VZCZCXRO1520
PP RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB
DE RUEHPF #1755/01 2700850
ZNR UUUUU ZZH
P 270850Z SEP 06
FM AMEMBASSY PHNOM PENH
TO RUEHC/SECSTATE WASHDC PRIORITY 7381
INFO RUCNASE/ASEAN MEMBER COLLECTIVE PRIORITY
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE PRIORITY

UNCLAS SECTION 01 OF 02 PHNOM PENH 001755 
 
SIPDIS 
 
SIPDIS 
 
STATE FOR EAP/MLS AND M/MED 
 
E.O. 12958: N/A 
TAGS: SOCI AMED CB
SUBJECT: CAMBODIA:  WORST DENGUE FEVER OUTBREAK SINCE 1998 
 
¶1.  Summary.  Cambodia is in the midst of its worst dengue 
outbreak since 1998, with 10,000 Cambodian children already 
infected this year.  Phnom Penh's SOS Clinic, a popular 
choice among the expatriate community, reports 47 dengue 
cases so far this year, in contrast to 45 during all of 2005. 
 The pattern of dengue infection in Cambodia is changing from 
a peri-urban, cyclical disease to one which affects more 
remote rural and core urban areas, and one which is affects 
10,000 to 12,000 people per year.  Although the fatality rate 
has fallen over the past several years, 100-200 Cambodian 
children die each year and low quality health care 
necessitates medical travel to Bangkok for some expatriate 
adults and children.  End Summary. 
 
10,000 Dengue Cases So Far This Year 
------------------------------------ 
 
¶2.  About 10,000 Cambodian children have been infected with 
dengue fever so far this year, compared to about 6,000 
children in the same period last year, according to Dr. Ngan 
Chantha, Director of the National Dengue Control Program.  In 
10 of Cambodia's 24 provinces, the incidence rate (defined as 
new cases per 100,000 individuals) for the first 32 weeks of 
2006 is more than double the rate for the same period in 
¶2005.  The incidence rate in Phnom Penh has risen even more 
dramatically, from 35.6 cases per 100,000 in 2005 to 99.3 
cases per 100,000 in 2006.  At least 102 Cambodian children 
have died from dengue infection this year.  Some health 
experts have speculated that the presence of a previously 
uncommon strain of dengue has contributed to the outbreak as 
fewer children have prior exposure to that strain. 
 
¶3.  The largest reported dengue epidemic in Cambodia occurred 
in 1998, with 16,216 dengue cases and 475 deaths reported. 
This epidemic mainly affected Phnom Penh and Kandal province. 
 Although the annual number of reported dengue cases has 
declined since 1998, the distribution of disease has spread 
from mainly urban areas to rural areas.  In the past, dengue 
infections in Cambodia have been cyclical, with years with 
fewer than 1,000 reported cases interspersed with years with 
3,000 or more cases.  Since 2001, however, there have been 
approximately 10,000-12,000 cases reported each year, 
resulting in 100-200 deaths per year.  In contrast to rising 
infection rates, the fatality rate has fallen from 2.9% 
during the 1998 outbreak to 1.0% so far this year, which may 
reflect better treatment, earlier diagnosis, and/or increased 
immunity to circulating strains.  Nonetheless, this fatality 
rate is relatively high compared to other Southeast Asian 
countries. 
 
Expats Affected as Well 
----------------------- 
 
¶4.  Brian Ritchie, director of the SOS Clinic, a private 
clinic serving 1,200 patients per month, stated that the 
clinic has confirmed 47 cases of dengue so far this year, in 
comparison to 45 cases during all of 2005.  (Comment:  Given 
that peak dengue season is from June to November, it is 
significant that YTD cases for 2006 have already outpaced 
cases for the entire calendar year 2005.  End Comment.) 
Despite having a patient base that is 35-40% Cambodian 
nationals, Ritchie reported that all but 1 or 2 of this 
year's dengue cases were among expatriates.  Ritchie also 
reported seeing an increase in urban exposure to dengue 
starting in mid-2005, whereas in past years dengue exposure 
among expatriates was often linked to peri-urban and rural 
exposure.  Several of these cases have been tied to stagnant 
water at construction sites which are proliferating in Phnom 
Penh's building boom. 
 
¶5.  Approximately 10 of this year's SOS clinic dengue cases 
had to travel to Bangkok for medical treatment, either 
because the patient's blood platelet count was falling 
quickly and safe blood products are not available in 
Cambodia, or because the patient was quite ill and needed 
symptomatic care in a hospitalized setting not available in 
Cambodia.  (Note:  One adult embassy family member was 
medevaced to Bangkok in July for dengue treatment, including 
a 7-day hospitalization.  End Note.) 
 
¶6.  Dengue infection among adults is far more common in the 
expatriate than the Cambodian population.  The average age of 
all dengue cases at the SOS clinic was 33 years, whereas 
according to National Dengue Control Program statistics, just 
1% of Cambodians infected with dengue are over the age of 15. 
 While Cambodian children have typically been exposed to 
several of the four strains of dengue by the time they reach 
adulthood, expatriates often come to Cambodia with no dengue 
immunity, leaving them vulnerable to infection.  Dr. Jim 
Cousins of the SOS Clinic noted that dengue infections among 
 
PHNOM PENH 00001755  002 OF 002 
 
 
adults are often more severe than those in children. 
 
¶7.  The three main international schools--Northbridge 
International School of Cambodia, International School of 
Phnom Penh, and the Lycee Rene Descartes--have all reported 
dengue cases so far this school year among students and/or 
staff.  Several schools noted that cases seem to be down 
slightly this year in their communities, though given their 
relatively small size this may be just statistical variation. 
 
 
Government Efforts to Battle Dengue 
----------------------------------- 
 
¶8.  Cambodia has acknowledged the public health importance of 
dengue fever and established a National Dengue Control 
Program in 1996.  Dengue control in Cambodia has shifted from 
reactive outbreak response measures to a preventive approach. 
 Insecticidal spraying against adult mosquitoes which have 
little or no impact on the larval population has been 
reduced, and more sustainable methods of vector control have 
been increasingly employed, including mass larviciding 
campaigns. 
 
¶9.  At a recent meeting of the Technical Working Group for 
Health, Dr. Chantha cited several factors hampering the 
effective prevention of dengue, including poor sanitation, 
lack of funding at a provincial level and lack of local 
participation in preventive activities.  In addition, efforts 
to treat dengue are hampered by patients who are late to seek 
medical care or resort to self-medication or folk remedies. 
 
¶10.  Comment:  Despite its public health significance, dengue 
prevention and control activities are under-funded and 
neglected compared to other diseases with similar disease 
burden and comparable impact on the health of the population. 
 This has resulted in the continued lack of awareness of the 
risk of dengue among the general population and the adoption 
of behaviors necessary to prevent infection from mosquitoes 
that bite during the day.  As most Cambodians lack confidence 
in the underfunded and understaffed public health system, 
many initially seek treatment from either poorly trained 
private providers, further delaying life-saving diagnosis and 
treatment.  At the same time, expatriates--including embassy 
staff and EFMs--face significant risks due to lack of prior 
exposure to dengue and the limited health facilities that 
even the best equipped clinics in Cambodia can offer.  End 
Comment. 
MUSSOMELI