WHO Defends Warning on Cambodia Virus

Health officials finally have an explanation for the mysterious disease in Cambodia that killed more than 50 children in the last few months. The WSJ's Patrick Barta explains to Jake Lee.

10th July, 2012 

The Wall Street Journal

By PATRICK BARTA

As Cambodian authorities grapple with a disease outbreak that has killed more than 50 children, they're also struggling with another issue: how to best manage interest from the outside world without triggering alarm.

The issue bubbled to the surface earlier this week when Beat Richner, a well-known doctor in Cambodia and founder of the Kantha Bopha Children's Hospitals where the disease was first reported, complained that international health authorities moved too quickly to sound the alarm, risking a panic before they had all the facts.

Writing in a post on his Facebook page, he said the World Health Organization's declaration earlier this month that a potentially new "unknown disease" had appeared in Cambodia "was neither professional nor necessary," causing "panic for nothing."

On Tuesday, he said he had no further comment on the matter beyond the statement and that he had seen no additional cases of the disease since the weekend.

The outbreak warning attracted widespread global news coverage from CNN, The Wall Street Journal and others, and triggered intense interest among people who feared a new disease could be emerging that could threaten other countries. The WHO has since said it believes the illness was probably linked to an enterovirus causing severe hand, foot and mouth disease, based on recent laboratory work using samples from victims, though they cautioned they can't be 100% sure and are still investigating.

While serious in some cases, hand, foot and mouth disease is far less-daunting than some other feared possibilities, such as a new mutation of avian flu.

Officials from the WHO said they were following international protocols in alerting the outside world to the disease when they put out a statement on the matter in conjunction with Cambodia's Ministry of Health on July 4. They said they did so after local authorities informed them of the then-unexplained disease, and that world health officials have agreed to share information on potential outbreaks so they can better marshal their resources before they get out of control – especially in poorer places like Cambodia, which lack some of the medical technology and expertise to handle complex illnesses.

"At the end of the day, we live in a global village, and if something is going on, other countries should know," said Nima Asgari, a WHO official in Phnom Penh.

The debate is an important one in Asia given the widespread fear that its poorer nations could someday give rise to a regional or even global pandemic that defies treatment. Asia has been hit by a number of disease scares in recent years, including an outbreak of severe acute respiratory syndrome, or SARS, in 2003 that briefly brought many of the region's economies to a near-standstill. There are also viruses like bird flu, which has killed nearly 60% of about 600 people known to have been infected in more than a dozen countries since 2003; reports of bird flu in Southeast Asia in recent years led restaurants at times to pull chicken from their menus.

Given the potential for economic damage when false alarms are sounded, health officials have had to walk a fine line between keeping governments and the public informed and avoiding unnecessary worry. By putting the word out about a possible outbreak early, though, they can also increase leverage on local officials – who might be wary of publicizing a disease – to take it more seriously, making it easier for international experts to move in and launch investigations.

"In this case, the WHO made a warning early which was the correct thing to do, since at that time the etiology of the disease was unknown," said Professor Wang Linfa, director of the Emerging Infectious Diseases research program at the Duke-NUS Graduate Medical School in Singapore. "In my personal view, it is better to overreact than under-react" to be safe, he said, even if a country's economy is affected.

Dr. Richner, in his letter, said he had suggested early on to health officials that an enterovirus may have been part of the problem in the latest outbreak. He also stressed that the number of children dying was still small considering the number of patients seen at Kantha Bopha clinics, which are well-known in Cambodia and treat a large percentage of the country's sick children. He noted that more than 75,000 children were treated in Kantha Bopha outpatient stations in June, and that only 34 children with the latest disease were hospitalized during that period.

Despite those low numbers, the disease was worrisome enough that his hospitals contacted Health Ministry officials to alert them.

To date, the disease has led to deaths in at least 52 of the 59 known cases since early April, affecting mainly very young children. A common infectious illness among infants and children, hand, foot and mouth disease typically brings fever, painful mouth sores and a skin rash, among other symptoms, and is transmitted by sneezing, coughing or direct contact with fluid from infected blisters. Although the disease often passes without serious long-term consequences, it can also entail dangerous complications, and there is no specific treatment.

Other countries have also reported deadly outbreaks of severe hand, foot and mouth disease in recent years, including Vietnam, where 166 people died from the disease last year.

—Shibani Mahtani contributed to this article. Write to Patrick Barta at patrick.barta@wsj.com