Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause - Nipah-like hen

[Shiloh]

Source: http://www.interaksyon.com/article/84518/100-hospitalized-in-sultan-kudarat-after-eating-horse-meat

100 hospitalized in Sultan Kudarat after eating horse meat
By: Philippines News Agency
April 10, 2014 12:18 PM
FROM WIKIPEDIA.ORG

InterAksyon.com
The online news portal of TV5

ISULAN, Sultan Kudarat -- Health officials are yet to declare an outbreak of a mysterious disease among animals here but local officials are thinking of putting the town under a state of calamity due to the number of hospitalized persons who had eaten horse meat.

Nestor Cassador, Sultan Kudarat agriculture officer, confirmed that the number of hospitalized rose to more than 100 in the past four days.

The victims, mostly farmers and members of indigenous communities, complained of stomach pain and heavy vomiting with diarrhea after eating horse meat in Barangay Tipalon given by neighbors who butchered four animals after they mysteriously died Wednesday last week.

Many of the victims were rushed to the town hospital but due to limited facilities and lack of manpower, they were moved to the provincial hospital here in Isulan, the capital of Sultan Kudarat.

The provincial government is now investigating the alleged viral disease believed to have been affecting farm animals in Senator Ninoy Aquino town in Sultan Kudarat...

 

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Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause - Nipah-like henipavirus confirmed

This seems highly unusual:

Published Date: 2014-05-20 05:00:55
Subject: PRO/AH/EDR> Encephalitis - Philippines: (SK) horsemeat susp, fatal, RFI
Archive Number: 20140520.2483556

ENCEPHALITIS - PHILIPPINES: (SULTAN KUDARAT) HORSEMEAT SUSPECTED, FATAL, 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

Date: Wed 14 May 2014
Source: Interaksyon, Philippines News Agency report [edited]
http://interaksyon.com/article/8680...-in-poisoning-death-of-7-s--kudarat-residents


The Department of Health (DOH) in Region 12 [SOCCSKSARGEN] has sought the assistance of laboratories in the USA and Japan to determine the cause of the deaths in April 2014 of 7 people in Senator Ninoy Aquino town in Sultan Kudarat province, who were initially believed to have consumed contaminated horse meat. Dr Teogenes Baluma, DOH Region 12 director, said they sent some samples earlier taken from the 7 victims to the American CDC in Georgia, and to another laboratory facility in Japan for examination and analysis.

"We don't have definitive findings yet as to the actual cause of the deaths but we're hoping that these laboratory examinations can provide us some answers," he said in a radio interview. The official said the samples comprised spinal fluid and blood specimens of the 7 victims, all residents of Sitio Parreno, Barangay Tinalon in Senator Ninoy Aquino town. The victims succumbed to severe poisoning symptoms several days after eating the entrails and meat of several horses that died of unknown causes.

Baluma said they sought the assistance of the US and Japan laboratories owing to the limited capability of local facilities. "We want to be really certain as to what caused their deaths so we can properly manage the treatment of the other victims and possible similar cases in the future," he said. Based on the agency's initial analysis on the signs and symptoms experienced by the 7 fatalities and other victims who were hospitalized, he said it appears that it was caused by the viral encephalitis disease.

Nestor Casador, Sultan Kudarat provincial agriculturist, earlier said the victims fell ill after consuming the meat of 3 horses that were slaughtered after turning weak and eventually died from unknown causes. Citing a report from their veterinary unit, he said 5 of the victims died several days after eating the entrails of the horses.

Baluma said no new cases of the disease have so far emerged in the affected area and all local residents who were earlier hospitalized have already recovered. "We have continuing interventions like antibiotic treatments for residents who were hospitalized and had close contact with the victims," he said.

--
communicated by:

<promed@promedmail.org>

[This is an interesting turn of events that may require a widening of the differential diagnosis bandwidth.

Toxic or poisonous substances were originally thought to be the underlying cause of the deaths of the horses and the also unfortunate individuals who ate the meat and entrails from the dead equines. This post suggests an alternate etiology, a viral encephalitis presumably involving both equines and humans with transmission by ingestion of the horse flesh and entrails. If this is the case, some of the following bears some consideration.

Classical rabies virus could do this and the non-hyperactivity form of the infection in man could make the diagnosis somewhat difficult. Specific immunologic stain of the brain tissue can make this diagnosis. If there are survivors, rabies becomes quite unlikely and a short, several day incubation period almost makes the diagnosis even more unlikely. Bat lyssaviruses other than classical rabies also might be considered and evidence of such viruses has been found in the Philippines.

Eastern equine encephalitis has been said to be present in the Philippines but it is overwhelmingly a western hemisphere disease and would be also quite unlikely. Trichinellosis can be a fatal, but not as rapidly, encephalitis from horsemeat and the histopathology should be characteristic with eosinophilia infiltration. This is also not at all likely and probably would not have killed the horses. Indeed, we do not truly know that the same agent caused the deaths of both horse and man.

Hendra virus is a rare emerging zoonosis that causes severe disease in both infected horses and humans. The natural host of the virus has been identified as being fruit bats of the Pteropodidae family, _Pteropus_ genus. It was first identified during the 1st recorded outbreak of the disease that took place in the Brisbane suburb of Hendra, Australia, in 1994. The outbreak involved 21 horses and 2 human cases. Outbreaks have appeared to be confined to the east coast of Australia. Horses have been identified as the intermediate hosts, transmitting infection to humans through close contact during care or necropsy of the ill or dead horses.

Symptoms of Hendra virus infection in humans range from mild influenza-like illness to fatal respiratory or neurological disease. Horses are the only animal species in which natural infection of Hendra virus has been reported, with a case fatality of approximately 75 per cent. The primary treatment for human cases is intensive supportive care. This virus has not been described in the Philippines but the bat reservoir does exist there. Whether this outbreak is related to a Hendra-like virus remains to be determined.

ProMED-mail would appreciate receiving information on the results of the investigation as it becomes available.

Maps of the Philippines can be accessed at http://www.freeusandworldmaps.com/i...siaCountries/Philippines/PhilippinesPrint.jpg and http://healthmap.org/promed/p/38490. - Mod.LL]

 

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Re: Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause

Re: Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause

Rabies seems excluded by the fact that several others became ill but recovered:

http://horsetalk.co.nz/2014/05/15/horse-meat-suspected-seven-deaths-philippines/#axzz32GhXvZmg

[snip]

Other people became ill but recovered.

The department?s own investigation pointed to brain inflammation triggering the deaths, with a viral origin suspected.

 

[Ronan Kelly]

Philippines - 10 Acute Encephalitis deaths in Sultan Kudarat

Philippines - 10 Acute Encephalitis deaths in Sultan Kudarat

DOH guard in acute encephalitis syndrome that killed 10 people in Sultan Kudarat
By Bombo Jovino Galang Posted in Latest News Friday, 17 October 2014 05:29
font size decrease font size increase font size
Monitored by the Department of Health (DOH) the increase of those afflicted with acute encephalitis syndrome disease killing of 10 people.

According to the DOH, some people have died after eat horse meat in Barangay jumped on Senator Ninoy Aquino town.

DOH investigating whether the meat of horses afflicted bats this is bringing the disease.

The victims have experienced vomiting, diarrhea and severe fever.

According to the regional epidemiologist and Surveillance Officer Dr. Alah baby Vingno that since April have ten dies and yet they observe others that have four to 27 day incubation period.
http://www.bomboradyo.com/news/late...e-na-pumatay-na-ng-10-katao-sa-sultan-kudarat


DEADLY HORSE MEAT | US, Japanese labs' help sought in poisoning death of 7 S. Kudarat residents
By: Philippines News Agency
May 14, 2014 5:49 PM


InterAksyon.com
The online news portal of TV5

GENERAL SANTOS CITY - The Department of Health (DOH) in Region 12 has sought the assistance of laboratories in the United States and Japan to determine the actual cause of the death last month of seven persons in Senator Ninoy Aquino town in Sultan Kudarat province, who were initially believed to have consumed contaminated horse meat.

Dr. Teogenes Baluma, DOH Region 12 director, said they sent some samples earlier taken from the seven victims to the US Centers for Disease Control (CDC) in Georgia, and to another laboratory facility in Japan for examination and analysis.

?We don?t have definitive findings yet as to the actual cause of their deaths but we?re hoping that these laboratory examinations can provide us some answers,? he said in a radio interview.
...
http://www.interaksyon.com/article/...-in-poisoning-death-of-7-s--kudarat-residents

TV News Report;

Acute encephalitis syndrome kills 10 in Sultan Kudarat

Posted at 10/16/2014 11:33 PM

A disease as dangerous as Ebola has killed at least 10 people since April. - ANC, Prime Time, October 16, 2014
http://www.abs-cbnnews.com/video/na...encephalitis-syndrome-kills-10-sultan-kudarat

 

[alert]

Re: Philippines - 10 Acute Encephalitis deaths in Sultan Kudarat

Re: Philippines - 10 Acute Encephalitis deaths in Sultan Kudarat

Published Date: 2014-10-18 23:18:27
Subject: PRO/AH/EDR> Undiagnosed illness - Philippines: (SK) fatal, acute encephal. synd. susp., RFI
Archive Number: 20141018.2878363

UNDIAGNOSED ILLNESS - PHILIPPINES: (SULTAN KUDARAT) FATAL, ACUTE ENCEPHALITIS SYNDROME SUSPECTED, 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

Date: Thu 16 Oct 2014
Source: ABS CBN News [edited]
http://www.abs-cbnnews.com/nation/re...sultan-kudarat


The Department of Health (DOH) in Sultan Kudarat is monitoring an "Ebola-like virus" that has killed at least 10 people in the province since April [2014].

Back in March [2014], more than 100 residents of Barangay Tinalon in Senator Ninoy Aquino town were rushed to the hospital due to stomach pains, vomiting, and diarrhea after eating what doctors believed was tainted horse meat. Several of the victims died. At that time, medical officials were baffled as to what kind of illness struck the victims. Samples of horse meat were sent to a laboratory for testing. [A more detailed report of these cases can be seen in ProMED-mail archive no. 20140520.2483556).

The DOH is checking whether the virus came from a bat and was transferred to the horse killed and eaten by residents of Senator Ninoy Aquino town.

Based on the laboratory results, the residents were hit by an acute encephalitis syndrome, a biosafety level 4 disease, making it as fatal as Ebola virus.

The [Ebola virus disease] illness is transmitted through body fluids. It has an incubation period of from 4 to 27 days. "It starts with a simple flu, but you can die in one week's time. 'Yung preparation natin dito ay the same sa preparation natin sa Ebola' ['Those preparations here are the same as preparation we have Ebola'; unclear machine translation]. Regional Epidemiology and Surveillance Officer Dr. Alah Baby Vingno said.

The disease has killed 10 residents since April [2014].

The DOH is setting up an information campaign, as well as training its personnel to deal with acute encephalitis syndrome.

The agency is also reminding the public to observe proper hygiene to ward off deadly diseases.

[Byline: Jay Dayupay]

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

[Information is not adequate to speculate on what the etiology of these cases might be. No evidence is presented that the virus is Ebola-like, or even if a virus is involved. Reston Ebolavirus is present in the Philippines, but affects pigs and non-human primates mainly. In the horse near-related fatalities reported in ProMED-mail archive no. 20140520.2483556, Mod.LL suggested in that post that a Hendra-like virus might be involved, and the above report mentions bats, which are the Hendra virus and Nepah virus reservoirs. Geographically, Nipah virus seems more likely because it occurs in Southeast Asia. Since that earlier report, there have been 3 additional fatalities. The laboratory results indicating that these were cases of acute encephalitis syndrome provides few clues about the etiology of those cases, nor if toxicants were ruled out. If additional tests were done or detailed results of previous tests are available, ProMED would appreciate receiving that additional information.

 

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Re: Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause

Re: Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause

Published Date: 2014-11-11 13:39:25
Subject: PRO/AH/EDR> Henipavirus - Philippines: (SK) RFI
Archive Number: 20141111.2944610

HENIPAVIRUS - PHILIPPINES: (SULTAN KUDARAT) 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

Date: Fri 7 Nov 2014
Source: Emerging Infectious Diseases journal [summ., edited]
http://wwwnc.cdc.gov/eid/article/21/2/14-1433_article

ref: Ching PKG, de los Reyes CV, Sucaldito MN, et al. Outbreak of henipavirus infection, Philippines, 2014. Emerg Infect Dis. 2014; 21(2) [published ahead of print]
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Abstract
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During 2014, henipavirus infection caused severe illness among humans and horses in southern Philippines; fatality rates among humans were high. Horse-to-human and human-to-human transmission occurred. The most likely source of horse infection was fruit bats. Ongoing surveillance is needed for rapid diagnosis, risk factor investigation, control measure implementation, and further virus characterization.

Background
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Henipaviruses belong to a genus of recently emerging viruses within the family _Paramyxoviridae_ and include 2 zoonotic members: Hendra virus (HeV) and Nipah virus (NiV). HeV was first described in Australia in 1994, when it caused an outbreak of severe acute respiratory diseases that led to a high mortality rate among horses. Subsequently, several sporadic cases of HeV infection have occurred in horses in Australia; transmission to humans has occurred and the fatality rate was high. NiV was first recognized as a human pathogen in peninsular Malaysia in 1998. This outbreak among pig farmers and abattoir workers exposed to infected swine secretions was associated with severe encephalitic illness and a high fatality rate. Subsequently, NiV emerged as a major public health problem in Bangladesh and India.

The natural reservoir of both viruses is pteropid bats, which harbor the viruses but do not show clinical illness. Virus transmission from bats to domestic animals is thought to be through pasture or feed contaminated by bat urine, feces, or other excretions. Human-to-human transmission of NiV also occurs.

The study
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On 2 Apr 2014, the Philippine National Epidemiology Center received a report of human deaths in 2 villages, Tinalon and Midtungok, in the municipality of Senator Ninoy Aquino, province of Sultan Kudarat, island of Mindanao. The villages are about 15 km [9.3 mi] apart, and the provincial referral hospital is in Isulan, 80 km [49.7 mi] away. An outbreak investigation led by the National Epidemiology Center identified additional human deaths and nonfatal infections and concurrent neurologic disease and sudden deaths in several horses, all of which were subsequently consumed by villagers. On 12 May 2014, the Philippine government asked the World Health Organization for further outbreak investigation assistance.

During 22-24 May 2014, a combined team from the Philippine Department of Health, Department of Agriculture, and the World Health Organization interviewed persons who survived, those with suspected cases, and family members of the deceased and conducted focus group interviews with other persons in affected villages. Key informants from local human and animal health agencies were also interviewed, and hospital records for persons with suspected cases were reviewed. We defined a human case as illness in any person with an epidemiologic link to the municipality of Senator Ninoy Aquino and who had experienced acute encephalitis syndrome, severe influenza-like illness (ILI), or meningitis during 3 Mar-24 May 2014.

Conclusions
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Clinical presentations, epidemiologic findings, and serologic results suggest that the virus causing this outbreak was a henipavirus. It was most likely NiV or a virus that is antigenically and genetically closely related to NiV.

Epidemiologic data suggest that the most common route of virus transmission to humans was direct exposure to infected horses, contact with contaminated body fluids during slaughtering of sick horses, and/or consumption of undercooked meat from infected horses. However, for at least 5 cases, clinical and epidemiologic evidence suggest direct human-to-human virus transmission. No protective equipment was used by those who cared for case-patients in the home, and health care workers used gloves and a face mask but not eye protection. The evidence of human-to-human transmission in this outbreak confirms the need for preventative measures in home care and health care settings.

Although the source of the horse infections is unclear, on the basis of the known ecology of henipaviruses, the most likely source is fruit bats (family _Pteropodidae_). Bats belonging to this family were reported near at least 1 of the 2 villages.

--
communicated by:
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[Although this is the 1st report that ProMED-mail has posted explicitly suggesting that Nipah virus infections were involved in these human and equine cases in the Philippines, there were earlier posts this year (2014) of undiagnosed human and equine cases of an undiagnosed disease in Sultan Kudarat province that undoubtedly are the same ones reported above.

In the earlier report, Mod.LL suggested that a Hendra-like virus might be involved. Nipah virus, which is endemic in south east and south Asia, seems more likely to be the etiological agent responsible for this outbreak than Hendra virus, which is endemic in Australia. Genomic analysis shows the viruses isolated from the outbreak are closely related to Nipah virus as do serological tests from sampled surviving humans.

 

[alert]

Re: Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause - Nipah-like henipavirus confirmed

I have merged this thread from three separate threads above, as it is clear that this is a single outbreak.

I would note that if this is the Nipah virus seen previously in Bangladesh and India, 7-15 deaths in over 100 cases would be a lower-than-expected CFR, but they may have included unrelated milder illnesses in the report.

 

[Ronan Kelly]

Re: Philippines: International help sought to diagnose the deaths of 7 people who died after eating horsemeat that died of unknown cause - Nipah-like henipavirus confirmed

Philippines bans eating meat of dead horses over Nipah virus cases
Reported deaths of people who contracted Nipah virus in two villages raises alarms
By Barbara Mae Dacanay, CorrespondentPublished: 21:47 November 28, 2014 Gulf News

Manila: Butchering dead horses and eating their meat has been banned in the southern Philippines due to the reported deaths of people who contracted Nipah virus in two villages in the southern Philippines in April.
The incident was investigated by representatives of the World Health Organisation (WHO) in May, but was not reported to the public, sources told Gulf News on Friday.
...
Of the 17 cases reviewed by the Philippine National Epidemiology Centre, WHO, and the health department, ?fatality rate among those with acute encephalitis syndrome was 82 per cent,? said the report, which did not specifically mention if 13 or 14 people had died.
?One survivor with acute encephalitis syndrome experienced residual severe cognitive impairment, motor weakness, and ataxia,? said the report, adding that one survivor with acute encephalitis syndrome ?experienced persistent ophthalmoplegia (paralysis of eye muscles)?.
Seven of the 17 cases (or 41 per cent) butchered horses that had previously died and ate their meat, said the report, adding that three of the cases also ate the meat but did not help prepare the dead horses.
...
http://gulfnews.com/news/world/phil...-dead-horses-over-nipah-virus-cases-1.1419512