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”.

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.

Cambodian children dying from mysterious illness

http://www.youtube.com/watch?v=zBlkKmicySs

What’s Killing Cambodia’s Children?

July 4, 2012
By MARK MCDONALD
International Herald Tribune (Paris, France)

WHO
As of this morning 4 July, 61 of the 62 children admitted in Cambodia hospitals have died from the unknown disease under investigation.

HONG KONG — This is the grim track of a mysterious new illness that has already killed scores of children in Cambodia: First, there’s a severe fever. Then comes encephalitis, a swelling of the brain. Finally, the lungs go, and the child dies. All this happens within 24 hours.

The disease is absolutely murderous in its efficiency — Dr. Beat Richner, the physician who first sounded the alarm about the outbreak, said Wednesday that 64 of 66 his patients with the illness have died. All children. All under 7.

Dr. Richner, a Swiss physician, is the founder of the Kantha Bopha children’s hospitals located in the capital Phnom Penh and in Siem Reap, home to the famed Angkor Wat temple complex. He first notified the Cambodian government about the appearance of the deadly new disease on June 20.

Cambodian health officials called in the World Health Organization, and together they announced they were investigating the unknown illness. “Assistance is being provided in the area of field epidemiology and active case finding,” the W.H.O. said.

Also Wednesday, the agency issued a global alert.

Early tests have ruled out simple pneumonia and other commonly known communicable diseases. Bird flu, which killed a young Cambodian mother and her 11-month-old son last year, also has been eliminated as a likely cause.

WHO: Unknown disease kills 60 children in Cambodia

Tuesday July 3, 2012
AFP

PHNOM PENH: An unidentified disease has killed 60 young children in Cambodia in three months, the World Health Organization said Tuesday as it raced to identify the cause.

"The number of deaths reported to WHO is 60 cases and they have all been in young children," said Dr Nima Asgari, a public health specialist for the UN body in Cambodia, adding that the first casualties were reported in April.

The WHO is currently working with the Cambodian Ministry of Health "to identify the cause and the route of spread of this disease", he said.

With the investigation still at an early stage, Asgari said it was difficult to specify the symptoms, which "include high fever and severe chest disease symptoms, plus in some children there were signs of neurological involvement".

Vietnam seeks foreign help after skin disease kills 19

HANOI | Sat Apr 21, 2012

(Reuters) - Vietnam's health authorities will seek foreign assistance to deal with a resurgence of a mystery skin infection that has already killed 19 people in the central region and terrified villagers, state-run media reported on Saturday.

The disease was first reported between April and December last year, with doctors unable to identify the cause and it has re-emerged in a mountainous district of Quang Ngai province.

One village was reported to be in a state of terror over the death of a resident, and altogether 171 people reported infections on palms and the soles of their feet.

Skin conditions, diarrhoea hit Borei Keila evictees

Living conditions of evicted Borei Keila children at Ponhear Leu district’s Srah Po village. (Heng Chivoan /Phnom Penh Post)

Wednesday, 01 February 2012
Khouth Sophakchakrya
The Phnom Penh Post

Hundreds of evicted Borei Keila residents living at a relocation site in Kandal province are suffering from diarrhoea, skin ailments and fever after consecutive days of rain, an NGO doctor said yesterday.

Dr Nhean Sarin, a medical officer with rights group Licadho, told the Post yesterday that Borei Keila residents relocated to Ponhear Leu district’s Srah Po village in early January were also at more risk of catching malaria and cholera.

“The raining over a few consecutive days caused them to develop fever, chills and diarrhoea due to them having inadequate sleep because their plastic, no-wall tents cannot stand the rain,” he said, adding that many were also suffering from a shortage of food.

Concern raised after dual flu infection found in Cambodia

November 7, 2011
ABC Radio Australia

Researchers say a rare case of people being infected with both swine and seasonal flu in Cambodia could lead to a potent combination strain emerging in the future.

A study looking at historical data found a boy and his teacher were infected with both H1N1 and a seasonal flu in 2009 - the year the pandemic swine flu emerged.

In these cases, tests showed there was no "genetic recombination," or mingling of the two flu strains.

The study, published in the American Journal of Tropical Medicine and Hygiene, says that while the cases don't pose a current threat they are a reminder of the dangers that a strain such as avian flu could mix with human flu and affect millions.

Presenter: Sen Lam

Speaker: Dr Ian Barr, deputy director of WHO Collaborating Centre for Reference and Research on Influenza in Melbourne

Click here to listen to the audio program (Windows Media)

BARR: Swine flu has symptoms of any of the standard influenza viruses. It's not particularly different, so normally people will suffer from sudden onset, so something will come on them with a short period of time, 8 to 12 hours, usually involving respiratory symptoms, such as a cough, in many cases a fever greater than 38 degrees centigrade and they'll generally feel unwell and may have muscle soreness, and some of the classic symptoms of influenza-like illness.

LAM: And so what do we know about the rare cases of co-infection?

Flooding Brings Additional Danger of Disease: Doctor

Local villagers wait on boats to receive flood donations at Prek Sussey, Kandal province, some 50 kilometers (31 miles) east of Phnom Penh, Cambodia, Tuesday, Oct. 18, 2011. More than a thousand families in a part of Kandal province Tuesday have received the China-funded flood donations from a group of the National Committee for Disaster Management. (Photo: AP)

Tuesday, 25 October 2011
Nuch Sarita, VOA Khmer | Phnom Penh

“The risks of malaria and dengue fever increase six to eight weeks after the flooding.”

Cambodia is undergoing its worst flooding in a decade. The floodwater has inundated homes and farmland, killing hundreds and displacing thousands of people. And aside from the immediate damage, a disaster of this scale can also mean the transmission of numerous diseases, a US-based doctor said Thursday.

Click here to listen to Nuch Sarita hosts 'Hello VOA' 20 October, 2011 (MP3)

Floods can carry water-borne diseases such as typhoid fever, cholera, leptospirosis and hepatitis A, Taing Tek Hong, a Florida-based physician, told “Hello VOA.”

“Direct contact with polluted waters can cause wound infection, skin rashes, inflammation in the eyes, ears, nose, and throat infections,” he said.

Cambodia lacks toilets

A foreign tourist visiting Cambodia provided this description about this toilet in Cambodia: And here's where I had to go to the bathroom at the ferry crossing. It was a squatter toilet, raised about 6 feet above the river-you just go straight into the river! (Photo: www.camereye.com)

13-11-2207
By Ky Soklim
Cambodge Soir
Translated from French by Luc Sâr

The conclusions from a National Forum on rural hygiene underscore deficiencies which threaten public health, and which constitute also obstacles to the country’s development.

Only 16% of Cambodians living in the countryside own a toilet, in comparison to 99% in Thailand, 61% in Vietnam, and 30% in Laos. “This number shows that rural people do not understand well family hygiene. Therefore, they are more prone to catching diseases. This pushes them into poverty,” launched Yim Chhay Ly, the secretary of state on the ministry of rural development, on Tuesday 13 November, during the National Forum on rural hygiene.

In less than one decade, thanks to the economic growth, the rate of drinking water went from 24% in 1998 to 45% in 2006. The number of individual toilets has also increased: it was 9% in 1998 versus 16% in 2006. According to Yim Chhay Ly, this improvement is not satisfactory yet. The objective of the ministry of rural development is to meet a goal of 50% of rural people who will benefit from purified water and 30% of housings will have toilets in 2015. Up to now, 60 villages in 9 out of 24 provinces have encouraged their people to stop relieving themselves outside of a toilet.

According to Yim Chhay Ly, because of the lack of toilets and hygiene, 20% of children less than 5-year-old suffer from diarrhea. The result of a World Health Organization investigation shows that for each $1 invested in hygiene, $23 is saved in health care cost. During the Forum, Hun Sen called on the ministries involved to find solutions for flooded areas. “This is not a small problem when people have to relieve themselves in water, there are strong risks of infections,” Hun Sen said.