Disputes Arise Over Cambodia’s Killer Illness

By Mary Kozlovski

PHNOM PENH, Aug 17 2012 (IPS) - The deaths of dozens of Cambodian children in recent months from an initially undiagnosed disease has highlighted the difficult balancing act between informing the public and potentially provoking panic.

On Jul. 4 the country’s Ministry of Health and the World Health Organization jointly announced that they were investigating an “unknown disease” that had killed 61 out of 62 children infected since April.

“The unknown disease starts with high fever, followed by respiratory and/or neurologic symptoms with rapid deterioration of respiratory functions,” the statement said.

Just over a week later, the MOH and WHO said that the cause in most of the cases was a severe form of hand, foot and mouth disease (HFMD). A majority of 31 samples obtained tested positive for enterovirus 71 (EV-71), which causes HFMD.

The controversy came after Swiss paediatrician Dr Beat Richner, founder of the respected Kantha Bopha children’s hospitals, criticised the WHO on Jul. 8, accusing it of causing panic “for nothing”.

ASEAN sec-gen issues statement of concern on Hand, Foot & Mouth Disease

Monday 30th of July 2012
Philippine Information Agency

MANILA, July 30 -- The secretary general of the Association of Southeast Asian Nations (ASEAN) has already issued a general statement of concern with the plight of Cambodia and Thailand in addressing Hand, Foot and Mouth Disease (HFMD).

In a statement, ASEAN Secretary General Surin Pitsuwan officially expressed that ASEAN Secretariat is still closely monitoring the health events in Cambodia and Thailand that have been related to the Hand, Foot and Mouth Disease (HFMD).

ASEAN said the secretary general has expressed concern regarding the social and health implications to the families in these countries whose children had either suffered or died due to the disease.

New case of Enterovirus 71 found [in the Philippines]

Tuesday, July 31, 2012
Sun Star (The Philippines)

THE Department of Health confirmed a new case of Enterovirus 71 (EV-71) in the country.

Although no other details were immediately known as of this posting Tuesday, a television report said the person found positive for EV-71 is from Benguet.

This is the second case since a one-year-old boy from Davao City was found positive for the same virus.

EV-71 causes diarrhea; rashes; and hand, foot and mouth disease; and is sometimes associated with severe central neurological disease. The virus, which was earlier tagged as a "mystery disease" in Cambodia, caused the deaths of 52 children there.

Cambodian boy died of HFMD in Thailand

Saturday, Jul 28, 2012
The Nation/Asia News Network

An investigation by the Epidemiology Bureau has concluded that a Cambodian boy who died in Rayong this week succumbed to hand, foot and mouth disease, Dr Prasert Thongcharoen said yesterday. The victim, aged two and a half years, became the second HFMD fatality in Thailand this year.

"This case is clearcut. We do not need to wait for a meeting of virologists to determine the cause of his death," Prasert said in his capacity as an adviser to the Disease Control Department.

Rayong public health chief Kris Palasut said separately, however, that the Medical Sciences Department was conducting a detailed lab test on the young boy's case.

"The results will be released within two weeks," he said as largescale public health campaigns started in his province.

HFMD can quickly spread among young children. Although the disease is not very dangerous, it can cause death in severe cases.

HFMD suspected in boy's death - Panic hits Rayong after Cambodian succumbs

27/07/2012
Bangkok Post

A Cambodian boy has died of suspected hand, foot and mouth disease (HFMD) in Rayong's Klaeng district, triggering panic in the eastern coastal province.

Workers hose down and scrub the exterior of a train at Hua Lamphong station yesterday. It was part of a joint clean-up campaign by the Transport and Public Health ministries aimed at preventing the spread of hand, foot and mouth disease. APICHART JINAKUL

Rayong provincial health authority chief Krit Palasuth said the two-and-a-half-year-old died in emergency treatment, two hours after being admitted to Klaeng Hospital on Wednesday.

The boy arrived at the hospital with breathing difficulty, fatigue and blisters on his palms and feet.

Asia's Health Workers Scramble to Contain HFMD Outbreak

Reports of outbreaks of the virus that causes hand, foot, and mouth disease (HFMD) have cropped up in countries across Asia in recent months.

27 July 2012
Ron Corben, VOA

BANGKOK — Doctors across Southeast Asia are on alert for outbreaks of a strain of the virus that causes hand, foot and mouth disease, responsible for killing scores of children across Asia in recent months. Medical authorities say the peak of the outbreak still has not been reached.

Reports of outbreaks of the virus that causes hand, foot, and mouth disease (HFMD) have cropped up in countries across Asia in recent months, mainly affecting young children.

The hardest hit has been China with more than 1.2 million cases and over 350 deaths.

Medical authorities in Japan, Hong Kong, South Korea, Malaysia, Singapore, Thailand, Taiwan and Vietnam have all reported cases largely among children under the age of 10 years.

Thailand confirms death from EV-71 virus

Jul 24, 2012

BANGKOK (AP) — Thailand has confirmed its first fatality this year from a virus that has killed hundreds of children across Asia.

The 2-year-old girl who died at a Bangkok hospital last week had a form of hand, foot and mouth disease known as enterovirus 71 strain, or EV-71. The disease is common among children ages 2 to 5 and is usually mild. But the severe form of the illness caused more than 400 deaths in the first half of this year in China, Vietnam and Cambodia.

Disease Control Department senior adviser Doctor Prasert Thongcharoen said Tuesday that laboratory tests showed the Thai girl was more vulnerable because she also had asthma.

2 More Cambodian Kids Killed by Hand, Foot, Mouth Disease over Weekend

2012-07-24
Xinhua

Three more Cambodian children were tested positive for Enterovirus 71 (EV-71) over the weekend and two of them were killed by the disease, bringing the death toll to 56 since April, a senior health official said Tuesday.

Ly Sovann, deputy director of the Health Ministry's communicable disease control department, told Xinhua that the two dead children were in Kampong Cham province, some 124 km east of Phnom Penh, and the other one is recovering from the disease at the Kantha Bopha Children's Hospital in Siem Reap province.

Cambodia has been plagued by EV-71, which causes hand, foot and mouth disease (HFMD) since April. The severe form of HFMD has killed at least 56 Cambodian children so far.

Deadly Enterovirus 71 strain found in 2-year-old [Thai] girl who died last week, hospital admits

Monday, July 23, 2012
Phuket Gazette / The Nation

PHUKET: The deadly Enterovirus 71 has been found in the throat of a two-year-old who died at a Bangkok hospital last week, although the child had no symptoms of HFMD.

Dr Passakorn Chaiwanich, director of Nopparat Rajathanee Hospital, where the girl died, said yesterday that doctors found the deadly virus, responsible for the death of dozens of Cambodian children recently, in the Thai girl's throat, but no symptoms had been recognised. He said the virus had attacked the victim's lungs, brain and heart.

Permanent Secretary for Health Paijit Warachit had said on Thursday that the girl's death that day was not caused by the HFMD contagion.

Cambodian child beggars sent back home [... from Thailand: A shame for Hun Xen's regime?]

21/07/2012
Bangkok Post

SA KAEO : Eighteen Cambodian child beggars aged one to 10 were yesterday detained in a raid at a Thai-Cambodian border market, checked for hand, foot and mouth disease and forced to return to their country.

The anti-HFMD operation was jointly conducted by local disease control and immigration authorities at Rong Kluea market in Aranyaprathet district.

Some children found to have a high fever of more than 39C and runny noses were separated from the group over HFMD concerns, said Thanakris Saisin, a disease control officer at the Aranyaprathet immigration checkpoint.

The sick were immediately taken to Cambodian health authorities at Poipet border checkpoint, he said.

Pol Lt Col Uthaiwan Promnok, chief of Sa Kaeo's immigration police, said local immigration police were instructed by the Royal Thai Police to work with other agencies to thoroughly check the Cambodian child beggars at the Rong Kluea market for possible signs of HFMD and to force them back into Cambodia.

Cambodia closes schools amid virus panic

Students leave Chaktomuk Primary School this morning after the Ministry of Education shut down all primary schools amid fear of more fatalaties from the EV71 virus. Photograph: Vireak Mai/Phnom Penh Post

Wednesday, 18 July 2012
May Titthara and David Boyle
The Phnom Penh Post

Fear that an outbreak of the EV71 virus could kill more children prompted the Ministry of Education to close all primary schools and kindergartens in Cambodia yesterday morning, according to an Education Ministry official, teachers and parents.

But the government was divided yesterday about the reason teachers abruptly turned students away, with a senior spokesman claiming it had nothing to do with EV71.

Students were sent home because a high number of colds had been reported in nine provinces, stoking concern the outbreak that has led to the death of scores of children could spread, Ministry of Education Secretary of State Mak Van said yesterday.

Bangkok schools close due to hand, foot and mouth disease

The number of Bangkok schools that have closed or suspended classes due to an outbreak of hand, foot and mouth disease (HFMD) has risen to nearly 30, the Bangkok Post reported yesterday (July 18).

Thursday 19 July 2012

Phuket News

On Tuesday, Chulalongkorn University Demonstration Elementary School was the first to close after a number of students fell ill with the disease.

The Health Ministry, which is racing to halt the disease’s spread and to prevent the possible appearance of a potentially lethal strain found in Cambodia, said that the current spread is likely to continue for another month or two.

Public Health Minister Witthaya Buranasiri said that authorities have been ordered to monitor the situation and to set up provincial-level operation centers when the number of HFMD cases exceeds 10 in one day.

Cambodia shuts all schools to fight virus spread

July 18, 2012
The Associated Press

PHNOM PENH, Cambodia — Cambodia is closing all kindergarten and primary schools two weeks before a regular vacation to try to stop the spread of a virus that has killed hundreds of young children around Asia.

Deputy Education Minister Mak Van said more than 2,700 kindergartens and 7,000 primary schools closed Wednesday to try to cope with the menacing form of hand, foot and mouth disease known as enterovirus 71 strain, or EV-71.

Cambodia closes schools amid fear of virus spread

PHNOM PENH, July 18 (Reuters) - Cambodia closed all its kindergartens and primary schools on Wednesday to prevent the spread of a deadly virus that causes hand, foot and mouth disease and has killed at least 55 children since April, a senior government official said.

Sixty-one cases had been identified as the Enterovirus 71 (EV-71), which has affected children between the ages of three months and 11 years.

The outbreak has raised concern in other parts of the region, such as Thailand and the Philippines. Children have tested positive in both countries for strains of hand, foot and mouth disease, although no deaths have been reported.

In Cambodia, 55 children are known to have died, according to the World Health Organization (WHO). Most were younger than three years old and died within 24 hours of being admitted to hospital.

Thai border on alert on Cambodian child death

16 July 2012
BERNAMA

BANGKOK: Quarantine experts are taking stern measures against Cambodian immigrants following the death of a Cambodian child from a deadly strain of hand, foot and mouth disease, Thai News Agency (TNA) reported.

The lethal ‘Entero-virus Type 71’ strain has been confirmed in Cambodia’s Battambang Province – about 70 kilometres from the Thai-Cambodian border -- where the child has reportedly died. Cambodian officials say they are still trying to verify the case.

Meanwhile, thousands of Cambodian families are crossing into Thailand through the Thai border district of Aranyaprathet on fears that their children will catch the disease.

Explaining Cambodia's 'mystery illness'

Villagers lined up for medical checks outside the Kuntha Bopha children's hospital in Phnom Penh

Dr Pochenda Chhorn says poor living conditions trigger disease

Children in Cambodia are vulnerable to infections because of poor hygiene

12 July 2012
By Guy De Launey
BBC News, Phnom Penh

It must be every parent's nightmare - reports of a mystery disease killing dozens of children.

Sixty undiagnosed deaths over a period of three months triggered a report from the Cambodian authorities to the World Health Organisation (WHO). In such cases, there is usually an internal investigation to discover the facts before anything is made public.

This time, however, the report was leaked to a news agency in the Philippines. It soon made international headlines, perhaps understandably, bearing in mind that diseases like SARS and bird flu had first been identified in this region.

But it turned out that the unidentified illness was nothing remotely so serious.

'Needless panic'

Working together with Cambodia's Ministry of Health, the WHO found a virus known as EV71. It was the first time it had been positively identified in Cambodia, but it is common in nearby countries, including Vietnam and China.

Hand, foot and mouth disease cause of recent deaths in Cambodia – UN-backed inquiry

Good hygiene practice such as frequent washing of hands can prevent hand foot and mouth disease. UN Photo/Martine Perret

12 July 2012
UN News Centre

A severe form of hand, foot and mouth disease (HFMD) was the cause of the majority of recent illnesses and deaths in children reported in Cambodia, according to a joint investigation by the country’s Government and the United Nations released today.

Following reports from a children’s hospital of unusual numbers of illnesses and deaths among children hospitalized since April 2012, the Cambodian Ministry of Health, with support from the World Health Organization (WHO) and other partners, conducted an investigation which identified 78 cases of HFMD, 54 of which resulted in deaths.

HFMD is a common infectious disease of infants and children. It is spread through direct contact with the mucus, saliva, or faeces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months. Nearly all patients recover in 10 days without medical treatment, and complications are uncommon.

China Sends Medical Team to Treat Epidemic in Cambodia [... after case subsided???]

2012-07-13
Xinhua

A Chinese medical team has been sent to Cambodia to aid in alleviation of an outbreak of EV71, an intestinal virus, the Ministry of Health said Thursday.

The medical team arrived in Phnom Penh Thursday morning with medical supplies, the ministry said.

The ministry was informed by the World Health Organization (WHO) that a number of children have been infected by EV71 in several provinces of Cambodia since April, the statement said.

The Chinese team will assist Cambodian medical workers in analyzing the virus, treating patients, studying the epidemic and training local staff, the statement said.

Mix of pathogens caused mystery illness in Cambodia, doctors say

 

http://cnn.com/video/#/video/world/2012/07/11/bpr-gupta-cambodia-mystery-disease.cnn 

July 11, 2012 By Dr. Sanjay Gupta and Danielle Dellorto, CNN

STORY HIGHLIGHTS

• Doctors say the inappropriate use of steroids worsened many cases
• No new cases of the condition have been confirmed since last Saturday
• The pathogens include enterovirus 71, streptococcus suis and dengue
• Most of the patients have come from southern Cambodia

Phnom Penh, Cambodia (CNN) -- The World Health Organization, in conjunction with the Cambodian Ministry of Health, will conclude that a combination of pathogens is to blame for the mysterious illness that has claimed the lives of more than 60 children in Cambodia, medical doctors familiar with the investigation told CNN on Wednesday.

The pathogens include enterovirus 71, streptococcus suis and dengue, the medical sources said. Additionally, the inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, they said.

The sources did not want to be identified because the results of the health organization's investigation have not yet been made public.

Dr. Beat Richner, head of Kantha Bopha Children's Hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases had been confirmed since last Saturday.

Thai discrimination against Cambodian children studying in Thailand due to Thai HFMD ignorance???

HFMD in Thailand is under control, says deputy minister

11/07/2012
Bangkok Post

Meanwhile, parents of 16 Cambodian children attending a pre-school child centre in Ban Dan in the same border district of Surin were asked to take their children back to Osamach in Cambodia.

Hand, foot, and mouth disease (HFMD) in Thailand is under control thanks to measures put in place to prevent a virulent strain from spreading to Thailand from Cambodia, Deputy Public Health Minister Surawit Khonsomboon said yesterday.


Extraordinary surveillance measures were being implemented to keep Enterovirus Type 71 (EV-71), a strain of HFMD that has claimed the lives of more than 60 children in Cambodia, from spreading to Thailand, Dr Surawit said.

Parents are being advised to encourage their children to wash their hands often and avoid taking them to crowded places, Dr Surawit said.

If parents suspect an infection they should immediately take their children to a doctor to reduce the risk of complications of the disease which can affect victims' brains, lungs, and hearts, he said.