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

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

Google translation:

WHO: Detection of viruses related to the mysterious disease in Cambodia
There are at least 52 children aged 3 months to 11 years had died of undiagnosed syndrome since mid-April. The number has been WHO and Cambodian health ministry confirmed the latest.

Joint statement said the recent results in the laboratory showed that a significant proportion of samples positive for the virus Enterovi virus 71 (EV71), a serious disease caused strains limbs, mouth .

Ev-71 is a common virus strains in Asia, but by Nima Asgari, medical experts of WHO in Cambodia, said he believes has not yet appeared before the virus strains in the country of Cambodia.

Asgari said that the determination of this vaccine virus is an important first step but still need more tests to find out if there are other strains of virus causing the death of this child.

Mr. Asgari said "This is an important finding." The mystery surrounding the disease include high fever, rapid respiratory failure, higher mortality rate in children is a major concern for the country of Cambodia today.

Paediatrician founder Beat Richner hospital Kantha Bopha children's charity said the death toll was up 64 victims, and only two survivors. Charity Hospital is where the majority of patients treated in the past.

Richner, who first alarm about the disease, said 15 of the 24 patients tested positive for EV-71 but this is still not a final figure.

Mr. Richner said, we consider whether the cause is what is causing fatal pulmonary complications and whether there are harmful elements in this case or not.

Cambodian Health Minister Mam Bunheng said they are conducting a further investigation of this disease.

Disease Hand, foot and mouth disease is a contagious and spreads through direct contact with body fluids or feces of an infected person. The best way to prevent this disease is good hygiene, he said.

Vinh Quach

AFP
Click to expand...

I have to guess that "vaccine virus" is either a mistranslation, or a reference to the fact that an experimental EV71 vaccine is being trialed in Taiwan as reported by Treyfish here.

I think its safe to assume that the article indicates co-infection with a still unknown virus is being pursued. I haven't seen a strong indication anywhere that the possibility problematic medications are being investigated, though.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Mix of pathogens caused mystery illness in Cambodia, doctors say

The World Health Organization, in conjunction with the Cambodian Ministry of Health, will conclude that a combination of pathogens is to blame for the mysterious illness that has claimed the lives of more than 60 children in Cambodia, medical doctors familiar with the investigation told CNN on Wednesday.

The pathogens include enterovirus 71, streptococcus suis and dengue, the medical sources said. Additionally, the inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, they said.

The sources did not want to be identified because the results of the health organization's investigation have not yet been made public.

Dr. Beat Richner, head of Kantha Bopha Children's Hospitals - which cared for 66 patients affected by the illness, 64 of whom died - said that no new patients had been seen there since last Saturday.

The World Health Organization (WHO) is also expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis, and breathing difficulties.

http://news.blogs.cnn.com/2012/07/1...used-mystery-illness-in-cambodia-doctors-say/
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

[Source: Secretary for Food and Health, Hong Kong PRC SAR, full text: (LINK).]

SFH on enterovirus infections


Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending the meeting of the Panel on Food Safety and Environmental Hygiene of the Legislative Council this morning (July 11):

Reporter: (On enterovirus infections in Cambodia and Hong Kong.)

Secretary for Food and Health: Indeed there are several incidents of infectious disease outbreak which have caused our concern and we are closely monitoring the situation. In Cambodia, there are more than 50 cases in which children suffered illness and died. We understand that the World Health Organisation (WHO) is assisting the country to examine the specimens, hopefully to come up with a clear situation of the outbreak. But up to this moment, most of the specimens being tested turn out to be enterovirus EV71. The finding also matched with the clinical symptoms and presentations of the patients concerned. As to the exact nature of this outbreak, whether there could be other pathogens involved, we have to wait for the report from the WHO. According to our knowledge, there has been no increase of new cases ever since the incident was notified to the WHO.

For our local situation, the Centre for Health Protection announced yesterday that they were investigating two cases of enterovirus infection but so far these cases are not EV71. As we all know, there are different types of enterovirus and both of these cases are imported cases.

Nevertheless, in the light of all these outbreaks, including the recent detection of avian influenza H5N1 in Bird Street, I would like to remind the citizens to remain vigilant in terms of food and personal hygiene. If we are travelling outside Hong Kong, special precautions must be taken as far as the food that we are going to eat as well as our personal hygiene.

People who have returned to Hong Kong with symptoms, particularly fever, should seek medical attention.

Reporter: (On the two imported cases of severe paediatric enterovirus infection.)

Secretary for Food and Health: I cannot comment on the purpose of the two patients coming to Hong Kong. But it is a fact that these two cases were classified as imported cases.

Reporter: (On the suggestion that the Agriculture, Fisheries and Conservation Department should implement policy to regulate caged birds imported into Hong Kong to prevent bird flu.)

Secretary for Food and Health: All the imported birds are required to have a (health) certificate of their exporting place.

(Please also refer to the Chinese portion of the transcript.)


Ends/Wednesday, July 11, 2012
Issued at HKT 12:54
NNNN
​
- -------
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

China to lend hand in battle with killer virus
Wednesday, 11 July 2012

China yesterday pledged to provide medical experts and funding to assist the investigation and clinical management of a virus that has killed more than 60 Cambodian children.

Eang Sophalleth, personal spokesman for Prime Minister Hun Sen, told reporters the pledge had been made during a meeting between the premier and Chinese Foreign Minister Yang Jiechi yesterday in Phnom Penh.

?There is a mysterious disease that is responsible for killing more than 60 Cambodian children. So China would like to provide experts and funding to assist Cambodia in finding the cause of the disease,? Sophalleth quoted Yang as saying to Hun Sen.

Cambodia?s largest children?s hospital, Kantha Bopha, has reported that 64 children have died from the virus since April.

Tests being conducted by Kantha Bopha and the Ministry of Health and the World Health Organisation have recently identified the disease as enterovirus 71 ? a virus associated with hand, foot and mouth disease that can cause severe complications for children.

WHO epidemiologist Dr Nima Asgari said the details of the co-operation with incoming Chinese experts was a matter for the Ministry of Health, but welcomed the additional assistance.

?What I can say is that China does have a lot of experience with clinical management of this virus,? Asgari said.

China has experienced several outbreaks of EV-71, including severe outbreaks in 2008 and 2009 that claimed hundred of lives, according to media reports of the events. During the 2008 outbreaks, the US embassy in Beijing reported that ?all the deaths were children less than six years old, and most were under two years of age?.

The commitment of expert assistance and funding was part of Yang?s promise from China to continue providing loans and aid to Cambodia as well as pushing for business and investment and tourists to the Kingdom.

According to Sophalleth, Hun Sen thanked China for its continuing support for Cambodia.:tiphat:http://www.phnompenhpost.com/index....to-lend-hand-in-battle-with-killer-virus.html
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

http://www.cnn.com/2012/07/10/world/asia/cambodia-children-disease/index.html

Mystery illness in Cambodia solved, doctors sayBy Dr. Sanjay Gupta and Danielle Dellorto, CNN
updated 11:17 AM EDT, Wed July 11, 2012
Phnom Penh, Cambodia (CNN) -- The cause of a mysterious illness that has claimed the lives of more than 60 Cambodian children has been determined, medical doctors familiar with the investigation told CNN on Wednesday.

A combination of pathogens, disease-causing micro-organisms, is to blame for the illness, the World Health Organization, in conjunction with the Cambodian Ministry of Health, has concluded, the doctors said.

The pathogens include enterovirus 71, which is known to cause neurological disease; streptococcus suis, which can cause infections like bacterial meningitis in people who have close contact with pigs or with pork products; and dengue, which is transmitted by mosquitoes.

The inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, the doctors said. The World Health Organization (WHO) is expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis and breathing difficulties.

While not all the microorganisms were present in each patient, doctors concluded the illness was caused by a combination of them and worsened by steroid use.

The WHO sources did not want to be identified because the results of the health organization's investigation have not yet been made public.

"I'm very confident for the reason of the epidemic," said Dr. Phillipe Buchy, chief of virology at the Institut Pasteur in Cambodia and one of the doctors who cracked the case.

"The first thing that goes through your mind is, is this one of the usual suspects you haven't detected before?" said Dr. Arnaud Tarantola, chief of epidemiology and public health at the Institut Pasteur. "If it is, has it mutated, or changed in a way that it causes more severe disease? Or is it something completely new?"

On the steroids issue, Tarantola said, "When you have a dying child, you try to use what you have at hand, and they were right to try that." But, he acknowledged, "from the cases we reviewed, almost all of the children died, and almost all of them had steroids."

Parents face anxious wait over mystery illness

"I think we can close the case and move ahead asking different questions," Buchy said. "Not what is the illness, but now, how long has the virus been circulating? What is the extent of the circulation of the virus? How many mild diseases are we missing? That's the next step."

Over the past four months, doctors at Kantha Bopha Children's Hospitals in Phnom Penh have been faced with the mysterious syndrome, which kills children so fast that nearly all of those infected with it die within a day or two of being admitted to the hospital.

Dr. Beat Richner, head of the children's hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases of the illness had been confirmed since Saturday.

Other hospitals in the country have reported similar cases, but far fewer than the children's hospitals in the capital, which are the most popular.

In the last hours of their life, the children experienced a "total destruction of the alveola(e) in the lungs," Richner said. Alveolae are the air sacs where oxygen enters the bloodstream.

Most of the children who have contracted the illness have come from the south of the country, though health officials cannot find what is known as a cluster -- a lot of cases coming from one specific area.

By June 29, the WHO had been contacted and Cambodian officials were scrambling to instruct health providers across the country to spread information about the illness as quickly as possible.

Officials search for clues in disease killing Cambodia's children

The WHO and the Cambodian authorities' announcement of the situation drew criticism from Richner, who said they were "causing unnecessary panic."

The WHO said the unexplained nature of the outbreak obliged it to communicate the information.

Over the weekend, lab tests linked enterovirus 71 (EV71) to some of the cases. But the tests didn't solve the whole puzzle and health officials continued their investigations, noting the detection of other elements like streptococcus suis and dengue.

The link to EV71 does not particularly help in the treatment of the illness, as there is no effective antiviral treatment for severe EV71 infections and no vaccine is available.

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.

Outbreaks of the enterovirus "occur periodically in the Asia-Pacific region," according to the CDC. Brunei had its first major outbreak in 2006. China had an outbreak in 2008.

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

"It looks like (EV71) has emerged strongly, probably because it hadn't circulated with the same intensity in the past years," Tarantola said.

Reported cases of streptococcus suis have risen significantly in recent years, notably in Southeast Asia, according to a paper that appeared last year in Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention in Atlanta.

The rainy season in Cambodia, which lasts from May to October, is a key problem in trying to control diseases like dengue. Because of a lack of indoor plumbing in many homes, people collect rainwater in vats, creating potential breeding grounds for mosquitoes.

In Cambodia, as with many places around the world, parents first try treating their child at home. If that doesn't work, they typically then go to a local clinic. A hospital visit, which often involves a long trip, is a last resort.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

http://www.marketwatch.com/story/ca...to-3-pathogens-2012-07-11?link=MW_latest_news

Cambodian mystery illness linked to 3 pathogens

By Val Brickates Kennedy BOSTON (MarketWatch) -- A deadly disease outbreak in Cambodia that resulted in the deaths of over 60 small children has been linked to a lethal mix of three known pathogens, CNN reported Tuesday. Officials from the World Health Organization investigating the outbreak have concluded that the illness, which quickly destroys the lungs of its victims, is a combination of enterovirus 71, also known as "hand, foot and mouth disease"; streptococcus suis; and dengue fever. Officials also found that steroids, which are often used to bolster patients, actually exacerbated the condition. WHO is expected to announce shortly that area healthcare workers refrain from using steroids on patients who exhibit signs of the illness, which include severe fever, brain swelling and difficulty breathing. Cambodia is currently in its rainy season, when disease rates can spike due to an increase in the mosquito population and inadequate sanitation.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

http://www.promedmail.org/
Published Date: 2012-07-11 14:48:55
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia (05): EV71 treatment options
Archive Number: 20120711.1197882

UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (05): EV71 TREATMENT OPTIONS
*************************************************************************
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: Wed 11 Jul 2012
From: Rogier van Doorn [edited]


EV71 in the outbreak of fatal illness in Cambodian children
-----------------------------------------------------------
In previous ProMED postings [listed below] the clinical illness in Cambodia was described as occurring mainly in children under 3, with a male/female ratio of 1.3 to 1. It was noted in 14 south and central provinces of the country. Around 60 children were admitted to Kantha Bopha hospital after having been treated in private clinics and most of these died within 24 hours of a syndrome with encephalitis and pulmonary edema, while platelets, liver function, and renal function appeared normal.

Epidemiology and clinical features
----------------------------------
EV71 has been associated with outbreaks of fatal encephalitis in infants in the 1970s in Hungary and Bulgaria (1, 2) and since 1998 with large outbreaks of hand-foot-mouth disease (HFMD) in Southeast Asia (3). A minority of patients in these outbreaks may develop rhombencephalitis and (neurogenic) autonomic dysregulation leading to pulmonary edema, which can be fatal within 24 hours, while laboratory markers of liver and kidney function usually stay within normal range. The age distribution and male to female ratio of the children in Kantha Bopha is very similar to what was prospectively observed in Children's Hospital 1 in Ho Chi Minh City, Viet Nam among 4000 children hospitalized with HFMD with a median age of 20 months and a male to female ratio of 1.6 to 1. It was also noted that if children progressed to more severe disease this was within a median of 24 hours of admission. The case fatality rate was 0.2 percent of all hospitalizations and 6/19 patients with pulmonary edema (TH Khanh, unpublished data).

Myoclonus, particularly of the fingers is often the 1st symptom of central nervous system involvement and is seen in a majority of patients with severe disease (4). Deterioration is hallmarked by autonomic dysregulation, which presents as hypertension and tachycardia in addition to uncontrollable fever and may lead to pulmonary edema and death (3). In Taiwan and Malaysia it was noted that a large fraction (one third to half) of the patients progressing to this severe form of disease do not have a rash (5, 6). On the paediatric ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam among the very severe cases 12/47 had no rash and 28/47 had myoclonic jerks. There is no mention of rash, myoclonus, and hypertension in the children in Cambodia, but this would be very interesting to know.

The laboratory findings from Institute Pasteur and the clinical and epidemiological features are compatible with the severe end of the spectrum of disease caused by EV71. The high case fatality rate is striking, but may be due to an underestimation of the total number of cases because less severe cases are not hospitalized and not reported. The absence of the typical rash of HFMD should not rule EV71 out as a causative agent.

Some notes on treatment
-----------------------
Guidelines from the Vietnamese ministry of health advice to suppress myoclonus with oral or intravenous phenobarbital, and when suppression is incomplete to instill IVIg at 2g/kg in 2 dosages. Autonomic dysregulation, particularly hypertension, is treated with milrinone (7). Pleconaril, a drug with anti-enteroviral activity, has no activity against EV71 in vitro (11).

Evidence for the use of IVIg comes from treatment of enteroviral meningitis in neonates and agammaglobulinaemic patients, but there is only observational and retrospective case data on its efficacy in HFMD and no evidence for who benefits (8-10). Large randomised controlled trials of all treatment options (IVIg, milrinone, magnesium, fluid regimens, etc) are urgently needed for EV71 HFMD.

We would be interested to learn if there are centers in the region that would be interested in joining such trials.

References
----------
1. M Chumakov et al., Arch Virol 60, 329 (1979).
2. G Nagy, S Takatsy, E Kukan, I Mihaly, I Domok, Arch Virol 71, 217 (1982).
3. M Ho et al., N Engl J Med 341, 929 (Sep 23, 1999).
4. HK Lu et al., J Microbiol Immunol Infect 37, 82 (Apr, 2004).
5. HF Lee et al., Pediatr Neurol 46, 225 (Apr).
6. K Shekhar et al., Med J Malaysia 60, 297 (Aug, 2005).
7. SM Wang et al., Pediatr Pulmonol 39, 219 (Mar, 2005).
8. P Quartier et al., Pediatr Infect Dis J 19, 1106 (Nov, 2000).
9. MH Ooi et al., BMC Infect Dis 9, 3 (2009).
10. MJ Abzug, HL Keyserling, ML Lee, MJ Levin, HA Rotbart, Clin Infect Dis 20, 1201 (May, 1995).
11. T Solomon et al., Lancet Infect Dis 10, 778 (Nov, 2010).

--
Phan Tu Qui
Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam

Truong Huu Khanh
Children's Hospital 1, Ho Chi Minh City, Viet Nam

Philippe Buchy
Institute Pasteur, Phnom Penh, Cambodia

Saraswathy Whitehorne
Jeremy Farrar
Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam

Rogier van Doorn, MD PhD
Head of Emerging Viral Infections
Centre for Tropical Medicine
Oxford University Clinical Research Unit
764 Vo Van Kiet, Ward 1, District 5
Ho Chi Minh City
Viet Nam


Wellcome Trust Major Overseas Program

In partnership with
Hospital for Tropical Diseases


[ProMED-mail thanks Rogier van Doorn for this authoritative account of the features of enterovirus 71-associated HFMD in Cambodia, Viet Nam, and elsewhere.

ProMED-mail welcomes this opportunity to relay the invitation from Dr van Doorn and his colleagues in the region to others able to participate in extended clinical investigations of treatment options. - Mod.CP]
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

EV-71 virus: Controls in place at all borders, says Liow



July 11, 2012
liow-tiong-lai6-june7.jpg
JASIN, July 11 — The Health Ministry has taken the precautionary measure of beefing up controls at all entry points to prevent the spread of enterovirus 71 (EV-71) that was found in Cambodia.
Health Minister Datuk Seri Liow Tiong Lai (picture) said the ministry had taken the necessary steps to curb the virus from spreading to Malaysia by sending a medical team as observers to monitor the development in the country.
“According to reports we have received, it has been proven that the virus (EV-71) was found in the country (Cambodia) but some of the deaths that occurred were due to dengue as well,” he told reporters after visiting the Jasin Hospital here today...:tiphat:

http://www.themalaysianinsider.com/...trols-in-place-at-all-entry-points-says-liow/
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Cambodians flee to Sa Kaeo

The hand, foot and mouth disease (HFMD) scare has resulted in a mass exodus of Cambodian parents with young children into Sa Kaeo province.

The Aranyaprathet immigration checkpoint was yesterday crowded with Cambodian travellers, most of them with young children, eager to enter Thailand.
The Cambodian parents were mainly workers and vendors at the Rong Kleau border market in Thailand.
Thai disease control officials used a thermal scanner to screen for children with a high fever _ one sign of possible HFMD infection.
One child was stopped and tested but the fever was not overly high.
Won Yom, 32, a Cambodian vendor in Poi Pet market in Cambodia, said the Cambodian public health authorities had announced on radio yesterday that the government needed urgent help from the World Health Organisation to control the spread of the virus that has already killed 64 children. That had added to mounting fears among parents with young children and explained why many wanted to come to Thailand.
A Cambodian mother working in Surin province on Tuesday took her two-year-old boy who had a high fever and was suspected of having HFMD to a local hospital.
The incident triggered panic at Sikhoraphum district hospital, which was crowded with children who were mostly there being treated for dengue fever.
Zalo Ann, 30, the Cambodian mother, said she had learned about the spread of HFMD in her home country from the media and when her son became ill, she feared it could be the same disease.
Upon learning about the Cambodian boy and reports of a number of deaths of children in Cambodia from HFMD, parents whose children were being treated at the hospital panicked.
In Kanchanaburi, three more new HFMD cases were reported yesterday at a municipal daycare centre in Sangkhla Buri district, prompting a temporary shutdown of the centre for disinfection. :tiphat:http://www.bangkokpost.com/news/local/302019/cambodians-flee-to-sa-kaeo
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Public health response and communication failures are putting strain in the Region. It is advisable some clear messages in order to make people less prone to panic, explaining the nature of enteroviral infection and routes of transmission.

An asinine media coverage may result in further damage to an already frail economy and impact on trade and travel.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Four Thai children develop symptoms like hand, foot and mouth disease <!-- Date created -->Thursday, 12 July 2012

..and tests are being conducted to determine the virus strain...
..The deputy minister said the ministry ordered public health offices in all provinces to keep watch for the disease, particularly in the provinces along the Thai-Cambodian border after 52 children out of 59 previously undiagnosed cases have died since mid-April...:tiphat:http://www.pattayamail.com/news/fou...mptoms-like-hand-foot-and-mouth-disease-14463
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

:tiphat:Gupta will be on CNN with the latest news on the 6 o'clock show. A preview said he was involved in solving the mystery.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Mix of pathogens caused mystery illness in Cambodia, doctors say



By Dr. Sanjay Gupta and Danielle Dellorto, CNN
July 11, 2012

11/bpr-gupta-cambodia-mystery-disease.cnn



STORY HIGHLIGHTS
  • Doctors say the inappropriate use of steroids worsened many cases
  • No new cases of the condition have been confirmed since last Saturday
  • The pathogens include enterovirus 71, streptococcus suis and dengue
  • Most of the patients have come from southern Cambodia
Phnom Penh, Cambodia (CNN) -- The World Health Organization, in conjunction with the Cambodian Ministry of Health, will conclude that a combination of pathogens is to blame for the mysterious illness that has claimed the lives of more than 60 children in Cambodia, medical doctors familiar with the investigation told CNN on Wednesday.



The pathogens include enterovirus 71, streptococcus suis and dengue, the medical sources said. Additionally, the inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, they said.
The sources did not want to be identified because the results of the health organization's investigation have not yet been made public.
Dr. Beat Richner, head of Kantha Bopha Children's Hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases had been confirmed since last Saturday.



The World Health Organization (WHO) is also expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis, and breathing difficulties.
Over the past four months, doctors at Kantha Bopha in Phnom Penh have been faced with the mysterious syndrome, which kills children so fast that nearly all of those infected with it die within a day or two of being admitted to the hospital.
In the last hours of their life, the children experienced a "total destruction of the alveola(e) in the lungs," Richner said.
Other hospitals in the country have also reported similar cases, but far fewer than the children's hospital in the capital, which is the most popular.
Most of the children who have contracted the illness have come from the south of the country, though health officials cannot find what is known as a cluster -- a lot of cases coming from one specific area.
By June 29, the WHO had been contacted and Cambodian officials were scrambling to instruct health providers across the country to spread the message to the masses as quickly as possible.
Officials search for clues in disease killing Cambodia's children
The WHO and the Cambodian authorities' announcement of the situation drew criticism from Richner, the head of the children's hospital, that they were "causing unnecessary panic."
The WHO said the unexplained nature of the outbreak obliged it to communicate the information.
Over the weekend, lab tests linked enterovirus 71 (EV71), which is known to cause neurological disease, to some of the cases. But it didn't solve the whole puzzle and health officials continued their investigations, noting the detection of other elements like streptococcus suis and dengue.
The rainy season in Cambodia, which lasts from May to October, is a key problem in trying to control diseases like dengue, which are transmitted by mosquitoes.
Because of a lack of indoor plumbing in many homes, people collect rainwater in vats, potential breeding grounds for mosquitoes.
Streptococcus suis is a pathogen that can cause infections like bacterial meningitis in people who are in close contact with pigs or pork-products. Reported cases of it have risen significantly in recent years, notably in Southeast Asia, according to a paper that appeared last year in Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention (CDC) in Atlanta.
The link to EV71 does not particularly help in the treatment of the illness, as there is no effective antiviral treatment for severe EV71 infections, and no vaccine is available.
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.
Outbreaks of the enterovirus "occur periodically in the Asia-Pacific region," according to the CDC. Brunei had its first major outbreak in 2006. China had an outbreak in 2008.
Adults' well-developed immune systems usually can fend off the virus, but children are vulnerable to it, according to the CDC.
In Cambodia, as with many places around the world, parents first try treating their child at home. If that doesn't work then they go to their local clinic, with a trip to the nearest hospital the last resort as it often involves a long trip.
Mystery illness claiming dozens of lives
CNN's Sara Sidner and Tim Schwarz contributed to this report.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Treyfish said:
:tiphat:Gupta will be on CNN with the latest news on the 6 o'clock show. A preview said he was involved in solving the mystery.
Click to expand...

We'll see what he claims. We had evidence of EV71 infection from the Pasteur Institute on the Sunday morning (Eastern US time). Dr. Gupta did not arrive in Cambodia until over 24 hours later.

Update: Well, I watched the segment. He really doesn't claim anything that isn't in this thread, and puts the emphasis on the steroids. He does interview a Dr. Buchy with the Pasteur Institure. After all, if he didn't know the outbreak was due largely to EV71, they wouldn't have allowed him in the ICU. After all, SARS, Nipah, and novel influenza were on the list of possible diagnoses for this outbreak, and they certainly wouldn't have wanted him in the ICU if the outbreak were due to any of those pathogens.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

They do admit it changed a bit, but gosh, I don't see serious spread of it.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

http://www.promedmail.org/

Published Date: 2012-07-11 17:18:13
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia (06): pathogen mix
Archive Number: 20120711.1198162

UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (06): PATHOGEN MIX
***************************************************************
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: Wed 11 Jul 2012
Source: CNN News [edited]
http://edition.cnn.com/2012/07/10/world/asia/cambodia-children-disease/index.html


The World Health Organization (WHO), in conjunction with the Cambodian Ministry of Health, will conclude that a combination of pathogens is to blame for the mysterious illness that has claimed the lives of more than 60 children in Cambodia, medical doctors familiar with the investigation told CNN on Wednesday [11 Jul 2012]. The pathogens include enterovirus 71, _Streptococcus suis_ and dengue virus, the medical sources said. Additionally, the inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, they said.

The sources did not want to be identified because the results of the WHO's investigation have not yet been made public. Dr. Beat Richner, head of Kantha Bopha Children's Hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases had been confirmed since last Saturday [7 Jul 2012]. The WHO is also expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis, and breathing difficulties. Over the past 4 months, doctors at Kantha Bopha in Phnom Penh have been faced with the mysterious syndrome, which kills children so fast that nearly all of those infected with it die within a day or 2 of being admitted to the hospital. In the last hours of their lives, the children experienced a "total destruction of the alveola(e) in the lungs," Richner said.

Other hospitals in the country have also reported similar cases, but far fewer than the children's hospital in the capital, which is the most popular. Most of the children who have contracted the illness have come from the south of the country, though health officials cannot find what is known as a cluster, a lot of cases coming from one specific area. By 29 Jun 2012, the WHO had been contacted, and Cambodian officials were scrambling to instruct health providers across the country to spread the message to the masses as quickly as possible.

The WHO and the Cambodian authorities' announcement of the situation drew criticism from Richner, the head of the children's hospital, that they were "causing unnecessary panic." The WHO said the unexplained nature of the outbreak obliged it to communicate the information. Over the weekend, lab tests linked enterovirus 71 (EV71), which is known to cause neurological disease, to some of the cases. But it didn't solve the whole puzzle, and health officials continued their investigations, noting the detection of other [agents] such as _Streptococcus suis_ and dengue virus.

The rainy season in Cambodia, which lasts from May to October, is a key problem in trying to control diseases like dengue fever, which are transmitted by mosquitoes. Because of a lack of indoor plumbing in many homes, people collect rainwater in vats, potential breeding grounds for mosquitoes [vectors of dengue feet virus].

_Streptococcus suis_ is a pathogen that can cause infections like bacterial meningitis in people who are in close contact with pigs or pork-products. Reported cases of it have risen significantly in recent years, notably in Southeast Asia, according to a paper that appeared last year [2011] in Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention (CDC) in Atlanta.

The link to EV71 does not particularly help in the treatment of the illness, as there is no effective antiviral treatment for severe EV71 infections, and no vaccine is available. In milder cases, EV71 can cause cold-like 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. Outbreaks of the enterovirus "occur periodically in the Asia-Pacific region," according to the CDC. Brunei had its 1st major outbreak in 2006. China had an outbreak in 2008. Adults' well-developed immune systems usually can fend off the virus, but children are vulnerable to it, according to the CDC. In Cambodia, as with many places around the world, parents 1st try treating their children at home. If that doesn't work, they go to their local clinic, with a trip to the nearest hospital the last resort, as it often involves a long journey.

[Byline: Dr. Sanjay Gupta and Danielle Dellorto]

--
Communicated by:
Kunihiko Iizuka

[It remains probable that enterovirus 71 is the major component in the current outbreak of severe HFMD in Cambodia, but the involvement of other pathogens cannot be discounted entirely. HFMD is prevalent especially where sanitation and personal hygiene are inadequate, and consequently its causation is likely to be multi-factorial. As highlighted in the previous posting in this thread, treatment protocols are critical in the absence of specific antivirals or vaccine.

The interactive HealthMap of Cambodia can be accessed at: http://healthmap.org/r/2g4s. - Mod.CP]
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Southeast Asia Travel, hand, foot and mouth disease warning occurs 2012-07-12 09:25:00

Recently, China, Singapore, Vietnam and other Southeast Asian countries are rapidly growing in the hand, foot and mouth disease cases were diagnosed with extreme caution is required..:tiphat:http://translate.google.com/transla...ticle/view.asp?arcid=0006237162&code=46111201
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

<TABLE border=0 cellSpacing=0 cellPadding=0 width=497><TBODY><TR><TD>Health Ministry orders quarantine along Cambodia border
</TD></TR><TR><TD>[FONT=arial, helvetica, sans-serif]The Vietnam's Ministry of Health has ordered authorities in all border localities along Cambodia to step up quarantine measures to prevent any spread of the mysterious disease that has been killing scores of children in Cambodia.[/FONT]
[FONT=arial, helvetica, sans-serif]Dr. Nguyen Van Binh, head of the Department of Preventive Medicine, said on July 11 that the unidentified disease in Cambodia is targeting mostly young children and hence local authorities must remain vigilant to stop its spread into Vietnam... :tiphat: http://www.saigon-gpdaily.com.vn/Health/2012/7/102031/[/FONT]

</TD></TR></TBODY></TABLE>
 
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