Re: 60 kids die in Cambodia - WHO investigates
Re: 60 kids die in Cambodia - WHO investigates
www.promedmail.org
Published Date: 2012-07-04 14:55:43
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia: RFI
Archive Number: 20120704.1190037
UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA: REQUEST FOR INFORMATION
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Date: Wed 4 Jul 2012
Source: The Phnom Penh Post [edited]
http://www.phnompenhpost.com/index.php/2012070457191/National-news/deadly-disease-a-mystery.html
An unknown deadly illness has appeared in Cambodia, killing at least 60 children in the past 3 months, health officials said yesterday [3 Jul 2012]. Of the 62 children admitted to the Kantha Bopha Children's Hospitals with similar symptoms of severe fever and respiratory and neurological destruction, only 2 were able to be saved, hospital founder Dr Beat Richner said yesterday [3 Jul 2012].
In a letter from Richner to minister of health Mam Bun Heng sent on 20 Jun 2012 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.
At the time of the letter, 47 children had died. In the 13 days following, there have been a further 13 deaths at the Kantha Bopha hospitals.
World Health Organization public health specialist Nima Asgari yesterday confirmed the international organisation had teamed this week with the Ministry of Health to investigate the mysterious and fatal affliction.
"It is very early to find the cause. We are still trying to gather data," Asgari said, adding it was unlikely the disease was related to dengue or the re-appearance of chikungunya [virus infections] in the Kingdom. [Chikungunya virus infections are not associated with encephalitis and a high fatality rate. - Mod.TY]
The United Nations agency said in a 30 Jun 2012 report that the clinical signs of those afflicted with the disease "appear unusual," with patients suffering from fever and a rapid deterioration of respiratory functions, although platelet counts, liver, and renal functions were found normal.
Ministry of Health officials, including minister and deputy director of the Communicable Disease Control Department Ly Sovann, referred all questions to department director Sok Touch, who could not be reached for comment yesterday [3 Jul 2012].
A hotline official at the Communicable Disease Control Department said
2 teams from the Health Ministry had visited Takeo and Kampong Cham provinces yesterday to investigate other cases of the unknown disease.
"
It has happened in 14 provinces across the country," the official said. "We have not found the cause of this disease yet, but they [patients] have severe respiratory problems," he said, adding that a 3rd team would go to the Kantha Bopha hospitals on Thursday 5 Jul 2012].
Takeo provincial hospital deputy director Te Vantha said he had joined a meeting with Ministry of Health and Kantha Bopha officials on 29 Jun 2012 to discuss the situation.
"Kantha Bopha has informed us about the rapid development of a disease that can kill children within 24 hours, so we must be careful," Vantha said. "This unknown disease happens to children mostly under the age of 5 years and the
symptoms are fever, coughing, and difficulty breathing."
He said that in Takeo, there were 2 known cases of children dying from the unknown lung-destroying disease in June 2012.
Speaking from the Kantha Bopha hospital in Siem Reap, where there have been 2 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.
[byline: Bridget Di Certo, Chhay Channyda]
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communicated by:
TW van der Vaart
[Were these cases of encephalitis virus without an accompanying severe, terminal pulmonary component in all patients, one might suspect Japanese encephalitis virus, Banna virus, or Nipah virus infections. The progression of Nipah virus infections has been described in a WHO fact sheet as, "Human infections range from asymptomatic infection to fatal encephalitis. Infected people initially develop influenza-like symptoms of fever, headaches, myalgia (muscle pain), vomiting, and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis.
Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours." (see
http://www.who.int/mediacentre/factsheets/fs262/en/).
Nipah virus has caused human encephalitis in Malaysia, Singapore, India, and Bangladesh. Its reservoirs are giant fruit bats (_Pteropus_ spp.) that are widely distributed across South East Asia to Australia. 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.
ProMED-mail thanks Thomas van der Vaart (a 5th year medical student at the Academic Medical Centre, Amsterdam, the Netherlands) for sending in this report while traveling in Cambodia.
A HealthMap/ProMED-mail interactive map of Cambodia can be accessed at . - Mod.TY]
