Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

[tropical]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

Thank you Dr. Niman.

Snowy, the Peruvian cited text seems downplaying if they still must be quarantined offshore:

El Ministerio de Salud de Perú descartó hoy las informaciones que indicaron que había dado una alerta de epidemia en el puerto limeño del Callao después de que dos ciudadanos chinos murieran en un barco de pesca.
...
"Ramírez dijo que el ministerio realiza la investigación sanitaria y ha tomado 'todas las medidas que corresponden', de acuerdo a las normas nacionales e internacionales, en salvaguarda de la población."

"las medidas" este quarantina?

 

[Giuseppe]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

One should keep in the mind other agents and no anticipate diagnosis as little is known about how exactly things happened.
Adenoviral disease is only one of the possible agent - as indicate from newswires - and there isn't reason to speculate about a bird flu infection or novel adenovirus strain until precise laboratory results will be released.
I repeat that it is important to highlight the HK SAR experiences in the last few weeks: several pediatric severe respiratory illneess with 1) H1N1 necrotizing encephalitis, 2) two cases of human metapneumovirus, 3) EV-71 (hand-mouth-foot disease).
Further, there isn't mention of intermediate ground vacancy for the ship crew. It is possible that other boat crew (from either China or south american countries personnell) to enter in contact with the 20+ chinese crew and pass an infectious agent via direct contact or via vector(s) or food contaminants.
Pneumonia with haemorrhages could be a result of septic shock secondary to another infection or toxic reaction.

 

[Gert van der Hoek]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

machinetranslated

April 20 , 2008

Health Ministry dismisses warning of epidemics in Callao

The Ministry of Health has not given a warning of epidemics in Callao as a result of the death of two Chinese citizens on board the vessel Chan An 168 the past 6 and April 8, stated that portfolio.


The director general of Epidemiology (EDM) Minsa, Gladys Ramirez, explained that the said vessel is kept in quarantine as a precautionary measure. The director general of Epidemiology (EDM) Minsa, Gladys Ramirez, explained that the said vessel is kept in quarantine as a precautionary measure.

"Peru has made a health intervention to this Chinese vessel on April 9 in coordination with the Maritime Captaincy and the Public Prosecutor to determine the death of the Chinese crew as a measure of preventive kind, according to the regulation," he said.

He said that such intervention was due to the fact that Peru is a member state of the World Health Organization (WHO) and in compliance with the International Health Regulations.

It also indicated that the investigation conducted with the clinical examinations performed the crew resulted in the ship's 21 crew members were in good health with no fever and no signs of alarm.

According to the laboratory results available to date, we have identified adenovirus in 8 of the 21 crew members.

However, he pointed out that the adenovirus is a germ common in the general population and causes respiratory infections not serious or fatal.

To date there is no evidence that the adenovirus identified as the direct cause death of two crew members.

The epidemiologist said that 14 days have passed since the death of the first case, and none of the 21 crew members presented evidence of a serious illness.

Even he continued, the crew member who attended one of the deceased giving mouth-to-mouth is currently asymptomatic and enjoys good health.

Finally, reported that Minsa through their bodies has been conducting the investigation and has taken all the steps that are as set out in national regulations and international public health, safeguarding the general population.

http://www.terra.com.pe/noticias/articulo/html/act1220326.htm

 

[tropical]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

"the said vessel is kept in quarantine as a precautionary measure"

We see that the news feed was correct - the off shore ship qurantine is going on.

The good news is that for now:

"The epidemiologist said that 14 days have passed since the death of the first case, and none of the 21 crew members presented evidence of a serious illness.
Even he continued, the crew member who attended one of the deceased giving mouth-to-mouth is currently asymptomatic and enjoys good health."

Every time such suspected things happened, the official bodies feel that they must trying to minimize the question, instead of giving more details.

Obviously, we would see the same behaviour with much more minimization if realy something bad starts, no matter where.

 

[Giuseppe]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

[PROMED Moderators Commentary excerpts. IOH]

(...)
[The identification of a 'mutated' adenovirus as the suspected cause of the deaths of members of the crew of a Chinese fishing vessel anchored off Callao is surprising.

''Adenoviruses are ubiquitous viruses that can be isolated from both sick and healthy individuals.

''Antibodies can be detected in virtually all humans, indicative of infection early in childhood and possible life-long persistence in adenoid and lung tissue.

''Morbidity and mortality associated with adenovirus infection are low, but adenovirus-associated respiratory and gastrointestinal disease can be serious especially in immunologically compromised patients.

''There are at east 170 serotypes of adenoviruses, about 50 of which
have been isolated from human sources.

''The designation 'mutant' or 'mutated' adenovirus is meaningful only in the sense that the adenovirus recovered from the affected individuals is associated with signs and symptoms not usually encountered in adenovirus infections.

''An adenovirus, however, cannot be excluded as the potential etiologic agent, particularly as the description of living conditions on board the fishing vessel suggest that the resistance of the crew to any infectious agent may have been very low.

''Information of the condition of the other crewmembers and those in quarantine will be relevant in confirming the diagnosis. - Mod.CP]

The interactive HealthMap of Peru can be accessed at
http://healthmap.org/promed?v=-9.2,-75.9,5.

Callao is located west of Lima, the country's capital, and is part of
the Lima Metropolitan Area. - Mod.CP

''Given the long time since the vessel left China, the disease was most likely introduced by one of the new crew members who went aboard in March 2008 (we are not told whether the fatal cases were those same 2).

''The adenovirus type is not stated, but the ProMED reader who contributed this report has suggested that it could be type 14, which has a 20 percent mortality rate -- see ProMED post Adenovirus 14-associated pneumonia - USA (OR) 20071010.3334.

''I quote Mod CP's comment on that report: "Human adenovirus 14 has not previously been regularly associated with human respiratory disease. It is perhaps too soon to designate human adenovirus 14-associated pneumonia as an emerging disease rather than perhaps a co-factor in an unusual disease situation."

''Given the prevalence of adenovirus antibody in the general population, could the finding of the virus in the fatal cases be merely a co-factor, or even a coincidence, with the actual etiology of the fatal cases being some other micro-organism? - Mod.JW]
-
http://apex.oracle.com/pls/otn/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,72300
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[Gert van der Hoek]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

Machinetranslated; no news, but a summary of the situation, from a Peruvian TV-channel


Mystery at Peruvian sea

A strange disease afflicting crew of a Chinese fishing boat, moored off the coast of Peru

Lima, Peru, in April. 22, 2008 .- The Chinese vessel An Chan 186, with 22 crewmen on board, departed from his country in August last year. It's a conditioned boat to fish pots and shrimp.

After an eight-month voyage by sea in the world, arrived on April 8 at the port of Callao, in the department of Lima, capital of Peru. The Chinese boat had no other contact on the ground, although in December and March was found at sea to other ships, which moved its cargo.

Everything seemed normal routine as usually happens in those long fishing operations internationally. What is not known, then, is that inside the boat and a dangerous disease silently walked their decks.

On April 8, when the 186 docked Chan An 10 kilometres from the port, just learned that an evil stranger had caused the deaths of two Chinese sailors 40 and 38 years old and was decimating the health of other crew members.

A day after the April 9, the Peruvian authorities, in compliance with the International Health Regulations, conducted a health intervention to the boat. In the necropsy of law was established that fishermen died from pneumonia, but the alarms were lit to confirm the presence of a mutated adenovirus that damages the respiratory system and intestines.

The adenovirus is a virus that is transmitted through respiratory and is more common in children. Epidemiologists say that it is extremely rare deaths that occur because of this virus.

The Directorate of Criminal Investigation is examining drugs and food eaten by the deceased, but just be known next week the results of this investigation.

Meanwhile, the Ministry of Health ordered the quarantine order. Spokespeople from the Institute of Forensic Medicine indicated that the Chinese vessel will remain in isolation, while identifying the scope of the disease.

The fear is that this is a virus that spreads rapidly expanding not only by physical contact, but also by air. The director general of Epidemiology, Gladys Ramirez has said that these deaths do not have the same characteristics as the dreaded bird flu.

At the time of the inspection took samples, and based on that, the National Reference Laboratory has been discarded for all types of influenza. All this is ruled out because the only thing they found was a pattern of common cold noted. So far, everyone who jumped ship to conduct the investigations are in good health, like most of the crew.

Why then two sailors died Chinese victims of a common cold, shortly before reaching territorial waters of Peru?

Why eight other Chinese sailors symptoms similar to those that caused the death of his companions, although fortunately they have not developed the disease?

These are questions that still have no answer, but in anticipation of any epidemic, the Chinese vessel Chan An 186 remain in quarantine and the Peruvian Navy has orders to monitor 24 hours a day to keep their crews try to leave the boat.

http://www.esmas.com/noticierostelevisa/noticieros/725871.html

 

[tropical]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

"Why then two sailors died Chinese victims of a common cold, shortly before reaching territorial waters of Peru?"

If indeed we can assume as correct that after 2 weeks of the deaths an enaugh portable lab taken on the ship by the navy spec. (quarantined also) escluded any kind of flu viruses, than we can speculate because of the deadly pneumonia an SARS, or mutated adenovirus, or ..., realy.

I can't see why an mutant adenovirus must be unlikely?

Many labs use that virus like a flu vaccines vector (FT threads), we saw reports of outbreaks of already mutated adenovirus strains in the Americas, maybe elsewhere. That's enaugh to suspect on it, also.

 

[Gert van der Hoek]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

machinetranslated

Quarantine Chinese boat in Callao lifted


After conducting an investigation, the Ministry of Health lifted the preventive quarantine the vessel China Chang An 168, where the past 6 and April 8 killing two people.

Ministry of Health Andean

A press release sector reported that such deaths do not represent a risk of epidemic in the country, do not involve significant risk of international spread and not merit restrictions for international trade.

. According to Annex 2 of the International Health Regulations, the incident, described as unusual, not an event for serious international public health.

Causes still not certain

. In addition, studies by the technical expert group of six institutions and addresses of the Ministry of Health, concluded that six of the triupulantes of the boat with mild acute respiratory infection, was detected adenovirus; however, is self-limiting in six affected the 21 crew members.

. But in the case of the deceased, the cause is still under study, but said it was possible to establish which do not constitute a risk to public health.

There is no danger

. The report adds 16 days have elapsed since the death of the first crew member and that others no symptoms of illness.

The ship remained in international waters for eight months, since leaving the People's China, which took away the possibility of carrying a virus epidemic in that region, according concluded technical committee.

http://www.terra.com.pe/noticias/articulo/html/act1224428.htm

 

[tropical]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

Than, changed adenovirus agent, and emergency over.

After 8 months of ship off shore I shall leave the folks another 2 weeks more without landing to reach the 40 days from onset (just in case ...)

 

[Gert van der Hoek]

Re: Undiagnosed Deaths, Chinese Fisherman - Peru (Callao)

UNDIAGNOSED DEATHS, CHINESE FISHERMEN - PERU (03): TOXIN SUSPECTED
******************************************************************
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: Mon 5 May 2008
From: Cesar Carcamo <carcamo@u.washington.edu


Peruvian National Institute of Health (INS): quarantine lifted
--------------------------------------------------------------
Members of the Chang An 168's crew and the Peruvian personnel in
contact with them are in good health, and local health authorities
therefore lifted the quarantine on [22 Apr 2008].

According to the ship's captain, the only symptom in the 2 fatal cases
on board of the ship was fever, 5 and 2 hours (respectively) prior to
death, but the language barrier has precluded a more detailed
investigation. [Poor excuse: there is a Chinese restaurant in every
major city worldwide! - Mod.JW]

Immunofluorescence showed evidence of adenovirus infection in the 2
cases and in 6 other crewmembers. No evidence of other respiratory
viruses has been found. Cultures for adenovirus are being processed
at this time, but there is still no evidence of a "mutant" strain.
Tests for leptospirosis were negative in all crewmembers. Upon
contact with Peruvian health personnel, 15 of the fishermen had mild
respiratory symptoms, but none had fever. No evidence of adenovirus
or respiratory symptoms has been found on a crewmember that provided
mouth-to-mouth breathing to one of the victims.

Autopsies on the fatal cases showed evidence of pneumonia and
cerebral edema. Histopathology revealed evidence of a toxic process,
although samples from the corpses were negative to 12 toxins
evaluated.

The ship set sail from Yan Tai on 19 Aug 2007 and has remained at sea
since. The Chang An 168 remained quarantined since 15 Mar 2008, when
it delivered its cargo to the (mother ship) Dong Fen in international
waters.

***Investigators interested in collaborating with the toxicological
studies can contact Dr Patricia Garcia, Chief of the Peruvian
National Institute of Health at pgarciaf@ins.gob.pe

--
Cesar Carcamo, MD, MPH, PhD
Universidad Peruana Cayetano Heredia
Lima, Peru
carcamo@u.washington.edu

[Although this may be a suspected toxin, it is difficult to judge just
what it might be. There are 2 previous articles discussing adenovirus
and flu, but aside from a mention of fever of undetermined origin
(FUO) and what may have been excessive pain, there is not a lot of
basis to speculate on a toxic cause. The evidence is confusing and
hopefully something more definitive will be identified. - Mod.TG]

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,72430