Unknown And
Undiagnosed Disease
Sichuan China
From Patricia Doyle, PhD
ProMed News
Unknown Disease Claims 9 Lives In Suchaun, China
Xinhua Net
An unknown disease has stricken 20 villagers and killed 9 of them in south west China's Sichuan Province over the past 4 weeks, the provincial health department confirmed on Saturday. A team of experts from the Ministry of Health and Ministry of Agriculture are in Sichuan to provide medical aid and conduct epidemiological investigation.
Between 24 Jun and 21 Jul [2005], 3 hospitals in the city of Ziyang received 20 patients with similar symptoms. They all started with a high fever, fatigue, nausea, and vomiting and became comatose later with bruises under the skin. By 21 Jul [2005], 9 patients had died and one had recovered and been discharged from hospital. 10 more were still being treated, 6 of whom were in a critical condition, the provincial health department said.
The patients, 19 men and a woman, are all farmers aged between 30 and 70. They are from 15 villages in Yanjiang and Jianyang and they all butchered sick pigs or sheep before coming down with the strange disease, a preliminary investigation has found. But the detected cases are not interrelated and no infection has been found in any close contact of the patients, the investigators said.
Medical workers are carrying out laboratory work hoping to determine the exact cause of the disease, though experts suspect exposure to the sick, as well as the dead, animals is mainly to blame. The local government has ordered all-out efforts to treat the patients and banned killing of sick pigs and sheep. It also instructed that animals killed by diseases are disinfected carefully and buried deep, and that farmers should avoid direct contact with sick or dead animals.
From Dr Irene Lai International SOS Online
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Deaths Of Unknown Cause Reported In Sichuan
The Centre for Health Protection (CHP) of the Department of Health (DH) is closely monitoring developments concerning reports of deaths due to unknown cause in Sichuan. A CHP spokesman said today (July 23) that the CHP had been informed by the Ministry of Health in the mainland about such reports. The spokesman said that the CHP was maintaining close communication with the Ministry of Health and would continue monitoring the situation closely.
The public are advised to observe the following as precautionary measures during travel especially to rural areas: to prevent insect bites by wearing long-sleeve clothes and trousers; use insect repellants over the exposed parts of the body; use mosquito screens or nets when the room is not air-conditioned; clean and cover all wounds properly and avoid exposing open wounds to soil, polluted stream or pond water and any contaminated object; to avoid contact with sick or dead animals and their excreta or body fluid; avoid contact with unknown chemicals, including agricultural chemicals such as pesticides, herbicides, rodenticides etc; observe good personal, food and environmental hygiene practices;
Returning travellers should consult their medical doctors and report their travel history if they do not feel well.
From the first newswire, there is a high suspicion that this outbreak may be due to Crimean Congo hemorrhagic fever (CCHF), known to be endemic in livestock in southern portions of China. According to GIDEON (Global Infectious Diseases & Epidemiology Network, CCHF was first reported in China in 1964, and is known locally as Xinjiang hemorrhagic fever. Cases are reported from the south west region. 260 cases (54 fatal) were reported in Xinjiang (southern desert region) during 1964 to 1995. 10 to 20 per cent of sheep, goats, and cattle in Sichuan are seropositive. This latter information raises the index of suspicion that CCHF is a likely candidate.
While CCHF is usually thought of as a tickborne disease, caused by an RNA virus of the Bunyaviridae family, it can also be transmitted through contact with infected bodily fluids from people (in nosocomial outbreaks) and animals (as possibly described above in the newswire).
Another of the hemorrhagic fevers seen in the region is hemorrhagic renal syndrome associated with hantavirus infection. The description above makes that diagnosis less likely, although one must recognize that newswire descriptions may not necessarily be representative of the actual clinical picture.
More information on this outbreak from authoritative sources would be appreciated. - Mod.MPP
[Elsevier online reference: Sheikha AS, et al. Bi-annual surge of Crimean-Congo haemorrhagic fever (CCHF): a five-year experience. Int J Infect Dis 2005; 9(1): 37-42
Jeff - I thought I should also repost the following information from Boxun News.
- Patricia Doyle
Boxun News (China) Description of Ebola in China
By Dr. Henry L. Niman, PhD
Recombinomics Commentary
1. EB-SZ type: It was found in Shenzhen of South China. People contracted the virus showing severe illness, and they were infected through the contact of blood. Incubation period is 2-4 weeks. Some individual cases have incubation period up to 6 months. Some cases are asymptomatic. Those infected people's immunity drops suddenly that triggers other co-infections and complications. When non-Ebola virus related infections become severe, it could lead to diathesis from the major blood vessels. In severe cases, blood vessels disintegrate; muscular tissues became fluid-like; patients died of lack of oxygen due to haemorrhage. After the case die, the disintegration symptoms persist with the change of room temperature, ie above 12.4 degree Celcius. The process continues until the carcass completely disintegrates. The disintegration process slows down when temperature is lower than 8.7 degree Celcius; and the process halts at below 4 degree Celcius. Therefore, the best treatment for infected person is to use low temperature therapy. To treat the deceased cases, it is better to seal the body under low temperature. To disinfect the environment where the cases die has to use both high temperature disinfection and low temperature disinfection with the assistance of potent medication.
2. EB-ST type: It was found in Shantou of South China. People contracted the virus showing severe illness. Transmission is unknown. Incubation period: 30-120 days. Infected people have localized maculopapular rash. Cases occur in the form of diathesis in the smallest capillaries that lead to necrosis of the involved tissues. The characteristic of this virus is its intermittent exacerbation of the symptoms. This virus is suspected to be the mutated by-product of Ebola virus and other viruses. The confirmative diagnosis is usually made by the identification of EB-SZ-like virus in the tissues of deceased cases.
3. EB-HN type: It was found in Hunan of Central China. Transmission is unknown. Incubation is about 30-60 days. Infected cases experience discomfort due to the localized diathesis. After the disintegration of blood vessels, patients experience symptoms related to blood loss. Most of the deceased cases' heavily infected organs were in their lungs. If the blood vessels of the internal organs were infected, it will cause hepatic damage. Deceased case's face and bottom will disintegrate within 2-8 hours afterwards; their nails also fall apart. Autopsy found that the tissues of tendons were as soft as muscle. The deceased cases' blood are contagious. Contact through other means will not lead to infection of the virus.
4. EB-FJ type: It was found in Fujian province of South China. The virus was transmitted through the carrier's blood. Incubation period is about 20-30 days. Infected people will become immunocompromised that leads to influenza induced pneumonia and bleeding in the lungs. Subsequently, it leads to respiratory failure. Autopsy found that the vessels in the deceased cases' lung were fluid like; other tissues were normal. Deceased cases displayed purplish spots in their necks.
5. EB-ZJ type: It was found in Zhanjian of South China. Not much details on this virus subtype.
6. EB-SZ77 type: It was found in Shenzhen of South China (adjacent to Hong Kong). This virus could infect birds.
The above human translation of a boxun report raises serious questions about Ebola infections in China. It has not been independently confirmed and Ebola has not been reported outside of Africa. The above report offers no genetic details on the relationship between the above isolates and the various sequenced Ebola and Marburg isolates.
The boxun reports on H5N1 bird flu strains appear to be quite believable and are supported by China's refusal to allow WHO visit the recent sites of H5N1 infections in Xinjiang province as well as the refusal to share sequence data on isolates from the latest outbreak.
Other boxun documents indicate details of H5N1 and Ebola infections are considered state secrets, which clearly if true, is cause for concerns. China's recent actions of limiting access and distribution of strains and sequences increases the credibility of the boxun reports.
Moreover, H5N1 and Ebola have a region of sequence identity between HA and spike genes.
Patricia A. Doyle, PhD Please visit my "Emerging Diseases"
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Zhan le Devlesa tai sastimasa
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