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HANTAVIRUS - INDIA (02): (MAHARASHTRA) BACKGROUND
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Date: Thu 4 Feb 2010
From: Jan Clement <jan.clement@uzleuven.be> [edited]


There are now some scant, but several, lines of evidence for the
existence of a hantavirus in India, and of its pathogenicity for
humans. The problem is that neither the exact hantavirus species, nor
its small mammal host are known so far, and that we probably have to
do with a new, hitherto unknown hantavirus species, hence the
difficulty of pinpointing it. An additional difficulty is that medical
awareness for isolated hantavirus cases in India is only recently
growing (as admitted for the Maharashtra patient), but nevertheless it
is improbable that large outbreaks, such as occur elsewhere in the
world, would have gone unnoticed in the past.

Although exceptional for Old World hantavirus infections (wherein the
kidney is the main target organ), some of these have clear lung
involvement as well, as in the described female Maharashtra patient.
The symptoms consist of rapid-onset, non-cardiogenic acute lung edema
(ARDS) that is, a complication hitherto mainly described in the New
World as "hantavirus pulmonary syndrome" (HPS). It is a common
misconception however, often repeated in the literature, that fatal or
non-fatal lung involvement should be typical only for New World
hantavirus infections. Already in 1994 a series of 7 Belgian Puumala
virus (a European hantavirus) patients was described with an HPS-like
complication, but non-fatal (Clement J, Colson P, Mc Kenna P:
Hantavirus pulmonary syndrome in New England and Europe. N Engl J Med.
1994 Aug 25; 331(8): 545-8;
<http://content.nejm.org/cgi/content/ful ... f_ipsecsha>).

Other symptoms that are almost always present are fever, myalgiae, and
varying degrees of acute renal failure (ARF), with typical lab
anomalies, such as initial thrombocytopenia and proteinuria. It would
be interesting to see if these anomalies were also present in the
patient described here. All these symptoms and lab anomalies are
rapidly self-remitting, as was apparently the case here, but bilateral
interstitial lung edema may be so extreme as to necessitate mechanical
ventilation in an ICU. In fact, one of the 2 fatal hantavirus patients
previously described in South India developed ARF and an HPS picture
with extreme hypoxia, prompting not only dialysis for fluid removal,
but additionally, also mechanical ventilation. Despite this intensive
care treatment, the patient died in refractory shock on hospital day 7.

As indicated earlier, the 2 fatal and other cases in India showed
serologic evidence in 2 different test formats for a Puumala virus
(PUUV) (Clement J, Maes P, Muthusethupathi M, Nainan G, Van Ranst M:
First evidence of fatal hantavirus nephropathy in India, mimicking
leptospirosis. Nephrol Dial Transplant. 2006 Mar ;21(3): 826-7;
<http://ndt.oxfordjournals.org/cgi/content/full/21/3/826>).

In Europe and Russia, PUUV infections are spread by bank voles
(_Myodes glareolus_), but this rodent is absent from India, as are all
other related species of the Arvicolinae subfamily. Consequently,
[since hantaviruses are highly reservoir-host specific - Mod.JW] PUUV
cannot be expected to be endemic in India, and we had to do with
cross-reactions. In the meantime, we found similar serologic evidence
for PUUV-like infection in non-fatal hantavirus cases in Sri Lanka,
considered to be leptospirosis cases, some of which also presented
with cough or dyspnea (manuscript in preparation, and see ProMED-mail
20080606 "Leptospirosis- Sri Lanka (02): Hantavirus also suspected").
Sri Lanka is a country neighbouring India, with a fauna very similar
to it, including the total absence of rodent species of the
Arvicolinae subfamily. We applied RT-PCR on all these "PUUV-positive"
sera, including the 2 fatal cases, with primers specific for most of
the hitherto known hantaviral pathogens: PUUV, SEOV [Seoul virus],
Hantaan virus (HTNV), Dobrava virus (DOBV), and Andes virus (ANDV).
All turned out to be negative. Moreover, we also performed RT-PCR for
Thottapalayam virus (TPMV), which was equally negative. TPMV is the
only indigenous hantavirus with a documented presence in India, since
it was isolated already in 1964 from a house shrew (_Suncus murinus_)
captured in Thottapalayam, near Vellore in south India. No human TPMV
pathogenicity has been demonstrated so far, and it should be noted
that shrews are insectivores, not rodents. So far, human hantavirus
pathogenicity has been linked to rodents only.

Of all of the pathogenic hantaviruses known to date, none has a small
mammal reservoir with a spread in India or Sri-Lanka. Detecting
unknown or "new" viruses is not an easy task. Moreover, RT-PCR
negativity in clinical samples can have multiple causes, including
poor conservation characteristics of the samples or (too) late
sampling. We are now in the process of developing new tests for this
problem, including primers for RT-PCR for several other newly
discovered insectivore-borne hantaviruses. Examining acute serum
samples of the described female Maharashtra patient, if available,
with these new techniques could be very rewarding.

--
Jan Clement MD
Piet Maes PhD
Hantavirus Reference Centre
Laboratory of Clinical and Epidemiological Virology
& Rega Institute for Medical Research
University of Leuven
U.Z. Gasthuisberg, Herestraat, 49
B-300 Leuven, Belgium
<jan.clement@uzleuven.be>


[ProMED-mail thanks Drs Clement and Maes for this interesting and
thorough assessment of the hantavirus situation in India. ProMED
awaits with considerable interest further information about the
presence of new hantaviruses in India as it becomes available.

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]

CHIKUNGUNYA AND DENGUE - INDIA: (TAMIL NADU) CONFIRMED
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Date: Fri 12 Feb 2010
Source: Expressbuzz [edited]
<http://www.expressbuzz.com/edition/stor ... 8nZDGQwwM=>


The mystery behind the unidentified fever that had baffled the Tamil
Nadu Health Department for some time now, has been cracked with the
Centre's report stating that it is nothing but a 'mixed fever' --
chikungunya and dengue [viruses] -- spread by mosquitoes.

There was no mystery behind the fever, health secretary VK Subburaj
said, adding that its spread could be checked if the mosquito menace
was controlled. He also attributed the disease's spread to adverse
weather conditions in the state.

Two teams from the National Institute of Communicable Diseases, New
Delhi, and the National Institute of Virology, Pune, were in Tamil
Nadu last month [January 2010] to determine the cause of the fever
that has affected hundreds across the State. They took 80 samples
from patients in Madurai and Tirunelveli for analysis.

The Centre's report is believed to state that surroundings need to be
kept clean.

[Byline: Nalini Ravichandran]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Chikungunya virus infections were suspected in an outbreak in Tamil
Nadu in October 2009 (see ProMED-mail archive no. 20091020.3612).
Assuming that the samples taken then were the ones tested and
reported in this article, there was a mixed chikungunya-dengue
outbreak going on there.

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

HEPATITIS E VIRUS - INDIA: (HIMACHAL PRADESH)
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Date: Thu 18 Feb 2010
Source: sifynews, Indo Asian News Service (IANS) report [edited]
<http://sify.com/news/Over-160-cases-of- ... diicg.html>


More than 160 people in the Himachal Pradesh state capital [Shimla]
have tested positive for hepatitis E [virus infection] -- a liver
problem caused by the consumption of water contaminated by sewerage --
since the outbreak of the disease in mid-January [2010], officials
said Thursday [18 Feb 2010]. "Patients suffering from jaundice
(hepatitis E virus infection) are being reported at various government
and private hospitals of Shimla. 12 patients were admitted to various
hospitals yesterday (Wed 17 Feb 2010). [Up to the present], 161
patients have been reported," Vinod Mehta, the surveillance officer of
the Integrated Disease Surveillance Programme, told IANS [Indo Asian
News Service] Thursday [18 Feb 2010].

The National Centre for Disease Control (NCDC) in New Delhi has
already confirmed the prevalence of hepatitis E mainly from the
Khalini, Panthaghati, Vikas Nagar, and Kasumpti areas of Shimla.
"Since the incubation period of the water-borne disease is up to 90
days, the people who acquired the disease when there was problem of
water contamination in January [2010] would continue to report [until
the end of March 2010]," he said. "Now, there is no problem of water
contamination. The health department and the municipal corporation are
regularly monitoring the water samples," he added.

An official of the Shimla Municipal Corporation said the source of
water contamination was located soon after the outbreak of the disease
and the problem has been rectified. "We are regularly conducting
random water sampling from localities affected by jaundice. We are
also educating people to take preventive measures against the disease
like consuming boiled water," said municipal health officer Sonam Negi.

Locals, however, claim that the state government [has] yet to realize
the gravity of the problem and provide the residents safe potable
water. "The water supplied from the Ashwani Khud drinking water scheme
(around 25 km [16 mi] from Shimla) is not fit for consumption as there
is no proper chlorination and filtration of water," a resident of Bhim
Singh Thakur said.

In 2007 the disease was also reported in these localities and more
than 1000 cases of jaundice were reported at that time.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Hepatitis E is caused by infection with hepatitis E virus, a
non-enveloped, positive-sense, single-stranded RNA virus. The virus is
transmitted via the faecal-oral route. Hepatitis E is a waterborne
disease, and contaminated water or food supplies have been implicated
in major outbreaks. Consumption of faecally contaminated drinking
water has given rise to epidemics, and the ingestion of raw or
uncooked shellfish has been the source of sporadic cases in endemic
areas. There is a possibility of zoonotic spread of the virus, since
several non-human primates: pigs, cows, sheep, goats and rodents, are
susceptible to infection. In general, hepatitis E is a self-limiting
infection followed by recovery. No cases of chronic infections have
been recognised so far.

According to the WHO hepatitis E fact sheet
<http://www.who.int/mediacentre/factshee ... index.html>, the
incubation period following exposure to hepatitis E virus ranges from
3 to 8 weeks, with a mean of 40 days. Since the 1st cases were
observed in mid January 2010, contamination of the water supply must
have occurred sometime after the beginning of November 2009. It is
likely that further cases will be diagnosed. Fortunately
person-to-person transmission of hepatitis E is uncommon, provided
acceptable standards of personal hygiene are practiced.

The source of the contamination of the water supply to areas of the
city of Shimla has not been disclosed and the local population remain
unconvinced that the hepatitis E outbreak has been contained.

The city of Shimla (formerly Simla) and the state of Himachal Pradesh
in northern India can be located in the political map of India at
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>.
The HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/017I>. - Mod.CP]

HEPATITIS B VIRUS - NEPAL: (DANG DEOKHURI)
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Date: Sun 28 Feb 2010
Source: Republica, Social Affairs [edited]
<http://www.myrepublica.com/portal/index ... s_id=15709>


With some positive cases reported within a week, villagers of a VDC
[Village Development Committee] of Dang [Deokhuri] district are
living in the shadow of hepatitis B fear.

A 30-year-old man, his wife, and 2 daughters of Punkhola, Sashaniya
VDC, have been found suffering from the disease caused by hepatitis B
virus, which infects the liver of humans. It can lead to scarring of
the liver and an increased risk of liver cancer.

Villagers do [not?] go to the man's home after this family was found
to be in hepatitis B's grip and fear that the disease might spread.
"We are panicked after hepatitis B virus [infection] was diagnosed,"
said a local teacher. "The disease could strike others too as public
awareness about the disease is very low among the villagers in the VDC."

Tirtha Raj Gyawali, chairman of Good Governance of Youth Unity, who
returned to the district headquarters after a field visit to the
hepatitis B-hit area, said villagers are apprehensive of the disease.
"We have urged all to [have a] medical check-up," he said.

It is said that the health post nearby Punkhola is [a 4-hour] walk.
The distance has also added fear among local people.

According to doctors, chronic hepatitis B may eventually cause liver cancer.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Previously, on 21 Feb 2010, it was reported that: "Just a few days
after 3 persons in a family committed suicide due to inability to
finance treatment of an epileptic daughter, 4 persons of a single
family have come forward with an appeal for help for treatment of
hepatitis B
(<http://www.myrepublica.com/portal/index ... s_id=15443>).
The members of this family (the subject of the current report) have
contracted the liver disease and are facing difficulty in [obtaining]
treatment. This family, who also has 12-year-old twin daughters and
an 8-year-old son, organized a press conference in Lamahi Sunday (28
Feb 2010) appealing for help. They said the uninfected 3 children
currently live in the ground floor while the others live upstairs on
doctor's advice. They also have separate kitchens to ensure that the
disease is not transmitted to the trio.

Hepatitis B is a potentially life-threatening liver infection caused
by hepatitis B virus (HBV). It is a major global health problem and
likely to be endemic throughout Nepal. Hepatitis B virus infection
can cause an acute illness with symptoms that last several weeks,
including yellowing of the skin and eyes (jaundice), dark urine,
extreme fatigue, nausea, vomiting, and abdominal pain. People can
take several months to a year to recover from the symptoms. Hepatitis
B virus can also cause a chronic liver infection that can later
develop into cirrhosis of the liver or liver cancer. The likelihood
that an hepatitis B virus infection will become chronic depends upon
the age at which a person becomes infected, with young children who
become infected with hepatitis B virus being the most likely to
develop chronic infections. About 90 percent of infants infected
during the 1st year of life develop chronic infections; 30 percent to
50 percent of children infected between 1 to 4 years of age develop
chronic infections. About 25 percent of adults who become chronically
infected during childhood die from hepatitis B virus-related liver
cancer or cirrhosis.

An effective vaccine against hepatitis B has been available since
1982, but it is unlikely that comprehensive vaccination has been
undertaken in Nepal. Hepatitis B vaccine is 95 percent effective in
preventing HBV infection and its chronic consequences,.

The Administrative Division of Dang Deokhuri is in the south of the
Mid-Western Region of Nepal and can be located using the map at
<http://ncthakur.itgo.com/map04.htm>. The HealthMap/ProMED-mail
interactive map of Nepal is available at
<http://healthmap.org/r/018H>. - Mod.CP]
...................................cp/mj/mpp

UNDIAGNOSED ILLNESS, WATER-BORNE - INDIA: (MUMBAI), REQUEST FOR INFORMATION
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Date: Fri 12 Mar 2010
Source: WaterTech online.com [edited]
<http://www.watertechonline.com/news.asp?N_ID=73642>


Jaundice outbreak blamed on contaminated water supply
-----------------------------------------------------
Residents here are continuing to fall ill and one has died after
contracting jaundice, which may be attributed to a contaminated
drinking water supply, a Diligent Media Corporation reported.

The 12 Mar 2010 story said around 400 families have been consuming
the water for one month and about 65 people have become ill with the
disease. A 58-year-old resident is one of the people with jaundice
and he lost his daughter-in-law to the disease on 23 Feb 2010.

The Brihanmumbai Municipal Corporation (BMC) distributed chlorine to
purify the water. In January [2010], BMC collected a total of 2143
water samples, 10 of which tested positive for _E. coli_. Then, in
February [2010], 1987 water samples were taken and 36 samples tested
positive for _E. coli_.

Ganpat Tambe, secretary of the housing society, said in the story,
"Even we have cleaned our water tanks twice, but nothing seems to
solve the problem. In the morning when the water supply starts, we
get contaminated water in our homes every day."

A civic official, who wished to remain anonymous, said in the story,
"Normally complaints of water contamination or water-borne disease
increase during the monsoon season, but this is strange."

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

[The recurrent detection of _E. coli_ organisms in the water supply
of a Mumbai suburb is an indication of fecal contamination in the
supply system. The occurrence of jaundice is suggestive of hepatitis
A virus infection, which has been frequently associated with
contaminated drinking water supplies. Water-borne outbreaks of
jaundice, though infrequent, are usually associated with
sewage-contaminated or inadequately treated water. Casual contact
among people does not spread hepatitis A virus.

The symptoms of hepatitis A virus infection range from mild to
severe, and can include fever, malaise, loss of appetite, diarrhoea,
nausea, abdominal discomfort, dark-colored urine and jaundice. Not
everyone who is infected will have all of the symptoms. Adults have
signs and symptoms of illness more often than children, and the
severity of disease and mortality increases in older age groups, with
jaundice occurring in more than 70 percent of cases. Most people
recover in several weeks -- or sometimes months -- without
complications. There is no specific treatment for hepatitis A, but
several effective hepatitis A virus vaccines are available. Further
information can be obtained at:
<http://www.who.int/mediacentre/factshee ... index.html>.

The HealthMap/ProMED-mail interactive map of India showing Mumbai on
the west coast of Maharashtra state is available at:
<http://healthmap.org/r/00BT>.
- Mod.CP]

DENGUE/DHF UPDATE 2010 (15)
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******
India (Kerala)
Date: Thu 18 Mar 2010
Source: The Times of India, Indo Asian News Service (IANS) report [edited]
<http://timesofindia.indiatimes.com/city ... 698150.cms>


Nearly 270 cases of dengue have been reported in Kerala this year
[2010], catching the authorities unaware as the mosquito-borne
disease [virus] usually spreads during the monsoon.

According to the latest report from the Kerala health department, the
state capital has accounted for 215 of the 268 dengue cases that have
been reported in state-run hospitals, while the figure is expected to
higher because there is no compilation of records from the numerous
private hospitals in the state. Ernakulam has reported 21 cases while
the remaining 12 districts have reported 32 cases between them.

Authorities are surprised as the fever has arrived months before the
monsoon, when the density of mosquitoes multiplies at a rapid pace.

Speaking to IANS, Thomas Mathew, who heads the department of
community medicine at the Thiruvananthapuram Medical College, said
that a recent study showed that 75 percent of the areas that have
reported the fever face water shortages. "The main reason for this is
that all these areas which reported a high rate of dengue cases face
a serious water shortage. There are areas under the
Thiruvananthapuram Corporation where water comes only once a week and
hence people are forced to store water and it is here that mosquitoes
breed," Mathew said. "The perception that dengue is associated with
the rains is wrong because the National Institute of Communicable
Diseases has in a study pointed out that it is endemic in nature," he
added.

Health minister PK Sreemathi Tuesday [16 Mar 2010] called a
high-level meeting to take stock of the situation. The meeting
decided to form a joint coordination committee of various departments
and to launch a campaign to spread awareness among the people,
officials said.

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

[This is an excellent example of how the necessity for household
water storage due to lack of a constantly available supply can create
situations for _Aedes aegypti_, the dengue virus vector, to breed
irrespective of rains.

A map showing the location of Kerala state in southern India can be accessed at
<http://lib.utexas.edu/maps/middle_east_ ... _pol01.jpg>.
A HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/01b4>. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (07): ASIA
****************************************************************
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In this update:
Asia
[1] Cholera, diarrhea, 2009 - Nepal (Far and Mid-Western Districts)
[2] Cholera - India (Maharashtra)

******
[1] Cholera, diarrhea, 2009 - Nepal (Far and Mid-Western Districts)
Date: Mon 15 Mar 2010
Source: Republica [edited]
<http://www.myrepublica.com/portal/index ... s_id=16295>


Almost a year after the cholera outbreak that killed over 300 people
in the far and mid-western districts including Jajarkot, the National
Health Research Council (NHRC) disclosed that the epidemic was caused
by a combination of pathogens, and not solely by the cholera
bacterium.

Disclosing the findings of a high-tech lab test carried out by the
Center for Molecular Dynamics of Nepal (CMDN), Dr Chop Lal Bhusal,
chairman of NHRC, said, "The outbreak was the consequence of an
amalgamation of various types of dangerous bacteria."

"The lessons learned from the Jajarkot outbreak may be useful in
fighting forthcoming epidemics," he added.

The latest lab test found _Aeromonas_, _Shigella_, _Campylobacter_,
and _E. coli_ O157:H7 bacteria in stool samples collected from
patients during the Jajarkot outbreak.

"We found bacterial strains of _Aeromonas_ as high as those of
cholera," Sameer M Dixit, country director of CMDN, said, adding,
"All bacteria were combined either with cholera or _Aeromonas_."

According to Dixit, all types of bacteria found in the lab test were
water-borne. "We have, therefore, concluded that the Jajarkot
outbreak was caused by contaminated water," he said. "But we need
further research with a high number of samples to scientifically
substantiate our conclusion."

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

[The Midwestern region of the mountainous country of Nepal can be
found on a map at
<http://ncthakur.itgo.com/map04.htm>.
The HealthMap/ProMED-mail interactive map of Nepal is available at
<http://healthmap.org/r/00BY>. - Mod.LL]

******
[2] Cholera - India (Maharashtra)
Date: Sat 20 Mar 2010
Source: Zee News [edited]
<http://www.zeenews.com/news612908.html>


The death toll due to cholera has gone up to 13 in Solapur city since
last week. Earlier, only few parts of the city were reported for the
gastroenteritis and cholera patients, particularly slums located at
the Ashok Chowk area. But even after the claims made by the civic
authorities, the epidemic is spreading rapidly in other parts.

Chief minister Ashok Chavan had recently sent a delegation of
ministers -- including Laxman Dhobale and Foujiya Khan -- to take
stock of the situation in the city.

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

[Maharashtra is a state in central-western peninsular India and can
be found on a map at
<http://upload.wikimedia.org/wikipedia/c ... RA.svg.png>.
Solapur can be located on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/01b8>. - Mod.LL]

JAPANESE ENCEPHALITIS AND OTHER - INDIA: (UTTAR PRADESH)
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Date: Thu 15 Apr 2010
Source: Yahoo News India, Asian News International (ANI) report [edited]
<http://in.news.yahoo.com/139/20100415/8 ... aliti.html>


Dozens of children have been admitted to a state-run hospital in
Uttar Pradesh's Gorakhpur district with symptoms of encephalitis. The
disease first came to India in 1978. Thousands of children have since
succumbed to encephalitis and those who survived are either
physically disabled or mentally unsound.

It is not the season for the disease, yet 210 patients have been
treated so far. Cases of encephalitis are expected to increase with
the arrival of monsoon and may continue till December [2010]. "The
most important thing is awareness among the people. Hygiene is
necessary because Japanese encephalitis is transmitted by mosquitoes.
There is a need to control mosquito growth and ensure personal
hygiene. Japanese encephalitis can thus be reduced," said Dr AK
Pandey, Research Officer at the National Institute of Virology.

According to specialists, the vaccine for encephalitis should be
administered around 3 months before the monsoons, but the
administration has not taken up such a step so far. In 2006, the
government had launched an encephalitis vaccination campaign but only
a few children were benefited by the campaign.

Encephalitis generally affects children between the ages of 1-15 years.

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

[The region of Gorakhpur, Uttar Pradesh, reported over 500
encephalitis cases last year (2009), some due to Japanese
encephalitis virus (JEV) and others were described as acute
encephalitis of undefined etiology but not due to JEV infections.
There is no information indicating how many of these current cases
are due to JJEV and 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 - Japanische Enzephalitis (JE)
19.04.2010

Die Übertragungssaison für JE beginnt im Mai, endet im Oktober und hat ihren Gipfel erfahrungsgemäß im August-September. Bereits vor Einsetzen des Monsuns wurden mehr als 200 Fälle gemeldet, darunter auch viele Kinder. Diese Viruserkrankung wird durch nachtaktive Stechmücken übertragen und kann zu Hirnentzündungen führen. Risikoreisende sollten geimpft werden. / Quelle: crm

JAPANESE ENCEPHALITIS AND OTHER - INDIA (02): (ANDHRA PRADESH)
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Date: Thu 22 Apr 2010
Source: The Hindu [edited]
<http://www.hindu.com/2010/04/22/stories ... 110400.htm>


A positive case of Japanese encephalitis has been reported from Bhavani
Nagar, Talabkatta, district health authorities on Wednesday [21 Apr 2010]
confirmed. An 8 month old baby girl was diagnosed with JE and was treated
at Niloufer hospital. The baby girl has suffered partial paralysis to the
right side of her body, authorities said.

Japanese encephalitis is an ailment [caused by] a virus transmitted by
_Culex_ mosquitoes causing inflammation of the membranes in human brain.
Health authorities pointed out that the mosquitoes are getting infected
with the JE virus from pigs, which are present in large numbers in
Talabkatta area.

Usually, according to authorities, JE virus [JEV] reproduces in pigs and
mosquitoes get infected when they feed and take blood meals from pigs. The
JE virus spills over to the community when the infected mosquito starts
biting human population. [Large aquatic habitat birds, such as herons, are
wildlife reservoirs of JEV. - Mod.TY]

Preventive measures
-------------------
To prevent outbreak of JE in and around Talabkatta, district health
authorities conducted a health camp on Wednesday [21 Apr 2010] and took up
house to house survey of the area. The health authorities collected 53
blood smears. "We covered nearly 70 houses and distributed medicines,
including Homeo preventive medicines, for children below 15 years. We have
requested GHMC [Greater Hyderabad Municipal Corporation] authorities to
isolate pigs in the locality," said district medical and health officer Dr
Ch Jaya Kumari.

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[One wonders if the report of blood smears, rather than blood samples for
JEV serology, is accurate. Perhaps they are looking for malaria infections
as well. Isolating pigs outside the flight range of _Culex_ mosquitoes may
prove a difficult task logistically. It is curious that no mention is made
of applying JEV vaccine if this case is indicative of potential risk of an
outbreak.

A map showing the location of Indian states, including Andhra 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/01dE>. - Mod.TY]

MALARIA - INDIA: (KARNATAKA)
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Date: Mon 26 Apr 2010
Source: Deccan Herald [edited]
<http://www.deccanherald.com/content/659 ... ricts.html>


Five districts have reported an outbreak of malaria recently in
Karnataka. Although the state is doing quite well in terms of
implementing the Central Government's National Vector Borne Disease
Control Programme (NVBDCP), malaria cases have been reported every
year from endemic pockets.

Of late, Bijapur has reported 436 cases, Bagalkot 74, Koppal 275,
Chitradurga 15 and Tumkur 214. Sources in the Department of Health
said the health officials needed to be proactive. "Many health
officials do not understand the severity of a malaria outbreak. If
necessary action is not taken on time, malaria can spread to the
cities," sources said.

Apparently, Karnataka had received a letter of appreciation from
NVBDCP for controlling malaria in a very short time span recently. In
2008, there were reportedly 8 deaths due to malaria, with 47 160
confirmed cases and 9957 _Plasmodium falciparum_ (PF) (severe) cases.
In 2009, there were 36 830 confirmed malaria cases and 5685 PF cases
with no reported deaths.

State health secretary Dr E V Ramana Reddy said the government is
doing well in controlling malaria. "Every time there is an outbreak
of malaria cases, we do take immediate action and do the needful. But
certain areas are endemic, and we can only make efforts to reduce the
number of cases," he said.

The secretary said lack of junior health assistants was a major
hurdle faced by the malaria programme. The junior health assistants
go door to door in affected areas and distribute medicines for
malaria. "We are in the process of recruiting 5000 health workers.
Shortly, we will have more staff to overcome the staff crunch," the
secretary added.

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[Southern India, including Karnataka state, is usually regarded as a
low risk area. However, the reports of malaria in visitors to Goa
have highlighted that there is little information about malaria in
other states of southern India. - Mod.EP]

CHIKUNGUNYA (16): INDIA (KARNATAKA) SUSPECTED
*********************************************
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Date: Mon 3 May 2010
Source: SahilOnline [edited]
<http://www.sahilonline.org/english/news ... s&nid=7935>


The growing menace of chikungunya [virus] has hit more than 300 people and
has claimed one person's life in Annechakanahalli in Holenarsipur taluk
[administrative division] of Hassan district. The deceased has been
identified as a 55 year old man. But sadly, the taluk health officer claims
that he is unaware of the prevalent situation.

The officer, Dr Rajesh, said that though the menace began almost a month
ago, he was not aware of the attacks in the village. While clarifying that
he yet hasn't received any complaint with this regard, he notified that he
got to know about this only on Friday [30 Apr 2010] and he had directed Dr
Sidde Gowda to visit the village on Saturday [1 May 2010]. However, Dr
Sidde Gowda said he had treated all the cases.

The village comes under the Doddakadanuru Primary Health Centre (PHC). The
inhabitants of the village stated that they had visited Doddakadanuru PHC
sometime ago, to report the symptoms of chikungunya [virus infection], but
the medical officer didn't respond to them in a proper manner. Now, the
disease has engulfed the whole village, just within a month.

A resident said chikungunya has affected him and 3 others in his family. He
said that the doctors did not bother to visit the village even after they
were informed about the death of the man a week ago, due to chikungunya.
[Another man] said that in his house 3 persons were down with chikungunya.
Another villager said that since one month, he was taking several people
from the village to the Doddakadanuru PHC for treatment.

When contacted, district health officer Thimmappa said that on Friday [30
Apr 2010], Zilla Panchayat chief executive officer MR Balakrishna convened
a meeting in this regard and sent medicines to the village.

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[It is not clear if any of these cases, and especially the fatality, have
been laboratory confirmed. Fatalities from chikungunya virus infection are
extremely rare. Chikungunya and dengue virus infections are not easily
distinguished from each other, especially by the lay public, in the absence
of laboratory tests. No mention is made in this report of acute arthralgia,
which would suggest chikungunya virus infection. Chikungunya virus
continues to circulate in India over the past year, including in Karnataka
state.

A map showing the location of Hassan district in Karnataka state, India can
be accessed at <http://en.wikipedia.org/wiki/Hassan_district>. A
HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/01g7>. - Mod.TY]

Indien - Malaria
10.05.2010

Aus fünf Distrikten in Karnataka werden Malaria-Ausbrüche gemeldet (Bijapur 436 Fälle, Bagalkot 74, Koppal 275, Chitradurga 15 und Tumkur 214). Die hohen Zahlen sind für diese Gegend relativ untypisch. Mückenschutz beachten, ggf. Malariaprophylaxe. / Quelle: crm
______________________________

Simbabwe - Malaria
10.05.2010

Die schlechte Straßeninfrastruktur im Binga-Distrikt (Matabeleland North) verhindert präventive Maßnahmen (Einsatz von Insektizid-Spray) der Anti-Malaria-Teams und wird als Grund für einen Malaria-Ausbruch in dieser Gegend angesehen. 4.500 Fälle sind in den letzten 4 Monaten aufgetreten, darunter 14 Todesfälle. / Quelle: crm

DENGUE/DHF UPDATE 2010 (23)
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******
Nepal (Kathmandu)
Date: Mon 17 May 2010
Source: The Himalayian [edited]
<http://www.thehimalayantimes.com/fullNe ... sID=244381>


For the 1st time, 2 cases of dengue fever have been found in
Kathmandu. Dengue is caused by dengue virus (DENV), a mosquito-borne
flavivirus. It is transmitted by _Aedes_ mosquitoes. "This is the 1st
discovery of dengue fever in the Kathmandu Valley even though the
disease was detected in the Tarai and inner-Tarai districts some 5
years ago," according Sukraraj Tropical and Infectious Disease Hospital, Teku.

"_Aedes_ mosquitoes are found in cold water, freeze [?], cooler
houses and other cold places, and rich people are vulnerable to
dengue fever," said Dr Bashu Dev Pandey at Teku Hospital on Monday
[17 May 2010]. [_Aedes_ mosquitoes that transmit dengue virus are
mainly tropical and subtropical, and not confined to cool or cold
places. - Mod.TY]

He said the disease is communicable from one person to another [via
_Aedes_ mosquitoes - Mod.TY], and its symptoms are high fever,
bleeding and unconsciousness. "If an infected person is not treated
on time, the patient may die," he said.

_Aedes_ mosquitoes also breed in water collections in artificial
containers such as plastic cups, used tires, broken bottles, flower
pots, etc. Dr Pandey advised people to keep their freezes [?] and
cooler houses clean and treat water to remain safe from the disease.

Dengue fever is an acute febrile disease which normally occurs in the
tropics. It is also known as break-bone fever and can be
life-threatening. There is no tested and approved vaccine for the
dengue flavivirus. Prevention of dengue mainly is in mosquito
control. Dengue may also be transmitted via infected blood products
including blood transfusions, plasma, and platelets.

--
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[A HealthMap/ProMED-mail interactive map of Nepal showing the
location of Kathmandu can be accessed at
<http://healthmap.org/promed/en?v=28.3,83.9,5>. - Mod.TY]

MALARIA - INDIA (02): MUMBAI
****************************
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Date: Tue 18 May 2010
Source: Hindustan Times [edited]
<http://www.hindustantimes.com/City-sees ... 45050.aspx>


Malaria has claimed 3 lives in the city this month [May 2010] and
more than 1250 people have tested positive for the disease. Doctors
are surprised at the rise in the number of malaria cases, as they
usually plummet in summer.

In April 2010, at least 3122 Mumbaiites tested positive, and 2 people
died of the disease. This is more than double the number of cases in
April 2009, which saw 1351 people diagnosed with malaria. In April
2008, only 790 people contracted the disease.

Transmitted by the bite of infected mosquitoes, a spurt in malaria is
normal during the monsoon and post-monsoon period as mosquitoes breed
in stagnant water.

"When temperature crosses 40 C, it slows mosquito breeding. But the
temperature in Mumbai is lower than that, and the humidity level is
high, so mosquitoes are continuing to breed," said Dr Ashok Bhosale,
state project director of the National Vector Borne Disease Control Programme.

The maximum number of cases has been reported from central Mumbai,
Lower Parel, Worli and Elphinstone Road. On Friday [14 May 2010], 21
people who went to KEM Hospital's Out Patient Department tested
positive for malaria. "I am surprised to see so many malaria cases in
the summer. We usually get 2-6 malaria cases a day," said a resident
doctor at KEM.

Civic officials believe the rise in construction activity is
facilitating mosquito breeding. "Water stagnates or is left
unattended on slabs at the construction sites, and it allows for
breeding," said G.T. Ambe, BMC executive health officer.

The BMC used to fumigate construction sites, but from 1 May 2010, the
responsibility has been handed over to builders.

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[Mumbai is usually regarded as a low risk area for malaria. The
report indicates that a change in the organization of mosquito
control measures could be one explanation. - Mod.EP]