A flu outbreak has hospitalized more than 1,000 children in the Cambodian capital and taken the lives of two babies, forcing some young patients to share beds and catching doctors by surprise.

The victims were boys, age 9 months and 14 months, Dr. Kdan Yuvatha, chief of the technical department at the state National Pediatric Hospital, said Thursday. Both died over the past two weeks from severe lung infections.

"When they arrived to our hospital, their conditions were beyond salvation already," the doctor said.

Deputy Health Minister Heng Tay Kry described the number of influenza cases as "unprecedented," with more than 1,000 children recently being admitted to Phnom Penh hospitals.

Government and World Health Organization officials have said the outbreak involves a form of human flu, not the avian influenza that has killed dozens of people in neighboring countries.

Cambodia is sandwiched between two countries, Vietnam and Thailand, that suffered heavily from last year´s bird flu. Thirty-eight people in Vietnam, 12 in Thailand and four in Cambodia were killed by avian influenza, which they contracted from sick birds.

Samples from sick children this week have tested positive for Influenza B virus, which is a "relatively mild disease compared to avian influenza," said Megge Miller, an epidemiologist with the World Health Organization in Cambodia.

Influenza types A or B viruses cause epidemics almost every year around the world, according to a Web site for the U.S. Centers for Disease Control and Prevention. Influenza B is the less common of the two types, but the symptoms are the same for both: fever, headache, body aches, fatigue, coughing and sneezing.

Saying the number of children admitted to hospitals with flu was more than would normally be expected, Miller said an investigation is under way to determine exactly how many children have been hospitalized and how many have died.

Officials at WHO headquarters in Geneva declined comment, saying they did not have enough information on the situation.

The outbreak has strained a grossly inadequate health care system that serves a population in which about 40 percent survive below the poverty line. Flu vaccines are rarely given.

The large number of cases has forced at least one hospital to put three or four children to a bed.

Kdan Yuvatha said the outbreak took doctors by surprise at the National Pediatric Hospital, where preparations were under way for a possible outbreak of dengue fever, a mosquito-borne disease that commonly strikes during the first months of the rainy season.

He said the National Pediatric Hospital has received more than 500 patients with acute respiratory infections in June alone, compared to 200 in May.

"The number keeps increasing this week, but the situation is still under control," he said. "Though the fatality rate is still low, we have to be constantly attentive to the problem."

He said extra beds were being set up in the main ward´s lobby and corridor to accommodate the influx of sick children.

On Thursday, wailing 13-month-old Em Sok Heng was carried by his father, who paced the hospital lobby holding the sick child connected to an intravenous drip.

"Don磘 cry son; we will go back home together," Em Kuong, 43, whispered to the child, who arrived at the hospital with his parents from Kampong Cham province in eastern Cambodia three days ago.

"When he began falling sick a week ago, he coughed and breathed heavily like a dog. I was heartbroken with pity for him," the father said.

Influenza B is currently also circulating in New Zealand, where three young people have died of its Hong Kong strain this year.

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In response to your request for further information about the
respiratory illness in Cambodia, [below is] the following response. I
hope this is useful in clarifying the current acute respiratory
infection (ARI) activity in Cambodia:

There is generally a high background level of ARI in children in
Cambodia. In mid-June 2005, clinicians from 2 paediatric hospitals in
Phnom Penh raised the alert that they were observing an increase in
the number of outpatients and admissions with acute respiratory
infections (ARI).

Staff from the Ministry of Health have been collecting simple
demographic data on number of outpatients, admissions and deaths
amongst children at the National Paediatric Hospital and following up
with health staff in all of the 24 provinces of Cambodia. Preliminary
results suggest the outbreak of ARI in children began in the 2nd week
of June in the major urban areas of Cambodia (Phnom Penh, Battambang,
Siem Reap and Kampong Cham). Remote and less populated provinces
report that there have been no increases in attendances to health
centres or hospitals.

Data from the National Paediatric Hospital indicates that there had
been a gradual increase in ARI outpatient consultations since early
May when there were approximately 100 cases per week, but there was a
distinct peak (n= 245 cases) in the week beginning 5 Jun [2005] and
the number of cases are currently returning to baseline levels.
Admissions also peaked in the week beginning 5 Jun [2005] (n=109
cases), but remained at this level for 2 weeks before starting to
decline to baseline levels.  2 deaths have been reported, but the
aetiological agent responsible for the deaths could not be determined
as samples were not collected. Both deaths occurred in children under
5. Since the outbreak began in 5 Jun [2005], nearly 90 percent of
outpatients and all admissions have been in children aged under 5
years.

A total of 43 samples have been collected from paediatric hospitals
in Phnom Penh and Siem Reap and 27 have already been completely
tested at Pasteur Institute, Phnom Penh. Pasteur Institute has been
running PCR to screen for influenza A, influenza B, RSV [respiratory
syncytial virus], human-Metapneumovirus, and Para-Influenza 1-4
viruses. Of the samples processed, 13 have tested positive for
influenza B. In Siem Reap and Phnom Penh, several co-infections of
influenza B and RSV have been found as well as isolated infection
with RSV.

The Ministry of Health has been conducting an education campaign
encouraging good hygiene. The focus has been on how to limit the
transmission of respiratory pathogens.

--
Ly Sovann
Department of Disease Control
Ministry of Health, Cambodia

Philippe Buchy
Head of Virology
Pasteur Institute, Cambodia

Megge Miller, Epidemiologist
World Health Organisation, Cambodia