2008.08.28 – South China Morning Post

The undiagnosed illnesses that killed three Hong Kong children and put another in intensive care this month have sparked concerns on a Web forum used by 20,000 international infectious disease specialists.

The Promed-Mail programme run by the International Society for Infectious Diseases has called for more information on the cases.

A posting by an Italian specialist noted that in March the government closed all primary schools and kindergartens after two children died.

It was found that the deaths were due to strains of H1N1 and H3N2 Brisbane flu viruses, which had appeared in different parts of the world.

A commentary on the forum suggested that the illnesses could have been caused by enteroviruses.

“The young age of the patients and the predominance of symptoms of blood poisoning and neurological damage suggest the involvement of one or more enteroviruses,” the commentary said.

But the mystery deepened when Centre for Health Protection controller Thomas Tsang Ho-fai said yesterday tests for enteroviruses had all come back negative in the three children who died.

Tests for flu viruses, parainfluenza, herpes simplex virus, and varicella zoster virus were also all negative. Further tests were being performed and it may take at least another week for test results to be available, he said.

Dr Tsang also revealed the postmortem findings for the three girls who died. “For the seven-year-old girl who died of encephalitis, the findings suggest inflammation of the brain,” he said.

“In the nine-year-old girl the postmortem findings revealed evidence of viral myocarditis [an infection of the heart], leading to her death.”

But for the three-year-old girl who died of sepsis and encephalopathy, definitive postmortem findings were pending, he said

Dr Tsang said the girl’s white blood cell count was abnormally high, which suggested a bacterial cause. He said tests for viruses, bacteria and fungi were being run.

The three-year-old boy, in the fourth case, is now in stable condition in a general ward, having been transferred from the intensive care unit of Kwong Wah Hospital. His specimens showed negative results for flu and enterovirus.

Schools, meanwhile, have been reminded of a possible surge in enterovirus 71 (EV71) infections from October, as the number of cases this year have reached 79, the highest in a decade. EV71, apart from causing hand, food and mouth disease, can cause severe neurological diseases in children.

Findings in 2006 and last year showed that the incidence of EV71 and hand, foot and mouth peaked from May to July, the centre said. But surveillance also showed that enteroviruses might be active again from October to December. “We therefore will issue letters to institutions to remind them of the preventive measures before school commences,” a centre spokeswoman said.

The previous highest number of EV71 cases in the city was 60, in 1998, the centre said.

The hand, foot and mouth outbreak was first reported in Anhui province in March, making more than 24,000 people ill and killed at least 43. in the mainland. EV71 has been blamed for most cases.