Viet Nam - Quang Ngai: Undiagnosed illness, 26 fatalities since April 2011

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

http://usa.chinadaily.com.cn/world/2012-05/11/content_15272054.htm

Mysterious disease claims two more dead in Vietnam
Updated: 2012-05-11 15:48(Xinhua)

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HANOI - The skin disease in Vietnam's central province of Quang Ngai has left two more dead, said Dang Thi Phuong, director of the affected Ba To district's Healthcare Center on Friday.

So far, the disease has left 21 dead in the province, some 730 km south of capital Hanoi, among 201 infected victims.

Late April, the provincial health department reported 14 out of 26 blood samples from patients were positive for the Rickettsia Virus which is transferred from animals to people by lice or fleas.

Recently, the Vietnam's Ministry of Health has sent a delegation of 70 experts to Ba To district to train local healthcare staff on the syndromes of the disease.

After the training, the delegation is scheduled to conduct studies on the disease in the district for five days and carry out research on clinical syndromes, micro-organisms, the living environment and epidemiology to identify the real cause of the disease.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

This probably rules out typhus; typhus would be permanently cured by antibiotics:

http://vietnamnews.vnagency.com.vn/social-issues/224649/doctors-unable-to-cure-mystery-disease.html

Updated May, 14 2012 10:07:40 Email
Print Doctors unable to cure mystery disease

QUANG NGAI — Local doctors say that patients with a mysterious skin condition in the central province of Quang Ngai cannot be cured completely because they still do not know how it is caused.

Although 10 missions have been sent to the epicenter of the diseases, Ba To District, no conclusion has been drawn about the skin condition that has so far killed at least 21 and infected more 230 people.

Several patients have recovered well from their illness at hospitals, but the condition has recurred after their discharge, often more seriously than the first time, according to an unnamed official from the Quang Ngai People's Committee.

There has been a sudden increase in the number of patients in recent days because health officials have identified an additional 19 people infected with the disease during an inspection of the locality, according to the latest report from the province's Health Department.

Dang Thi Phuong, director of the Ba To District's healthcare centre, said most of the infected people chose not to go to the hospital, making it difficult to know the exact number of patients suffering the disease.

The disease has relapsed in nearly 50 per cent of the total number of infected cases. Among the 21 fatalities, at least 10 people had the disease recur with serious complications including multiple organ failure.

After contracting the disease, most patients choose to stay at home because they do not believe that their illness can be treated well in hospitals, the report says.

The Quy Hoa National Leprosy and Dermatology Hospital has been the favourite choice of residents so far, but several patients have had to be transferred to other hospitals after developing serious symptoms like organ failure.

Recently, the Binh Dinh General Hospital received nine patients with serious complications of the disease. Four have died and the other four have temporarily recovered. One child is in intensive care.

The Nguoi Lao Dong (The Labourer) newspaper quoted Nguyen Hoang Minh, deputy director of the Binh Dinh General Hospital, as saying that the death rate was high when the disease affected internal organs of the patients.

Minh said that the nine patients the hospital received were those who had suffered serious complications. They'd only had skin treatment at the Quy Hoa National Leprosy and Dermatology Hospital during the early time of illness.

Minh admitted that the hospital could only help the patients overcome their critical health symptoms, but could not treat the disease completely because the cause of the illness was not known.

Meanwhile, a Tuoi Tre newspaper report yesterday cited Le Han Phong, head of the Ba To District People's Committee as urging the Ministry of Health to take help immediately from the World Health Organisation in identifying the cause of the disease which has occurred in the locality for roughly three years now. — VNS

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

http://www.mysinchew.com/node/73548

Fatal skin disease in central Vietnam remains mystery: official
Foreign 2012-05-15 17:29
HANOI, May 15 (Xinhua) -- The Vietnamese Ministry of Health dismissed the idea that a transmissible skin disease was responsible for the 21 deaths and over 200 cases that have occurred in Vietnam's central Quang Ngai province since April 2011, reported Vietnam News Agency on Tuesday.

The report quoted Deputy Minister of Health Nguyen Thanh Long as saying that so far no sign of infection was found, which means the condition is not caused by a virus or bacteria. There is no proof of that the disease is spread through the air, via a water source or between humans.

Long made the statement at a press briefing in Hanoi on Monday after the ministry completed a fact-finding mission to the province's Ba To District, some 730 km south of capital Hanoi.

Long also confirmed that the ministry still had not identified the cause of the disease, called Inflammatory Palhoplantar Hyperkeratosis Syndrome, which is characterized by thickened skin over the palms of the hands and soles of the feet. A majority of the patients also developed liver problems.

Most of patients died because of multi-viscera failure, liver poisoning and immune deficiency, Long added.

The deputy ministry said that more than 1,900 diseased samples had been collected for testing at all laboratories nationwide with the support of international experts from the World Health Organization (WHO), the United States' Center for Disease Control and Prevention (CDC) and Japan.

The ministry also confirmed that they would collaborate closely with WHO, CDC and other international organizations to find the cause in the near future.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

http://english.vietnamnet.vn/en/society/22308/bizarre-skin-disease-caused-by-several-agents.html

Last update 14/05/2012 11:01:00 AM (GMT+7)


Bizarre skin disease caused by several agents
VietNamNet Bridge ? The Ministry of Health?s mission finished their field-trip survey in Ba Dien commune in the central province of Quang Ngai, and defined several elements that cause the strange skin disease, including moldy rice, fleas and environment.




Health workers decontaminate water resources in Reu village, where 21 people died of the
unknown skin disease.


Dr. Phan Trong Lan, Vice Chief of the Preventive Medicine Agency, confirmed that many elements caused the strange disease.
He said that experts detected Aflatoxin toxin in moldy rice (which is fermented under the custom of H?re ethnic minority people) used by local people. ?This toxin is dangerous for the liver. It can cause cirrhosis and even liver cancer,? he said.

The Ministry of Health asked the local government to provide white rice to the people.

Dr. Trieu Nguyen Trung, director of the Central Institute for Malaria and Parasitology, said that polluted environment is another element.

According to Trung, most of local people live in narrow houses on stilts, which do not have windows. They raise cattle under their houses. Experts found out a lot of fleas in their sedge mats. These mats were destroyed and locals were provided with new mats.

Experts said that of the four villages that have strange skin diseases, the environment in Tuong village was better so it had fewer patients than the three others.

The Ministry of Health is releasing an official report on May 14.

A patient named Pham Thi An, who has hospitalized for over 10 times but her disease has not been cured yet, has been moved to the Hue Central Hospital. She will be given a free liver transplant. Up to four people in Ms. An?s family got this disease. Her son died.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

http://www.saigon-gpdaily.com.vn/Health/2012/5/101200/

Tuesday, May 15, 2012, Posted at: 15:09(GMT+7)

No recorded medical document of bizarre skin disease: Ministry
At a press conference in Hanoi on May 14, health officials announced that since last April the bizarre skin disease that has been plaguing the central province of Quang Ngai is still a mystery, as no such disease has ever been recorded in any medical document.

The conference in Hanoi was meant to highlight the dangers of the disease and the unknown causes, one being suspected to be high toxic substances in malnutritioned patients.



Multi-vitamin supplement tablets given to local residents

Nguyen Thanh Long, Deputy Minister of Health, said that medical experts found no signs of contagious infection, which meant that the condition is not caused by a virus or bacteria. This was revealed after the ministry completed a fact-finding mission in Ba To District in Quang Ngai Province.

The ministry also dismissed the idea that a transmissible disease was responsible for the 21 deaths and over 205 cases from April 19, 2011 to May 13, 2012.

There was no evidence of a virus or bacteria in the tested water, air, soil or food samples. There is no proof that the disease is transmitted through air, water or between humans, Long said.

Noticeably, the deputy minister said experts found mouldy fungus and Aflatoxin in rice samples which were nearly five times higher than in other areas. Aflatoxin, a toxic fungus, is recorded in medical documents in the world for causing chronic and acute liver damage. Kenya and India have experienced epidemics caused by the toxic with high fatality rates of over 26 per cent.

In healthcare journals, people suffer from dermatitis but no liver damage and vice versa; consequently, the health sector will focus on the relation between skin dermatitis and liver damage.

The ministry has still not identified the cause of the disease, called inflammatory palhoplantar hyperkeratosis syndrome, which is characterised by thickened skin over the palms and soles. A majority of the patients also develop liver problems.

The deputy minister said that more than 1,900 diseased samples had been collected for testing in laboratories nationwide with the support of international experts from the World Health Organisation, the US Centre for Disease Control and Prevention (CDC) and Japan.

The ministry also confirmed that they would collaborate closely with WHO, CDC and other international organisations to find the cause of the disease.

Long affirmed that the ministry is targeting to reduce the affliction in people; subsequently, it ordered medical experts and medics from central hospitals to provide training to local healthcare workers.

Moreover, disinfectants have been sprayed and the government has distributed new mattresses, blankets and mosquito nets to residents in Ba Dien Commune as well as medicines to local residents.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Didn't they earlier state they had 14 confirmed cases of Rickettsia?

http://vietnamnews.vnagency.com.vn/social-issues/224700/fatal-skin-disease-remains-a-mystery.html

Updated May, 15 2012 09:55:58 Email
Print Fatal skin disease remains a mystery

HA NOI — Health officials yesterday dismissed the idea that a transmissible disease was responsible for the 21 deaths and over 200 cases of a mysterious skin condition that have occurred in central Quang Ngai Province since last April.

"We found no sign of infection, which means the condition is not caused by a virus or bacteria," said Deputy Minister of Health Nguyen Thanh Long at a press meeting in Ha Noi yesterday after the ministry completed a fact-finding mission to the province's Ba To District.

"There was no evidence of a virus or bacteria in the tested water, air, soil or food samples. There is no proof of that the disease is transmitted through the air, via a water source or between humans," he added.

Long also confirmed that the ministry still had not identified the cause of the disease, called inflammatory palhoplantar hyperkeratosis syndrome, which is characterised by thickened skin over the palms of the hands and soles of the feet. A majority of the patients also developed liver problems.

"We are thinking about the fact that a lot of the patients were not well nourished. We also found mouldy fungus and Aflatoxin in rice samples at a rate of nearly 5 times higher than in other areas," said Long.

Aflatoxin is a fungal toxin that commonly contaminates maize and other types of crops during production, harvest, storage or processing. Exposure to Aflatoxin is known to cause both chronic and acute liver damage.

The deputy minister said that more than 1,900 diseased samples had been collected for testing at all laboratories nationwide with the support of international experts from the World Health Organisation, the US Centre for Disease Control and Prevention (CDC) and Japan.

Regarding public scepticism over the effectiveness of the disease treatment guideline, Long emphasised that it worked and had been updated three times by the country's leading experts since its introduction a few weeks ago.

Long also added that most of patients died because of multi-viscera failure, liver poisoning and immune deficiency. In the most recent two fatal cases, one patient did not go to hospital for treatment and the other had already been diagnosed with cancer.

The ministry also confirmed that they would collaborate closely with WHO, CDC and other international organisations to find the cause in the near future. — VNS

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Is it possible that this "outbreak" is the result of inadvertently aggregating several different illness occurring in the same location? Perhaps. Either Aflatoxin poisoning or Rickettsia infection (or both!) would explain the rapdily fatal illness with liver failure. Considering that most of the 21 fatalities died at home, it is possible that may represent a total fatality count for all causes. We have plenty of examples of outbreaks here at FT where a "mystery" disease was in fact severeal known ailments.

This would likely explain as well why there are conflicting reports of whether or not the illness is febrile; some of it is, and some of it isn't.

The problem with this explanation, at this point, is we don't seem to have any explanation of the skin rash that started this thread. That doesn't seem to be compatible with any of the diagnoses confirmed so far, raising the possibility that there is at least one more undiagnosed etiology going on here.

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Apparently, vitamins are the correct treatment for aflatoxin poisoning:

http://en.wikipedia.org/wiki/Aflatoxin

[snip]

Symptomatic and supportive care tailored to the severity of the liver disease may include intravenous fluids with dextrose, active vitamin K, B vitamins, and a restricted but high-quality protein diet with adequate carbohydrate content.

 

[Ronan Kelly]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Last update 15/05/2012 10:00:00 AM (GMT+7)

Bizarre skin disease patients in poor nutrition
VietNamNet Bridge ? The Ministry of Health on May 14 officially released a report on the unknown skin disease in Bao To district of the central province of Quang Ngai.

According to the report, poor nutrition is the major reason causing the disease. Dr. Nguyen Thanh Long, Deputy Minister of Health, said that up to 94 percent of blood samples revealing B3 vitamin deficiency. Most of patients who had high liver enzyme were in poor nutrition state and in blood deficiency.

Tests conducted by the Nagasaki University, Japan, show that the disease is not a communicable disease.
...
http://english.vietnamnet.vn/en/society/22343/bizarre-skin-disease-patients-in-poor-nutrition.html
Experts confirmed to not find threats caused by virus or bacteria from tested samples of soil, water, or food.

 

[Ronan Kelly]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Health Ministry held a press conference on the horn syndrome gastritis hands, feet washing in three districts, Quang Ngai (14/05/2012 04:44)
Pm on 14.05.2012, at the Health Ministry press conference took place on gastro-horned hands and feet (strange disease) in the Ba district - Quang Ngai.
Attended and chaired the press conference with Dr. Nguyen Thanh Long - Deputy Minister of Health, and representatives of Heads of Department / Department of the Ministry of Health, Center and Office. On the international organizations with WHO representative in Vietnam, CDC director of disease control in Vietnam. From the province of Quang Ngai is BS. Director Dang Thi Phuong district TTYT Ba To, Quang Ngai, and all agency media under the Ministry of Health, the central media attended and reported on for the press conference.



At the press conference Deputy Minister Nguyen Thanh Long said horn syndrome gastritis hands, feet are recorded from the date 19/04/2011, 13/05/2012 accumulated to date in the district has recorded Ba 205 cases in 5 communes are: Ba Dien, Three Amazingly, Ba Xa, Ba Vinh and Ba team which has recorded 10 deaths in Ba Dien commune. From early 2012 to the date of 13.05.2012 has recorded 115 cases re: 9 deaths were in Ba Dien commune. The number of patients in the treatment of 33 cases.

The results of the surveys, survey and evaluation of the sample did show that disease reported in 5 communes but the focus in social Ba Dien (95.1%), especially in the village of Moss ( 106) people, with 7 100% of households with family members were infected, all patients who H're. Patients with dermatitis manifested as thick horn hands, feet; almost all patients with increased liver enzymes on the local poor nutritional status, anemia is common. Not that these factors proved to be infectious (virus, bacteria) syndrome due to infection, laboratory confirmation of disease blood samples at the University of Nagasaki by Pyro techniques - sequencing compared to bank genes in 240 species of viruses, bacteria showed no infectious agent. No evidence was found to spread from person to person. Not found in plant protection chemicals including their carbamate, organic chlorine, organic phosphorus synthesis Chrysanthemum in soil samples, rice water tested. There are many types of mold found and discovered aflatoxin in rice samples annealed, annealed, tested rice. The scientific council has identified: "The thick horns dermatitis hands, feet much thought to cause local toxicity on patients with poor nutritional status."

Under these circumstances the Health Ministry has directed the Central Hospital officials have sent many professional qualifications of the district health center Ba, General Hospital of Quang Ngai province for training and professional support in place . Currently there are 4-5 doctors of the Hospital Central Phong and Quy Hoa Dermatology, Central Hospital Dermatology to help detect, diagnose, treat patients at the Center for Health and Social Ba Ba Dien. Organizations classified as treatment with the participation of the Central Hospital closed in the area, organizations and screening patients in the community and patients receiving treatment at commune health stations with the support of the higher echelon . Adequate treatment for the Medical Center District Three silk, drugs birth Day, vitamin synthesis, anti-trust ... Morning 14/05/2012 Ministry of Health has provided 01 ambulances to district health centers to serve the Ba and transfer emergency patients, dialysis machine for 01 machines and biochemical tests for the Health Service Advertise Ngai.



According to current forecasts the health sector is actively implementing interventions to reduce deaths, reduce suffering. With the active intervention has and will implement, the death toll in the coming period will be reduced. However, questions will be slower due to reduced current may be the causative agent in most infected people in this community, and the disease in the future, but when the pathogen to interfere, excluded, the cases will be reduced.

Editorial Board Electronic Portal Department of Health
http://www.moh.gov.vn/wps/portal/bo..._tinhoatdong/32bb51004b3d7ef9b352fbcab175044f

Press release in Vietnamese (PDF) http://www.moh.gov.vn/wps/wcm/conne...bcab175044f/Thong+cao+bao+chi.pdf?MOD=AJPERES

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Last update 15/05/2012 10:00:00 AM (GMT+7)

Bizarre skin disease patients in poor nutrition
VietNamNet Bridge – The Ministry of Health on May 14 officially released a report on the unknown skin disease in Bao To district of the central province of Quang Ngai.

According to the report, poor nutrition is the major reason causing the disease. Dr. Nguyen Thanh Long, Deputy Minister of Health, said that up to 94 percent of blood samples revealing B3 vitamin deficiency. Most of patients who had high liver enzyme were in poor nutrition state and in blood deficiency.

Tests conducted by the Nagasaki University, Japan, show that the disease is not a communicable disease.
...
http://english.vietnamnet.vn/en/society/22343/bizarre-skin-disease-patients-in-poor-nutrition.html
Experts confirmed to not find threats caused by virus or bacteria from tested samples of soil, water, or food.

And that might do it. Vitamin B3 is also known as niacin, and deficiency causes:

http://en.wikipedia.org/wiki/Vitamin_B3

Severe deficiency of niacin in the diet causes the disease pellagra, which is characterized by diarrhea, dermatitis, and dementia, as well as “necklace” lesions on the lower neck, hyperpigmentation, thickening of the skin, inflammation of the mouth and tongue, digestive disturbances, amnesia, delirium, and eventually death, if left untreated.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

According to Wikipedia (http://en.wikipedia.org/wiki/Quang_Ngai), the total population of Quang Ngai is 119,251 people. I have to imagine that Ba To district as a whole within the province has a population of only a few thousand people, so in the four affected communes within Ba To, I have to imagine that 230 or so people represents a significant attack rate, which would be consistent with this explanation, since everyone in the commune would be eating the affected food.

This would also explain the fact that the patients transported to Hanoi or Singapore recovered and then relapsed after returning home; they ate uncontaminated food in the hospital, and then returned home and went back to eating the toxic/nutritionally deficient rice.

We will see if this explanation holds up any better than the previous ones.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

And yet another etiology suspected:

http://www.bbc.co.uk/news/world-asia-18065786

Poisoned soil suspected cause of Vietnam illness
Medics say early intervention is key to treat the mystery infection successfully

A mystery illness that has claimed 21 lives in Vietnam may have been caused by poisonous heavy metals in the soil and toxic mould on rice, officials say.

At least 200 other people have been made ill by the condition, which begins with a skin-rash but can progress to liver problems and organ failure.

Health advisers have been sent to the Ba To area, in the central province of Quang Ngai, to determine the source.

Vietnamese officials said many of those who fell ill were also malnourished.

This meant their immune systems did not have the resources to fight the disease, they said.

The World Health Organization has said an epidemiologist is working with authorities in the affected area to try and establish the cause of the outbreak.

According to the health ministry, initial findings reveal that victims have been poisoned by a chemical imbalance in the soil.

Investigators have found traces of heavy metals including arsenic, lead, cadmium and mercury in the soil, though the exact source is not yet known.

Officials also found mould growing in uncooked rice which had been improperly stored due to a lack of facilities.

The ministry said it is sending a team to help teach people to protect themselves, and to supply dialysis machines to local medical centres.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

http://www.tuoitrenews.vn/cmlink/tu...-bizarre-skin-disease-remains-mystery-1.72045

[snip]

There has been no evidence of the disease transmitting through air or from human to human, Long said. ?I have stayed in the affected areas for two days and came into contact with 20 patients, but I remain unaffected.?

When asked by Tuoi Tre about seeking assistance from international organizations, Long said biopsy samples of patients? skin and liver have also been sent to some foreign institutions, including Nagasaki University, for testing.

 

[Anne]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

automatic translation :
http://www.passeportsante.net/fr/Solutions/PlantesSupplements/Fiche.aspx?doc=vitamine_b3_ps
Pellagra is characterized by what is called the disease of 3 D: dermatitis, dementia and diarrhea, and if untreated, death can ensue. The symptoms of pellagra result in skin irritation with redness of the face, neck and limbs (redness resembling a sunburn), muscle weakness, dizziness or lightheadedness, headache, and nausea, vomiting, diarrhea, loss of appetite, inflammation of the lining of the mouth and tongue red and swollen, and psychological problems (bad mood, irritability, anxiety, depression).

no fever.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

http://www.promedmail.org/mbds

Published Date: 2012-05-16 23:23:24
Subject: PRO/MBDS> Undiagnosed Illness - Viet Nam (09): Quang Ngai, update (RFI)
Archive Number: 20120516.1122

UNDIAGNOSED ILLNESS - VIET NAM (09): QUANG NGAI, UPDATE (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: Tue 15 May 2012Source: Sai Gon Giai Phong [edited]http://www.saigon-gpdaily.com.vn/Health/2012/5/101200/


No recorded medical document of bizarre skin disease: Ministry
--------------------------------------------------------------
At a press conference in Hanoi on [14 May 2012], health officials
announced that since last April [2011] the bizarre skin disease that has
been plaguing the central province of Quang Ngai is still a mystery, as
no such disease has ever been recorded in any medical document.

The conference in Hanoi was meant to highlight the dangers of the
disease and the unknown causes, one being suspected to be highly toxic
substances in malnourished patients.

Nguyen Thanh Long, Deputy Minister of Health, said that medical experts
found no signs of contagious infection, which meant that the condition
is not caused by a virus or bacteria. This was revealed after the
ministry completed a fact-finding mission in Ba To District in Quang
Ngai Province.

The ministry also dismissed the idea that a transmissible disease was
responsible for the 21 deaths and more than 205 cases from 19 Apr 2011
to 13 May 2012.

There was no evidence of a virus or bacteria in the tested water, air,
soil or food samples. There is no proof that the disease is transmitted
through air, water or between humans, Long said.

Noticeably, the deputy minister said experts found mouldy fungus and
Aflatoxin in rice samples which were nearly 5 times higher than in other
areas. Aflatoxin, a toxic fungus, is recorded in medical documents in
the world for causing chronic and acute liver damage. Kenya and India
have experienced epidemics caused by the toxic with high fatality rates
of over 26 per cent.

In health care journals, people suffer from dermatitis but no liver
damage and vice versa; consequently, the health sector will focus on the
relation between skin dermatitis and liver damage.

The ministry has still not identified the cause of the disease, called
inflammatory palhoplantar hyperkeratosis syndrome, which is
characterised by thickened skin over the palms and soles. A majority of
the patients also develop liver problems.

The deputy minister said that more than 1900 diseased samples had been
collected for testing in laboratories nationwide with the support of
international experts from the World Health Organisation, the US Centre
for Disease Control and Prevention (CDC) and Japan.

The ministry also confirmed that they would collaborate closely with
WHO, CDC and other international organisations to find the cause of the
disease.

Long affirmed that the ministry is targeting to reduce the affliction in
people; subsequently, it ordered medical experts and medics from central
hospitals to provide training to local health care workers.

Moreover, disinfectants have been sprayed and the government has
distributed new mattresses, blankets and mosquito nets to residents in
Ba Dien Commune as well as medicines to local residents.

[Byline: K. Nguyen]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[The newswire above highlights key points of a press conference
organized by Viet Nam Ministry of Health. Since April 2011, more than
205 people in Quang Ngai have been affected by a strange skin disease.
Among those, 21 people died. There is no evidence that the disease is
transmissible. The specific etiologic agents have not yet been
identified. However, high toxic substances in malnutrition people are
suspected to be potential causes of the disease.

PRO/MBDS would appreciate further information from knowledgeable sources
regarding this undiagnosed illness in Quang Ngai province, Viet Nam.

For a map of Viet Nam with provinces, see
http://upload.wikimedia.org/wikipedia/commons/f/f0/VietnameseProvincesMap.png.
For the interactive HealthMap/ProMED-mail map with direct links to other
outbreaks in Viet Nam and surrounding countries reported on ProMED-mail
and PRO/MBDS, see http://healthmap.org/r/008O. - Mod.QCN]

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

This is about to get bizarre. This is a different commune in the same province, but the same herbicide originally suspected in the main outbreak of the thread (and apparently dismissed).

It is unclear whether these three deaths are being counted in the 21 reported.

http://www.tuoitrenews.vn/cmlink/tu...the-culprit-of-3-deaths-in-quang-ngai-1.72511

Herbicide the culprit of 3 deaths in Quang Ngai
Updated : Fri, May 18, 2012,4:28 PM (GMT+0700)

The herbicide that contains Glyphosate, which has been found in samples of spring water and soil in Son Ha Commune, Quang Ngai Province
Photo: VnExpressAfter more than a month of investigation, Quang Ngai Province authorities have concluded that an active ingredient from a kind of herbicide used in Son Ky Commune was responsible for 3 deaths and health problems of 50 others in early April.

The herbicide is KANUP 480SL, which originated from the US and was bottled and provided by a company in northern Bac Giang Province.

Test results of samples of spring water and soil taken from the commune in Son Ha District showed they have been contaminated with glyphosate, a broad-spectrum systemic herbicide used to kill weeds, Ho Minh Nen, director of provincial Preventive Health Center, told Tuoi Tre yesterday.

The tests were carried out by the Pasteur Institute in Nha Trang City.

Glyphosate has been found in water samples at a level of nearly 1 mg per liter, while in the soil samples, the substance was measured at up to 14.3 mg per kg. These levels are above the acceptable limits.

KANUP 480SL is among plant protection chemicals that are allowed, but it has high toxicity, according to Son Ha District Plant Protection Station.

“If people have the herbicide stuck in their skin, they may get skin irritation, vomit and even die,” warned Pham Luc, head of the station.

Early last month, 19 people in the commune's Lang Rieng Hamlet were hospitalized for emergency treatment after developing bad health conditions after using and/or drinking the spring water.

Three of them later died.

After the deaths, local residents turned to water from dug wells or from other localities.
.

 

[Ronan Kelly]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Bizarre skin disease eludes Vietnam?s health officials
The unidentified skin disease plaguing Ba To District in Quang Ngai Province continues to elude Vietnam?s public health officials and medical research teams, who now have sort assistance from the World Health Organisation (WHO), the US Centre for Disease Control and Prevention and Japan?s Nagasaki University.
...
The skin disease has already claimed 21 lives and is showing an upward trend with more than 230 infectious cases; mostly in Ba Dien Commune, whose residents use the spring water, well water and ground water, which are all contaminated.

In related news, the Preventive Medicine Centre in Quang Ngai Province has concluded that ?Herbicide KANUP 480SL? is the real culprit behind three deaths and 40 infected residents in Rieng Village of Son Ky Commune in Son Ha District.
...
Test results of samples of spring water and soil taken from the commune in Son Ha District showed contamination of ?Glyphosate?, a broad-spectrum herbicide used to kill weeds. Contents of ?Glyphosate? were found in the water samples of up to 1 mg per litre, while in the soil samples, it measured up to 14.3 mg per kilogram.
...
http://www.saigon-gpdaily.com.vn/Health/2012/5/101303/

 

[alert]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

94 out of 220 samples is not the 94% cited earlier, but is instead closer to 43%, raising doubts about this diagnosis as well:

http://www.zing.vn/news/doi-song/them-3-ca-mac-benh-viem-da-la-o-quangngai/a251181.html

3 more cases of dermatitis in Quang Ngai strange

(Zing) - On 21/5 past Ba Dien commune further recorded three new cases, bringing the total number of cases of dermatitis thick horn hands, feet at Ba To, Quang Ngai to 209, which 21 people died.

Complete >> regimen strange dermatitis in Quang Ngai

In addition, 55 patients still being treated at all levels, including 4 cases of severe disease.


There were 209 cases of the strange dermatitis Ba Dien Commune, Ba To, Quang Ngai - (Photo)


Also on 21/5, the delegation of the Ministry of Health has allocated food nutrition and health advice for over 250 patients of Ba Dien commune.

Ministry of Health continues to allocate 30,000 multivitamin tablet, conduct health advice, dietary guidelines and ensure nutritional enhances the body's resistance.

Results of laboratory tests of blood samples from 220 people showed that 94 samples of vitamin B3, however, the lack of this vitamin is more impact for many cases only by lack of vitamin B3 does not yet have the clinical manifestations gastritis horn palms, feet.

 

[alert]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

http://vietnamnews.vnagency.com.vn/...more-diagnosed-with-mystery-skin-disease.html

Updated May, 23 2012 10:03:42 Email
Print More diagnosed with mystery skin disease

QUANG NGAI ? Three more people in central Quang Ngai Province were diagnosed with the mysterious skin disease on Monday, increasing the number of infected patients to nearly 240, 21 of whom are already dead.

At the moment, 55 patients are being treated in provincial and central hospitals. Four of them are in critical condition.

The Ministry of Health issued 30,000 vitamin pills and gave health and dietary advice to help local people avoid contracting the disease. ? VNS

 

[alert]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

http://www.promedmail.org/mbds

Published Date: 2012-05-23 04:16:30
Subject: PRO/MBDS> Undiagnosed illness - Viet Nam (10): Quang Ngai, update, RFI
Archive Number: 20120523.1166

UNDIAGNOSED ILLNESS - VIET NAM (10): QUANG NGAI, UPDATE, RFI
***********************************************

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 22 May 2012Source: Sai Gon Giai Phong [edited]http://www.saigon-gpdaily.com.vn/Health/2012/5/101303/


The unidentified skin disease plaguing Ba To district in Quang Ngai
province continues to elude Viet Nam's public health officials and
medical research teams, who now are seeking assistance from the World
Health Organisation (WHO), the US Centers for Disease Control and
Prevention, and Japan's Nagasaki University.

The Ministry of Health on 20 May 2012 proposed to clean up the district
water supply system in an attempt to remove any infectious bacteria.

The ministry said that health authorities in Ba To district must adopt
measures to strictly monitor the water resource to prevent residents
from being affected.

One medical team after another has taken samples of blood, hair, and the
nails of people from the affected areas, but the bizarre skin disease in
the central province of Quang Ngai has yet to be identified.

The skin disease has already claimed 21 lives and is showing an upward
trend, with more than 230 infectious cases; mostly in Ba Dien commune,
whose residents use spring water, well water, and ground water, which
are all contaminated.

In related news, the Preventive Medicine Centre in Quang Ngai province
has concluded that "Herbicide KANUP 480SL" is the real culprit behind 3
deaths and 40 infected residents in Rieng Village of Son Ky commune in
Son Ha district.

After more than a month of investigation, health officials in the
central province of Quang Ngai pointed out that the herbicide used in
Son Ky commune was responsible for 3 deaths and health problems for 40
others last April [2011]. Victims experienced symptoms of numbness of
the hands and feet and severe eye problems.

The herbicide originated from the US and was bottled and supplied by a
company in the northern province of Bac Giang.

Test results of samples of spring water and soil taken from the commune
in Son Ha district showed contamination with "Glyphosate," a
broad-spectrum herbicide used to kill weeds. Contents of "Glyphosate"
were found in the water samples of up to one mg per litre, while in the
soil samples, it measured up to 14.3 mg per kilogram.

Medical experts said that small amounts of "Glyphosate" can cause harm
to human health and even kill if it exceeds permissible limits.
Accordingly, health authorities have asked residents to dig wells at a
depth of 6-8 metres to replace the current water supply.

[Byline: Ng. Khanh, H. Minh]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[The newswire above updates information regarding the strange skin
disease in Ba To district, Quang Ngai, which affected more 230 people;
among those, 21 have people died since April 2011.

The article says the Ministry of Health asked the district to clean up
the water supply system, as all water supply sources in that area were
contaminated. However, the article does not provide information about
the type of contamination. International experts from WHO, CDC and a
Japan University were consulted. However, the pathological agents of the
strange skin disease have not yet been identified.

Apparently, there was an outbreak of herbicide poisoning in the other
district of Quang Ngai, which affected more than 40 people, and among
those, 3 died.

PRO/MBDS would appreciate further information from knowledgeable sources
regarding this undiagnosed illness in Quang Ngai province, Viet Nam.

For a map of Viet Nam with provinces, see
http://upload.wikimedia.org/wikipedia/commons/f/f0/Viet
NameseProvincesMap.png. For the interactive HealthMap/ProMED-mail map
with direct links to other outbreaks in Viet Nam and surrounding
countries reported on ProMED-mail and PRO/MBDS, see
http://healthmap.org/r/008O. - Mod.QCN]