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

[Giuseppe]

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

[Source: The Nation, full text: (LINK).]
Sick Cambodian children sent home from Sa Kaew



‎20 July ‎2012

Eight Cambodian children found with high fever at Sa Kaew province's Rong Kluea border market yesterday were quarantined and deported to their homeland, as Thai authorities tried to control the spread of hand, foot and mouth disease (HFMD).

 

[alert]

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

http://www.promedmail.org/

Published Date: 2012-07-19 14:23:47
Subject: PRO> Undiagnosed illness, fatal, child - Cambodia (08): EV71, school closure
Archive Number: 20120719.1207675

UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (08): EV71, SCHOOL CLOSURE
************************************************************************
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 18 Jul 2012
Source: BBC News Asia [edited]
http://www.bbc.co.uk/news/world-asia-18882095


Cambodia has closed schools weeks ahead of the summer holidays to prevent the spread of a virus that has killed dozens of children since April 2012. Officials say that they closed kindergarten and primary schools in reaction to parental concern about the spread of the EV71 [enterovirus 71] virus. EV71 is one of the triggers of hand, foot and mouth disease. But the World Health Organization said closing schools "could create unnecessary panic."

The mystery illness had caused panic among parents. The World Health Organization (WHO) and Cambodia's Ministry of Health eventually identified the virus as EV71. For most children, the virus causes nothing more than a few days' discomfort. But for those already weakened by malnutrition or diarrhoea, it can become more serious if not properly treated. Good hygiene prevents the virus from spreading, health experts say.

Mak Vann, Education Ministry secretary of state, said that they did not have to wait 2 more weeks to close the schools before the start of the holidays. "This is to prevent the spread of the disease," he was quoted by news agency Agence-France Presse as saying. "Parents have voiced concern that the disease could infect their children." But a WHO spokesman told the BBC that it did not recommend the school closures as "[they] could create unnecessary panic." The WHO said matters were under control, and no new cases of EV71 have been recorded.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[It is likely that human enterovirus 71 is a component of many of the outbreaks of hand, foot and mouth disease which are currently affecting most countries in East and Southeast Asia. Local factors such as the use of steroid drugs in the treatment of some patients may explain the apparently greater severity of disease observed in the course of the outbreak in Cambodia. Closure of schools 2 weeks ahead of schedule is an unusual response and contrary to WHO recommendation.

The HealthMap interactive map of Cambodia can be accessed at: http://healthmap.org/r/2g4s. - Mod.CP]

 

[alert]

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

Dr. Richner remains unhappy (but I can't get the text to copy):

http://twitter.com/_amansingh/status/226225884649095168/photo/1/large?tw_p=twt

 

[Treyfish]

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

:tiphat:

 

[Treyfish]

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

 

[Treyfish]

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

Education ministry faces flak for closures
<DL class="article-info clearfix"><DD class=create>Friday, 20 July 2012</DD><DD class=createdby> </DD></DL>

Children wait to be picked up from a school in Phnom Penh after kindergarten and primary schools were closed on Wednesday. Photograph: Vireak Mai/Phnom Penh Post

A number of factors were weighed when making Wednesday?s decision to close all of Cambodia?s primary schools and kindergartens in an bid to stymie the spread of EV71, but the Ministry of Health?s opinion does not appear to have been one of them.

Dr Ly Sovann, deputy director of the Communicable Disease Control Department of the Ministry of Health, said that his ministry had not counselled the Ministry of Education to shutter the nation?s classrooms.

?No. It is not recommended by the Ministry of Health and the World Health Organization,? Sovann said via text message.

In fact, education officials said, the Ministry of Education didn?t even consult with the Ministry of Health in making its decision ? at least not in person.

Pen Saroeun, director of the School Health Department of the Ministry of Education, said yesterday that the decision was based solely on media reports, teachers? concerns and online materials from the Ministry of Health and the WHO....:tiphat:
http://www.phnompenhpost.com/index....al-news/ministry-faces-flak-for-closures.html

 

[Treyfish]

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

The hospital ship USNS Mercy will be in Cambodia on July 29. The medical team will provide free medical services including optometry, dental, pediatrics, and general medicine.

Medical services will be available from 8:30 a.m. to 4:30 p.m. at the following locations:

Jul 29 ? Aug 2 Hun Sen Cheungkor Primary School, Sihanoukville
Jul 30 ? Aug 1 Som Dach Out High School, Takeo
Aug 2 ? Aug 6 Kandol Dom Primary School, Kampung Speu
Aug 4 ? Aug 8 Hun Sen Chamyeam Junior High, Koh Kong

Veterinary services for small animals, immunizations, spaying and neutering, etc., will be available from 8:30 a.m. to 4:30 p.m. on the dates listed below:

Jul 30 ? Aug 2 Kandol Dom Primary School, Kampung Speu
Aug 4 ? Aug 9 Hun Sen Cheungkor Primary School, SihanoukvilleSee More


<FORM id=u9lsmk_38 class="commentable_item autoexpand_mode" method=post action=/ajax/ufi/modify.php rel="async">:tiphat:http://www.facebook.com/us.embassy.phnom.penh

</FORM>

 

[Ronan Kelly]

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

2 More Cambodian Kids Killed by Hand, Foot, Mouth Disease over Weekend
2012-07-24 19:34:04 Xinhua Web Editor: Liuyuanhui
Three more Cambodian children were tested positive for Enterovirus 71 (EV-71) over the weekend and two of them were killed by the disease, bringing the death toll to 56 since April, a senior health official said Tuesday.

Ly Sovann, deputy director of the Health Ministry's communicable disease control department, told Xinhua that the two dead children were in Kampong Cham province, some 124 km east of Phnom Penh, and the other one is recovering from the disease at the Kantha Bopha Children's Hospital in Siem Reap province.

...
http://english.cri.cn/6966/2012/07/24/2561s713441.htm

 

[Treyfish]

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

Doctor slams WHO for causing virus panic
Thursday, 26 July 2012

A Cambodian girl walks out of a school with her father in Phnom Penh on July 18, 2012. Cambodia closed all its kindergartens and primary schools on July 18 to prevent the spread of an illness. AFP PHOTO/0Tang Chhin Sothy

“The WHO in Cambodia should be closed” is the emphatic sign-off to a lengthy and vivid analysis by Kantha Bopha Children’s Hospitals of the recent “mystery disease” scare.

While the World Health Organization and Ministry of Health have declared that a series of recent child deaths are linked to EV-71, causing severe hand, foot and mouth disease, Kantha Bopha founder Dr Beat Richner has slammed the conclusion as a “catastrophic declaration”.

Richner said 72 cases of the unexplained illness have appeared in his hospitals, and of those, 68 have died.

The WHO yesterday said the totals from the Ministry of Health stood at 61 cases and 56 deaths, including one new death over the weekend that fit the case definition of severe HFMD.

The “case definition” is the critical impasse between the MoH and WHO, and Kantha Bopha, which treat 85 per cent of all Cambodian children.

Kantha Bopha’s “case definition” is encephalitis and complete lung destruction leading to a rapid death.

Not one of these cases showed lesions associated with HFMD, Richner’s statement says.

However, WHO communications officer Sonny Inbaraj Krishnan told the Post yesterday that of the cases recorded by the UN agency and the MoH, rashes and blisters were present.

“Sometimes, with EV-71, either blister or rash appears and it could be one or the other,” he said. “The case definition [for WHO and MoH] is that the child has fever with neurological systems such as vomiting and prolonged stretches of sleepiness or convulsions and respiratory symptoms such as difficulty breathing.”

This conclusion is wrong and is still confusing the media and public, Richner rebuts in his statement.

The question that has still not been answered, Richner said, is “what is destroying the lungs in these 72 cases of encephalitis in the last 6 hours of their life, all treated in private clinics?”

Richner believes that the administration of incorrect drugs to these 72 children could be a factor in the astonishing destruction of the lungs present in the cases that have been recorded by his hospitals.


The most “catastrophic” press release by the MoH and WHO, according to the Swiss doctor, was the most recent, in which the joint investigation conclusion is that a mix of pathogens and a root affliction with EV-71 has been aggravated and worsened by the use of steroids.

The Post previously reported Richner decrying WHO’s criticism of the use of steroids as “absolute nonsense”.

The doctor emphasised that all patients arriving with the unknown illness at Kantha Bopha hospitals showed signs of encephalitis, which requires steroids to stem fatal swelling of the brain.

A high number of platelets during the final moments before death could be a sign that underlying tuberculosis is complicating treatment, Richner said in the statement.

Kantha Bopha Children’s Hospitals operate in parallel to the public health system in Cambodia and provide outpatient and emergency care free of charge at their five hospitals in Phnom Penh and Siem Reap.

However, a bitter relationship between Kantha Bopha and the WHO appears to be complicating investigations into and solutions to the child deaths.

MoH Secretary of State Heng Tay Kry said only the minister or WHO could respond about Richner’s allegations.

Minister Mam Bunheng, Communicable Disease Control Department director Sok Touch and his deputy, Ly Sovann, could not be contacted yesterday.

WHO country representative Pieter Van Maaren, told the Post he considered Richner’s statement “irrelevant”.

“We don’t communicate with Kantha Bopha through the media,” Van Maaren said. “And we don’t give comment [on press releases]. The Ministry of Health and WHO joint press releases state what is our position [on the child deaths]." :tiphat:http://www.phnompenhpost.com/index....doctor-slams-who-for-causing-virus-panic.html

 

[Treyfish]

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

CAMBODIA - Alert for an epidemic of foot and mouth disease that primarily affects malnourished children



Phnom Penh (Agenzia Fides) - According to some experts, the high rate of malnutrition in Cambodia has led to the rapid spread of an outbreak of foot and mouth disease that, since last April, has claimed the lives of 54 poor children . In the country have closed all kindergartens and primary schools to try to contain the spread of enterovirus-71 (EV-71), which is the responsible course of the outbreak of the disease known as HFMD Hand, foot and mouth (HFMD .) The HFMD affects especially children and infection occurs through contact with the mucus, saliva or feces of an infected person. Outbreaks usually occur in Southeast Asia during the rainy season.

The Kantha Bopha hospital in the capital of Cambodia, most infected children have died between April and late June. In several provinces there have been mild forms of the disease and could be hundreds of cases not detected by the health services are very limited in the country. It is impossible to determine the mortality rate from severe form of HFMD.
Only recently the government of Cambodia has begun to collaborate with the World Health Organization (WHO) for monitoring
In a joint investigation by the Ministry of Health of Cambodia and the WHO has shown that the virus EV-71, is one of the known causes of HFMD, estuva present in most reported cases. Many children have died during the first day of hospitalization and before the disease were malnourished or suffering from other chronic diseases.

Malnutrition affects 40% of Cambodian children, making them more vulnerable to infectious diseases. The country recorded the third highest rate of child malnutrition among members of the Association of Southeast Asian Nations (ASEAN), and 28% of children under 5 are underweight or too small for age. The "hidden hunger", lack of vitamins or minerals, is another serious problem in the country where half of all children under 5 years, the most vulnerable to HFMD, are anemic, mainly due to iron deficiency . Nearly 9 in 10 are already anemic year-old.

According to WHO, this year, there have been in China more than 1.27 million cases of mild and severe foot and mouth disease, with 356 deaths, compared with just over 711,300 cases last year. It also appears that the number of cases in Singapore has grown from 871 to over 26,000 in the first six months of this year. (AP) (Agenzia Fides 26/7/2012):tiphat:http://www.fides.org/aree/news/newsdet.php?idnews=33886&lan=spa

 

[alert]

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

http://www.promedmail.org/

Published Date: 2012-07-26 18:29:38
Subject: PRO/EDR> Human enterovirus 71 - Cambodia: genotype C4
Archive Number: 20120726.1216290

HUMAN ENTEROVIRUS 71 - CAMBODIA: GENOTYPE C4
********************************************
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: Thu 26 Jul 2012
From: Philippe Buchy [edited]


Following an initial report by the clinicians of the Kantha Bopha hospital that, despite their best efforts, dozens of deaths had occurred in young children presenting with encephalitis associated with pulmonary edema, human enterovirus serotype 71 (EV71) was identified by the Institut Pasteur in Cambodia. The virus was then also detected in mild or severe hand, foot and mouth disease (HFMD) cases in many hospitals throughout the country through a surveillance system established by the Ministry of Health, WHO, National Institute of Public Health with the support of many partners like US CDC.

We analyzed 3 isolates randomly selected from patients originating from different Cambodian provinces over a 4-week period. Approximately 841 base pairs of the VP1 gene (positions 2268 to 3109) were sequenced and aligned with sequences of strains isolated in Viet Nam in 2011 and 2012 (data kindly provided by Thanh Tran Tan, Jeremy Farrar, Rogier van Doorn; Oxford University Clinical Research Unit -- Ho Chi Minh City -- Viet Nam/Wellcome Trust Major Overseas Programme), in Shanghai in 2011 and 2012 (data provided by Ralf Altmeyer and Ke Lan; Institut Pasteur Shanghai), and with various sequences available in GenBank and originating from other Asian countries (e.g., Singapore, Malaysia).

The phylogenetic analysis shows that the EV71 sequences from Cambodia cluster with those of the EV71 strains genotype C4 isolated in Viet Nam in 2011 and 2012 (homology at the nucleotide level: 98.78-99.39 percent; homology at the amino acid level: 98.78-100 percent) [and] are closely related to the sequences of the C4 genotype viruses detected in 2010-2012 in China (homology at the nucleotide level: 98.17-99.39 percent; homology at the amino acid level: 98.17-100 percent).

Further genomic characterization is still ongoing. These preliminary data, however, suggest that strains in Cambodia are part of the ongoing outbreak of EV71 that is proceeding across Asia and involves strains similar to those observed in other countries in the region. This is important, as Cambodia does not have enough data yet to evaluate the true case fatality rate of the current EV71 outbreak. This denominator of the total number of non-severe cases will be ascertained by targeted seroprevalence studies that are currently being developed.

--
Philippe Buchy, MD, PhD
Head of Virology Unit
Institut Pasteur in Cambodia
5, Monivong blvd
PO Box 983
Phnom Penh - Cambodia


[ProMED-mail thanks Dr Philip Buchy for providing the information that human enterovirus 71, genotype C4 is the principal etiologic agent responsible for the outbreak of hand, foot and mouth disease currently affecting children in Cambodia and Thailand, and other countries in Southeast Asia.

According to Chan YF, Sam IC, AbuBakar S., in "Phylogenetic designation of enterovirus 71 genotypes and subgenotypes using complete genome sequences," published in Infect Genet Evol. 2010 Apr;10(3):404-12. Epub 2009 May 22. (http://www.sciencedirect.com/science/article/pii/S1567134809001257):
"Human enterovirus 71 (EV-71) is genotyped for molecular epidemiological investigation mainly using the 2 structural genes, VP1 and VP4.

Based on these, EV-71 can be divided into 3 genotypes, A, B and C, and within the genotypes B and C, there are further subgenotypes, B1-B5 and C1-C5. Classification using these genes is useful but gives incomplete phylogenetic information. In the present study, the phylogenetic relationships amongst all the known EV-71 and human enterovirus A (HEV-A) isolates with complete genome sequences were examined.

A different tree topology involving EV-71 isolates of subgenotypes C4 and B5 was obtained in comparison to that drawn using VP1. The nucleotide sequence divergence of the C4 isolates was 18.11 percent (17-20 percent) when compared to other isolates of subgenotype C. However, this positions the C4 isolates within the cut-off divergence value of 17-22 percent used to designate the virus genotypes.

Hence, it is proposed here that C4 should be designated as a new genotype D. In addition, the subgenotype B5 isolates had an average nucleotide divergence of only 6.14 percent (4-8 percent) when compared to other subgenotype B4 isolates. This places the B5 isolates within the subgenotype B4. It is proposed here that the B5 isolates be re-designated as B4. With the newly proposed genotype D and inclusion of subgenotype B5 within B4, the average nucleotide divergence between genotypes was 18.99 percent (17-22 percent). Inter- and intra-subgenotype average divergences were 12.02 percent (10-14 percent) and 3.92 percent (1-10 percent), respectively. A phylogenetic tree built using the full genome sequences is robust as it takes into consideration changes in the sequences of both the structural and non-structural genes. Similar nucleotide similarities, however, were obtained if only VP1 and 3D RNA polymerase genes were used. Furthermore, addition of 3D RNA polymerase sequences will also show recombination events. Hence, in the absence of full genome sequences, it is proposed here that a combination of VP1 and 3D RNA polymerase gene sequences be used for initial genotyping of EV-71 isolates."

Further information on the progress of analysis of clinical isolates of enterovirus 71, genotype C4 particularly in relation to severity of disease is awaited.

The interactive HealthMap of Cambodia can be accessed at: http://healthmap.org/r/00N5. - Mod.CP]

 

[alert]

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

I can't get the article to copy and paste, but this release from Dr. Richner is a must-read:

http://cambopedia.com/2012/07/the-grave-failure-of-who-in-cambodia.html

He rejects the steroids as an explanation for these symptoms, and suggests dormant TB or a toxic outpatient drug is to blame for these deaths. He repeatedly states that he thinks the WHO should be closed. The article may have cone through a translator; some of the grammar is difficult to understand.

 

[Treyfish]

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

'No doubt' Cambodian boy died of HFMD
Rayong could be made disaster zone

An investigation by the Epidemiology Bureau has concluded that a Cambodian boy who died in Rayong this week succumbed to hand, foot and mouth disease, Dr Prasert Thongcharoen said yesterday. The victim, aged two and a half years, became the second HFMD fatality in Thailand this year.

"This case is clearcut. We do not need to wait for a meeting of virologists to determine the cause of his death," Prasert said in his capacity as an adviser to the Disease Control Department.

Rayong public health chief Kris Palasut said separately, however, that the Medical Sciences Department was conducting a detailed lab test on the young boy's case.

"The results will be released within two weeks," he said as largescale public health campaigns started in his province.


Prasert said the young Cambodian had lived in Rayong for quite a long time. He urged the public not to discriminate against Cambodians.

Kris said three children who were close to the boy were being closely monitored. Deputy Public Health Minister Surawit Khonsomboon said the parents of these children had been given advice and the children tested to determine whether they had been infected.

In Rayong, 384 people have come down with HFMD this year.

"The number of HFMD cases is rising. If we are unable to control the outbreak of the disease, we may have to declare the province as a disaster area," he said...:tiphat:
http://www.nationmultimedia.com/national/No-doubt-Cambodian-boy-died-of-HFMD-30187159.html

 

[alert]

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

http://www.promedmail.org/

Published Date: 2012-09-05 17:49:32
Subject: PRO/EDR> Human enterovirus 71 - Cambodia (02): genotype C4 sequenced
Archive Number: 20120905.1282339

HUMAN ENTEROVIRUS 71 - CAMBODIA (02): GENOTYPE C4 SEQUENCED
***********************************************************
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 5 Sep 2012
From: Philippe Buchy [edited]


The recent epidemic of enterovirus infections in Cambodia was responsible for dozens of deaths of young children. Human enterovirus 71 genotype C4 was identified as the principal etiologic agent (ProMED-mail: Human enterovirus 71 - Cambodia: genotype C4 archive number 20120726.1216290).

We randomly selected 4 EV71 strains isolated between 15 Jun and 30 Jul 2012 from patients presenting with fatal encephalitis associated with pulmonary edema and hospitalized at the Kantha Bopha Hospital in Phnom Penh. All 4 patients originated from different Cambodian provinces. The 4 EV71 strains were amplified in cell culture and fully sequenced using Next Generation Sequencing (NGS) on Roche 454 Flex and/or by Sanger method by a joint international team led by Institut Pasteur in Cambodia (Philippe Buchy) with collaborators from Institut Pasteur of Shanghai, Chinese Academy of Sciences (IPS-CAS; Ralf Altmeyer), and the State Key Laboratory for Emerging Infectious Diseases at Hong Kong University (Guan Yi and Maria Zhu Huachen). The 4 full genome sequences were aligned with sequences available in GenBank or unpublished sequences from recently circulating Chinese strains communicated by IPS-CAS and Children's Hospital of Fudan University (Mei Zeng). The phylogenetic analysis demonstrated close relationship with strains circulating in China between 2009 and 2011. Of note, recent full genome sequences from Vietnamese isolates are not yet publicly available and were thus not included in the analysis. Additional bioinformatic analysis did not show evidence of recombination in the genome of the 4 isolates.

In addition, we sequenced approximately 840 base pairs of the VP1 gene (positions 2268 to 3109) of 13 EV71 strains and 3 non-EV71 enteroviruses isolated from patients with mild or severe symptoms of infection and hospitalized between 15 Jun and 22 Jul 2012. These strains were selected randomly from children originating from various Cambodian provinces. All the EV71 virus sequences clustered together within the C4 subgenotype group (or D subgenotype according to the classification suggested by Chan YF et al., Infect Genet Evol 2010; 10(3): 404-412) with a percentage of homology at nucleotide level varying from 98.4 to 100 percent, and were closely related to strains isolated in 2011 in Viet Nam (homology at the nucleotide level: 98.4-100 percent, sequences kindly provided by Thanh Tran Tan, Jeremy Farrar and Rogier van Doorn; Oxford University Clinical Research Unit, Ho Chi Minh city, Viet Nam), confirming previous preliminary data. The other 3 viruses analyzed belonged to one other human enterovirus species, one echovirus, and one coxsackievirus species. Some coxsackie A6 viruses were also detected directly from clinical specimens using specific PCR.

These data confirm our preliminary findings showing that EV71 genotype C4 is at the origin of most hand, foot and mouth disease (HFMD) severe cases associated with encephalitis and edema in Cambodian children. Besides EV71, various other enteroviruses were also detected, mainly in non-severe cases. The full genome sequences generated as of today do not suggest any recombination event in the strains analyzed and obtained from patients deceased from severe encephalitis.

[Reported by: Dr. Philippe Buchy on behalf of The EV71 Task force to investigate the Cambodian epidemic. International EV71 Task force team members:

Institut Pasteur in Cambodia: Mey Channa, Duong Veasna, Arnaud Tarantola, Vincent Deubel and Philippe Buchy

Institut Pasteur of Shanghai, Chinese Academy of Sciences: Zhong Huang, Ke Lan, Gang Zou, Peijun Ren, Qianqian Zhu, Shanshan Xu, Jia Liu, Lili Wang, Qingwei Liu and Ralf Altmeyer

State Key laboratory on Emerging Infectious Diseases at University of Hong Kong: Maria Huachen Zhu and Yi Guan

Institut Pasteur France/WHOCC for enteroviruses and Pathoquest: Ana-Maria Burguiere, Justine Cheval, Therese Couderc, Francis Delpeyroux, Marc Eloit, Magali Herrant, Marc Jouan, Marc Lecuit, Jean-Claude Manuguerra, Erika Muth, Jerome Salomon, and all their collaborators.]

--
Dr. Philippe Buchy MD, PhD
Head of Virology Unit
Institut Pasteur du Cambodge
5, Monivong blvd - PO Box 983
Phnom Penh - Cambodia


[ProMED-mail welcomes the opportunity to post the outcome of these studies of enterovirus 71 isolates obtained during the recent/current outbreaks of hand, foot and mouth disease affecting children in several Southeast Asian countries.

The data confirm that the C4 genotype of enterovirus 71 is the predominate enterovirus associated with these outbreaks. The whole genome sequences are closely related and show no evidence of genetic recombination or other genome rearrangements that might be indicative of enhanced virulence.

Readers interested in obtaining an understanding of "next generation" sequencing should consult the review: "Application of next generation sequencing technologies in virology, by A.D. Radford et al., in the current issue of the Journal of General Virology 93, 1853-1868 (2012), open access article, http://vir.sgmjournals.org/content/93/Pt_9/1853.full.pdf+html." - Mod.CP

 

[alert]

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

This is still going on, and Dr. Richner is still upset. I can't get the text to copy.

He reports 13 additional fatalities from the syndrome reported in this thread, and positive EV71 tests. All had been treated in other clinics first.

He also reports 19 dengue fatalities, that he attributes to drug intoxication, also having been previously hospitalized in private clinics first.

To Dr. Richner, the cause is not EV71 or dengue, but a bad batch of drugs:

http://www.beat-richner.ch/pdf/2012/August2012_KanthaBopha.pdf

 

[Ronan Kelly]

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

From Alert's link above;

In August Again Kantha Bopha Has
Saved Thousands of Lives of Children
and innumerous children would be damaged without its
hospitalization for all their life

Admissions for Hospitalization from August 1st to August 31st 2012:
Severely sick children: 13 105

Severe Dengue cases: 4412 . (19 have died. All 19 were hospitalized in private
clinics two up to five days before, treated by wrong and too many perfusions and by
wrong and too many drugs and medicines. They died from drug intoxication.)

Encephalitis: 412 (30% Japonese Encephalitis (JEV), 40% Tuberculosis
Encephalitis, 10% Dengue Encephalitis, 20% not identified Virus)

Meningitis : 185

Hand / Foot / mouth Disease: 357. Among these 357 cases were 139 confirmed
Encephalitis, being not included in the 412 cases of Encephalitis mentioned above.
We could save these 149 cases of EV71 encephalitis by different measures and the
application of Steroids. In the MRI we can observe the lesions in the stem of the
brain disappearing after a treatment of 10 to 14 days.

Only 13 cases with the new phenomena without lesions H/F/M, but where EV71
was found, have died within hours after hospitalization. All were treated for two or
three days before in private clinics. In 3 cases, which have died later, that means one
or two days after hospitalization, we could find by the MRI not only an Encephalitis
but a Cerebritis. Here we could confirm by MRI and MRS the Metabolite Lipid,
significant for Tuberculosis.

Every day is an enormous effort, for the staff and for the
costs, for example Thursday, 30th August 2012:
Admissions of severely sick children: 531
Admissions of new severe Dengue cases: 139 (40 arrived the night, 15 in shock)
Surgical operations: 58
Deliveries in the maternity in Siem Reap Angkor: 52

Friday 31st August, 06.00 am 2012:
Hospitalized severely sick children: 2131,
Hospitalized severe Dengue cases: 396

The last 20 years 465 Million USD were spent. 3,5% was contributed by the
Cambodian Government, 7% by the Swiss Government. 90% were private
donations. All access to the Hospitals and all its treatment, including the longtime
treatments after Hospitalization, is free for all. Most families could not pay for. They
are poor.

2012 the costs will be 40 Million USD. The Dengue Epidemic is expensive for Kantha
Bopha. In 2012 there were already 20 998 severe Dengue cases hospitalized in the
Kantha Bopha Hospitals. (85 have died). The most severe Dengue case alone with up
to 15 transfusions costs 1500 USD or more. Hundreds of children could be saved by
transfusions, not only by one, but by up to twenty.

We are grateful for all donations, if big or small.

Dr. Beat Richner, www.beatocello.com
Facebook.com/pages/Dr‐Beat‐Richner