See UPDATE EV71 Linked To Cambodian `Mystery’ Virus
# 6423
Since last Tuesday (see Cambodia: WHO Investigating Child Deaths From Unknown Disease) the number of suspected cases of an often-fatal `mystery illness’ in Cambodia has increased from 61 to 74. All of the reported victims have been children, with most being under the age of 3.
So far, while some causes have been tentatively eliminated by laboratory testing (including Nipah, H5N1, & SARS) the pathogen responsible for this rapidly fatal respiratory & febrile illness has not been determined.
Updates today from the ECDC, the World Health Organization, and media reports on some of the precautionary measures being taken by other countries in the region.
First stop, the ECDC:
Cambodia: undiagnosed illness affecting children
06 Jul 2012
ECDC
An outbreak of an undiagnosed illness affecting children has been reported by the Ministry of Health of the Kingdom of Cambodia to World Health Organization (WHO). Out of the 62 children, 61 have died. No apparent clustering of cases or signs of transmission have been reported so far.
Between April and June, a total of 58 children below age of 7 years have been admitted to a hospital in Phnom Penh. Further 4 children were admitted to a hospital in Siem Reap, with high fever and encephalitic and/or respiratory symptoms. In total, 62 cases were reported, the majority being on children under 3 years of age.
Fifty-six of 58 patients hospitalized in Phnom Penh and four of four patients hospitalized in Siem Reap have died. Of these cases, 46 died within 24 hours of admission, and the majority of the rest died between 1-3 days after admission. Sixty-one deaths were reported.
The Cambodian Ministry of Health and WHO are conducting an active investigation in order to determine cause and source of the illness. ECDC is closely monitoring the situation.
From the World Health Organization, an update into the investigation posted yesterday (Friday, July 6th).
Undiagnosed illness in Cambodia - update
6 July 2012 - 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 July 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 three 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.
The Ministry of Health was first 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 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-mouth and Chikungunya.
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.
Although these cases have been occurring since last April, and the mode of transmission remains unknown, other countries in the region are watching this outbreak closely and – in some cases – tightening their airport screening.
One such example comes today from Bernama – the official news agency of the government of Malaysia.
Philippines Tightens Airport Screening Following Disease Outbreak In Cambodia
MANILA, July 7 (Bernama) -- The Philippine government has implemented a stricter procedure in screening passengers at the country's international airports following an outbreak of a fatal respiratory syndrome affecting children in Cambodia.
Presidential spokesperson Edwin Lacierda said in an interview with a local radio that the Department of Health is currently monitoring the situation through its National Epidemiology Centre.
"That respiratory disease is now being looked into," Xinhua news agency quoted Lacierda.
Health Secretary Enrique Ona has ordered the Quarantine Bureau to be more vigilant in carrying out routine screening procedures at all international airports.
The Philippines was recently alerted to the unknown disease by the World Health Organisation (WHO) after Cambodia reported at least 60 deaths of children.
-- BERNAMA
`Mystery Illnesses’ are not uncommon around the world, and while a diagnosis may be initially elusive, they often end up due to previously identified diseases that have either evolved or mutated a bit, or have migrated to a new area.
Rarely, something previously unknown does crop up, such as we saw in 2003 with SARS epidemic or more recently with the hemorrhagic fever that emerged in South Africa in 2008 (see Lujo Virus: Newly Identified Arenavirus).
According to well respected anthropologist and researcher George Armelagos of Emory University, we are entering the Third Epidemiological Transition - which began in the late 1970s or early 1980s; an age characterized by an increase in the number of (mostly zoonotic) emerging or re-emerging infectious diseases (see The Third Epidemiological Transition).
While the origin and ultimate public health threat posed by this unknown disease outbreak in Cambodia remains undetermined - given the impact of other emerging infectious diseases (including HIV, SARS, Lyme, XDR-TB) in recent years - it is understandable why reports like these elicit intense media attention and scientific investigation.
I’ll update this story as more information becomes available.
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