What’s Killing Cambodia’s Children?

View From Asia July 4, 2012, 

The New York Times 

 By MARK MCDONALD  

 An Al Jazeera report from the Phnom Penh hospital where a new illness was first noticed.

 

HONG KONG — This is the grim track of a mysterious new illness that has already killed scores of children in Cambodia: First, there’s a severe fever. Then comes encephalitis, a swelling of the brain. Finally, the lungs go, and the child dies. All this happens within 24 hours.

The disease is absolutely murderous in its efficiency — Dr. Beat Richner, the physician who first sounded the alarm about the outbreak, said Wednesday that 64 of 66 his patients with the illness have died. All children. All under 7.

Dr. Richner, a Swiss physician, is the founder of the Kantha Bopha children’s hospitals located in the capital Phnom Penh and in Siem Reap, home to the famed Angkor Wat temple complex. He first notified the Cambodian government about the appearance of the deadly new disease on June 20.

Cambodian health officials called in the World Health Organization, and together they announced they were investigating the unknown illness. Also Wednesday, the agency issued a global alert.

  WHO
@WHO

WHO is assisting the Cambodian Ministry of Health with field epidemiology, clinical management and active case finding. goo.gl/9sjkk

Early tests have ruled out simple pneumonia and other commonly known communicable diseases. Bird flu, which killed a young Cambodian mother and her 11-month-old son last year, also has been eliminated as a likely cause.

“It is very early to find the cause. We are still trying to gather data,” said Nima Asgari, a W.H.O. public health specialist interviewed by The Phnom Penh Post.

The new illness has apparently not spread to other wards in Dr. Richner’s hospitals, and he told The Post that “wrong treatment” could be the culprit in the new illness.

“All these children had encephalitis and were hospitalized and treated at private clinics before coming to us,” Dr. Richner said. “I worry that a wrong treatment and drug intoxication at some private clinics has destroyed the lungs leading to a pneumonia we cannot treat.”

Cases have now appeared in 14 Cambodian provinces, according to a local health hotline worker quoted by The Post. The U.S. Embassy in Phnom Penh has not issued any special warnings or health alerts on its Web site.

Mr. Asgari, who worked on the bird flu cases last year, said the new illness was probably not related to dengue fever or a new outbreak of Chikungunya, also known as CHIKV, an untreatable alphavirus similar to dengue fever that is transmitted by mosquitoes.

CHIKV has not been seen in Cambodia for nearly 10 years, health officials say, and its re-emergence might have caused a dramatic spike in dengue fever, with more than 9,000 reported cases so far this year. There have been at least 38 dengue deaths, including 14 children.

Dr. Char Meng Chuor, director of the National Center for Parasitology, Entomology and Malaria Control, told the news agency Xinhua that the infection rate had increased by 369 percent compared to 2011.

He said people were being reminded to use mosquito nets and to fill in any puddles around their homes. He said the government was distributing Abate, a larvae-killing chemical.

Cambodia has suffered through two recent epidemics of dengue fever: In 1998, there were more than 16,000 reported cases, followed by an outbreak in 2007 with nearly 40,000 cases.

The country’s infant mortality rate, despite improvements in recent years, still places it in the bottom 10 percent worldwide, according to the most recent U.N. figures — 158th out of 194 nations. Life expectancy for all Cambodians is 61 for men, 65 for women.

U.S. health officials rate the risk of infectious disease in Cambodia as “very high,” notably from food or waterborne diseases (bacterial and protozoal diarrhea, hepatitis A and typhoid fever) and “vectorborne” diseases like dengue fever, Japanese encephalitis and malaria.