Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky
Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky
http://www.promedmail.org/
Published Date: 2012-07-01 11:49:59
Subject: PRO/EDR> Undiagnosed illness - Viet Nam (08): (QG) WHO/CDC input
Archive Number: 20120701.1186507
UNDIAGNOSED ILLNESS - VIET NAM (08): (QUANG NGAI) WHO/CDC INPUT
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Date: Fri 29 Jun 2012Source: thanhniennews.com [edited]http://www.thanhniennews.com/index/pages/20120629-with-help-vietnam-skin-disease-still-mysterious.aspx
The World Health Organization (WHO) and the US-based Centers for Disease Control and Prevention (CDC) have been unable to solve the mystery of the fatal skin disease plaguing the central province of Quang Ngai.
According to a press release issued by WHO and Vietnam's Ministry of Health on Thursday, early this month two experts from WHO and the CDC were invited to help local agencies identify the disease that has affected 216 people and caused 12 deaths in Ba To District since April of last year.
However, the cause of the disease, referred to as inflammatory palmoplantar hyperkeratosis (IPPH) syndrome by WHO, is still unknown. "We do no know what causes the syndrome, or its source of transmission, identifying the cause may take longer than anticipated or prove elusive," the press release quoted WHO representative for Vietnam, Dr. Takeshi Kasai, as saying.
So far it has been confirmed that the syndrome is characterized by a chronic intoxication that can lead to inflammation and lesions of the hands, feet and liver.
Several field investigations conducted by the health ministry have established that the syndrome may not be infectious in origin and that most patients suffered from inflammation of liver, according to the press release.
Other results included the discovery of aflatoxins - a fungus that contaminates grains before harvest or during storage - in few rice samples, and no presence of elevated levels of heavy metals or agrochemicals taken from human or environmental samples, it said.
The health ministry will continue focusing its efforts in treating current patients and monitoring new cases as they occur. Meanwhile, further investigations will be conducted to measure and evaluate the effectiveness of interventions as well as to identify other risk factors associated with IPPH syndrome, the press release said.
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Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The news article above concerns an outbreak in several villages in the Bo To district of Quang Ngai province, Viet Nam, on which ProMED-mail has previously reported. Those affected are reported to have developed an acute febrile illness [or not?? - alert] with loss of appetite and respiratory symptoms followed by a rash on the hands and feet described as "palmoplantar keratoderma" (
http://emedicine.medscape.com/article/1108406-overview#aw2aab6b), accompanied by liver dysfunction and, in some patients, by multi-organ failure and death. Ulcers on the hands, feet, mouth, back, and abdomen, eye disease, stiffness of the limbs, and miscarriage are also described. Mainly children and young adults have been affected.
The disease is said to have started in April 2011, subsided somewhat between November 2011 and February 2012, and picked up pace again in March and April 2012. The numbers of patients affected and the death toll has varied in the news reports, but the news report above says that the number affected is 216 people and caused 12 deaths in Ba To District since April of last year.
Pictures of the rash on the hands and feet of the affected Vietnamese villagers are available at
http://www.saigon-gpdaily.com.vn/Health/2012/4/100698 and
http://www.eyedrd.org/2012/04/break...-has-claimed-27-lives-in-central-vietnam.html.
Chronic arsenic toxicity (
http://icmr.nic.in/ijmr/2008/october/1007.pdf) and dioxin toxicity (Patel S, Zirwas M, English JC: Acquired palmoplantar keratoderma. Am J Clin Dermatol. 2007; 8(1): 1-11; abstract available at
http://www.ncbi.nlm.nih.gov/pubmed/17298101) can produce skin lesions similar to those seen in the Vietnamese villagers. In fact, hair samples taken from a 9-year-old boy who died contained arsenic at a level 100 times higher than the country's acceptable limit (ProMED-mail post Undiagnosed illness - Viet Nam (06): (QG) toxin susp. RFI 20120601.1153587). However, the news reports in prior ProMED-mail posts say that authorities did not find residues of dioxin or heavy metals, presumably including arsenic, in the affected villages, and now the above news report says that WHO and the US-based Centers for Disease Control and Prevention (CDC) experts have also failed to find a cause for this outbreak.
Quang Ngai is a Vietnamese province located in the South Central Coastal region along the South China Sea, 883 km (549 miles) south of Hanoi and 838 km (521 miles) north of Ho Chi Minh City (
http://en.wikipedia.org/wiki/Quang_Ngai_province). The province has a large plain along the coast and in the center of the province and has mountains and hills in the west. Ba To is a rural district of Quang Ngai province with a population of 47 268 in 2003 (
http://en.wikipedia.org/wiki/Ba_To_District).
A map of Viet Nam provinces can be seen at
http://upload.wikimedia.org/wikipedia/commons/f/f0/VietnameseProvincesMap.png. Viet Nam may also be found on the interactive HealthMap/ProMED-mail map at
http://healthmap.org/r/2bxT. - Mod.ML]
