The Ministry of Health of Viet Nam is actively providing intervention measures to treat people as well as prevent, investigate and monitor the development of new cases of inflammatory palmoplantar hyperkeratosis syndrome (IPPH) in Ba To district Quang Ngai province in Central Viet Nam. The Ministry of Health has been actively supported in it’s response to the situation in the affected area by other Ministries and sectors, including the Ministry of Science and Technology, Ministry of National Defense and Ministry of Agriculture and Rural Development.
IPPH syndrome is characterized by a chronic intoxication that can lead to inflammation and lesions of the hands, feet and liver. People with IPPH syndrome have only been found in Ba To district in Quang Ngai province.
People with IPPH syndrome were first reported on 19 April 2011 in Ba To district. By 28 June 2012, a total of 216 cases and 12 deaths had been reported in five communes (Ba Dien, Ba Ngac, Ba Xa, Ba Vinh and Ba To) in Ba To district. Currently 18 people are being treated in health care facilities in or around Quang Ngai province.
The Ministry of Health has conducted several field investigations focusing on epidemiology, clinical medicine, occupational health, nutrition, toxicology and environmental factors but has yet to find a cause. However, results from these extensive investigations indicate the following:
• To date, investigation suggests that IPPH syndrome may not be infectious in origin.
• Some people with IPPH ate rice from the previous harvest;
• Many people with IPPH suffer from malnourishment;
• Aflatoxins were present in a few rice samples;
• Most people with IPPH had liver inflammation;
• No evidence of elevated levels of heavy metals or agrochemicals were found in human or environmental samples;
“In addition to on-going investigations to identify the cause, it is important that the comprehensive intervention measures in place to reduce mortality and the development of new cases as well as to improve the overall health status of the people living in Ba To district are followed,” said Minister of Health, Dr. Nguyen Thi Kim Tien.
To reduce mortality, the Ministry of Health has developed treatment guidelines, provided training for doctors, sent consultants from central hospitals to directly guide and provide case management in Ba To district. Ministry of Health has also put in place measures in the affected community for the prevention, treatment and diagnosis of illness. Preventive measures include: the provision of rice for people as well as advice on proper storage methods, distribution of vitamin and nutrient supplements to Ba To district residents, provision of environmental sanitation and vector control services for the households, treatment of community water supplies for people and strengthened communication activities to promote personal hygiene and to seek healthcare as soon as symptoms develop.
The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (US CDC) have been in close communication with Viet Nam's Ministry of Health for this response. In early June 2012, the Ministry of Health' General Department of Preventive Medicine invited two experts from WHO and US CDC to consult with the Ministry of Health’s General Department of Preventive Medicine. They conferred with Vietnam investigators of the outbreak, reviewed data collected to date, and made recommendations for additional studies and testing to guide interventions and direct further investigation.
“We support the intervention measures implemented by Viet Nam’s Ministry of Health in addressing the cases of IPPH syndrome in Quang Ngai province and believe that the Ministry of Health are on the right track. As we do not know what causes the syndrome, or its source of transmission, identifying the cause may take longer than anticipated or prove elusive,” said Dr. Takeshi Kasai, WHO Representative in Viet Nam.
The Ministry of Health will continue to focus its efforts in treating current IPPH syndrome patients and monitoring new cases as they occur. Further investigations will be conducted to measure and evaluate the effectiveness of interventions as well as to identify other risk factors associated with IPPH syndrome. WHO and US CDC will continue to provide technical support to the Ministry of Health, Viet Nam.
The Ministry of Health recommends the following measures to prevent and control IPPH syndrome:
For the residents of Ba To district- Consume rice provided by local health authorities- Take the vitamin and nutritional supplements distributed by local health authorities - Ensure good environmental sanitation and personal hygiene - Monitor for early detection of symptoms and seek immediate care at the nearest health facility
For local authorities in Ba To district- Supervise and implement current intervention measures- Continue to provide nutritional supplements and rice to residents of Ba To district- Promote and encourage people: to maintain environmental and personal hygiene; to consume nutritious foods; and to seek healthcare as soon as symptoms develop.
Notes to the editor
1. Aflatoxins are a fungus that contaminates grains before harvest or during storage. Prolonged exposure to high levels of aflatoxins can lead to liver dysfunction.