Re: China: EV-71 outbreak Kills 42 Children Nationwide, 24,934 Children infected
Re: China: EV-71 outbreak Kills 42 Children Nationwide, 24,934 Children infected
[A chronology of EV71 in the city of Fuyang, in Annui.]
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Hand, Foot and mouth disease epidemic of fatal 28 days
2008年05月17日10:55 At 10:55 on May 17, 2008 Source: Newsweek
Cases of children died from the first release to the epidemic, has experienced a total of 28 days.
For a nearly 40 have been found in the virus, confirmed the need for four weeks time ?
Within 28 days of the epidemic and rumors Guoxie each other, the spread of Fuyang in Anhui. When the truth was open, more than 700 people have been infected, more than 10 children died. Since then, the number of daily infections are on the rise, at present, the EV71 virus infection intestinal children throughout the 16 provinces in China, the number nearly 20,000, 29 children have died of this disease.
History strikingly similar - will be the first reported outbreak of Fuyang doctors, is that four years ago opened "Datouwawa" incident of people, and this was considered a sign of "lies辟谣words," the press release of the officials, is "Formula" in the incident were disciplined, vice mayor of Fuyang City, Mrs Chang-ping.
阜阳 Fuyang
There is no Chibao ?
Our reporter / winter snow
intern / Lu high Iron Army (from Fuyang, Anhui,
北京) Beijing)
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This is the gastro-intestinal virus infection in Fuyang City of Anhui EV71 child's growth figures. From April 27, 2008 official epidemic, the number has been rising. As of May 4, the city has 22 children so young. The virus infected people, has also appeared in Hong Kong, including more than 10 provinces and regions.
From the first children's deaths in Fuyang released to the epidemic, which has experienced 28 days.
Reported or not reported ?
Jia Shuaishuai this less than two-year-old, cute boys, died March 28, 2008 evening.
17:30 the same day, when the People's Hospital of Fuyang City Jiaojie Ban Liu Xiaolin, director of pediatrics, Dr. Bai Ban told her: Branch, admitted the two "severe pneumonia" children. Liu Xiaolin not enough time to look at medical records, one of the boys Shuaishuai Jia called on the last days of a state. "He difficulty in breathing, Tuzhe pink bubble solution." At that time, the presence of a doctor recalled, "after inspection found that the child has left heart failure pulmonary edema. Cardiac monitor that his heart rate in the slow-down Have gradually stopped breathing?? "
Jia Shuaishuai is so far confirmed the first death due to EV71 virus to children.
One hour after the death the same way take away the other "children with severe pneumonia" - the two-year-old Fang Yu Qian. Liu Xiaolin told the nurses, ward the day before, a child who died, and the two men is very similar. But many doctors believe that that child's symptoms similar to pneumonia.
"General right of severe pneumonia to heart failure, and that three people were left heart failure pulmonary edema." Accept "the China News Weekly" interview, Liu Xiaolin said. Pneumonia in this section cure rate is 98 percent, but now, two and a half hours on the death of two children. The 26-year clinical experience of doctors, the next day will be abnormal situation was reported to the hospital.
In either to the hospital in particular, the Municipal Public Health Bureau reported on the issue, 57-year-old Liu Xiaolin have been hesitant. By the end of 2004, shocked the whole country in Fuyang inferior milk powder led to the "Taitouwawa", is home from the hospital reported to the pediatrician. "At that time, we take the initiative to find the media, the public can look forward to a education, warning. But in the end to overwhelming pressure from public opinion, we have become sinners." Liu Xiaolin said, "If the events of an accident, I will not Council gave the city Tianma Fan ?"
March 29, the same disease, the same within a few hours, two children died. Liu Xiaolin reported and no longer hesitate, Fuyang City Health Bureau was informed that the news.
"In the afternoon, we have organized experts in Fuyang City, samples were collected for identification." Accept "the China News Weekly" interview, Fuyang City Health Bureau said a deputy director. "We initially ruled out bird flu, SARS and other viruses, but not sure what exactly is this virus." March 30, but also a day of local experts testing, but the type of virus no conclusions. March 31, Fuyang City Health Bureau to the Anhui Provincial Health Office reported that several deaths.
That night, from the Anhui health department dispatched by the CDC experts arrived in Fuyang. "But that day did not appear similar cases, they returned." Sighed Liu Xiaolin said.
The experts left the province, on April 3 morning, 4-month-Zhang Manli was sent to Fuyang City People's Hospital. At that time, this girl has a shortness of breath and other symptoms of illness, a few hours later, she died.
A doctor said: Back in early March, Fuyang City on several hospitals have treated such "abnormal" children. Most of them were diagnosed with respiratory disease, with typical pneumonia symptoms but not fully consistent. It was not until half a month, were not pay attention to this unusual situation.
A press release: "This is not abnormal"
April 4, including Anhui Province, Ren Jun, director of the CDC experts Zaifu Fuyang survey, sampling tests. A parent stand out - the same evening, the father agreed to Zhang Manli, the remains will be donated to children's hospitals. Prior to that, "the deceased as a" concept, a number of parents have refused this request. But ultimately, the outcome of these experts is still "can not be confirmed." Then is the third instalment, in the fourth?? investigations continue.
Indeed, this is a more difficult task - the pathogen identified the need to rely on epidemiological investigation as a supplementary means, such investigations related to a large number of sampling, including the patient's physical condition, living environment, such as data collection. It can be said that samples collected from the pathogen that in the end, a dependence on a large number of sampling, analysis of the quantitative change to qualitative change from the process.
Experts course of the investigation, the influx of a large number of suspected patients of the People's Hospital of Fuyang City, the second People's Hospital. Most of the children repeatedly fever, herpes appear on their hands, buttocks and mouth. Children are mostly from rural areas, due to massive outflow of labour, grandparents take the children into staying in the hospital, "the main force."
This confusion has also increased the risk of infection. Accept the "China Newsweek" interview, the Chinese CDC in Beijing Ditan Hospital Chuan Ranke experts have said: Although the incidence adults often do not, but after close contact with patients, may have carried the virus. If such a hidden infection four flows, it will become one of the legs of the source of infection. This is also a village with the San Siqian Although people are often only one or a few of the reasons for patients.
Like viruses, the city also spread rumors. Some people say that this is the pig foot and mouth disease has spread to humans, it was said to be "human avian flu", said the direct "atypical pneumonia in children"! Allow more people to panic rumors, especially the closure of rural residents, so that more people dashed to the hospital. Confusion, the virus has spread faster speed - experts said, EV71 virus through close contact between the crowd spread, including respiratory droplets.
April 15, a "person of Fuyang in the recent respiratory infection symptoms in children with serious problems answering a reporter's question" (hereinafter referred to as "reporters"), at the same time, including "Fuyang Daily", Fuyang Local television stations, and other major media. Reports are questions and answers, not a signed, nor specify who is the respondent.
"A" on the people of Fuyang said: "Recently the city is treated several patients with respiratory tract infection and the patients have serious complications, a few have died. Spring is the high incidence of respiratory disease season this year, compared with previous years, the incidence Level has not increased, the situation is not unusual. "
"Infectious disease?" Of the doubt, this press release to explain: "The CDC experts epidemiological investigation, that these cases of disease transmission without mutual contact?? children and their families contacted by the crowd, So far not found in patients with similar symptoms, please tell the people not to worry. "And" is a normal phenomenon? "The question, the answer is" a normal year and compared to the same period, no special nature. "
But at the moment, a group of epidemiological, clinical, testing experts are in tension. Anhui Provincial Health Office to the Ministry of Health for help. "A reporter asked," broadcast on television, the Ministry of Health sent the first batch of experts went to Fuyang in the road. On the 16th morning, they reached the Fuyang.
Who signed the press release ?
A news release from six of the print paper, in its April 14 was sent to Fuyang mainly the media. The rise of the first page of the center signed a "? ? arrangements to publish - Mrs Chang-ping, 14 / 4" and later had a second person for the signing - Liu Ting-feng.
Before the two documents is an article entitled "interview with the media, CDC experts," the article. Is the article "A reporter asked" in the form of Fuyang Yizibucha to appear in the media. Signatory Mrs Chang-ping, that is, in 2004 for "Datouwawa" events are subject to administrative punishment demerits of the vice mayor of Fuyang City. In the spring of 2004, 189 cases in Fuyang City of Anhui baby food because of inferior milk powder, be suffering from a disease - "Big Head", which killed 12 people.At that time, "Information Times," an interview with Mrs long peacetime, Du said, "I do not want to take the blame and resign, I would like to continue to Ganxia Qu, I would like to find the weak links and work to correct shortcomings, is to strengthen."
After the outbreak public, the media questioned the "reporters" for "lie辟谣statement." Anhui Provincial Health Office of the Information Office Deputy Director FENG Li-said: "A reporter asked:" is not provided by the Fuyang city government, but the views of the Group. At that time, rumors are more social, health and the Office of Fuyang city government that it is necessary to publish some information. However, "" Fuyang Daily "reported not comprehensive - in fact, the Group's preliminary view is the diagnosis of respiratory tract infection and hand, foot and mouth disease."
"China Newsweek" reporter received the document, "Fuyang Daily" published an article compared determined, both exactly the same - "hand, foot and mouth disease" has never appeared.
Another media report: The second document signed - Vice Minister of Municipal Party Committee Propaganda Department said Liu Ting-feng, April 14, the group preliminary findings as "rule out SARS, avian flu is a respiratory illness" , Also did not mention the hand, foot and mouth disease.
Experts are not informed of Fuyang City ? Fuyang officials or conceal the situation ? May 6, Fuyang City Health Bureau and the CDC is responsible for two people to the "China Newsweek" reporter: experts did not give the conclusions of hand, foot and mouth disease.
April 15 after the children leave have been sent back to the kindergarten, or in crowded public places. But there are also attentive parents found that: the next two days, some kindergartens and hospitals quietly put up a gate "on the hand, foot and mouth disease control measures," the leaflets.
16, Fuyang City Ying-chuen District kindergarten held a straight "emergency meeting" - the Park, named Wang Zhen Yu (Music), 3-year-old boy died two days ago. Until the child's grandmother to the claim, the teachers will know, he is due to "abnormal" premature end. Kindergarten children start to the day Liangti Wen, and check the upper hand-foot-and spray every day, "84 disinfectant solution." As long as children have a slight fever and would enable parents to reclaim. These measures, Park does not have any explanation, let parents Momingqimiao. On the morning of 18 scheduled in the park at the "Spring on how to prevent respiratory disease," the expert talks also "cancelled some reason."
After 28 days, EV71 surface
From April 4 was the first case of Fuyang anatomy of the remains of the deceased to April 16, 12 days have passed. At this point, Fuyang City Health Bureau to collect the samples have been sent to the hand of the Chinese CDC virus.
"On the 18th, we get the samples." Accept "the China News Weekly" interview, the CDC by a virus experts said, "This includes patients with the cerebrospinal fluid, blood and other fluid collection, but it did not identify the patients with matching Information such as the patient's name, gender, age, home address do not know what; epidemiological survey data do not know; clinical course it was not clear. "- Epidemiological investigation and clinical course of the pathogen is very important, but if patients Medical treatment before and after the record is not complete, and so after his death will re-back investigation to verify more difficult.
This has a background in Liuyang, highly professional training of experts, the cause of the need to be very stringent verification procedures, but in Fuyang - such a relatively backward cities in the Mainland, the doctor's professional nature and extent of many of his difference .
In many patients with information are missing cases, the virus which experts began the test. SARS、SARS, bird flu, pig-borne virus?? possible causes have been ruled out one by one. 19, Zhang Yong, the virus laboratory and other researchers have found some important clues. Fuyang City at the time but limited to only provide a specimen of a person, "This can not be used as the judgement of this event (based on)." China's disease control center, said Yang Wei, deputy director.
At this point, Fuyang, the local "abnormal" situation has become increasingly serious. The city health department collected more samples and sent to the Chinese CDC. April 23 afternoon, in five deaths among the samples, the experts detected in the gut of the EV71 virus nucleic acid, and the sequencing. In addition, from 21 only in the performance of only hands, mouth and feet of these sites appear rash of light patients, but also detected that the EV71 virus nucleic acid.
At 16:00 on April 23, Hsu Wen-wave laboratory, Zhang Yong identified the cause: intestinal virus is EV71. During the five days of the "sea election" has finally ended.
The same day, Fuyang clinical experts and local experts in epidemiology survey results also support the lab's test results. At 23:00 on the 23rd, the Ministry of Health expert group final, leading causes of infectious diseases is the EV71 virus, it caused by the hand, foot and mouth disease, resulting in 22 children died.
From the first cases of death in children to test results identified a total of 28 days.
"Last year, Linyi in Shandong also had hand, foot and mouth disease outbreak, the final total of nearly 40,000 cases. But in Shandong Province in the early CDC gave brought us enough information and a complete sample. And in submission before, they have basically Identify the disease because of hand, foot and mouth disease. "Virus by the Chinese CDC experts said. Finally, in 2007 in Shandong Province reported a total of hand, foot and mouth disease mortality rate was 0.043 percent. The April 23, 2008, the Anhui Provincial Health Office of the first public site in Fuyang epidemic data - As of the day, Fuyang found 610 children infected with EV71, mortality rate close to 3 percent.
"We do not have the power to release the epidemic"
Pathogen was identified by the news on the website of the Office of the Anhui Provincial Health "health information" for the "Comprehensive News" column, but this location is not visible. At 7:30 on May 6, the reporter from the site, opened it, the page record: 13 days to this news "was read 1379 times." At this time, the number of infections in Fuyang close to the 5000.
April 24, "Anhui Daily" reported the website of the Ministry of Health on this news. But the public often read "Xinan Evening News" and "Anhui Commercial Daily" "Jianghuai Morning News" and "Hefei Daily" newspaper, and most of the day of the Fuyang City media, did not mention this news. Faced with "Chi Bao-reporting false positives" Zhi Yisheng, Fuyang City, deputy director of the Centers for Disease Control Perfect Mount million repeatedly said: Fuyang no history of the Hand, Foot and mouth disease epidemic, no laboratory testing capacity, so that from the epidemic To determine the epidemic will take some time. "We did not receive the Ministry of Health or the Health Department's mandate, there is no power to release the epidemic." Fuyang Another local official said.
25, 26, in this two-day "blank media", another 179 sick children, one child died. Xinhua News Agency released on the 27th-draft, but the next day's Anhui province, most of the media again aphasia.
April 30, when the "China Newsweek" reporter rushed to Fuyang People's Hospital, in addition to out-patient floor, and first-aid center in the normal reception of other patients, the surgical floor, temporary entrance into the pediatric clinic, was surrounded by holding the parents of children The.
14:00 pm the same day, a middle-aged women in the out-patient floor, I do not know why the door crying, was quickly at the scene to maintain order in the pediatric clinic doctors advise taking; 20:30, have scheduled a team of four hours, 402 children with the grandmother , Fortunately, said: "There are nine on the turn us!" Other crowded in front of the children attending pre-parents, most of Jinzhou Meitou - on a car from the past, raised dust, direct flutter To three meters away from the road outside the pre-consultation on the Taiwan them. "It is not easy to find relations into the wards, but inside there is little disinfection measures. With the ground like the street, no one trailer," a children's parents named Li Juan, "said the doctor more and more people Some children just a mosquito bite, Learn from the parents. "
Provisional included in the ward by ward infection, the corridor, who have lived in the children with severe. A nurse and parents are lectures on hand-foot-mouth disease in the common sense: "Hand, Foot and mouth disease have a variety of ways, mainly through the gastrointestinal or respiratory infection, but also through contact with infected patients or hidden the stool, such as herpes infection of ?? "But the window of the ward were strewn on the lawn more than 10 reactor faeces, in the stool next to the bush on the drying of the more than 20 pieces of children clothes.
On this day, Fuyang intestinal virus infections surged to 2,477 cases, of which 20 patients died. Are still hospitalized and observed by 702 cases, of which 36 cases for critically ill patients.
More than 10 provinces found that the epidemic
Hand, Foot and mouth disease outbreaks in Anhui Fuyang, other parts of the country are epidemic. "China Newsweek" time, the national total, including Beijing, Hubei, Hong Kong, Macau, 16 provinces and regions have been reported.
"China Newsweek" reporter of nearly 10 cases of infection provinces CDC conducted an interview. Person in charge of the Beijing CDC: As of noon on May 5, Beijing reported a total of 1,482 cases of infected patients, but no one died. And Hubei, Jiangxi, Guangdong and other CDC official said, the exact number of infections and deaths to the official website published figures prevail.
Although the epidemic in the last week in the spread of the trend, but not many deaths, and no adult infections reported. "The epidemic will not threaten Beijing Olympic Games," WHO representative in China, or the Hanzhuo "China Newsweek" said that "China's health sector should be more open and timely communication to the public the information they should know."
At present, the provincial disease control center site, will be the Ministry of Health "issued by the Hand, Foot and Mouth Disease Control and Prevention Guide (2008 edition)" in a prominent position. However, some provinces in health, disease control departments have remained wary of the press - as a reporter in the provinces contact the Centers for Disease Control, the other side "of the leadership." Henan Provincial Health Department on the official website of the latest information, stay in the April 30. 5月1日， May 1, "the People's Republic of China Government Information Disclosure Ordinance" has been officially implemented.
"EV71 disease epidemic hand, foot and the cause once they are identified, the disease itself is not terrible. Although there is no vaccine against it or vaccine or treatment, but it and polio, about 99 percent of people infected with the virus only, but No incidence. Incidence of which very few people, fewer people will also only occur fatal complications. "China by a CDC virus expert said," In general, as long as the early discovery, early treatment, EV71 From hand, foot and mouth disease in general can be quickly cured. Of course, the prerequisite for broad public, the right to publicity. "★
Editor: Pei Chunmei
