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Virus linked to Cambodian child deaths

9th July 2012

The deaths of 52 people, mostly children, in Cambodia recently have been linked to a virulent strain of a familiar childhood disease, according to experts at the World Health Organisation (WHO) and the Cambodian Health Ministry.

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Laboratory tests have confirmed the presence of the enterovirus EV-71, a form of hand, foot and mouth disease, in 15 of 24 patients sampled since the middle of June.

According to Phillipe Buchy, head of Cambodia's Institut Pasteur, the authorities were now focusing on containing the spread of the virus.

But Beat Richner, head of the struggling Kantha Bopha hospital group said EV-71 still did not fully explain the respiratory problems suffered by the patients.

Richner said that all the children seen at the hospital had encephalitis, or inflammation of the brain, and had developed severe pneumonia with destruction of the alveoli in the lungs in their final hours of life, which was what had killed them.

There are questions over whether the high mortality rate could have more to do with poor treatment at improverished rural hospitals than with the virus itself.

Richner's hospital, the best paediatric referral unit in the country, treated the only two survivors.

EV-71 is fairly common in Asia, and frequently results in large outbreaks among young children.

The virus is associated with hand, foot and mouth disease, and is not connected to foot and mouth disease found in cattle.

Spread through direct contact with bodily fluids of an infected person, the disease currently has no treatment or vaccine.

The virus is the same one that infected more than 110,000 people in neighbouring Vietnam, killing 166, mostly children under 3.

According to WHO spokeswoman Aphaluck Bhatiasevi, the telltale rash normally associated with hand, foot and mouth disease was seen in only a few of the Cambodian cases.

The EV-71 patients presented with fever, neurological and respiratory signs, and most were under the age of three. The majority of cases were clustered in southern and central Cambodia, although many have been transferred to the Kantha Bopha Children's Hospital in the capital, Phnom Penh.

The children who died from the virus did so within 24 of symptoms appearing, according to Cambodian health officials, in spite of efforts to save them.

The samples were sent to the Institut Pasteur in Cambodia, which identified the EV-71 virus, after ruling out influenza viruses, including H5N1 avian influenza, severe acute respiratory syndrome, or SARS, and Nipah, which can be passed to humans from infected pigs, causing life-threatening encephalitis.

The Kantha Botha hospital notified the health ministry, which alerted WHO to the outbreak, using the International Health Regulations (IHR) notification mechanism, WHO said, adding that the Cambodian health authorities had met criteria for notification.

The government is warning parents to seek immediate medical help if their children develop unusual symptoms, and a hygiene awareness programme is being expanded across the country.

WHO statistics show that the quality of life in Cambodia has improved drastically over the last 10-15 years, thanks to a mixed system of private and public healthcare providers.

The country now spends around 5.8% of its GDP on health, and had an infant mortality rate of 54 per 1,000 live births in 2009, compared with 115 per 1,000 live births in 1993.

Mortality in the under-fives has fallen from 181 per 1,000 live births in 1993 to 115 in 2009, but in poverty stricken Ratanakiri Province, 22.9% of children die before the age of five.

Many of the country's land-mine victims are children, and more than 600,000 people have died in land-mine accidents since 1970, which many more maimed and injured.


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