Wednesday, April 23, 2008

Mutating adenovirus suspected in deaths in Peru

Deadly virus
Medical examinations have determined that 8 other Chinese sailors have the deadly virus, but have not developed any illness. The cook, aged 40, and a crewmember of the vessel, aged 38, died on 9 Apr 2008,after suffering high fevers for hours. No medication was able to stop the progression of the disease.

Experts of the Forensic Medicine Institute of Public Prosecutions[IML] have determined that the cause of death was an adenovirus that has become extremely deadly.

Adenoviruses are spread by physical contact or through the air andare one of the causes of the common flu, but were not considered fatal. At least, not so far.

The virus that causes severe acute respiratory [syndrome], anatypical pneumonia that first appeared in November 2002 in Guangdong Province, China, has been ruled out.

The head of the IML, Luis Bromley Coloma, indicated that "we are facing an adenovirus that has mutated and become deadly, but it is still unknown what caused the mutation and how fast it can spread",which is why an Epidemiological Alert has been declared.

The autopsy performed on the 2 victims showed multiorgan edema in the brain, lungs, heart, liver, pancreas, and kidneys, and microhemorrhages in all organs. Toxicological, biological, and pathological tests performed revealed the presence of the mutated adenovirus.

Now, health authorities are working to establish where and what generated the mutation to find a cure or a way to contain it.

"Chan An 168" is a squid and shrimp fishing vessel that sailed from the port of Yautay, China, on 19 Aug 2007 with 23 people on board. Since then they have not had contact with dry land. On 13 Dec 2007 it delivered its catch to another boat and received 2 other crewmembers. The same happened on 15 Mar 2008.

On 9 Apr 2008, the port captaincy of Callao received a distress call from the captain of the "Chan An". That morning 2 Chinese crewmembers-- the cook and a fisherman -- had died. The only symptom was a high fever lasting from 2-5 hours; none of the medicines on board helped.

Unfortunately, the Navy and International Maritime Health personnel boarded the Chinese ship to provide the care they needed, without taking the precautions needed to avoid contagion, hence it has been decided to quarantine them. The disease can manifest itself in 14 days to 3 months.

Specialists from the IML, and epidemiologists from the Ministry of Defense, the Navy, and the Ministry of Health, met yesterday 19 April, to assess the results of the biological and pathological examinations in order to take the necessary preventive measures toavoid spread of the virus.

"The autopsies carried out indicate that the 2 Chinese crewmembersdied from pneumonia resulting from an adenovirus, a cause of the fluthat is not usually fatal. What happened in this case is that thevirus has mutated and become deadly, and we are on an epidemiological alert,'' the head of the Institute of Forensic Medicine, LuisBromley, said yesterday [19 Apr 2008]. The specialist added that this outbreak has 2 characteristics: the victims are people with weakened immune systems, having been almost a year at sea, isolated and living in subhuman conditions. The other factor is still being studied -- still unknown are the cause that led to the mutation and how to fight it.

"The entire crew has been evaluated and it has been found that 8 crewmembers are infected with the mutated adenovirus and are underobservation; they can not be treated, because we do not know how to fight this virus," stressed Bromley.

It has been arranged for 30 Peruvian people who have been to the ship to provide help and have come into contact with patients remain under epidemiological surveillance, isolated, and without contact withtheir families until the deadly disease has been ruled out. In these cases ''security measures may sound extreme, but prevention is betterthan later to have to bear the consequences if nothing was done,"asserted emphatically the head of the Institute of Forensic Medicine.

The identification of a 'mutated' adenovirus as the suspected causeof the deaths of members of the crew of a Chinese fishing vessel anchored off Callao is surprising. Adenoviruses are ubiquitous viruses that can be isolated from both sick and healthy individuals. Antibodies can be detected in virtually all humans, indicative ofinfection early in childhood and possible life-long persistence in adenoid and lung tissue. Morbidity and mortality associated with adenovirus infection are low, but adenovirus-associated respiratory and gastrointestinal disease can be serious especially in immunologically compromised patients. There are at least 170 serotypes of adenoviruses, about 50 of which have been isolated from human sources. The designation 'mutant' or'mutated' adenovirus is meaningful only in the sense that the adenovirus recovered from the affected individuals is associated with signs and symptoms not usually encountered in adenovirus infections.An adenovirus, however, cannot be excluded as the potential etiologicagent, particularly as the description of living conditions on board the fishing vessel suggest that the resistance of the crew to any infectious agent may have been very low. Information of the condition of the other crewmembers and those in quarantine will be relevant in confirming the diagnosis.

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