Wüstenschiff

JAPANESE ENCEPHALITIS AND OTHER - INDIA (04): (MANIPUR) SUSPECTED
*****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 6 Jul 2010
Source: Kangla Online, The Imphal Free Press report [edited]
<http://www.kanglaonline.com/index.php?t ... 6&typeid=1>


An epidemic alert has been sounded in the state following reports of
3 fatal cases so far from suspected acute encephalitis syndrome (AES)
in several parts of the state [Manipur]. As per official surveillance
reports, more than 100 cases of suspected AES have been found mostly
in the valley districts of the state.

The patients with such syndrome have been admitted to RIMS [Regional
Institute of Medical Sciences] and some other private hospitals. The
official reports further revealed that 3 deaths were reported from
Bishnupur, Khelakhong, and Mantripukhri. All of the victims were
children below the age of one year.

Blood samples of some infected persons have already been sent to
advanced laboratory at Dibugarh (Assam) for the confirmation of
Japanese encephalitis [JE] and more blood samples would also be sent
to the National Institute of Communicable Diseases (NICD), New Delhi,
stated the source.

The official source further maintained that equipments for the
diagnosis of Japanese encephalitis have already been installed at the
JN Hospital, Porompat. However, at this crucial point of time the
equipments are malfunctioning adding more hurdles to counter the
suspected cases of acute encephalitis syndrome.

The state health services and district vector borne diseases control
societies have taken up necessary steps to counter the outbreak of
suspected AES in the state. Fogging of malathion chemical was widely
done in those areas where there are cases of such syndrome.

Imphal East district vector borne diseases control society has
already done fogging at Naorem Leikai, Uchekon Laikon, and
Mantripukhri areas. Both urban and rural areas of the state have been
widely fogged as a part of the emergency measures to counter outbreak
of Japanese encephalitis which is carried by _Culex_ mosquitoes.

As a precautionary measure, the state vector borne diseases control
society would take up mass vaccination programme for Japanese
encephalitis for children between 0-14 years of age within few months.

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

[Cases of what this report termed as acute encephalitis syndrome
(AES) continue in the Manipur area. It will be of interest to see if
these and earlier cases are confirmed as Japanese encephalitis virus
infections, or due to infection by some other virus(es). It is
unfortunate that the equipment is not functioning for local
laboratory diagnosis of JE virus infections. ProMED-mail awaits the
results of the laboratory tests with interest. Effectively
controlling the _Culex_ JE virus vector mosquitoes over large
geographic areas is difficult and expensive. Vaccination of the
population at risk seems to be the better approach to reducing the
number of encephalitis cases, should JE virus prove to be the
etiological agent involved.

An interactive map showing the region where these cases occurred in
far eastern India can be accessed at
<http://www.maplandia.com/india/manipur/imphal/>.
A map showing the location of states in India, including Manipur, 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/01Cs>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (05): (MANIPUR) SUSPECTED
*****************************************************************
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: Sun 11 Jul 2010
Source: The Hindu [edited]
<http://www.thehindu.com/news/article509631.ece>


At least 15 persons have died of suspected Japanese encephalitis
(JE), and more than 100 others are undergoing treatment in Manipur.

Dr Y. Yaima, Director, Health Services, said blood samples had been
sent to the Regional Medical Research Centre in Dibrugarh, Assam, and
the National Institute of Communicable Diseases, New Delhi to
ascertain whether Japanese encephalitis was the cause of the deaths.

Y. Mohen, Medical Superintendent at the Regional Institute of Medical
Sciences here, told The Hindu that the number of patients with
symptoms of JE [virus infection] was increasing. He attributed the
alarming outbreak of this disease to widespread rearing of pigs in
villages and urban residential areas.

Official reports said hospitals only had stocks of Acyclovir
medicine, which treats the disease, that had expired several months
ago. Efforts were on to airlift the drug from Delhi, sources said.

[Byline: Iboyaima Laithangbam]

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

[The suspected JE outbreak in Manipur state continues and may be
intensifying. The 6 Jul 2010 ProMED post (archive no. 20100707.2261)
reported just 3 fatalities. The current report states that there are
now at least 15. ProMED-mail continues to await the results of the
laboratory tests.

Pigs are amplifying hosts of JE virus. The virus is maintained in
wild birds, such as night herons, and is transmitted by _Culex
tritaeniorhynchus_ and _Culex vishnui_ groups, which breed
particularly in flooded rice fields. Effectively controlling the
_Culex_ JE virus vector mosquitoes over large geographic areas is not
practical. Vaccination of the population at risk seems to be the
better approach to reducing the number of encephalitis cases, should
JE virus prove to be the etiological agent involved. Unfortunately,
contrary to the above report, there is no effective antiviral
treatment for JE virus infections. Only intensive supportive
treatment is indicated.

A question and answer bulletin for JE can be accessed at
<http://www.cdc.gov/ncidod/dvbid/jencephalitis/qa.htm>.

An interactive map showing the region where these cases occurred in
far eastern India can be accessed at
<http://www.maplandia.com/india/manipur/imphal/>. A map showing the
location of states in India, including Manipur, 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/01Cs>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (06): (MANIPUR) CONFIRMED
*****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 13 Jul 2010
Source: E-Pao [summ. Mod.TY, edited]
<http://www.e-pao.net/GP.asp?src=1..140710.jul10>


The results of the blood samples sent to the Regional Medical
Research Centre, Dibrugarh for testing the disease [Japanese
encephalitis virus] got [in] this late evening, the Director of State
Health Services, Dr Y Yaima, said to Hueiyen Lanpao. The Director
said that he was informed by the authority of the Regional Medical
Research Centre, Dibrugarh that out of 27 blood sample sent to the
Centre for testing Japanese Encephalitis, 24 of them have been found
positive. He, however, said that official documents are yet to [be]
received. The official results of the testing are likely to get in
the next 1-2 days, Yaima said, adding that officials of the Centre
assured him [they would] provide the results at the earliest so that
state can take up necessary measures to control the disease.

The blood sample collected from patients developing symptoms similar
to the disease was sent to Regional Medical Research Centre,
Dibrugarh on 6 Jul [2010] last. Once the results [are] received, the
particulars of the patients found infecting with the disease could be
ascertained for taking up necessary treatments, the director added.
[In addition to the] above blood samples sent to the Centre at
Diburgarh, his directorate has sent some samples to the National
Institute for Communicable Diseases (NICD), New Delhi. The results of
the testing will be received by tomorrow [14 Jul 2010], he believed.

The number of patients suffering from the disease suspected to be
Japanese encephalitis admitted to different hospitals was 66 on 9
July [2010] last but the same [number] was reduced to 61 now, a
highly reliable source said.

In the meantime, state authority has started taking up measure to
control the spreading of the mosquito-borne arboviral disease that
can affect the central nervous system and cause severe complications
and death by way of fogging and distributing medicated mosquito nets
to the people at various places. To discuss further steps, a high
level meeting will be convened tomorrow, said the director.

On the other hand, Newmai News Network today [13 Jul 2010] reported
that since 19 Jun [2010] at least 16 persons have died so far [and]
89 persons are undergoing treatment in the various hospitals in the
state due to the mysterious disease which has similar symptoms
[compatible] with those of the Japanese encephalitis (JE).

--
Communicated by:
Ronan Kelly
<ronankelly@comcast.net>

[ProMED thanks Ronan Kelly for sending in this report, which provides
the 1st (although still unofficial) laboratory evidence that JE virus
infections are involved in this outbreak in Manipur. The number of
individuals dying of encephalitis has increased from at least 15 on
11 Jul 2010 (see ProMED archive no.20100711.2323) to 16 in this
report. However, the above report indicates that there are 61
suspected JE cases whereas the previous ProMED post states that there
are more than 100. Now that laboratory results will be coming in
soon, it is hoped that the accurate number of cases will become available.

An interactive map showing the region where these cases occurred in
far eastern India can be accessed at
<http://www.maplandia.com/india/manipur/imphal/>. A map showing the
location of states in India, including Manipur, 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/01Cs>. - Mod.TY]

MALARIA - INDIA (03): (KERALA)
******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 12 Jul 2010
Source: The Hindu [edited]
<http://www.hindu.com/2010/07/12/stories ... 110300.htm>


Malaria returns to Kerala
-------------------------
Malaria, which made a comeback in Kerala after it was officially
eradicated several years ago, has been causing deep concern for the
people and health authorities in Thrissur district.

In the district, so far 82 cases of malaria have been reported this
year [2010]. Last year [2009], 154 instances of malaria attack were reported.

Of the 82 cases this year [2010], 77 cases were due to _Plasmodium
vivax_ infection; one due to _P. falciparum_, and 4 due to mixed
infections. 7 of last year's [2009] 154 cases were caused by _P.
falciparum_. While _P. vivax_ is less dangerous than _P. falciparum_
infection can be fatal.

Thrissur district in the past had a decent health record, but the
situation has changed drastically now in spite of the fact that
healthcare facilities have improved remarkably. The outbreak of
infections and emergence of eradicated diseases such as malaria are
particularly worrying.

District medical officer [DMO] AS Surendran told The Hindu that most
of the malaria cases identified in the district were among migrant
labourers, mainly from north Indian States of Orissa, Bihar, and West
Bengal. Some persons who had been working outside the State also come
for treatment after they were infected by the disease, he added.

"No indigenous spreading has been reported so far in the district
this year [2010]," he said. He does not rule out chances for it,
though. Resurgence of malaria in the State, which claims high health
standards, poses a real challenge for the Health Department.

"The Health Department conducts screening test for malaria among the
migrant labourers as soon as they arrive at their work sites," Dr
Surendran said. Block health inspectors have been asked to monitor
construction sites and building contractors were asked to report to
the health centres as soon as new workers arrived, the DMO said.

"Regular health camps have been conducted at the places where there
is sizeable number of migrant labourers. Blood smears have been
collected and drugs administered as soon as symptoms are found."

As most of the construction workers stay in the makeshift sheds near
the worksites, they are more susceptible to attack of mosquitoes,
which are the disease carrying vectors. Malaria is a parasitic
disease that involves high fevers, shaking chills, flu-like symptoms,
and anaemia.

Viral fever cases
-----------------
The district also reported a spurt in the number of viral fever
cases, which were common during the monsoon season. Recently, about
850 trainees at the Kerala Police Academy were administered drugs for
swine flu [A (H1N1)], as many of them started showing flu-like symptoms.

Among the random samples collected from 16 trainees, 8 were reported
positive for A (H1N1) influenza. So far 133 swine flu cases were
confirmed in the district.

Healthcare professionals say stern steps are necessary to revive
Thrissur's past healthy profile. For this, they said, the cooperation
of the public was necessary.

[Byline: Mini Muringatheri]

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

[82 cases of malaria have been reported over the 1st 6 months of 2010
compared to 154 for the entire 2009. This is not a major difference,
and the situation looks more like a stable, low level transmission.
This is underlined by only one _P. falciparum_ case detected in 2010
compared to 7 for the whole of 2009, which is a decline. The number
of malaria cases is still very limited out of a population of 31
million (<http://en.wikipedia.org/wiki/Kerala>).

Transmission of H1N1 is expected and there is no indication whether
it is increasing based on just a few confirmed cases. - Mod.EP]

[The state of Kerala in south western India can be located on the maps at
<http://www.globalsecurity.org/military/ ... ourism.gif>
and
<http://healthmap.org/r/018G>. - Sr.Tech.Ed.MJ]

DENGUE/DHF UPDATE 2010 (34)
***************************
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 (Delhi)
Date: Mon 12 Jul 2010
Source: Big News Network.com, Indo Asian News Service (IANS) report [edited]
<http://feeds.bignewsnetwork.com/?sid=658887>


The number of people suffering from the dreaded dengue fever is
slowly rising, with 4 new cases being reported from the capital
[Delhi]. The total of patients afflicted by the fever this season is
5 an official said. Chief medical officer (CMO) of the Municipal
Corporation of Delhi (MCD), NK Yadav said: 'The fresh cases have been
reported in the month of July [2010].' The people who tested positive
were immediately admitted to Apollo, Safdarjung, and Ram Manohar
Lohia hospitals, said the CMO. Dengue usually hits the capital after
monsoon showers, when the mosquitoes breed in stagnant rainwater. The
1st case in the capital was reported in June [2010].

Symptoms of dengue are high fever for 4-5 days, usually accompanied
by headache and body ache, after which the patient's blood platelet
counts begin to fall and rashes could also occur.

The health department of the MCD has issued guidelines for checking
the spread of dengue. These are: cooler tanks should be emptied and
dried regularly, water kept for birds should be changed regularly,
containers should not be kept in the open, water tanks should be
tightly covered with lids, unused containers should be kept upside
down, and water should not be allowed to accumulate near homes.

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

[A HealthMap/ProMED-mail interactive map of India showing the
location of Delhi can be accessed at
<http://healthmap.org/r/01Jf>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (07): (MANIPUR) CONFIRMED
*****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[ProMED subscriber Ronan Kelly <ronankelly@comcast.net> forwarded the
following updates on the encephalitis outbreak in Manipur, India.
These reports include new laboratory test results that increase the
number of confirmed JE virus infection cases. - Mod.TY]

******
[1]
Date: Thu 14 Jul 2010
Source: The Telegraph [edited]
<http://www.telegraphindia.com/1100715/j ... 684684.jsp>


The Manipur health department today declared an outbreak of Japanese
encephalitis [JE] in the state and sounded an alert among health
institutes and people residing in the affected areas. After issuing a
notification, director Y. Yaima asked all hospitals and medical staff
in private and government health institutes as well as people,
particularly in the 4 valley districts where the outbreak has been
reported, to be on maximum alert.

The department declared the outbreak of the disease after 34 of the
40 blood samples sent to the Regional Medical Research Centre,
Dibrugarh, and the National Institute of Communicable Diseases, New
Delhi, tested positive. Of the 40 samples, 27 were sent to the
Dibrugarh centre. Test results received by the state health
department today showed that 24 of the 27 samples had tested positive
for Japanese encephalitis.

"Of the 27 samples sent to Dibrugarh centre, 3 patients have already
died," the director said. The Delhi institute also informed officials
at the state health department over phone today that of the 13
samples sent to it, 10 had tested positive, sending alarm bells
ringing in the department. "Since 34 of the 40 samples tested
positive and many more people are reported to be suffering, we
consider this an outbreak of the disease. Therefore, we are issuing
the declaration," a senior official of the health department told
this correspondent.

The latest information received by the department says at least 88
patients from Imphal East, Imphal West, Thoubal and Bishnupur
districts have been admitted to 4 hospitals in and around Imphal
city. These are the Regional Institute of Medical Sciences, the
government-run Jawaharlal Nehru Hospital and 2 private hospitals. The
department has issued guidelines to the hospitals on how to treat
patients affected by the disease. The director said since Japanese
encephalitis was a viral infection, there was no curative treatment.
The only way to deal with the situation was to continue with
symptomatic treatment.

Officials of the department said since the 1st report of suspected
cases of the disease came last month [June 2010], fogging had been
intensified in the valley areas to kill mosquitoes. Officials of the
department have also stepped up an awareness campaign called
information education campaign in these areas. The department
appealed to people residing in the affected areas not to expose
themselves to mosquitoes.

Official sources said the disease had been reported once in a while
in recent years but this was the 1st time that an outbreak of such a
magnitude had hit the state. They said the department was finalising
a strategy to control the outbreak.

******
[2]
Date: Thu 14 Jul 2010
Source: E-Pao [summ. & edited]
<http://e-pao.net/GP.asp?src=7..150710.jul10>


The department will henceforth introduce mass vaccination programme
starting from November and December of this year [2010]. Among the
states of the country asked for taking up mass vaccination programme
by the Central government, Manipur [is] also included. As the
vaccination programme is normally not carried out when the disease
causing virus is active, the mass vaccination programme is to be held
in November and December, [the official] clarified.

[This clarifies the status of the JE virus vaccination plans for the
region. - Mod.TY]

******
[3]
Date: Fri 15 Jul 2010
Source: E-Pao [summ. & edited]


The outbreak of Japanese encephalitis has claimed 3 lives while 5
other persons are suspected to have died of the disease, stated
Health and Family Welfare Minister Pheiroijam Parijat during the
Assembly session today [15 Jul 2010].

Responding to a call attention motion raised by MPP MLAs Dr Ng Bijoy,
RK Anand and Dr I Ibohalbi, Parijat said that 3 confirmed cases of
death due to Japanese encephalitis were reported from RIMS. However,
5 other fatal cases could not be confirmed whether they were caused
by Japanese encephalitis [virus] or not.

Out of around 75 people admitted in different hospitals for treatment
with symptoms of Japanese encephalitis, only about 4-5 people remain
in the hospitals.

******
[4]
Date: Wed 14 Jul 2010
Source: E-Pao [summ. & edited]


It is said that apart from infections from mosquito bites at Khunthak
village claiming the life of a 14-year-old boy and scores still
awaiting hospitalisation, suspected JE cases has been spreading at
the Indo-Myanmar border village since the last few days. According to
Kasom Khullen Sub-division Development Association chairman Jojo
Robertson, out of the 9 persons infected in Khunthak village, the
condition of 4 is stated to be serious.

[This report suggests that the outbreak is continuing in rural areas
along the Indian-Myanmar border. It is not clear how many, if any, of
the cases in this report have been or will be laboratory confirmed as
JE virus infections. Since neither JE virus nor the _Culex_ mosquito
vectors of this virus will be constrained by international borders,
it would be of interest to know if cases are also occurring in
Myanmar. - Mod.TY]

An interactive map showing the region where these cases occurred in
far eastern India can be accessed at
<http://www.maplandia.com/india/manipur/imphal/>. A map showing the
location of states in India, including Manipur, 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/01Cs>. - Mod.TY]

MALARIA - INDIA (04): (MUMBAI)
******************************
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: Sat 17 Jul 2010
Source: DNA [edited]
<http://www.dnaindia.com/mumbai/report_b ... al_1410362>


Malaria in Mumbai
------------------
The state government on Thursday [15 Jul 2010]
admitted that Mumbai had become the malaria
capital of the state. Out of the total cases
registered in the state, 47 percent were from the
city. Public health minister Suresh Shetty said
that though the state percentage had declined by
12 percent, the number of cases in Mumbai, Thane
and Nashi went up by 7, 10 and 1 percent respectively.

Of the 22 159 people reported to be suffering
from malaria till 10 June 2010, 12 393 were in
the city. In 2008-09, the death toll in the state
was 166, including 104 in Mumbai, the minister
said. Shetty said only 2 percent of the
construction work contractors were following the
norms laid down by the civic body to contain malaria.

"There are 2500 ongoing constructions in the
city. Even though the civic body made compliance
of the anti-larvae treatment compulsory for
developers to get the intention of
disqualification for the construction, none of
the builders follow it. Now, the BMC has decided
to recover the expenses from the developers," the minister said.

An official from the public health department
alleged that BMC officials were protecting the
developers. "Criminal cases should have been
registered against developers who weren't following the norms," he said.

The official also claimed that five wards in the
city had the maximum number of victims. "Lack of
sanitation, filth and contaminated water are the
major reasons of the epidemic in the wards in
eastern and western suburbs," he said.

The minister said 700 paramedical workers and 396
fogging workers had been appointed by the BMC to contain malaria.

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

[Mumbai is regarded as a low risk area, but this
applies to affluent areas only. The report state
that 22 159 cases of malaria were registered in
Mumbai between 1 Jan and 10 Jun 2010. This is
still low considered that Mumbai has
approximately 14 million inhabitants (Wikipedia).
Furthermore, a previous study (Karn and Harada.
Water Sci Technol. 2002;46:269-75) found that
malaria was common in slum areas of the city with
an annual incidence of 126 per 1000 population.

The report mentions that construction workers and
construction sites have been targeted for an
malaria spraying campaign based on the assumption
that the present situation is due to lack of
control at construction sites. Based on the study
by Karn and Harada it could just as well be an
extension of malaria in the slum areas of the city. ­ Mod.EP]

JAPANESE ENCEPHALITIS - NEPAL
******************************
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: Sat 17 Jul 2010
Source: The Himalayian [edited]
<http://www.thehimalayantimes.com/fullNe ... sID=249994>


A minor [child] died of Japanese encephalitis [JE] in Mahottari on
Friday [16 Jul 2010]. The deceased has been identified as 5-year-old
boy of Dhamaura VDC-1. He died while undergoing treatment in BP
Koirala Institute of Health and Sciences, Dharan. He had been getting
treatment in the hospital on special supervision for 4 days,
according to the deceased's family source.

Similarly, a 20-year-old young woman has also been suffering from the
disease in the same village, according to local Rehan Shah.

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

[There is no indication in this report if these JE virus infections
have been laboratory confirmed. This area is located in the northern
area of the Ganga River plain, where JE virus probably remains
endemic. There have been significant JE outbreaks in Nepal in the
past, with 24 districts having been classified as endemic previously
(see ProMED archive no. 20060831.2475). The 1st outbreak was reported
in 1978, and there have been sporadic outbreaks since.

A map showing the location of Dhamaura, Nepal can be accessed at
<http://en.wikipedia.org/wiki/Dhamaura>.
A map showing the general terrain of the area can be accessed at
<http://www.maplandia.com/nepal/central/janakpur/>.
A HealthMap/ProMED-mail interactive map of Nepal can be accessed at
<http://healthmap.org/promed/en?v=28.3,83.9,5>. - Mod.TY]

Indien - Anthrax
12.07.2010

Im Murshidabad Distrikt in West Bengalen sind 7 Personen an Milzbrand erkrankt, nachdem sie Fleisch eines erkrankten Bullen verarbeitet hatten. Der letzte Ausbruch in in diesem Bundesstaat, bei dem ca. 50 Menschen erkrankten, liegt nur wenige Monate zurück. Auch aus dem Bundesstaat Orissa wurden im April/Mai dieses Jahres 18 Milzbrand-Erkrankungen gemeldet. / Quelle: crm
__________________

Indien - Malaria
19.07.2010

Mumbai gilt mit ca.12.400 Erkrankungen mittlerweile als die Malaria-Hochburg des Bundesstaates Maharashtra (22.159 bestätigte Fälle). 47 Prozent der gemeldeten Fälle kamen aus der 14-Millionen-Stadt an der Westküste, betroffen sind hauptsächlich die Bewohner der Slum-Gebiete. Auch aus fünf Distrikten in Karnataka werden vermehrte Malaria-Fälle gemeldet. Die hohen Zahlen sind für diese Gegend relativ untypisch. Im südindischen Bundesstaat Kerala, wo Malaria noch vor einigen Jahren als eradiziert galt, wurden in der ersten Jahreshälfte 2010 bisher 82 Erkrankungen (im Vergleich zu 154 im gesamten Jahr 2009) gemeldet. Die meisten der Fälle kamen bei Wanderarbeitern aus den nördlichen Bundesstaaten (Orissa, Bihar, West Bengal) vor. Dringend Mückenschutz beachten, ggf. Chemoprophylaxe bzw. standby-Therapie. / Quelle: crm
__________________

Tadschikistan - Polio
12.07.2010

Der Polio-Ausbruch in Tadschikistan scheint allmählich unter Kontrolle zu sein. Durch Impfkampagnen, die unmittelbar nach Bekanntwerden der ersten Fälle eingeleitet wurden, konnte die Anzahl der Neuerkankungen deutlich reduziert werden. Seit Beginn des Ausbruchs in der 1. Maihälfte wurden 643 Erkrankte registriert, bei 334 konnte Polio Wildvirus Typ 1 nachgewiesen werden. Unter den bestätigten Fällen kam es zu 14 tödlichen Verläufen. Dringend Impfschutz gegen Polio überprüfen und ggf. auffrischen. / Quelle: crm

JAPANESE ENCEPHALITIS AND OTHER - INDIA (08 ): (MEGHALAYA)
*********************************************************
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 23 Jul 2010
Source: NewKerala.com [edited]
<http://www.newkerala.com/news2/fullnews-5964.html>


Health authorities in Meghalaya today sounded an alert following
reports of 2 people being infected with Japanese encephalitis [JE]
[virus], officials said. The mosquito-borne disease had been reported
from Ri-Bhoi and West Khasi Hills districts in Eastern part of
Meghalaya, a senior health official said.

"Both the patients infected with Japanese encephalitis [virus] are
undergoing treatment in 2 city hospitals here," Director of Health
Services AS Kynjing told UNI. He said instructions have been given to
hospitals to collect blood samples from all suspected patients,
including malaria patients, in order to confirm the disease.

Dr Kynjing said a team of doctors have rushed to Langja village in
the state's West Khasi district to ascertain the outbreak of Japanese
encephalitis in the valley areas.

The disease [virus], transmitted from pigs [and wild birds - Mod.TY]
through mosquitoes, strikes during the period of April to September.

Encephalitis causes inflammation of the brain tissue, producing
symptoms of high fever, headache, rigidity of the neck, and loss of
voice and involuntary movement of the body.

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

[JE virus infections continue in northeastern India. No indication is
given if this area is covered by the government's JE virus
vaccination program. This report infers that these cases are
laboratory confirmed, but is not stated explicitly.

A map showing the location of Meghalaya in northeastern India can be
accessed at
<http://en.wikipedia.org/wiki/File:India ... or_map.svg>
A map showing the Indian states can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>

Indien - Malaria
26.07.2010

Mumbai gilt mit ca.12.400 Erkrankungen mittlerweile als die Malaria-Hochburg des Bundesstaates Maharashtra (22.159 bestätigte Fälle). 47 Prozent der gemeldeten Fälle kamen aus der 14-Millionen-Stadt an der Westküste. Alleine in den ersten beiden Juliwochen traten fast 9.000 Fälle auf. Betroffen sind hauptsächlich die Bewohner der Slum-Gebiete und Bauarbeiter auf den über 100 Baustellen in der Innenstadt. Auch aus fünf Distrikten in Karnataka werden vermehrte Malaria-Fälle gemeldet. Die hohen Zahlen sind für diese Gegend relativ untypisch. Im südindischen Bundesstaat Kerala, wo Malaria noch vor einigen Jahren als eradiziert galt, wurden in der ersten Jahreshälfte 2010 bisher 82 Erkrankungen (im Vergleich zu 154 im gesamten Jahr 2009) gemeldet. Die meisten der Fälle kamen bei Wanderarbeitern aus den nördlichen Bundesstaaten (Orissa, Bihar, West Bengal) vor. Dringend Mückenschutz beachten, ggf. Chemoprophylaxe bzw. standby-Therapie. / Quelle: crm

PARATYPHOID FEVER - TAIWAN ex INDIA (ANDHRA PRADESH): INTERNATIONAL ALERT
*************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
[1]
Date: Sat 24 Jul 2010
Source: CNA News [edited]
<http://www.cna.com.tw/ShowNews/Detail.a ... pTypeSel=0>


Taipei County Health Department said that 5 people complained of
headache and diarrhea upon their return from India. Of these, 2 are
confirmed to have paratyphoid.

The 2 cases went to India for a spiritual growth course. One began to
have symptoms on 22 June 2010, while still in India. The person had
headache, watery diarrhea, anorexia, malaise, and fever. She sought
medical attention while in India, but her symptoms did not improve.
Upon returning to Taiwan, she was hospitalized on 12 Jul 2010. The
patient has since been discharged. The other patient had similar
symptoms, and is still hospitalized.

Investigation revealed that there were 87 people who went to the same
spiritual course. So far, 5 people have reported symptoms and sought
medical attention.

--
Communicated by:
Dr. Jen-Hsiang Chuang and
Dr. Angela Song-En Huang
Taiwan Centers for Disease Control
<huang.songen@cdc.gov.tw>

*****
[2]
Date: Fri 30 Jul 2010
From: Dr. Jen-Hsiang Chuang & Dr. Angela Song-En Huang [edited]
<huang.songen@cdc.gov.tw>


Investigation showed that during 18-27 Jun 2010, 88 people from Taiwan
and 9 other countries attended the Oneness Process at the Oneness
University in Varadaiahpalem, Chittoor District, Andhra Pradesh,
India. Upon returning to Taiwan, 5 persons reported gastrointestinal
symptoms with fever. Some had symptom onset while in India.

So far, a total of 40 people have reported gastrointestinal symptoms.
_Salmonella paratyphi_ was isolated from 7 patients [whether this is
type A, B or C is not stated - Mod.LL].

While attending the Oneness Process in India, attendees lived in rooms
housing 10-12 persons from different countries. Because of the
possibility that attendees from [more] countries might also be
affected, we are reporting this incident.

--
Communicated by:
Dr. Jen-Hsiang Chuang and
Dr. Angela Song-En Huang
Taiwan Centers for Disease Control
<huang.songen@cdc.gov.tw>

[ProMED thanks Drs. Chuang and Huang for contributing this report
which has added value because of the possibility of cases being found
in other countries.

Paratyphoid fever is similar to typhoid fever, in that both are
enteric fever types of disease, although the former can be, but is not
necessarily, less severe. The paratyphoid salmonellas are divided into
A, B and rarely now C. _Salmonella paratyphi_, also referred to as _S.
enterica_ serotype Paratyphi. Types B and C also have species, now
serotypes, _schottmuelleri_ and _hirschfeldii_, respectively. Like
typhoid, paratyphoid is generally considered not to be a zoonosis,
with [only] humans as the reservoir, but the paratyphoid bacillus has
been isolated from domestic animals and fish.

In India, paratyphoid A has become an increasing problem, accounting
for up to 45 percent of cases of enteric fever in 1998 (1). Although
initially quite sensitive to antimicrobials, strains have become more
resistant to quinolones; in contrast, _S. typhi_ has manifested
resistance for some time.

In a recent report regarding differential risk factors for typhoid and
paratyphoid in Indonesia, the authors found that the infections seemed
to have distinct routes of transmission (2). Typhoid was associated
with factors within a household (recent case in the house, no soap for
handwashing, sharing of food from the same plate, no toilet in the
house), whereas paratyphoid was associated with sources outside the
household such as food from street vendors and flooding.

1. Sood S, Kapil A, Dash N, et al. Paratyphoid fever in India: an
emerging problem. Emerg Infect Dis 1999; 5: 483-4.
2. Vollaard AM, Ali S, van Asten HAGH, et al. Risk factors for typhoid
and paratyphoid fever in Jakarta, Indonesia. JAMA 2004; 291: 2607-15.

- Mod.LL]

DENGUE/DHF UPDATE 2010 (39)
***************************
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 (Delhi)
Date: Wed 28 Jul 2010
Source: The Times of India [edited]
<http://timesofindia.indiatimes.com/city ... 224918.cms>


An alert has been sounded in the city to control
the spread of dengue. With the Commonwealth Games
round the corner and the fear of a dengue
epidemic looming large, the Municipal Corporation
of Delhi (MCD) has said it will further intensify
the spray of chemical larvicides. The civic body
started a special training programme for doctors
on Tuesday [27 Jul 2010] to strengthen case
management and curb fatalities due to the viral
infection. Meanwhile, 3 new cases of dengue were
reported in the city on Tuesday [27 Jul 2010]
taking the total count this season to 31.

"To strengthen the case management of different
forms of dengue, dengue fever, DHF and dengue
shock syndrome and to follow standardized
protocol, we are training physicians and
paediatricians. We plan to involve Delhi Medical
Association in this program so that private
practitioners are also involved," said municipal
health officer Dr N K Yadav. He said that
excessive administration of fluids and blood has been observed in some cases.

"Administration of blood and platelets is not
required in all cases. But doctors tend to do so
and it leads to unnecessary panic at times,"
Yadav said. A meeting of the medical
superintendents and nodal officers of all 33
sentinel surveillance hospitals in Delhi will be
held on Thursday [29 Jul 2010] to deliberate further on the issue, he added.

Dr Bir Singh, head of the community medicine
department at All India Institute of Medical
Sciences (AIIMS), said that if in July-end 3-4
dengue cases are reported daily the situation
should not be seen as alarming. "The number of
cases reported to date is not epidemiologically
significant. However, this year the potency
[virulence?] of the dengue virus is expected to
be higher and extensive surveillance as well as
anti-larval spray is needed. We cannot depend on
the civic agencies alone to check mosquito
breeding. Public participation is more
important," said Singh. He said that people who
have contracted the disease before should take
extra precaution because they may get hit by a
more severe strain of dengue, DHF, and dengue shock syndrome.

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

[There is reason to be concerned about an
increasing number of cases. The 3 Aug 2010
edition of Big News Network.com
(<http://feeds.bignewsnetwork.com/?sid=667460>)
reported that with 4 new dengue cases, the total
in Delhi has now reached 61 with one death in
2010. In the 4 Aug 2010 edition of the India
News post
(<http://www.indianewspost.com/health/280 ... delhi.html>)
N.K. Yadav, chief medical officer of Municipal
Corporation of Delhi, reported Tuesday (3 Aug
2010) 7 fresh confirmed cases of dengue, taking
the number of people affected by the
mosquito-borne virus disease to 68 this year (2010).

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]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (10): (ASSAM)
*****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 3 Aug 2010
Source: The Assam Tribune [edited]
<http://www.assamtribune.com/scripts/det ... 10/state06>


Japanese encephalitis [JE] which broke out for the 1st time in
Nalbari district has so far claimed one life at Barkuriha village
under Barbhag Revenue circle. The deceased was aged about 74. He was
admitted to Gauhati Medical College Hospital (GMCH) with high fever
where he was diagnosed with Japanese encephalitis. One more patient
from the village is undergoing treatment at the hospital.

The surfacing of his fatal disease has created panic among the people
of these areas. The people have alleged that the District Health
Department has taken no serious steps to combat it. The district
malaria department sprayed DDT only among 4 families. The district
malaria officer opined that as the area is not included in the action
plan for spraying DDT, they have no right to spray DDT without the
permission of the higher authority. On the other hand the district
health department, though, sent a bugging vehicle to the affected
village but it miserably failed to discharge smoke due to some
mechanical defect. Even, the deputy commissioner of Nalbari who is
the president of district health society or the joint director of
health services is yet to visit the affected village, which is
situated only 8 km [5 mi] away from Nalbari town.

The panic stricken villagers on Sunday [1 Aug 2010] organised an
awareness meeting at Barkuriha LP school inviting health and malaria
officials. The awareness meeting presided over by Dr Biren Deka was
addressed among others by Dr Kamal Dev Goswami, health officer of
Kamarkuchi PHC [primary health care], Dr Gokul Patowary, IDS [India
Development Service], Nalbari, Dipak Tamuli, district malaria
officer, Rajib Sarma, media expert NRHM [National Rural Health
Mission], and Ashok Kalita, panchayat [village assembly] president.

The panicky villagers demanded the health department to immediately
administer Japanese encephalitis [virus] vaccine in the village. They
also demanded the district administration to shift the piggery farm,
the source of this virus, to a areas away from inhabited places.

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

[This report does not indicate if these JE virus cases were
laboratory confirmed or were presumptive diagnoses. Pigs are
amplifying hosts of JE virus and would have to be relocated well
beyond the flight range of the _Culex_ mosquito vectors to avoid
transmission to humans in the affected village. Wild birds are the
reservoir hosts of the virus. This report raises again the conflict
relating to use of DDT insecticide for vector control. The _Culex_
vectors of JE virus are abundant and widely distributed, making their
control with insecticides difficult logistically and costly.

A map showing the locations of the Indian states can be accessed at
<http://www.indianorphanages.net/images/ ... al-map.gif>.
The HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/00J->. - Mod.TY]

UNDIAGNOSED ENCEPHALITIS - INDIA: (GUJARAT) 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: Thu 5 Aug 2010
Source: Ahmedabad Mirror [edited]
<http://www.ahmedabadmirror.com/article/ ... rsen-.html>


Fears that Gujarat may soon face another viral outbreak have grown
stronger. The state government revealed on Wednesday [4 Aug 2010]
that acute viral encephalitis, an illness which causes swelling of
the brain, had claimed 17 lives. Shockingly, of these, 11 people
breathed their last on Tuesday [3 Aug 2010] alone.

Alarmed by the high number of deaths in a day, the state health
department has sent emergency medical teams to Vadodara, Kheda, and
Panchmahal -- the 3 districts where all the 17 deaths have occurred.
"We have sent rapid action teams to the affected regions," State
health minister Jay Narayan Vyas told Mirror. "Every necessary step
will be taken to prevent the outbreak of the disease."

He also said that so far 29 people had tested positive for viral
encephalitis. [The tests employed are not specified, nor specific
viruses implicated. - Mod.TY] Till Tuesday [3 Aug 2010], this figure
was 16. "We have sent samples of suspected cases to National
Institute of Virology in Pune. Once we receive the reports, we will
prepare an action plan (to deal with the situation)," he said.

Of the 17 deaths in Gujarat, 9 have been reported in Panchmahal, 6 in
Kheda, and 2 in Vadodara. The 3 districts seem to be in the grip of
viral encephalitis as they also account for all the positive cases so
far. Sources in the health department said one could contract the
disease through many ways. However, in the current situation, sand
fly appears to be spreading the infection.

Though the number of positive cases is not that high at present,
there is still a lot of concern among health authorities. This is
because more than 36 000 people in the state, including 2006 in
Ahmedabad, are suffering from a "fever of unknown origin" (FUO).
There are fears that a significant number of these people may have
contracted viral encephalitis.

Encephalitis is caused mostly by a viral infection, which can be
contracted through insect bites, food, drink, or contact with an
infected person. Once the virus enters the bloodstream, it localises
the brain, forcing white blood cells to invade the brain issue to
battle the infection. This results in swelling of the brain. The
disease can cause nerve damage, permanent impairment, and even death
if there is a delay in treatment. Fever, headaches, clumsiness,
drowsiness, vomiting, and convulsions are among the symptoms related
to the illness. The elderly, infants, and HIV patients are the most
at risk. Though the acute phase of viral encephalitis lasts for a
couple of weeks, some people may take several months to recover.

"The percentage of children testing positive is high. They have high
fever and suffer from convulsions. There are also instances where
affected people have gone into comma," Vyas said. He said people who
show symptoms of encephalitis should be hospitalised immediately. "If
an infected person is not put under immediate medical observation,
the chances of his/her condition becoming acute increase sharply,"
the health minister said.

On the carrier of the infection, he said that sandflies were mostly
found in mud houses. "They enter through cracks in the walls," he said.


[Byline: Dilip Patel]

--
Communicated by:
HealthMap alerts via PRO/MBDS
<promed-mbds@promedmail.org>

[Although the virus involved in these encephalitis cases is not
specified, the health authorities apparently suspect a
sandfly-transmitted virus. The most likely candidate is Chandipura
virus, which has been recognized previously in parts of India as an
etiologic agent of encephalitis. It occurs both epidemically and in
sporadic cases. In children, the course of the disease can be rapid
with 55-75 percent mortality. Chandipura virus outbreaks have
occurred previously in Gujarat state. ProMED-mail would be interested
in receiving additional information, and especially the results of
the laboratory tests, as they become available.

References
----------
1. Rao BL, Basu A, Wairagkar NS, et al: A large outbreak of acute
encephalitis with high case fatality rate in children in Andhra
Pradesh, India in 2003 associated with Chandipura virus. Lancet.
2004; 364(9437): 869-74; abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/15351194>.
2. Chadha MS, Arankalle VA, Jadi RS, et al: An outbreak of Chandipura
virus encephalitis in the eastern districts of Gujarat state, India.
Am J Trop Med. 2005; 73(3): 566-70; available at
<http://www.ajtmh.org/cgi/content/full/73/3/566>.
3. Tandale BV, Tikute SS, Arankalle VA, et al: Chandipura virus: a
major cause of acute encephalitis in children in North Telangana,
Andhra Pradesh, India. J Med Virol. 2008; 80(1): 118-24; available at
<http://www3.interscience.wiley.com/cgi- ... 5/PDFSTART>.
4. Basak S, Mondal A, Polley S, et al: Reviewing Chandipura: a
vesiculovirus in human epidemics. Biosci Rep. 2007; 27(4-5): 275-98;
available at <http://www.bioscirep.org/bsr/027/0275/0270275.pdf>.

A map showing Gujarat state in northwestern India 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/008x>. - Mod.TY]