Announcement

**Theresa42** · June 4, 2006, 11:53 PM

Sesap does not admit PHI epidemic, but it investigates cases

Google-translated from Portugese:

Hemorrhagic pneumonia Idiop?tica
for Riscobiologico.org, in 31/05/2006
Sesap does not admit PHI epidemic, but it investigates cases

No new case of Pneumonia Hemorr?gica Idiop?tica (PHI) was registered yesterday for the State Secretariat of Public Health (Sesap). For the part of the afternoon it had new meeting of the team that investigates the situation. In accordance with the infectologista Kleber Giovanni Luz, remains to wait the results of the examinations sent to Par? and that they will be able to identify the causing agent of the illness or to discard more cases.

Yesterday also the Sesap unified and brought up to date the information on the PHI in a note technique where it discrimou all the details with regard to inquiry that this being promoted since landmark passed for technician of the Secretariat and that counts on the support of the Health department. In the note it is kept that it does not have bond epidemiologist between the studied cases.

The inquiry was initiated later that doctors - the proper Kleber Luz - had alerted to the Sesap on deaths of children due serious the respiratory picture and fast evolution of the evil. The first chaos dates of day 10 of landmark.

First they had participated of the inquiry only technician of the vigilancia epidemiologist of the Secretariat and the City department of Saude, infectologistas assistants and of the federal University of the Great River of Norte (UFRN), patologistas of the Service of Verification of ?bitos (SVO) and technician of the Central laboratory (Lacen).

Still in landmark, the Secretariat of Vigilancia de Saude of the Ministry of Sa?de (SVS/MS) was informed on the deaths. Contanto, the support of the SVS alone was requested in April, when three deaths had more been registered. From then on the alert one in the hospitals in intention was given to get notification of cases better. He was established that the patients would be suspected who presented acute picture of cough; difficulty to breathe without reply medicines broncodilatadores; e evolution for bleed of the respiratory ways.

For identification ends, he was definite that the health event would be called ?idiopatica hemorragica penumonia? (without known cause).

Beyond the examinations, the involved professionals in the task to discover the causing agent had investigated the life of vitimas, specifying aspects, the alimentary conditions of housing among others and habits.

Beyond the inquiry on PHI, the Sesap also he carries through another one on it I occasion of viroses that acomete currently Native.

Already this clearly for the Secretariat that at least three types of viroses is acting in the region: the intestinais, respiratory and the affection. With regard to this illness, of January the 29 of April of 2005 had been 2,673 against 718 in 2006.

Already with regard to viroses respiratory, in 2005 (January the March), they had been 4,495 internments against 4.146 in this year.

Already for diarr?ia, they had been 107,283 (entire year) notifications in 2005 against 36.389 in 2006 (until May).

Inquiry discloses details of the cases

Of the nine cases that remain being investigated, it measured it of age is of 4 years. 67% of this total are of boys. T he average period of the beginning of the symptoms until the appearance of the difficulty in the breath is of four days. In general, this period varies of one the 12 days. Of the beginning of the symptoms until the death the average of evolution of the picture is of 12 days, varying of one the 20.

None of the cases that still are being investigated presented historical of recent displacement nor of contact with bushes.

4 of the 9 suspicion had had contact with feeding the maize base.

11% of the children had contact with plantations and grass.

The alert one on the PHI continues in the hospital units of the State.

On the basis of the note divulged yesterday and reaffirmed that does not have reason for panic and that it does not have bond between the cases.

http://www.riscobiologico.org/bionews/materias_detalhes.asp?ID=417

**Theresa42** · June 4, 2006, 11:54 PM

Christmas - Population is at the mercy of rumors

Google-translated from Portugese:

Christmas - Population is at the mercy of rumors
May 30, 2006

30/05/2006 - Tribune of the North
Ita?rcio Porpino - Reporter

When adopting the politics of silence in what it says respect to the hemorrhagic pneumonia, the State Secretariat of Public Health (Sesap) at the mercy of left the population of the Great River of the North of rumors and without trustworthy information, what it has contributed to spread a fear atmosphere.

The notification of the first case in the RN was in 10 of March of this year and the Sesap not yet established the cause of the same illness or if it has a transmitting agent. So far, 20 registered cases are suspicious. Eleven had been discarded and eight had resulted in death of the patients - all they children. Information run, however, of that the symptoms have also appeared in adults.

The TN received an information giving account of that last week a gestante would have died in the Hospital of the Military Policy with the symptoms of the illness. A case was not confirmed nor contradicted. Yesterday to the afternoon, the director of the unit was not more in the workstation and informed, by means of a doctor, who would only speak personally. An employee of the Central Laboratory of Public Health (Lacen), with twenty years of experience in the virology sector, commented that the ages with the symptoms have appeared people of all and that the specialists are idiot, without knowing well what to make.

While the rumors run and the fear increases, the Sesap, by means of its assessorship of the press, directs to periodicals an official notice informing: ?Due to great demand and it looks for of the journalists on information concerning the called illness Pneumonia Hemorr?gica Idiop?tica (PHI), the State Secretariat of Public Health (Sesap) decided to carry through, in the weeks where it will have some new fact, a collective one with the press. The interviews will be granted by the state secretary of Health, Adelmaro Cavalcanti J?nior, folloied of the coordinator of Promotion to the Health, Lav?nia Uchoa, and of the subcoordenadora of Monitoring Epidemiologist, Maria Antonieta Delgado Marinho?.

E continues: ?Next the collective one will be carried through in this Friday (02/06) in the audience of the Sesap, in 12? to walk, impreterivelmente to 9h. Each journalist will have right to make two questions. The order for the questionings will be in accordance with the arrival of each vehicle. After the clarifications, will be opened a space so that the TV vehicles can record its sonorous?.

With the ranks and units of health, the State Secretariat of Health started to distribute, has about one week, a protocol of monitoring and assistance of suspected cases, guiding the correct sequence of procedures to be adopted for the doctors in the case of a patient to look to assistance presenting the symptoms of the illness. The children who had died and are being investigated presented acute cough and difficulty to breathe. When being medicated, they had not reacted and they had started to present bleed. The death if gave in question of hours.

Examinations had been sent for Bel?m

Since that it was started to speak in the hemorrhagic pneumonia, the only cases directed for the Central Laboratory of P?bblica Health (Lacen) for analysis in the Institute Evandro Chagas, International Center of Laboratorial Reference for Leishmanioses and Arboviroses, in Bel?m of Par?, they had been of the eight children who had come to die, what she gives to understand that, after them, did not appear plus none another one suspicious case.

The director of the Lacen, Maria Goretti Lins de Queiroz, informed that the laboratory, in Christmas, carries through analysis of seven respiratory types of virus and leptospirose, beyond investigating affection and one rotavirus that diarr?ia cause. All the tests had been made and it was not detected, in none of the children who had died, any one of these illnesses. ?The examinations had given negative. Not appearing none of the causes that we knew, we direct the collected material for analysis in the Institute Evandro Chagas?, said Goretti. It informed despite the Center of Laboratorial Reference must be sending the result of the analyses until the end of the week.

The director of the Lacen spoke that she was unaware of cases of adults who have been acometidos for illnesses with symptoms of the PHI. ?I was not knowing you are welcome in this direction. What it is had so far they are these cases of the children. Nothing more it is known?.

Editorial: Disastrous and antipopular attitude

Transcorridos 81 days since the first notification of the cases of hemorrhagic pneumonia in the Great River of the North, the State Secretariat of Health did not establish, still, which the same origin or if it has a transmisssor pathogenic agent of the illness, that resists all the applied medication and kills in few hours. But it has, of concrete, the 20 registered cases as suspected and eight confirmed deaths.

If it cannot deny that efforts, in the direction to diagnosis the origins of the PHI, have been made. While they do not reach success, it is basic that the population takes precautions, remains itself informed and contributes with the necessary support to the identification, the control and not the dissemination of the illness. The health authorities can and must use themselves the press to help them in this task. When receiving and speaking with the reporters, daily, on the PHI, these authorities they are not giving ?a favor? to the medias, but yes ?fulfilling with an obligation it public agent?: to keep the made entire citizen of what it comes occurring.

However, perhaps inhaled in the method adopted for the attendance to the population, to procrastinate consultations and examinations, the Sesap opted - through its assessorship of the press - in ?only granting interviews when it will have a new fact' and to limit, in these occasions, the questions made for the reporters. It is inconceivable, for a democratic government, a so disastrous and antipopular attitude.

415 Unsupported Media Type

http://www.tribunadonorte.com.br/noticia.php?id=11574

DB · June 5, 2006, 10:49 AM

Re: Brazil - Hemorrhagic pneumonia (Rio Grande Do Norte)

Thank you Theresa42 for your work on this.

This is definetly something to watch.

**Theresa42** · June 5, 2006, 11:25 AM

Re: Brazil - Hemorrhagic pneumonia (Rio Grande Do Norte)

Someone just reminded about the woman in Brazil who did not die of bf last week, but who was buried in a sealed coffin:

Brazil - Brazilian did not die of avi?ria grippe, says Fiocruz - FluTrackers News and Information

http://www.flutrackers.com/forum/showthread.php?t=6603

**Theresa42** · June 6, 2006, 12:35 AM

Pro-Med Brazil reports

There are four Pro-Med Brazil reports [hat-tip max] on this situation in Portugese from the last couple of weeks. I'm going to post all four of them babelfished from Portugese. They're not easy to read -- pretty dense with info (and I haven't had time to digest them properly yet) -- so here goes (in chronological order, oldest to most recent)....

This first one: Virtually the same (or exactly the same) as this report:

Brazil - Hemorrhagic pneumonia (Rio Grande Do Norte) - FluTrackers News and Information

http://www.flutrackers.com/forum/showpost.php?p=15580&postcount=2

PNEUMONIA HEMORRAGICA - BRASIL (RIO GRANDE DO NORTE)
************************************************** *****
Uma mensagem / Una mensaje / de ProMED-mail <http://www.promedmail.org>
ProMED-mail e um programa da / es un programa de la International Society
for Infectious Diseases <http://www.isid.org>

Data: Sabado, 20 de maio / mayo de 2006
De: Promed-Port Promed-Port@promedmail.org
Fonte: Tribuna do Norte [20.05.2006] http://www.tribunadonorte.com.br

Sesap nao admits PHI epidemic, but it investigates cases

No new case of Pneumonia Hemorragica Idiopatica (PHI) was registered yesterday [May 19] for the State Secretariat of Greets Publishes (Sesap). For the part of the afternoon it had new reuniao of the team that investigates situacao. In accordance with the infectologista Kleber Giovanni Light, remains to wait the results of the examinations sent to the one For and that podera to identify the causing agent of doenca or to discard more cases.

Yesterday they tambem the Sesap it unified and it brought up to date informacoes on the PHI in a tecnica note where investigacao discrimou all the details with relacao that this being promoted since landmark passed for tecnicos of the Secretariat and that it counts on the support of the Ministerio of Saude. In the kept note and that nao ha I tie epidemiologico between the studied cases.

Investigacao was initiated later that medicos - the proprio Kleber Light - they had alerted the Sesap on deaths of criancas had the respiratorio picture serious and rapida evolucao of the evil. The first chaos dates of day 10 of landmark. First they had participated of investigacao only tecnicos of the epidemiologica vigilancia of the Secretariat and of the City department of It greets, infectologistas assistants and of the federal University of the Great River of the north (UFRN), patologistas of the Servico de Verificacao de Obitos (SVO) and tecnicos of the Central laboratorio (Lacen).

Still in landmark, the Secretariat of Vigilancia de Saude of the Ministerio of Sapude (SVS/MS) was informed on the deaths. Contanto, the support of the SVS so was requested in April, when tres obitos had more been registered. To leave you give was given the alert one in the hospitals in intention to get notificacao of cases better. He was etabelecido that the patients would be suspected who presented acute picture of cough; difficulty to breathe without reply medicines broncodilatadores; e evolucao for bleed of the respiratorias ways.

For ends of identificacao, he was definite that the event of greets would be called "penumonia idiopatica hemorragica "(without known cause). Alem of the examinations, the involved professionals in the task of decobrir the causing agent had investigated the life of vitimas, having specified among others ascpectos, condicoes of housing and alimentary habitos.

Alem of investigacao on PHI, the Sesap tambem carries through another one on it occasions of viroses that acomete currently native. Ja this clearly for the Secretariat that at least tres types of virorese estao acting in regiao: the intestinais, the respiratorias and the affection. With relacao to this doenca, of January the 29 of April of 2005 had been 2,673 against 718 in 2006. Ja with relacao viroses respiratorias, in 2005 (January the landmark), had been 4,495 internacoes against 4.146 in this year. Ja for diarreia, had been 107,283 (entire year) notificacoes in 2005 against 36.389 in 2006 (it ties May).

Investigacao discloses details of the cases

Of the nine cases that remain being investigated, it measured it of age and 4 years. 67% of this total and boys. Periodo medio of the beginning of the symptoms ties the appearance of the difficulty in respiracao and four days. In general, this periodo vaira of one the 12 days. Of the beginning of the symptoms it ties the obito measured it of evolucao of the picture and 12 days, varying of one the 20.

None of the cases that estao being investigated had still presented historico of recent displacement nor of contact with bushes. 4 of the 9 suspicion had had contact with alimentacao the maize base. 11% of criancas had contact with plantacoes and pasto. O alert on the PHI continues in the hospital units of the State. On the basis of the note divulged yesterday and reaffirmed that nao ha reason for panico and that nao ha I tie between the cases.

Comentario: [ Dificil to make one hipotese. Possibly it would be hemorragico affection? I believe, still that other diagnosticos must be remembered, between them, leptospirose and hantavirose. We go to wait greaters informacoes - ljs ]

http://www.promedmail.org/pls/promed/f?p=2400:1001:2914079769811128991::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1055,33008

**Theresa42** · June 6, 2006, 12:43 AM

Pro-Med Brazil - report 2

babelfished from Portugese:

Archive Number 20060524.1458
Published Date 24-MAY-2006
Subject PRO/POR> Pneumonia hemorragica - Brasil (Rio Grande do Norte) (02)

PNEUMONIA HEMORRAGICA - BRASIL (RIO GRANDE DO NORTE) (02)
************************************************** ***
Uma mensagem / Una mensaje / de ProMED-mail <http://www.promedmail.org>
ProMED-mail e um programa da / es un programa de la International Society
for Infectious Diseases <http://www.isid.org>

Data: Quarta-feira / Miercoles, 24 de maio / mayo de 2006
De: Promed-Port Promed-Port@promedmail.org
Fonte: Diario de Natal [24.05.2006] http://diariodenatal.dnonline.com.br

Tecnicos nao detects.causing agent of doenca

Apos 47 days of analyzes, tecnicos of the epidemiologica vigilancia of the city departments and state of It greets Publishes had identified 20 cases suspicious of idiopatica hemorragica pneumonia, of which 11 had been discarded for clinico, laboratorial or patologico criterio, remaining nine of them in process of investigacao. This and the result of the relatorio divulged yesterday for manha, that it delimits the Great Christmas and the municipio of Sao Tome (distant 129km of the capital) as areas by incidencia of the disease. It measured it of age of vitimas and 4 years, being 67% of the cases involving criancas of the masculine sex. None of the hipoteses raised on the causing agent of doenca ties the moment was proven.

In accordance with the relatorio, the date of beginning of the first case occurred in 10 of passed landmark, being finishes it of them, evidenced in day 4 of this month. The document discloses that the percentage of deaths, in turn, was of 88%, identified in different hospital units of Christmas [Natal]. A suspected case, second informacoes, remains hospitalized. The symptoms most frequent had been the air lack, bleed and fever. Periodo medio so that the appearance of the symptoms was of four days. To arrive the obito, vitimas had led in measured 12 days, counted from identificacao of the first signals of doenca.

Compared in a grafica scale of zero the 100%, they had appeared tambem as symptoms of the diarreia hemorragica pneumonia, I vomit, edema, hepatomegalia and high fever. When of avaliacao of antecedent cases, 66% of the ocorrencias had presented cronica historico of doenca, as asthma, deficiencia of antitripsina alpha-1 -causing of disfuncao of the metabolism - and falciforme anemia. In accordance with the relatorio, in tres of the nine cases had story of previo contact with the sick person. Nao ha indicios of that vitimas has travelled for other localities or exactly had contact with the bush. In avaliacao of the alimentary habitos, exposicao the foods the base of maize before the adoecimento was of 44% - four of the nine cases. The nine cases suspicious estao distribuidos by six municipios, in the following way: tres in Christmas [Natal], two in Sao Goncalo of the Amarante, one in Ceara Mirim, one in Taipu, one in Parnamirim and another one in Sao Tome.

Comentario: [ This moderator had access to the data of this occasions. Situacao really is about one dificil to decide. The causes you use, hantavirus, influenza and affection would have been discarded laboratorialmente. Let us wait more informacoes - ljs ]

http://www.promedmail.org/pls/promed/f?p=2400:1001:2914079769811128991::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1055,33033

**Theresa42** · June 6, 2006, 12:50 AM

Pro-Med Brazil - report 3

babelfished from Portugese:

Archive Number 20060602.1534
Published Date 02-JUN-2006
Subject PRO/POR> Pneumonia hemorragica - Brasil (Rio Grande do Norte) (03)

PNEUMONIA HEMORRAGICA - BRAZIL (GREAT RIVER OF THE NORTH) (03) **************************************************
A message/Joins mensaje/of ProMED-mail ProMED-mail and a program of/es un program of la International Society will be Infectious Diseases

Date: Friday/Viernes, 02 of junio June/of 2006
Of: Promed-Port Promed-Port@promedmail.org
Source: Native Diario de [ 02.06.2006 ] http://diariodenatal.dnonline.com.br

PHI makes nineth vitima

Of eight, they had passed to nine it I number of deaths suspicion of Pneumonia Hemorragica Idiopatica (PHI), that estao being investigated for the State secretary and Greets Publishes (Sesap). The death most recent was last week, of a woman of 32 years, who was pregnate, and interned in the Hospital of Policia Militar (HPM). In accordance with the subcoordenadora of Epidemiologica Monitoring, Thin Antonieta Maria, informacao so arrived the Coordenadoria de Promocao Saude (CPS), this week, saw the Servico de Verificacao de Obito (SVO). Alem of the nineth death, appeared one suspicious other in case that that this interned in Christmas [Natal], of a girl of two years, that lode of Goianinha. Now ja and as, therefore ja exists a boy of 11 years interned in the Papi Hospital.

Although if it has added more two municipios to the PHI cases suspicious, the Comissao that this investigating since landmark this unknown pneumonia ''desconhecida'' still nao has significant answers. The relatorio divulged in the last terca-fair says in stretch: "none of the hipoteses raised for definicao of the etiologico agent ties the moment or exposicoes of risk still explains the majority of the cases under investigacao". It consists tambem in the relatorio that "this proven'' that nao exists I tie epidemiologico between the cases. Thin Antonieta Maria said to the Native Diario de that the Comissao continues waiting resulted of the collection that was directed to the referencia laboratorio in Brazil, Institute Evandro Chagas. "We bind (terca-fair yesterday, 30) but nao had resulted. We believe that this week we will be able to have some reply of the Laboratorio'', said it.

In periodo of 1? of landmark it ties the last monday had been identified 24 suspected cases, of which 15 ja had been discarded. Being being investigated only nine, that estao distribuidos in the municipios of: Christmas, Parnamirim, Sao Goncalo of the Amarante, Canguaretama, Ceara-Mirim, Good Greet, Sao Tome, Galinhos and Taipu. It measured it of age was of 3 years. But now, a case of death of an adult added. Inquired on if this new death it would bring other tracks for investigacao, Antonieta Maria said that the two added municipios (Galinhos and Boa Greets) sao relatively we proximos of Christmas and excessively, being in the coast or wasteland to potiguar.

The Hospital of Military Policia was looked, but the news article saw secretariat of direcao was informed of that the director Gilson Cantidio nao would be in the Hospital yesterday, all the day, that ninguem more could speak and that so would have the possibility of it to be disponivel today to speak on the death of the pregnate woman under PHI suspicion.

http://www.promedmail.org/pls/promed/f?p=2400:1001:2914079769811128991::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1050,33116

**Theresa42** · June 6, 2006, 12:52 AM

Pro-Med Brazil - report 4

babelfished from Portugese:

Archive Number 20060603.1546
Published Date 03-JUN-2006
Subject PRO/POR> Pneumonia hemorragica - Brasil (Rio Grande do Norte) (04)

PNEUMONIA HEMORRAGICA - BRAZIL (GREAT RIVER OF THE NORTH) (04) **************************************************
A message/Joins mensaje/of ProMED-mail ProMED-mail and a program of/es un program of la International Society will be Infectious Diseases

Date: Sabado, 03 of junio June/of 2006
Of: Promed-Port Promed-Port@promedmail.org
Source: Tribune of the North [ 03.06.2006 ] http://www.tribunadonorte.com.br

You analyze done nao disclose causing agent of doenca

Exactly apos it analyzes it of celulas of tres criancas that they had died with the caracteristicas of the hemorragica pneumonia in the State, the debrucados specialists who estao on the research still are unaware of the causing agent of doenca. But they ja know that nao if deals with. I medicate it infectologista Kleber Light, integrant of comissao that it investigates the cases suspected in the Great River of the North, discarded, on the basis of the results, the existencia of one would bacteria causing of doenca and the possibility of transmissao of person for person.

"People know that nao and would bacteria, that nao and virus of the affection and still that nao ha associacao with none virose. Tambem nao we are ahead of one I occasion of doenca, due to I little number it significant of cases", said it, of manha, during yesterday collective the press where they had participated the state secretary of Greets, Adelmaro Cavalcanti, and the professionals who integrate the team of investigacao of the PHI, alem of the virologista Willer Mello, the Ministerio of Saude and the Institute Evandro Chagas.

The laboratorio, in Belem of the one For, concluded analyzes it microscopica of fabrics of tres criancas. The results fortify the PHI suspicion still more. The examinations had indicated that tres had died of one same pathology, still of unknown cause. Of the seven cases of obito, it still lacks to be made analyzes it of fabrics of two - the gestante [the pregnant woman] of 33 years that died in it I finish day 24 and one crianca. The others two criancas suspicion to have died of PHI permanecerao without one I diagnosis conclusive, therefore the families nao had authorizeed that the Servico de Verificacao de Obito in the RN made the fabric collection for analyzes them.

In the press conference, the subcoordenadora of Vigilancia Epidemiologica of the State Secretariat of Greets (Sesap), Marine Thin Antonieta Maria, informed that one of the nine cases suspicious that were being investigated was discarded. It spoke tambem that the civil engineer who died in the terca-fair, 30, nao was incluido enters suspicious because the picture presented for caracteristico it and of hemorragica affection.

The discarded case and of crianca of Galinhos. The girl, of two years, had an improvement and in the Wednesday she left the UTI for the infirmary. It nao presented bleed in pulmao and doenca was diagnosised as influenza. The other suspicious case and of the boy of 11 years. It continues in the UTI of the Papi, in considered state very serious.

The authorities of greet had remembered, however, that to as much this crianca as the others five that they had been the obito presented historico of doenca cronica, as bronquica asthma, epilepsy and falciforme anemia.

By means of you analyze them carried through in the Institute Evandro Chagas, center of national referencia in respiratorias research of doencas, the authorities of greets of the RN ja know that ha two types of virus circulating in the State. Sao influenza and the respiratorio sincicial, responsaveis for I occasion it that it has crowded the units of greets.

The infectologista Kleber Light assured that nao ha associacao of these virus with the PHI, saying, also, that nao was detected presenca of none of them in the concluidos examinations ja. "And facil to separate virose of the pneumonia. First and the one doenca benign, that it lasts some days and it bothers for pains in the body and fever but later passes, and to serious other and".

Two cases under suspicion estao in the Wheat Giselda

They had appeared two new cases suspicious of hemorragica pneumonia in the RN, but they nao had been still notified the Sesap. The people with suspicion to have been attacks for doenca of still unknown cause sao two agriculturists of Garden of the Serido, the one of 44 years and other of 40. They had given entered in the soon-aid of Wheat the Giselda Hospital, in Christmas [Natal], the first hours of the night of anteontem, presenting high fever, strong cough and escarrando blood.

In the sector of social assistencia, the TN obtained to confirm the entrance of the two patients, but none informacao more was given. However, the woman of one of them, Francisda of the Chagas, 30 years, confirmed that its husband and another man had been transferred of the hospital of Garden of the Serido pressas to the Giselda in the same day.

It said that the husband adoeceu in the Monday, presenting fever, cough and ja escarrando blood. In the fourth a late, Francisca took it to the hospital of the city and la I medicate it spoke of the possibility of hemorragica pneumonia, ordering the patient immediately the Christmas [Natal].

For comissao that it investigates doenca, the cases suspicious sao eight, ja that these nao had been still notified and crianca of 2 years, inhabitant of Galinhos, was discarded. I medicate it infectologista Kleber Light came back to explain, during the press conference, as if of the o development of doenca, in accordance with the inquired cases ja.

"The person presents cough and lack of air, as it was itself a asmatica bronchitis. Ahead of the picture of respiratoria insuficiencia, the patient and taken to the ready aid, but the treatment the base of antibioticos nao occasions effect. To if using artificial respirators, bleed in pulmoes is perceived. The sick worsening and nao answer ventilacao mecanica and die".

The infectologista speaks that and facil to separate of virose because this finishes and well more branda. Diferenca, according to it, and always the gravity of the clinico picture. "Crianca with virose can come to develop bronchitis, but under treatment it recovers. Exactly with the lack of air - that she occurs in 100% of criancas - and facil to make separacao. The important one and that nao exists evidences of transmissao of the HPI of person for person. This and data favoravel."

Comentario: [ Nao I agree, the results of autopsy and the laboratoriais examinations suggest one strong co-infeccao viral and bacterial or a viral pneumonia. The reply it must come more of well-taken care of etiologicos examinations detailed and the study of the autopsy material - ljs ]

http://www.promedmail.org/pls/promed/f?p=2400:1001:2914079769811128991::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1050,33128

**Theresa42** · June 7, 2006, 04:28 AM

Neighboring province on the lookout for similar cases / none reported to date

babelfished from Portugese:

Monitorial SES internments because of mysterious illness in the RN
June 07, 2006

The State Secretariat of Sa?de (SES) of the Para?ba is monitoring the hospital internments for pneumonia, because of the cases of the mysterious illness, that already vitimou seven people in the Great River of the North. In accordance with the coordinator of Monitoring Epidemiologist of the SES, Diom?ia Garci'a, the deaths in the neighboring State, still is being investigated and has the suspicion that they can have been caused for the idiop?tica hemorrhagic pneumonia (of unknown origin).

According to Diom?ia, no alteration in the behavior and the number of cases of pneumonia in the Para?ba was not identified, but the monitoring is important. "Until the final diagnosis of the cause of the deaths in the Great River of the North is given, that will come through the result of the examinations made for the Institute Evandro Chagas, of Bel?m (Par?) must be alerts, therefore we do not know the etiology of the illness, however so far does not have indications of that it is transmitted between people", says.

It standes out that by means of done examinations for the institute any possibilities of that the illness is caused by virus H5N1, causer of the avi?ria grippe had also been discarded, that already killed hundreds of people in diverse countries.

The symptoms of the hemorrhagic pneumonia, as it informs Diom?ia are very acute cough, with dispn?ia (breath difficulty), that it does not answer to the broncodilatadores and that evolves for bleed of the respiratory ways, being able to lead to the death. "As it has a specific and different sintomatologia, still it was not possible if to arrive at a diagnosis. The pneumonia can occur for diverse causes and is what he is being analyzed", detaches it.

The cases in the Great River of the North had started to be investigated in the March month, when they had been registered the first cases of death of children with serious respiratory picture and evolution of the illness of fast form (around 13 days of the appearance of the symptoms until the death). The cities where the deaths had been informed suspicion had been: Good Health, Canguaretama, Cear? Mirim, Galinhos, Christmas, Parnamirim, Are Gon?alo of the Amarante, Are Tom? and Taipu. "The cases still are in study and it does not have confirmations until the examinations can disclose the origin of the evil", Diom?ia standes out Garci'a.

http://jornaldaparaiba.globo.com/cida-09-070606.html

**Theresa42** · June 18, 2006, 12:08 PM

ProMed update - reportedly not H5N1

Archive Number 20060618.1689
Published Date 18-JUN-2006
Subject PRO> Hemorrhagic pneumonia - Brazil (RN)(02): follow-up

HEMORRHAGIC PNEUMONIA - BRAZIL (RIO GRANDE DO NORTE)(02): FOLLOW-UP
***********************************************
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: 18 Jun 2006
From: Luiz J. da Silva <ljsilva@promedmail.org>

The cases of hemorrhagic pneumonia, reported from 10 May 2006 onwards in the northeastern Brazilian State of Rio Grande do Norte, were considered initially as a distinct, possibly new, disease entity. [See Archive Hemorrhagic pneumonia - Brazil (RN) 20060604.1561].

Tests were negative for hantavirus, leptospirosis and dengue in the 1st few cases. The state department of health together with the Ministry of Health initiated an investigation.

After extensive epidemiological, clinical, laboratory and pathology work-up, the conclusion was that the hemorrhagic pneumonia was in fact severe cases of different respiratory diseases. The state was suffering 2 simultaneous outbreaks of respiratory disease, one of respiratory syncytial virus (RSV) and another of influenza A, as well as outbreaks of dengue and rotavirus diarrhea. The combination of these outbreaks had the expected results: persons with risk factors, like malnutrition, pregnancy, sickle cell anemia and old age, suffered severe, sometimes fatal cases of pneumonia with hemorrhage.

The hemorrhage was solely in the lungs with no evidence of hemorrhage elsewhere, except in the dengue cases.

Although the outbreak caused great anxiety in the population and in local health authorities, the situation is calm at the moment, and, as the RSV and influenza outbreaks have waned, no more cases of severe pneumonia have occurred, although surveillance has been enhanced.

--
Luiz J. da Silva
ProMED-PORT Moderator
<ljsilva@promedmail.org>

[We are thankful to Luiz for this follow-up. - Mod.DK]

http://www.promedmail.org/pls/promed/f?p=2400:1001:14412994725056543592::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,33275

**Sharpe** · June 19, 2006, 08:28 PM

Re: Brazil - Hemorrhagic pneumonia (Rio Grande Do Norte)

Nature has a little editorial on the outbreak.

<table border="0" cellpadding="0" cellspacing="0" width="434"> <tbody><tr xmlns=""><td height="22" valign="top">News</td></tr><tr xmlns=""><td></td></tr><tr xmlns=""><td height="14"></td></tr><tr><td>Published online: 19 June 2006; | doi:10.1038/news060619-1 Brazilian outbreak raises fears over disease preparedness

Monitoring criticized after 'unnoticed' disease spread.Declan Butler
<table xmlns="" border="0" cellpadding="0" cellspacing="0" width="434"><tbody><tr><td height="20"></td></tr><tr><td height="1"></td></tr><tr><td height="20"></td></tr></tbody></table><table xmlns="" align="right" border="0" cellpadding="1" cellspacing="5" width="20%"><tbody><tr><td class="black"><table border="0" cellpadding="2" cellspacing="0"><tbody><tr><td class="ltpink" align="center">

</td></tr><tr><td class="ltpink">News of a disease outbreak in northern Brazil took almost three months to reach the international community.
? Getty</td></tr></tbody></table></td></tr></tbody></table>Health-monitoring experts are coming under fire for their response to a mysterious and fatal outbreak of respiratory disease in northeastern Brazil in March. News of the outbreak, which began on 10 March, only reached the international community on 4 June, when a translation of a local news article was published on the international ProMED mailing list, a service for disseminating information about outbreaks. Four posts on ProMED's Latin American list in Portuguese had appeared the week before.

The 2003 outbreak of severe acute respiratory syndrome (SARS) stressed the importance of using modern communications to at least alert the world to any unusual suspected disease outbreaks.

The Brazilian outbreak was eventually declared a false alert, but that has not stopped health-monitoring officials coming under fire. "Brazil's capacity for outbreak monitoring and response leaves much to be desired," one Brazil-based US official, who declined to be named, told news@nature.com.

Waiting game

When contacted on 6 June, World Health Organization (WHO) spokeswoman Maria Cheng said that the organization's Geneva headquarters had received no information. She said that WHO experts are still awaiting information from the Pan American Health Organization (PAHO), the WHO's Latin America office. "Unfortunately, I don't have any more information about this mystery illness right now," she said.

<table xmlns="" align="left" border="0" cellpadding="0" cellspacing="0" width="180"><tbody><tr><td align="center" valign="top"><table border="0" cellpadding="1" cellspacing="0"><tbody><tr><td class="black"><table border="0" cellpadding="5" cellspacing="0"><tbody><tr><td class="white" width="178"> Surveillance is still problematic in Brazil, at least for respiratory diseases. </td></tr></tbody></table>
<table border="0" cellpadding="5" cellspacing="0"><tbody><tr><td class="ltpink" width="178">Luiz Jacintho da Silva
health official, Rio Grande do Norte state, Brazil</td></tr></tbody></table></td></tr></tbody></table></td><td></td></tr><tr><td colspan="2"></td></tr></tbody></table>The same day, Donna Eberwine-Villagr?n, a PAHO spokeswomen, said they didn't have any information either, but had asked their Brazil office, while pointing to the first report on the Brazilian Ministry of Health's website, a post dated 29 May as "The latest info we know of 'officially'". On 7 June, Daniel Epstein, a spokesman for the PAHO Brazil office, said it too could not furnish further details, as it was waiting on the Brazilian government for information.

The ProMED report, titled 'Mysterious disease keeps Health Department on alert' cited an unknown disease, referred to as 'idiopathic haemorrhagic pneumonia', that had been suspected in 24 cases, and killed seven of nine confirmed cases (an 80% mortality rate) in the state of Rio Grande do Norte. Symptoms include high fever, respiratory difficulties and bleeding from airways.

Local health official Luiz Jacintho da Silva has confirmed that the scare was a false alarm. Rio Grande do Norte is affected by respiratory syncytial virus (RSV) and seasonal flu, and the initial diagnosis of haemorrhagic pneumonia is now thought to have been "severe, and lethal, cases of either RSV or influenza", he says, with the symptoms compounded in many cases by malnutrition, sickle-cell anaemia or asthma.

Response time

Samples were also tested for the deadly avian flu strain H5N1 at the Evandro Chagas Institute in Bel?m, part of a WHO flu lab network, even though avian flu has not yet been reported in Brazil, says da Silva. At the same time, he adds, the speed of the outbreak response was complicated by the impact of decentralization on the chain of command, a problem that has been blamed for Indonesia's poor response to avian flu outbreaks.

"The problem with the outbreak investigation is that, as Brazil is a federation, states have to ask for help from the Ministry of Health before an investigation is done," says da Silva. However, federal surveillance has improved recently, he adds, but it "is still problematic in Brazil, at least for respiratory diseases." It's only recently that this has received attention, he says. "Coordination is still in need of improvement."</td></tr></tbody> </table>

KC · June 20, 2006, 04:43 PM

Re: Brazil - Hemorrhagic pneumonia (Rio Grande Do Norte)

Local health official Luiz Jacintho da Silva has confirmed that the scare was a false alarm. Rio Grande do Norte is affected by respiratory syncytial virus (RSV) and seasonal flu, and the initial diagnosis of haemorrhagic pneumonia is now thought to have been "severe, and lethal, cases of either RSV or influenza", he says, with the symptoms compounded in many cases by malnutrition, sickle-cell anaemia or asthma.

I went to the WHO and CDC sites for both RSV and seasonal influenza. The signs and symptoms for both RSV and seasonal influenza do not have the hemorrhagic involvement that was seen in the Brazil outbreak.

**Sharpe** · June 22, 2006, 07:08 PM

Re: Brazil - Hemorrhagic pneumonia (Rio Grande Do Norte)

I am very concerned about Brazil to put it lightly. Massive country, isolated villages, poultry and pig-raising, incredible abundance of animals and birds, Amazon River prime target for migratory birds from across the world. That outbreak of hemorrhagic fever in the north is incredibly concerning. It does not fit the diseases they cite as the cause. It fits bird flu though. Now they have another outbreak, also lethal of course due west of there, causing paralysis--a classic clinical symptom of bird flu. Could polio have arrived? Maybe. It apparently is affecting young farmers the most. What is going on in Namibia anyway--the most polio-immunized country in the world? Is it really polio? Or was it just that one case that South Africa found it in? I don't know. We will have to wait and see. The truth always comes out in the end. Below is a Google Translate'd version of this Portuguese Promed post. A better translation would always be appreciated.

SINDROME NEUROLOGICA - BRAZIL (EMPRESS, ME) ************************************************** * a message/Joins mensaje/of ProMED-mail < http://www.promedmail.org > ProMED-mail and a program of/es un program of la International Society will be Infectious Diseases < http://www.isid.org > Date: Thursday/Jueves, 22 of junio June/of 2006 Of: Marjorie P. Pollack "
Source: Online leaf [22.06.2006] http://www1.folha.uol.com.br/folha/cotidiano unknown

Sindrome killed seven in the Maranhao neurologica Uma sindrome, whose cause nao was identified, killed seven people in regiao south of the State of the Maranhao. Others 24 interned people estao with symptoms in the municipal hospital of Empress (637 km of Sao Luis). Since day 26 of May, when concentracao of cases of paralysis in inferior members without defined causes was perceived one, tecnicos of the Vigilancia Epidemiologica of the State and the Ministerio of Saude they investigate sindrome. According to Enrique Jorge Dos Santos, coordinator of Vigilancia Epidemiologica of the Maranhao, pparently sindrome nao and transmissivel of person for person. “Nao we can say if and this or that, but impressao and that nao and transmissivel”, said. The symptoms of sindrome sao dormencia in the legs, difficulty to walk and respiratoria insuficiencia, what it causes cardiacos problems e, as conseqüencia, the death. For Saints, doenca nao and mortal if the symptoms will be fought precociously, before the respiratorios problems compromise the functioning of coracao. “Doenca nao and necessarily lethal. But as the people they live in distant municipios, when sao led for the hospital arrives in situacao criticizes”, it said Saints. According to it, the majority of vitimas and young agriculturists, with ages between 15 and 49 years. Samples of blood, excrements, skin and hair for examinations had been harvested. All material it was sent to the Institute Evandro Chagas, of Belem (Par&#225

, but it still analyzes it nao was concluida. The Secretariat of Saude of the Maranhao comes alerting populacao of regiao to look attendance medicates the symptoms as soon as to appear. In the terca-fair (20), 16 people had given entered in the hospital with symptoms of doenca. Comentario: [Manifestacoes neurologicas, evolucao for obito and concentracao of the cases in young adults, agriculturists, points with respect to intoxicacao exogena for pesticide or another one substantiates used in agriculture. Some organofosforados present sintomatologia many times are of the classico picture, making it difficult diagnosis it - ljs]

SINDROME NEUROLOGICA - BRASIL (IMPERATRIZ, MA) ************************************************** * Uma mensagem / Una mensaje / de ProMED-mail <http:> ProMED-mail e um programa da / es un programa de la International Society for Infectious Diseases <http:> Data: Quinta-feira / Jueves, 22 de junho / junio de 2006 De: Marjorie P. Pollack"
Fonte: Folha Online [22.06.2006] http://www1.folha.uol.com.br/folha/cotidiano Sindrome desconhecida matou sete no Maranhao Uma sindrome neurologica, cuja causa nao foi identificada, matou sete pessoas na regiao sul do Estado do Maranhao. Outras 24 pessoas estao internadas com sintomas no hospital municipal de Imperatriz (637 km de Sao Luis). Desde o dia 26 de maio, quando foi percebida uma concentracao de casos de paralisia em membros inferiores sem causas definidas, tecnicos da Vigilancia Epidemiologica do Estado e do Ministerio da Saude investigam a sindrome. Segundo Henrique Jorge dos Santos, coordenador de Vigilancia Epidemiologica do Maranhao, aparentemente a sindrome nao e transmissivel de pessoa para pessoa. "Nao podemos dizer se e isso ou aquilo, mas a impressao e que nao e transmissivel", disse. Os sintomas da sindrome sao dormencia nas pernas, dificuldade para caminhar e insuficiencia respiratoria, o que acarreta problemas cardiacos e, como conseqüencia, a morte. Para Santos, a doenca nao e mortal se os sintomas forem combatidos precocemente, antes que os problemas respiratorios comprometam o funcionamento do coracao. "A doenca nao e necessariamente letal. Mas como as pessoas moram em municipios distantes, quando sao levados para o hospital chegam em situacao critica", disse Santos. Segundo ele, a maioria das vitimas e de jovens agricultores, com idades entre 15 e 49 anos. Foram colhidas amostras de sangue, fezes, pele e cabelos para exames. Todo material foi enviado ao Instituto Evandro Chagas, de Belem (PA), mas a analise ainda nao foi concluida. A Secretaria da Saude do Maranhao vem alertando a populacao da regiao para procurar atendimento medico assim que os sintomas aparecerem. Na terca-feira (20), 16 pessoas deram entrada no hospital com sintomas da doenca. Comentario: [As manifestacoes neurologicas, a evolucao para obito e a concentracao dos casos em adultos jovens, agricultores, aponta para intoxicacao exogena por pesticida ou outra substancia utilizada na agricultura. Alguns organofosforados apresentam sintomatologia muitas vezes fora do quadro classico, dificultando o diagnostico - ljs]</pollackmp></http:></http:></pollackmp>

Attached Files

**Sharpe** · June 22, 2006, 07:18 PM

Re: Brazil - Hemorrhagic pneumonia (Rio Grande Do Norte)

The English Promed version is out, with a long commentary at the end.

UNDIAGNOSED NEUROLOGIC SYNDROME, DEATHS - BRAZIL (MARANHAO): 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: 22 Jun 2006 From: ProMED-mail <promed@promedmail.org> Source: Folha [trans. from Portuguese by Mod.MPP; edited] <http://www1.folha.uol.com.br/folha/cotidiano/ult95u123046.shtml> A neurological syndrome, whose cause has not been identified, has killed 7 people in the southern region of the state of Maranhao. Another 24 people are hospitalized with symptoms [of this same illness] in the municipal hospital of Imperatriz (637 km from Sao Luis [the capital of Maranhao]). Since 26 May [2006], when a concentration of cases with paralysis of the lower extremities without defined causes was noted, technical personnel from the Epidemiologic Surveillance Unit of the State Ministry of Health went to investigate the syndrome. According to Henrique Jorge dos Santos, the Coordinator of the Epidemiologic Surveillance Unit of Maranhao, the syndrome is not transmitted person to person. "We cannot say if [the syndrome] is this or that, but the impression is that it is not transmissible [person to person]," he said. The symptoms of the syndrome are paresthesias in the legs [loss of sensation], difficulty walking and respiratory insufficiency, which leads to cardiac problems and as a consequence, death. [According to] Santos, the disease is not lethal if the symptoms are treated early, before respiratory compromise occurs and leads to cardiac compromise. "The disease is not necessarily lethal. But as the [affected] population lives in municipalities that are distant [remote], when they are taken to the hospital, they arrive in critical condition." said Santos. According to him, the majority of the cases are young agricultural workers with ages between age 15 and 49. Specimens of blood, feces, skin and hair were taken for laboratory testing. All of the material [specimens] were sent to the Evandro Chagas Institute in Belem [Para] but the analyses have not as yet been completed. The Secretary of Health from Maranhao has been alerting the population of the region to get medical attention as soon as the symptoms appear. On Tuesday, [20 Jun 2006], 16 people were admitted to the hospital with symptoms of this disease. [Byline: Silvia Freire] -- ProMED-mail <promed@promedmail.org> [The description of the epidemiological and clinical picture seen with this as yet undiagnosed neurologic syndrome can lead down several pathways. One initial thought is the possibility of a toxic exposure (such as organophosphates), as the predominant population affected is agricultural workers and the syndrome does not appear to be transmitted person-to-person (although we do not have the information/data that would lead to this conclusion), further suggesting this might be due to a toxic exposure. That being said, the absence of mention of gastrointestinal symptoms along with the description of paresthesias is not classical for organophosphate poisoning, the mechanism of action of which the inhibition of acetylcholinesterase at cholinergic junctions of the nervous system, leading to accumulation of acetylcholine, resulting in initial excessive stimulation followed by depression of the parasympathetic nervous system. This translates to symptoms such as excessive salivation, lacrimation, abdominal pain, vomiting, intestinal hypermotility and diarrhea. In the respiratory tract it leads to bronchoconstriction and an increase in bronchial secretions. It also leads to violent muscle contractions and weakness of voluntary muscles (which could explain the observed lower extremity weaknesses). Death is usually due to respiratory failure. Another possible interpretation of the clinical picture as presented above would be an outbreak of Guillain Barre Syndrome (GBS). GBS typically presents as an ascending paralysis (beginning in the lower extremities but ultimately can lead to total paralysis of all extremities and respiratory musculatures), usually seen several weeks following an acute infectious process. Predisposing infectious agents include those associated with various types of gastroenteritis (such as campylobacter infection) or viral illnesses such as influenza and enterovirus infection including infection with poliovirus. Ninety percent of those affected usually have full recovery after a prolonged illness that may include respiratory failure and necessitate respiratory assistance during the acute phases of the illness. The lack of mention of predisposing illnesses in the above cases would also lead one to question the diagnosis of an outbreak of GBS. As anecdotal information, this moderator is reminded of several prior outbreak notifications this moderator was involved in investigating in the past that were similar to the above description in the newswire -- the 1st goes back to the early 1980s when an outbreak of GBS was reported in Colombia. Further investigations revealed that this was an outbreak of poliomyelitis that was being misdiagnosed as GBS, due to clinicians feeling that it couldn't be polio since vaccination coverages were felt to be good in the area. Similarly in Brazil in 1985, during a major epidemic of polio in the northeast of the country, many cases of polio were initially diagnosed as GBS, also due to clinicians feeling that it couldn't be due to polio since vaccination coverages were "too high" as a result of many vaccination campaigns. The 3rd anecdotal information comes from a report of organophosphate poisoning in Chancay, a community north of Lima Peru in 1991. In that instance, the clinical presentation was profuse watery diarrhea and severe muscular spasms/cramping. Further investigations revealed that this outbreak was due to cholera, and was the 1st major introduction of V. cholera 01 into the Americas region in over 100 years. That being said, this moderator would very much appreciate more information from knowledgeable sources on the epidemiology and clinical presentation of the cases, as well as information on laboratory results from specimens collected for investigation. - Mod.MPP] [This moderator requested further commentary from our toxicology moderator included below. - Mod.MPP] [In the early 1930s Jamacian Ginger extract (Jake, by US slang) was adulterated with tri-o-tolyl phosphate, also known as tri-ortho cresyl phosphate or TOCP. This particular OP has a delayed onset, and most often and primarily affects the lower extremities. However, it may also affect the upper extremities and in some rare cases in the early 1930's was thought to contribute to some respiratory cases (I am uncertain if this was ever proven, but we see a limited amount of this phenomenon in exposed animals). Because TOCP is not a toxin that works immediately and does not cause the usual SLUD (salivation, lacrimation, urination, defecation) effects, the condition it produces has been given the name organophosphate-induced delayed neuropathy (OPIDN). We see it in animals, and I know there are cases in humans. So it may be that these folks came into contact with TOCP or some similar chemical and are suffering from OPIDN. There are also some plants whose effects are very similar to those of TOCP, although they contain different agents. Cassava, which contains cyanogenic glycosides, when improperly prepared and eaten for long periods of time can cause similar symptoms, including lower limb paresesis and paralysis as the first signs. Intoxication by karwinol A, found in the seeds of _Karwinskia humboldtiana_ (also known variously as coyotillo, Humboldt coyotillo, tullidora, capulincillo, capulincillo Cimarron, capulin, palo negrito, margarita, cacachila, china, frutillo negrito, cochila, or margarita del cero; see <http://aggie-horticulture.tamu.edu/ornamentals/nativeshrubs/karwinskiahumbold.htm>) presents a neurological picture similar to that for Guillain-Barre syndrome or other polyradiculoneuropathies. The toxin is frequently seen in people in Mexico. N-methly-beta-Phenyl ethyl amines amd tyramine are the toxic agents in _Acacia berlanderi_, which also causes a similar clinical picture and has been the cause of human intoxication in Mexico and other South American countries. - Mod.TG] ....................mpp/pg/tg/mpp/pg/mpp

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