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Bệnh Lạ

Bệnh Lạ

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An essay for the 2012 Undergraduate Awards (International Programme) Competition by Chuan-jay Chen. Originally submitted for Epidemiology at Princeton University, with lecturer Joseph Amon in the category of Medical Sciences
An essay for the 2012 Undergraduate Awards (International Programme) Competition by Chuan-jay Chen. Originally submitted for Epidemiology at Princeton University, with lecturer Joseph Amon in the category of Medical Sciences

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Published by: Undergraduate Awards on Aug 31, 2012
Copyright:Attribution Non-commercial

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06/01/2014

 
 
Bệnh Lạ
Outbreak Investigation of a “Strange Disease” in theQuảng Ngãi Province of Vietnam
 A Quảng Ngãi boy with bệnh lạ (“strange disease”) retrieves water in a pail.Image from [13]
 
 
1Bệnh Lạ
 ABSTRACT
Bệnh lạ (“strange disease” in the Vietnamese language) is a mysterious skin diseasethat has plagued the Quảng Ngãi province in Vietnam for at least the past two years. Thefirst symptom is skin rashes that usually arise on the feet or the palm of the hands.Complications often include fever, loss of appetite, and sometimes, multi-organ failure. Thedisease is currently classified as an epidemic that has affected 132 local people and killed21 in 2012 alone. Despite numerous investigations, little progress has been made ininvestigating the etiology of this strange skin disease.This paper proposes four steps for an outbreak investigation to determine thecauses of bệnh lạ. The first step is to create a case definition, which must be broad enoughto include all patients with the disease but specific enough to exclude patients with similardiseases. This definition allows investigators to calculate attack rates and focus their efforts.In this proposal, a diagnosis of bệnh lạ requires rashes on the hands and feet, elevatedlevels of aspartate transaminase (AST) & alanine transaminase (ALT), and living in alocation where the disease is endemic. The next step is to construct an epidemic curve andevaluate the spatiotemporal distribution of bệnh lạ, clarifying questions regardingseasonality, modes of transmission, and other clues regarding the causes of the disease.The final step of the investigation is to conduct a case-control study to identify any possibleexposures that are associated with developing the disease.As progress is made during the investigation, results will be reported to scientificjournals as well as inhabitants of Quảng Ngãi. As with many epidemiological studies, it ishoped that health policies will be enacted to contain, treat, and prevent future outbreaks of bệnh lạ.
 
 
2Bệnh Lạ
Bệnh Lạ
On March 27, 2012, the first death of the year from a mysterious skin diseasesometimes accompanied with multi-organ failure was reported in the Quảng Ngãi Provincein Vietnam.
1
Since then, the condition, popularly referred to as bệnh lạ (“strange disease”),has affected at least 132 more people in the province this year as of May 14, 2012 andkilled at least 21 of them toal.
2,3
However, this is not the first time the disease has strickenQuảng Ngãi. Bệnh lạ first appeared April 2011 and affected 98 people in the region untilJanuary 2012, when the disease disappeared.
1,4
A local resident has even claimed that bệnhlạ or a similar disease has been affecting people in the area for the past 5-6 years.
5
Despitethe time since these first cases, no specific etiology has yet been identified. News agencieshave reported causes ranging from molded rice to the herbicide Kanup 480 SL to the
Ricketssia
“virus” (
Ricketssia
is not a virus but rather a genus of gram-negative bacteria,
6
 reflecting the dearth of quality in previous investigations).
1,7,8
However, none of thesepurported causes has been proven to cause disease. Considering the ongoing morbidity andmortality caused by bệnh lạ, continued investigation of the disease is critical.
 Step 1: Define & Identify the “Numerator” 
The first step of my outbreak investigation is to define a bệnh lạ case, which enablesfuture steps of the study. The number of people that fit my definition will be considered the“numerator” in initial statistical measures of attack rate, incidence, and prevalence.Initially, before the disease is extensively characterized, this definition should focuson the most apparent clinical symptoms. Throughout various news sources bothVietnamese and foreign, reported symptoms have varied. Sources invariably identifypainful skin rashes as a symptom but have also included different combinations of limbstiffness, contusions, fever, loss of appetite, miscarriage, miscarriages, eye problems, andsymptoms of liver failure.
1–5,7,9–13
However, if investigators only had access to the articlespinpointing contusions as a symptom of bệnh lạ and thus included bruising in their casedefinition, they would exclude all the patients with the same disease caused by the sameagents that fail to present with bruises. Similarly, including miscarriages in the casedefinition would exclude all men from being considered in the numerator. Including thesesymptoms would underestimate the calculated attack rate. It is thus necessary to devise aprecise definition of a case that is comprehensive and includes all patients with bệnh lạ.

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