Cambodia Outbreak Is Unlikely to Be Influenza

Children waited for treatment Wednesday at a hospital in Phnom Penh. (Reuters)

A woman waits with her child for free medical treatment at Kantha Bopha Hospital in Phnom Penh.

July 5, 2012
By JAMES HOOKWAY
The Wall Street Journal

Investigators remain perplexed by the latest disease, though, which has garnered broad international attention in part because many world leaders, including U.S. Secretary of State Hillary Clinton, are scheduled to gather in Cambodia later this month for a regional security conference.

International health officials investigating the outbreak of an unidentified disease in Cambodia that has killed more than 60 children since early April say it is unlikely to be a form of influenza, but they still face a long struggle to identify the precise nature of the illness.

Describing the initial finding as "positive," World Health Organization physician and public-health specialist Nima Asgari said the mystery illness "doesn't look like any kind of influenza."

"There doesn't seem to be any kind of transmission taking place between patients who were placed next to each other in hospitals, nor has there been any transmission to medical staff," Dr. Asgari said.

Cambodia for years has been on the front lines of the fight against avian influenza, which has killed over 600 people across Southeast Asia and East Asia in recent years. In February, Cambodian authorities were dealt a grim reminder of the threat when a mother and child contracted the H5N1 bird-flu virus after coming into contact with sick poultry at a family farm. Both died. Cambodian health officials say another child, who was 10 years old, also died from H5N1 influenza in May.

International health specialists have long warned that new pandemics could emerge in places with limited health infrastructure such as Cambodia and then gain traction before medical experts realize what is happening. Their specific fear is that the H5N1 virus could one day mutate into a more dangerous, more easily communicable form, but that doesn't appear to be happening in the case of this new, unidentified illness.

In addition, health policy experts say Cambodia has improved disease surveillance with the help of the international community in recent years.

Investigators remain perplexed by the latest disease, though, which has garnered broad international attention in part because many world leaders, including U.S. Secretary of State Hillary Clinton, are scheduled to gather in Cambodia later this month for a regional security conference.

So far, only one of 62 children admitted to hospitals suffering symptoms from the unknown respiratory disease has survived. Health officials say the illness begins with a high fever followed by respiratory or neurological problems and then a rapid deterioration of respiratory functions.

Authorities were alerted to the illness by physicians working at a children's hospital in Phnom Penh. Many of the cases originated in the country's south, but officials say that so far there is no evidence of any clustering of cases, which is often a sign that the illness is contagious.

Dr. Asgari at WHO said the illness is proving to be a complex case.

"We have to look at a whole host of potential pathogens on the laboratory front. We can't ignore anything, or ignore any combination of other factors which could be causing this," he said. "We also need to support the case data with empirical data from the field. Only then can we start seeing a comprehensive picture, but now it is very difficult to say whether it is caused by 'x', 'y' or 'z'."