Mystery disease strikes remote area of Panama

[Gert van der Hoek]

Mystery disease strikes remote area of Panama

Posted on Tue, Oct. 02, 2007

BY ERIC JACKSON

Special to The Miami Herald

PANAMA CITY, Panama -- Local officials are reporting that 42 people have died, almost all of them children, in an outbreak of a still unidentified disease in the remote ?urum district of Panama's indigenous Ngobe-Bugle region.

The ailment begins with a runny nose, coughing and fever, and when it gets deadly the victims present symptoms that look like bronchial pneumonia, according to a statement by Panama's Health Ministry.

The Health Ministry and the semi-automomous Gorgas Memorial Laboratory say they don't know the cause of the illness.

`WE'RE STUDYING IT'

''We're studying it, and the Gorgas Lab is working on it, but to say anything now would be speculation,'' said a ministry official who asked for anonymity because he lacked authorization to comment on the case.

Federal government officials say they know of only 10 deaths, but some of their comments on the case have been contradictory.

LIMITED ACCESS

The information problem has been made worse by the difficulty in getting to ?urum in central Veraguas province, where the dirt roads become impassable to most vehicles in this, the rainy season. The population in many cases lives a long walk from even those precarious roads.

Word of a problem first got out in mid-September when local officials contacted the Health Ministry and then, alarmed by what they considered a lackadaisical response, took their story to the news media.

On September 23 Gladys Guerrero, the ministry's director of epidemiology, denied to a reporter for the tabloid El Siglo that there was any viral or bacterial pathogen at work, attributing the problem to complications of rainy season colds that are common in the area, especially because of its poor sanitary conditions.

Guerrero also said that local claims at the time of 10 deaths since late August were exaggerated. Within five days, Ngobe officials were reporting 40 deaths and many more sick. The La Prensa newspaper has reported that more than 30 children from ?urum are being treated in various hospitals around the country.

PRESS RELEASE

The country's disease control center, the Gorgas Memorial Institute, is working to identify the cause of the outbreak.

The Health Ministry said in a Sept. 29 press release that the problem appears to be ''a known acute viral respiratory situation like influenza,'' but on Monday a ministry spokesman said that no flu or other virus had yet been identified.

The U.S. government has offered help, but as of Tuesday Panama had not asked for international assistance.

The Ngobe-Bugle district, the youngest of Panama's semi-autonomous indigenous regions, comprises about 9 percent of the country's land mass and has its biggest concentration of poverty. Many of the inhabitants leave for part of the year to pick coffee or other crops.

FRACTIOUS AREA

The district, shared among its Ngobe majority and Bugle and other minorities, is politically fractious and its self-governing institutions are not as developed as in some other indigenous areas in Panama.

After news of the illness broke, President Mart?n Torrijos cut short a trip to the United States and flew into ?urum with a team of some 60 healthcare workers.

Government officials fanned out to visit thousands of families and advise them to cooperate with health officials and that nobody evacuated to a city hospital would be left stranded -- a concern that had led some of the poor parents to refuse to let their children be taken to a hospital.

http://www.miamiherald.com/news/breaking_news/story/258274.html

credits Ross

 

[Gert van der Hoek]

Re: Mystery disease strikes remote area of Panama

Archive Number 20071003.3271
Published Date 03-OCT-2007
Subject PRO/EDR> Undiagnosed deaths, children - Panama (Ngobe-Bugle): RFI


UNDIAGNOSED DEATHS, CHILDREN - PANAMA (NGOBE-BUGLE): REQUEST FOR INFORMATION
***************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Tue 2 Oct 2007
Source: The Miami Herald [edited]
<http://www.miamiherald.com/news/breaking_news/story/258274.html>


Local officials are reporting that 42 people have died, almost all of
them children, in an outbreak of a still unidentified disease in the
remote Nurum district of Panama's indigenous Ngobe-Bugle region.

- snip -

******
[2]
Date: Mon 1 Oct 2007

Source: Ministry of Health Panama Press Release [in Spanish, trans.
Mod.MPP, edited]
http://www.minsa.gob.pa/


The Ministry of Health reports that during the integral health
operatives conducted in the Nurum district of the Ngobe-Bugle comarca
[county] during the period 20 to 30 Sep 2007, they have cared for
5000 patients coming from the areas of Agua de Salud, Guayabito,
Buenos Aires, El Bale, and the communities of Guibale, El Penon, and
Virigua. There is a permanent ministry presence in these areas and
they are continuing with activities, incorporating the communities of
Guabal, Valle Bonito, and others.

As of 30 Sep 2007, there were 48 patients in the regional hospital
Luis "Chicho" Fabrega, in the province of Veraguas, coming from the
district of Nurum, with acute respiratory syndromes. These were
primarily young children less than 5 years of age who as of the
stated date were in stable condition, and 14 of them had already been
discharged from the hospital.

Laboratory reports on studies conducted revealed the presence of a
respiratory virus, with a predominance of a type of adenovirus, for
which there is no vaccine, but whose early detection permits
management and effective treatment avoiding the onset of complications.

During the weekend [29-30 Sep 2007] 6 minors from Kankintu and
Kusapin with diarrheal disease and dehydration, were transferred to
the [county hospital] of Bocas del Toro province. These transfers
were done in a timely manner to prevent fatalities and an appropriate
epidemiologic investigation is being conducted.

The coordinated efforts of health professionals at the national,
regional, and local levels, with local authorities and the community
from the county of Ngobe Bugle, have provided valuable information,
achieving greater impact of the activities, which has prevented new
deaths from occurring and has permitted the handling of the current situation.

So far [1 Oct 2007] there have been 10 deaths officially reported
attributable to this respiratory syndrome. Nevertheless, the Ministry
of Health has given instructions for a detailed countrywide
epidemiologic investigation of all cases and deaths associated with
respiratory and diarrheal infections to be carried out in all of the
health regions and for the appropriate measures to be implemented.

Recommendations have been made for the entire population to closely
watch the children; those presenting with a clinical picture of
fever, cough, and difficulty breathing, should be brought to health
facilities. Personal cleanliness measures such as hand washing and
adequate handling of respiratory secretions are to be observed. In
addition, there should be care to avoid smoke, rain, cold, and
contact with other young children, avoiding gathering places.

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

[The clinical description provided in the newswire is consistent with
any number of respiratory pathogens including viral, bacterial,
fungal, and parasitic. Based on the newswire, one can't help but
speculate this might be a respiratory viral outbreak with a high
mortality often seen in rural hard-to-reach areas where access to
medical care is limited. Using the Global Infectious Disease and
Epidemiology Network (GIDEON -- <http://www.gideononline.com>), the
differential diagnosis (with probability of occurrence includes:
respiratory viruses - - miscellaneous (36.9 percent), influenza (31.3
percent), respiratory syncytial virus infection (20 percent),
parainfluenza virus infection (10.1 percent); then the remainder with
a less than one percent probability of occurrence include: pertussis,
adenovirus infection, laryngotracheobronchitis, hantavirus pulmonary
syndrome, enterovirus infection, measles, diphtheria, ornithosis,
_Chlamydophila pneumoniae_ infection, Q-fever, dengue, and
paracoccidioidomycosis.

That being said, the findings stated in the Ministry of Health (MOH)
press release in part [2] of an adenovirus, are not overly
surprising. One might postulate here that there is the ongoing
transmission of a respiratory virus (adenovirus) with probable
secondary bacterial infection among a remote, rural childhood
population where acute respiratory infections are a leading cause of
death. There is clearly a conflict of information provided in the
newswire when compared with the official MOH statement. The former
mentions reports of 40 deaths, compared with the MOH reports of 10
deaths. Clarification of the situation from knowledgeable sources
would be greatly appreciated.

For background information: "Ngobe-Bugle is a comarca (roughly,
"county" though signifying a high degree of administrative autonomy)
in Panama. It was formed in 1997 with lands from the provinces of
Bocas del Toro, Chiriqui, and Veraguas. The capital is Chichica.
Ngobe-Bugle has a population of 169 130 mainly Guaymi (Ngobe and
Bugle). They are actually 2 different groups: the Ngobes and the
Bugles. The Ngobes speak Ngabere and the Bugles speak Buglere. The
comarca is divided into 7 districts." Nurum is one of the districts
and its capital is Buenos Aires. For a map of the comarca and further
links on the region, see http://en.wikipedia.org/wiki/Ngöbe-Buglé)

A map of Panama can be found at
http://www.lib.utexas.edu/maps/americas/panama.jpg, but the
Ngobe-Bugle Comarca is best visualized (albeit not in detail) at the
link in the preceding paragraph. - Mod.MPP]
...................................mpp/mj/mpp

http://www.promedmail.org/pls/askus..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,39565

 

[Laidback Al]

Re: Mystery disease strikes remote area of Panama

Human interest/perspective story from Panama . . .

machine translated from: http://www.elsiglo.com/siglov2/Nacion.php?idnews=52901&idsec=1&fechaz=01-10-2007

When we are dying, they say in ?urum
?Therefore they only remember us?

Text and photo: Gloria Leiva Gait?n
gleiva@elsiglo.com

?URUM, Veraguas. They were the 4:30 of the dawn when we arrived at the bus shutdown, where we would take a kid who would take us to the Rock. More than a dozen of people also they waited for the transport with anxieties, because many were days old without going to visit their families, but we were going to know a reality.
Suddenly, somebody shouted: ?it arrived, it arrived? and all ran towards the part of back of pick up blue and began to raise. This one had to the sides wood tables, was covered by a canvas and in his interior it had banks, there they complied as they could, whereas some remained without position and they could not approach the kid. They had to wait for the transport of the 10 in the morning.
The driver said to me: ?she si?ntese ahead? and next to me, one lady with her baby of a year seated. It was going to visit her mother, who was several days old of not seeing, the reason for her trip was to know how she was his family, since she found out, through the television, that a virus was killing people.
She left from Chilibre the night previous, arrived at Santiago to 2 from the dawn. The fatigue noticed to him in the face.
To 5 of the dawn it left the kid. During the way, still by the Pan-American one, the ma?anero cold whipped strongly, but those that went back underwent more, since it entered by hendijas.
After 30 minutes by the comfortable Pan-American highway, we entered by a rock road and mud. ?Here it begins the good thing?, it says the driver and thus it was. By four hours, this one had to maneuver with the rudder in lofty hills and Straits enlodados ways.
A little after the six in the morning began dawn, the sky was dressed orange and the thick fog covered the mountains that were seen the distant spot.
During the paved with stones way, we descried inhabitants who went on foot in horse or, towards its destinies. This is the transport form commonest, by these areas.
In the route, a mother went with her two daughters and loaded one ch?cara in the full head of clothes, when seeing the car made signs so that we stopped. Luckily, minutes before passengers lowered of the kid and left space.
The gorges were level, that indicated that we could happen without no danger. The driver told that kill a time, a kid turned upside down filled with people when she crossed one of the gorges, ?is that it had rained, the water was until above, dragged them and she turned around them, but luckily nobody died?.
Our voices woke up to the small one, that began to cry and her mother consoled it with her chest. ?The President goes for the Rock?, comments the lady, while he nursed his son.
With that commentary he initiated a debate between the driver and she. Both agreed in which the President had to travel in car and not in helicopter, so that he knew the reality in which they live. ?Which it comes to horse or leg?, it shouted somebody in the part of back, where the commentaries were more critical against Torrijos.
?Only thus, they remember us?, says to the lady, talking about to the uncontrollable deaths of children and indigenous children, in the region Ng?be Bugle, specifically in the district of ?urum.
The conversation on the conditions in which they live, the lack of health, the difficult access and the abandonment of all the governments, was extended until arriving at the community of the Rock, located in ?urum.
They were four hours which lasted the trip to arrive at the forgotten community and that now it is taken into account by the authorities, but by a tragedy.

Archimedes: one more a victim
In a house of quincha, seated in a hammock and with its granddaughter in arms we found to Marinda Mendoza, a mother who not yet understands how an influenza killed its baby of 11 months of been born.
While it rocked to his granddaughter of a year in the hammock and watched mountains to the distant spot, Marinda counts how resfriado ended its son.
She remembers that the first symptom of the small Archimedes was a cough, soon gave fever him and a day before its death gave pains him in the body.
?I did not have silver to take it to the Chicho and I took it there down (health center)?, says with sadness.
There to only they said him that he was resfriado and they prescribed a syrup to him that cleared the fever to him, but not them pains nor the cough.
The boy was in favor thus of four days, until one night began to cry and to twist of the pain, ?I I did not know what to do?, Marinda comments.
On the following day, Archimedes died, becoming one more a victim of the resfriado one than he is killing to the minors in the region Ng?be Bugle.
Although the health authorities do not register deaths in the Rock, Marinda assures that his son died by that disease, because they gave the symptoms him.
?I cried?, says one of the daughters of Marinda with timidity, that took hold me of the hand and it took to me towards where they buried the boy of 11 months.
The small Archimedes is buried in front of the house, underneath a tree that gives shade him and next to the small earth hill there is a chair done with wood trunks. ?There my mother feels every day, to see it?, comments the young person.
Whereas she prefers to be placed next to the tree and to see it from there.
In these communities it is very common to bury to the smaller babies of a year in the patio or the garden, because thus their parents can visit them every day, since Marinda does.

 

[tropical]

Re: Mystery disease strikes remote area of Panama

... the presence of a respiratory virus, with a predominance of a type of adenovirus, for which there is no vaccine ...
... during the period 20 to 30 Sep 2007, they have cared for
5000 patients
... 42 people have died ...

~1% of people have died
no vaccine - is this an novel type of adenovirus?

 

[Gert van der Hoek]

Re: Mystery disease strikes remote area of Panama

Panama tries to identify lethal mystery disease

Thu Oct 4, 2007

PANAMA CITY (Reuters) - At least 10 people have died and dozens more are hospitalized due to a mysterious respiratory illness that has struck indigenous villages in western Panama, health authorities said on Wednesday.

The health ministry said epidemiologists are still trying to identify the illness that has killed at least 10 people and hospitalized 67 more.

Panamanian media say the death toll could be closer to 50. Local media reported the first deaths about two months ago.

The majority of victims are said to be indigenous children under 5. Symptoms include coughing, fever and difficulty breathing.

The outbreak comes a year after the death of at least 94 people who drank a Chinese-made tainted cough syrup. It took the government some time to establish what had caused the deaths.

The new mystery illness has occurred between the Panama City and the Costa Rican border, in an area known as Ngobe Bugle, one of several indigenous regions in Panama.

Ngobe Bugle is one of Panama's poorest areas, with high levels of malnutrition.

According to Nutre Hogar, a charity which works on children's health, one in three indigenous children in Panama is malnourished. One senior foreign health official, who asked not to be named, said the spate of deaths was caused by complications linked to malnutrition.

In a statement, the health ministry called on Panamanians to be alert for symptoms of the disease, which may spread more easily due to wet conditions.

The illness has struck during Panama's rainy season, which brings frequent downpours from May to December.

http://uk.reuters.com/article/healthNews/idUKN0334213320071004

credits Solitaire

 

[tropical]

Re: Mystery disease strikes remote area of Panama

One senior foreign health official, who asked not to be named, said the spate of deaths was caused by complications linked to malnutrition.

Thank you Dutchy.

 

[Gert van der Hoek]

Re: Mystery disease strikes remote area of Panama

UN says Panama mystery disease is malnutrition

The U.N. has dismissed Panama's claims it is fighting a mystery respiratory illness that has killed at least 10 people, saying the deaths are linked to malnutrition.

Posted: Saturday, October 6, 2007,

PANAMA CITY - The U.N. has dismissed Panama's claims it is fighting a mystery respiratory illness that has killed at least 10 people, saying the deaths are linked to malnutrition.

The head of UNICEF in Panama, Fernando Carrera, said on Friday that the illness, which local media have reported may have killed up to 50 people in the last two months, is a direct result of poverty among Panama's indigenous population.

Panama says epidemiologists are investigating an unknown adenovirus -- or respiratory virus -- that has hospitalized at least 67 people in the province of Ngobe Bugle, near Panama's border with Costa Rica.

The illness has primarily affected children between 2 and 4 years old, with symptoms including headaches, fever and breathing difficulties.

"These children have likely died because of a combination of poor nutrition and the infection," said Carrera, "There is a virus, but it is not something rare. It is a virus that is known and that occurs each winter in the mountains."

According to Carrera the death rate, based on government figures, is unlikely to vary greatly from previous years.

The government has been criticized for its handling of the case and is facing questions about how a country with one of the fastest growing economies in Latin America continues to experience such high levels of poverty.

"The indigenous population has always been abandoned by the government" said opposition lawmaker, Enrique Garrido, "Bolivia strongly backs its indigenous groups, why can Panama not do the same?"

http://www.christiantoday.com/article/un.says.panama.mystery.disease.is.malnutrition/13730.htm

http://today.reuters.co.uk/news/art...5269497_RTRIDST_0_HEALTH-PANAMA-HEALTH-DC.XML

 

[Gert van der Hoek]

Re: Mystery disease strikes remote area of Panama

machinetranslation

Minister confirms deaths of Panamanian natives by adenovirus

Panama, 10 oct (PL) the minister of Panamanian Health, Rosario Turner, today confirmed the death of 17 smaller indigenous children of five years, victims of curable respiratory diseases that proliferate in the isolated region Ngobe Bugl?.

In an appearance before the Commission of Health and Social Security of the National Assembly, Turner said that 93 members of the community were hospitalized and of them 77 withdrew after receiving the corresponding treatments.

Turner declared that the respiratory deaths and serious pictures that appeared the last weeks in the community of ?urum, in the referred region, must adenovirus and influenza, in as much discarded all possibility of a mortal germ.

Communitarian leaders said days back that at least 40 minors and an adult passed away of the attacks of cough, fevers and diarreas, but as many were buried near their houses, far from health facilities.

The holder of Health expressed that the problem must to a virus that affects to children and adults with nutricionales problems and of anemia, but that the fast action of the unfolded medical personnel in the region avoided new deaths.

It added that the comparison of the health facilities, the construction of rural aqueducts and to reinforce the monitoring in the region will be some of the actions that the Ministry of Health in the region will implement.

He explained that 60 civil employees of health trabajarono in the region, 10 nutricionistas will remain in the region until controlling the situation in the 10 existing districts.

Turner said that the arisen respiratory diseases in the indigenous community are own of the rainy station in the country reason why it reiterated to maintain the measures of personal hygiene.

http://www.prensa-latina.cu/article.asp?ID={179ED95D-060D-46B6-911F-B9890E9CB4F8}&language=ES