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DENGUE/DHF UPDATE 2009 (17)
***************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
India (Kerala)
Date: Tue 21 Apr 2009
Source: NDTV.com [edited]
<http://www.ndtv.com/convergence/ndtv/st ... 0090091424>


A dengue outbreak has been reported in some parts of
Thiruvananthapuram district. What's even more worrying is that the
Thiruvananthapuram Medical College campus may itself may be the
epicentre from where the disease has spread.

Health workers are trying to stop the spread of dengue in the campus.
There are reports that some doctors and paramedical staff in the
hospital have been affected. The outbreak was first reported a week
ago but with elections happening, this apparently did not get
attention. "Doctors and the paramedical staff are under threat of the
disease that's why we are cleaning the campus," said Dr Sreekumar,
Resident Medical Officer. The Thiruvananthapuram medical college has
now been closed down because of dengue outbreak, 12 cases were
reported from this hospital and the doctors have now been shifted to
a new accommodation. Patients with suspected dengue are to be shifted
out from general wards to this exclusive ward for fever cases. With
summer showers already on and monsoon approaching medical teams are
carrying out vector control measures and cleanliness drive on the
campus.

"Awareness of the people is very [low] even in Kerala that is a
surprise. So, people are dumping all waste in plastic bags in this
area," said P K Sreemathy, Health Minister, Kerala.

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

[A map of Thiruvananthapuram District, Kerala State, India can be accessed at
<http://www.mapsofindia.com/maps/kerala/ ... apuram.htm>.
A HealthMap/ProMED-mail interactive map can be accessed at
<http://healthmap.org/r/00aD>. - Mod.TY]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (17)
**********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


******
Cholera - India: Matlab variant
Date: Sat 11 Apr 2009
Source: The Times of India (TNN) [edited]
<http://timesofindia.indiatimes.com/Dead ... 386452.cms>


A highly virulent and deadly form of cholera strain "the El Tor
hybrid" [also called the Matlab variant - Mod.LL] has now been found
in India. First discovered in Bangladesh in 2006 and subsequently
found in parts of Africa, this recombinant strain is more dangerous
than the El Tor strain, with the power to kill more people and cause
prolonged outbreaks.

What's worse, scientists at the National Institute of Cholera and
Enteric Diseases (NICED) in Kolkata fear that almost 100 percent of
all new cholera infections in West Bengal and Orissa are being caused
by this strain.

"Usually in cholera, with proper oral rehydration therapy, case
fatalities shouldn't exceed one percent. Alarmingly, with the El Tor
hybrid, case fatalities in Ghana is 24 percent and 8 percent in
Orissa," said NICED director Dr G B Nair, who had actually discovered
the strain in Bangladesh in 2006.

ICMR [Indian Council of Medical Research] director general Dr V M
Katoch said the present strain has better survival techniques in the
environment. "El Tor hybrid has higher case fatality rates, higher
surviving power in the environment, and the ability to cause
prolonged outbreaks," Dr Katoch said.

The most severe warning about the risks of the El Tor hybrid,
however, came from Dr Nair. According to him, the classical strain
was more virulent and less infectious while El Tor was less virulent
and more infectious. "The El Tor hybrid has picked up both attributes
and is more virulent and more infectious," Dr Nair said.

[Byline: Kounteya Sinha]

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

[Formally, the 2 established biotypes of _Vibrio cholerae_, classical
and El Tor, can be distinguished from one another by a number of
phenotypic properties including hemolysis of sheep red blood cells,
agglutination of chicken red blood cells, the Voges-Proskauer
reaction, as well as susceptibility to polymyxin B and to
biotype-specific viral bacteriophages. Hybrid biotypes, so-called
Matlab variants, are also described (Nair GB, Faruque SM, Bhuiyan NA,
et al: New variants of _Vibrio cholerae_ O1 biotype El Tor with
attributes of the classical biotype from hospitalized patients with
acute diarrhea in Bangladesh. J Clin Microbiol 2002; 40(9): 3296-9;
abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/12202569>.)

The HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/008o> - Mod.LL]

******

CHIKUNGUNYA (10): INDIA (KARNATAKA) SUSPECTED
*********************************************
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International Society for Infectious Diseases
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Date: Mon 4 May 2009
Source: Deccan Herald [edited]
<http://www.deccanherald.com/Content/May ... 134149.asp>


Suspect chikungunya cases are rising in DJ Halli area. On Sunday [3
May 2009] around 100 new patients were treated at the BBMP [Greater
Bangalore Municipal Body] health camps and 28 new cases were reported
at the DJ Halli Hospital. On the whole 281 patients with fever have
visited camps and hospitals for their dose of paracetamol
[acetaminophen].

Deputy commissioner (Health) Venkateshappa visited DJ Halli and
surrounding areas and carried out cleaning work of garbage and drains
in the area. Additional workers were deployed to carry out intensive
cleaning work. Spraying and fogging were also carried out extensively
on Sunday [3 May 2009].

Hundreds of residents around DJ Halli, Kavalabyrasandra, and
surrounding areas have been having symptoms of chikungunya [virus
infection] for the past one week. Blood samples of patients have been
collected to verify the possible epidemic.

--
Communicated by:
Dr Javeed Ahmed
SpR (Virology)
Guy's & St.Thomas' NHS Foundation Trust
London
United Kingdom
<drjaveedahmed@yahoo.com>

[Chikungunya virus has been circulating in Karnataka state for over a
year (see ProMED archives cited below). ProMED-mail will be
interested in receiving information about the results of the
laboratory tests confirming (or not) chikungunya virus infection in
this outbreak. One hopes that this outbreak can be halted before it
reaches the concentrated populations in central Bangalore city.
ProMED thanks Dr Ahmed for sending in the report above.

[The DJ Halli area is located 5 km (3 mi) north of the center of the
city of Bangalore (Bengaluru). A map of Bangalore can be accessed at
<http://www.maplandia.com/india/karnatak ... bangalore/>.
A map of India showing the location of Bangalore in Karnataka state
can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>
A HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/00bl> - Mod.TY]

Nepal - Japanische Enzephalitis
11.05.2009

Im Mai beginnt in den tiefer gelegenen, südlichen Landesteilen (Terai) die Übertragungssaison für diese durch nachtaktive Stechmücken übertragene Viruskrankheit, die zu Hirnentzündungen führen kann. Sie endet im Oktober und hat ihren Gipfel erfahrungsgemäß im August-September. Risiko-Reisende sollten geimpft sein. / Quelle: crm
__________________________________

Indien - Chikungunya (CHIC), Dengue (DF)
11.05.2009

Die beiden grippeähnlichen, mückenübertragenen Viruskrankheiten sind in Indien verbreitet. Vor allem während der Monsunregen muss mit einem erhöhten Infektionsrisiko gerechnet werden, auch in den Städten. Die ersten CHIC-Ausbrüche dieses Jahres werden seit April von der SW-Küste gemeldet. Schutz vor tag- und nachtaktiven Stechmücken beachten. / Quelle: crm
___________________________________

Indien - Poliomyelitis
11.05.2009

Trotz flächendeckender Impfkampagnen gehört Indien noch immer zu den vier Ländern mit endemischer Polio und steht mit den Fallzahlen weltweit nach Nigeria an zweiter Stelle. Bis Ende März wurden 40 Erkrankungen registriert. 2008 wurden 557 Erkrankungen gemeldet. Hygiene und Impfschutz beachten. / Quelle: crm

ANTHRAX, HUMAN, BOVINE - INDIA: (ANDHRA PRADESH)
************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Sun 10 May 2009
Source: Thaindian News Asian News International (ANI) report [edited]
<http://www.thaindian.com/newsportal/ind ... 90619.html>


An outbreak of anthrax in the remote areas has been reported from
Visakhapatnam district of Andhra Pradesh. According to the Labburu Primary
Health Centre, nearly 51 cases of anthrax are reported so far. Out of this,
11 people [have] died and 5 persons are showing the symptoms of anthrax.

To allay the panic among the people, a medical official has announced that
all possible measures were taken to counter the disease. "The special team
will visit the houses. We are recommending to all these families that they
must resort to tablets. All the steps required are being taken up. I would
like to appeal that there is no reason to panic," said Janardhan Rao, a doctor.

--
communicated by:
ProMED-mail rapporteur Susan Baekeland

[I suspect that what the report above is trying to say is that the Labburu
Primary Health Centre is observing 51 people and of those 11 have died and
5 are clinically ill. I would suspect that the remaining 35 may be
receiving prophylactic oral antibiotics. - Mod.MHJ

A further report received later (via Mod.MPP) expressed similar numbers a
little differently
<http://news.xinhuanet.com/english/2009- ... 353495.htm>. - Mod.SH]

******
[2]
Date: Sun 10 May 2009
Source: The Times of India (TNN) [edited]
<http://timesofindia.indiatimes.com/Hyde ... 504111.cms>


Bhadrachalam CPM Lok Sabha MP M Babu Rao on Saturday [9 May 2009] demanded
that a health emergency be declared in the Visakha agency [tribal] areas
with the reports of more and more anthrax cases coming from the border
mandals [districts]. He demanded the state government to implement
recommendations of various committees by recruiting sufficient doctors and
health staff to improve the medical condition of the tribals. Babu Rao told
newspersons that the tribals need to be provided with work as part of the
National Employment Assurance Scheme.

Seventeen tribals died of anthrax and diarrhoea in the past 2 months in the
agency mandals. Deaths of 937 cattle were reported in Munchingput mandal
alone, but the government has not taken any measures to stop the deaths of
the tribals, Babu Rao regretted.

The authorities should take up construction of water tanks and install
borewells in each village of the agency mandal. The MP [member of
parliament] asked the government to recruit necessary number of veterinary
doctors and the staff and ensure a better implementation of the free
insurance scheme for the cattle. "There is hardly any agricultural output
because of the prevailing drought conditions. We brought to the notice of
the state government about the prevailing conditions there 3 months ago.
But till today, the government has not initiated any action in this
regard," he said.

Babu Rao said there were 197 water springs in the 11 agency mandals in
Visakha with scope for water supply extension to 346 villages. But the
government has not taken care about this provision, he alleged. The
proposals of the Rs 7.5 crore [USD 1.52 million] Gravity Water Scheme were
sent to the state government by Paderu ITDA project officer in 2005. No
action was taken on this too. The CPM would conduct ganji-ambali kendras
[community outreach meeting at village level. - Mod.MHJ] in the anthrax
affected Karlapodur, Mebha villages of Munchingput mandal from 11 May
[2009], the MP said.

--
communicated by:
ProMED-mail rapporteur Susan Baekeland

[We try to avoid posting political statements but it seems from MP Babu
Rao's "demands" that there has been an ongoing anthrax problem in Visakha
with significant livestock deaths and associated human cases, which has
been affected by levels of health and veterinary staffing and support in
the area. Regular annual vaccination of livestock can prevent livestock
deaths with minimal cost and maximum efficacy. Informed clarification by
our Indian members in Andhra Pradesh would be welcome.

Map of India:
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>
For Andhra Pradesh:
<http://www.mapsofindia.com/maps/andhrap ... ysical.htm> and
<http://www.mapsofindia.com/maps/andhrap ... strict.htm>
For Visakhapatnam:
<http://www.mapsofindia.com/maps/andhrap ... patnam.htm>
and
<http://healthmap.org/r/007n>. - Mod.MHJ]

UNDIAGNOSED ILLNESS - NEPAL: (ROLPA) REQUEST FOR INFORMATION
************************************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 12 May 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009- ... 361962.htm>


Over 60 people ill due to "mysterious" disease in mid-western Nepal
-------------------------------------------------------------------
More than 60 people at Jaimakashala in Rolpa district in mid-western Nepal
have been taken ill due to a mysterious disease that spread in the village
3 days ago.

According to Tuesday's [12 May 2009] eKantipur.com, most of the victims are
women, elderly, and children. An official at the District Public Health
Office informed that a team of health workers has been dispatched to the
disease-hit area, some 270 km (168 mi) west of Kathmandu, to take stock of
the situation and to offer treatment to the sick.

All patients have similar symptoms of acute headache, fever, and vomiting
up blood, a health worker said. He said that the disease may have been
caused due to consumption of polluted water and inadequate sanitation.

With no health worker at the local health post, the patients could not
receive treatment on time.

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

[Unless the described hematemesis (vomiting up blood) was associated with
intense vomiting leading to esophageal tears and subsequent bleeding,
hematemesis is not usually associated with the variety of microorganisms
that are usually the culprits in waterborne gastroenteritis outbreaks. The
mention of acute headache and fever as a predominant finding does have one
wonder about malaria and the encephalitides such as Japanese encephalitis,
although the possibility of entrance of one of the hemorrhagic fevers such
as CCHF (Crimean-Congo hemorrhagic fever) or one of the old world
hantaviruses is there as well. ProMED-mail would greatly appreciate
receiving more information from knowledgeable sources in the region.

For a map of Rolpa district in the Rapti Zone of Nepal, see
<http://en.wikipedia.org/wiki/Rolpa>. For a larger map of Nepal to
juxtapose the map of Rolpa, please see
<http://www.lib.utexas.edu/maps/middle_e ... _pol90.jpg>. And
for the interactive HealthMap/ProMED-mail map of Rolpa Nepal, with links to
other recent outbreaks in Nepal and surrounding regions, see
<http://healthmap.org/r/00bS>. - Mod.MPP]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY: (SAMSUN)
**************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 14 May 2009
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... &bolum=100>


Two individuals undergoing treatment for Crimean Congo hemorrhagic fever
(CCHF) at the 19 Mayzs University Medical Faculty Hospital in the Black Sea
province of Samsun died on Sunday [10 May 2009], the Anatolia news agency
reported. One of the CCHF victims was an 82 year old woman and the other
was a 55 year old man.

Mostly infecting animals, CCHF is a viral disease transmitted by ticks. The
virus can infect sheep and cattle in addition to humans and is fatal if not
detected and treated early. It has been responsible for the deaths of more
people in Turkey each year since the 1st recorded infection in Turkey in
2002. Last year [2008] 55 people died in Turkey from CCHF, bringing the
total number of CCHF deaths in the country over the past 6 years to 147,
according to research conducted by the Turkish Healthcare Workers' Union.

--
communicated by:
ProMED-mail rapporteur A-Lan Banks

[These 2 deaths appear to be the 1st fatal cases of CCHF reported in Turkey
this year (2009). The number of cases can be expected to increase from now
on with the onset of warmer weather and proliferation of the tick vector.

The HealthMap/ProMED-mail interactive map of Turkey is available at
<http://healthmap.org/r/00bZ>, and a map showing the location of the
province of Samsun can be accessed at
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]

MUSHROOM POISONING, FATAL - KYRGYZSTAN
**************************************
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: 11 May 2009
Source: Information portal stan, [Trans. By Mod.NR]
<http://www.stan.tv/news/10261>


There have been 2 cases of mushroom poisoning registered in Kyrgyzstan. One
of them was a baby who died as a result of severe intoxication. In
addition, 3 more children are in the intensive care unit. Another case was
a family of 2 children and a mother. The mother is in coma; one boy is
dead, while the other one is improving.

The family was gathering mushrooms they were thought were the edible
version of the blue-leg mushroom (_Lepista saeva_) which doctors think had
mutated into a very poisonous type. Several more people hospitalized with
poisoning said that they were gathering mushrooms near the airport where
the discharge of highly toxic gasoline may have caused a less than
favorable environment for mushrooms.

Altogether more than 10 people are suffering from the poisoning and doctors
are thinking this is only the beginning of an outbreak. There was evidence
the poisonous mushrooms have appeared in the marketplace. The Ministry of
Health is working on prohibiting sale of any wild growing mushrooms.

--
communicated by:
ProMED-mail Russian correspondant BA

[Beginning today it is forbidden in Kyrgyzstan to sell any mushrooms
according to Kyrgyzstan (KG) sanitary surveillance center. The regulation
is a result of frequent poisoning cases taking place the last days. Such
poisonings in KG were happening during previous years, as well. In 2005
there were 36 people hospitalized in Chuysk due to poisoning with wild
mushrooms. 3 children died during this outbreak while in 2006 there were 37
poisoned and 4 died. - Corr.BA

The blue-leg mushroom can be seen at
<http://www.rogersmushrooms.com/gallery/ ... d~6320.asp> and
<http://cabd0.tripod.com/sitebuildercont ... ieldb1.jpg>.
It is apparently more beautiful than tasty but nevertheless, there are
numerous recipes that treasure the flavor of this edible fungus. Many
mushrooms are toxic and many toxic varieties closely resemble the non-toxic
version. Collecting mushrooms can prove dangerous to deadly should the
wrong variety of mushroom be consumed. - Mod.TG]

PNEUMONIA DEATHS - NEPAL: (GORKHA), REQUEST FOR INFORMATION
***********************************************
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: 8 May 2009
Source: The Himalayan Times via Masta.org [edited]
<http://www.thehimalayantimes.com/index.php>


The mystery disease that has triggered panic in remote Gumda VDC
[village development committee area] for the past 2 weeks has been
identified. Health Minister Giriraj Mani Pokhrel arrived here on
Thursday [7 May 2009] along with a team of officials. He announced
that post-viral pneumonia led to the deaths of 13 villagers.

Dr Gunaraj Lohani, chief district health and medical superintendent,
said that so far, around 100 patients had been treated for the
outbreak. A majority of the patients are children.

Gumda VDC is located around 75 km from district headquarters. The
disease is spreading to adjoining Uhiya VDC as well.

--
Communicated by:
Michelle Sellors <michelles@masta.org>

[The above newswire report was sent to us in response to the earlier
posting on an outbreak of undiagnosed illness with hemorrhagic
manifestations reported in Rolpa district in Nepal. From the
description of the above described outbreak in Ghorka district (which
is in the Western Region of Nepal, whereas Rolpa district is in the
mid-western region of Nepal <http://ncthakur.itgo.com/map04.htm>),
these do not appear to be related.

The mention of "post viral pneumonia" could refer to primary viral
pneumonia or secondary bacterial pneumonia following a viral
syndrome. Clarification of this diagnosis would be
appreciated. Given the heightened awareness of respiratory illnesses
worldwide and concerns for continued spread of novel influenza
strains, more information on the outbreak in Ghorka district with
laboratory results, if available, would be greatly appreciated. - Mod.MPP]

Indien - Japanische Enzephalitis (JE)
18.05.2009

Im Mai beginnt in Indien die Übertragungssaison für diese durch nachtaktive Stechmücken übertragene Viruskrankheit, die zu Hirnentzündungen führen kann. Sie endet im Oktober und hat ihren Gipfel erfahrungsgemäß im August-September. Aus dem Bundesstaat Uttar Pradesh (N) werden bereits die ersten Verdachtsfälle gemeldet. Risiko-Reisende sollten geimpft sein. / Quelle: crm

HEMORRHAGIC FEVER WITH RENAL SYNDROME - TURKEY (04): (BARTIN, 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: Thu 21 May 2009
Source: Eurosurveillance edition 2009; 14(20) [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19214>


[This report in Eurosurveillance confirms the earlier 20 Apr 2009
ProMED-mail post (archive no. 20090418.1476) of 12 cases of suspected
hemorrhagic fever with renal syndrome in Turkey. - Mod.TY]

An outbreak caused by hantavirus in the Black Sea region of Turkey,
January-May 2009
----------------------------------------------------------------------
[Authors: M Ertek on behalf of the Refik Saydam National Public
Health Agency, Ankara, Turkey; T Buzgan on behalf of the Ministry of
Health, Ankara, Turkey]

Abstract
--------
We present a preliminary report of 12 laboratory-confirmed cases of
haemorrhagic fever with renal syndrome (HFRS) in Turkey, diagnosed
between January and May 2009 according to the clinical symptoms and
serological confirmation. Studies are still ongoing to better
understand the dynamics of the reservoir population as well as the
epidemiological characteristics and risk factors among humans.

Conclusion
----------
We confirmed 12 cases of HFRS reported in Turkey in 2009 using IFA
[immunofluorescent assay] and immunoblotting techniques. Our results
were serologically positive for Puumala subtype, but it should be
considered that among the subtypes of hantavirus, cross-reactivity is
frequently seen serologically. In addition, the generic hantavirus
RT-PCR was not positive; hence, sequence analyses have not been
performed. The reason for this might be that viraemia is very short
in hantavirus infections. Another limitation of the study was that
neutralisation tests have not been performed.

We found a 5.2 percent seroprevalence of hantavirus antibodies
amongst the healthy but at-risk population of one of the affected
provinces. These preliminary data show that the virus is circulating
in the area. Until now, asymptomatic or mild infections with
non-specific symptoms may have been the cause for the underestimation
of the real number of hantavirus infections. It is necessary to
finalise the statistical analysis of the seroepidemiological study to
plan further studies and surveys in Turkey. The plan is to inventory
the local rodent species, identify circulating hantavirus serotypes
in rodents, perform molecular characterisation of strains isolated
from rodents and humans and compare them with strains circulating in
the neighbouring countries, and investigate transmission mechanisms
and the time and space-distribution of human hantavirus infections.

Hantavirus causes a significant number of human illnesses, making it
a global public health threat. The presence of the virus in Turkey is
not surprising because it is circulating in the neighbouring
countries. In the affected area, a comprehensive preventive strategy
against hantavirus infection, including health education and
promotion activities, rodent control and surveillance, has been
implemented. For example, guidelines were distributed for public on
rodent proofing and trapping in and around homes, and the careful
disposal of dead rodents.

Reference
---------
Ertek M and Buzgan T 21 May 2009: An outbreak caused by hantavirus in
the Black Sea region of Turkey, January-May 2009. Eurosurveillance, 14 (20).

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

[The authors indicated that the IFA and immunoblotting techniques
they used indicated that the samples tested were serologically
positive for Puumala virus, but that cross-reactivity with other
hantaviruses could not be ruled out. In his 20 Apr 2009 communication
with ProMED-mail (archive no. 20090420.1495), Prof Heikki Henttonen
pointed out that "Dobrava virus in _Apodeus 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. _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..."

The report above includes a map of Turkey indicating the area where
human cases of hantavirus infection were reported in January-May
2009; it can be seen at
<http://www.eurosurveillance.org/images/ ... s_Fig1.jpg>.

A HealthMap/ProMED-mail interactive map of Turkey can be accessed at
<http://healthmap.org/r/00cM>. - Mod.TY]

LEISHMANIASIS - IRAQ (MAYSAN)
******************************
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: 21 May 2009
Source: Alertnet citing IRIN [edited]
<http://www.alertnet.org/thenews/newsdes ... 1e0598.htm>


Nearly 200 cases of leishmaniasis have been registered in the
southern province of Missan [Maysan], about 350 km south of Baghdad,
a local health official said on 19 May 2009. "So far, we have
registered 190 cases of leishmaniasis in different parts of the
province, both in urban and rural areas and among different age
groups," Zamil Shia, the provincial health chief, told IRIN. Shia
said the epidemic was manageable at present and teams were monitoring
affected areas.

Leishmaniasis is also known as Baghdad boil, oriental sore, Aleppo
button, Jericho boil and Delhi boil. In its most unpleasant form --
visceral leishmaniasis -- organ failure and death can result. It is
transmitted by the bite of the female sandfly. Dogs and other animals
can act as a source of infection to humans. Rodents, especially
certain species of rodent, are considered the main carriers.

Shia said people in affected areas tended to sleep in the open and in
places with poor sanitation.

According to the World Health Organization, the 20 or so infective
species or subspecies of the leishmaniasis parasite cause a range of
symptoms like fever, malaise, weight loss and anaemia, as well as --
in its visceral form -- swelling of the spleen, liver and lymph
nodes. Cutaneous leishmaniasis -- the most common form -- causes
1-200 simple skin lesions which self-heal within a few months but
which leave unsightly scars. The disease's incubation period is up to
6 months, so doctors say thousands could have the disease without knowing it.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Leishmaniasis is widespread in Iraq, and ProMED reported
leishmaniasis from the southern province in May 2008 (see below).
Leishmania is transmitted by sandflies, and small rodents serve as
reservoirs. Control measures are vector and rodent control. Please
refer to the WHO statement concerning visceral leishmaniasis in Iraq,
published in ProMED-mail (Leishmaniasis - Iraq: comments 20030602.1348).

Map of Maysan province: <http://healthmap.org/r/00cP>. - Mod.EP]

Türkei - Haemorrhagisches Fieber mit renalem Syndrom (HFRS)
25.05.2009

Seit Anfang des Jahres wurden in den Provinzen Bartin und Zonguldak 12 Fälle von Hantaviruserkrankungen nachgewiesen. Hantaviren sind weltweit verbreitet. Verschiedene Virustypen haben spezifische Nagetiere als Reservoire und führen beim Menschen zu unterschiedlichen Verläufen. Hantaviren werden von infizierten Nagetieren über Urin, Speichel und Fäzes ausgeschieden. Die Übertragung auf den Menschen erfolgt über die Inhalation von virushaltigen Aerosolen, durch den Kontakt mit kontaminiertem Staub und selten auch durch Bisse. / Quelle: crm

DENGUE/DHF UPDATE 2009 (21)
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
India (Kerala)
Date: Mon 25 May 2009
Source: Kerala Online [edited]
<http://keralaonline.com/news/3-dengue-c ... 46634.html>


On Sunday [24 May 2009], 3 cases of dengue fever have been reported from
the Vamanapuram area, leading the Health Department to initiate measures to
seek out and destroy ?"at source"? the mosquito that spreads the disease.

Officials are trying to ascertain whether the 3 cases are an indication of
a widespread outbreak of the disease in the area. District medical officer
N Sreedhar said the department had geared up to tackle the situation at
Vamanapuram.

A number of cases of fever, particularly in children, were reported from
the Neyyattinkara Taluk Hospital, Dr Sreedhar said. While this may be due
to the sudden change in the weather, a team from the Health Department
would investigate these incidents, Dr Sreedhar said.

--
communicated by:
ProMED-mail rapporteur Brent Barrett

[Maps showing the location of Kerala state in southern India can be
accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg> and
the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/00d3>.
- Mod.TY]

HEPATITIS B VIRUS - INDIA (11): (GUJARAT)
*****************************************
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: Fri 29 May 2009
Source: The Times of India (TNN) [edited]
<http://timesofindia.indiatimes.com/Citi ... 590937.cms>


Hepatitis B outbreak: government yet to produce report
------------------------------------------------------
The outbreak of hepatitis B, which claimed the lives of 92 people, is
believed to be Gujarat's worst epidemic since the plague, which hit Surat
in 1994.

Most of the deaths in Modasa happened in the age group of 15 to 45 years.
While during the Surat plague, 2 investigation committees -- one by state
and another by Centre [government] -- were formed when 52 people died of
the disease. The state government has yet to make public the cause and
spread of the disease and also investigate whether few doctors' medical
malpractices led to the outbreak.

A paper by deputy director (epidemic) in the state health department claims
that the hepatitis B virus detected in Modasa was noticed in the 2001 focal
outbreak of hepatitis B in Mehsana. Further details on the virus have been
wilfully avoided. This, the officer claims, is a certain ayw subtype, which
became lethal this year [2009].

However, the virus this time claimed lives in 3 talukas Modasa, Idar, and
Meghraj in Sabarkantha district, which is believed to be the epicentre of
the outbreak. A total of 495 persons were admitted to government public
health centres in the 3 talukas and Ahmedabad Civil Hospital for treatment.

Till now, the disease has shown presence in Himmatnagar, Bayad, Bhiloda,
Prantij, Balasinor, Vijaynagar, and Khedbrahma. "Like the Surat plague, the
state government should bring out a white paper on hepatitis B in the
state. It is one of the worst epidemics to have struck Gujarat and people
have the right to know," says IIM-A [Indian Institute of
Management-Ahmedabad] professor Dileep Mavlankar.

[byline: Paul John]

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

[This press report seems to indicate that the cause of the serious outbreak
of hepatitis B virus infection in Gujarat state earlier in the year (2009),
at the time attributed to medical malpractice, remains unresolved. Further
information from any informed source would be welcomed.

The HealthMap/ProMED-mail interactive map of India can be used to locate
the state of Gujarat and the district of Modasa
<http://healthmap.org/r/00dA>. - Mod.CP]