Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

[Ronan Kelly]

Re: 64 children die of unknown illness in Cambodia - WHO investigates

Re: 64 children die of unknown illness in Cambodia - WHO investigates

FRIDAY, JUL 6, 2012 02:55 PM EDT
Cambodia?s mystery disease
Sixty four Cambodian children are dead as WHO and government authorities scramble to determine cause
BY FAINE GREENWOOD,
...
In a CTV report released today, WHO officials cautioned that it?s too early to know if the disease is actually new. CTV interviewee Dr. Neil Rau noted that it?s important to figure out how encephalitis (brain infection) and respiratory symptoms are interconnected in this new ailment. Respiratory symptoms, as they are much more likely to be transferred from person to person, are of much more concern on the world stage, said Dr Rau.

Encouragingly, WHO officials have reported the unexplained disease isn?t ?clustering? around specific locales-indicating that the problem is an environmental one, instead of a possible new pandemic.
...
http://www.salon.com/2012/07/06/cambodias_mystery_disease_salpart/

 

[Treyfish]

Re: 64 children die of unknown illness in Cambodia - WHO investigates

Re: 64 children die of unknown illness in Cambodia - WHO investigates

Unknown Disease Killing Children Across Cambodia, WHO Says


<CITE class=byline>By Jason Gale - Jul 6, 2012 3:26 AM ET</CITE>

• http://www.bloomberg.com/news/2012-...s-child-victims-across-cambodia-who-says.html

Victims of a disease that?s killed dozens of children in Cambodia were from more than half the country?s provinces, a World Health Organization official said.
The first 57 patients were from 14 of Cambodia?s 24 provinces, with most coming from the southeastern provinces of Kampong Cham, Kampong Speu and Prey Veng, said Joy Rivaca Caminade, a technical officer with WHO?s Regional Office for the Western Pacific in Manila. The Ministry of Health was first alerted to the cases by Kantha Bopha Children?s Hospital in the capital, Phnom Penh, Caminade said in an e-mail today.

Enlarge imageUnknown Disease Killing Children Across Cambodia, WHO Says

People wait with their children for free medical treatment at Kuntha Bopha Hospital in Phnom Penh. Photograph: Landov



People wait with their children for free medical treatment at Kuntha Bopha Hospital in Phnom Penh. Photograph: Landov



http://shlinks.industrybrains.com/s...243e2c3656b87fdf4159a53a9b1114cee05857718e7e1
Health officials are searching for the cause of the deaths, which may be the result of a combination of different diseases, according to Caminade. Surveillance in the Southeast Asian nation hasn?t picked up anything of this scale in recent years, she said. So far, there is no evidence of clustering of cases that could indicate that it?s spreading from person to person.
The undiagnosed syndrome has been reported in 67 hospital patients since April, 66 of whom have died, said Aphaluck Bhatiasevi, a WHO spokeswoman, in a telephone interview fromPhnom Penh today. It?s unlikely influenza is the cause, she said.
No Autopsies

?No autopsy was done on any of the cases,? said Nima Asgari, the leader of the WHO?s emerging disease surveillance and response team in Cambodia.
Health officials are reviewing hospital records and treatments provided, as well as surveying relatives of patients, to understand the events that occurred from when the children fell ill to their hospitalization. The information is then being matched with laboratory data, he said.
?As you can imagine, this will take time and we are still at the data analysis part,? Asgari said in an e-mail today.

Children admitted to the hospital with symptoms including high fever, breathing difficulty and neurological problems saw their respiratory function worsen quickly, Caminade said yesterday. A review of 57 cases found 46 of them died within 24 hours of admission, with the rest suffering the same fate within three days, she said. The stricken children were aged three months to seven years.
The United Nations health agency is working with Cambodia?s health ministry and has offered support and access to international experts in areas such as epidemiology, she said. The WHO is on standby to provide support for clinical management and supplies of medicines if requested. :tiphat:http://www.bloomberg.com/news/2012-...s-child-victims-across-cambodia-who-says.html

 

[Treyfish]

Re: 64 children die of unknown illness in Cambodia - WHO investigates

Re: 64 children die of unknown illness in Cambodia - WHO investigates

PHL officials on alert for Cambodia respiratory disease


July 7, 2012 7:34am


Philippine authorities are now on alert for a mysterious respiratory disease that has so far killed at least 56 children in Cambodia.

The Bureau of Quarantine has intensified its medical inspection of passengers from Southeast Asia especially from Cambodia, radio dzBB reported Saturday....


?The DOH is now monitoring (the disease). Airports will screen inbound travelers as standard operating procedure,? he said.

So far, he said little is known of the disease other than that it ?affects children, (and is) very fatal,? with its mode of transmission unknown, and causative organism unknown.

In other posts on his Twitter account, Tayag said symptoms of the disease include fever and respiratory and/or neurological symptoms followed by death within 24 hours.

Another sign of the disease includes an elevated white blood cell count, he added.

So far, he said none of the hospital staff who took care of the children with symptoms had gotten sick.

WHO: 74 cases identified, at least 56 fatal

The World Health Organization said the Cambodian Ministry of Health is actively investigating the syndrome.

It said preliminary findings identified 74 cases who were hospitalized from April to July 5...


:tiphat:http://www.gmanetwork.com/news/stor...als-on-alert-for-cambodia-respiratory-disease

 

[Treyfish]

Re: 64 children die of unknown illness in Cambodia - WHO investigates

Re: 64 children die of unknown illness in Cambodia - WHO investigates

..The Cambodian Ministry of Health and the World Health Organization (WHO) said late Friday that the initial investigation results showed that 56 children had died of the undiagnosed disease in the last three months and an active investigation is still going on.
The death toll was lower than the 61 deaths announced on Wednesday.
"Preliminary findings identified a total of 74 cases who were hospitalized from April to 5 July 2012," said a joint statement of the ministry and the WHO....:tiphat:http://news.xinhuanet.com/english/health/2012-07/07/c_131700297.htm

 

[sharon sanders]

Undiagnosed illness in Cambodia - update

6 JULY 2012 - The Ministry of Health of the Kingdom of Cambodia is conducting active investigation into the cause of a recent undiagnosed syndrome that has caused illness and deaths among children in the country.

Preliminary findings of the investigation identified a total of 74 cases who were hospitalised from April to 5 July 2012. Of these, 57 cases (including 56 deaths), presented a common syndrome of fever, respiratory and neurological signs, which is now the focus of the investigation.

The majority of the identified cases to date were under three years old. Most of them were from the southern and central parts of the country and received treatment at Kantha Bopha Children?s hospital, which is a reference paediatric hospital. Despite all efforts, many of the children died within 24 hours of admission.

Available samples have been tested at the Institut Pasteur in Cambodia. Although a causative agent remains to be formally identified, all these samples were found negative for H5N1 and other influenza viruses, SARS, and Nipah.

The Ministry of Health was first alerted to this by Kantha Bopha Children?s hospital in Phnom Penh, where the majority of the cases were hospitalised.

The Ministry of Health notified WHO about this event through the IHR notification mechanism as it met the criteria for notification of any event where the underlying agent or disease or mode of transmission is not formally identified.

WHO and partners are assisting the Ministry of Health with this event which focuses on hospitalised cases, early warning surveillance data, laboratory data and field investigations.

While this event is being actively investigated, the Government is also looking at other diseases occurring in the country, including dengue, hand-foot-mouth and Chikungunya.

Parents have been advised to take their children to hospital if they identify any signs of unusual illness. The Government is also reinforcing awareness of good hygiene practices to the public, which includes frequent washing of hands.

http://www.who.int/csr/don/2012_07_06a/en/index.html

 

[tetano]

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

The World Health Organization and Cambodian health officials are investigating why at least 61 children in the country have died mysteriously after suffering severe neurological and respiratory complications.

Dr. Beat Richner of the Kantha Bopha Children's Hospitals, who first alerted Cambodia's health authorities about the unknown disease, said that as of Friday he knew of 64 cases in which only two children have survived.

The Cambodian Ministry of Health said that 56 of the deaths were preceded by a common syndrome of fever and respiratory and neurological problems.

http://articles.cnn.com/2012-07-06/...dren-phnom-penh-cambodian-ministry?_s=PM:ASIA

 

[alert]

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

This source is from Hong Kong and may have rounded off the case count:

http://rthk.hk/rthk/news/englishnews/20120708/news_20120708_56_853445.htm

Cambodia rules out Sars in child deaths

08-07-2012


Cambodian and World Health Organisation officials have ruled out birdflu and Sars as the viruses behind the deaths of 56 young children - most of them under three years of age. Up till now the Cambodian Ministry of Health and the World Health Organisation have not been able to identify the disease that's infected nearly 80 children since April. Of those 56 fatal cases, many had died within 24 hours of admission. And the majority of them had suffered from fever and had presented respiratory and neurological syndrome. ?? A World Health Organisation spokeswoman in Phnom penh, Apaluk Bhatiasevi, says health officials have stepped up their investigation but have ruled birdflu and Sars. And she said it was not necessary to issue any travel alert for Cambodia at the moment. ?? However, Ms Bhatiasevi has advised those felt ill after travelling to Cambodia to seek medical attention immediately.

 

[Emily]

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

60 children killed in Cambodia by mystery disease

Wednesday, 04 July 2012
Bridget Di Certo and Chhay Channyda
Phnom Penh Post

A small child is treated at Kantha Bopha hospital in Phnom Penh. 60 children have died from a new and unidentified disease, while only two of the 62 admitted to the hopsital have survived. Photograph: Hong Minea/Phnom Penh Post

Of the 62 children admitted to the Kantha Bopha Children?s Hospitals with similar symptoms of severe fever and respiratory and neurological destruction, only two were able to be saved, hospital founder Dr Beat Richner said yesterday.

In a letter from Richner to Minister of Health Mam Bun Heng sent on June 20 and obtained by the Post yesterday, the Swiss doctor raised the urgency of the issue and told the minister such a disease had not been seen in the past 20 years in Cambodia.

?They [the children] are suffering from an Encephalitis and in the last 6 hours they develop a most severe pneumonia," he wrote. ?The X Ray and CT are showing that the alveolus [pockets in the lung for oxygen exchange] are destroyed within hours before passing away.?

All the children who died, died within 24 hours of being hospitalised in what Richner called a ?dramatic evolution? of the lung-destroying disease.
[snip]
Speaking from the Kantha Bopha hospital in Siem Reap, where there have been two deaths, Richner said his team had been unable to definitively determine a cause yet but worried it may be the result of what he termed ?wrong treatment?.

?All these children had encephalitis [acute inflammation of the brain] and were hospitalised and treated at private clinics before coming to us," he said. ?I worry that a wrong treatment and drug intoxication at some private clinics has destroyed the lungs leading to a pneumonia we cannot treat.?

He added that his hospitals had been receiving a high number of encephalitis cases.

 

[alert]

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

http://www.promedmail.org/

Published Date: 2012-07-07 18:07:30
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia (02)
Archive Number: 20120707.1193413

UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (02)
*************************************************
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 6 Jul 2012
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2012_07_06a/en/index.html


The Ministry of Health of the Kingdom of Cambodia is conducting active investigation into the cause of a recent undiagnosed syndrome that has caused illness and deaths among children in the country.

Preliminary findings of the investigation identified a total of 74 cases who were hospitalised from April to 5 Jul 2012. Of these, 57 cases (including 56 deaths), presented a common syndrome of fever, respiratory, and neurological signs, which is now the focus of the investigation.

The majority of the identified cases to date were under 3 years old. Most of them were from the southern and central parts of the country and received treatment at Kantha Bopha Children's hospital, which is a reference paediatric hospital. Despite all efforts, many of the children died within 24 hours of admission.

Available samples have been tested at the Institut Pasteur in Cambodia. Although a causative agent remains to be formally identified, all these samples were found negative for H5N1 and other influenza viruses, SARS, and Nipah [virus].

The Ministry of Health was 1st alerted to this by Kantha Bopha Children's Hospital in Phnom Penh, where the majority of the cases were hospitalised.

The Ministry of Health notified WHO about this event through the IHR [International Health Regulations] notification mechanism as it met the criteria for notification of any event where the underlying agent or disease or mode of transmission is not formally identified.

WHO and partners are assisting the Ministry of Health with this event which focuses on hospitalised cases, early warning surveillance data, laboratory data, and field investigations.

While this event is being actively investigated, the government is also looking at other diseases occurring in the country, including dengue, hand, foot and mouth disease, and chikungunya [virus infections].

Parents have been advised to take their children to hospital if they identify any signs of unusual illness. The government is also reinforcing awareness of good hygiene practices to the public, which includes frequent washing of hands.

--
communicated by:
ProMED-mail rapporteurs Mary Marshall and Marianne Hopp

[It is interesting to note that H5N1 and other influenza viruses, SARS, and Nipah virus infections have been ruled out as the etiological agent involved in these cases. This WHO report makes no mention of testing for Japanese encephalitis virus or Banna virus infections. As mentioned in the moderator comment in the initial report (see ProMED-mail archive no. 20120704.1190037), Banna virus (a Seadornavirus in the Reovirus family) has caused cases of human encephalitis in China and the virus has been isolated from _Culex_ mosquitoes in Viet Nam and Indonesia, hence likely occurs in Cambodia as well. One hopes that appropriate samples from these cases are being sent to a WHO reference laboratory for diagnosis. Severe pulmonary disease is not reported in the earlier reports in the published literature of Banna virus infection, however. ProMED-mail awaits further reports of this outbreak with interest. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1iGB.]

 

[alert]

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

http://www.gmanetwork.com/news/stor...advisory-to-cambodia-yet-amid-mystery-disease

DOH: No need for travel advisory to Cambodia yet amid 'mystery disease'
July 8, 2012 8:49am

Health authorities are not yet recommending a travel advisory to Cambodia amid fears about a mysterious respiratory disease that has killed at least 61 children there.

A report on dzBB radio Sunday quoted Health Secretary Enrique Ona as saying that for now, the Bureau of Quarantine will be more alert in watching for symptoms of the disease among incoming travelers.

Amid reports on the deadly lung disease, Malacañang assured the public Philippine health officials are closely monitoring developments about the malady.

In an interview on government-run dzRB radio, presidential spokesman Edwin Lacierda said the DOH should come out with the proper precautionary measures.

“The Department of Health is monitoring that, tingnan kung ano ang respiratory disease nayan," he said.

Earlier, Philippine authorities were placed on alert for the disease that has so far killed scores of children in Cambodia.

Initial reports indicated the symptoms of the disease included severe respiratory problems and neurological symptoms.

National Epidemiology Center head Dr. Enrique Tayag said the disease has so far affected children seven years old and below.

Tayag said airports will screen inbound travelers as standard operating procedure, even as he said little is known of the disease other than that it “affects children, (and is) very fatal,” with its mode of transmission unknown, and causative organism unknown.

He said symptoms of the disease include fever, an elevated white blood cell count and respiratory and/or neurological symptoms followed by death within 24 hours.

For its part, the World Health Organization said the Cambodian Ministry of Health is actively investigating the syndrome.

The WHO said preliminary findings identified 74 cases who were hospitalized from April to July 5.

“Of these, 57 cases (including 56 deaths), presented a common syndrome of fever, respiratory and neurological signs, which is now the focus of the investigation,” it said in a July 6 statement. — LBG, GMA News

 

[tetano]

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

Re: Cambodia - 74 pediatric cases of unknown disease - 56 deaths - fever, respiratory and neurological symptoms

Officials make break in baffling disease killing Cambodian children

(CNN) -- Health officials say they have made an important discovery in the mystery surrounding the deaths of more than 60 children in Cambodia.

The Institut Pasteur in Cambodia tested samples taken from 24 patients and found 15 had tested positive for Enterovirus Type 71.

"These results now give a good explanation to this outbreak," Dr. Philippe Buchy, head of the institute's virology unit, said in an e-mail. "We will get more results hopefully by next Tuesday or Wednesday."

In milder cases, EV71 can cause coldlike symptoms, diarrhea and sores on the hands, feet and mouth, according to the journal Genetic Vaccines and Therapy.

But more severe cases can cause fluid to accumulate on the brain, resulting in polio-like paralysis and death.
Deadly disease kills Cambodian children

There is no effective antiviral treatment for severe EV71 infections, and no vaccine is available.

Adults' well-developed immune systems usually can fend off the virus, but children are vulnerable to it, according to the CDC.


http://edition.cnn.com/2012/07/08/world/asia/cambodia-children-disease/

 

[sharon sanders]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Please see:

China - Alarming Outbreak of "Mutated" Virulent form of Hand, Foot, and Mouth Disease in Guangxi - April 2010

"..According to the test conditions and symptoms, experts say there multiple organ failure in children,.."

 

[Emily]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

From CNN article in Tetano's #51 post:

"Over the past three months, 66 children -- between 2 and 3 years old -- were admitted to Kantha Bopha facilities. All but two died mysteriously after suffering severe neurological and respiratory complications, Richner said.

In their last hours of their life, the children suffered a "total destruction of the alveola(e) in the lungs," Richner said.

"We have now to see what really is causing the deadly pulmonary complication and see if a toxic factor is playing a role too," he said."

So they were in the younger age range quoted in some articles. Dr. Richner is not the only one concerned about why in some EV71 encephalitis patient clusters there are much higher fatality rates than in other clusters of EV71 encephalitis in the same age range.

Deaths of Children during an Outbreak of Hand, Foot, and Mouth Disease in Sarawak, Malaysia: Clinical and Pathological Characteristics of the Disease

L. G. Chan, Umesh D. Parashar, M. S. Lye, F. G. L. Ong, Sherif R. Zaki,
James P. Alexander, K. K. Ho, Linda L. Han, Mark A. Pallansch, Abu Bakar Suleiman, M. Jegathesan, Larry J. Anderson, and Outbreak Study Group
Clin Infect Dis. (2000) 31(3): 678-683 doi:10.1086/314032
[snip]
However, further evidence is required to define the link between EV71 infection and the fatal disease. The fact that only 2 outbreaks of deaths (i.e., this outbreak and the one in Taiwan) with this clinical picture have been reported, despite the occurrence of numerous HFMD and EV71 outbreaks worldwide, raises the possibility that other factors (e.g., toxins, medicines, or environmental exposures) or other infectious agents might contribute to the disease process. For example, a fastidious adenovirus has also been isolated from several case patients who died [20]. Adenoviruses have been reported to cause a cardiomyopathy that is not associated with inflammatory changes in cardiac muscle [43]. Studies are presently being conducted to assess the etiologic role, if any, of these agents and other factors in the pathogenesis of this unique illness. These studies should provide clues to the prevention and treatment of this devastating illness.

This is an outbreak with encephalitis patients having an almost 100% mortality rate:
MR Imaging Findings of Enteroviral Encephalomyelitis: An Outbreak in Taiwan 1998

This group of patients with the same clinical picture had a 19% mortality rate.
Clinical characteristics and treatment of severe encephalitis associated with neurogenic pulmonary edema caused by enterovirus 71 in China 2008

The survivors in the China outbreak are reported to have few neurological complications. Both articles are full text.

 

[Giuseppe]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Enterovirus-71 could be 'guilty by association'. For this reason, other pathogens, toxins and toxic chemicals might contribute to the rapid deterioration of Cambodian children victims of this outbreak.

 

[alert]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

http://www.bloomberg.com/news/2012-07-08/children-s-deaths-in-cambodia-linked-to-enterovirus.html

Children?s Deaths in Cambodia Linked to Enterovirus
By Natasha Khan - Jul 8, 2012 4:39 AM ET

The Institut Pasteur in Cambodia has discovered Enterovirus Type 71 in about two-thirds of patients it tested after a mystery disease killed more than 60 children in the country, said the head of the institute?s virology unit.

Enterovirus Type 71 is a ?perfect explanation? for the deaths, Philippe Buchy said by telephone today. ?We can now focus on how to contain it,? he said.

 

[alert]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

http://www.globaltimes.cn/content/719666.shtml

64 Cambodian children died of Encephalitis since April
Xinhua | 2012-7-8 13:58:27

Sixty-four young children out of 66, having been admitted to Kantha Bopha Children's Hospitals in Cambodia since the end of April, were killed by Encephalitis, Dr. Beat Richner, Founder and Head of the Kantha Bopha Children's Hospitals, said Sunday.

"The 66 children were admitted with just same symptoms and clinical findings. The children, most between 2 and 3 years old, suffered from Encephalitis," he wrote in a letter to the media on Sunday.

Encephalitis is a serious illness caused by an infection that makes the brain swell.

"They develop in the last hours of their life a total destruction of the alveolas in the lungs," he said. "Up to now 64 have died. Only two have survived."

He said from July 2-7, there were only two more cases.

Dr. Richner said that on July 7, the Institut Pasteur could confirm that in the majority of the above described cases the Enterovirus Type 71 was found.

"Still we have now to see what really is causing the deadly pulmonary complication and see if a toxic factor is playing a role too," he said.

In the letter, Dr. Richner said that the World Health Organization (WHO) has given a declaration on July 2 to Reuters, saying that "New mystery killer disease in Cambodia"

"This was causing unnecessary panic in Cambodia," he said. " On the level of public health, it is not an alarming issue."

"This declaration by WHO, which is not at all involved in this matter, was neither professional nor necessary, but causing panic for nothing," he added.

The Kantha Bopha Children's Hospitals are the largest pediatric ones in Cambodia. The hospitals are covering 85 percent of all Cambodian sick children.

 

[alert]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Apparently, 240 children have died of HFMD in China this year, presumably also caused by EV71:

http://europe.chinadaily.com.cn/china/2012-07/05/content_15549951.htm

so this may be a bad year for HFMD.

 

[Ronan Kelly]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

There has also been an EV71 HFMD outbreak in Vietnam for the past couple of years. The major difference I can see is the cfr. In Vietnam 40,000 cases resulted in only 27 fatalities to June 3rd this year. http://www.flutrackers.com/forum/showthread.php?t=181344

Is there evidence of a large scale HFMD outbreak in Cambodia this year?

 

[alert]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Maybe. The WHO GAR post:

http://www.who.int/csr/don/2012_07_06a/en/index.html

did mention HFMD, along with dengue and chikungunya, as diseases on which they had been working with Cambodian authorities. The deep question right now is, as you note, the discrepancy in apparent fatality ratios. Could the virus have mutated? Could some kind of poor/contaminated/toxic treatment have worsened the Cambodian cases? Or are we just looking at the most severe out of tens of thousands of cases?

 

[Treyfish]

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Pathology
"The Enterovirus 71 (EV71) infection may be asymptomatic or it may cause diarrhoea, rashes, and hand, foot and mouth disease (HFMD). However, EV71 also has the potential to cause severe neurological disease. To date, little is known about the molecular mechanisms of the host response to EV71 infection. [...] EV71 infection led to increases in the level of mRNAs encoding chemokines, proteins involved in protein degradation, complement proteins, and proapoptotis proteins."<SUP id=cite_ref-5 class=reference>[6]</SUP>
"Enterovirus 71 (EV71), one of the major causative agents for hand, foot and mouth disease (HFMD), is sometimes associated with severe central nervous system diseases. In 1997, in Malaysia and Japan, and in 1998 in Taiwan, there were HFMD epidemics involving sudden death among young children, and EV71 was isolated from the HFMD patients, including the fatal cases. The nucleotide sequences of each EV71 isolate were determined and compared by phylogenetical analysis. EV71 strains from previously reported epidemics belonged to genotype A-1, while those from recent epidemics could be divided into two genotypes, A-2 and B."<SUP id=cite_ref-6 class=reference>[7] </SUP>
"Ever since the 1980s, large and small EV71 epidemics caused by distinct genotypes have occurred in Asian countries and regions sharing trade with China. In Hong Kong, sporadic EV71 infections with incidences of monoplegia were reported in 1987, and a fatal case was documented in 2001. A large outbreak of HFMD due to EV71 infection occurred in Taiwan in 1998, including 129,106 case reports, 405 children with severe complications, and more than 80 deaths. After 1998, smaller EV71 epidemics occurred almost annually in Taiwan, primarily associated with EV71 viruses of genotypes C2 and B4. In Malaysia, EV71 outbreaks occurred in 1997 and 2000, mainly associated with genotypes B3 and B4. Since 1997, EV71 epidemics (genotypes B and C) have been reported annually in Singapore, with genotype B4 forming the predominant causative agent of a large outbreak in 2000 (5). In Korea, an EV71 epidemic in 2000 was caused by a relatively new genotype, C3, which has only rarely been identified outside of Korea in recent years (10). Thus, the EV71 genotypes of these HFMD epidemics seem to be regionally and temporally unrestricted."<SUP id=cite_ref-China_7-0 class=reference>[8] :tiphat:http://en.m.wikipedia.org/wiki/Enterovirus_71#section_3</SUP>