Phnom Penh, Cambodia (CNN) --
Health officials continued on Monday to investigate the causes behind the
mysterious deaths of 64 children in Cambodia after saying they had made an
important discovery over the weekend.
The Institut Pasteur in Cambodia
tested samples taken from 24 patients and found 15 had tested positive for
Enterovirus Type 71 -- a common cause of hand, foot and mouth disease that can
also cause severe neurological complications, mainly in children.
"These results now give a
good explanation to this outbreak," Dr. Philippe Buchy, head of the
institute's virology unit, said in an e-mail over the weekend. "We will
get more results hopefully by next Tuesday or Wednesday."
The World Health Organization
also noted that a "significant proportion of the samples" had tested
positive for EV71, but it cautioned that the outbreak had not been fully
solved, and more analysis was needed.
Outbreaks of the enterovirus
"occur periodically in the Asia-Pacific region," according to the
Centers for Disease Control and Prevention. Brunei had its first major outbreak
in 2006. China had an outbreak in 2008.
Though the detection of EV71 in
Cambodia is significant, there may be other factors, said Dr. Beat Richner of
Kantha Bopha hospitals.
Over the past three months, 66
children -- between 2 and 3 years old -- were admitted to Kantha Bopha
facilities. All but two died mysteriously after suffering severe neurological
and respiratory complications, Richner said.
In their last hours of their life,
the children experienced a "total destruction of the alveola(e) in the
lungs," Richner said. The patients also suffered from encephalitis, which
is inflammation of the brain, he said.
"We have now to see what
really is causing the deadly pulmonary complication and see if a toxic factor
is playing a role too," he said.
The positive test for EV71 does
not particularly help in the treatment of the illness, as there is no effective
antiviral treatment for severe EV71 infections, and no vaccine is available.
The way the syndrome is attacking
the children is "merciless," Dr. Sanjay Gupta, CNN's chief medical
correspondent, said from Cambodia.
Gupta noted, though, that the
disease did not appear to be "clustering," or spreading rapidly in
particular geographic areas, reducing fears of a possible epidemic.
In milder cases, EV71 can cause
coldlike symptoms, diarrhea and sores on the hands, feet and mouth, according
to the journal Genetic Vaccines and Therapy.
But more severe cases can cause
fluid to accumulate on the brain, resulting in polio-like paralysis and death.
Adults' well-developed immune
systems usually can fend off the virus, but children are vulnerable to it,
according to the CDC.
On Sunday, a World Health
Organization (WHO) representative in Cambodia warned the new discovery
"does not mean we have solved the problem of the undiagnosed cases. A lot
more analysis is needed, and further laboratory investigations need to be done."
The WHO said that other pathogens
had been detected in the investigations, including dengue and Streptococcus
suis. It added that samples tested negative for H5N1 and other influenza
viruses.
Tensions have arisen between the
WHO and Kantha Bopha hospitals about the dissemination of information about the
outbreak.
The international organization
has provided a lower death toll than the hospitals, saying Sunday that 52 out
of a total number of 59 children affected by the mysterious syndrome had died
between April and early July.
In his statement Sunday, the
hospital official Richner criticized the WHO for previously making statements to
the news media "without being clear on the facts."
"WHO was telling whole the
world: New mystery killer disease in Cambodia! This was causing unnecessary
panic in Cambodia," Richter said.
Richner has said the number of
cases affected by the mysterious disease is relatively low -- 34 cases in June,
compared with the 75,000 sick children at Kantha Bopha's outpatient clinics and
16,000 hospitalized kids.
But Pieter van Maaren with the
WHO in Cambodia rejected suggestions that his organization caused any kind of
panic. He said Richner was the one who stated, in a letter to the government,
that the situation in Cambodia was "most severe."
"WHO has not made any
statement about the disease, other than what we issued in the joint press
release with the Ministry of Health," van Maaren said.
The ministry reported the
outbreak to WHO through the International Health Regulations, which 194 nations
are parties to, van Maaren said.
"Since this event fitted the
criteria of being an event where the underlying agent, disease or mode of
transmission is not identified at the time, WHO is obliged to communicate
information to other member states," he said.
EV71 was first isolated in
California in 1969, according to the CDC.
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