12304

	va1-sg19016.securesites.net

	version=3.1.8



***************************************************************************



[1]





Local officials are reporting that 42 people have died, almost all of 

them children, in an outbreak of a still unidentified disease in the 

remote Nurum district of Panama's indigenous Ngobe-Bugle region.



The ailment begins with a runny nose, coughing, and fever, and when 

it gets deadly the victims present symptoms that look like bronchial 

pneumonia, according to a statement by Panama's Health Ministry.



The Health Ministry and the semi-autonomous Gorgas Memorial 

Laboratory say they don't know the cause of the illness.



"We're studying it, and the Gorgas Lab is working on it, but to say 

anything now would be speculation," said a ministry official who 

asked for anonymity because he lacked authorization to comment on the case.



Federal government officials say they know of only 10 deaths, but 

some of their comments on the case have been contradictory.



The information problem has been made worse by the difficulty in 

getting to Nurum in central Veraguas province, where the dirt roads 

become impassable to most vehicles in this, the rainy season. The 

population in many cases lives a long walk from even those precarious roads.



Word of a problem 1st got out in mid-September [2007] when local 

officials contacted the Health Ministry and then, alarmed by what 

they considered a lackadaisical response, took their story to the news media.



On [23 Sep 2007] Gladys Guerrero, the ministry's director of 

epidemiology, denied to a reporter for the tabloid El Siglo that 

there was any viral or bacterial pathogen at work, attributing the 

problem to complications of rainy season colds that are common in the 

area, especially because of its poor sanitary conditions.



Guerrero also said that local claims at the time of 10 deaths since 

late August [2007] were exaggerated. Within 5 days, Ngobe officials 

were reporting 40 deaths and many more sick. The La Prensa newspaper 

has reported that more than 30 children from Nurum are being treated 

in various hospitals around the country.



The country's disease control center, the Gorgas Memorial Institute, 

is working to identify the cause of the outbreak.



The Health Ministry said in a [29 Sep 2007] press release that the 

problem appears to be "a known acute viral respiratory situation like 

influenza," but on Monday [1 Oct 2007] a ministry spokesman said that 

no flu or other virus had yet been identified.



The US government has offered help, but as of Tuesday [2 Oct 2007] 

Panama had not asked for international assistance.



The Ngobe-Bugle district, the youngest of Panama's semi-autonomous 

indigenous regions, comprises about 9 percent of the country's land 

mass and has its biggest concentration of poverty. Many of the 

inhabitants leave for part of the year to pick coffee or other crops.



The district, shared among its Ngobe majority and Bugle and other 

minorities, is politically fractious and its self-governing 

institutions are not as developed as in some other indigenous areas in Panama.



After news of the illness broke, President Martin Torrijos cut short 

a trip to the United States and flew into Nurum with a team of some 

60 healthcare workers.



Government officials fanned out to visit thousands of families and 

advise them to cooperate with health officials and that nobody 

evacuated to a city hospital would be left stranded -- a concern that 

had led some of the poor parents to refuse to let their children be 

taken to a hospital.





--



******

[2]

Mod.MPP, edited]





The Ministry of Health reports that during the integral health 

operatives conducted in the Nurum district of the Ngobe-Bugle comarca 

[county] during the period 20 to 30 Sep 2007, they have cared for 

5000 patients coming from the areas of Agua de Salud, Guayabito, 

Buenos Aires, El Bale, and the communities of Guibale, El Penon, and 

Virigua. There is a permanent ministry presence in these areas and 

they are continuing with activities, incorporating the communities of 

Guabal, Valle Bonito, and others.



As of 30 Sep 2007, there were 48 patients in the regional hospital 

Luis "Chicho" Fabrega, in the province of Veraguas, coming from the 

district of Nurum, with acute respiratory syndromes. These were 

primarily young children less than 5 years of age who as of the 

discharged from the hospital.



Laboratory reports on studies conducted revealed the presence of a 

respiratory virus, with a predominance of a type of adenovirus, for 

which there is no vaccine, but whose early detection permits 

management and effective treatment avoiding the onset of complications.



During the weekend [29-30 Sep 2007] 6 minors from Kankintu and 

Kusapin with diarrheal disease and dehydration, were transferred to 

the [county hospital] of Bocas del Toro province. These transfers 

were done in a timely manner to prevent fatalities and an appropriate 

epidemiologic investigation is being conducted.



The coordinated efforts of health professionals at the national, 

regional, and local levels, with local authorities and the community 

from the county of Ngobe Bugle, have provided valuable information, 

achieving greater impact of the activities, which has prevented new 

deaths from occurring and has permitted the handling of the current situation.



So far [1 Oct 2007] there have been 10 deaths officially reported 

attributable to this respiratory syndrome. Nevertheless, the Ministry 

of Health has given instructions for a detailed countrywide 

epidemiologic investigation of all cases and deaths associated with 

respiratory and diarrheal infections to be carried out in all of the 

health regions and for the appropriate measures to be implemented.



Recommendations have been made for the entire population to closely 

watch the children; those presenting with a clinical picture of 

fever, cough, and difficulty breathing, should be brought to health 

facilities. Personal cleanliness measures such as hand washing and 

adequate handling of respiratory secretions are to be observed. In 

addition, there should be care to avoid smoke, rain, cold, and 

contact with other young children, avoiding gathering places.



--



[The clinical description provided in the newswire is consistent with 

any number of respiratory pathogens including viral, bacterial, 

fungal, and parasitic. Based on the newswire, one can't help but 

speculate this might be a respiratory viral outbreak with a high 

mortality often seen in rural hard-to-reach areas where access to 

medical care is limited. Using the Global Infectious Disease and 

respiratory viruses - - miscellaneous (36.9 percent), influenza (31.3 

percent), respiratory syncytial virus infection (20 percent), 

parainfluenza virus infection (10.1 percent); then the remainder with 

adenovirus infection, laryngotracheobronchitis, hantavirus pulmonary 

syndrome, enterovirus infection, measles, diphtheria, ornithosis, 

_Chlamydophila pneumoniae_ infection, Q-fever, dengue, and 

paracoccidioidomycosis.



That being said, the findings stated in the Ministry of Health (MOH) 

press release in part [2] of an adenovirus, are not overly 

surprising. One might postulate here that there is the ongoing 

transmission of a respiratory virus (adenovirus) with probable 

secondary bacterial infection among a remote, rural childhood 

population where acute respiratory infections are a leading cause of 

death. There is clearly a conflict of information provided in the 

newswire when compared with the official MOH statement. The former 

mentions reports of 40 deaths, compared with the MOH reports of 10 

deaths. Clarification of the situation from knowledgeable sources 

would be greatly appreciated.



"county" though signifying a high degree of administrative autonomy) 

in Panama. It was formed in 1997 with lands from the provinces of 

Bocas del Toro, Chiriqui, and Veraguas. The capital is Chichica. 

Ngobe-Bugle has a population of 169 130 mainly Guaymi (Ngobe and 

Bugles. The Ngobes speak Ngabere and the Bugles speak Buglere. The 

comarca is divided into 7 districts." Nurum is one of the districts 

and its capital is Buenos Aires. For a map of the comarca and further 



A map of Panama can be found at 

Ngobe-Bugle Comarca is best visualized (albeit not in detail) at the 

link in the preceding paragraph. - Mod.MPP]

...................................mpp/mj/mpp