Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

http://www.nationmultimedia.com/2011/05/13/national/Probe-team-narrows-possibilities-30155299.html

MYSTERIOUS DEATHS
Probe team narrows possibilities
By Kwandao Jitpana
The Nation
CHIANG MAI
Published on May 13, 2011



Health official says finding exact cause of deaths may be impossible
The investigation into the Downtown Inn Hotel deaths hadn't determine the exact cause of death yet but now focused on three possible causes: infection, chemical or environment, and would get experts' help to determine the cause of deaths, it was announced at the press conference yesterday.

This move followed headlines about a New Zealand tourist Sarah Carter's mysterious death especially the New Zealand TV3's "60 Minutes" programme, which suggested the chemical spray chlorpyrifos that kills bed bugs was responsible for the death of Sarah Carter, as well as six others who were reported to have died in similar circumstances since January.

At the Chiang Mai Public Health Office yesterday, Chiang Mai Governor Panadda Diskul presided over the threehourlong closedoor conference with Chiang Mai health authority and consulate representatives of 10 countries including Todd Cleaver from the New Zealand Embassy in Bangkok.

In the press conference later, Chiang Mai Public Health chief Dr Wattana Kanchanakamon said they had a lot of meetings and get helps from experts including those from the World Health Organisation and Japan's Osaka City to determine the cause and what to do next.

He said they had Carter's stomach liquid sample that needed to be retested for credibility before reporting the result to those involved without any hiding or covering up attempts.

Wattana's deputy Dr Surasing Wisarutrat said that the probe had progressed half way now and the initial possible causes (infection, chemicals, crime, drug and environment) were narrowed to focus on infection, infection and environment - all of which needed further inspections. Surasing said the team would also be happy to accept any help in term of experts and also warned that public should not expect too much because a disease investigation might not definitely find the exact cause of the death sometimes. He said the team would also have a teleconference over the case with foreign experts at 6pm yesterday. He said the hotelroom where Carter stayed prior to her death was also closed and the hotel insisted they didn't use the chemical spray chlorpyrifos. He also added that chlorpyrifos would be fatal if one drank a glassful of it or 87cc hence death by inhaling it was unlikely. He said they would continue the probe with helps from experts and would keep those involved updated.

Panadda said that the Thai authorities didn't ignore the problem and all tried their best to restore the Thai people's integrity that they worked with sincerity and transparency. But to be appropriate, the Thai authorities had to contact the families of those who died or fell sick to make them at ease. Panadda said he therefore brought the probing team to explain to the international convoys about what they had done in the probe so far. He said that the convoys agreed that they had done a lot. He said that the team would need more time to get the answer.

Prior to the conference yesterday, Panadda commented that the international media's news reported had exaggerated facts especially the number of seven persons died after staying or using the facilities of Downtown Inn Hotel. He said that there were actually only four people; the elderly English couple whose deaths weren't questioned by relatives due to their ages, hence only a Thai female tour guide and the 23yearold New Zealand tourist Sarah Carter - the latter whose death on February 6 led to news headlines. He also said the hotel owner wasn't his relative as claimed.

 

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

I can't tell what the evidence for this is....

http://news.smh.com.au/breaking-new...ry-in-thai-tourist-deaths-20110513-1emks.html

Rat poison theory in Thai tourist deaths Ron Corben
May 13, 2011 - 8:54PM
.Ads by Google
Crowd Control Barricadeswww.PortableBarricadeStore.com

Low Prices on Barricades & Safety Barriers Factory Direct

AAP

Rat poison is among the latest theories surrounding the mystery deaths of several tourists in northern Thailand.

A 23-year-old New Zealand student, two elderly Britons and a 48-year-old Thai tour guide had all been staying at the Downtown Inn Hotel in Chiang Mai, 800 kilometres north from Bangkok, before their mysterious deaths in recent months.

Reports from New Zealand have suggested they were poisoned by a chemical used to kill bedbugs, but a senior Thai physician has told AAP that forensic investigations were widening to include insecticides capable of killing rodents.

Advertisement: Story continues below Dr Surasing Visaruthrat, a deputy director at the Chiang Mai Public Health Office, said investigations had widened beyond the initial theory that a bedbug killer spray containing chlorpyrifos was responsible for the deaths.

Dr Surasing said investigations covered three hypotheses focused on a potential virus, chemical contamination or environmental factors that led to the deaths and illness.

"We have to look at another type of pesticide," he told AAP.

The New Zealand student, Sarah Carter, died on February 7 and her travelling companions Amanda Eliason, 24, and Emma Langlands, 23, fell gravely ill but later recovered.

Later in February, a British couple, George Everitt, 78, and his wife Eileen, 74, died from reported heart attacks at the same hotel.

The Associated Press reported that seven tourists had died in Chiang Mai earlier this year, and six of them had been staying in the same hotel in January and February.

The AP said the other victims were from France, the United States and Canada.

An independent investigation carried out in New Zealand and broadcast on New Zealand TV alleged traces of chlorpyrifos had been detected in the hotel rooms.

Chlorpyrifos is a restricted-use agricultural pesticide in the United States.

Downtown Inn Hotel manager, Thanthep Bunkaeo, has denied the hotel used the bed bug pesticide containing chlorpyrifos in the recent past, local media reported this week.

Mr Thanthep was unavailable for comment when contacted by AAP.

Chiang Mai governor, Panadda Disakul, in media reports on Friday said there was insufficient medical information to support the claims that chlorpyrifos was responsible for the deaths.

Mr Panadda said Thai police were to launch their own investigation into the deaths, adding that the incident had damaged the image of Chiang Mai as a tourist destination.

The Chiang Mai Public Health Office this week met with foreign diplomats and consulates from affected embassies, as well as medical staff, to share the outcome of the investigation.

Test samples have been sent to the US-based Centre for Disease Control in Atlanta as well as Osaka University in Japan for examination.

"I think we are halfway now," Dr Surasing said, with investigations likely to be concluded in two months before a final report.

A spokesperson for the New Zealand Ministry of Foreign Affairs and Trade said the New Zealand government was "actively encouraging the Thai authorities to progress the investigation into Sarah Carter's tragic death".

She said the New Zealand Embassy, as well as New Zealand medical experts, were in "close and regular contact" with their counterparts in Thailand.

But she added in a statement to AAP that given the "investigation is not yet complete", it was "premature to comment on possible findings".

 

[Giuseppe]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

[Source: Nation, full text: (LINK).]

WHO supports probe



‎14 May ‎2011

The World Health Organisation (WHO) is fully backing Thailand's investigation into the mysterious death of a young New Zealander in a Chiang Mai hotel, a senior health official said yesterday.
​

- ------

 

[Emily]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - chlorpyrifos insecticide poisoning suspected

I finally dug up some information about a bedbug product that a professional pest control website I read some time ago was concerned could be misused by the public during a bedbug panic. It was described as an odorless pest strip that is used for fumigation of objects in sealed spaces, NEVER to be used in living areas. The website owner thought that using these strips in living areas could kill people.

The active ingedient is dichlorvos or 2,2-dichlorovinyl dimethyl phosphate (DDVP) and it is an organophosphate as is chlorpyrifos (IUPAC name: O,O-diethyl O-3,5,6-trichloropyridin-2-yl phosphorothioate) , but they are not the same chemical.

Reading up on this, I noticed that there is another product marketed on the Internet for bedbug control with an active ingredient of lambda-cyhalothrin. This is not an organophosphate, so is allowed to be used more broadly, but there was a warning on the bedbug product to NEVER spray mattresses or other sleeping material in contact with humans with the product.

 

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

http://www.monstersandcritics.com/n...-pest-control-chemical-caused-tourists-deaths

Experts suspect pest-control chemical caused tourists' deaths
May 22, 2011, 4:18 GMT


Bangkok - World Health Organization (WHO) experts suspect a pest-control chemical caused the death of a 23-year-old New Zealand woman while holidaying in Thailand this year, reports said Sunday.

A team of experts on Friday examined the Downtown Inn in Chiang Mai city, where Sarah Carter and three other foreigners died under mysterious circumstances in January and February.

They concluded that a 'pest-control chemical' was the likely cause of the deaths, the Bangkok Post reported.

Chiang Mai public health director Surasing Visaruthrat said the experts were still trying to identify the substance which he claimed was unlikely to be chlorpyrifos, as suggested by an investigation conducted by New Zealand's TVs's 60 Minutes programme this month.

'We are looking into a toxic substance other than chlorpyrifos,' he told the newspaper.

The WHO team will continue to investigate the case in bid to provide a transparent inquest into the deaths which have drawn much media attention.

Chiang Mai governor Panadda Disakul, who initially described the deaths as a 'coincidence,' said he hoped investigation would be concluded soon for 'the sake of the good image of Chiang Mai and Thailand.'

Carter was one of seven people who died under mysterious circumstances within six weeks in the popular resort city of Chiang Mai, 650 kilometres north of Bangkok. Four of the victims had been staying at the Downtown Inn.

Ron McDowall, a consultant to the United Nations who specializes in hazardous chemicals, told TV3's 60 Minutes that he suspected Carter's death was caused by a bug spray using toxin chlorpyrifos.

'I think she was killed by an overzealous sprayer, who has been acting on the instruction of the hotel owner to deal with bed bugs,' he told the TV programme.

Reporters for the programme, posed as tourists to gain access to the room in which Carter and two friends had stayed. Team took swabs to be tested.

McDowall said the fact that the swabs found traces of chlorpyrifos - a chemical used to kill bed bugs and cockroaches, but banned for indoor use in many countries - three months after her death suggested there would have been a high concentration in February.

Carter's father Richard set up a website called thailandtraveltragedies.com to highlight what he called the official cover-up over his daughter's death on February 6.

 

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88566

Archive Number 20110524.1574
Published Date 24-MAY-2011
Subject PRO> Undiagnosed deaths - Thailand (08): (CM)

UNDIAGNOSED DEATHS - THAILAND (08): (CHIANG MAI)
************************************************
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: 22 May 2011
Source: Bangkok Post [edited]
<http://www.bangkokpost.com/news/local/238200/pesticide-theory-backed-in-hotel-deaths>


Pesticide theory backed in hotel deaths
---------------------------------------
World Health Organisation (WHO) experts suspect that a pest-control
substance is a cause of the mysterious deaths at a Chiang Mai hotel.

Chiang Mai's head of public health Surasing Visaruthrat, who joined
the WHO investigation team in examining the Downtown Inn on Friday [20
May 2011], said the world body's experts agreed with his team that it
was unlikely that New Zealand tourist Sarah Carter died of a bedbug
spray containing chlorpyrifos as had been suggested.

"We are looking into a toxic substance other than chlorpyrifos," Dr
Surasing said. He refused to name the substance, saying only that it
was "a pest control chemical."

Carter was one of 7 people who died mysteriously in the northern
province between January and February [2011]. 4 of them had stayed at
the Downtown Inn.

The mystery over Carter's death resurfaced recently after an
investigation commissioned by the New Zealand TV3 show 60 Minutes
found traces of chlorpyrifos in the hotel. But Thai authorities cited
a medical report that found no trace of insecticide in Carter's body,
while the hotel manager has denied using the highly toxic substance.

Dr Surasing said WHO officials and his team examined over 10 guest
rooms, including Room 516, where Carter and 2 of her friends stayed.
The WHO officials cut out part of the carpet under the hotel beds for
laboratory testing. They also inspected the hotel kitchen and swimming
pool, he said. According to Dr Surasing, the carpet samples were sent
to a WHO-certified laboratory at Ramathibodi Hospital in Bangkok.

The WHO investigation team is expected to return to Chiang Mai for
further investigation after lab test results early next week, he said.
Chiang Mai governor Panadda Disakul said yesterday [21 May 2011] the
WHO investigation would ensure a transparent inquest following
conflict over earlier theories of whether a virus or exposure to a
chemical toxin had caused the deaths.

The investigation would boost confidence for all parties currently
trying to uncover the cause of the deaths, the governor said after
meeting WHO representative Richard Brown. ML Panadda said he would
like the investigation to uncover the truth as soon as possible for
the sake of the "good image of Chiang Mai and Thailand," which have
been marred by media coverage of the deaths.

--
Communicated by:
Denis Legion
<legion@q-net.net.au>

[This article does little more than tell us that a new pesticide
investigation is underway and that chlorpyrifos is not the cause of
the deaths. The article also tells us that the WHO is now involved.

We can hope that this investigation will be more productive for the
sake of those seeking to know the cause of their love ones' demise. -
Mod.TG]

 

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

http://www.heraldsun.com.au/news/br...t-deaths-unknown/story-e6frf7jx-1226062270791

Cause of Thai tourist deaths unknown

THAILAND said today that there was insufficient evidence to link a spate of mysterious tourist deaths in its northern city of Chiang Mai, and the full cause may never be known.
Five foreigners and a Thai guide died while three others fell ill while staying in the popular tourist destination between January 11 and February 19 of this year.

Six of them stayed at the same hotel, while three others were at two different hotels. Most were young women.

But beyond that there were "few common traits" in their deaths, the Thai Ministry of Public Health's Department of Disease Control said in a statement, noting that international toxicologists were assisting the investigation.

"Despite the best efforts of Thai authorities and international partners, a complete explanation for the cause of deaths may not be found for all cases," it added.

Herald Sun, 24 Mar 2011.End of sidebar. Return to start of sidebar.
The dead included a young New Zealand woman, an elderly British couple and a Thai tour guide who were all taken ill in February at the Downtown Inn in Chiang Mai, Thailand's second-biggest city.

The others were American and French, while a Canadian and two New Zealand women also fell sick.

One theory is that chlorpyrifos, which is used as an insecticide, was responsible for at least some of the deaths.

But experts said that chlorpyrifos generally emits a strong odour, which was not reported by those who fell ill, and is not usually fatal unless ingested or inhaled in very large quantities.

"Furthermore, the details of the clinical and laboratory investigation do not support chlorpyrifos as a cause," it said, adding that toxicologists were investigating whether other pest control chemicals might have been involved.

Acting hotel manager Vinai Julsiri told AFP in March that the deaths were a coincidence.

"The news about the hotel's mystery deaths is really bad for our business. It was not true," he said. "There is nothing wrong or dangerous in our hotel."

 

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88583

Archive Number 20110525.1588
Published Date 25-MAY-2011
Subject PRO/EDR> Undiagnosed deaths - Thailand (09): (CM)

UNDIAGNOSED DEATHS - THAILAND (09): (CHIANG MAI)
************************************************
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: Tue 24 May 2011
Source: Phuket Wan Tourism News [edited]
<http://phuketwan.com/tourism/chiang-mai-deaths-riddle-update-discounts-big-killer-14153/>


Investigations into a ''cluster'' of mysterious deaths of tourists in
Chiang Mai have so far produced no clear patterns, an official update
reveals.

The riddle of what killed [a 23-year-old female New Zealander] and 5
others remain, and inquiries are reported to be continuing.

The latest official account rejects any link involving a 7th victim
and makes the point that there is no sure connection between all 6
deaths.

''Despite the best efforts of Thai authorities and international
partners, a complete explanation for the cause of deaths may not be
found for all cases,'' the report says, noting that toxicology
investigations can take time.

Toxicologists from 7 countries or international organizations are
involved in continuing investigations, says the Department of Disease
Control in Thailand's Ministry of Public Health.

Interestingly, although the deaths of 2 young female tourists on Phi
Phi in 2009 are not part of this investigation, the Chiang Mai cases
update reports that the bug-killer chemical ''chlorpyrifos generally
emits a strong odor which was not noted by the 2 surviving women.''

However, [an American], one of the survivors of the incident on Phi
Phi that killed his fiancee and [a Norwegian woman] in adjoining rooms
at the Laleena Guesthouse 2 years ago, has always said he noted a
strong chemical smell when entering their room.

The chances of solving the mystery of the Phi Phi deaths is slim but
in the Chiang Mai cases, it appears an effort is at least being
mounted to explain 6 deaths and salvage some of the popular
destination's tourism reputation.

Here's what the latest official report says:

International toxicologists consulted in Chiang Mai tourist deaths -
update 3, 23 May 2011
----------------------------------------------------------------------
Thai public health authorities have enlisted the assistance of
international toxicology experts this month [May 2011] to determine
whether toxins or chemical agents might be involved in the deaths of 5
foreign tourists and a Thai guide and the associated illnesses of 3
other individuals in Chiang Mai earlier this year [2011].

The Department of Disease Control, Ministry of Public Health (MOPH)
and the Chiang Mai provincial authorities, enlisted the help of these
expert toxicologists as part of the on-going investigation into the
deaths that occurred between January and February this year [2011].
The toxicologists are from Australia, India, Sri Lanka, the United
Kingdom, the United States, the World Health Organisation (WHO), and
the US Centers for Disease Control and Prevention (US CDC).

This consultation followed an earlier meeting of experts at the
Department of Disease Control held on 10 May 2011 with the Chiang Mai
provincial authorities to review information gathered over the past
few months. This meeting involved clinicians, epidemiologists,
laboratory specialists, pathologists, toxicologists, and police as
well as the WHO and the US CDC. Subsequently, representatives of
relevant consulates were briefed on the progress of the
investigation.

The toxicology experts have reviewed the available evidence and
discussed several possible causes involving toxins and chemical agents
as a cause of death. The toxicologists also discussed the suggestion
made by the New Zealand TV3 '60 Minutes' program that chlorpyrifos
(used as an insecticide) was responsible for the death of one woman
from New Zealand and the illness of her 2 traveling companions.

While a cause has not been clearly identified to date, experts
recognized that chlorpyrifos generally emits a strong odor which was
not noted by the 2 surviving women. They also noted that chlorpyrifos
is not well absorbed by the skin nor would it cause rapid illness or
death in a healthy adult unless it was ingested or inhaled in very
high quantities. Furthermore, the details of the clinical and
laboratory investigation do not support chlorpyrifos as a cause.

The toxicologists are also considering the possibility that other
chemical agents including those found in pest control products might
cause signs, symptoms and laboratory findings consistent with the
features seen. Experts are also currently working to identify the most
suitable laboratories to carry out specific tests for selected pest
control ingredients in the remaining samples.

Concurrently, environmental and toxicology assessment involving
experts and laboratories from the Ministry of Agriculture; the
Department of Health, MOPH; Ramathibodi Poison Center; the Faculty of
Agriculture, Chiang Mai University is underway at the hotel where 4
persons died.

The initial assessment of overnight room ventilation in April [2011]
found adequate air ventilation with normal levels of nitrogen dioxide
and sulfur dioxide; and no evidence of carbon monoxide accumulation. A
parallel investigation has also been undertaken by local police.

While Thai authorities and international partners are actively
pursuing the hypothesis that these 6 deaths might be linked to a
similar cause, the investigation so far reveals few common traits
except that:
- All occurred in Chiang Mai between 11 Jan and 19 Feb 2011;
- 6 of the 9 reported people affected lodged at one hotel (3 were at
2 different hotels);
- The 1st 6 people identified are young (aged 23-29) female non-Thai
nationals.

The people who died and fell ill are being examined in 3 groups based
on the hotels they stayed in, as follows:
1. One American woman (age 33) who died on 11 Jan 2011 and her
Canadian colleague (age 29) who fell ill;
2. One French woman (age 25) who died on 19 Jan 2011;
3. a) One Thai woman (age 47) who died on 3 Feb 2011
b) One New Zealand woman (age 23) who died 6 Feb 2011 and her 2
traveling companions (both age 23) who both fell ill;
c) A couple from the UK -- one man (78) and woman (74) who both died
on 19 Feb 2011.

Based on findings currently available, there is insufficient evidence
to link the illnesses and deaths among these 3 groups.

The American, Canadian, and French women had no activities in
connection with other hotels and other cases. The French woman also
began to fall ill few days before arrival in Chiang Mai.

There have been reports that a Canadian man who died in January
[2011] may have used the swimming pool of the hotel where the Thai
woman, the New Zealand women, and the UK couple stayed (hotel number 3
above).

However it has not been possible to confirm these reports or even to
establish the day when this visit was supposed to have occurred. In
addition, the available evidence from medical records and autopsy by
forensic experts do not currently support linkage with other deaths.
Therefore the death of this man has not been included in the cluster.

It was also initially believed on the basis of clinical findings that
myocarditis (inflammation of the heart muscle) was a common factor in
a number of deaths. However, although it is clear that heart muscle
damage occurred in these cases, further investigation of clinical,
laboratory, and histopathology records, has only established clear
evidence of myocarditis in the case of the French woman.

It is partly this evidence that has resulted in the scope of the
investigation being widened to look for other causes of cardiac damage
(that can mimic the clinical appearance of myocarditis), including
toxins and chemical agents.

A final explanation of the most likely cause of the event(s),
including exact cause of illnesses and deaths, and any important
related factors, will be made based upon the synthesis of evidence
from clinical, epidemiologic, laboratory, environmental, and forensic
investigations.

It is important to highlight that a complex investigation such as
this, which also includes international laboratory analyses, takes
time. Any new toxicology results are also likely to take time if
specimens need to be shipped to specialist laboratories.

It is also possible that cases may not all be linked, and may instead
be due to different causes. Despite the best efforts of Thai
authorities and international partners, a complete explanation for the
cause of deaths may not be found for all cases.

The Thai Ministry of Public Health will provide information as it
becomes available to the families, the international community and the
media, and will provide regular updates on its Thai and English
websites (<http://www.ddc.moph.go.th>). Any persons who may have
specific medical or public heath concerns about this event are invited
to report them or make queries to <askcmevent@gmail.com>

--
Communicated by:
Denis Legion
<legion@q-net.net.au>

[There really is not much new information in this post. It could be
summed up as an international team is examining the deaths, and
determining if they are linked. The investigation will take time as
international labs are involved. Sadly, no cause or link may be found
with all the labs.

While this article does state that a number of the victims stayed at
the same hotel, I cannot recall if it said they were in different
rooms or the same room? - Mod.TG]


[Different rooms. - alert]

 

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

Apparently, the Canadian woman travelled with the American woman, not the Frenchwoman.

http://eafr.promedmail.org/mbds

Published Date: 2011-06-23 22:16:56
Subject: PRO/MBDS> Undiagnosed deaths - Thailand (09): Chiang Mai
Archive Number: 20110623.1927

UNDIAGNOSED DEATHS - THAILAND (09): CHIANG MAI
**********************************************

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: Tue 21 Jun 2011Source: Department of Disease Control, Thailand Ministry of Public Health [edited]http://www.ddc.moph.go.th/pnews/showimgpic.php?id=296


Probe into Chiang Mai deaths concluding - update 4
--------------------------------------------------
Thai authorities are rounding up the investigation into the deaths of 5
tourists and a Thai guide in Chiang Mai earlier this year [2011]. The
extensive information gathered during the investigation will now be
analysed with a consultative expert panel appointed by the province. The
expert panel and the investigation team will review interviews and
examine clinical, laboratory, and environmental data before the latter
make their conclusions and recommendations which are expected in the
next month.

The 8-member expert panel is composed of an infectious disease expert
from the Faculty of Medicine, Chiang Mai University; a clinical
toxicologist from Ramathibodi Hospital, Bangkok; a pathology and
forensic medicine expert from Siriraj Hospital, Bangkok; a senior
epidemiologist from the Department of Disease Control, Ministry of
Public Health; an expert on pesticide use from the Faculty of
Agriculture, Chiang Mai University; an environmental specialist from the
Faculty of Medicine, Chiang Mai University; a psychiatrist from the
Faculty of Medicine, Chiang Mai University; and a cardiologist from the
Chest Disease Institute, Department of Medical Services, Bangkok.

The formation of the expert panel follows an exhaustive investigation
into the 6 deaths as well as the associated illnesses of 3 other
tourists in Chiang Mai between 11 Jan and 19 Feb 2011. The investigation
is examining potential viral, toxin, and chemical causes and involves a
large number of domestic and international partners. These include the
Department of Disease Control and the Department of Medical Sciences at
the Ministry of Public Health; the Provincial Public Health Office,
Chiang Mai; Ramathibodi Poisons Centre, Bangkok; the Ministry of
Agriculture; the World Health Organization (WHO); and the United States
Centers for Disease Control (US CDC). Staff of the consulates and
embassies concerned are also kept informed and consulted.

The investigation, which is winding down with only some laboratory
results pending, has involved clinicians, epidemiologists, laboratory
specialists, pathologists, and toxicologists.

Certified laboratories in Thailand as well as the US, Japan, and Germany
were used to test biological and chemical samples collected from the
patients, their hotels, and the Night Bazaar in Chiang Mai. In addition,
international toxicologists from Australia, India, Sri Lanka, the United
Kingdom, the United States, the WHO, and the US CDC examined the
evidence gathered and reviewed the laboratory findings. The
investigation also includes interviews with co-travelers and some family
members in the US, Canada, and New Zealand, in an effort to gather and
standardise information about all possible exposures.

The people who died and fell ill are being examined in 3 groups based on
the hotels they stayed in, as follows:
1. One American woman (age 33) who died on 11 Jan 2011 and her Canadian
colleague (age 29) who fell ill;
2. One French woman (age 25) who died on 19 Jan 2011;
3. a. One Thai woman (age 47) who died on 3 Feb 2011;
b. One New Zealand woman (age 23) who died 6 Feb 2011 and her 2
traveling companions (both age 23) who both fell ill;
c. A couple from the United Kingdom -- one man (78) and woman (74) who
both died on 19 Feb 2011.

Major findings to date
----------------------
- Based on the evidence gathered and the clinical presentations of the
cases, investigators and their partners largely concur that the French
woman had acute myocarditis (inflammation of the heart muscle) which may
represent a sporadic case due to an infection, rather than exposure to a
poison. The clinical symptoms and inflammatory cells found throughout
her heart muscle (confirmed in 3 different laboratories, 2 in Thailand
and one at the US-CDC) support this opinion. There was general consensus
amongst experts that this patient appears to have suffered from a
different cause than the other cases under investigation.
- For the other cases, the investigation has been pursuing the
hypothesis of a toxin or chemical cause including chemicals found in
some pesticides. Laboratory tests are still being gathered under this
hypothesis. These test results will be submitted for consideration by
the panel of experts and investigation team.

A final conclusion of the most likely cause of these deaths and
illnesses, as well as any important related factors, will be made by the
official investigation team, following a thorough consultation with the
8-member multi-disciplinary panel of experts. The investigation team
will base their conclusion upon the synthesis of evidence from clinical,
epidemiologic, laboratory, environmental, and forensic investigations.
It is also possible that despite the best efforts of Thai authorities
and international partners, a complete explanation for the cause of
illness and death may not be found for all cases.

The Department of Disease Control will provide information on its Thai
and English websites (http://www.ddc.moph.go.th>). Any persons who may
have specific medical or public health concerns about this event are
invited to report them or make queries to

--
Communicated by:
PRO/MBDS


[This post updates the investigation of the 6 undiagnosed death in
Chiang Mai, Thailand in 2011. There has been no confirmation about the
causes of those deaths so far. The laboratory tests results suggest that
the French woman among the victims might have died from a different
cause than that for the other cases which are being investigated.

 

[Emily]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

http://www.inews880.com/Channels/Reg/LocalNews/story.aspx?ID=1514312

Thai mystery deaths report expected this week
9am
Ed Mason
8/8/2011

A panel of experts in Thailand is expected to release a report this week on what killed an Edmonton man and several other tourists earlier this year....

More on this victim, Bill Mah, here:
http://www.flutrackers.com/forum/showpost.php?p=404698&postcount=61

 

[Emily]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

http://www.3news.co.nz/Thailand-authorities-say-pesticides-possible-cause-of-Sarah-Carters-death/tabid/423/articleID/222350/Default.aspx

Thailand authorities say pesticides possible cause of Sarah Carter's death

UPDATED 1:30PM
Published: Tue, 16 Aug 2011 12:38p.m.

By Dylan Moran

Thai authorities have released a report of their findings after investigating the death of New Zealander Sarah Carter, four other tourists and a tour guide in Chiang Mai over a one month period.....

Read more: http://www.3news.co.nz/Thailand-aut...3/articleID/222350/Default.aspx#ixzz1VAZzc4HA

There is a link in the article to Thai authorities' full report.


ETA: The article below seems to have the whole report available for you to read without have to read the Word doc.

http://phuketwan.com/tourism/phuket-expat-deaths-likey-closely-investigated-chiang-mai-report-14564/
Phuket Expat Deaths Likely to be More Closely Investigated After Chiang Mai Report

By Alan Morison
Tuesday, August 16, 2011

 

[alert]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

http://beta.promedmail.org/mbds

Published Date: 2011-09-05 22:30:41
Subject: PRO/MBDS> Undiagnosed deaths - Thailand (11): Chiang Mai
Archive Number: 20110905.2715

UNDIAGNOSED DEATHS - THAILAND (11): CHIANG MAI
***********************************************

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: Tue 23 Aug 2011Source: The Department of Disease Control, Ministry of Public Health, Thailand [edited]http://www.ddc.moph.go.th/pnews/showimgpic.php?id=334


Thai authorities have concluded their investigation into the deaths of 5
tourists and a Thai guide. Following the months-long investigation,
experts ultimately could identify the likely cause of death for most
cases, but not the specific agents or mechanism of exposure. Experts
also concluded that some, but not all of the cases appear to have been
causally related. The conclusions, investigation constraints, and
actions taken by Thai authorities are explained in detail below.

The investigation covered the 6 deaths and associated illnesses of 3
other tourists (travelling companions) in Chiang Mai between [11 Jan
2011 and 19 Feb 2011]. The conclusions follow an exhaustive probe during
which Thai and international experts from numerous disciplines were
consulted in several rounds of face-to-face, tele- and video-conferences
to consider the available scientific evidence. These included clinical
and biological samples from patients, the results of on site
environmental experiments, and chemical samples from one of the
concerned hotels and a nearby market. Chemical and tissue samples were
tested at certified laboratories in Thailand, the United States, Japan
and Germany during the course of the inquiry.

The investigation also included interviews with co-travelers and some
family members in the US, Canada, France and New Zealand in an effort to
gather information about all possible exposures. Potential viral,
gaseous, toxin and chemical hypotheses were considered by domestic and
international partners. Agencies partnering together during the
investigation included the Department of Disease Control and the
Department of Medical Sciences at the Ministry of Public Health; the
Provincial Public Health Office, Chiang Mai; Ramathibodi Poisons Centre,
Bangkok; the Ministry of Agriculture and Cooperatives; the World Health
Organization (WHO), and the United States Centers for Disease Control
and Prevention (US CDC). Staff of the consulates and embassies concerned
were also kept informed.

The final conclusions were reached by the official Chiang Mai
investigation team in conjunction with a review panel of outside experts
in infectious disease, toxicology, pathology and forensic medicine,
epidemiology, and environmental science and pesticide use.

Investigation findings:
The people who died and fell ill were grouped under 4 events based on
suspected causes. The case findings are as follow:

Event 1:
One American woman, age 33, died on [11 Jan 2011]. Her friend, a
Canadian woman, age 29, fell ill but recovered. Both stayed in the same
room at Hotel "A" and developed severe vomiting on the night of [8 Jan
2011].

The diagnosis based on clinical and pathological findings is that the
American woman died from myocardial injury (injury to the heart muscle).
Laboratory tests indicate that drugs and other suspected viruses
(Adenovirus, Echovirus, Ebstein-Barr Virus, Influenza A) are unlikely to
be the cause. The suspected agent that caused her death is most likely
to be chemical or biotoxin in nature, and it is probable that it might
have been a rodenticide. However, the exact agent could not be
identified because the quantity of sample from the case was
insufficient. The 2 women are likely to have the same cause of illness,
but no epidemiological linkage is found between them and other cases in
other events.

Event 2:
One French woman, age 25, died on [19 Jan 2011]. She developed fever and
other symptoms on [16 Jan 2011] before arriving in Chiang Mai where she
checked in at Hotel "B" on [17 Jan 2011] with a female friend who
remained well.

Based on the evidence gathered and the clinical presentations of the
case, investigators and experts concur that the French woman had
evidence of acute severe myocarditis (inflammation of all the heart
muscles) that represents a sporadic case most likely due to a viral
infection, rather than exposure to a poison. The clinical symptoms and
inflammatory cells found throughout the heart muscle (confirmed in 3
different laboratories including 2 in Thailand and one at the US CDC)
support this opinion. Although state-of-the-art tests were performed for
many viruses and bacteria, no etiologic agent could be identified. Given
that her illness began before she arrived in Chiang Mai, the
epidemiological linkage to the other events is tenuous.

Event 3:
a) One New Zealand woman, age 23, died on [6 Feb 2011]. Her 2 female
traveling companions, both age 23 and also from New Zealand, fell ill
but recovered. All 3 women stayed in the same room and developed severe
vomiting on the morning of [3 Feb 2011].
b) One Thai woman, age 47, a tour guide, was found dead in her room on
the morning of [3 Feb 2011].

The 3 NZ women had severe metabolic acidosis (abnormal acid level in
circulation) and 2 of them suffered myocardial injury (injury to the
heart muscle). Clinical symptoms of the Thai woman are unknown since she
was found dead in her room. Forensic autopsy found no abnormalities
other than 40 percent occlusion of the right coronary artery. It is most
likely she died from sudden cardiac arrhythmia (abnormal rhythm of the
heart beat).

The women grouped in this event stayed at Hotel "C." The Thai tour guide
was in a room adjacent to that of the 3 NZ women. The investigation
found that it is very likely the cause of the illnesses of these 4 women
is the same given the timing of the onset of their illness and the
proximity of their rooms. The cause is unlikely to be bacterial or
viral. Insecticides in the organophosphate, organochlorine and carbamate
group, such as chlopyrifos, are also unlikely to be the cause because
they conflict with clinical specimens and blood tests.

The clinical manifestation in the 3 NZ women, who were all hospitalised,
could be explained by exposure to some chemicals such as those found in
pesticides which contain aluminum or zinc phosphide (different class of
pesticide than that mentioned in above paragraph).

It should be noted that tests on blood and biological samples from the 3
NZ patients at US CDC and German laboratories returned negative results
for suspected chemicals such as sodium monofluoroacetate (compound 1080)
and phosphine gas (by-product of phosphides). However, negative results
from some of these toxic substances do not necessarily confirm their
absence, as the suspected chemical compounds can be difficult to detect
or can dissipate easily from biological specimens. Tests on the 2 rooms
where the NZ and Thai women stayed found aluminum molecules on carpet
samples; however, it cannot be definitively concluded that these came
from a pesticide containing aluminum phosphide. The aluminum molecules
could have come from the paint on the walls and ceilings or from fluids
used to clean air-conditioning units. Aluminum is an ingredient in paint
and air-conditioning cleaning fluids, and aluminum molecules were also
found in other rooms sampled throughout in the hotel.

Two separate rounds of environmental experiments on the air quality in
the affected rooms were also carried out to test the hypothesis of
poisoning by carbon monoxide, sulphur dioxide, nitrous oxide and nitrous
dioxide, as the women stayed at the hotel during Chinese New Year when
incense and ritual burning of silver and gold paper was carried out by a
neighbouring shrine. The experiments found that only a small amount of
these gases entered the rooms, and experts agreed that this amount
seemed unlikely to have caused their illnesses.

Event 4:
An older couple from the United Kingdom -- a man (78) and woman (74) --
were found dead in their hotel room on the afternoon of [19 Feb 2011].
Consequently, their clinical symptoms were unknown. Forensic experts
estimated the time of death to be between [17-18 Feb 2011]. Autopsies
and standard panels of tests for chemicals, drugs and pesticides were
performed but revealed no abnormal results. There is evidence of 40-80
percent occlusion in 3 coronary arteries in the man, and 30-60 percent
occlusion in the coronary arteries of the woman, which might suggest
death caused by a cardiac event or arrest. It is not unusual for older
people to die from cardiac arrest; however, it is uncommon for a couple
to die of this cause at the same place and at around the same time.

As they also stayed at Hotel "C," albeit on a different floor to that of
the women in Event 3, the possibility that the cause of this event is
related to Event 3 cannot be excluded.

Despite the best efforts of the Thai authorities and their international
partners in undertaking an exhaustive investigation, the specific agents
that caused the deaths and illnesses in these events cannot be
identified, and it cannot be determined exactly how people might have
been exposed to them.

However, the investigation team and the panel of experts agree that
available evidence suggests the following:

1. Event 1: The 2 cases in this event, an American and a Canadian woman,
have similar clinical manifestations as those of the 3 NZ women in Event
3. Although there is a possibility that these 2 events might have the
same causative agent, investigators cannot find additional supporting
evidence.

2. Event 2: The illness and death of the French woman is not related to
any other cases or events. It is a sporadic case of myocarditis, most
likely of viral origin.

3. Event 3: The 4 women, 3 New Zealanders and one Thai are most likely
to have the same cause of illness, probably exposure to some toxic
chemical, pesticide or gas, but the agent cannot be identified.

4. Event 4: This event, involving the older English couple, is possibly
related to Event 3, as they occurred in the same hotel, but again
laboratories could not establish a direct link or the specific cause.

Investigators spent 5 months pursuing numerous hypotheses about
potential causes. More than 350 drug, chemical and organism tests were
done on each fatality, and some 1250 tests in the New Zealand case, in
laboratories in Thailand and overseas. A large number of personnel in
Chiang Mai and Bangkok, along with consultants from the US CDC in
Atlanta and the WHO in Geneva worked on the investigation of these
events. Despite these efforts, and as difficult as it may be to accept,
ultimately, the precise causes for the deaths and illnesses cannot be
definitively identified or confirmed.

Actions taken by Thai authorities to reduce future risks:

1) A panel will be set up to investigate and recommend stricter measures
for the use of chemicals, including pesticides, in hotel and market areas.

2) A channel to receive notification of illnesses of tourists and
expatriates has been set up. Visitors can post their notification at
http://www.chiangmaihealth.com or call 053-216592. Events will be
verified and investigated.

3) Surveillance of hospitalised tourists, already in effect, will be
continued, and a new protocol for investigation of fatal cases is being
developed and implemented.

4) Retailers of household and agricultural chemicals (pesticides) must
declare a watch list of products whose procurement and sales are to be
closely monitored. The provincial health office will carry out periodic
checks on these items.

5) Hotel operators must use only licensed pest control companies, and
their contracts must specify which chemicals are to be used. Samples
will be collected and sent for testing by the authorities twice a year.

6) Municipal authorities are to give safety advice and monitor public
celebrations where the burning of ritual papers and other materials are
performed in communities, temples and shrines as part of traditional
festivals.

7) Food safety standards at eateries and among street vendors,
especially around the Night Bazaar area frequented by tourists in Chiang
Mai, are being reviewed and revised to assure safety and compliance.

8) Health Education Cards to advise tourists about food safety and other
health concerns will be made available to foreign visitors to the province.

9) The Ministry of Public Health will apply these measures to safeguard
tourists in other provinces.

--
Communicated by:
PRO/MBDS


[The Department of Disease Control, Ministry of Public Health, Thailand
has concluded the detailed and final conclusion of their investigation
on undiagnosed deaths in Chiang Mai, Thailand. Detailed general and
clinical information of the deaths and findings of previous
investigations can be accessed at prior PRO/MBDS postings listed below.

For maps showing Thailand's regions, see
http://www.thailand-map.net/thailand_provinces/ and provinces, see
http://en.wikipedia.org/wiki/Provinces_of_Thailand. For the
interactive HealthMap/ProMED-mail map of Thailand with links to other
recent ProMED-mail and PRO/MBDS postings, see
http://healthmap.org/r/0A1L. - Mod.SCM]

 

[Emily]

Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

Magic mushrooms on menu

July 2, 2012 by Wanwisa Ngamsangchaikit
[snip]
Also the mysterious death of a 23-year-old New Zealand woman,Sarah Carter and several other tourists in Chiang Mai who allegedly stayed at the city?s Downtown Inn has still not been solved, although it is understood the hotel will be demolished.