Doctor slams WHO for causing virus panic

Dr Beat Richner (Photo: Sam Rith/The Phnom Penh Post)

Thursday, 26 July 2012
Bridget Di Certo
The Phnom Penh Post

Richner believes that the administration of incorrect drugs to these 72 children could be a factor in the astonishing destruction of the lungs present in the cases that have been recorded by his hospitals.

“The WHO in Cambodia should be closed” is the emphatic sign-off to a lengthy and vivid analysis by Kantha Bopha Children’s Hospitals of the recent “mystery disease” scare.

While the World Health Organization and Ministry of Health have declared that a series of recent child deaths are linked to EV-71, causing severe hand, foot and mouth disease, Kantha Bopha founder Dr Beat Richner has slammed the conclusion as a “catastrophic declaration”.

Richner said 72 cases of the unexplained illness have appeared in his hospitals, and of those, 68 have died.

The WHO yesterday said the totals from the Ministry of Health stood at 61 cases and 56 deaths, including one new death over the weekend that fit the case definition of severe HFMD.

The “case definition” is the critical impasse between the MoH and WHO, and Kantha Bopha, which treat 85 per cent of all Cambodian children.

Kantha Bopha’s “case definition” is encephalitis and complete lung destruction leading to a rapid death.

Not one of these cases showed lesions associated with HFMD, Richner’s statement says.

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.

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.

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.

EV71 hits Mainland China

Mainland baby, young girl treated for deadly virus

Wednesday, July 11, 2012
Mary Ann Benitez
The Standard (China)

Two mainland children - a five-year-old girl from Guangxi and a 39-day-old baby boy from Shenzhen - are being treated at Hong Kong hospitals for a severe form of enterovirus infection, the Centre for Health Protection said last night.

It is the third and fourth such case of the infection this year and comes days after Cambodia announced that Enterovirus71 was the dominant virus that killed 52 of 59 children during the past three months.

EV71 is a virulent strain of the common childhood ailment hand, foot and mouth disease.

Cambodian Killer Unmasked?

9 July 2012
By Mara Hvistendahl
Discover Magazine (USA)

Scientists have identified a possible culprit in the mysterious syndrome that has killed dozens of children in Cambodia since April, the Cambodian Ministry of Health and the World Health Organization announced on 8 July.

Since April, 59 children in Cambodia have fallen ill with symptoms that include respiratory illnesses, fever, and convulsions, according to the health ministry. Of those patients, 52 have died. Most were younger than 3 years old. Laboratory work is ongoing and a conclusive diagnosis is not yet in. But tests at Institut Pasteur du Cambodge in Phnom Penh point to hand, foot, and mouth disease, a contagious and sometimes fatal illness, head virologist Philippe Buchy wrote ScienceInsider in an e-mail.

A significant clue came when Institut Pasteur virologists tested cerebrospinal, throat, and rectal swab samples from 24 patients. Last weekend, throat and/or rectal swab samples from 15 patients tested positive for Enterovirus 71, one of the pathogens that causes hand, foot, and mouth disease. (The disease is different from foot-and-mouth disease, which infects cattle, sheep, and pigs.) The institute's scientists earlier had ruled out SARS, Nipah virus, and H5N1 and other influenza viruses as possible causes. They found strains of Streptococcus in throat samples from a number of patients but eliminated it as the cause of death after finding the same strains in samples from children with other symptoms.

Mysterious Cambodian Disease May Have a Name. But Why Is It So Lethal?

10 July 2012
Discover Magazine (USA)

Last week, the World Health Organization reported that an unknown respiratory disease was killing children in Cambodia at terrifying rates. The latest word is that of the 59 kids admitted to hospitals with the disease since April, 52 have died.

Mara Hvistendahl at ScienceInsider has corresponded with the team of virologists in Phnom Penh who are working to identify the illness, and while the diagnosis isn’t certain, they say that they’ve found signs of Enterovirus 71 in cerebrospinal fluid from 15 patients. Enterovirus 71 is one of the causes of hand, foot, and mouth disease, a usually benign childhood infection that causes a rash, vomiting, and other symptoms. The disease is very common and usually clears up in a week or so, and, as with most viral infections, has no cure to speak of.

A small proportion of patients with hand, foot, and mouth disease (not to be confused, incidentally, with foot and mouth disease, a livestock infection) do develop neurological complications that can put them in the hospital and even kill them. But, as Hvistendahl points out, the statistics in the Cambodian outbreak are a little odd. Cambodia is a small country, about 15 million people, and for this many kids to be developing complications and dying of them, a truly large chunk of the population would have to be infected. To put that in perspective, neighboring Vietnam, which had an outbreak of the disease earlier this year, has more than 86 million people and reported only 20 deaths.

Health officials don’t know how many people in Cambodia have the disease, nor do the virologists know whether there’s anything unusual about this strain of Enterovirus 71. It’s on their list to find out, though, as they culture more samples and prepare to sequence the strain’s genome.

Authorities Walk Fine Line With Cambodia Virus

http://live.wsj.com/video/answers-found-in-deadly-cambodian-outbreak/5F3BC909-6E38-476F-A900-8AC2F176EC1B.html

July 10, 2012
By PATRICK BARTA
The Wall Street Journal

As Cambodian authorities grapple with a disease outbreak that has killed more than 50 children, they're also struggling with another issue: how to best manage interest from the outside world without triggering alarm.

The issue bubbled to the surface earlier this week when Beat Richner, a well-known doctor in Cambodia and founder of the Kantha Bopha Children's Hospitals where the disease was first reported, complained that international health authorities moved too quickly to sound the alarm, risking a panic before they had all the facts.

Writing in a post on his Facebook page, he said the World Health Organization's declaration earlier this month that a potentially new "unknown disease" had appeared in Cambodia "was neither professional nor necessary," causing "panic for nothing."

On Tuesday, he said he had no further comment on the matter beyond the statement and that he had seen no additional cases of the disease since the weekend.

Cambodian kids died of strain detected in Thailand

10/07/2012
Bangkok Post

The Disease Control Department has confirmed that the lethal hand, foot and mouth disease (HFMD) virus found in Cambodia is of the same strain previously detected in Thailand.

The virus - suspected of being responsible for the deaths of more than 50 children in Cambodia - is known as EV-71, said department director-general Pornthep Siriwanarangsan after receiving a report from the WHO and the Cambodian Health Ministry.

Dozens of Thai children nationwide fell ill with HFMD last month, although there have been no fatalities.

"It is the same viral strain detected in Thailand," Dr Pornthep said.

Cambodia’s Outbreak Linked to Hand, Foot, Mouth Virus

People wait with their children for free medical treatment at Kuntha Bopha Hospital in Phnom Penh. Photograph: Landov

By Natasha Khan and Daniel Ten Kate on July 09, 2012
Bloomberg News

Researchers found a virus that causes hand, foot and mouth disease in patients who succumbed to an illness that has killed dozens of children in Cambodia.

The Institut Pasteur du Cambodge discovered enterovirus 71 in 15 of 24 children presenting with the symptoms since mid- June, Philippe Buchy, head of the Phnom Penh-based institute’s virology unit, said yesterday by phone. The virus may be linked to the deaths of more than 60 children across the country since April, he said.

“This information is valuable and will help the investigation tremendously,” said Nima Asgari, leader of the emerging diseases surveillance and response group at the World Health Organization in Cambodia, which is helping the local Ministry of Health find the cause of the illness.

Cambodia Mystery Illness Tied To Common Childhood Illness

Cambodian villagers from countryside hold their children as they wait for a medical check up for their children, outside a children hospital of Kuntha Bopha, in Phnom Penh, Cambodia, Monday, July 9, 2012. A deadly form of a common childhood illness has been linked to many of the mysterious child deaths in Cambodia that caused alarm after a cause could not immediately be determined, health officials said Monday. (AP Photo/Heng Sinith)

07/09/12
By SOPHENG CHEANG and MARGIE MASON
AP

PHNOM PENH, Cambodia -- A deadly form of a common childhood illness has been linked to the mysterious child deaths in Cambodia that sparked alarm after a cause could not immediately be determined, health officials said Monday.

Lab tests have confirmed that a virulent strain of hand, foot and mouth disease known as EV-71 is to blame for some of the 59 cases reviewed since April, including 52 deaths, according to a joint statement from the World Health Organization and Cambodian Health Ministry. The numbers were lowered from the initial report of 62 cases.

EV-71 is a virus that can result in paralysis, brain swelling and death. Most of the Cambodian cases involved children younger than 3 who experienced fever, respiratory problems that led to rapid shutdown and sometimes neurological symptoms.

Children's deaths in Cambodia linked to Hand, Mouth and Foot disease

Cambodian children and their parents sitting at Kantha Bopha children's hospital in Phnom Penh. Medical experts are scrambling to respond to what the Cambodian health ministry and World Health Organization have labelled an "undiagnosed syndrome" that has claimed the lives of at least 56 boys and girls since April. Photograph: AFP PHOTO / Khem Sovannara

Monday, 09 July 2012
Bridget Di Certo and Chhay Channyda
The Phnom Penh Post

Doctors have made a breakthrough in their efforts to identify the unknown and deadly illness that has claimed the lives of dozens of Cambodian children over the past four months.

Enterovirus 71, commonly associated with Hand, Foot and Mouth disease, has been singled out by virologists at Institut Pasteur as the explanation of the outbreak, according to emails from the head of the non-profit institute’s virology unit to the Ministry of Health and Kantha Bopha Children’s Hospital doctors sent on Friday and obtained by the Post yesterday.

HFM is endemic in Vietnam and virologists homed in on the EV71 strain after adapting investigative testing to detect recent mutations of the virus that have appeared in Cambodia’s neighbour.

World Health Organization epidemiologist Dr Nima Asgari said the findings had “demystified” the situation, but added that they are “still looking at the clinical picture”.

Lab results show dead Cambodian children positive for Enterovirus 71

Xinhua | 2012-7-9

The latest laboratory results showed that Enterovirus Type 71 (EV-71) was found among children who had died from undiagnosed syndrome since April, according to a joint statement of Cambodia's Health Ministry and the World Health Organization (WHO) released Sunday midnight.

"Based on the latest laboratory results, a significant proportion of the patients' samples tested positive for Enterovirus 71," said the statement, adding the samples were found negative for H5N1 and other influenza viruses.

Sixty-four young children out of 66, having been admitted to the largest children's hospitals in Cambodia since the end of April, were killed by Encephalitis.

Hand, Foot, Mouth Disease Found in Cambodia Outbreak

July 8, 2012
By PATRICK BARTA
The Wall Street Journal

Health officials investigating an unexplained disease outbreak that has killed more than 50 children in Cambodia say they have detected the presence of a virus that causes hand, foot and mouth disease. But they stressed the investigations were ongoing, with other illnesses, including dengue, also associated with some of the cases.

The outbreak has drawn international attention because of longstanding fears that poor countries such as Cambodia could be incubators for new, virulent disease strains that defy treatment. The latest outbreak has killed at least 52 children since early April and was first reported as an unexplained illness involving respiratory and neurological symptoms by Cambodian and international health authorities last week.

In a news release, the Cambodian Ministry of Health and the World Health Organization said that laboratory samples were not available for the majority of cases, because the victims died before appropriate samples could be taken. But in the cases for which samples could be studied, the officials said "a significant proportion" tested positive for Enterovirus 71 (EV-71), which causes hand, foot and mouth disease. Hand, foot and mouth disease is a common infectious illness among infants and children and typically involves fever, painful mouth sores and a skin rash, among other symptoms. Although less serious than some other feared culprits, with patients often recovering, there is no specific treatment for the disease and it can involve other, more serious complications.