Undiagnosed Paralytic Disease 3 Dead 19 Hospital

UNDIAGNOSED PARALYTIC DISEASE - NAMIBIA: REQUEST FOR INFORMATION
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A ProMED-mail post


Date: 2 Jun 2006
From: A-Lan.Banks@thomson.com
Source: The Namibian [edited]
<http://www.namibian.com.na/2006/June/national/06275E4F29.html>


Panic is sweeping through suburbs north of Katutura after 3 people
died and 19 others were hospitalised with a disease that still has to
be identified.

A press release from the Ministry of Health and Social Services last
night indicated that the disease was not confined to the Khomas
Region, and that cases of "undiagnosed paralysis" among adults had
been reported in the Otjozondjupa and Hardap regions.

A media briefing is scheduled for this morning to reveal information
related to the outbreak.

Well-placed hospital sources confirmed yesterday that 2 other people
were fighting for their lives in the Intensive Care Unit (ICU) of the
Windhoek Central Hospital after contracting the mystery disease.

Health personnel revealed that parts of the Katutura and Windhoek
Central Hospital have been declared restricted areas as Government
intensifies efforts to identify the disease and to deal with it.

When The Namibian visited the Okahandja Park informal settlement
yesterday to speak to a family who lost a baby, residents confirmed
that another child had died a few hours earlier in Babilon.

An emergency meeting took place late yesterday afternoon after health
personnel conducted a quick survey in Okuryangava and Okahandja Park.
They were reporting their findings to the Deputy Minister of Health,
Petrina Haingura, and other senior staff members of the Ministry.

Health sources said 18 adults and a child were hospitalised at the
Katutura and Windhoek Central hospitals and samples have been sent to
South Africa for analysis.

There were fears that they were all attacked by Guillain-Barre
syndrome (GBS) -- a disorder of the peripheral nervous system. It
causes the nerves to inflame, slowing communication to and from the
brain. Eventually, the brain is not able to effectively communicate
with the peripheral nerves, causing paralysis. Victims become
severely out of breath and unable to perform previously effortless
tasks, such as swallowing. Cramps and body aches often follow. After
approximately 2 weeks, the patient may deteriorate to a condition of
severe paralysis.

However, health personnel said the disease appeared not to be GBS,
although the symptoms were similar. "We can't say exactly what it is
but we also do not want to sound alarm.

"People must stay calm for now," said one senior health official.

A [father] who lost his 10-month-old baby on Monday, said it all
happened very quickly. "She started crying on Sunday night and we
took her to hospital where she got tablets. She was fine the next
morning when I went to work and took medicine. Next thing she started
vomiting and we took her back. She died while we were waiting for
treatment," he said. He also said the baby was not sick before that.
He is leaving for the North today to bury the baby.

A community activist in Okahandja Park, said she knew of a man who
died on board a bus to the North. "It is very strange. He stopped
speaking and his eyes started getting bigger before he died. He was
in the bus waiting for its departure to the North," she said.

Another volunteer at the Okahandja Park Bridging Children School said
they had 19 children absent yesterday. They were told that some had
polio symptoms but will only know today what exactly was wrong.

[Byline: Christof Maletsky]

--
ProMED-mail
<promed@promedmail.org>

[The above description of clinical illness is not very clear, making
a differential diagnosis difficult at this point.  The newswire (and
presumably the reporter) are suggesting clinical symptoms consistent
with a diagnosis of Guillain-Barre Syndrome and or polio, although
the 2 cases that are described do not seem consistent with either
classical GBS or classical polio.

GBS, an acute ascending, usually symmetrical, paralysis, associated
with sensory deficits can be confused with polio, especially with the
formerly called "bulbar" version of polio, in which there is
accompanying respiratory compromise due to paralysis of the muscles
associated with respiration. Typically though, polio is an acute
flaccid paralysis that is asymmetrical and not associated with
sensory deficits.

Before venturing speculations on the etiology of the above illness,
this moderator would very much appreciate more information from
knowledgeable sources. - Mod.MPP]
........................mpp/pg/lm

That's just what I was thinking Diode, related to vaccine.

FluPrepper,

Namibia Risk Profile

	If poliovirus is re-introduced, is your population protected?   Yes  In Namibia , 82 % of children under 1 year of age are routinely immunized with at least 3 doses of OPV - this means that the population in Namibia is protected if polio were to be re-introduced.  A cornerstone of the polio eradication strategy is the maintenance of high levels of routine immunization coverage with at least 3 doses of oral polio vaccine (OPV) among children under 1 year of age. Routine immunization rates of 90% or above would provide substantial protection of polio re-introduction.  Coverage below 90% would leave your population quite exposed to paralytic cases if a virus is re-introduced. Even with high routine immunization coverage, pockets of non-immunized children accumulate, favoring the spread of polioviruses and eventual polio outbreak.  It is essential to ensure all segments of the population are immunized. < style="FONT-WEIGHT: bold; FONT-FAMILY: Arial" scrollAmount=60 scrollDelay=0 =slide loop=1 width=570 height=19 align="center">Polio importations will remain a risk until polio is eradicated everywhere < style="FONT-WEIGHT: bold; FONT-FAMILY: Arial" scrollAmount=60 scrollDelay=0 =slide loop=1 width=470 height=19 align="center">and should be treated as an urgent public health threat!

: J Infect Dis. 1997 Feb;175 Suppl 1:S30-6.

Related Articles, < =1.2> < =1.2> Links

Polio outbreaks in Namibia, 1993-1995: lessons learned.

Biellik RJ, Allies T, Woodfill CJ, Lobanov A.

Expanded Programme on Immunization, Southern Africa, World Health Organization, Harare, Zimbabwe.

In 1993, a nationwide outbreak of 53 cases of paralytic poliomyelitis occurred in Namibia. The World Health Organization-recommended supplemental vaccination strategy of national immunization days (NIDs), providing two doses of oral polio vaccine (OPV) to all children <5 years, was implemented to control the epidemic. A second focal outbreak of 16 confirmed polio cases occurred during 1994-1995 in northeast Namibia. "Mopping-up" vaccination was implemented to control the second outbreak, followed by NIDs. Both epidemics appeared to be associated with wild poliovirus importation from Angola, where polio is endemic. Although supplemental vaccination measures achieved suboptimal OPV coverage, surveillance of acute flaccid paralysis has not detected wild poliovirus in Namibia since April 1995. Future NIDs should aim to ensure OPV coverage >90% in each round of NIDs in each district. Nevertheless, the risk of new poliovirus importations will continue until efforts in Angola to increase routine coverage with three doses of OPV and extend supplemental vaccination activities can be implemented.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9203689&dopt=Abstract

Doug wrote: FluPrepper,   A Google News Search yielded:   "Your search - namibia paralytic - did not match any documents." The News Crawlers love the word "Panic", I'm suprised there is not more on this ???

                Hi Flupreper , I followed your link big thanks , read everyone of every article .

Bulbar Polio

Bulbar Polio is thought to be the result of a person having no natural resistance to the poliovirus, so the brain stem is affected. This strain of the virus attacks the brain stem, which contains the motor neurons that control breathing. Damage to these neurons often results in paralysis of the respiratory muscles. Bulbar polio involved the brain stem where the centers for the cranial nerves are located. The cranial nerves involve smell (olfactory), vision (optic), three cranial nerves control the various muscles that control eyeball movements, the trigeminal nerve and facial nerve which innervate cheeks, tears, gums, and muscles of the face, etc, the auditory nerve which provides hearing, the glossopharyngeal nerve which controls in part swallowing, and functions in the throat, another cranial nerve which controls tongue movement and taste and one that actually sends signals to the heart, intestines, respiratory (lungs) and the accessory nerve that controls upper neck movement. Thus bulbar polio could affect any or all of these functions. Death from bulbar usually occurred from damage to the cranial nerve sending the signal to breathe to the lungs. Bulbar victims could also die from damage to the swallowing function because a victim could drown in their own secretions unless adequately suctioned or given a tracheostomy to suction secretions before the secretions entered the lungs. It was difficult to have a tracheostomy and still be able to tolerate the airtight collar of an iron lung. Death also occurred from the overwhelming invasion of the virus into other parts of the brain causing coma and death. Bulbar polio can be fatal, and the infected person must be placed in an iron lung. The mortality rate of bulbar polio ranges from twenty-five to seventy-five percent, with the variable being the age of the person. To this day there are still polio survivors who must spend their entire day or most of their day in an iron lung or attached to an assistive respiratory machine to stay alive. As mentioned, without respiratory support, bulbar polio usually results in death. Of those who become infected, from five to ten percent die when their breathing muscles become immobilized. Bulbar polio and spinal polio often coexist. They are both a subclass of paralytic polio. Paralytic polio is not necessarily permanent. One can have had paralytic polio and recover seemingly normal function.