Keshan Disease

Abstract

Keshan disease (KD) is a novel cardiomyopathy of unclear cause which only occurred in some poor rural areas of China, characterized by obvious yearly and seasonal prevalence as well as vulnerability for self-sufficient farming population, killing hundreds of thousands of people over last century. Based on time course of onset and cardiac function of a suffering patient, KD is generally classified into four transformable types: acute type, sub-acute type, chronic type, and latent type. And their major clinical manifestations are cardiac dysfunction and arrhythmia.

KD was first recognized in medicine in the period when Japan invaded Northeast China. Since 1949, Chinese governments have made great efforts in fighting against KD epidemics, through broad social mobilization and engagement of local residents, especially deployment of substantial resources including money and medical teams to stem the outbreaks and save lives with combined measures. In the 1960s, Chinese investigators achieved multiple groundbreaking discoveries in the control and prevention of KD—several plausible etiological hypotheses and highly effective approaches for emergency rescue of critically ill patients by high-dose intravenous vitamin C therapy and for community-based primary prevention by selenium supplementation or balanced diet. Most importantly, since China’s open policy in 1978, the overall prevalence of KD has begun to decline dramatically thanks to rapid economic development in affected villages, reaching the lowest level ever and sustaining a steady state. Ultimately, we won the battle but at immense cost. Relevant sectors of governments have moved on, shifted from 1990 to focus on the disease surveillance and home care for heart failure, and believed that it would be completely eliminated following the implementation of poverty relief programs.

In this chapter, we provide basic knowledge on KD from perspectives of clinical medicine, pathology and epidemiology, and will particularly give emphasis on the major accomplishments and experiences worth spreading by reviewing its past control history.