Comparing Cambodia and Sydney situation

[Malcolm]

This "thing" in Cambodia sounds a bit like what is happening in Sydney.
There was a warning on T.V. last night but nothing in the newspapers sooo no link
http://www.globalpost.com/dispatch/t...ambles-find-ca

[CanadaSue]

Malcolm - are you telling me you're seeing a similar outbreak of neuro/respiratory illness of unexplained origin in children in Sydney?

[CanadaSue]

Here's a BusinessWeek aticle on the Cambodian issue. I'm frustrated - want more details, many more...

http://www.businessweek.com/news/201...bodia-who-says



57 dead out of how many KNOWN cases giving a known CFR of what? And I don't doubt for all those known cases, many more never made it to any kind of medical care - Cambodia is still 'developing' & currently 80% of its population is rural. If this or a similar condition is known among citizens - I'd sure love to hear about it.

It's stated bird flu has been ruled out - what of any other type of flu? I'd love to know what, if anything else, they've ruled out at this point.

The initial 'burst' of cases were reported as coming from 14 of 24 provinces - are they contiguous? I'm not reassured that there's no geographical focal point - I'm simply mystified. It also to me - argues against an incorrect treatment regime - would all treatment centers have made the same fatal error in treatment? Doubtful.

They sure need some sound & thorough epidemiology - now.

---------- Post added at 08:53 PM ---------- Previous post was at 08:51 PM ----------

Other questions - with the dead & presumably ill children distributed so widely yet cases limited, (as best we know), to a very specific age cohort what do kids that age in Cambodia have in common that would hold across the country? Hard to think of a contaminated food produt affecting only that age group & distributed to widely. Is it possible a really bad batch of some sort of vaccine is somehow responsible?

[Malcolm]

Originally Posted by CanadaSue

Malcolm - are you telling me you're seeing a similar outbreak of neuro/respiratory illness of unexplained origin in children in Sydney?

I have see a lot of people collapse and "pass out" of ALL age groups.
I think "neuro" is referring to the brain so I presume that is what is causing it.
I had it in April and nearly passed out several times........ imagine what might happen if bus or train drivers get it. Did you notice the person collapsing on T.V....... link below
http://www.theage.com.au/entertainme...702-21dks.html

[Kassy]

Originally Posted by CanadaSue

Other questions - with the dead & presumably ill children distributed so widely yet cases limited, (as best we know), to a very specific age cohort what do kids that age in Cambodia have in common that would hold across the country? Hard to think of a contaminated food produt affecting only that age group & distributed to widely. Is it possible a really bad batch of some sort of vaccine is somehow responsible?

Have you seen specifics on the ages somewhere?

With this pattern of spread i suspect we only see the worst cases.

[Kassy]

I moved the posts out of the H5N1 thread because they're not related.

Thread about Cambodia in Health forum.
http://thisbluemarble.com/showthread.php?t=47528

I decided not to merge because there's some relation with flu here.

I think someone collapsing on TV because they want to be on TV shortly after they had a bout of flu isn't quite the same as what's happening in Cambodia but it seems to be a more general issue in Australia?

[CanadaSue]

Kassy - the ProMed posts mentions the age range of the dead children - sorry, just got home from work, so just read this.

[Kassy]

Here's the new one:

Published Date: 2012-07-07 18:07:30
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia (02)
Archive Number: 20120707.1193413

UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (02)
*************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 6 Jul 2012

Source: WHO Global Alert and Response [edited]

http://www.who.int/csr/don/2012_07_06a/en/index.html





The Ministry of Health of the Kingdom of Cambodia is conducting active investigation into the cause of a recent undiagnosed syndrome that has caused illness and deaths among children in the country.



Preliminary findings of the investigation identified a total of 74 cases who were hospitalised from April to 5 Jul 2012. Of these, 57 cases (including 56 deaths), presented a common syndrome of fever, respiratory, and neurological signs, which is now the focus of the investigation.



The majority of the identified cases to date were under 3 years old. Most of them were from the southern and central parts of the country and received treatment at Kantha Bopha Children's hospital, which is a reference paediatric hospital. Despite all efforts, many of the children died within 24 hours of admission.



Available samples have been tested at the Institut Pasteur in Cambodia. Although a causative agent remains to be formally identified, all these samples were found negative for H5N1 and other influenza viruses, SARS, and Nipah [virus].



The Ministry of Health was 1st alerted to this by Kantha Bopha Children's Hospital in Phnom Penh, where the majority of the cases were hospitalised.



The Ministry of Health notified WHO about this event through the IHR [International Health Regulations] notification mechanism as it met the criteria for notification of any event where the underlying agent or disease or mode of transmission is not formally identified.



WHO and partners are assisting the Ministry of Health with this event which focuses on hospitalised cases, early warning surveillance data, laboratory data, and field investigations.



While this event is being actively investigated, the government is also looking at other diseases occurring in the country, including dengue, hand, foot and mouth disease, and chikungunya [virus infections].



Parents have been advised to take their children to hospital if they identify any signs of unusual illness. The government is also reinforcing awareness of good hygiene practices to the public, which includes frequent washing of hands.



--

communicated by:

ProMED-mail rapporteurs Mary Marshall and Marianne Hopp

[It is interesting to note that H5N1 and other influenza viruses, SARS, and Nipah virus infections have been ruled out as the etiological agent involved in these cases. This WHO report makes no mention of testing for Japanese encephalitis virus or Banna virus infections. As mentioned in the moderator comment in the initial report (see ProMED-mail archive no. 20120704.1190037), Banna virus (a Seadornavirus in the Reovirus family) has caused cases of human encephalitis in China and the virus has been isolated from _Culex_ mosquitoes in Viet Nam and Indonesia, hence likely occurs in Cambodia as well. One hopes that appropriate samples from these cases are being sent to a WHO reference laboratory for diagnosis. Severe pulmonary disease is not reported in the earlier reports in the published literature of Banna virus infection, however. ProMED-mail awaits further reports of this outbreak with interest. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1iGB.]




See Also
http://www.promedmail.org/direct.php...120707.1193413

[Malcolm]

Dispite all the "medical" jargon on this website nearly every-one is talking like a full blown "flubie" here and I am hearing more talk about "Spanish" flu in Sydney now.
You had better hope they diagnose this and get a vaccine before winter brings it to you.

[Sysiphus]

It is not flu. My guess is a nasty strain of Japanese encephalitis. Especially since they have been having a lot of flooding there.

[Kassy]

For Cambodia it seems to be enterovirus:

Published Date: 2012-07-08 17:41:28
Subject: PRO/EDR> Undiagnosed illness, fatal, child - Cambodia (03): EV71
Archive Number: 20120708.1193960

UNDIAGNOSED ILLNESS, FATAL, CHILD - CAMBODIA (03): EV71 CONFIRMED
************************************************** ***************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org



******

[1]

Date: Sun 8 Jul 2012

Source: rthk.hk News [edited]

http://rthk.hk/rthk/news/englishnews..._56_853564.htm





Cambodian disease linked to virus


---------------------------------


Cambodian health officials and the World Health Organization say most of the children who died from a mystery disease in Cambodia had contracted the EV-7 [human enterovirus 71] infection -- a virus linked to hand, foot and mouth disease [HFMD]. The children were below 3 years of age and were mainly from the southern and central parts of the country. 56 have died since April 2012.



Dr Nimal Asgari, a WHO spokesman in Phnom Penh, said a significant number of the samples tested by the Institut Pasteur identified the virus as EV-71. However, it is still not known if all the children had the virus because not all children were able to provide samples.



--

communicated by:

ProMED-mail from HealthMap alerts

<promed@promedmail.org>




******

[2]

Date: Sun 8 Jul 2012

Source: Bloomberg News [edited]

http://www.bloomberg.com/news/2012-0...terovirus.html





Children's deaths in Cambodia linked to enterovirus


---------------------------------------------------


The Institut Pasteur in Cambodia has discovered Enterovirus Type 71 in about two-thirds of patients it tested after a mystery disease killed more than 60 children in the country, said the head of the institute's virology unit.



Enterovirus Type 71 is a "perfect explanation" for the deaths, Philippe Buchy said by telephone today. "We can now focus on how to contain it," he said.



(byline: Natasha Khaan)



--

communicated by:

ProMED-mail <promed@promedmail.org>

[It remains to be determined whether other viruses or infectious agents are implicated in this outbreak of fatal disease in Cambodia. Hand, foot and mouth disease (HFMD) is generally a mild disease usually caused by an enterovirus such as human coxsackievirus A, human coxsackievirus B, or human enterovirus 71. Infection by human enterovirus 71 may have more serious outcomes, but otherwise HFMD is a mild illness. HFMD gets its name from the non-itchy rash that develops on the palms of your hands and soles of feet. It can also cause ulcers in the mouth although many individuals have no symptoms.



Human enterovirus 71 has emerged as an important cause of viral encephalitis in South East Asia over past 15 years. A pattern of increased epidemic activity and endemic circulation of HEV71 has been observed since 1997 and is associated with the regular emergence of new genetic lineages. Although the reason for this increase in HEV71 circulation remains unknown, evidence is accumulating that recombination events may drive the evolution of new genetic lineages. [see: McMinn PC. Curr Opin Virol. 2012 Apr;2(2):199-205].



Although poliomyelitis has been mostly eradicated worldwide, large outbreaks of the related human enterovirus 71 have been seen in Asia-Pacific countries in the past 10 years. This virus mostly affects children, manifesting as hand, foot, and mouth disease, aseptic meningitis, poliomyelitis-like acute flaccid paralysis, brainstem encephalitis, and other severe systemic disorders, including especially pulmonary oedema and cardiorespiratory collapse. Clinical predictors of severe disease include high temperature and lethargy, and lumbar puncture might reveal pleocytosis. Many diagnostic tests are available, but PCR of throat swabs and vesicle fluid, if available, is among the most efficient. Features of inflammation, particularly in the anterior horns of the spinal cord, the dorsal pons, and the medulla can be clearly seen on MRI. No established antiviral treatment is available. Intravenous immunoglobulin seems to be beneficial in severe disease, perhaps through non-specific anti-inflammatory mechanisms, but has not been tested in any formal trials. Milrinone might be helpful in patients with cardiac dysfunction. [See: Ooi MH, Wong SC, Lewthwaite P, Cardosa MJ, Solomon T. Lancet Neurol. 2010 Nov; 9(11):1097-1105].



The HealthMap interactive map of Cambodia is available at http://healthmap.org/r/1iGB. - Mod.CP]

http://www.promedmail.org/direct.php...120708.1193960

---------- Post added at 08:10 PM ---------- Previous post was at 08:07 PM ----------

Originally Posted by Malcolm

Dispite all the "medical" jargon on this website nearly every-one is talking like a full blown "flubie" here and I am hearing more talk about "Spanish" flu in Sydney now.
You had better hope they diagnose this and get a vaccine before winter brings it to you.

Well it won't be the Spanish flu. IIRC it is the season there. Most active strains are A/H3N2 en B only a small amount is A/H1N1:

http://www.who.int/influenza/surveil.../en/index.html

[Pablo Escobar]

Originally Posted by Malcolm

Dispite all the "medical" jargon on this website nearly every-one is talking like a full blown "flubie" here and I am hearing more talk about "Spanish" flu in Sydney now.
You had better hope they diagnose this and get a vaccine before winter brings it to you.

Which website, Malcolm, are you referring to?

[Malcolm]

I am not the only person on Earth who suspects that the media is "gagged"... below
http://english.pravda.ru/health/17-0...7-swine_flu-0/

[CanadaSue]

The article is 18 months old.

The media may be gagged but hospitals, health care workers & the public are not.

[Malcolm]

"At Last" the media is telling us what we have known for 2 months......... below
http://www.heraldsun.com.au/news/nat...-1226423010010

[Kassy]

A yes a really bad flu season.