Wüstenschiff

RABIES, HUMAN, ANIMALS - INDIA: (HIMACHAL PRADESH), SUSPECTED,
REQUEST FOR INFORMATION
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Date: Thu 19 Nov 2009
Source: Thaindian.com [edited]
<http://www.thaindian.com/newsportal/hea ... 76795.html>


An entire hamlet near here is eerily emptying out day by day due to a
rabies scare. Villagers say they cannot take any chances as 2 dozen
farm animals have died, and no medical assistance has reached them in 10 days.

Bara Bhangal, which has the state's remotest polling station, is
located in Kangra district [see map at <http://healthmap.org/r/00-H>]
at an altitude of over 2800 metres and is not accessible by road.
While officials are yet to confirm whether the disease is spreading
there, the village of 400 people is running scared and migrating
despite snow-laden pathways.

"More than 12 cattle and an equal number of sheep have died due to
rabies. A large number of animals have symptoms of the disease.
Despite repeated requests to the administration, no veterinarian team
has been deputed to the village so far," said Kanchana Devi, head of
the gram panchayat of the village.

She along with other villagers have migrated to Bir in Baijnath
subdistrict, near Palampur town, some 250 km from the state capital Shimla.

"After trudging more than 75 km, we managed to reach Bir in 3 days.
Most of the areas are under a thick blanket of snow (following heavy
snowfall)," she said.

According to her, 4 people who are still stuck in the village have
reported symptoms of the disease.

Sheep and cattle rearing is the main occupation of the people, who are nomads.

Akshay Jasrotia, a member of the Kangra Zila Parishad, who is taking
up their cause with the administration, said the situation is quite
grim. "Since the satellite telephone installed in the village is not
working, it's difficult to get the exact information. The people who
have migrated say the situation is quite grim there. We are
requesting the government to airlift a team of veterinarians and
doctors to the village to treat both animals and humans," he said.

He said since most trekking routes leading to Bara Bhangal are out of
bounds due to snow, the helicopter is the only mode of transportation
to reach there. Bara Bhangal is also accessible through the Thamsar
Pass, located at an attitude of 4700 metres.

Kangra Additional District Magistrate Sandeep Kumar told IANS that a
team of doctors was sent to the village last week, but it returned
mid-way due to harsh climatic conditions.

"A 2nd team was sent from another route in Chamba district 2 days
ago. But so far, we have not been able to establish contact with
them. If the team again fails to reach, then we will arrange a
helicopter for them," he said.

On the spread of rabies, he said: "From initial reports, it seems
that animals had died due to rabies. However, there is no official
confirmation regarding the spread of the disease in humans. So far,
80 people have migrated to Bir. But this is their annual practice. We
have vaccinated both the humans and the livestock. We have not
noticed any symptoms of rabies," he said.

Bara Bhangal is part of the Dhauladhar Wildlife Sanctuary, which is
spread over 944 sq km at an altitude above 3000 metres.

[Byline: Vishal Gulati]

--
Communicated by:
Merritt Clifton
Editor, Animal People
Clinton, WA 98236
<anmlpepl@whidbey.com>

[The above newswire is confused and confusing. Animals, such as sheep
and cattle, which may have been bitten by rabid animals such as dogs
or fauna (foxes?), will show the typical rabies clinical signs at
least 10 days to several weeks after their exposure. Since the
clinical signs observed are not included in the report, it is
difficult to check the validity of the published diagnosis.

The description of the disease in humans is rather strange. People
who remained in the village are not likely to get infected just
because of their location. Rabies is not transmitted by aerosols or
casual contact; a bite, or at least close contact of infected
material (e.g. saliva) with non-intact skin are necessary to infect.
Information on the disease in animals and humans is requested. - Mod.AS]

DENGUE/DHF UPDATE 2009 ( 48 )
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*****

India (Delhi)
Date: Sun 22 Nov 2009
Source: Prokerala.com, Indo Asian News Service (IANS) report [edited]
<http://www.prokerala.com/news/articles/a94878.html>


With 7 new cases of dengue reported in the national capital Saturday
and Sunday [21, 22 Nov 2009], the total number of people infected
with the vector-borne disease has touched 999, a health official
said. "7 new cases were recorded within last 24 hours and with that
dengue cases in Delhi have reached 999," state nodal officer for
dengue cases, Debashish Bhattacharya, told IANS.

According to the Delhi Health Department, the dengue cases are likely
to come down within next 7-10 days with the fall in temperature.

So far, 2 dengue deaths have been reported in the capital -- one of a
9-year-old and another of a 15-year-old boy.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[A HealthMap/ProMED-mail interactive map of India showing the
location of Delhi can be accessed at
<http://healthmap.org/r/00-Z>. - Mod.TY]

Indien - Chikungunya (CHIC), Dengue (DEN)
23.11.2009

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. Chikungunya-Erkrankungen wurden dieses Jahr insbesondere aus dem Südwesten des Landes gemeldet. Die Dengue-Fallzahlen in der Hauptstadt Neu Delhi sind bis Mitte November auf 661 Erkrankungen angestiegen, in der letzten Woche wurden 45 Neuinfektionen gemeldet. Schutz vor tagaktiven Überträgermücken (Aedes-Arten) beachten. / crm

JAPANESE ENCEPHALITIS - INDIA (16): (UTTAR PRADESH, BIHAR)
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Date: Wed 25 Nov 2009
Source: Sify News, Indo Asian News Service (IANS) report [edited]
<http://sify.com/news/Japanese-encephali ... giagd.html>


The viral infection Japanese encephalitis has claimed more than 500
lives in Uttar Pradesh and Bihar so far this year [2009], with
children facing the brunt of the disease.

According to a union health ministry document, Uttar Pradesh is the
worst affected with 23 of its districts having been declared endemic.
"23 districts of eastern Uttar Pradesh are endemic to Japanese
encephalitis," the document said, adding that till 16 Nov 2009, 476
people have died due to the disease in the state.

In Bihar, the number of deaths is at least 30 this year [2009]. Over
140 are still undergoing treatment for this viral disease in the
state.

Domestic pigs and wild birds are reservoirs of the Japanese
encephalitis virus. The virus is transmitted by infective bites of
female mosquitoes, mainly belonging to _Culex tritaeniorhynchus_,
_Culex vishnui_, and the _Culex pseudovishnui_ group.

The disease gets its name as the virus was first detected in Japan.

The ministry document said that 7 districts in Gorakhpur and Basti
division in Uttar Pradesh -- Gorakhpur, Kushinagar, Deoria,
Maharajganj, Sant Kabir Nagar, Basti, and Siddarth Nagar --
contribute over 90 percent of the Japanese encephalitis deaths in the
state.

Official statistics said that last year [2008], 537 people lost their
lives due to the disease in the state. The ministry also believes
that it is children in the age bracket of 1-15 years who are facing
the maximum difficulty due to the disease.

To curb the spread, the health ministry claims that it has vaccinated
83 percent of the children belonging to the high risk group in 21 of
the 23 endemic districts of Uttar Pradesh.

One of the major problems facing Uttar Pradesh is wastage of vaccine
due to its over-exposure to heat. This year [2009] alone, the state
refused to use over a million doses of such vaccines due to the same
problem.

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

[Northeastern India, and especially Uttar Pradesh state, has had a
difficult time with Japanese encephalitis virus (JEV) infections in
2009. Interestingly, this report does not mention the virologically
undiagnosed acute encephalitis syndrome as have previous reports from
Uttar Pradesh over the past 3 months. The comments on failure to
maintain a cold chain for the vaccine are troublesome. Loss of over a
million doses of JEV vaccine is unfortunate, indeed, given the
ongoing outbreak in the state. No mention of sequelae in survivors
has been given in any JEV reports from India this year (2009).

A map showing the location of Indian states, including Uttar Pradesh,
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/00Hk>. - Mod.TY]

MALARIA (AUTOCHTHONOUS) - GEORGIA: REQUEST FOR INFORMATION
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Date: 26 Nov 2009
Source: Georgia Online [transl.ATS, edited]
<http://www.apsny.ge/2009/other/1259270153.php>


6 tropical malaria case have been registered in Georgia
-------------------------------------------------------
The Institute of Parasitology announced that 6
tropical malaria cases have been registered in
[the Republic of] Georgia; however there was no
information on locations. The representative of
the Institute carried out training sessions for
the physicians of Gurjaani. She emphasized that
tropical malaria manifests with flu-like symptoms
and high fever.

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

[According to WHO the situation for malaria in
Georgia started to deteriorate beginning from mid
1990s. The peak of the morbidity occurred in
2002, when 473 local cases were registered. The
incidence of malaria between 1998 and 2002
increased 30 fold. The situation improved in
2007, when only 24 cases registered after
preventive measure were taken. Currently the
highest risk of malaria exists in the neighboring
regions with Armenia, Azerbaijan and also in the
lowlands of Kolkhida. - Corr.BA]

[The term "tropical malaria" implies that the
cases are due to _Plasmodium falciparum_.
Transmission of _P.falciparum_ requires an
average 24 hour temperature of 20 deg C [68 deg
F] and transmission in Georgia is therefore not
possible in the winter.

[...]

ProMED will be happy to publish further information on the cases. - Mod.EP]

[The interactive HealthMap/ProMED map of Georgia is available at:
<http://healthmap.org/r/00*t> - CopyEd.EJP]

MALARIA, AUTOCHTHONOUS - GEORGIA (02): BACKGROUND
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Date: Sat 28 Nov 2009
Source: Gideon Online [edited]
<http://www.gideononline.com/>


Although autochthonous cases continue to be reported, malaria rates
in Georgia and surrounding countries have decreased considerably
since 1999.

With the exception of Russia, all of the countries which border
Georgia had reported higher rates in recent years. See graph:
<http://www.gideononline.com/blog/wp/wp- ... orgia1.PNG>.
(Note: Gideon contains a menu-driven tool which allows users to
display any combination from among 36 000 base graphs).

--
Communicated by:
Steve Berger
Geographic Medicine
Tel Aviv Medical Center
<mberger@post.tau.ac.il>

[ProMED thanks Steve Berger for proving data comparing the situation
in Georgia with neighboring countries. - Mod.EP]

Indien - Chikungunya (CHIC), Dengue (DEN)
30.11.2009

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. Chikungunya-Erkrankungen wurden dieses Jahr insbesondere aus dem Südwesten des Landes gemeldet. DEN: Die Dengue-Fallzahlen in der Hauptstadt Neu Delhi sind bis Mitte November auf 999 Erkrankungen angestiegen, in der letzten Woche wurden 45 Neuinfektionen gemeldet, es gab 2 Todesfälle. Mit Beginn der kühleren Jahreszeit, sollten die Fallzahlen ab Dezember wieder sinken. Schutz vor tagaktiven Überträgermücken (Aedes-Arten) beachten. / Quelle: crm

JAPANESE ENCEPHALITIS & OTHER - INDIA (17): (UTTAR PRADESH)
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[It is time to change the name of this thread. Since late August 2009
Uttar Pradesh has been reporting acute encephalitis of unidentified
etiology, suspected to include cases of Japanese encephalitis. One
might have expected a definitve lab result from the Mational Institute
of Virology in Pune by now. We wonder if they have excluded Nipah
virus; south UP appears to be just within the range of _Pteropus_, the
fruit bat vector. - Mod.JW]


Date: Tue 1 Dec 2009
Source: The Hindu, Press Trust of India (PTI) report [edited]
<http://beta.thehindu.com/news/states/ot ... e57918.ece>


Another 3 children succumbed to encephalitis [in Gorakhpur, Uttar
Pradesh], taking the toll of the viral disease in eastern Uttar
Pradesh districts to 545 so far this year [2009].

Additional director, health, LP Rawat said that the dead included 2
from Kushinagar and one from Maharajganj. The deaths took place over
the last 2 days. Some 11 persons suffering from the disease[s] have
been admitted to district hospitals.

Out of the 3088 patients admitted to various hospitals with Japanese
encephalitis and acute encephalitis syndrome, 545 have died. Japanese
encephalitis is transmitted by mosquitoes and causes inflammation of
the membranes around the brain.

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

[Japanese encephalitis virus (JEV) and the acute encephalitis syndrome
of unspecified etiology, perhaps enteroviruses, continue to claim
victims in Uttar Pradesh. No mention was made in this report about
ongoing vaccination for JEV.

A map showing the location of Indian states, including Uttar Pradesh,
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/00Hk>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (03): (UTTAR PRADESH)
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Date: Sun 13 Dec 2009
Source: DNA, Press Trust of India (PTI) report [edited]
<http://www.dnaindia.com/india/report_on ... 60_1323162>


The toll due to different types of encephalitis has mounted to 560 this
year [2009] in eastern Uttar Pradesh as one more child succumbed to the
brain fever, an official said today [13 Dec 2009]. Additional director
(health) LP Rawat said 5 new patients with symptoms of acute encephalitis
syndrome and Japanese encephalitis have been admitted to BRD Medical
College Hospital and government hospitals of the adjoining districts. "5
deaths have occurred during the past one week," he said, adding that a
child patient from Bihar died last night [12 Dec 2009].

He said 63 patients are undergoing treatment at BRD Medical College while 5
are being treated at other government hospitals of the region.

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

[The number of encephalitis cases has increased in this area by 8 since the
5 Dec 2009 report (see ProMED-mail archive no. 20091205.4153). Other than
Japanese encephalitis virus, these reports continue to provide no
information about the etiological agent (presumably a virus) responsible
for the acute encephalitis syndrome mentioned, that may be due to
enteroviruses or Nipah virus.

A map showing the location of Indian states, including Uttar Pradesh, 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/00Hk>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (04): (UTTAR PRADESH)
*************************************************************
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Date: Tue 22 Dec 2009
Source: Yahoo News, Press Trust of India (PTI) report [edited]
<http://in.news.yahoo.com/20/20091222/14 ... up-to.html>


With the death of one more person due to encephalitis in Uttar
Pradesh today [22 Dec 2009], the statewide toll due to the disease
rose to 567, officials said. The patient died at BRD Medical College
Hospital [in Gorakhpur], they said.

As many as 52 encephalitis patients are undergoing treatment at BRD
hospital, while 2 are being treated at other government hospitals of
the region, they said. "However, the cases of Japanese encephalitis,
caused due to mosquito bites, have substantially dropped due to fall
in temperature resulting in low mosquito density," additional
director of health LP Rawat said.

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

[The number of encephalitis cases has increased by 7 since the 14 Dec
2009 report (see ProMED archive no. 20091214.4241). There is no
information indicating how many of these recent cases are due to
Japanese encephalitis virus an how many to another etiological agent,
perhaps enteroviruses or Nipah virus.

A map showing the location of Indian states, including Uttar Pradesh,
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/00Hk>. - Mod.TY]

Indien - Malaria
11.01.2010

Aus Mizoram, Assam (NO) werden erhöhte Malariafallzahlen gemeldet. Im Zeitraum Januar - Oktober 2009 wurden mehr als 8.000 Erkrankungen und 119 Todesfälle registriert. Im Nordosten Indiens besteht seit Jahren landesweit das höchste Malariarisiko. Konsequente Expositionsprophylaxe und Mitnahme eines Standby-Mittels werden empfohlen. Bei erhöhter Exposition, insbesondere während der Regenzeit kann eine regelmäßige Chemoprophylaxe sinnvoll sein. / Quelle: crm

TYPHOID FEVER UPDATE 2010 (01): TOURISTS, NEPAL
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Date: Thu 6 Jan 2010
Source: News agency Cursor [trans. Mod.ATS, edited]
<http://cursorinfo.co.il/news/novosti/20 ... 6/pokhara/>


Israeli travelers - Russian Far East ex Nepal

40 Israeli travelers who were traveling in the [Russian] Far East
became ill with enteric fever. This news came from the news agency NRG
on 6 Jan 2009. The source of the outbreak probably was the canteen at
the Jewish Center Beit-Khabat in the city of Pokhara in Nepal. All the
travelers had been there before going to the [Russian] Far East. The
chairman of epidemiological control of tropical diseases in Israel,
Professor Eli Schwarz, mentioned that none of these cases became
infected by enteric fever from exposures within Israel. All the
patients had been hospitalized, properly treated and then returned to
Israel. "There is no threat for the spread of enteric fever within
Israel," the professor said.

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

[Where in Asia the travelers were hospitalized and treated is not
stated in the posting.

Enteric fever (caused by _Salmonella enterica_ serotypes Typhi or
Paratyphi serogroups A-C) has a totally different presentation than
the more common kinds of salmonellosis. Vomiting and diarrhea are
typically absent; indeed, constipation is frequently reported. As it
is a systemic illness, blood cultures are at least as likely to be
positive as stool in enteric fever, particularly early in the course
of the infection, and bone marrow cultures may be the most sensitive.

Initial symptoms typically include fever, anorexia, lethargy, malaise,
dull continuous headache, non-productive cough, vague abdominal pain,
and constipation. Despite the often high fever, the pulse is often
only slightly elevated. During the 2nd week of the illness, there is
protracted fever and mental dullness [classically called coma vigil -
Mod.LL]. Diarrhea may develop, but usually does not. Many patients
develop hepatosplenomegaly. After the 1st week or so, many cases
develop a maculopapular rash on the upper abdomen. These lesions
("rose spots") are about 2 cm in diameter and blanch on pressure. They
persist for 2-4 days and may come and go. Mild and atypical infections
are common.

As many as 10 percent of untreated infections may be fatal, and
relapses are not uncommon. The illnesses caused by Paratyphoid
serotypes are generally milder. The specific organism or organisms
related to this report are not stated.

The development of enteric fever in Israeli travelers going to Nepal
is well known (1) and was reported to be higher than in other
travelers, possibly due to the low vaccination rate for typhoid in the
Israeli travelers. More recently, there was a significant increase in
the percentage of cases related to Paratyphoid, which is not a
vaccine-preventable infection (2,3). Of note, the Paratyphoid serotype
cases were observed not to be any milder than the typhoid serotype
cases.

1. Schwartz E, Shlim DR: Enteric fever among Israeli travelers in
Nepal: the need for typhoid vaccination. Isr J Med Sci. 1990;26:
325-327.
2. Meltzer E, Yossepowitch O, Sadik C, Dan M, Schwartz E: Epidemiology
and clinical aspects of enteric fever in Israel. Am J Trop Med Hyg.
2006;74: 540-545.
3. Meltzer E, Sadik C, Schwartz E: Enteric fever in Israeli travelers:
a nationwide study. J Travel Med. 2005;12: 275-281.

Pokhara is located in the Kaski District in the Western Region of
Nepal and can be found on a map at:
<http://ncthakur.itgo.com/map04.htm>. - Mod.LL]

TYPHOID FEVER UPDATE 2010 (02): TOURISTS, NEPAL
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[1]
Date: Wed 13 Jan 2010
From: Buddha Basnyat <rishibas@wlink.com.np>


I would like to comment on the post written on Thu 6 Jan 2010 (Typhoid
fever update 2010 (01): tourists, Nepal).

First of all, without the results of proper investigation, testing and
diagnosis, it may be premature to suggest that one particular Jewish
canteen in Pokhara, Nepal is the cause for this disease. Enteric fever
is rampant in Nepal, and without a thorough investigation, it may be
unfair to label one center as the source.

Secondly, I would like to comment on some of the statements made.
Constipation used to be thought as more common in enteric fever than
diarrhea. This may no longer be accepted on the basis of a large case
series, including work from South and Southeast Asia, including our
own data. A recent report from our group based on a large cohort of
over 600 culture proven patients studied in Nepal showed that diarrhea
is a common presentation in enteric fever. The same large study also
showed (contrary to what is stated in one part of the write up) that
paratyphoid is not any less aggressive than typhoid fever. In our
report and in other reports, it is becoming clear that there is an
enormous overlap between the clinical syndromes caused by typhoid and
paratyphoid fever. Paratyphoid fever should no longer be considered a
more mild form of enteric fever.

--
Dr. Buddha Basnyat
Oxford University Clinical Research Unit
Patan Hospital
Kathmandu, Nepal
<rishibas@wlink.com.np>

******
[2]
Date: Mon 11 Jan 2010
From: Henry Wilde <wildehenry@yahoo.com>


The presence of paratyphi A in Nepal, India, Indonesia and China,
representing up to 50 percent of enteric fever cases, is now well
documented and was 1st publicized as far back as 1995. We have seen
several cases of paratyphoid A enteric fever that have been evacuated
to Bangkok hospitals from Nepal who had current _S._ Typhi vaccines.
Also, it has been our impression that Israeli tourists are usually
vaccinated with Ty21 or Vi vaccines before leaving home. It would be
very interesting to know what salmonellae were identified in the
patients reported recently.

--
Henry Wilde, MD, FACP
Professor of Medicine
Division of Research Affairs
WHO-CC for Research and Training in Emerging Zoonoses
Faculty of Medicine, Chulalongkorn University
Bangkok, Thailand
<wildehenry@yahoo.com>

[ProMED thanks Drs. Basnyat and Wilde for their comments as well as
their continued interest in ProMED. - Mod.LL]

UNDIAGNOSED ILLNESS, FATAL, ADULTS - INDIA: (ASSAM) REQUEST FOR INFORMATION
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Date: Sat 23 Jan 2010
Source: The Telegraph [edited]
<http://www.telegraphindia.com/1100123/j ... 016261.jsp>


A group of 3 doctors and a few paramedical personnel equipped with
life-saving medicines and saline drips today [23 Jan 2010] moved out
of the state hospital at the block headquarters town of Lala to set
up medical camps at Kundanala and Nunai villages where an unknown
fever has claimed the lives of 5 tribals in 12 days; 4 of the dead
were women. The Reang-inhabited villages are nearly 40 km [25 miles]
from Hailakandi town.

Hailakandi Deputy Commissioner T.C. Goswami today [23 Jan 2010] said
over phone that he had instructed the joint director of health
services in the district headquarters town to arrange the despatch of
the team of doctors and paramedical staff besides consignments of
medicines to the affected places under Lala block town under
Katlicherra Assembly constituency in the district on its boundary with Mizoram.

High fever accompanied by inflammations on the body of the victims
and severe pain were the symptoms, Goswami said, adding the virus was
yet to be properly diagnosed.

The in-charge of the Lala primary hospital, Jayanta Das, denied that
the villagers had died of malaria. He said Jahidul Islam, who is
heading the team of 3 doctors, had been specially instructed to
collect blood samples of the tribals afflicted with the "mystery
disease" for proper diagnosis at Silchar Medical College and Hospital.

The 5 who had died over the past 12 days in the Reang-inhabited
villages are individuals, 32, 38, 40, 50 and 55 years of age. Except
one who belonged to Channighat village, the rest were from Kundanala,
official sources in Hailakandi town said today.

Sources said a woman was 1st treated at the civil hospital in
Hailakandi from where she was shifted to Silchar Medical College and
Hospital. She died there on 17 Jan 2010. Her ailment could not be
diagnosed at the medical college hospital as no blood culture was
conducted there.

At least 20 Reang tribals, with high fever, are battling for life in
Durgapur, Bander-cherra, Yakubnala and Lalch-erra villages near Nunai.

The president of the District Tribal Sangha, Ramendra Reang, had
demanded a mini-hospital and quick economic development in the Reang
enclaves of Lala block.

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

[Given the non-specific symptoms of these cases, it is difficult to
make a definitive diagnosis. The Deputy Commissioner T.C. Goswami is
quoted as saying that the etiologic agent is a virus. No evidence is
provided to support that general diagnosis. Since this area is
adjacent to Bangladesh and part of that broad plain, Nipah virus
might be suspected, as this virus has been a problem in Bangladesh in
recent years. Falciparum malaria and leptospirosis should be ruled
out as well, although the physician in charge of the Lala hospital
indicated that malaria was not involved. ProMED awaits further
information with interest.

An interactive map showing the location of Lala, Hailakandi, Assam
can be accessed at
<http://maps.google.com/maps?hl=en&q=MAP ... CAkQ8gEwAA>
A HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/promed/en?v=22.9,79.6,5>. - Mod.TY]
....................ty/ejp/dk

HANTAVIRUS - INDIA: (MAHARASHTRA)
*********************************
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: Wed 3 Feb 2010
Source: Mumbai Mirror [edited]
<http://www.mumbaimirror.com/article/2/2 ... sease.html>


A woman with a rare respiratory disease baffled doctors at a Chembur
hospital [Mumbai], as they had not come across the disease in their
careers. Brought in a critical condition with [a] hantavirus
[infection], she was discharged after treatment on Tuesday [2 Feb
2010], but government health departments have been alerted about the
case.

The woman, a 21-year-old resident of Govandi, was admitted to Joy
Hospital on 21 Jan [2010]. She suffered from severe abdominal pain,
vomiting, headache, rapid shallow breathing, and constipation. She had
earlier consulted a general practitioner, but as her symptoms were
similar to the flu, the disease could not be diagnosed. She then
approached a specialist, who said she needed hospitalisation.

At the hospital, investigations found her haemoglobin level was low
and she was given a blood transfusion. Only when doctors made a
special request to a private laboratory to test her blood samples for
hantavirus did they find the cause. After 7 days in the ICU and 3 days
in a ward, she was discharged on Tuesday [2 Feb 2010].

"I have never come across the disease in my 8 years of practice. This
is a very rare virus and not common in our country. Once we ruled out
any other disease, we made a special request to a laboratory to
conduct the test. After the sample tested positive, I spoke to senior
doctors, all of whom agreed that they had not come across the disease
in their careers," said Dr Vikrant Shah, senior physician and
intensivist.

Experts say 70 percent of patients infected by the virus do not
survive if it is not diagnosed in time. The woman said, "I thought it
was just fever. Doctors have told me that maintaining hygiene is the
best precaution against the disease."

"Since a rare viral disease was found in the city, we immediately
informed the BMC's [Brihanmumbai Municipal Corporation] M/west ward
health officer," said Dr Roy Patankar, director, Joy Hospital.

Experts said there was no need to worry as the disease cannot be
spread by humans. "Our laboratory is not equipped to do this test.
Generally, the virus is not found in our population," Dr Abhay
Chowdhary, director, Haffkine Institute of Research and Training.

"It is not found in the city and is a very rare virus. Though I have
headed the department of microbiology here for the last 11 years, I
have not seen a hantavirus positive patient," said Dr Priti Mehta, KEM
[King Edward Memorial] Hospital.

[Byline: Santosh Andhale]

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

[It would be of interest to know which hantavirus was the etiological
agent in this case. In 2005, 2 fatal cases of hantavirus infection in
India were reported by Dr Jan Clement (see ProMED-mail archive no.
20051105.3240), with an excellent review of hantaviruses in India. The
Clement report provided serological evidence of Puumala or a related
hantavirus infection. Other possible hantaviruses responsible for the
above case include Seoul virus, which is widely distributed in rats
(_Rattus norvegicus._) around the world, and Thailand virus (host
_Bandicota indica_), which can cause mild hemorrhagic fever with renal
syndrome and occurs in Southeast and South Asia.

The CDC has an excellent PowerPoint presentation on hantaviruses available at
<http://www.cdc.gov/ncidod/diseases/hant ... es1-12.htm>.

A map showing the location of Mumbai in Maharashtra 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/014d>. - Mod.TY]