Wüstenschiff

Indien - Meningokokken-Meningitis
24.02.2009

Aus dem Bundesstaat Meghalaya (NE) wird ein Meningokokken-Ausbruch mit bisher mehr als 2.000 Erkrankten und 230 Todesfällen gemeldet. In den letzten Jahrzehnten kam es in Indien wiederholt zu Meningitis Ausbrüchen, insbesondere durch die Serogruppe A verursacht. Impfschutz bei Risikoreisenden mit engem Kontakt zur einheimischen Bevölkerung beachten. / Quelle: crm

HEPATITIS B - INDIA (06): (GUJARAT)
***********************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Tue 24 Feb 2009
Source: The Hindustani times online [edited]
<http://www.hindustantimes.com/StoryPage ... a2281b3a60>


With more deaths, hepatitis toll now 43
---------------------------------------
The toll in the hepatitis-hit Sabarkantha district climbed to 43 with
the report of 5 new deaths. Meanwhile, state health department
launched a mass vaccination drive in Modasa town on Monday [23 Feb
2009]. According to district health officials, 6 new cases of
hepatitis have been registered on Monday from Modasa town and nearby
villages. The officials said that people of all ages had queued up
since morning to get themselves vaccinated.

"In the 1st phase we will be administering the hepatitis B vaccine to
around 60 000 people in Modasa, where we have set up 60 booths,"
Sabarkantha District Collector M. Thennarasan said. "We have block
level medical officers supervising the team at each booth with over
400 health workers including female health workers (FHWs) monitoring
the vaccination drive," Thennarasan said. He said that they have also
deployed number of mobile teams who will provide support wherever
there is shortfall. The team of experts have already vaccinated the
medical and PHC staff and other officials who are working in hospital
with the hepatitis-infected patients, he said.

--
Communicated by:
HealthMap Alerts
via ProMED-mail
<promed@promedmail.org>

[With little evidence of hepatitis D virus involvement, the name of
the thread is now changed. Mod.LM]

HEPATITIS B VIRUS - INDIA (08 ): (GUJARAT), RECYCLED MEDICAL WASTE
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Date: Thu 12 Mar 2009
Source: The National Newspaper online [edited]
<http://www.thenational.ae/article/20090 ... /1103/NEWS>


Officials in Gujarat state seized hundreds of tons of recycled
medical equipment and arrested more than 100 medical scrap dealers
and 22 doctors over the past week, after an outbreak of hepatitis B
killed at least 70 people and left about 240 others infected with the
deadly virus.

[Hepatitis B] virus is usually transmitted through sexual contact or
by sharing needles or syringes.

Two of the arrested doctors in the town of Modasa in Sabarkantha
district, the centre of the epidemic in Gujarat, were charged with
culpable homicide after it was learnt that some victims had been
treated in their clinic. The doctors -- father and son -- had used
the same syringes and needles on multiple patients, police said.

After raiding underground warehouses in Modasa, police and pollution
control officials seized recycled medical waste, most of it packaged
and ready for supply to clinics or hospitals. A similar seizure of
recycled medical waste took place in other parts of Gujarat,
including Ahmedabad. In Modasa, Surat, Rajkot and Ahmedabad,
officials discovered makeshift packaging units where recycled
needles, syringes, pediatric droppers, intravenous drips and other
equipment were being sorted, simply washed and neatly repackaged for sale.

Five Ahmedabad-based pharmaceutical companies were also found
repackaging used medical waste in the same unsafe manner, and the
Gujarat pollution control board has issued closure notices against
them. Investigators found that medical waste pickers collected used
needles and other equipment from hundreds of private hospitals,
thousands of doctors and some government hospitals and then sold them
to underground recycling gangs who traded in them.

Scientists from Pune's National Institute of Virology identified the
killer virus as a "dangerously mutated strain" of hepatitis B [virus]
that can kill its victims in an unusually short time. Jay Narayan
Vyas, Gujarat's health minister, said his department was sure the
infection spread fast because of the use of infected syringes or
needles by private doctors and that his government would take
stringent action against those responsible. "The situation turned
worse because private doctors and hospitals are not under a
regulatory mechanism. In the absence of any legal obligation and
related punitive measures of dereliction, the private medical
practitioners use substandard facilities and equipment," Mr Vyas said.

The practice of recycling medical equipment is not a new problem in
India. The Indian Clinical Epidemiology Network said that up to 31.6
per cent of the 3 billion to 6 billion injections administered in the
country annually were done with used equipment and carried the
potential risk of spreading such blood-borne viruses as those causing
hepatitis and AIDS. The authorities in Gujarat were aware that many
clinics in the state were unsafe but had failed to act sooner because
of the "high regard for doctors," said Dr Ramesh Shah, secretary of
the Gujarat Pollution Control Board.

"This entire saga of medical waste trading is disgusting, and we will
not spare the offenders. I am aghast that doctors can risk lives like
this for the cost of small change." Some experts said that in the
absence of a regulatory mechanism, similar outbreaks are bound to
occur in the future.

"There is no law under which it could be mandatory for Gujarat's 13
000 private medical practitioners to reveal where they bought their
equipment. In this situation, many culprits -- including doctors and
infected equipment suppliers -- are slipping out of the police
dragnet," said one Ahmedabad-based pollution control officer. "We
have no idea how many thousands of infected needles or syringes may
already be in use in medical clinics across the state. It is
impossible to trace them all," he said.

[Byline: Shaikh Azizur Rahman]

--
Communicated by:
HealthMap Alerts via
ProMED-mail <promed@promedmail.org>

[This is an appalling revelation. In these circumstances, it seems
unnecessary to attribute the outbreak to a "dangerously mutated
strain" of hepatitis B virus that can kill its victims in an
unusually short period. The exposure of patients to non-sterile
recycled medical equipment would be likely to enhance the severity of
any disease condition. - Mod.CP]

HEPATITIS B VIRUS - INDIA (09): (GUJARAT), RECYCLED MEDICAL WASTE
*****************************************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
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<http://www.isid.org>

Date: Fri 13 Mar 2009
From: Jose Manuel Echevarria
<jmecheva@isciii.es>


Re: Hepatitis B virus - India (08 ): (GJ), recycled medical waste 20090312.1024
-------------------------------------------------------------------------------
I don't think exposure of patients to recycled medical material is
likely to enhance the severity of any disease condition, acute
hepatitis B in particular, and is enough at all to explain the high
mortality rate observed in this outbreak. Exposure to non-sterile
recycled syringes and needles spread HBV [hepatitis B virus]
infection among hundred thousands intravenous drug users worldwide,
and such mortality rate has never been observed otherwise HDV
[hepatitis D virus] superinfection was involved. The revelation from
Pune's National Institute for Virology might be meaningful and very
relevant for Public Health everywhere, and details regarding such HBV
mutant strain must be made public as soon as possible in order to
evaluate its true relevance. This deadly mutant strain of HBV might
be present in other areas of the world, and Public Health authorities
do need detailed data in order to plan efficient surveillance activities.

--
Jose Manuel Echevarria
Virologist
National Centre of Microbiology
Instituto de Salud Carlos III
Majadahonda
Madrid, Spain
<jmecheva@isciii.es>

[The reasons for the severity of the outbreak of hepatitis B virus
infection in Gujarat have not been established unequivocally.
Initially the severity of the outbreak was attributed to hepatitis D
virus co-infection. This explanation was superseded by accounts of
widespread medical malpractice in the state. Now the outbreak is
being attributed to the presence of a "dangerously mutated strain" of
hepatitis B virus. ProMED-mail supports the correspondent's plea that
the situation needs to be resolved, particularly as the possible
evolution of a strain of hepatitis B virus of enhanced virulence
would have implications for the control of hepatitis worldwide. It is
incumbent on the Indian National Institute of Virology in Pune to
further define the nature of the mutant virus which may be associated
with this outbreak. - Mod.CP]

CHIKUNGUNYA (04): INDIA (GUJARAT)
*********************************
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Date: Sat 14 Mar 2009
Source: Express India [edited]
<http://www.expressindia.com/latest-news ... ge/434415/>


More than 100 suspected cases of chickungunya have been reported in
Kothra village of Nandod taluka, Narmada district recently. The
district health authorities had sent blood samples of 5 individuals
for further tests at the B J Medical College in Ahmedabad, of which 2
cases have tested positive.

Chickungunya cases were 1st reported on 6 Mar [2009]. Narmada
district health officials said the disease had spread across Dabhoi
taluka in Vadodara district. Pradeep Prajapati, Joint Director of
Malaria programme in Gujarat, who visited the village, said: "The
chikungunya virus is endemic in the state and sporadic cases have
been reported from some places."

Narmada Chief District Health Officer Dr Appu Rao said: "The health
officials 1st came to know about the case on 6 Mar [2009]. The cases
were taken to the Primary Health Centre (PHC) at Jesalpur. There
could be 2 reasons for the spread of the disease: one due to the
extensive breeding of the _Aedes aegypti_ mosquitoes in the utensils
used to feed livestock. Secondly, the virus could have spread from
the neighbouring villages." He added that nearly 15 people from
Dabhoi, Vadodara district, visited Kothra village in February [2009]
for a religious meet and might have carried the virus, which has now spread.

Meanwhile, Vadodara health authorities denied having any reports on
the outbreak across the. The district health authorities had carried
out health inspection in Savli and Dabhoi talukas on Friday [13 Mar
2009]. Blood samples of all the fever cases were collected for
further tests for chikungunya and other vector borne diseases.

Dr Rao refused to divulge further details about 2 confirmed cases of
chickungunya. He said: "We have started anti-larval activities, and
are also spreading information in the area."

Symptoms of the disease
-----------------------
* Fever up to 40 C (104 F)
* A petechial or maculopapular rash of the trunk
* Arthralgia or arthritis affecting multiple joints
* Joint pain depends on age
* Intense headache, insomnia and an extreme degree of prostration

Prevention
----------
* The most effective means of prevention are protection against
contact with the disease- [virus-] carrying mosquitoes and mosquito control
* Wearing bite-proof long sleeves and trousers (pants) also offers protection
* Use insect repellents
* Securing screens on windows and doors will help to keep mosquitoes
out of the house

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[If 3 of the 5 suspected chikungunya cases were laboratory negative
for that virus, on wonders if another agent of febrile disease,
perhaps dengue virus, was also being transmitted simultaneously in the area.

Narmada district is located at the southern end of Gujarat state,
western India, the map for which can be accessed at
<http://en.wikipedia.org/wiki/Gujarat>
A HealthMap/PrroMED-mail interactive map of India can be accessed at
<http://healthmap.org/promed/en?v=22.9,79.6,5> - Mod.TY]

HEPATITIS B VIRUS - INDIA (10): (GUJARAT), RECYCLED MEDICAL WASTE
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ProMED-mail is a program of the
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Date: Sat 14 Mar 2009
From: F. Blaine Hollinger
<blaineh@bcm.tmc.edu>


Further comment
---------------
Prior vaccination is usually the key to preventing these outbreaks so
let's not forget that we still have much work to be done. But it
would be useful to learn whether any of the individuals who acquired
hepatitis B, and especially those who died, had received a verifiable
series of the HBsAg vaccine. Without knowing the denominator of those
infected, the true infection-to-mortality rate remains unknown, but
from what data is available, the high mortality rate in this outbreak
is unusual (in the US, approximately 1 percent among icteric
hospitalized patients) as stated by Dr. Echevarria [see: Hepatitis B
virus - India (09): (GJ), recycled medical waste 20090313.1042]. In
2004, the CDC reported an outbreak of hepatitis B in injection drug
abusers with a mortality rate from fulminant hepatitis approaching 50
percent and noted several variables that might be associated
(acetaminophen, alcohol, genotype, etc).

--
Communicated by:
F. Blaine Hollinger, M.D.
Professor of Medicine, Molecular Virology & Epidemiology
Director, Eugene B. Casey Hepatitis Research Center
Baylor College of Medicine
One Baylor Plaza, BCM-385
Houston, TX 77030
<blaineh@bcm.edu>

[From the comments received it is clear that more basic information
is required for the proper understanding of this outbreak and its
implications for global health care. Hopefully the Gujarat Medical
Authorities will respond accordingly. - Mod.CP]

UNDIAGNOSED DEATHS - NEPAL: (DOLPA) REQUEST FOR INFORMATION
***********************************************************
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Date: Mon 16 Mar 2009
Source: nepalnews.com [edited]
<http://www.nepalnews.com/archive/2009/m ... news06.php>


A total of 5 persons have died of an unidentified sickness in a
village in mid-western Dolpa district. Reports quoting local health
officials said several others have been infected with the disease in
Chharka village. The area is a 3-day walking distance from the
district headquarters, Dunai.

Those infected with the unknown disease complained of headache,
fever, and cough. Officials at the public health office at Dunai said
a team of medics left for the area on Sunday [15 Mar 2009] with
drugs, but they have not been able report back due to lack of means
of communication.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The description of the symptoms of the disease is too limited to
permit a tentative diagnosis. Further information is requested from
the team of investigators dispatched to Chharka village, or from any
other informed source. Unfortunately, as revealed by the archive
material below, during the past decade reports of undiagnosed disease
in Nepal have been frequent without significant resolution.

Dolpa district can be located on the map of the districts of Nepal at
<http://www.kantipuronline.com/election/ ... es/map.jpg>
and Dunai the district administrative centre can be located on the
map of Nepal at
<http://www.lib.utexas.edu/maps/middle_e ... _pol90.jpg>.
The interactive HealthMap/ProMED map of Nepal can be accessed at
<http://healthmap.org/r/007i>. - Mod.CP]

ANTHRAX, HUMAN, LIVESTOCK - INDIA: (ANDHRA PRADESH)
***************************************************
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Date: Fri 20 Mar 2009
Source: The CNN Wire [edited]
<http://cnnwire.blogs.cnn.com/2009/03/20 ... ian-state/>


Health officials said Friday [20 Mar 2009], 15 people have been
diagnosed with cutaneous anthrax in the southern Indian state of
Andhra Pradesh over the past week.

The outbreak has occurred in some half-dozen villages of the state's
Vishakhapatnam district, its medical and health officer, J Sarojini,
told CNN. Four of the patients have been hospitalized, with one in
critical condition, she said. Health officials are also looking into
the cause of one death, she added.

The disease has been blamed on [infected meat from] cows and goats
that Sarojini said died recently. However, veterinary experts
surveying the district have found no infection among livestock.

Health officials are administering antibiotics in the affected villages.

Byline: Harmeet Shah Singh]

--
Communicated by:
Michael P Owen
Regulatory/Counterterrorism Microbiologist
U.S. Food and Drug Administration
Pacific Regional Laboratory Northwest
22201 23rd Drive SE
Bothell, WA 98021-4421
USA
<michael.owen@fda.hhs.gov>

[Cattle outbreaks have been reported in Andhra Pradesh each year to
OIE since 2000; and in 2005 there were 39 outbreaks, with 20 cattle
cases and 135 sheep and goats affected; in 2006 there were 46
outbreaks, 8 cattle cases and 251 sheep and goats affected; and in
2007 there were 54 outbreaks, 35 cattle cases, 216 sheep and goats.

In general in India cases in small ruminants are extensively
under-reported. In 1999 there was one human pneumonic death, and 2
gastroenteric and 8 cutaneous cases reported in relation to "several
goats in hundreds died and buried," part of an ongoing problem since
1988. All of which makes one wonder why the AP state veterinary
service has not established a statewide control programme. Such is
long overdue.

That no evidence of livestock cases is forthcoming in the relevant
villages is just a function of the quality of the investigation and
of local mutual trust between the locals and state officials. The
trick is to have a junior officer drift away from the formal enquiry
and casually ask the kids what happened.

For maps of India see
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.pdf>
for Vishakhapatnam, see
<http://www.fallingrain.com/world/IN/2/V ... atnam.html> and
<http://healthmap.org/r/007n>. - Mod.MHJ]

Indien - Hepatitis B
23.03.2009

Aus dem Bundesstaat Gujarat (W) wird eine ungewöhnliche Häufung von Todesfällen, verursacht durch Hepatitis B, gemeldet. Bisher wurden 240 Erkrankungen und 70 Todesfälle gemeldet. Die Infektionen wurden durch infizierte Spritzen und Kanülen übertragen. Die Behörden stellten hunderte Tonnen von illegal recyceltem medizinischem Equipment sicher und verhafteten mehr als 100 Personen, u.a. 22 Ärzte. Nach Schätzungen des Indian Clinical Epidemiology Network werden bis zu 31,6% der jährlichen 3-6 Milliarden Injektionen im Land mit gebrauchtem Injektionsmaterial durchgeführt. Eine umfassende Impfkampagne wurde gestartet. Impfschutz beachten. Risikoreisende sollten ggf. sterile Einmalspritzen und Kanülen mit sich führen. / Quelle: crm

ANTHRAX, HUMAN - INDIA: (ORISSA)
********************************
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Date: Tue 24 Mar 2009
Source: The Statesman, Kolkata [edited]
<http://www.thestatesman.net/page.arcvie ... &id=280744>


At least 4 people have died of suspected anthrax and many others
seriously afflicted in a couple of weeks at Chancharaguda area under
Bissamcuttack block of Rayagada district [Orissa state]. The exact
number of the victims has not yet been ascertained as the tribal
people usually prefer "disari" (a traditional village doctor) to
professional doctors, and any case of death while under treatment with
the disaris remains unreported, sources said.

The disease claimed many lives in the same region last year [2008] too
[see ProMED archives below]. This time, the matter has come to the
fore after some people brought the matter to the notice of the
personnel of the nearest PHC [Primary Health Center]. A medical team
was immediately rushed to the area. The patients were treated and
blood samples were collected.

The medical officials were informed about the deaths of [the 4 named
dead, ages 30-45]. Many others were checked by the health service
personnel. Their condition is said to be out of danger. A 12-year-old
boy is reportedly undergoing treatment at Bissamcuttack Christian
Hospital.

Dr Nabakishore Kundu of Bissamcuttack CHC [Community Health Cell]
opined that consumption of stale meat may be the prime reason. "Lack
of awareness mainly due to illiteracy is the biggest hindrance in
providing treatment to the affected tribal people. We have been
convincing them [to get] health checkups, but with little success," he
said. [It is not stale, but infected, meat that is the culprit -
Mod.JW]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Same old, same old story. It is long overdue for the Indian states
affected by this disease to get together and mount an effective
surveillance and control programme. The latter is not complicated and
the significant numbers of human cases each year indicates a public
health risk, quite apart from the greater implications for an
effective veterinary response. Those states with repeated outbreaks
are well known. In 2007 OIE reported outbreaks in Andra Pradesh,
Gujurat (aka Gujarat), Jammu and Kashmir, Karnataka, Orissa,
Pondicherry, Tamil Nadu and West Bengal, while ProMED reported the
outbreaks in Andra Pradesh and Orissa, and also a suspected outbreak
in Kerala.

To find Orissa, go to:
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg> and
<http://healthmap.org/r/007F>
Rayagada district:
<http://www.fallingrain.com/world/IN/21/Raygarh.html>
Bissamcuttack:
<http://www.fallingrain.com/world/IN/21/ ... ttack.html>. - Mod.MHJ]

ANTHRAX, HUMAN, OVINE - INDIA: (ANDHRA PRADESH)
***********************************************
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Date: Mon 30 Mar 2009 01:35:46 PM IST
Source: Express Buzz [edited]
<http://www.expressbuzz.com/edition/stor ... umeA==&SEO>


In what is reported to be an isolated outbreak of anthrax in the
country, 5 persons were diagnosed with it in Prakasam district
today [30 Mar 2009]. They were taken ill after consuming meat [from]
affected sheep reared at Kalluru village in Kurichedu mandal of
Prakasam district.

Experts from the Animal Husbandry Department confirmed reports that
200 of the sheep reared in Kalluru village were affected with anthrax,
while there are chances of many more such cases. Following reports
[that] 200 sheep died due to a mysterious disease, the veterinary
doctor at Kurichedu mandal rushed to the village and alerted deputy
director of Animal Husbandry K Niranjan. Niranjan immediately rushed a
medical team to the village, which took samples of the dead sheep,
conducted tests, and confirmed that death was due to anthrax.

The Animal Husbandry Department has set up a medical camp at the
village and also conducted tests on people to check if they have
been affected by the disease. "We have quarantined the 10 persons,
who reportedly ate the meat of the affected sheep. We are also
conducting a door-to-door survey to know, if anybody else consumed
the contaminated meat" Niranjan said. The 10 persons were
administered anti-anthrax vaccine.

Speaking to Express, Niranjan said that they had identified that
around 8000 more sheep were being reared within 5 km (3 mi) radius of
Kalluru village and added that the Animal Husbandry Department had
formed special teams and will visit all the villages and vaccinate the
sheep as a precautionary measure.

Prakasam District Collector K Devanand told 'Express' that he had
asked the police and revenue officials to take precautionary measures
to check spread of the disease.

Niranjan said that the Animal Husbandry Department had 3000
anti-anthrax vaccines [for livestock] at hand and had ordered more
from Hyderabad. He said that experts would be called to dispose of the
carcasses as anthrax spores had the capability of surviving extreme
conditions for many years, sometimes for over a century.

[Byline: Ch Ramagopala Sastry]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The reason that anthrax outbreaks in sheep can involve large numbers
of animals is that they are not valued individually as highly as
cattle, and in some cultures they are also the responsibility of
women. So deaths are ignored until it is patently obvious that
something has gone wrong, as in this instance. It is also why the
disease is under-reported in sheep and goats. - Mod.MHJ]

[The HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/007T>.
Prakasam district can be located on the map of Andhra Pradesh at
<http://www.mapsofindia.com/maps/andhrap ... strict.htm>.
- CopyEd.MJ]

DENGUE/DHF UPDATE 2009 (14)
***************************
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******

Pakistan (Punjab)
Date: Sun 29 Mar 2009
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), Integrated Regional Information Networks (IRIN) News [summ.
Mod.TY, edited]
<http://www.IRINnews.org/Report.aspx?ReportId=83683>


With warmer weather returning to Punjab, Pakistan's most populous
province, the vector-borne dengue fever virus has also returned, say
officials. Six patients have been diagnosed with dengue in 2009 so
far, according to Anwar Saeed Mirza, an additional medical
superintendent at Services Hospital in Lahore, the Punjab capital.

The most recent case was reported 27 Mar [2009], when the virus was
detected in a man at the Services Hospital. The status of this
patient is considered critical.

Last year 1240 cases of dengue fever were reported in the province.
The disease also caused 6 deaths.

Experts urge action to prevent an epidemic of dengue in 2009. With
the first cases of the viral disease already coming in, doctors fear
the situation could worsen rapidly.

"We need to remind people of the need for safety measures, like
ensuring there is no standing water in their homes. The government
must also urgently begin a spraying campaign at [mosquito] breeding
places," Faiza Riaz, a family physician, said.

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[A map of Pakistan showing the location of Punjab can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>.
A HealthMap/ProMED-mail interactive map of Pakistan can be accessed at
<http://healthmap.org/r/008Q>. - Mod.TY]

HEMORRHAGIC FEVER WITH RENAL SYNDROME - TURKEY (BARTIN)
*******************************************************
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Date: Thu 16 Apr 2009
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... &bolum=100>


The Health Ministry has discovered that a
46-year-old man who died in February [2009] in
the northwestern district of Bartyn was infected
with the hantavirus, a virus carried by rodents
that causes epidemic hemorrhagic fever and severe
respiratory infections in humans, making him the
first known victim of the virus in Turkey.

The man, who was hospitalized with symptoms of
fever, chills and nausea, died on 20 Feb [2009]
of "multi-organ failure in connection to acute
renal failure," according to his doctors. The
Health Ministry, however, recently announced that
the hantavirus was found in the man's blood and
was the cause of his death. Describing the virus
in a statement made about the death, the Health
Ministry said: "Some rodents carry the virus, and
it spreads through inhaling their droppings.
There are 2 types of hantavirus infections. One,
which causes lung failure, is widely seen in
America; the other, which causes renal failure,
is seen in Asia and Europe. The infection, which
is known to be seen in southern Russia and the
Balkans, has been discovered for the 1st time in
our country."

In the meantime, 12 people in Bartyn and 4 in the
city of Zonguldak have been hospitalized for
possible hanta virus infection. Including this
patient, the virus has been discovered in 8
people in the region so far.

The disease associated with the hantavirus is
called hemorrhagic fever with renal syndrome
(HFRS), a term that is accepted by the World
Health Organization (WHO). It was formerly called
Korean hemorrhagic fever. The appearance of the
virus causes flu-like symptoms in those infected.
The disease spreads through the saliva, urine and
droppings of deer mice, not through
person-to-person contact. The virus can be spread
through bites, but is typically is contracted
through inhaling dust from rodent droppings,
urine and saliva stirred into the air of garages,
cabins and other closed-off areas.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[It is unfortunate that this report refers to "a
hantavirus" as though there was just one such
virus, when, in fact, there are 4 recognized Old
World or European hantaviruses that could be
responsible for these hemorrhagic fever with
renal syndrome cases in Turkey. These, and their
rodent hosts, include: Dobrava virus (_Apodemus
flivicollis and _A. agararius_), Seoul virus
(_Rattus norvegicus and R. rattus_) and Puumala
virus (_Myodes glareolus_; synonymous with or
formerly classified as _Clethrionomys
glareolus_). _Apodemus agrarius_, the rodent host
for Hantaan virus, has also been reported from
Turkey.

In an article published in 2006, a field study of
rodents in Turkey reported, "Antibodies to
Puumala virus (family Bunyaviridae, genus
Hantavirus, PUUV) were detected in four of 65
_Microtus_ voles tested. Of the PUUV-IFA-positive
voles, one _Microtus guentheri lydius_ was caught
from Izmir, and one _Microtus roberti_ and two
_Microtus rossiaemeridionalis_ were captured near
Trabzon. All 264 _Apodemus_ spp. mice tested
negative for antibodies to Saaremaa virus (family
Bunyaviridae, genus Hantavirus, SAAV); the single
_Dryomys nitedula_ tested negative for both PUUV
and SAAV antibodies.

Reference:
----------
Laakkonen J, Kallio-Kokko H, Oktem MA, Blasdell
K, Plyusnina A, Niemimaa J, Karataþ A, Plyusnin
A, Vaheri A, Henttonen H. 2006. Serological
survey for viral pathogens in Turkish rodents. J
Wildl Dis 42:672-676.

The US CDC has an excellent hantavirus teaching
slide set at:
<http://www.cdc.gov/ncidod/diseases/hant ... s37-42.htm>.

A map showing the location of Bartin on Turkey's
northwest Black Sea coast can be accessed at
<http://www.map-of-turkey.co.uk/map-of-bartin.htm>
- Mod.TY]

HEMORRHAGIC FEVER WITH RENAL SYNDROME - TURKEY (02): (BARTIN)
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 20 Apr 2009
From: Heikki Henttonen <Heikki.Henttonen@metla.fi>


With regard to the hantavirus outbreak in Turkey, _Apodemus agrarius_ is
found only on the European side of the Bosporus Strait, and, therefore,
Saaremaa virus, the hantavirus carried by this host species in Europe,
could hardly be responsible for the outbreak reported on the northern,
Black Sea coast of Turkey.

There are several other _Apodemus_ mouse species in Turkey that could carry
hantaviruses. Dobrava virus in _A. flavicollis_ is a well-known severe
pathogen in the Balkan region, and this rodent species is common in Turkey.
The severity of disease may suggest Dobrava virus or a Dobrava-like virus.

Other _Apodemus_ species on the Anatolian side of Turkey include e.g. _A.
mystacinus_, _A. uralensis_, _A. witherbyi_, _A. hermonensis_, _A.
fulvipectus_, _A. ponticus_, and possibly _A. hyrcacinus_ and _A. arianus_,
several of which can occur on the northern coast. It is good to know that
the taxonomy of _Apodemus_ in the region is not completely settled, but
_Apodemus_ diversity potential for new hantaviruses surely exists. In our
screening in northeastern and western Turkey (referred to by moderator TY),
we had samples from _A. flavicollis_, _A. uralensis_ (mentioned by us as
_A. sylvatics s._l.) and _A. mystacinus_, but no hantaviruses were found.

_Myodes glareolus_, the host of Puumala virus, is found on the northern
Black Sea coast in Turkey, and, therefore, this virus is also a potential
cause of the outbreak, but our samplings were not in the range of this vole
species in Turkey. Hantaviruses in _Microtus voles_ are usually considered
nonpathogenic to humans.

--
Communicated by:
Heikki Henttonen
Professor of Forest Zoology
Finnish Forest Research Institute
Vantaa Research Unit
POB 18
FIN - 01301 Vantaa
Finland
<Heikki.Henttonen@metla.fi>

[ProMED-mail welcomes the opportunity to post this comment from Professor
Henttonen based his extensive experience of European hantaviruses and their
vectors, which is directly relevant to the question of the precise identity
of the agent responsible for the current outbreak in Turkey. - Mod.CP]

HEMORRHAGIC FEVER WITH RENAL SYNDROME - TURKEY (03): (ZONGULDAK)
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 21 Apr 2009
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=173061>


One more suspected [hantavirus] death in Zonguldak
--------------------------------------------------
The authorities are speculating that the death of a 29 year old man in
Zonguldak is attributable to [a hantavirus infection]. Hantaviruses are
carried by rodents and cause epidemic hemorrhagic fever and severe
respiratory infections in humans, which can be fatal [the syndrome known as
hemorrhagic fever with renal syndrome (HFRS). - Mod.CP].

If a hantavirus is confirmed as the culprit, it will raise the number of
deaths from this virus infection to 2 in Bartin and Zonguldak. The victim
was among 16 people admitted to hospitals complaining of high fever,
chills, and nausea in Bartin and Zonguldak and among 5 of whom doctors
believe had contracted a hantavirus infection.

Dr Guven Celebi of the infectious diseases department at Zonguldak
Karaelmas University Hospital told the press that it was too early to say
for sure whether or not the man had contracted a hantavirus infection. "He
was one of 5 suspected cases the hospital was monitoring. But preliminary
testing had come back negative. Before he came to the hospital he had
suffered a number of problems and exhibited vascular problems connected
with epilepsy and his brain. Because he fit the bill [differential
diagnosis] for a hantavirus infection as well, we carried out a number of
tests. Some of these will produce results in 15-20 days. When those results
come back, we can say some concrete things," the doctor explained.

Celebi was the 1st doctor to identify a case of hantavirus infection in
Turkey when a man arrived at his hospital's emergency room on 20 Feb 2009
and was admitted with symptoms of fever, chills, and nausea. He died the
same day, and blood tests later confirmed he died of a hantavirus
infection, while his doctors' initial diagnosis of the cause of death was
'multi-organ' failure as a consequence of acute renal insufficiency.

[byline: Abdullah Karabacak]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Confirmation of the diagnosis of hantavirus infection and identification
of the species of hantavirus involved remain unresolved pending the outcome
of the laboratory tests still in progress. Readers are referred to the 2
previous posts in this thread for discussion of the possible identity of
the etiologic agent.

Zonguldak (and Bartin) on the Black Sea coast can be located in the
HealthMap/ProMED-mail interactive map of Turkey at
<http://healthmap.org/r/00a4>. - Mod.CP]