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Mystery Fatal Hemorrhagic Disease in Shandong China
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[quote:tosspot:MV81NzkyNTBfODgzMDU4Nl83NjQ0QjVCMQ==] And here's the PROMED Article Archive Number 20080727.2300 Published Date 27-JUL-2008 Subject PRO/AH/EDR> Undiagnosed hemorrhagic disease - China: (Shandong), RFI UNDIAGNOSED HEMORRHAGIC DISEASE - CHINA: (SHANDONG), REQUEST FOR INFORMATION **************************************************************************** A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org> Date: 27 Jul 2008 From: Stephen O. Cunnion <scunnion@potomacinstitute.org> I received the following email from Chuck Dolejs of the International Association of Emergency Managers regarding a Sound of Hope web page (<http://en.epochtimes.com/n2/china/strange-disease-kills-three-in-china-1742.html>) updated [26 Jul 2008]. Has this outbreak been verified by authorities? "China reported that approximately 20 days ago, a man suddenly died from an unidentified disease in Wanjiakou Village, Xiaoguan Town, Wendeng City, Shandong Province. His entire body turned dark purple, and he bled from his mouth, nostrils, ears, and eyes just as he died. Shortly after the man died, 2 other men who been in contact with him, died showing the same symptoms. Villagers who had left the village to work said "3 people died 10 days ago. 6 or 7 more are being treated in the Wendeng Central Hospital. People have been to the area to investigate, but they are unable to classify the disease." Most people outside of the village do not know about the illness. Their families do not want people who have left the village to return. "Reporters from Sound of Hope Radio Network (SOH) interviewed local residents and staff from a health clinic. What follows are transcripts from the recorded interviews. A male villager verified that the disease broke out in the northern section of Wanjiakou Village, and spread rather quickly. The SOH reporter then phoned the Department of Health and Prevention of Contagious Diseases in Wendeng City and Yantai City, Shandong Province using numbers published on the official web sites. However, he was unable to talk with anyone, as the line was either filled with static or the call was routed to a wrong number announcement." [The actual details of the interviews are available at the URL link provided above - Mod.MPP] -- Stephen O. Cunnion, MD, PhD, MPH Medical Director, National Security Health Policy Center The Potomac Institute for Policy Studies 901 N. Stuart Street, Suite 200 Arlington, VA 22203 <scunnion@potomacinstitute.org> [ProMED-mail would like to thank Dr. Stephen Cunnion for sending on this information. As a reminder, it was he who sent ProMED-mail the 1st report on an outbreak of "atypical pneumonia" in Guangdong, China, on 10 Feb 2003 that we posted and was the 1st public notification of the early outbreaks of what was later named Severe Acute Respiratory Sydrome (SARS) (see ProMED-mail posting Pneumonia - China (Guangdong): RFI 20030210.0357 for this report). Using the database of the Global Infectious Disease and Epidemiology Network (GIDEON <http://gideononline.com>) to see possible etiologies for a hemorrhagic fever syndrome in China, the most likely diagnosis would be Old World hantavirus infection (57 percent probability), followed by _Streptococcus suis_ infection (40 percent), leptospirosis (1.8 percent) and Crimean-Congo hemorrhagic fever (CCHF -- less than one percent probability). According to the GIDEON database, hantaviruses are endemic in 28 of the 32 provinces, with most cases occurring in the eastern and northeastern provinces (where Shandong is located). Hantaan virus is endemic to Hubei, Heilongjiang, Jiangxi, Jilin and Shanxi. (Fang LQ, Li CY, Yang H, Wu XM, Yang H, Chen HX, Li XW, Cao WC [Using geographic information system to study the association between epidemic areas and main animal hosts of hemorrhagic fever with renal syndrome in China.] Zhonghua Liu Xing Bing Xue Za Zhi 2004 Nov ;25(11):929-33. - 52.2 percent of infections in Hubei are caused by Hantaan virus, and 31.5 percent by Seoul virus. - Most infections in Shandong provin ce are caused by Seoul virus. (Wang ZQ, Wang YL, Fu JH, Zhao L, Sun CY, Zhang XQ, Zhang YX, Fan SZ, Wang ND [Molecular analysis of hantavirus isolated from Shandong province]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2003 Jun ;17(2):121-3.) - Seoul virus was identified in humans and rodents (_Rattus norvegicus_ and _Mus musculus_) in Beijing during 2003 to 2005. (Zuo SQ, Zhang PH, Jiang JF, Zhan L, Wu XM, Zhao WJ, Wang RM, Tang F, Dun Z, Cao WC. Seoul virus in patients and rodents from Beijing, China. Am J Trop Med Hyg 2008 May ;78(5):833-7. A new Puumala virus subtype, most closely related to strains from Japan and South Korea, has been isolated from bank voles in Northeast China. (2007 publication) (Tang LH, Zhang QF, Xiu MH, Gu GW, Bo S, Yang XD, Liang MF, Li DX [Identification of a new Puumala hantavirus subtype in rodents from China] Bing Du Xue Bao 2007 Jul ;23(4):320-5. The abstract does not give any information about human infection by it. ProMED-mail has reported on hantavirus outbreaks in China earlier this year in Inner Mongolia (see Hantavirus infection - Taiwan ex China (Inner Mongolia) 20080119.0249), and in prior years (see references below) According to the GIDEON database, CCHF has been reported from the southwestern desert region in Xinjiang province and is referred to as Xinjiang fever. Hence it would be a significant geographic change were this outbreak to be due to CCHF. There is also mention that 10 to 20 percent of sheep, goats and cattle in Sichuan are seropositive -- so movement of livestock from the southwest to other provinces may very well move the disease geographically. One should not forget the earlier major outbreaks of _Streptococcus suis_ in China in 2005. A recurrence of the problem is possible. It is noteworthy that according to the question and answer part of the referred media report, there is mention that the cases to date have been in predominantly in men, suggesting that exposure may well be occupational, which places both hantavirus infection and _Streptococcus suis_ as leading possibilities for the etiologic agent for this outbreak. The outbreak is occurring in a rural zone where there is a high likelihood of exposure of males to rodents and to the porcine population during usual occupational activities in an agricultural zone. ProMED-mail would greatly appreciate more information from knowledgeable sources in the region on this as yet unsubstantiated report of a cluster of hemorrhagic-like illnesses with fatalities in Shandong Province. For a map of China with geographic divisions see <http://www.lib.utexas.edu/maps/middle_east_and_asia/china_pol01.jpg>. Of note, Shanjong province is contiguously north of Jiangsu province, where there was an outbreak of 'epidemic hemorrhagic fever' in 2007, which while the etiologic agent was not mentioned, was felt to most likely be due to an Old World hantavirus infection (see prior ProMED-mail postings Epidemic hemorrhagic fever - China (Jiangsu) 20070113.0179 and Epidemic hemorrhagic fever - China (Jiangsu) (02) 20070116.0206). The interactive HealthMap/ProMED map of China can be accessed at <http://healthmap.org/promed?v=36.5,103.9,4> This map provides links to other recent ProMED-mail postings on events occurring in China and neighboring countries. - Mod.MPP] [Seoul virus occurs worldwide and is unlikely to be associated with a localized outbreak in China. Puumala virus is prevalent throughout northern Europe and middle Asia and is usually responsible for only mild forms of hemorragic fever with renal syndrome (HFRS). - Mod.CP] [see also: Hantavirus infection - Taiwan ex China (Inner Mongolia) 20080119.0249 2007 ---- Streptococcus suis, human - China (Guangdong) 20070726.2411 Streptococcus suis - China (Hong Kong) 20070517.1573 Streptococcus suis - China (Hong Kong)(02) 20070527.1707 Epidemic hemorrhagic fever - China (Jiangsu) 20070113.0179 Epidemic hemorrhagic fever - China (Jiangsu) (02) 20070116.0206 2006 ---- Streptococcus suis, porcine, human, 2005 - China (... 20060411.1082 2005 ---- Hemorrhagic fever - China (Inner Mongolia) 20050701.1863 Streptococcus suis, human - China (Hong Kong) 20050728.2196 Streptococcus suis, porcine, human - China 20050730.2217 Streptococcus suis, porcine, human - China (20) 20051024.3099 Streptococcus suis, porcine, human - China (Sichuan) (02) 20050728.2194 Streptococcus suis, porcine, human - China (Sichuan) 20050727.2179 2000 ---- Hantavirus infection - China (Chongqing) (02) 20001121.2020 Hantavirus infection - China (Chongqing): alert 20001117.2008 Hantavirus infection - China: background 20001118.2015 Hantavirus infection - China: background (02) 20001126.2056 Hantavirus infection - China: background (03) 20001206.2127 1999 ---- Strep. suis, human infection - China (Hong Kong) 19991009.1810 1998 ---- Hantavirus infection - China (Hong Kong) 19980412.0670 Hemorrhagic fever, epidemic warning - China 19980905.1782 1997 ---- Hemorrhagic fever with renal syndrome - S.E. Asia 19970408.0743] ...............................mpp/ejp/jw http://www.promedmail.org/pls/otn/f?p=2400:1001:3053288207592996::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,73306 [/quote]
Original Message
Mystery Fatal Hemorrhagic Disease in Shandong China
July 28, 2008
"China reported that approximately 20 days ago, a man suddenly died from an unidentified disease in Wanjiakou Village, Xiaoguan Town, Wendeng City, Shandong Province. His entire body turned dark purple, and he bled from his mouth, nostrils, ears, and eyes just as he died.
Shortly after the man died, 2 other men who been in contact with him, died showing the same symptoms. Villagers who had left the village to work said "3 people died 10 days ago. 6 or 7 more are being treated in the Wendeng Central Hospital. People have been to the area to investigate, but they are unable to classify the disease."
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