Enigmatic disease in Vietnam

Mysterious disease affects hundreds of people

06/29/2012

In Vietnam, hundreds of people have been affected by a mysterious disease since April 2011. As reported by the World Health Organization (WHO) and the Ministry of Health of Vietnam in a joint press release, 216 people in the Ba To district have suffered from the enigmatic so-called "Inflammatory Palmoplantar Hyperkeratosis (IPPH) Syndrome". Twelve people have already died as a result of the disease.

Inflammatory palmoplantar (hand and foot related) hyperkeratosis (keratinization of the skin) is a chronic poisoning, according to WHO and Vietnamese health officials. This leads to symptoms such as inflammation and injuries of the hands, feet and liver. Although the disease is therefore not transferable from person to person, but as the cause remains unclear, the WHO estimates that further illnesses can also be expected in the future. In order to prevent this, the WHO and the Ministry of Health of Vietnam have recommended some measures to combat and prevent the IPPH syndrome in the current press release.

Mold in rice as a trigger of mysterious diseases?
The Ministry of Health of Vietnam has conducted several field investigations in Ba To district (Quang Ngai Province) to investigate the causes of the mysterious diseases. It took into account "epidemiology, clinical medicine, health, nutrition, toxicology and environmental factors," according to a joint statement from the WHO and the Vietnamese Ministry of Health. Although no clear cause for the diseases could be found so far, the results of the extensive investigations provided some important information. Many people have suffered from malnutrition with IPPH. Some ate rice from the previous harvest, with aflatoxins (mold toxins) being detected in several rice samples. Almost all sufferers suffered from liver inflammation. These indications suggest, according to the WHO, that the causative chronic poisoning of IPPH was caused by mold in rice, but so far no clear evidence has been provided. Therefore, "in addition to ongoing investigations, it is important to initiate comprehensive interventions to reduce the mortality and development of new cases, as well as to improve the overall health status of people in Ba to District," said Vietnam Health Minister. Nguyen Thi Kim Tien.

Intervention measures against the spread of the enigmatic disease
In order to reduce the mortality rate of IPPH syndrome, the Ministry of Health has issued treatment guidelines to physicians, offered training and sent consultants from central hospitals to the region. Preventive measures were also taken, such as the provision of rice and advice on proper storage. Recommendations for the population as well as for the responsible municipalities in the district Ba To were developed together with the WHO. According to the survey, residents should now consume as much rice as possible provided by local health authorities, use the vitamins and supplements distributed by the authorities and ensure good environmental hygiene and personal hygiene. At the first sign of IPPH, the nearest healthcare facility is in demand. Municipalities, in turn, are called upon to implement and monitor current intervention measures, continue to provide dietary supplements and rice to residents of Ba To, and to promote improvements in (environmental) hygiene conditions.

The responsible WHO representative in Vietnam, Takeshi Kasai said that WHO supports all intervention by the Vietnamese Ministry of Health to deal with the cases of IPPH syndrome in Quang Ngai province. Kasai was convinced that "the Ministry of Health is on the right track", but emphasized that "identifying the cause may take longer than planned" and likely "difficult to prove". (Fp)

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Vietnam: Fatalities due to mysterious skin disease

Picture: Gerd Altmann