7 research outputs found
Re-emergence of thiamine deficiency disease in the Pacific islands (2014-15): A case-control study.
BACKGROUND:From late 2014 multiple atolls in Kiribati reported an unusual and sometimes fatal illness. We conducted an investigation to identify the etiology of the outbreak on the most severely affected atoll, Kuria, and identified thiamine deficiency disease as the cause. Thiamine deficiency disease has not been reported in the Pacific islands for >5 decades. We present the epidemiological, clinical, and laboratory findings of the investigation. METHODOLOGY/PRINCIPAL FINDINGS:We initially conducted detailed interviews and examinations on previously identified cases to characterize the unknown illness and develop a case definition. Active and passive surveillance was then conducted to identify additional cases. A questionnaire to identify potential risk factors and blood samples to assay biochemical indices were collected from cases and asymptomatic controls. Thiamine hydrochloride treatment was implemented and the response to treatment was systematically monitored using a five-point visual analogue scale and by assessing resolution of previously abnormal neurological examination findings. Risk factors and biochemical results were assessed by univariate and multivariate analyses. 69 cases were identified on Kuria (7% attack rate) including 34 confirmed and 35 unconfirmed. Most were adults (median age 28 years [range 0-62]) and 83% were male. Seven adult males and two infants died (13% case fatality rate). Resolution of objective clinical signs (78%) or symptoms (94%) were identified within one week of starting treatment. Risk factors included having a friend with thiamine deficiency disease and drinking kava; drinking yeast alcohol reduced the risk of disease. Higher chromium (p<0·001) but not thiamine deficiency (p = 0·66) or other biochemical indices were associated with disease by univariate analyses. Chromium (p<0·001) and thiamine deficiency (p = 0·02) were associated with disease by multivariate analysis. CONCLUSIONS/SIGNIFICANCE:An outbreak of thiamine deficiency disease (beriberi) in Kiribati signals the re-emergence of a classic nutritional disease in the Pacific islands after five decades. Although treatment is safe and effective, the underlying reason for the re-emergence remains unknown. Chromium was highly and positively correlated with disease in this study raising questions about the potential role of factors other than thiamine in the biochemistry and pathophysiology of clinical disease
Monthly cases of confirmed and unconfirmed thiamine deficiency disease by month and year of symptom onset on Kuria, Kiribati, during the period from 1 October 2012 to 13 February 2015.
<p>Monthly cases of confirmed and unconfirmed thiamine deficiency disease by month and year of symptom onset on Kuria, Kiribati, during the period from 1 October 2012 to 13 February 2015.</p
Biochemical results for cases and controls on Kuria, 2015.
<p>Biochemical results for cases and controls on Kuria, 2015.</p
Demographics and mean thiamine diphosphate and chromium values in Kuria cases and controls and Tarawa participants.
<p>Demographics and mean thiamine diphosphate and chromium values in Kuria cases and controls and Tarawa participants.</p
Clinical features of cases and controls, Kuria, 2015.
<p>Clinical features of cases and controls, Kuria, 2015.</p
Thiamine diphosphate and chromium in cases, controls and Tarawa participants, 2015.
<p>Thiamine diphosphate and chromium in cases, controls and Tarawa participants, 2015.</p
Crude and adjusted odds ratios and 95% CIs for risk factors for thiamine deficiency disease.
<p>Crude and adjusted odds ratios and 95% CIs for risk factors for thiamine deficiency disease.</p