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Sunday, July 29, 2012

Gene analysis connects Cambodian EV-71 to Asian outbreaks

Jul 27, 2012 (CIDRAP News) – A preliminary genetic analysis of enterovirus serotype 71 (EV-71) isolates from Cambodia suggests that the virus is part of ongoing EV-71 outbreaks in Asia and is similar to those in other countries in the region, including Vietnam.

Writing in a ProMED Mail post yesterday, Philippe Buchy, MD, PhD, who heads the virology unit at the Pasteur Institute in Cambodia, wrote that the lab analyzed three randomly selected isolates from patients in different parts of Cambodia over 4 weeks.

Genetic sequencing showed that the viruses aligned with sequences from strains isolated in Vietnam in 2011 and 2012, in Shanghai in 2011 and 2012, and from those in other Asian countries that have been submitted to GenBank. He added that phylogenetic analysis suggests that the EV-71 sequences from Cambodia cluster with EV-71 genotype C4 strains recently isolated in Vietnam and are closely related to those detected in China.

Buchy said further genetic studies continue, but it's useful to know that the strains in Cambodia are part of an ongoing outbreak of hand, foot, and mouth disease (HFMD) across the region, an important consideration given that Cambodia doesn't have enough data to gauge the true case-fatality rate of its EV-71 outbreak.

ProMED Mail is the online reporting system of the International Society for Infectious Diseases.

In a comment accompanying the post, ProMed moderator Craig Pringle, PhD, a virologist and emeritus professor at the University of Warwick in England, proposed that, based on the institute's phylogenetic findings, some of the subgenotypes should be reclassified. This would include designating the C4 subgenotype as a new genotype D, he said.

He said scientists await the results of further isolate analysis, especially of genotype C4 and any possible relation to clinical severity.

In other developments, Beat Richner, MD, founder and head of Kantha Bopha Children's Hospitals in Cambodia—where many of the country's EV-71 patients with encephalitis and severe lung complications were treated—yesterday lashed out for the second time against the World Health Organization (WHO) for statements it made during the outbreak.

He said the WHO statements created panic and gave the impression that steroid treatment made some of the children's conditions worse.

In a letter posted on his Facebook page, he wrote that all 72 children treated at Kantha Bopha had encephalitis, which must be treated with steroids to ease brain swelling. He pointed out that HFMD lesions are a symptom that can be caused by an array of viruses and that the severely ill patients the hospital treated didn't have the lesions.

Richner said the patients' cause of lung destruction in the last 6 hours of their lives still isn't clear.
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US Navy hospital ship provides assistance to Cambodian communities

The United States Navy Military Sealift Command's hospital ship USNS Mercy (T-AH 19) docked at Cambodia's Sihanoukville Autonomous Port on Sunday in order to provide free medical, dental, veterinary, and engineering assistance to communities.

The ship was greeted by Admiral Tea Vinh, Commander of Cambodian Navy, and Jeff Daigle, US Embassy Charg d'Affaires, as well as other Cambodian senior naval officials.

Speaking at the event, Tea Vinh said that the hospital ship's visit will help strengthen bilateral ties between Cambodia's Navy and the US Navy.

"Moreover, the ship's visit will benefit Cambodian people as its staff will provide free-of-charge medical treatment," he said.

According to a press release from the US Embassy here, the ship has more than 1,200 multi-national military service members and civilians onboard.

The visit is made under the Pacific Partnership Program 2012. Pacific Partnership is US Pacific Fleet's largest annual humanitarian and civic action mission in the Asia-Pacific region that involves coordination amongst host and partner nations, non- government organizations (NGOs), and other international agencies to ensure a synchronized ability to respond to natural disasters, said the press release.

It will stay at the port until August 11. During that period, the Mercy staff will provide free medical services including optometry, dental, pediatrics, and general medicine to locals, it said.

Cambodia first hosted Pacific Partnership in 2010 when over 14, 000 people received free medical services.


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