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Chinese Doctors Battling to Contain Spread of Intestinal Virus

by VR Sreeraman on  May 2, 2008 at 6:07 PM General Health News   - G J E 4
Chinese doctors are struggling to contain the spread of an intestinal virus that has infected more than 3,300 children, killing 21 of them so far, state press reported Friday.
Chinese Doctors Battling to Contain Spread of Intestinal Virus
Chinese Doctors Battling to Contain Spread of Intestinal Virus
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The latest death occurred in the city of Fuyang in Anhui province, the epicentre of the epidemic with 2,946 children infected there as of Friday, Xinhua news agency reported, citing local health officials.

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The number of children in Anhui infected with the enterovirus 71, known as EV71, has risen by nearly 500 since Wednesday.

Up to 340 children have been infected in central Hubei province and five others are sick in the city of Hangzhou in eastern Zhejiang province, Xinhua reported.

Sixteen children have also fallen ill in Henan province, which borders Anhui.

EV71, which causes hand, foot and mouth disease, is highly contagious and is spread through direct contact with the mucus, saliva, or faeces of an infected person. Young children are most susceptible because of lower immune systems.

The disease begins with fever, blisters, mouth ulcers and rashes, and has spread in Anhui since early March, amid accusations by the Chinese media of a government-led cover-up of the epidemic.

Most of those stricken are under the age of six, with 879 children currently being treated in Fuyang hospitals, nine of whom are in critical condition, the report said. Forty others were in serious condition.

News of the epidemic only surfaced on Monday, when it was reported that 19 children had died.

State television showed video footage of parents from rural areas of Anhui bringing their toddlers to overcrowded hospitals in Fuyang.

Health officials warned that although older people may not show symptoms of the disease, they could be carriers of the virus and could possibly infect others, the report said.

"Fuyang city is strengthening medical emergency treatment and prevention and control measures in every way possible," Xinhua said, noting that treatment facilities would be expanded.

The World Health Organisation earlier this week expressed concern over the epidemic, which in serious cases can lead to brain, heart and lung damage.

It said in a statement Wednesday that while enteroviruses are found across the world, "the situation (in Anhui) is still of concern especially because of the current high reported case fatality rate compared to previous years."

China's health ministry has tried to calm fears, saying early discovery of the disease and better treatment has lowered the mortality rate, but has warned that the disease was likely to spread.

"We estimate that the hand, foot and mouth disease (caused by EV71) in Fuyang city will still continue for some time, the number of cases will continue to increase, and serious and fatal cases might still continue to happen," the ministry said Wednesday.

Source: AFP
SRM/L
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Enterovirus 71 was first isolated in 1969. Since then it has been associated with sporadic cases of outbreaks in various parts of the world, including the U.S., Brazil, Europe, Austrailia, Malaysia, and Taiwan. Entervirus 71 infection may present itself much like other enterovirus infections, with symptoms ranging from asymptomatic to the presentation of rashes, diarrhea, colds, meningitis, encephalitis, hand-foot-mouth disease, myocarditis, or some combination of these syndromes. On the other hand, Enterovirus 71 may cause many unusal syndromes such as acute flaccid paralysis (similar to paralytic poliomyelitis), bulbar and brain encephalitis, Guillain-Barre syndrome, and rapidly fatal pulmonary edema and hemmorrhage.


The association of Enterovirus 71 with fatal cases was based on autopsy which revealed the presence of Enterovirus 71 in the spinal cord and medulla of a fatal case. When children went to the hospital with a serious case, many had a high fever for 2-4 days and then suddenly their condition worsened and the children died within 12-24 hours. Most of the patients who died in the Taiwan outbreak had hand-foot-mouth disease or herpangina and died of pulmonary edema and hemorrhage or after they developed brain-stem encephalitis.

The Taiwan outbreak brings out several questions. First of all, what was the precise mode of transmission? Enteroviruses are usually transmitted by fecal-oral route, but the pattern of spread in this epidemic suggests repiratory transmission. Secondly, Enterovirus 71 has been known to cause infections in Taiwan before this deadly outbreak. Thus, why wasn't the Taiwan population more immune to this particular strain? Was this a particularly virulent strain of Enterovirus 71? If so, what made it so virulent? One interesting theory to explain this situation is that the Taiwanese people may have had hypersensitivity to Enterovirus 71 when they were concurrently or previously infected with Coxsackievirus A16. If this were the case, then the outcome would be much like the outcome superinfection of dengue virus in a patient who has already been infected with another dengue virus strain: the patient may develop dengue shock and hemorrhagic syndrome.

What is for sure though, is that clinicians and epidemiologists throughout the world, need to be aware of the capacity of Enterovirus 71 to cause large epidemics which may lead to death.

guest Sunday, May 4, 2008

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