Outbreak of Beriberi Among Illegal Mainland Chinese Immigrants at a Detention Center in Taiwan

Abstract

Objective. The authors describe an outbreak of beriberi in a detention center in Taiwan and examine risk factors for illness. Methods.A survey was conducted among a sample of 176 randomly selected detainees. A menu-assisted dietary recall method was used to obtain diet information from nine hospitalized detainees. A probable case patient was defined as an individual who had at least two of the following characteristics: leg edema, weakness of the extremities, poor appetite, and dyspnea. Possible case patients were those who had only one of these characteristics.Results. Of the 176 survey respondents, 19% were classified as probable case patients and 40% as possible case patients. The mortality rate based on probable cases was 1.1%. Body Mass Index (BMI) was negatively associated with illness (pϽ0.0001), and length of stay in the detention center was independently positively associated with illness (pϽ0.05). The average intake of dietary thiamine among the nine hospitalized case patients who completed three-day dietary recall surveys was 0.49Ϯ0.1 mg/day. After thiamine administration, all symptoms and signs of beriberi resolved.Conclusion. This outbreak is a reminder of the importance of ensuring adequate diets for poor, institutionalized, or refugee populations who are unable to supplement their diets.

Outbreak of Beriberi in a Prison in Côte D'Ivoire

“…The combined form of beriberi was the most frequently diagnosed clinical form. These findings are similar to those described for other outbreaks in detention centers [8,10,20]. The absence of cases among women was probably related to the fact that they cooked their own meals inside the prison with various ingredients brought to them during visits or bought in their own prison market.…”

“…We report here a large outbreak of beriberi in a prison context, with more than 700 cases among an overall at-risk population of 5,000 detainees. The overall attack rate (14%) was close to the rates in previous outbreaks in prisons in West Africa (19%) and Taiwan (24%) [8,10]. The case fatality rate observed in this study was relatively low (1%), probably because of the prompt initiation of thiamin treatment.…”

“…Elsewhere, thiamin deficiency has been described in an apparently healthy population of workers in the Middle East, due to the limited variety of food and no provision of essential nutrients by their employers [26]. Prisoners are also at risk for beriberi for similar reasons [8,10,20,27]. The penal food ration in our study was comparable in nutritional terms to those described in Taiwan and Thailand [8,22].…”

“…Outbreaks of beriberi have been reported in prisons and among refugees and internally displaced persons [8][9][10][11]. These populations are much more vulnerable to micronutrient deficiency diseases because their food intake depends mainly on outside sources.…”

Epidemics and outbreaks of peripheral nervous system disorders: II. Toxic and nutritional causes

“…Between 2008 and 2014, an increasing number of Myanmarese refugees admitted in Malaysia with acute/subacute predominantly sensorimotor axonal PN was observed: most of them were malnourished, with a preceding history of starvation of 2-4 weeks before onset of symptoms [64]. This clinical picture was closed to the neurological complications of thiamine deficiency, as observed in other refugees [65] or prisoners [66], so a nutritional cause was suggested. Moreover, folate and vitamin B12 deficiencies were also detected in 31.5% of the patients, and most of them improved after supportive treatment with appropriate vitamins supplementation [64].…”