As epidemic hits China, pediatrician becomes a heroine

McClatchy NewspapersMay 9, 2008 

WORLD NEWS MED-CHINA 1 MCT

Dr. Liu Xiaolin helped alert high officials to an outbreak of an often-fatal children's disease in Fuyang, China.

TIM JOHNSON — Tim Johnson / MCT

FUYANG, China — It's rare that a physician would single-handedly play a crucial role in resolving two big health crises in China, saving untold scores of children's lives. But that's precisely the case with Dr. Liu Xiaolin.

A soft-spoken pediatrician, Liu figured out four years ago that adulterated infant formula was leaving a trail of dead babies in this rural corner of eastern China. The case brought big headlines, landed the formula makers in prison and heightened awareness of consumer rights in China.

In the past few weeks, the national spotlight again found Liu. This time, she raised an alarm over a mystery viral ailment in children, bringing it to provincial, then to national attention. While colleagues initially balked at her fuss, authorities soon realized that a sometimes fatal variant of hand, foot and mouth disease had spread around China.

As of Friday, state media said the death toll from the disease had climbed to 32 children, with 15,799 others stricken.

The spread of the sickness across eastern and southern China, as well as in Beijing, the host city for the upcoming Summer Olympic Games, has raised comparisons to the deadly SARS outbreak in 2003 that originated in China and extended around the world.

The 1,100-bed Fuyang People's Hospital is a flurry of activity, and doctors are too busy to discuss such comparisons. An additional infectious disease ward has been set up, and physicians pulled in from Shanghai, Beijing and Jinan hover over the beds of children with painful blisters on their feet, hands and even in their mouths.

During a brief break in her rounds, the 51-year-old Liu was as eager to talk about her battle with breast cancer, her failings as a parent and the distress of families who lost children to hand, foot and mouth disease as she was to talk about her role in calling attention to the viral outbreak. With nudging, she acknowledged that citizens are grateful.

"A farmer recognized me in the market and said that his child would have died without me. He thanked me," Liu said.

It was late March when the first child died, then others in quick succession. Puzzling over the ailment, Liu urged superiors to report the outbreak to higher levels.

"It occurred to me that the disease might be a variant of a virus or it might be a new kind of infectious disease," Liu recalled. "I figured that even if I made a wrong call, we are a primary-level hospital and our expertise is poor, so I could only be criticized. So what?"

Soon, parents in this city of 400,000 people were chattering in fear.

"The symptoms were obvious — the fever, the blisters and rashes on the hands, mouth and feet, quite like a cold. But the kids began to get lung infections," said Li Shimao, a municipal official.

By the third week of April, 20 children had died in the city.

"We were very anxious," said Dr. Ma Jie, a burn specialist and a senior director at the hospital. "The city-level experts weren't able to determine the disease. We thought it might be SARS again or bird flu."

By April 20, national health officials identified the outbreak as hand, foot and mouth disease, which usually hits children ages 5 and younger with weak immune systems.

The illness has no relation to the similar-sounding hoof and mouth disease that strikes cattle, sheep and swine and is transmitted by a different virus.

Several different viruses can cause hand, foot and mouth disease. When triggered by a Coxsackie virus, the illness is often benign, requiring neither medication nor hospitalization. But China linked its outbreak to enterovirus 71, which triggers a more severe illness that can include paralysis and concurrent viral meningitis.

Moreover, China's outbreak included some atypical symptoms, primarily lung infections. Chinese officials say the difficulty of identifying EV71, as the virus is known, is why they delayed in providing news of the outbreak to the nation until late April.

Even international health experts say the disease can be difficult to identify.

"When I worked as a physician in Sweden it actually took me several weeks once to diagnose a similar case of hand, foot and mouth disease because I didn't know then what to look for," Dr. Hans Troedsson, the World Health Organization representative in China, said at a news conference.

Parents of sick children found themselves ostracized.

"People were very scared. They avoided us," said Ding Min, the mother of 22-month-old Liu Jiaming, as she bounced the recovering toddler on her knee in the hospital.

China last week declared a national alert over the outbreak, shut down kindergartens in affected areas and deployed public health workers to explain in schools the importance of washing hands frequently to prevent viral transmission.

Liu, a practicing physician since 1982, said she focused hard on good care.

"I know how painful it is to be a patient," Liu said, describing her bout with breast cancer in 1999, which left her undergoing chemotherapy for six months.

Health Minister Chen Zhu publicly hailed Liu on a visit to Fuyang, comparing her to Zhong Nanshan, a Guangzhou doctor who played a critical role in fighting SARS, the usually fatal illness that brought vast areas of China to a halt five years ago.

It's common in China for local doctors to cover up outbreaks of disease, fearful that they'll be blamed and their careers will be ruined. Already some are being punished for failing to get adequate health care for children and infants struck by EV71.

"There were some health professionals who failed to refer cases to higher levels," said Mao Qunan, a spokesman for the national Health Ministry.

At least eight doctors, health clinic managers and village officials have been sacked or reprimanded for not sending sick infants to better-equipped hospitals, the state Xinhua news agency said.

Still unanswered is why Fuyang has had such a cluster of the EV71 illness, which also has been reported this year in Singapore, Malaysia and Vietnam.

"Fuyang had a flood last year. As an old saying goes, a plague follows a natural disaster," Liu said.

The huge attention the state is now giving the outbreak has calmed parents, even as health officials warn of a possible summer spike in cases.

But memories are still fresh of the infant formula scandal, which caused the heads of infants to swell and was dubbed "big head disease." The state says 12 infants died from the nutrient-poor formula in 2003 and 2004, but provincial newspapers put the death toll at more than 50 children. The scandal led to 31 arrests.

Liu led doctors in quizzing parents, finally settling on infant formula as the cause of the malnutrition. Although she declines to speak about it, a Nanjing newspaper said on May 5 that Liu paid out of her own pocket to have the infant formula tested.

"I didn't do anything worthy of praise," Liu said. "I'm only a normal pediatrician."

McClatchy Newspapers 2008

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