Deadly Enterovirus 71 strain found in 2-year-old girl who died last week, hospital admits

The Nation on Sunday

BANGKOK: -- The deadly Enterovirus 71 has been found in the throat of a two-year-old who died at a Bangkok hospital last week although the child had no symptoms of hand, foot and mouth disease (HFMD).

Dr Passakorn Chaiwanich, director of Nopparat Rajathanee Hospital, where the girl died, said yesterday that doctors found the deadly virus - responsible for the death of dozens of Cambodian children recently - in the Thai girl's throat but no symptoms had been recognised. He said that the virus attacked the victim's lungs, brain and heart.

Permanent Secretary for Health Paijit Warachit had said on Thursday that the girl's death, on that same day, was not caused by the HFMD contagion.

Passakorn said that the hospital and Public Health Ministry did not intend to conceal the truth, as the hospital's initial check did not find the virus. It was later found that Enterovirus 71 attacked the victim's lungs, brain and heart.

"Also, we found Enterovirus 71 four or five years ago that killed a patient. Normally, 10 per cent of people infected with this kind of virus succumb to the disease as it can spread to many physical systems in the patients quickly," he said.

However, the Public Health Ministry has not confirmed that she died from HFMD. Dr Paijit said the lab test result of the hospital showing the exact cause of the girl's death would be handed to the ministry, then it would be considered by a committee of virus experts next week to finally conclude if she died from HFMD. The consideration would be based on epidemiology, clinical symptoms and the lab-test result.

In related news, Bangkok Metropolitan Administration (BMA) officials are closely monitoring the HFMD outbreak. It has issued five measures to prevent the spread of the disease, including checking all children's health before they enter nurseries, schools and amusement parks in shopping malls in "risky areas".

It plans to separate patients suspected of being infected with HFMD for seven days, to clean toys, utensils and places, give out information on how to prevent the disease being spread to relevant officers, parents and people, as well as give treatments to HFMD patients according to the ministry's guidelines.

In Kanchanaburi, four more children have been found with HFMD. So far, 338 people in this province have caught the disease.

Officials in Si Sa Ket's Phu Sing district have strictly screened Cambodian children travelling through the Chong Sangam border crossing point with their parents to see if they have the disease.

With Cambodia having closed primary schools and kindergartens for two months to stop the spread of HFMD, more Cambodian children have accompanied their parents who cross the border to Thailand.

Authorities at the four border checkpoints in Sa Kaeo province have been seriously checking Cambodian children. Any found with the flu have been refused entry into Thailand until a hospital in Cambodia issues a document guaranteeing that they have not got HFMD. They are also providing hand gel for all Cambodians to clean their hands before entering Thailand.

So far, the authorities have not found Enterovirus 71 infection among any such children.

-- The Nation 2012-07-22

Not good. Very sad.

What an absolute mess. Hope for the best, plan for nothing bad to happen

Exactly as the Pasteur Institute predicted. With all due respect to my friends at WHO, who I love to bits and respect, I have no idea why they are dragging their collective asses on the E71 and asking for additional clinical assessments and lab tests.

And btw, in the thread that first raised the issue, someone was quoting Sanjay Gupta and saying the cause of the deaths in Cambodia in the pediatric cases was due to treatment with medications containing steroids. A big fail on that statement, because there is no reported link to steroids in this case. This is one deadly virus that doesn't need any help when it invades someone with a weakened or undeveloped immune system.

Normally, 10 per cent of people infected with this kind of virus succumb to the disease as it can spread to many physical systems in the patients quickly. Time to start necking the vit C, methinks.

Exactly as the Pasteur Institute predicted. With all due respect to my friends at WHO, who I love to bits and respect, I have no idea why they are dragging their collective asses on the E71 and asking for additional clinical assessments and lab tests.

And btw, in the thread that first raised the issue, someone was quoting Sanjay Gupta and saying the cause of the deaths in Cambodia in the pediatric cases was due to treatment with medications containing steroids. A big fail on that statement, because there is no reported link to steroids in this case. This is one deadly virus that doesn't need any help when it invades someone with a weakened or undeveloped immune system.

Thanks for the clarification on the issue of steroids. I may have been the guilty party who posted it, I don't recall. I do know that I heard something about steroids being the culprit in Cambodia.

Knowing that this strain is as serious as it first appeared to be is important. I hope the country takes a great deal of effort to prevent the spread.

This is quite scary... If I catch this it could be fatal to me with my kidney failure. Also I work with kids.

Independent, expert information regarding the disease, and the outbreak, from CIDRAP's website:

"HFMD, which most frequently strikes children younger than 10, is usually caused by coxsackievirus A16, which produces a mild self-limiting disease that causes few complications, according to the WHO. Enteroviruses, including EV-71, can also cause HFMD that is more serious in certain groups and can be deadly. The period from infection to symptom onset is 3 to 7 days.

The CDC said that since 1997 large outbreaks of HFMD caused by EV-71 have been reported, mostly in children in East and Southeast Asia. Most children have a mild illness and recover without complications, though a small number have severe infections that can be fatal. The agency said research is underway to explore why the outbreaks occur and why the disease is so severe in some patients.

The disease typically begins with fever, poor appetite, malaise, and sore throat. A day or two after fever begins, painful sores develop in the mouth, with a non-itchy skin rash that develops over the next 1 or 2 days on the palms of the hands, soles of the feet, and sometimes on the buttocks or genitals.

The disease spreads from person to person by direct contact with a sick patient's nose or throat secretions, saliva, fluid from blisters, and stool.

There is no specific treatment for HFMD. The WHO said patients with HFMD should drink plenty of fluids and seek treatment for symptoms. It urged health providers to treat patients according to their symptoms and avoid prescribing steroids.

Dr Nima Asgari, who is heading the WHO's investigation efforts, said blistering was reported in only some of Cambodia's cases and that it's possible that steroids administered by doctors masked the symptoms or that the symptoms may not have been recorded, the Associated Press (AP) reported today."

...the above was excerpted; for the complete article and further references, go to http://www.cidrap.umn.edu/cidrap/content/other/news/jul0912cambodia-br.html

Exactly as the Pasteur Institute predicted. With all due respect to my friends at WHO, who I love to bits and respect, I have no idea why they are dragging their collective asses on the E71 and asking for additional clinical assessments and lab tests.

And btw, in the thread that first raised the issue, someone was quoting Sanjay Gupta and saying the cause of the deaths in Cambodia in the pediatric cases was due to treatment with medications containing steroids. A big fail on that statement, because there is no reported link to steroids in this case. This is one deadly virus that doesn't need any help when it invades someone with a weakened or undeveloped immune system.

Thanks for the clarification on the issue of steroids. I may have been the guilty party who posted it, I don't recall. I do know that I heard something about steroids being the culprit in Cambodia.

Knowing that this strain is as serious as it first appeared to be is important. I hope the country takes a great deal of effort to prevent the spread.

Wasn't you on the steroids, someone else. It was a legit hypothesis because some anti inflammatories were prescribed to reduce the swelling, but the patients were in critical conditions when the last ditch efforts were made. At the time, the attending healthcare workers still didn't know what they were dealing with. At the risk of contradicting myself, the use of steroids may have been a contributing factor in the deaths, but they were exacerbating factors, not the cause of death.

This is quite scary... If I catch this it could be fatal to me with my kidney failure. Also I work with kids.

You are exposed to variants of the implicated virus regularly, but you have survived so far haven't you?. If you are well rested and taking care of yourself, the odds are in your favour. If you are concerned, thoroughly wash your hands regularly and avoid hand to mouth /eye/nose contact. You have to carry on and there is no point in worrying about this as there isn't much you can do aside from proper prevention. Believe it or not stress can weaken you, so try not to stress out. I think you'll be just fine.