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_|Hong Kong, Prc Sar: Epi-surveillance (august)|_

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Giuseppe

Giuseppe

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Re: _|hong Kong, Prc Sar: Epi-surveillance (august)|_

Re: _|hong Kong, Prc Sar: Epi-surveillance (august)|_

Case of EV71 confirmed

August 15 2008, 12.31.01

The Centre for Health Protection (CHP) of the Department of Health today (August 15) urged people to be vigilant against Enterovirus-71 (EV71) infection following confirmation of one EV71 case involving a 2-year-old girl.

The child developed oral ulcer and rash over her hands and feet on August 11 and consulted general outpatient clinic on August 13.No hospitalisation was required.

Her stool specimen was confirmed positive for EV71 by PCR today.

CHP's investigation revealed that the girl had visited the Mainland between July 3 and August 11.

Her family members did not have similar symptoms.

A total of 78 EV71 infection cases have been reported to CHP so far this year. There were 35, eight, 16 and 12 cases in 2004, 2005, 2006 and 2007 respectively.

For more information, people may visit the CHP's website (www.chp.gov.hk) or call the Central Health Education Hotline 2833 0111.
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http://www.info.gov.hk/gia/general/200808/15/P200808150204.htm
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Re: _|hong Kong, Prc Sar: Epi-surveillance (august)|_

Re: _|hong Kong, Prc Sar: Epi-surveillance (august)|_

A case of Streptococcus suis infection under investigation

August 18 2008, 12.22.01

The Centre for Health Protection (CHP) of the Department of Health is today (August 18) investigating a case of laboratory-confirmed infection of Streptococcus suis, a bacteria isolated from pigs.

The case involved a 71-year-old woman living in Kowloon City who developed fever and headache on August 16.

She was admitted to Queen Elizabeth Hospital on the same day and is now in stable condition.

A CHP spokesman said the patient had no travel history recently.

Her home contact did not have any symptoms.

This is the third reported case of Streptococcus suis infection in 2008.

A total of six, eight and 13 cases were reported in 2007, 2006 and 2005 respectively.

The spokesman said Streptococcus suis infection may present as meningitis (inflammation of the membrane enclosing the brain), septicaemia (blood stream infection), and less commonly endocarditis (inflammation of the inner lining of the heart chambers), arthritis and bronchopneumonia (a kind of lung infection involving the bronchioles).

Streptococcus suis infection can be treated with appropriate antibiotics.

To prevent the disease, members of the public are advised to always observe personal and environmental hygiene practices and avoid contact with pigs that are sick or dead from diseases and their excreta or body fluids.

If contact with pigs or raw pork is necessary, one should:
-- Use protective gloves;
-- Wash hands after handling pigs or raw pork; and
-- Clean and cover all wounds properly.

Members of the public with suspected symptoms should consult their doctors as soon as possible and report their relevant exposure histories.

They can obtain more information on Streptococcus suis from the CHP website (www.chp.gov.hk).

They can also obtain the latest information on infectious diseases in other places on the department's Hong Kong Travel Health Service website (www.travelhealth.gov.hk).
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http://www.info.gov.hk/gia/general/200808/18/P200808180191.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Public urged to be vigilant against community-associated MRSA

August 19 2008, 10.36.01

The Centre for Health Protection (CHP) of the Department of Health today (August 19) called on people to be vigilant against infection from community-associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) - a drug resistant bacterium.

The appeal was made in view of the notification to the CHP of 37 confirmed cases in July this year, which was the highest monthly total in 2007 and 2008.

CHP's Consultant of Community Medicine, Dr SK Chuang, said investigations had indicated that except for two cases in the same family, the other cases were all sporadic and no further person-to-person transmission had occurred.

Dr Chuang said that these cases affected 20 males and 17 females aged from two months to 87 years.

Twenty-seven cases required hospital admission while 10 cases were managed as out-patient.

The majority had skin and soft tissue infection and none had life-threatening forms of the disease.

Thirty-five of them have recovered and the remaining two are in hospital in stable condition.

MRSA is a type of staphylococcus aureus that is resistant to beta-lactam antibiotics. It is a common infection worldwide and is usually associated with hospital settings.

However, in recent years, many countries observed MRSA infections among healthy individuals in the community. It is mainly transmitted through direct contact with wounds, discharge and soiled areas, usually via hands, which may then contaminate other areas of the body, items or surfaces. Symptoms may include redness, warmth, swelling, skin tenderness or pus drainage.

Sometimes more serious effects such as purulent wound infections and severe pneumonia may occur, requiring hospitalisation and special antibiotics for treatment.

It is widely recognised that indiscriminate use of antibiotics may contribute to antibiotics resistance.

Dr Chuang said patients who were advised by doctors to take antibiotics should take the medicine according to the prescribed frequency and dosage and complete the whole course.

She said the risk of transmission could be minimised by maintaining good personal hygiene including washing hands with soap frequently and wearing gloves when touching grossly soiled items.

"People should clean any broken skin with waterproof adhesive bandages and wash hands before and after touching wounds. "If they have an open wound, they should avoid contact sports and visiting public bath houses.They should also avoid sharing personal items such as unlaundered towels, clothing or uniforms and razors," Dr Chuang said.
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http://www.info.gov.hk/gia/general/200808/19/P200808190175.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

[See also: http://www.flutrackers.com/forum/showpost.php?p=175126&postcount=101]

Update on reports under paediatric surveillance programme

August 20 2008, 12.27.16

A spokesman for the Centre for Health Protection (CHP) of the Department of Health said that a report involving a three-year-old boy was received today (August 20) through the paediatric surveillance programme set up by the CHP with private and public hospitals.

The programme started earlier this year to monitor the trend of complications due to influenza-like illnesses and enterovirus infection in children.

Since its establishment in mid-March this year, the programme has recorded 51 cases with two to 27 cases received per month.

The new report was a boy living in Mong Kok who developed fever and cough on August 17.

His condition deteriorated on August 19 and he was admitted to Kwong Wah Hospital (KWH) on the same day.

He developed convulsions after admission and the clinical picture suggested sepsis and encephalopathy.

He is now in critical condition.

Laboratory tests are pending.

The boy had no recent travel history and his family members did not have similar symptoms.

The kindergarten that the child attended did not report similar illnesses in other children.

CHP's investigation on this case is on-going.

Meanwhile, the seven-year-old girl admitted to Prince of Wales Hospital (PWH) on August 8 with symptoms of encephalitis is still under intensive treatment.

She is in critical condition.

Tests conducted on the cerebrospinal fluid, blood and respiratory specimens taken from the girl have so far yielded negative results.

Further investigations are ongoing.

The coroner's investigation into the deaths of the three-year-old girl and the nine-year-old girl who passed away in KWH and PWH on August 11 and 13 respectively is also on-going.

The spokesman said a baseline average of some 50 public hospital admissions per year among children aged 12 and below were related to myocarditis, encephalitis or encephalopathy.

"CHP expects to find, as a baseline, a certain number of these cases of sporadic nature throughout the year.

"CHP will continue to monitor the occurrence of these cases to detect any abnormal increase or clustering," the spokesman said.

The spokesman said although definitive identification of a causative organism may not be possible in many cases of encephalitis and myocarditis based on literature, CHP was committed to conducting intensive tests to determine possible etiologic agents in these cases.

He reminded parents to monitor their children's personal hygiene.

"If their children develop persistent high fever, uncontrollable vomiting, fits or convulsions, they should take them to doctors immediately as the symptoms may be signs of viral infections," the spokesman said.
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http://www.info.gov.hk/gia/general/200808/20/P200808200202.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

CHP investigating a case of Q fever

August 20 2008, 12.53.17

The Centre for Health Protection (CHP) of the Department of Health and the health authority of Macau are jointly investigating today(August 20) a confirmed case of Q fever , a zoonotic infection, involving a 52-year-old-man living in Macau.

The patient presented with prolonged fever on June 11 and received treatment in Macau.

He came to Hong Kong and was admitted to Queen Mary Hospital on July 28.

He is now in stable condition.

Paired serum samples of the patient showed elevated Coxiella burnetii antibodies.

His clinical picture and serology results were compatible with those of acute Q fever.

Investigations revealed that the patient worked indoors and had no history of visiting zoos, farms or rural areas during the incubation period.

His family members are asymptomatic.

This is the first case of Q fever reported to the CHP in 2008.

In 2004, 2005 and 2006, there were one, three and two confirmed cases respectively. In 2007, no case was reported.

Q fever is caused by Coxiella burnetii, usually affecting meat workers and farmers.

Symptoms usually include with fever, chills, headache and weakness.

Pneumonia may occur in serious cases.

The disease is usually contracted through inhalation of excreta particles from infected ticks and animals (for example, sheep, cattle, cats, dogs, rodents and birds). It can also spread by direct contact with infected animals or consuming polluted water and unpasteurised dairy products.

Members of the public and travellers should adopt the following measures to reduce the risk of infection:
*avoid direct or indirect contact with livestock and poultry;
*choose a hotel or inn with satisfactory hygiene conditions;
*observe good personal and food hygiene, drink boiled water and consume pasteurised dairy products only.

Anyone returning from travel to a Q fever affected area who falls sick should seek medical attention immediately.
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http://www.info.gov.hk/gia/general/200808/20/P200808200221.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Source: http://www.macaudailytimesnews.com/index.php?option=com_content&task=view&id=14942&Itemid=28

Resident hospitalised in HK with first case of Q fever PDF
Thursday, 21 August 2008

The Centre for Disease Prevention and Control was notified yesterday by the Centre for Health Protection of Hong Kong that a Macau resident had been hospitalised in Hong Kong with Q fever.
The 52-year-old man's symptoms began to show in Macau on June 11, suffering from persistent fever, and was hospitalised in Macau's Kiang Wu Hospital before being sent to the Conde de San Januario Hospital for further treatment.
With symptoms persisting he was moved in late July to the Queen Mary Hospital in Hong Kong. Yesterday it was confirmed by the Division of Public Health Laboratory of the Centre for Health Protection of Hong Kong that the man had been infected with Q fever.
The fever is a disease caused by the Coxiella burnetii bacteria and transmitted from animals to humans. The Q fever is common throughout the world, and appears, suddenly, in agricultural areas and grassland, agricultural farms, slaughterhouses, workshops for manufacturing of meat and plants in production of leather.
The patient is still hospitalised in Hong Kong and his condition is stable.
Once the diagnosis was received, the Centre for Prevention and Control of Disease immediately began investigating how the man was infected. The patient is an electrician, has no pets at home, and in the course of his activity had no contact with animals. Two weeks before the onset of symptoms, the patient and his wife were in Zhongshan, not having had, however, contact with animals. Currently, there is no case of infection between family and colleagues.
Previously no case of Q fever had been registered in Macau. Hong Kong recorded no Q fever cases last year with two in 2006 and three in 2005.
Most patients are farmers and workers in the manufacturing workshop of meat, and the main route of infection is the inhalation of small particles of excrement of infected animals (including sheep, cows, cats, dogs, rodents and birds) and ticks.
In addition, the contact with infected animals or drinking contaminated water or milk products can also cause infection.
As the likelihood of transmission of Q fever between humans is very low the patient has not been isolated. The incubation period of Q fever varies from 12 to 39 days, and symptoms include high fever, chills, fatigue, muscle aches, pains of the joints and sense of lack of strength, showing pneumonia in about half of patients. The acute Q fever may be cured by the body naturally within two to three months. Only a small number of patients suffer chronic Q fever, with a length of illness ranging from months to over a year. Antibiotics are used to treat the fever.
The Health Services has asked citizens to adopt measures to reduce the risk of infection such as avoiding travelling to places of animal husbandry, slaughterhouses or other places of manufacturing animal products, avoiding contact with domestic animals or products of animals and not to drink non-boiled water and milk products that have not been disinfected.
 
Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Five imported cases of dengue fever confirmed

August 21 2008, 13.23.16

The Centre for Health Protection (CHP) of the Department of Health urged members of the public to guard against dengue fever following the confirmation by laboratory test of five imported cases.

The first case involved a 41-year-old man who travelled to Thailand between July 28 and August 4.

He developed symptoms of dengue fever including fever, chills, myalgia, joint pain and petechiae over his limbs upon his return to Hong Kong. He consulted a private doctor and was admitted to Tseung Kwan O Hospital on August 9. He was discharged on August 14.

In the second case, a 28-year-old woman travelled to the Maldives, Sri Lanka and Thailand between July 28 and August 7 and developed symptoms of fever, diarrhoea and chills on August 10. She was admitted to Princess Margaret Hospital (PMH) on August 16 and is now in stable condition.

The third case affected a 38-year-old woman who went to Bangladesh from July 23 to August 3. She had fever, chills and headache on August 8 and was admitted to Pamela Youde Nethersole Eastern Hospital two days later. She was discharged on August 18.

As for the fourth case, a 49-year-old woman went to the Philippines between July 13 and August 10 and developed fever and chills on August 14. She was admitted to PMH on August 17 and is now in stable condition.

The last case involved an expatriate man aged 17, who travelled to Thailand from July 27 to August 10. He developed symptoms of dengue fever such as fever, headache and joint pain on August 15 and consulted private doctors. No hospitalisation was required and his condition is stable.

The family members and travel collaterals of these five patients did not have any symptoms of dengue fever.

A total of 26 cases of imported dengue fever have been reported to the CHP so far this year.

Fifty-eight cases were reported in 2007 and all of them are classified as imported cases.

A spokesman for CHP urged the public to stay alert to the threat of dengue fever and to help prevent mosquito breeding by taking the following measures:

* Put all used cans and bottles into dustbins with covers;
* Change water for plants at least once a week, leaving no water in the saucers underneath flower pots;
* Cover tightly all water containers, wells and water storage tanks, and
* Keep all drains free from blockage.

Travellers should take the following preventive measures:
* Wear long-sleeved tops and trousers;
* Use insect repellent on exposed parts of the body, and
* Use mosquito screens or nets when rooms are not air-conditioned.

Anyone feeling unwell after returning from their trip should consult a doctor as soon as possible and provide details of their travel to the doctor.

The latest information on dengue fever in other places can be found under "Outbreak News" on the Hong Kong Travel Health Service website, www.travelhealth.gov.hk/eindex.html.

Travel agents, tour guides and travellers can visit the website for the latest news and advice on preventive measures.
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http://www.info.gov.hk/gia/general/200808/21/P200808210290.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

A case of EV71 confirmed

August 21 2008, 12.01.01

The Centre for Health Protection (CHP) of the Department of Health today (August 21) urged members of the public to be vigilant against Enterovirus-71 (EV71) infection following confirmation of one EV71 case involving a three-year-old boy.

The child developed fever, oral ulcer and rash over his hands and feet on August 18.

He consulted the Accident and Emergency Department of Kwong Wah Hospital on August 20 and no hospitalisation was required.

Laboratory results of both his throat swab and stool specimens yielded positive results for EV71.

CHP's investigation revealed that the boy had visited the Mainland between July 14 and August 19.

His family members did not have similar symptoms.

A total of 79 EV71 infection cases have been reported to CHP so far this year.

There were 35, eight, 16 and 12 cases in the years 2004, 2005, 2006 and 2007 respectively.

For more information, the public may visit the CHP's website (www.chp.gov.hk) or call the Central Health Education hotline 2833 0111.
-
http://www.info.gov.hk/gia/general/200808/21/P200808210261.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Girl with encephalitis symptoms passed away

[See also, post no. 6: http://www.flutrackers.com/forum/showpost.php?p=175127&postcount=6 - IOH]

August 22 2008, 13.39.41

A spokesman for the Centre for Health Protection (CHP) of the Department of Health said that the seven-year-old girl who was admitted to Prince of Wales Hospital on August 8 with symptoms of encephalitis and reported under the paediatric surveillance programme set up by the CHP with private and public hospitals passed away today (August 22).

The case will be referred to the Coroner's Court to ascertain the cause of death.

CHP's investigation is on-going.
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http://www.info.gov.hk/gia/general/200808/22/P200808220411.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Case of necrotising fasciitis under investigation

August 27 2008, 12.01.01

The Centre for Health Protection (CHP) of the Department of Health today (August 27) received a report of a case of necrotising fasciitis (flesh-eating disease) involving a 75-year-old man.

The man, living in Wong Tai Sin, injured the back of his right hand when handling crab on August 24.

He noted a painful swelling over his wound the next day and was admitted to United Christian Hospital and later underwent surgery.

He is currently in critical condition.

Laboratory tests on his blood yielded vibrio vulnificus, a type of bacteria causing necrotising fasciitis.

CHP is now investigating the case.

A CHP spokesman said necrotising fasciitis was a serious bacterial infection of the soft tissue and fascia.

It can destroy tissue and can cause death within 12 to 24 hours after infection.

Members of the public are reminded to adopt the following preventive measures:
- Avoid exposure of open wounds or broken skin to seawater or salty water;
- Wounds should be thoroughly cleansed and properly covered;
- Wear thick rubber gloves when handling raw shellfish;

Patients should seek medical advice promptly if symptoms and signs of infection like increasing redness, pain and swelling are found.
-
http://www.info.gov.hk/gia/general/200808/27/P200808270177.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Imported case of dengue fever confirmed

August 29 2008, 11.51.41

The Centre for Health Protection (CHP) of the Department of Health today (August 29) urged people to guard against dengue fever following the confirmation of an imported case by laboratory test.

The case involved a 38-year-old female tourist who developed symptoms of dengue fever including fever, malaise and rash one day before her arrival in Hong Kong on August 11.

She was admitted to a private hospital in the Hong Kong Island on August 15. She was discharged and had left Hong Kong.

According to CHP's investigation, the tourist had travelled to Indonesia and Singapore before coming to Hong Kong.

A total of 27 cases of imported dengue fever have been reported to the CHP so far this year. 58 cases were reported in 2007 and all of them were classified as imported cases.

A spokesman for CHP urged the public to stay alert to the threat of dengue fever and to help prevent mosquito breeding by taking the following measures:
* Put all used cans and bottles into dustbins with covers;
* Change water for plants at least once a week, leaving no water in the saucers underneath flower pots;
* Tightly cover all water containers, wells and water storage tanks, and
* Keep all drains free from blockage.

Travellers should take the following preventive measures:
* Wear long-sleeved tops and trousers;
* Use insect repellent on the exposed parts of the body, and
* Use mosquito screens or nets when rooms are not air-conditioned.

Anyone feeling unwell after returning from their trip should consult a doctor as soon as possible and provide details of their travel to the doctor.

The latest information on dengue fever in other places can be found under "Outbreak News" on the Hong Kong Travel Health Service website, www.travelhealth.gov.hk/eindex.html.

Travel agents, tour guides and travellers can visit the website for the latest news and advice on preventive measures.
-
http://www.info.gov.hk/gia/general/200808/29/P200808290206.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Inland is occupied by the baby boy to send in the prestige courtyard incurable cause of death to wait for investigating
2008-08-30 21:19

[on.cc special news]The department of health health protection center spokesperson indicated that this center receives the hospital administrative bureau to notify, 1 11 month big baby boy this morning in Crown Prince Wells hospital death case. The preliminary examination showed that this baby boy and the parents resides in inland, yesterday had a fever and the breath has the short situation, because after that suspicion pneumonia moved in a Haifeng hospital. North today approximately 3:50, the baby boy takes to the area hospital by the relative to treat in the morning, after that passes along the prestige courtyard, but died in 5:54 am. The baby boy has not come Hong Kong in the near future. The preliminary chemical examination demonstrated that obtains the nasopharyngeal secretion sample from the baby boy body to the armor, the Type B influenza virus, the bird flu virus, the thazi virus to assume the negative reaction. The baby boy family member and not presents the similar symptom. The health protection center contacted Guangdong Province health department, learns in the province not the unusual infectious disease eruption situation. The case will hand over by the cause of death courtyard investigates. :tiphat: http://svsurl.systransoft.com/?t=ou...=11d1def534ea1be0--578a2941-11c0f4fd3b4--1fb1
 
Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Prince of Wales Hospital's paediatric case

August 30 2008, 15.24.01

The following is issued on behalf of the Hospital Authority:

In response to media enquiries, the spokesperson of the New Territories East Cluster gave the following reply:

An 11-month old boy was brought by his relatives to the Accident and Emergency Department of North District Hospital at 3.51am this morning (August 30) after returning from Mainland China.

He presented with symptoms of severe pneumonia and was in critical condition.

After resuscitation he was transferred to the Prince of Wales Hospital for further treatment.

He passed away at 5.54am.

The case has been reported to the Hospital Authority and the Centre for Health Protection for necessary follow up.
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http://www.info.gov.hk/gia/general/200808/30/P200808300207.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

CHP receives report about the death of baby boy in PWH

August 30 2008, 15.17.11

In response to media enquiries, a spokesman for the Centre for Health Protection of the Department of Health today (August 30) said that the centre was informed by the Hospital Authority about the death of a 11-month-old baby boy in Prince of Wales Hospital (PWH) this morning.

Initial enquiries revealed that the boy, lived in the Mainland with his parents, developed fever and shortness of breath yesterday.

He was admitted to a hospital in Haifeng for treatment of suspected pneumonia.

He was taken by his relatives to North District Hospital at about 3.50am today.

He was subsequently transferred to PWH.

The boy passed away at 5.54am.

He had not traveled to Hong Kong recently.

Initial laboratory tests on the boy's nasopharyngeal aspirate specimen yielded negative results to influenza A and B, influenza H5N1 and SARS.

The family members of the boy did not have similar symptoms.

The CHP contacted the Department of Health of Guangdong Province today and was learnt that there was no abnormal outbreak of infectious diseases in the province.
The case will be referred to the Coroner's court for investigations.
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http://www.info.gov.hk/gia/general/200808/30/P200808300204.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Test of boy who passed away yesterday yielded positive result to EV 71

August 31 2008, 15.33.26

A spokesman for the Centre for Health Protection of the Department of Health today (August 31) said that further laboratory tests on respiratory specimens taken from 11-month-old boy who passed away in the Prince of Wales Hospital yesterday yielded positive result to enterovirus 71 (EV71).

The boy has not travelled to Hong Kong recently.

His three-year-old sister living in Haifeng was taken by her relative to Hong Kong this morning and was admitted to Pamela Youde Nethersole Eastern Hospital for fever and rash.

She is now in stable condition.

Initial laboratory tests on the respiratory specimen taken from her also yielded positive results to EV71.

The girl has not travelled to Hong Kong recently.

CHP has informed the Health Department of Guangdong Province of the result.
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http://www.info.gov.hk/gia/general/200808/31/P200808310196.htm
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Re: _|Hong Kong, Prc Sar: Epi-surveillance (august)|_

Source: http://www.worldjournal.com/wj-hk-news.php?nt_seq_id=1767779

Google translation:
Order of the virus wins brother sister hospital infection

Hong Kong - An outbreak of infectious diseases in the haze, the new school year started on the 1st. Prince of Wales Hospital on August 30 morning a 11-month-old baby boy from the mainland to Hong Kong to hospital rapidly after death, the Center for Health Protection of the respiratory tests confirmed that he had samples of EV71-positive. The three-year-old baby sister on the 31st morning also came to Hong Kong patients, laboratory tests revealed that the same virus infection, admitted to Pamela Youde Nethersole Eastern Hospital. Infectious diseases specialist Lo Wing-lok said, EV71 intestinal virus this year in mainland China and Hong Kong speed the spread of more mainland so many children died. The new school year, he fears that local cases soared to alert parents and school children pay attention to personal hygiene, especially between the two places to be a day of cross-border students.

CHP spokesman said the boy died after Xin Xiaobin, Guangdong Province, Haifeng living in the three-year-old sister, because of fever and limbs rash, accompanied by friends and relatives to come to Hong Kong doctor in the Eastern Hospital, is in stable condition. Center for Health Protection in the first eight months of this year received a total of 79 cases of enterovirus EV71, five times more than last year, breaking the record over the years, four children died due to serious complications.
 
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