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Monday, July 9, 2012

Health News: Cambodia Severe Respiratory Disease

Doctor takes a nasal swab from young Cambodian

A severe respiratory disease with neurological symptoms has been affecting children in Cambodia. Still do not know the cause and source, this respiratory illness has killed 61 children since April 2012. To date, of the 62 children admitted to hospitals with the disease, 61 have died.
The condition begins with a high fever, followed by respiratory and/or neurologic symptoms. Rapid deterioration of respiratory functions follows.
The Ministry of Health of Cambodia and the World Health Organization are investigating the cases and possible causes of the disease. The focus of the investigation is to find the cause and source of the disease for appropriate treatment and control.
The Ministry of Health of the Kingdom of Cambodia, meanwhile, has identified at least 74 suspected patients diagnosed with fever with respiratory or neurological symptoms from April to June. The Cambodian ministry said 56 deaths were reported in Phnom Penh while 4 more were reported in Siem Reap.

Meanwhile, neighbouring countries have been informed.
The World Health Organization (WHO) earlier issued a warning to the Philippines and other neighboring countries of Cambodia of the “unknown respiratory disease.” WHO said those carrying the disease, which has “neurological symptoms,” usually manifest signs of high fever, followed by respiratory or neurological symptoms with rapid deterioration of respiratory functions.

“WHO is closely monitoring the situation and is providing technical assistance to Ministry of Health on field epidemiology, clinical management and active case finding,” said Dr. Nima Asgari, team leader of the WHO Country Office in Cambodia, in a statement.
WHO said most of the reported cases were under three years old and came from the southern and central parts of Cambodia.

Many of the children diagnosed with the case were admitted at the Kantha Bopha Children’s hospital in Phnom Penh. WHO said a significant number of patients died within 24 hours of admission.The Ministry of Health of the Kingdom of Cambodia continues to thoroughly investigate the disease.

Philippine Scenario

Quarantine authorities manning all ports of entries to the Philippines are now on alert after the World Health Organization (WHO) issued a global alert response memorandum to all human quarantine officers around the world. 

The global alert response memorandum noted the undiagnosed illness from Cambodia was detected by the WHO.According to the Health Ministry of Cambodia, majority of the cases originated from the southern part of Cambodia. Initial symptoms of the unknown disease are high fever, rapid deterioration of respiratory functions and neurologic symptoms. 

Airport human quarantine duty doctor Ali Salvador Agama assured the public that human quarantine personnel are properly trained to handle the outbreak, based on international safety and medical protocol. Personal protective equipment is available for on-duty health workers on a 24/7 basis. Agama said this is composed of goggles, mouth cover, body suit and gloves. 

All passengers coming from international flights are being monitored by a thermal scanner. Any one who has a body temperature higher than 36.5 will be subjected to initial medical inspection and background check on his country of origin prior to arriving to the Philippines. 

There is also a standby ambulance ready to transport any suspected carrier of the disease. Immediate isolation and quarantine is recommended for the suspected carrier, in order to ensure the safety of other passengers and prevent the spread of the disease.
Agama advises passengers to maintain a high level of hygiene and report to health authorities if they suspect anyone is infected by the disease

UPDATE (JULY 9, 2012)

An investigation into a perplexing outbreak among young kids in Cambodia is getting traction. Doctors have identified a potential cause, a virus associated with hand, foot and mouth disease. (The illness is not foot-and-mouth disease, which affects only animals.)

In an update on the outbreak, the World Health Organization said there have been 59 cases of hospitalized young children since April. Fifty-two of the children died. An earlier estimate had put the death toll at 61.

Virologists found 15 of 24 samples from sick children tested positive for enterovirus 71, NPR's Anthony Kuhn reports from Singapore. But the investigators couldn't obtain samples in most of the cases because the children had already died, said a joint statement from WHO and the Cambodian health ministry.

The virus, first identified in California more than 40 years ago, is associated with a form of hand, foot and mouth disease.

Most of the Cambodian cases involved children under 3, who experienced high fevers, respiratory and neurological problems. The outbreak has hit children in Cambodia's southern and central provinces.

Kuhn reports this is believed to be the first known EV-71 outbreak in Cambodia. The disease has struck other parts of Asia. It has killed hundreds of children in China and Vietnam in the past two years.

But the form of the illness in Cambodia appears to have a higher fatality rate. "Further investigation is ongoing and this includes the matching of the laboratory and epidemiological information," Cambodia's health minister H.E. Mam BunHeng said in the joint statement with WHO. "We hope to be able to conclude our investigation in the coming days."

Hand, food and mouth disease typically stats with fever, lack of appetite, malaise, and often a sore throat, WHO said. A day or so after the fever, painful sores show up in the mouth. They start as small red spots then become blistered and sometimes ulcerated. A rash on the hands or soles of the feet is also common a few days after the fever begins.

But, WHO said, someone with the illness may not develop the hallmark symptoms, or may have only have some, such as the rash or mouth ulcers.

UPDATE (JULY 10, 2012)

The World Health Organization (WHO) and the Department of Health (DOH) reported today that the disease that struck and killed Cambodian children in the last few months was of the encephalitis type and not the hand foot and mouth disease (HFMD) they earlier reported.

The health agencies maintained, however, that the new strain discovered is linked to the Enterovirus-71 (EV-71), which causes different diseases of varying intensities. EV-71 may also cause HFMD as well as acute respiratory disease, acute flaccid paralysis (polio-like), and the deadly brainstem encephalitis. Encephalitis is an acute inflammation of the brain.

“Affected Cambodian children generally presented with fever followed by rapid respiratory deterioration and impaired consciousness. Death occurred 24 hours from hospital confinement,” DOH said. It said that EV-71 infections have already occurred in the Philippines in the past, but are still considered rare.

As such, Health Secretary Ona instructed the Department of Health’s (DOH) National Epidemiology Center to include EV-71 infections as a “notifiable” disease in the country, which means all health providers, especially physicians, are compelled to report individual cases or even outbreaks.

“This is necessary to make sure that the Philippines is free from the highly fatal severe form of EV-71 infections that have claimed the lives of 52 [out of 59 infected] children in Cambodia since April this year,” he said. He said there are still no travel restrictions to and from Cambodia. All passengers will be subjected to thermal screening, however.

To prevent the spread of EV-71, DOH is urging the proper disposal of baby diapers or human waste, strict personal hygiene and regular hand washing. The virus is known to be excreted in the feces since it is found in human intestines, DOH said. It also urged parents and day-care personnel to clean and disinfect toys and teaching tools that are easily shared with other children. There is no known drug or vaccine yet to combat EV-71 infections.

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