mountainous districts of Quang Ngai. On 6 Mar 2013, the total number of patients was 12. Of the 12 patients, there are 2 cases of recurrence.

          The latest case is a 60 year old [woman], in Reu village, Ba Dien commune. This is also a case of recurrence. Last year [2012], [this woman] had the disease and was well again after treatment. 2 members of her family [died of] this disease, including her 26 year old daughter, who died in July 2012, and [the daughter's] son, 4.

          The disease has killed 23 people, but so far health experts have not found the cause. The 2nd case of recurrence is a 75 [year old woman], also a resident of Ba Dien commune. Notably, the "strange" disease not only broke out in Ba To district, but also appears in the mountainous district of Son Ha. The 2 patients here are a 63 year old man and his wife, 57 years old, in Ka Park Village, Son Ba commune. The 2 patients were treated at the dermatology ward of the Quang Ngai Province Hospital on 19 Feb 2013. The couple has escaped the hospital to go home.

          Mr Le Han Phong, chairman of Ba To district, says that the "strange" disease is developing complicatedly. He wishes health experts will soon clarify the cause to definitively treat people.

          Chief of the Department of Preventive Medicine -- Nguyen Van Binh says: "The test of rice that used by farmers in the area of the strange disease (in Ba Dien Commune, Ba To district) was performed at a Hong Kong laboratory for some kind of poisonous fungus, but it did not indicate the exact type of fungus which is the specific agent of the disease."

          Many experts have come to survey and collect samples for testing but in the last 2 years they have yet to determine the cause. The health sector has made a lot of speculation about the cause, such as dermatitis caused by infection, fever caused by rickettsia, hepatitis E, malnutrition...

          2012 was the peak of the "strange" disease. The minister of health -- Nguyen Thi Kim Tien visited Quang Ngai to inspect the disease. After that health experts said, "Eating moldy rice is one of the suspicious factors." However, the Ministry of Health has not confirmed that eating moldy rice as the cause of the disease.

          Mr Pham Van But, chairman of Ba Dien Commune, says that he and the local people are very worried about this disease. He adds that the district authorities firstly provided the local people 15 kg of rice per person per month. In August 2012, it reduced the amount to 4 kg and nothing. Since then the local people have eaten moldy rice again.

          [byline: Le Ha]

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          [The news articles above concerns an outbreak in several villages in the Ba To, and now the Son Ha districts, in Quang Ngai province, Viet Nam, on which ProMED-mail previously reported last year (2012). Those affected developed an acute febrile illness with loss of appetite and respiratory symptoms followed by a desquamating rash on the hands and feet described as "palmoplantar keratoderma" (http://emedicine.medscape.com/articl...rview#aw2aab6b), accompanied by liver dysfunction and, in some patients, by multi-organ failure and death. Ulcers on the hands, feet, mouth, back, and abdomen, eye disease, stiffness of the limbs, and miscarriage were also described. Mainly children and young adults have been affected.

          The disease is said to have started in April 2011, subsided somewhat between November 2011 and February 2012, and picked up pace again in March and April 2012. This pattern has repeated itself again this year (2013), having abated in the fall of 2012 and recurred in this past month. The disease seems to have relapsed in several patients whose disease remitted last year. The numbers of patients affected and the death toll has varied in the news reports, but one of the news reports above says that the disease has caused 24 deaths since beginning in 2011.

          Pictures of the rash on the hands and feet of the affected Vietnamese villagers are available at the source URL above and at http://www.saigon-gpdaily.com.vn/Health/2012/4/100698 and http://www.eyedrd.org/2012/04/breako...l-vietnam.html.

          Prior reports say that WHO and the US-based Centers for Disease Control and Prevention (CDC) experts have failed to find a cause for this outbreak, but the disease seems to follow a seasonal pattern and recurred after resumption of eating moldy rice.

          Quang Ngai is a Vietnamese province located in the South Central Coastal region along the South China Sea, 883 km (549 mi) south of Hanoi and 838 km (521 mi) north of Ho Chi Minh City (http://en.wikipedia.org/wiki/Quang_Ngai_province). The province has a large plain along the coast and in the center of the province and has mountains and hills in the west. Son Ha is a rural district of Quang Ngai province with a population of 64 398 in 2003 (http://en.wikipedia.org/wiki/Son_Ha_District). Ba To is a rural district of Quang Ngai province with a population of 47 268 in 2003 (http://en.wikipedia.org/wiki/Ba_To_District).

          Comment


          • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky, 1 in Son Ha

            Machine translation of original article:

            "Wednesday, 03/13/2013

            WHO supports Vietnam to investigate strange disease
            13/3, WHO sent a team of experts in epidemiology to Quang Ngai investigate the strange back and prophylactic.

            According to information from the Ministry of Health on 12/3, today (13/3), the mission of which includes representatives of the Department of Preventive Medicine, Institute of Hygiene and Epidemiology Surgeons, Dermatology Hospital of Central and epidemiological experts of the World Health Organization (WHO) in Vietnam to Quang Ngai investigate the strange diseases back and how to prevent the disease. According to the Ministry of Health, this is the second expert team in Quang Ngai since the strange disease is determined to return from the end of February.

            On the same day, deputy director of the Department of Health Nguyen Tan Duc Quang Ngai said that apart from the deaths of the Cross (17) in the village of Re, Son Ky Son Ha district, the province had 16 cases of unknown disease."



            "What information consumes is rather obvious: it consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention, and a need to allocate that attention efficiently among the overabundance of information sources that might consume it." - Herbert Simon

            "The benefits of education and of useful knowledge, generally diffused through a community, are essential to the preservation of a free government." - Sam Houston

            Comment


            • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky, 1 in Son Ha

              Mysterious fatal disease remains just that: what is being done?
              Last Updated: Thursday, March 14, 2013 05:05:00

              Another person suspected to have a fatal skin syndrome has died in the central province of Quang Ngai.

              The victim, a 17-year-old boy, was one of 17 people to have been suffering from the condition since it reappeared last month end after a few months’ hiatus.

              Overall, the disease, known as the syndrome of dermatitis and horny layer thickening in foot and hand, has so far killed 25 people ( alert - Ro) out of 240 who contracted it in Ba To and Son Ha districts since it was first detected in 2011.
              ...
              http://www.thanhniennews.com/index/p...eing-done.aspx
              Twitter: @RonanKelly13
              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

              Comment


              • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky, 1 in Son Ha

                Breakfast @ Tuoitrenews – March 16

                -- The Health Ministry has confirmed that the mysterious skin disease that has raged in central Quang Ngai Province since April 2011 is caused by a kind of toxic fungi found in local rice. The ministry asks provincial authorities to advise local residents not to eat any rice that has been contaminated with fungi. The ministry also requests concerned agencies to provide quality rice to people in areas affected by the disease, which is characterized by fever and a rash most frequently seen on the palms of the hands, soles of the feet, and inside the mouth.

                Read more: http://www.tuoitrenews.vn/cmlink/tuo...#ixzz2Nf6FTbri

                Experts attribute mildewed rice for cause of bizarre disease
                Nguyen Tran Hien, head of the National Institute of Hygiene and Epidemiology, said that medical experts attribute mildewed rice for the bizarre disease striking people in Ba Dien Commune in Ba To District in the central province of Quang Ngai.


                Experts attribute mildewed rice for cause of bizarre disease in Ba To District in the central province of Quang Ngai
                Representatives from the Ministry of Health, National Institute of Hygiene and Epidemiology, Quy Hoa National Leprosy Dermatology Hospital in the central province of Binh Dinh, Pasteur Institute in Nha Trang, and World Health Organization, have arrived in the village to meet patients for further investigation as to the cause of the disease.
                ...
                http://www.tuoitrenews.vn/cmlink/tuo...ch-16-1.100309
                Twitter: @RonanKelly13
                The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                Comment


                • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky, 1 in Son Ha

                  http://www.intellasia.net/mysterious...-report-351765
                  Mysterious skin disease kills girl in Vietnam: report
                  21-Apr-2014 Intellasia | thanhniennews | 6:00 AM Print This Post

                  A 14-year-old girl in the central province of Quang Ngai died on Thursday after being afflicted with a mysterious skin disease that has sickened hundreds and killed 26 people in the province since 2011.

                  Pham Thi Huy was one of the two infection cases and the first death of the syndrome of dermatitis and horny layer thickening in foot and hand to be recorded in Quang Ngai’s Ba To District this year, Vietnam News Agency reported.

                  She was admitted to Ba To Health centre on April 8 with symptoms like thickened horny layers in her feet and hands and increased liver enzyme level.

                  ...

                  Local health agencies have arrived in Ba Nam Commune, where the girl lived, to conduct checks-up on people and have found 13 with increased liver enzyme levels so far, according to the news report....
                  “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed

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                  Comment


                  • Re: Viet Nam - Quang Ngai: Undiagnosed illness, 24 fatalities since April 2011 in Ba To commune, 4 in Son Ky, 1 in Son Ha

                    I take it by the wording of this article and Emily's above that the aflatoxin hypothesis has been discarded?

                    Published Date: 2014-04-21 02:41:44
                    Subject: PRO/EDR> Inflammatory palmoplantar hyperkeratosis - Viet Nam: (QG)
                    Archive Number: 20140421.2417845

                    INFLAMMATORY PALMOPLANTAR HYPERKERATOSIS - VIET NAM: (QUANG NGAI)
                    ************************************************** ***************
                    A ProMED-mail post
                    http://www.promedmail.org
                    ProMED-mail is a program of the
                    International Society for Infectious Diseases
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                    Date: Fri 18 Apr 2014
                    Source: Thanh Nien News [edited]
                    http://www.thanhniennews.com/health/...ort-25473.html


                    A 14-year-old girl in the central province of Quang Ngai died on Thursday [17 Apr 2014] after being afflicted with a mysterious skin disease that has sickened hundreds and killed 26 people in the province since 2011. The girl was one of the 2 cases and the 1st death of the syndrome of dermatitis with a horny layer thickening in foot and hand to be recorded in Quang Ngai's Ba To District this year [2014], Viet Nam News Agency reported.

                    She was admitted to Ba To Health Center on [8 Apr 2014] with symptoms like thickened horny layers in her feet and hands and increased liver enzyme level. Her condition got worse, and she was transferred to Children Hospital 2 in Ho Chi Minh City on [14 Apr 2014] and succumbed 4 days later to failure of respiration and multiple organs. Local health agencies have arrived in Ba Nam Commune, where the girl lived, to conduct check-ups on people, and they have found 13 with increased liver enzyme levels so far, according to the news report.

                    Since it was 1st discovered in April 2011, the disease, which was believed to be the 1st reported in the world, has sickened 231 people in Ba To and Son Ha districts. It begins with blisters on the hands and feet and loss of appetite and can turn fatal due to organ failure, starting with the liver. The condition is thought to be caused by chronic poisoning, but the toxin responsible for it has yet to be identified, although a few factors have been suspected, like heavy metals in the soil and moldy rice. An effective method of treatment has not been established.

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                    [A 28 Jun 2012 WHO report on this entity entitled "Media statement on Inflammatory Palmoplantar Hyperkeratosis (IPPH) syndrome in Ba To district, Quang Ngai Province" http://www.wpro.who.int/vietnam/medi...28June2012/en/ is reported as follows:

                    "The Ministry of Health of Viet Nam is actively providing intervention measures to treat people as well as prevent, investigate and monitor the development of new cases of inflammatory palmoplantar hyperkeratosis syndrome (IPPH) in Ba To district Quang Ngai province in Central Viet Nam. The Ministry of Health has been actively supported in its response to the situation in the affected area by other ministries and sectors, including the Ministry of Science and Technology, Ministry of National Defense and Ministry of Agriculture and Rural Development.

                    "IPPH syndrome is characterized by a chronic process that can lead to inflammation and lesions of the hands, feet and liver. People with IPPH syndrome have only been found in Ba To district in Quang Ngai province. People with IPPH syndrome were 1st reported on 19 Apr 2011 in Ba To district. By 28 Jun 2012, a total of 216 cases and 12 deaths had been reported in 5 communes (Ba Dien, Ba Ngac, Ba Xa, Ba Vinh and Ba To) in Ba To district. Currently, 18 people are being treated in health care facilities in or around Quang Ngai province.

                    "The Ministry of Health has conducted several field investigations focusing on epidemiology, clinical medicine, occupational health, nutrition, toxicology and environmental factors but has yet to find a cause. However, results from these extensive investigations indicate the following:

                    "To date, investigation suggests that IPPH syndrome may not be infectious in origin. Some people with IPPH ate rice from the previous harvest; many people with IPPH suffer from malnourishment; aflatoxins were present in a few rice samples; most people with IPPH had liver inflammation; no evidence of elevated levels of heavy metals or agrochemicals were found in human or environmental samples.

                    "In addition to on-going investigations to identify the cause, it is important that the comprehensive intervention measures in place to reduce mortality and the development of new cases as well as to improve the overall health status of the people living in Ba To district are followed," said Minister of Health, Dr. Nguyen Thi Kim Tien.

                    "To reduce mortality, the Ministry of Health has developed treatment guidelines, provided training for doctors, and sent consultants from central hospitals to directly guide and provide case management in Ba To district. The Ministry of Health has also put in place measures in the affected community for the prevention, treatment and diagnosis of illness. Preventive measures include: the provision of rice for people as well as advice on proper storage methods, distribution of vitamin and nutrient supplements to Ba To district residents, provision of environmental sanitation and vector control services for the households, treatment of community water supplies for people, and strengthened communication activities to promote personal hygiene and the seeking of healthcare as soon as symptoms develop.

                    "The WHO and the US CDC have been in close communication with Viet Nam's Ministry of Health for this response. In early June 2012, the Ministry of Health's General Department of Preventive Medicine invited 2 experts from WHO and US CDC to consult with the Ministry of Health's General Department of Preventive Medicine. They conferred with Viet Nam investigators of the outbreak, reviewed data collected to date, and made recommendations for additional studies and testing to guide interventions and direct further investigation.

                    "'We support the intervention measures implemented by Viet Nam's Ministry of Health in addressing the cases of IPPH syndrome in Quang Ngai province and believe that the Ministry of Health are on the right track. As we do not know what causes the syndrome, or its source of transmission, identifying the cause may take longer than anticipated or prove elusive,'" said Dr. Takeshi Kasai, WHO Representative in Viet Nam.

                    "The Ministry of Health will continue to focus its efforts in treating current IPPH syndrome patients and monitoring new cases as they occur. Further investigations will be conducted to measure and evaluate the effectiveness of interventions as well as to identify other risk factors associated with IPPH syndrome. WHO and US CDC will continue to provide technical support to the Ministry of Health, Viet Nam.

                    "The Ministry of Health recommends the following measures to prevent and control IPPH syndrome:

                    "For the residents of Ba To district: Consume rice provided by local health authorities; take the vitamin and nutritional supplements distributed by local health authorities; ensure good environmental sanitation and personal hygiene; Monitor for early detection of symptoms; and seek immediate care at the nearest health facility.

                    "For local authorities in Ba To district: Supervise and implement current intervention measures; continue to provide nutritional supplements and rice to residents of Ba To district; promote and encourage people to maintain environmental and personal hygiene, to consume nutritious foods, and to seek healthcare as soon as symptoms develop."

                    A pictures of the hyperkeratotic rash can be found at: http://www.saigon-gpdaily.com.vn/Health/2012/4/100698/.

                    A case fatality rate of about 10 percent for this entity of unclear but probably not infectious etiology has been reported. Specifically, no evidence of a heavy metal intoxication has been reported.

                    Quang Ngai (http://en.wikipedia.org/wiki/Quang_Ngai_Province) is a province in the South Central Coast region of Viet Nam on the coast of the South China Sea. It is located 883 km south of Hanoi and 838 km north of Ho Cho Minh City. - Mod.LL

                    Comment


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

                      Perhaps a different mycotoxin suspected?

                      Published Date: 2014-05-06 18:51:19
                      Subject: PRO> Undiagnosed illness - Viet Nam: (QG) fatal, grain fungus susp, RFI
                      Archive Number: 20140506.2449481

                      UNDIAGNOSED ILLNESS - VIETNAM: (QUANG NGAI) FATAL, GRAIN FUNGUS SUSPECTED, REQUEST FOR INFORMATION
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                      Date: Sun 4 May 2014
                      Source: Thanh Nien News [edited]
                      http://www.thanhniennews.com/society...ase-25944.html


                      Authorities have again blamed moldy rice for causing a mysterious skin disease that has returned to a central mountain district after a year's reprieve, killing one girl and infecting at least 4 others.

                      Test results from the Ho Chi Minh City Institute of Hygiene and Public Health showed that most rice samples taken from Ba To District in Quang Ngai Province were positive for fungi, news website VnExpress reported. The samples contained up to 100 times the amount of aflatoxins permitted by Vietnamese health standards.

                      [Tests in] family members of the deceased girl showed high amounts of aflatoxin B1, which is considered a highly toxic fungus.

                      The victim, 14, died on 17 Apr 2014 of the disease which has sickened some 250 people in Ba To and Son Ha districts [Quang Ngai province] and killed 26.

                      Local health officials said a family member of the deceased girl is likely to end up the same as he has refused to remain in the hospital and receive treatment.

                      The disease begins with high fever, loss of appetite, and causes the skin on one's palms and feet to thicken and swell. It can cause fatal organ failure, which typically begins in the liver.

                      The condition is thought to be caused by chronic poisoning, but the toxin responsible for it has yet to be identified, although a few factors have been suspected like heavy metals in the soil and moldy rice.

                      In May 2012, local officials brought in 60 tons of rice to the area after a Health Ministry study suggested rice mold as a possible cause for the illness.

                      Le Huy, a spokesman for Quang Ngai's health department, said he had the samples sent to Ho Chi Minh City after noticing that many ethnic minorities in the affected areas continue to eat fungus-covered rice as a traditional food.

                      The locals bury wet rice and dig it up to eat the black grains. Health checks in April [2014] found at least 35 locals suffered from high levels of liver enzymes.

                      But local officials said that they suspect there's another cause related to the weather, as the disease tends to recur between February and May every year.

                      In an interview with VnExpress last year [2013], Dr Babatunde Olowokure from the World Health Organization (WHO) in Viet Nam said the disease bears no resemblance to any disease or illness that has ever been known in the world.

                      No effective method of treatment has been established, despite several visits to the area by the ministry officials and WHO experts.

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                      <promed@promedmail.org>

                      [While aflatoxin in grains can cause problems, the issues mentioned here are not consistent with those of aflatoxicosis. This particular syndrome may be related to a grain fungus, but it is not aflatoxin. Some of the clinical signs resemble those of aflatoxin, but most mycotoxins may have some of these signs in common.

                      Further, the article mentions that the levels found are 100 times the allowable limit by standards in Viet Nam. There are standards and guidance documents established in the European Union, the United States, Australia, and a few others, but I was unable to find the guidance documents or allowable levels in human foodstuffs in Viet Nam.

                      Years of research in aflatoxin do not indicate it produces thickened skin or any other type of skin lesions.

                      Information regarding the investigation and confirmation of the cause of this outbreak would be appreciated. - Mod.TG

                      Comment


                      • And ongoing (and undiagnosed) once more:

                        Published Date: 2016-08-21 20:06:33
                        Subject: PRO/MBDS> Undiagnosed Illness - Viet Nam: (Quang Ngai)
                        Archive Number: 20160821.4431565
                        UNDIAGNOSED ILLNESS - VIET NAM: (QUANG NGAI)
                        ********************************************
                        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: Fri 19 Aug 2016
                        Source: Sai Gon Giai Phong Daily [edited]
                        http://www.saigon-gpdaily.com.vn/Health/2016/8/120205/


                        Head of the Dermatology Ward of the General Hospital in the central province of Quang Ngai Dr. Le Thi Bich Lien on 18 Aug 2016 said that the hospital is treating 2 people suffering a bizarre skin disease which was plaguing the province 3 years ago.

                        The strange skin disease struck Son Ba Commune in Quang Ngai Province's Son Ha District 3 years ago. Now it has re-occurred on 2 men who are father and son. The father, 70 and his 21-year-old son were taken to the hospital on 16 and 18 Aug 2016. Dr. Lien said they just had skin damage on their limbs, while their health condition is stable. The hospital is treating them per the Ministry of Health's guidelines.

                        Right after receiving the information of re-occurrence of the odd skin disease in Son Ha District, the Department of Health in Quang Ngai Province send a delegation led by director Nguyen Tan Duc to arrive at the commune to inspect the environment, daily activities, and the eating and drinking habits of locals.

                        The disease has seen a 3-year hiatus. Now, it has 5 infection cases.

                        [Byline: Nguyen Dac Thanh]

                        --
                        Communicated by:
                        PRO/MBDS


                        [The newswire reports the re-occurrence of the strange skin disease from Quang Ngai, which was 1st reported in April 2011. Since then, the cause of the disease has not been identified despite the efforts of the Viet Nam government. As in the previous PRO/MBDS post (Undiagnosed illness - Viet Nam (02): Quang Ngai, fatal 20140418.2414584), by Apr 2014, 26 patients with this disease died.

                        Comment


                        • Published Date: 2018-01-13 12:44:03
                          Subject: PRO/EDR> Undiagnosed illness - Viet Nam: (QG) fatal, palmoplantar hyperkeratosis, resurg.
                          Archive Number: 20180113.5556991
                          UNDIAGNOSED ILLNESS - VIET NAM (01): (QUANG NGAI) FATAL, PALMOPLANTAR HYPERKERATOSIS, RESURGENCE
                          ************************************************** **********************************************
                          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: Thu 11 Jan 2018
                          Source: Vietnamnet [edited]
                          http://english.vietnamnet.vn/fms/soc...uang-ngai.html


                          Mysterious skin disease kills one in Quang Ngai. A strange skin disease has claimed the life of a student in Ba To District, central province of Quang Ngai, according to the provincial Health Department. Nguyen Tan Duc, the department's director, on [Tue 9 Jan 2018] confirmed the death of the 13-year-old student from Ba Ngac Secondary School in Ba Ngac Commune.

                          The health centre in Ba To District came across the student earlier this year [2018]. He was believed to be suffering from an unidentified skin disease, but was later diagnosed with dermatitis, a condition that causes people's skin to peel off their feet and palms.

                          He also showed symptoms of high liver enzyme and septicemia (a blood infection), and was admitted to Da Nang General Hospital for treatment. However, he died after a week.

                          A total of 10 cases have been reported from the end of 2017 [to today]. The 1st case was reported in 2011; since then, 26 deaths have been reported, according to the Vietnam Television (VTV). Tran Dac Phu, head of the Ministry of Health's Preventive Medicine Department, said that the disease was more common in the age group between 15 and 29.

                          Earlier, after gathering evidence and consulting experts, the ministry concluded the disease was caused by mold, mainly aflatoxins, and by eating old rice, he said. Aflatoxins are poisonous carcinogens that are produced by certain molds
                          (Aspergillus flavus and Aspergillus parasiticus), which grow in soil, decaying vegetation, hay and grains. The ministry has recommended to people not to eat old rice, to clean the environment and their bodies.

                          "The patient, who is confirmed to be suffering from this disease, must be treated according to the method defined by the ministry," Phu said.

                          Currently, the health sector is conducting disinfection in the area where the disease has resurfaced and is continuously working towards finding its cause.

                          --
                          Communicated by:
                          ProMED-mail


                          [The news article above refers to an outbreak mainly in the Bo To district of Quang Ngai province, Viet Nam. Those affected were reported to have developed an acute febrile illness with loss of appetite and respiratory symptoms followed by a rash on the hands and feet, with liver dysfunction, and in some patients multiorgan failure and death. Ulcers on the hands, feet, mouths, back, and abdomen, eye disease, stiffness of the limbs, and miscarriage were also described. The disease was said to affect mainly children and young adults. The disease was said to have started in April 2011, subsided somewhat between November 2011 and February 2012, and picked up pace again in the spring of 2012, 2013, and 2014; it was noted to recur after resumption of eating moldy rice. The numbers of patients affected and the death toll have varied in the news reports.

                          Pictures of the rash on the hands and feet are available at http://english.vietnamnet.vn/fms/soc...y-disease.html and http://english.vietnamnet.vn/fms/soc...uang-ngai.html.

                          Lesions of the hands and feet are described as "palmoplantar keratoderma", that is, an increased keratin layer on the skin (hyperkeratosis) of the palms and soles; (see http://emedicine.medscape.com/articl...rview#aw2aab6b). Palmoplantar keratoderma may be inherited or acquired (https://www.ncbi.nlm.nih.gov/pubmed/17298101). Conditions that can lead to acquired palmoplantar keratoderma include inflammatory and reactive dermatoses such as reactive arthritis (arthritis, conjunctivitis or uveitis, and urethritis that follow dysentery or chlamydial or gonococcal genital infection). Encrusted scabies may progress to hyperkeratotic and/or crusted lesions on palmar surfaces.

                          Painful keratotic plaques that involved the skin surrounding the ears, the nose, and the soles in association with polyarthritis has been described in patients with HIV infection (http://www.nejm.org/doi/full/10.1056...00312113492425) and keratoderma of the palms and soles has been seen in glucan-treated patients with AIDS (https://www.ncbi.nlm.nih.gov/pubmed/2953313). The authors postulated that "since glucan is a naturally occurring component of the cell walls of yeast, fungus, and some bacterial organisms, recognition of its ability to induce such a striking reaction pattern may be of general significance."

                          Arsenic exposure can also lead to multiple, irregular, warty keratotic lesions on the palms and soles, typically decades after chronic arsenic ingestion. Exposure to certain chemicals, namely chloracnegens, has been reported to present as palmoplantar keratoderma (Patel S, Zirwas M, English JC. Acquired palmoplantar keratoderma. Am J Clin Dermatol. 2007; 8(1): 1-11; abstract available at https://www.ncbi.nlm.nih.gov/pubmed/17298101). Dioxins are also associated with hyperkeratosis, the most toxic of which, dioxin, 2,3,7,8-tetrachlorodibenzo-p-dioxin, is a contaminant of Agent Orange, a herbicide used in the Viet Nam war. However, a WHO report in 2012 (entitled "Media statement on Inflammatory Palmoplantar Hyperkeratosis (IPPH) syndrome in Ba To district, Quang Ngai Province" http://www.wpro.who.int/vietnam/medi...28June2012/en/) said that there was no evidence of elevated levels of heavy metals or agrochemicals in human or environmental samples.

                          The population of the Ba To district is predominantly the Hre ethnic group (http://en.wikipedia.org/wiki/H're_people), which may have a genetic predisposition to palmoplantar keratoderma.

                          Quang Ngai is a Vietnamese province located in the South Central Coastal region along the South China Sea, 883 km south (549 mi) of Hanoi and 838 km (521 mi) north of Ho Chi Minh City (http://en.wikipedia.org/wiki/Quang_Ngai_province). The province has a large plain along the coast and in the center of the province and has mountains and hills in the west. Ba To is a rural district of Quang Ngai province with a population of 47 268 in 2003 (http://en.wikipedia.org/wiki/Ba_To_District).

                          A map showing the location of Ba TO can be found at https://www.google.com/maps/place/Ba...Ngai,+Vietnam/. A map of Viet Nam provinces can be seen at http://upload.wikimedia.org/wikipedi...ovincesMap.png. Viet Nam may also be found on the interactive HealthMap/ProMED-mail map at http://healthmap.org/r/2bxT. - Mod.ML]

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