Re: China - Henan/Shangdong Province: Unknown disease kills 31 - 33, possibly a new Bunyavirus carried by ticks
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85122
Archive Number 20101002.3573
Published Date 02-OCT-2010
Subject PRO/AH/EDR> Anaplasmosis, human granulocytic - China (03): susp.
ANAPLASMOSIS, HUMAN GRANULOCYTIC - CHINA (03): SUSPECTED
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[1]
Date: Sat 11 Sep 2010 [Received by ProMED 1 Oct 2010]
Source: Google News [edited]
<http://www.google.com/hostednews/afp/article/ALeqM5jT-fDJWWxSJK5FvgjBI47NF_E1Sg>
Health authorities in China are scrambling to allay public fears about
a tick-borne disease that has killed more than 30 people since 2007
[and sickened many more], but admitted they do not know how many have
been infected.
The illness known as human granulocytic anaplasmosis (HGA) has spread
to 12 provinces including Henan in central China and Shandong in the
east, where the deaths have been reported, the China Daily reported
Saturday [11 Sep 2010].
HGA is treatable if detected early. Symptoms include fever, headache
and muscle aches, but the infection can reduce a patient's white blood
cell and platelet count, leading to organ failure and death. The
illness has mainly affected those aged 40 to 70 [years], state media
reported.
"So far we have no details on the general epidemic situation across
the country," health ministry spokesman Deng Haihua told a press
conference on Friday [10 Sep 2010], calling on authorities in affected
provinces to report any cases. But Deng downplayed suggestions of an
official cover-up of the outbreaks, saying it was simply difficult to
raise public awareness about a little-known infectious disease.
Henan authorities only announced Wednesday [8 Sep 2010] that 557
people had been infected with HGA since May 2007, 18 of them fatally,
after a state-run newspaper reported on a fresh outbreak in the city
of Xinyang that began months ago. A total of 182 cases have been
identified in Shandong since May 2008. HGA was 1st detected in Anhui
province in 2006. The health ministry subsequently issued guidelines,
which stipulate that suspected cases be reported within 24 hours of
detection, the China Daily said.
The health ministry has sent experts to Henan province to assist in
epidemic control work by helping to educate local doctors about the
disease, the paper said. "It is still difficult to pinpoint the
pathogen of the disease since it may be caused by a new virus," Wang
Shiwen, an expert at the Chinese Centre for Disease Control and
Prevention, was quoted as saying by Xinhua news agency. [HGA is a
tick-borne disease that is caused not by a virus, but by a
rickettsia-like bacterium _Anaplasma phagocytophilum_. - Mod.ML]
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[2]
Date: Sat 11 Sep 2010 [Received by ProMED 1 Oct 2010]
Source: Asiaone Health [edited]
<http://health.asiaone.com/Health/News/Story/A1Story20100911-236664.html>
China's top health authorities admitted on Friday [10 Sep 2010] they
still did not have the exact number of patients suffering from the
disease from tick bites. By Friday, the infection recognized as human
granulocytic anaplasmosis (HGA), had reportedly spread to 12 provinces
including Henan and Shandong, causing at least 31 deaths.
However, the Ministry of Health (MOH) at a Friday news conference
still couldn't tell the exact number of such cases reported
nationwide, though officials stressed that the ministry is aware of
the situation and has taken actions and provided prevention advice to
the public. "So far we have no details on the general epidemic
situation across the country," said Deng Haihua, spokesman of the
ministry. Information about the exact epidemic situation in each
affected province should be available from the local surveillance and
reporting system of infectious diseases, he said.
After detecting the 1st HGA case in Anhui province in 2006, the
ministry issued a guideline on HGA prevention and control in 2008,
which stipulates that local health authorities report suspected cases
within 24 hours upon detection. However, many tended to ignore this
order, as HGA was not listed among the nearly 40 infectious diseases
required by law to be reported, experts said. Only after the Beijing
News broke a story early this week about the outbreak in Xinyang,
Henan province, did the provincial health authority on Wednesday make
the outbreaks public -- 557 reported cases including 18 deaths [in
Henan province].
Health authorities of Shandong province also announced on Friday [10
Sep 2010] that 182 HGA cases, including 13 deaths, had been detected
locally since May 2008. By Friday, they were the only 2 [provinces] to
have publicized occurrences of HGA.
Under current law on infectious disease prevention and control, local
health administrations are required to publicize local epidemics. But
the ministry is still pushing local health authorities to make timely
reports of public health concerns, particularly public health
emergencies and outbreaks, Deng said. "We still have a long way to go
in that regard," he said. But he also dismissed criticism that the HGA
outbreaks were deliberately covered up and not made public, citing the
complexity of publicizing an unknown disease.
Vivian Tan, spokeswoman for the WHO Beijing Office, told China Daily
on Friday that they had officially requested more information from the
Ministry of Health, and the WHO is willing to offer technical
assistance if requested. "So far there has been no such request. We
are standing by to help as required," she said.
Chinese experts are yet to determine the type of pathogen carried by
ticks, Li Dexin, director of the Chinese Center for Disease Control
and Prevention, said at the Friday conference. Most of the patients
suffering from tick-borne pathogens had fevers and low blood cell
counts. Some of the patients died of intestinal complications. Now,
the center has temporarily named the disease "fever-thrombocytopenia
syndrome," but many kinds of pathogens are likely to cause the
syndrome, said Li. Ticks can carry 83 kinds of viruses and 14 kinds of
bacteria, he added.
--
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[3]
Date: Fri 1 Oct 2010
Source: China.org [edited]
<http://www.china.org.cn/china/2010-09/14/content_20924743.htm>
A new bunyavirus has already been isolated as a possible pathogen of
the tick bite cases in several Chinese provinces including Henan. But
so far experts cannot yet confirm that the virus is the culprit
causing the infections, said Wang Shiwen, a researcher with the
virology institute of the Chinese Center for Disease Control and
Prevention. Despite [the fact] that the pathogen remains unclear,
"there is no need to panic as the disease can be cured with timely
detection and treatment," he said at a workshop on the epidemic in
Shangcheng county, Henan on Sunday [26 Sep 2010]. [True only if it is
anaplasmosis, which is caused by bacteria which respond to antibiotics
-- viruses don't. - Mod.JW].
Bunyaviruses are largely transmitted in nature by vertebrates and
arthropods like mosquitoes, ticks and sandflies, experts said.
Symptoms of infections in humans include hemorrhagic fever and
meningitis. Transmitted in a similar way as pathogens carried by
mosquitoes, the illness is also preventable, he added.
Chinese health authorities have been trying hard to lessen public fear
about the tick-borne disease, which as of 10 Sep 2010 has reportedly
spread to 12 provinces including Henan and Shandong, and claimed at
least 31 lives.
Experts sent by the Ministry of Health to the site in Henan outlined
preventative measures on Sunday, including that medical staff in
infected areas should receive training on the prevention and treatment
of the disease recognized as human granulocytic anaplasmosis (HGA).
The affected areas, however, have yet to be recognized, Wang said. A
preliminary study showed that women and the elderly are most at risk
of contracting the disease. "They usually work the farmland and are
thus more likely to be exposed to tick bites," Wang said.
The Ministry of Health has designated experts to develop new clinical
guidelines for the diagnosis and treatment of the tick-borne disease.
The last set of guidelines was issued in 2008. Training on diagnosis
and treatment has been organized by experts including Wang, who
arrived in Shangcheng county on Friday to teach local medics. After
the 1st such case was detected in 2007, the Henan provincial health
authority announced 557 reported cases, including 18 deaths, on
Wednesday [29 Sep 2010].
After the media inquired whether officials failed to publicize the
epidemic in a timely manner, authorities from the Henan provincial
center for disease control and prevention (CDC) said the procedure to
confirm that a fatality was caused by a certain infection is
complicated and takes time. Xu Bianli, deputy director of the Henan
CDC, said the statistical departments have a difficult time collecting
data as some victims suffering from the disease died at home, largely
off the government's radar. Investigations have already been launched
regarding neglected cases disclosed by media reports, he noted.
--
Communicated by:
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[Human granulocytic anaplasmosis (HGA), formerly known as human
granulocytic ehrlichiosis, is a tick-borne disease caused by a
rickettsia-like bacterium called _Anaplasma phagocytophilum_. Many
people with HGA experience headaches, fever, chills, and muscle aches
that can be confused with other common infections. The symptoms tend
to be most severe in aged and immunosuppressed people. Some
individuals who become infected with _A. phagocytophilum_ do not
become ill or experience only very mild symptoms and do not seek
medical treatment.
Anaplasmosis should be suspected in patients with the acute onset of
unexplained fever, chills, and headache, often in association with
thrombocytopenia, leukopenia, and/or increased liver enzyme levels
with a history of tick exposure within the prior 3 weeks. Wright
stains of peripheral blood smears or buffy-coat preparations
demonstrate cytoplasmic inclusions consisting of vacuolar
microcolonies of _A. phagocytophilum_ within neutrophils in 20 to 80
percent of patients with anaplasmosis.
The diagnosis of anaplasmosis can be confirmed by a 4-fold increase in
antibody titer by IFA (indirect immunofluorescent assay) in acute and
convalescent phase serum samples, PCR (polymerase chain reaction)
amplification of anaplasma DNA in a clinical specimen, immunostaining
of _A. phagocytophilum_ antigen in a tissue sample, or isolation of
_A. phagocytophilum_ from a clinical specimen in cell culture (Centers
for Disease Control and Prevention. Ehrlichiosis/Anaplasmosis 2008
Case definition. September 2008 [date cited] Available at
<http://www.cdc.gov/ncphi/disss/nndss/casedef/ehrlichiosis_2008.htm>).
However, it is clear from the 3 news releases above and those reported
in a prior ProMED post (Anaplasmosis, human granulocytic - China: (HE)
susp, RFI 20100910.3274) that there is uncertainty concerning the
diagnosis in these cases in China. We await further clarification. A
detailed discussion of HGA can be found in the moderator's comments in
the prior ProMED-mail post, Anaplasmosis, nosocomial transmission -
China: (AH) 20081120.3661.
Henan province is located in the eastern central part of China and is
the 2nd most populated province of China after Guangdong
(<http://en.wikipedia.org/wiki/Henan>). Xinyang is subtropical and
mountainous and is the southernmost administrative division in Henan
province. Henan province is adjacent to Shandong province to the
northeast and Anhui province to the east.
