A fatal ailment that triggers heart failure in children--apparently never seen before--has surfaced in Malaysia. A team of experts from the U.S. Centers for Disease Control and Prevention (CDC) is now in Malaysia trying to help the government learn what causes the disease, which has killed 31 children in just 3 months.
The outbreak has been confined so far to the Sarawak region of northwestern Borneo, an island off the coast of the more populous Malaysia. "We've collected a fair bit of data with nothing clearly providing an answer as to what's going on," says the CDC's Larry Anderson. Scientists speculate that there may be a link to an epidemic of hand, foot, and mouth (HFM) disease now raging in Malaysia. But HFM, which is caused by Coxsackie A16 and other enteroviruses, is rarely fatal and indeed has not led to any deaths among 2140 children diagnosed with it on peninsular Malaysia last month.
Malaysian health officials also suspect Coxsackie B virus, which is linked to myocarditis, as a possible cause of the heart failure disease. Another possibility is enterovirus 71, a bug that causes heart failure and which has been isolated from several of the dead children. The culprit could even be a pathogen never before seen in people, says Anderson. At this point, he says, "it's detective work." The Sarawak Health Department  is posting outbreak updates on its Internet site.