China's answer to Ebola: a lethal haemorrhagic fever that kills 20,000 people a year

by Michael Woodhead

Like many other countries, China has gone into a hysterical spin about the threat posed by Ebola virus disease.

Authorities have dusted off the useless thermal scanners last used in the avian flu outbreaks, and have started screening passengers arriving at from Africa at Chinese airports. And despite the World Health Organization saying that China does not need to be overly concerned about the disease, authorities have been issuing stern warnings to health workers about being vigilant for Ebola and also looking with suspicion on the African expats living in cities such as Guangzhou. The irony is that China has seen its own counterpart of Ebola virus disease, a killer disease that has been increasing dramatically in the last two years.

But first some background: Ebola is a haemorrhagic fever, caused by the Ebola virus, which belongs to the  Filoviridae family of RNA viruses. The virus comes from apes and bats and is only transmitted between humans by body fluids such as blood and saliva - in Africa it has been spread by hunters cutting up meat from infected animals, and spread to healthcare workers and close relatives to touch the dead bodies of Ebola victims at traditional African funerals. In the latest outbreak there have been 1323 confirmed and suspected cases of Ebola reported, and 729 deaths. That's a mortality rate of 55% according to my calculator.

What to make then of China's recent little remarked but lethal cases of haemorrhagic fever? In April, Dr Du Hong and colleagues from the Center for Infectious Diseases, Tangdu Hospital, Xian, described the horrific symptoms of some of the 356 patients who had been treated at their hospital for  "hemorrhagic fever with renal syndrome" (HFRS),  a disease caused by Hantavirus that is spread by rats (or more specifically in their droppings, which may become aerosolised and spread to anyone working near where rats have been active).

The symptoms are similar to Ebola: fever, circulatory collapse with hypotension, hemorrhage, but also with acute kidney failure (hence the name renal syndrome). The difference between Ebola and HFRS is that the Hantavirus disease has a death rate of 'only' 40%. For China, which has had about 50,000 cases of HFRS annually, that means about there have been, at a conservative estimate, 20,000 deaths from Hanta virus every year. Makes the 730 Ebola deaths in Africa look fairly insignificant doesn't it? And as with Ebola, there is no treatment or vaccine for Hantavirus, only supportive care.

And that's not all. China has other types of haemorrhagic fever. This month The Lancet carries a report of the emergence of one, known as "severe haemorrhagic fever with thrombocytopenia". This is a viral disease spread by ticks, caused by the SFTS phlebovirus in the Bunyaviridae family. According to Dr Liu Quan and colleagues from the State Key Laboratory of Veterinary Etiological Biology, Lanzhou, SFTS was first reported in 2010 and has since been found in 11 provinces of China, with about 2500 reported cases, and an average case-fatality rate of 7%. That's about 175 deaths. As the study authors say with some understatement: "The disease has become a substantial risk to public health".

China is the epicentre for Hantavirus haemorrhagic fever in the world, but it is not the only country affected. The disease is also seen in Europe and the US - a Denver man died of the infection just this week. But with tens of thousands of Chinese people dying every year from this terrible haemorrhagic disease, perhaps China ought to worry more about curbing Hantavirus - and the rats that carry it - rather than panicking over the threat from an African outbreak of Ebola.

Xian parents say government has suppressed findings of side effect damage from kindergarten antivirals

by Michael Woodhead
One of the top Xinhua stories this week is a report from Xian claiming that the local government in the city has suppressed or manipulated the results of health checks on children dosed with antivirals by kindergartens.
The report is a follow up on the shock discovery that two local kindergartens had been routinely dosing children with antiviral medication. The so-called "Yao Er Yuan" [药儿园] scandal (a pun on the Chinese name for kindergarten - You Er Yuan 幼儿园 - replacing one character with that for drug) was supposedly about schools dosing kids with antivirals to prevent them getting colds and to improve their attendance (and performance) at the schools. The practice was strongly condemned by health authorities, with the National Health and Family Planning Commission (NHFPC) issuing a warning that this kind of practice was strictly prohibited, and calling on all local authorities to conduct checks on kindergartens. 
The children attending the kindergartens involved were referred to local hospitals to undergo checks to ensure that there had been no untoward effects from having being exposed to the antivirals. However, some parents are now saying that the checks have been a sham and the results of health checks have either been fabricated or suppressed. One parent quoted by Xinhua is a Mr Zhu, who says that his five year old daughter had suffered from renal impairment and haematuria from the antivirals, but this had not been picked up by the official hospital checks. He took his daughter to another hospital for a check up and they found significant kidney damage, but this was not reported by the official hospital. Further investigation by Xinhua reporters found that there were several hundred children whose tests showed that had experienced adverse health effects from the antivirals, but the official government figure was just 65. Further investigation revealed other anomalies. Many of the tests results were identical, suggesting they were not genuine but just copies. Discrepancies were also seen in ultrasound scans of children, which experts again said were not genuine. One parent reported that when he took his child for a scan he was given the 'result report' even before she had undergone a scan.
A Xinhua reporter put these claims to the local government in Xian, which responded by saying that the investigation into adverse effects had not been concluded and any figures released were premature. They said the concerns raised by parents and the media would be referred to higher authorities, which would take the feedback as part of its ongoing investigation into the antiviral dosing of kindergarten children.
[Editor's note: it might seem odd that a Chinese government newspaper is highlighting apparent government malpractice ... there may be more than this than meets the eye, or perhaps it is genuine attempt to expose wrongdoing as part of Xi Jingping's campaign against 'formalism' and 'poor working styles'].

PM2.5 pollution from coal burning kills 9000 a year and costs $1 billion

Report shows the high health costs of fine particle pollution in four Chinese cities

An estimated 8,572 premature deaths occurred in four major Chinese cities in 2012, due to high levels of PM2.5 pollution, a joint study by Greenpeace East Asia and Peking University’s School of Public Health has concluded.
The report also estimates PM2.5 pollution caused the cities of Shanghai, Guangzhou, Xi’an and Beijing to suffer a combined total of US$1.08 billion in economic losses over the past year. Greenpeace is calling for an urgent policy adjustment, including capping regional coal consumption, De-NOx retrofiting for existing coal-fired power plants, and shutting down inefficient coal-fired industrial boilers.
The report “PM2.5: Measuring the human health and economic impacts on China's largest cities” states that if these cities can effectively lower their PM2.5 levels to meet the World Health Organization’s Air Quality Guidelines (WHO AQG), such deaths would be reduced by at least 81%, and the economic losses for these four cities could be reduced by $US868 million. Unfortunately no cities currently have a timeline to meet WHO AQG.
“PM2.5 is putting public health at high risk every day, but worse still, if we follow the current official plans we would need to wait 20 years to get to the national standard, which is still risky compared to the WHO guidelines,” said Greenpeace campaigner Zhou Rong. “Who can afford the wait?” Greenpeace is calling for a concrete and ambitious timetable to tackle PM2.5 pollution, thus improving the air quality to reach the health standard set out by WHO AQG.
For the report, researchers from Greenpeace and Peking University’s School of Public Health studied the impact of PM2.5 in Beijing, Shanghai, Guangzhou and Xi’an, which represented major urban centres in China’s north, east, south and west respectively.
“Besides saving a lot of human lives, combating PM2.5 can also significantly reduce the national cost on health care,” said Zhou Rong. Taking Beijing as an example, the report found the Chinese capital experienced a loss of US$328 million in 2012 because of PM2.5 pollution. But had it reached WHO AQG, US$283 million could have been saved. (For details please refer to the media briefing paper section three).
Recent statistics from China’s Ministry of Environmental Protection (MEP) show cities in China’s Yangtze River Delta, Pearl River Delta, and Beijing-Tianjin-Hebei region suffered over 100 hazy days a year with PM2.5 concentration two to four times above World Health Organization guidelines. The effects of PM2.5-related air pollution extend beyond hazy days, also leading to systematic damage to human health.
PM2.5 is small in particle size but as pollution can reach a large surface area. It is more prone to carrying a variety of toxic heavy metals, acid oxides, organic pollutants and other chemicals, as well as microorganisms such as bacteria and viruses in the air. When inhaled, it can enter a person’s blood stream. Exposure to PM2.5 can contribute to cardiovascular, cerebrovascular and respiratory diseases, as well as greater cancer risks, all leading to a significantly higher mortality rate.
Studies have shown PM2.5 is most prevalant in the combustion of coal. Since the majority of China’s energy comes from coal plants, Greenpeace is urging regional governments to cap coal consumption.
Greenpeace is also calling on the local governments in key regions to go beyond requirements raised by recent MEP plans, and to take ambitious steps to set up specific air quality improvement plans, including detailed PM2.5 pollution reduction timelines.
Source: Greenpeace

iPhone sphygmomanometer validated by Xian cardiologists

The iHealth BP3 upper-arm blood pressure monitor can be recommended for clinic use and self-measurement in an adult population, according to the results of a validation study on the basis of the European Society of Hypertension International Protocol revision 2010.
The study aimed to evaluate the performance of the iHealth BP3 upper-arm blood pressure monitor, which is designed for clinic use and self-measurement of blood pressure using Apple touch devices as an interface.

The European Society of Hypertension International Protocol (ESH-IP) revision 2010 for the validation of blood pressure measuring devices in adults was followed precisely. Ninty-nine couples of test device and reference blood pressure measurements were obtained during the study (three pairs for each of the 33 participants).

In 33 participants, the device passed all of the requirements fulfilling the standards of the protocol, and the mean device–observer difference was 2.8±4.2 mmHg for SBP and −0.4±3.5 mmHg for DBP.

Read more: Blood Pressure Monitoring  (17:253)