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CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (18 )
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Asia
[1] Cholera - Pakistan (Baluchistan)
[2] Cholera, diarrhea - India (Kashmir)

******
[1] Cholera - Pakistan (Baluchistan)
Date: Tue 24 Aug 2010
Source: GEO TV [edited]
<http://www.geo.tv/8-24-2010/70416.htm>


At least 8 people including 2 children died during a breakout of
cholera and diarrhea after deadly floods multiplied sufferings of
already ravaged people in Jaffarabad District in Baluchistan, Geo
News reported.

The district has been disconnected from other parts of country for
the last 11 days, while abject scarcity of drinking water and
shortages of food and medicines have let situation go from bad to worse.

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

[Baluchistan is in southwestern Pakistan. Exactly how many
cases/deaths of diarrhea are due to cholera is not clear but
significant diarrheal illnesses almost always occur in the wake of
such catastrophes. - Mod.LL]

[The HealthMap/ProMED-mail interactive map of Pakistan is available
at <http://healthmap.org/r/03Bd>. - Sr.Tech.Ed.MJ]

******
[2] Cholera, diarrhea - India (Jammu and Kashmir)
Date: Mon 23 Aug 2010
Source: Greater Kashmir [edited]
<http://www.greaterkashmir.com/news/2010 ... oms-18.asp>


The diarrhea, which claimed 2 lives and left over 700 ill in central
Kashmir's Budgam district, could be cholera as the patients have the
same symptoms and the authorities have started treatment on those lines.

Sources told Greater Kashmir that the preliminary investigations
suggested that the disease was cholera and the health department was
trying to hush up the issue to avoid international concern.

In the past few days, over 700 people in Budgam villages including
Reyar, Waterhaal, Kralnar, Harpanzu, and Shoolipora were hit by the
disease while over 150 people are still undergoing treatment at
health care centers.

[Byline: M Hyderi]

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

[Jammu and Kashmir state can be located on the HealthMap/ProMED-mail
interactive map of India at <http://healthmap.org/r/03Be>. - Sr.Tech.Ed.MJ]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (12): (UTTAR PRADESH)
***********************************************
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 24 Aug 2010
Source: Chennaionline.com [edited]
<http://news.chennaionline.com/national/ ... 76c265.col>


With 4 more encephalitis deaths in the region, the total number of
people killed by the disease in Uttar Pradesh's eastern region this
year [2010] has gone up to 189, health officials said. Out of the 32
fresh cases of the deadly disease that were reported yesterday [23
Aug 2010], there have been 4 deaths. Children in particular have
become targets of this deadly disease with 1179 cases reported alone
among children this year [2010].

29 districts of eastern UP, some parts of Bihar and neighbouring
Nepal have been hit hard by the virus. Deaths due to encephalitis
have been reported from Gorahkpur, Deoria, Mahrajganj, Kushinagar
district of Eastern Uttar Pradesh, Bihar and Nepal, Additional
Director Health, U K Srivastava said.

About 170 patients are undergoing treatment in various hospitals
across the region, they added.

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

[Previous reports of this outbreak indicated that both Japanese
encephalitis virus and other unnamed viruses (responsible for
so-called acute encephalitis syndrome) were the etiological agents
responsible for the encephalitis cases. This report mentions neither,
although it refers to "the virus," implying that only one is
involved. It would be of interest to know the results of laboratory
tests to determine the identity of the viruses involved in these cases.

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/02lp>. - Mod.TY]

DENGUE/DHF UPDATE 2010 (44)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


Asia
India (Delhi)
Date: Sun 22 Aug 2010
Source: NDTV [edited]
<http://www.ndtv.com/article/cities/deng ... ster-46383>


The number of dengue cases is highest in the last 6 years. Delhi on
Saturday [21 Aug 2010] recorded the highest single-day incidence of
dengue this season with 36 more patients testing positive for the
disease, taking the total cases to 384. According to statistics
released by the Municipal Corporation of Delhi, the number of cases
till this time in 2009 was only 3. The figure was 55 and 12 in the
same periods in 2008 and 2007 respectively.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The 21 Aug 2010 edition of ProKerala News
<http://www.prokerala.com/news/articles/a161008.html> said that up to
Saturday (21 Aug 2010), the Municipal Corporation of Delhi (MCD) said
that 384 dengue cases had been reported. However, the figures quoted
by the capital's private hospitals present a vastly different
picture. MCD Medical Officer NK Yadav is quoted as saying they only
take into account the cases tested for dengue using the IgM capture
ELISA test. "Private hospitals generally don't conduct this test as
it is expensive, so we don't take into account their cases," he
added. This policy doubtless leads to significant underreporting of
dengue cases and deaths. It does, however avoid including false
positives in the dengue case totals. The 19 Aug 2010 edition of News
One India
<http://news.oneindia.in/2010/08/19/deng ... orted.html>
indicated that there were 4000 dengue cases reported in Delhi,
especially in Jamia and Okhla, the worst hit region in the capital.
The source of this figure is not stated.

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

ENCEPHALITIS - TURKEY: (MANISA) WEST NILE VIRUS SUSPECTED, 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: Wed 25 Aug 2010
Source: World Bulletin [edited]
<http://www.worldbulletin.net/news_detail.php?id=63002>


A virus that has killed 6 people in the past 2 weeks may be the same
strain of the West Nile virus that was also observed in the north of
Greece, doctors say, as most of the symptoms resemble those presented
in patients with the West Nile virus.

The Turkish Health Ministry announced that 6 out of the 16 patients
who have come to the Manisa State Hospital since 12 Aug [2010] [with]
fever, thrombocytopenia (lack of blood clotting cells), altered
states of consciousness, and skin eruptions have died. The statement
also announced that a scientific committee was rapidly set up
following reports from the Manisa State Hospital's infectious
diseases experts. The committee is composed of experts from the
Health Ministry's Fundamental Health Services General Directorate,
the Refik Saydam National Public Agency (RSHM), which deals with
bacteria and viral disease prevention, and academics from relevant
medical backgrounds.

The statement said the medical cases were currently being evaluated
by doctors, adding that a field inspection was also under way. The
committee is also investigating possible cases that might have gone
unreported and has laid out a strategy for managing a potential
outbreak. The committee has been working for a full diagnosis and to
determine treatment options. The statement said, "Whether the cases
in Manisa bears any resemblance to the mosquito-born West Nile virus
cases observed in the north of Greece is being investigated
separately in cooperation with international health agencies."

RSHM President Mustafa Ertek said they started working on identifying
the virus 10 days ago, following a notification from the Manisa State
Hospital. Ertek said, "Currently, there is a West Nile epidemic in
the north of Greece. Minor West Nile epidemics have also been
observed in countries such as Morocco and Algeria. It is not a
contagious disease, but it can be transmitted to another patient
through blood transfusion. The symptoms in the Manisa cases resemble
the West Nile strain that was recently detected in northern Greece."
However, he added that they would have to wait for laboratory results
to make a definite identification.

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

[West Nile (WN) virus has been circulating in some areas of the
Mediterranean Basin this year (2010). It is possible that West Nile
(WN) virus has turned up in Manisa, Turkey, perhaps brought in by
wild birds as they begin their post-fledging, migratory movements.
Manisa is across the Aegean Sea from Greek Macedonia, where a WN
outbreak is occurring, and somewhat inland. However, until the
laboratory results are in, the WN virus etiology of this outbreak and
possible relationships to the WN virus occurring in Greek Macedonia
is speculative. If WN virus is confirmed, this will be the 1st report
of the virus in Turkey that ProMED-mail has posted. ProMED awaits
those results with interest.

An interactive map showing the location of Manisa can be accessed at
<http://www.maplandia.com/turkey/manisa/manisa/>.
A HealthMap/ProMED-mail interactive map of Turkey can be accessed at
<http://healthmap.org/r/03J4>. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (19)
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Asia
[1] Cholera, diarrhea - Pakistan (Balochistan)
[2] Cholera - India (Punjab)
[3] Diarrhea - Nepal (Midwestern region)
[4] Cholera - China (Hong Kong), locally acquired

******
[1] Cholera, diarrhea - Pakistan (Balochistan)
Date: Wed 25 Aug 2010
Source: Daily Times [edited]
<http://www.dailytimes.com.pk/default.as ... 2010_pg7_6>


At least 12 more people including 8 children lost their lives on
Tuesday [24 Aug 2010] due to gastroenteritis and/or cholera and other
infections in flood affected-areas of Balochistan.

A report said that 3 children had died in district headquarters
hospital in Dera Murad Jamali where hundreds of affected people had
been admitted. In a relief camp at a bypass in Quetta, 2 children who
were suffering from gastroenteritis had died.

Another child was also died in gastroenteritis in Khuzdar. Official
sources said that several people were suffering from gastroenteritis
and other diseases in the affected areas. At least 8 persons,
including 2 children, died of cholera and other epidemics in Jaffarabad.

The level of the floodwater in Dera Allah Yar is constantly rising,
and The district has been disconnected from other parts of country
for the last 11 days, while abject scarcity of drinking water and
shortages of food and medicines have let situation go from bad to worse.

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

[The HealthMap/ProMED-mail interactive map of Pakistan is available
at <http://healthmap.org/r/03Bd>. - Sr.Tech.Ed.MJ]

******
[2] Cholera - India (Punjab)
Date: Fri 20 Aug 2010
Source: The Tribune, Tribune News Service (TNS) [edited]
<http://www.tribuneindia.com/2010/20100821/jal.htm#3>


Detection of cases of cholera in the Chandan Nagar locality of
Kartarpur has put the health authorities on alert again. Earlier, the
death of a person near Nurmahal due to cholera had put the health
authorities in a spot. Stool samples of the diarrhoa patients,
collected by the health authorities after finding more than 20 cases
of severe diarrhea in Kartarpur on Tuesday, 17 Aug 2010, were found
to test positive for _Vibrio cholerae_.

Although restricted to a single locality, the magnitude of the
outbreak was severe. Suspecting cholera behind the incident, the
stool samples of patients were sent to Government Medical College for
a microbiological examination.

Confirming the report, Dr RL Wassan, DHO [district health officer],
Jalandhar, said out of the total of 4 stool samples taken by the
department on Tuesday [17 Aug 2010], 2 tested positive for cholera.
Additionally, 3 water samples, out of the total 4 taken from the
locality, were also declared unfit for drinking after laboratory
examination, he confirmed.

[Byline: Amaninder Pal]

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

[The state of Punjab can be located on the HealthMap/ProMED-mail
interactive map of India at <http://healthmap.org/r/03J6>. - Sr.Tech.Ed.MJ]

******
[3] Diarrhea - Nepal (Midwestern region)
Date: Thu 26 Aug 2010
Source: Himalayan Times [edited]
<http://www.thehimalayantimes.com/fullNe ... sID=255267>


At least one person was killed and more than 200 others have badly
been affected by diarrhea in Banke district on Thursday, 26 Aug 2010.
The disease, which has been spreading in the district over the past 3
days, claimed the life of a 25-year-old local resident of Udarpur VDC
[village development committee] of the district.

More than 100 people are suffering from the disease in Ward No. 8 and
9 of Udarpur VDC and at least 150 people, in Sonpur VDC.

Diarrhea has so far claimed 9 lives in the district.

[Byline: Surendra Kafle]

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

[The HealthMap/ProMED-mail interactive map of Nepal is available at
<http://healthmap.org/r/03J7>. - Sr.Tech.Ed.MJ]

******
[4] Cholera - China (Hong Kong), locally acquired
Date: Wed 25 Aug 2010
Source: 7th Space, Government of Hong Kong SAR report [edited]
<http://7thspace.com/headlines/354967/tw ... ation.html>


The Centre for Health Protection (CHP) of the Department of Health
today (25 Aug 2010) is investigating another confirmed cases of
cholera and reminds people to observe good personal, food, and
environmental hygiene, whether in Hong Kong or traveling abroad.

The case involved another 30-year-old woman who developed diarrhea
and vomiting on 22 Aug 2010. The patient lives in Tsing Yi and did
not have history of recent travel. Her home contact has no symptoms of cholera.

The patient has been admitted to Princess Margaret Hospital and is in
stable condition. Laboratory tests showed that stool specimens
yielded positive result for _Vibrio cholerae_ O1 Ogawa.

This is the 8th case of cholera reported in 2010. There were 7
cholera cases in 2008, 3 cholera cases in 2007, 1 in 2006, and 5 in 2005.

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

[Hong Kong can be seen on the HealthMap/ProMED-mail interactive map
at <http://healthmap.org/r/03J9>. - Sr.Tech.Ed.MJ]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (13): (UTTAR PRADESH)
*************************************************************
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 28 Aug 2010
Source: Yahoo News, Agence France-Presse (AFP) report [edited]
<http://news.yahoo.com/s/afp/20100828/hl ... cephalitis>


At least 215 people, mostly children, have died in an outbreak of
Japanese encephalitis in an impoverished region of northern Indian
and the death toll is likely to soar, officials said Saturday [28 Aug
2010]. Eastern parts of India's most populous state Uttar Pradesh are
ravaged by encephalitis each year ... but this is one of the worst
outbreaks, officials said.

The deaths of 4 more children on Saturday [28 Aug 2010] pushed the
toll to 215, with hundreds sick in hospitals in Gorakhpur, an ...
area of 14 million people, regional health officer UK Srivastava told
AFP by telephone from Gorakhpur. "A total of 1324 patients had been
admitted in hospitals until Saturday in Gorakhpur," which is the
epicentre of the outbreak, and "more encephalitis patients are coming
into our hospitals," Srivastava said.

The outbreak began in early July [2010]. "We fear the total number of
encephalitis cases will go up to at least 3500 and the death rate
will be at a ratio of around 20 percent," he said.

"We have begun spraying insecticide to wipe out populations of the
_Culex_ mosquitoes which transmits the disease [virus] and we're
handing out chlorine to villagers to disinfect drinking water
supplies," Srivastava said.

KP Kushwaha, chief paediatrician at Gorakhpur's BRD Medical College,
said doctors were overwhelmed ... and "encephalitis usually surfaces
by August but this year [2010] patients began coming in from early
July" and if it continues this is going to be "an impossible task to
handle," he added.

VS Nigam, in charge of Uttar Pradesh's encephalitis prevention
programme, said a mammoth project to contain the disease had ended
with 35 million children vaccinated in the state's 34 districts. But
as soon children are vaccinated against Japanese encephalitis, they
fall sick with acute encephalitis syndrome "because when one virus is
suppressed by vaccines, others become dominant," he said. "It's a
large challenge," he added.

The regional chapter of the Voluntary Health Association, India's
largest non-governmental organisation, which works alongside the UN
Children's Fund (UNICEF), blamed the annual tragedy on the state's
failure to effectively immunise children. "A high alert is sounded
only after an encephalitis epidemic flares," association executive
director JP Sharma said. "Preventive steps should be taken well ahead
of the monsoon as vaccines need an incubation period to make human
beings immune to the virus," Sharma told AFP [immunity is not
immediate following vaccination, there is a time lag during which
time the immune system develops antibodies against the antigen
contained in the vaccine. - Mod.MPP] .

[Byline: Pratap Chakravarty]

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

[The encephalitis outbreak continues. The number of reported
fatalities has increased from 189 on 24 Aug 2010 to the 215 in just 4
days, reported today (28 Aug 2010). Vaccination to get ahead of an
ongoing outbreak requires a very aggressive campaign. Once again, the
acute encephalitis syndrome is mentioned as involved in the outbreak,
without indicating which viruses might be involved, nor what
proportion of the cases are due to Japanese encephalitis virus infections.

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/02lp>. - Mod.TY]

TYPHOID FEVER - INDIA: (HARYANA)
*********************************
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 28 Aug 2010
Source: Indianexpress.com [edited]
<http://www.indianexpress.com/news/43-ty ... out/673785>


More than 43 cases of typhoid have been reported in the last one week
at General Hospital, Sector 6, forcing them to gear up to handle the situation.

These cases have been reported from urban as well as rural areas, and
the figures are on similar lines as the previous week's, when about
45 cases of typhoid had surfaced.

Diarrhea too is on the rise, as nearly 40 cases have been reported in
the past 3 days alone. Doctors blame it on rains and contamination of
water. As a combat measure, the hospital has decided to crackdown on
colonies, which they claim are the breeding grounds for these
diseases. Teams of health officials have been visiting various
colonies every fortnight to assess the situation. The main colonies,
including Rajiv, Indira and Azad Colony [slums in the city of
Panchkula], are the ones that the hospital is keeping a close watch
on [Unhygienic conditions in these slums were cited in a recent news
release <http://www.tribuneindia.com/2009/20090725/cth1.htm#9>.].

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Typhoid fever is caused _Salmonella enterica_ subtype Typhi, and at
times by _Salmonella paratyphi_ A and B. Typhoid fever is transmitted
from a human intestinal carrier, usually by means of contaminated
food or water. For a discussion of typhoid fever, see ProMED-mail
postings Typhoid fever - USA: (TN) cluster 20090608.2120 and Typhoid
fever update 2009 (01) 20090710.2472.

Panchkula is a planned city in the northwestern Indian state of
Haryana, with an estimated population of in 2006 of 200 000
(<http://en.wikipedia.org/wiki/Panchkula>). It is located adjacent to
Chandigarh, the capital city of both the Indian states of Punjab and Haryana.

A map of Haryana, on which Panchkula can be located, is available at
<http://www.mapsofindia.com/maps/haryana/haryana.htm>. The
HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/02v_>. - Mod.ML]

DENGUE/DHF UPDATE 2010 (45)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Asia
[1] India (Delhi)
[2] India (Orissa)

******
[1] India (Delhi)
Date: Sun 29 Aug 2010
Source: The Indian Express [summ. & edited]
<http://www.indianexpress.com/news/800-d ... lhi/674105>


Dengue cases increased alarmingly in the national capital as 59 more
patients tested positive for the vector-borne disease [virus], taking
the total number of people being affected by it to 800. The national
capital has recorded 2 confirmed and 3 suspected dengue deaths this
season [2010].

The MCD [Municipal Corporation of Delhi] said it has deployed
additional staff to tackle the situation in the worst-hit Central and
South Delhi, from where 271 cases have been reported so far. It is
also maintaining round-the-clock surveillance near all the
Commonwealth Games venues, municipal commissioner KS Mehra said.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Dengue cases for specific localities within municipal Delhi are
given at the source URL above.

The 23 Aug 2010 edition of News-Views
(<http://news-views.in/69-new-dengue-case ... total-434/>)
reported on Delhi's efforts to reduce _Aedes aegypti_ breeding sites.
The report stated that the MCD has issued 45 532 legal notices
against owners of property where water stagnation was found. A total
of 6125 persons have been prosecuted. Mosquito breeding has been
detected in 44 743 houses in various parts of the city. Other reports
indicate that city officials are concerned about dengue virus
transmission continuing into October [2010] when the Commonwealth
Games will be held in Delhi.

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

******
[2] India (Orissa)
Date: Fri 27 Aug 201
Source: IBN Live, Press Trust of India (PTI) report [edited]
<http://ibnlive.in.com/generalnewsfeed/n ... 68922.html>


At least 7 persons died and about 50 others were affected in an
outbreak of dengue in Orissa's tribal-dominated Malkangiri district
in past 3 weeks, official sources said today [27 Aug 2010]. The
deaths were reported from Padia, MV-67, and Materu villages under
Padia block of the district during the period, chief district medical
officer (CDMO) Rabindra Kumar Nath said adding 5 of the deaths took
place in last week alone.

Though most of the patients, showing symptoms of high fever, had
undergone treatment at the local primary health centre (PHC)
initially, several had to be shifted to Visakhapatnam in neighbouring
Andhra Pradesh later, he said. Blood tests of the patients at
Visakhapatnam detected dengue [virus or antibodies?], Nath said
adding about 50 persons suffering from the disease were currently
undergoing treatment at various hospitals and health authorities took
steps to deal with the situation.

A team of experts and doctors visited the affected areas to ensure
proper treatment of patients besides taking preventive steps against
the disease through mosquito control, sources said. An awareness
drive has also been launched to check spread of the disease.

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

[A map showing the Indian states can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.
Malkangiri District can be located on the map of Orissa state at
<http://orissaonline.in/Maps/DISTRICT/>.
A HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/04jO>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (14): (UTTAR PRADESH)
*************************************************************
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 28 Aug 2010
Source: Samachar Today [edited]
<http://www.samachartoday.com/1300-cases ... hpur/10215>


1300 cases of encephalitis reported in Gorakhpur
---------------------------------------------------------
In Uttar Pradesh, the deadly encephalitis is surging again as 3 more
patients have succumbed during past 24 hours in Gorakhpur.
Correspondent reports that of 1300 cases of acute encephalitis
syndrome 90 have been tested positive for Japanese encephalitis [JE]
since January this year [2010]. Rest of the cases were of water-borne
encephalitis. As many as 211 deaths have occurred in the eastern
districts due to the disease this year [2010].

The additional director (health) of Gorakhpur division U.K.
Srivastava said that the disease mainly spreads through the mosquito
bite and contaminated water.

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

[ProMED thanks Ronan Kelly for forwarding this report and the one
that follows. The previous report posted yesterday (28 Aug 2010]
indicated that there were 4 new deaths (see ProMED-mail archive no.
20100828.3065), not just the 3 as given in the above report. It would
be of interest to know which tests employed that were positive for JE
virus or antibody. Presumably "water-borne encephalitis" cases were
caused by some type of enterovirus. It would be of interest to know
which one(s).

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/02lp>. - Mod.TY]

******
[2]
Date: Sat 28 Aug 2010
Source: NDTV [edited]
<http://www.ndtv.com/article/india/uttar ... r-47684?cp>

[There were] 17 deaths in 72 hours; it is encephalitis nightmare in
Gorakhpur. All the beds at the Gorakhpur Medical College are taken,
mostly by children suffering from acute encephalitis syndrome [AES],
a more dangerous form of the disease than Japanese encephalitis.
"There are 2 times the numbers of patients of AES here in proportion
to JE. This one is worse because it ruins all these organs in the
body which JE didn't and that's why it's harder to save the patient,"
said Dr Khushwaha, HOD, Paediatrics Department, Gorakhpur medical college.

As per the nurses, 2 people die every day on an average due to
encephalitis in the Gorakhpur Medical College. A figure, which in
itself shows, how deep the roots of the epidemic have
reached. Also, In western Uttar Pradesh, 7 children have died and
another hundred are in the hospital in Moradabad. Though the cause of
death is not confirmed, the children were beleived to be suffering
from viral fever.

It is believed that encephalitis is caused due to mosquitoes that
breed in stagnant water. Hygiene is an important factor that plays a
great role in the spiraling of the disease.

In the last 32 years, more than 7000 people have died of encephalitis
just at the Gorakhpur Medical College Hospital. But, the centre is
still unable to devise a vaccination programme for Japanese
encephalitis which has already killed 200 this year. Even as cases
continue to pour [in], the centre has no idea about how to deal with
this outbreak. Adding to the misery is the fact that more rains are
expected in eastern Uttar Pradesh in the coming weeks. Something that
is indicative of only more despair.

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

[As in the 1st report above, there is no specific virus given as the
AES etiological agent involved in this outbreak. Samples should be
sent to a WHO virus reference center for virus identification. -Mod. TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (20)
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Asia
[1] Cholera - Pakistan (Khyber-Pakhtunkhwa)
[2] Diarrhea - Pakistan (Punjab, Sindh)
[3] Diarrhea - India (Jammu and Kashimir state)
[4] Diarrhea - Nepal (Midwestern region)


******
[1] Cholera - Pakistan (Khyber-Pakhtunkhwa)
Date: Sat 28 Aug 2010
Source: Daily Times [edited]
<http://www.dailytimes.com.pk/default.as ... 010_pg7_11>


At least 1370 cases of cholera have been reported in recent days in
Hangu, health authorities said on Friday [27 Aug 2010]. According to
Executive District Officer (Health) Dr Muhammad Ishaq, the waterborne
disease has broken out due to torrential rains in the area. He said
most of the patients were children, women and elderly people. He said
medical teams had been sent to the affected areas to control the
situation. The general public in the affected areas said the disease
was growing fast.

--
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[Cholera, as well as many other diarrheal diseases, is certainly
increasing in the flood ravaged areas of Pakistan. Whether all these
cases are _V. cholerae_ is not clear. - Mod.LL]

*****
[2] Diarrhea - Pakistan (Punjab, Sindh)
Date: Mon 30 Aug 2010
Source: Express Tribune [edited]
<http://tribune.com.pk/story/44302/prcs- ... hea-cases/>


Health teams of Pakistan Red Crescent Society (PRCS) treated more than
60 000 flood victims of Southern Punjab and Sindh. The health teams
reported 15 000 severe diarrhea cases in flood hit areas among those
treated.

The PRCS has also set up water filtration plants with the daily
capacity of a million liters of water. The organisation provided free
medicines and ambulance services to the patients of diarrhea and other
waterborne diseases besides providing purification tablets in the
flood-hit areas.

The PRCS set up 31 health teams in collaboration with International
Federation of Red Cross/Red Crescent Societies and International
Committee of Red Cross, which are working round the clock in different
worst affected areas of Southern Punjab, Sindh and KPK.

--
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[Again, the etiology of the diarrheal illness are certainly likely to
be multifactorial with a prominent role of cholera. - Mod.LL]

*****
[3] Diarrhea - India (Jammu and Kashimir state)
Date: Mon 30 Aug 2010
Source: DNA India [edited]
<http://www.dnaindia.com/india/report_ov ... ir_1430949>


With more than 2000 people affected by diarrhea epidemic in
mountainous districts of Doda and Ramban, Jammu and Kashmir government
have geared up with army help to tackle the situation as more than
1700 people have so far been admitted in the hospitals.

As many as 2047 diarrhea patients have been identified in several
remote and mountainous areas of Doda and Ramban districts by the teams
of doctors till now, state health department officials said here
today, 30 Aug 2010.

Of these, 1347 patients were identified in Doda and 700 in Ramban
district, they said adding 1747 have been admitted in Doda and Banihal
hospitals and rest were treated in their hamlets by the teams of
doctors from the army and state health department.

So far, 3 people have died due to the disease in past 9 days in Doda,
they said, adding 16 people have been shifted to the hospital in Jammu
for specialized treatment.

--
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*****
[4] Diarrhea - Nepal (Midwestern region)
Date: Fri 27 Aug 2010
Source: Nepal News [edited]
<http://www.nepalnews.com/main/index.php ... rrhea.html>


More than 100 people in a village in Banke district have fallen sick
due to diarrhea, which has become an epidemic due to lack of enough
medicines and health professionals to check its spread.

Among them, 2 people died Thu 26 Aug 2010, after suffering from a
serious bout of the otherwise easily treatable disease in Udharpur
village of Banke district.

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JAPANESE ENCEPHALITIS AND OTHER - INDIA (15): (UTTAR PRADESH, BIHAR)
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Date: Tue 31 Aug 2010
Source: Yahoo News [edited]
<http://in.news.yahoo.com/20/20100830/14 ... lives.html>


In Gorakhpur, 4 more persons have died of encephalitis here, taking
the number of victims claimed by the disease in Uttar Pradesh's
eastern region this year to 219, a health official today said. All the
4 deaths occurred at BRD Medical College Hospital here during the past
2 days, Additional Director (Health) U K Srivastava said.

The dead included one each from Gorakhpur, Deoria and Kushinagar
districts of UP and one from neighbouring state Bihar, he said.
Meanwhile, 45 new encephalitis patients have been admitted in
different hospitals of the region.

Out of a total of 219 deaths due to the disease this year, 208
occurred at BRD Medical College Hospital alone, he said.

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

The number of fatal encephalitis cases in the region continues to
slowly, but steadily climb, increasing from 215 on 28 Aug 2010 to 219
today (31 Aug 2010). The etiology of these new infections is not
given, but presumably some are due to Japanese encephalitis virus.

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/02lp>. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (21): ASIA
******************************************************
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ProMED-mail is a program of the
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In this update:
Asia
[1] Cholera - Afghanistan (Ghazni)
[2] Cholera, diarrhea - India (Jammu and Kashmir)
[3] Cholera - India (Tamil Nadu)
[4] Diarrhea - India (Punjab)


*****
[1] Cholera - Afghanistan (Ghazni)
Date: Tue 31 Aug 2010
Source: Central Asia Online [edited]
<http://centralasiaonline.com/cocoon/cai ... wsbrief-13>


Afghanistan's Ministry of Public Health and the World Health
Organization (WHO) say a cholera outbreak in the northern province of
Ghazni has been brought under control, according to a WHO press release.

The outbreak, which sickened at least 130 people in the Nowa
district, began 9 Aug 2010, when a health NGO (non-governmental
organization) confirmed the 60 initial cases through laboratory
testing. The Ministry of Public Health and the WHO immediately
deployed staff with emergency medical supplies to treat the outbreak.
Since then, the outbreak has slowed to just 3 new cases daily, the
WHO reported in its release.

Diarrheal diseases are common in Afghanistan, where just 23 percent
of residents have access to safe drinking water. To limit the expanse
of outbreaks, Afghanistan has created the Disease Early Warning
System, which is now operational in 284 districts in all 34
provinces, with more than 300 surveillance officers tracking disease outbreaks

--
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*****
[2] Cholera, diarrhea - India (Jammu and Kashmir)
Date: Tue 31 Aug 2010
Source: Greater Kashmir [edited]
<http://www.greaterkashmir.com/news/2010 ... ley-28.asp>


More than 130 cases of gastroenteritis were reported from different
parts of the Valley on Tue 31 Aug 2010. At least 70 new cases of
gastroenteritis and mixed infection were reported from different
hospitals in central Kashmir's Budgam district that was worst hit by
cholera and other infectious disease. However, no new cases of
cholera were reported in the district.

Sources said though some of the patients had cholera-like symptoms,
they were treated in the district health institutions, and most of
them were discharged.

"Our medical teams are actively involving village heads, local Imams
to educate people. There is no need to panic as number of cases has
fallen," The Chief Medical Officer, Dr Abdullah told Greater Kashmir.

More than 57 villages of the district including Khansahab were badly
hit by the acute infectious diseases including cholera and gastroenteritis.

In Hajin area of north Kashmir's Bandipore district, more than 60
cases of gastroenteritis were reported from different hospitals. The
worst hit villages of the district were Magarpora, Inderkoot, Murtaza
abad, Wangipora and Singapore in Hajin Block.

--
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*****
[3] Cholera - India (Tamil Nadu)
Date: Wed 1 Sep 2010
Source: Express Buzz [edited]
<http://expressbuzz.com/cities/chennai/c ... 02977.html>


Cholera cases have been increasingly reported for the past 3 weeks,
especially among the residents of North Chennai, with many patients
being treated in hospitals for the bacterial disease. Doctors
attribute the trigger to consumption of contaminated water amid rains
and water-logging.

Dr Mohana Kumar of Ezhil hospital in Tondiarpet confirmed, on Tue 31
Sep 2010, a spurt in cholera patients, adding that some of the cases
had been severe owing to a mix-up of drinking water and sewage water.
"Of the many diarrheal cases, there are at least 3 confirmed cases of
cholera every week. The affected age group ranges from from 5 to 55
years," he pointed out.

Most of the cases are from Vysarpadi, Tiruvotriyur, Tondiarpet and
other areas in North Chennai. A hospital authority at the
Communicable Diseases Hospital in Tondiarpet informed that the last
week saw more than 20 persons getting admitted with serious diarrheal
disorder, and that a few of them did test positive for cholera.

A senior official at the Department of Public Health and Preventive
Medicine said in 2010 has so far reported 707 cases of cholera and a
death prior to August 2010. August 2010 alone has had reported 166
cases of cholera. The main reason is unhygienic water supply system,
he said, asking for a better water supply system.

[Byline: Nalini Ravichandran]

--
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*****
[4] Diarrhea - India (Punjab)
Date: Wed 1 Sep 2010
Source: Sify.com [edited]
<http://sify.com/news/gastroenteritis-ou ... chjjd.html>


There has been a outbreak of gastroenteritis in Ludhiana and around
34 people have been admitted to local hospitals. Most of the cases
have been registered from the Niwasi Bihari Colony, Sherpur Colony
and Gaspura area of the district, where, according to the
authorities, the disease has broken out mainly due to waterlogging.
Many people have died due to the disease.

Ramesh Tiwari, a resident of the Niwasi Bihari Colony, also said that
the waterborne disease broke out due to continuous waterlogging in the area.

"There is always waterlogging here in this area due to jammed sewage
system. This has caused the outbreak of gastroenteritis in the area.
All the clinics and hospitals in area are full of gastroenteritis
patients," said Tiwari.

Local administration has also confirmed the outbreak, and has said
that the numbers of the cases are increasing every day. "Almost 5 to
6 cases are coming every day. Most of them are coming from a
particular area. Symptoms of the disease are that one suffers from
vomiting, dysentery, and this can lead to dehydration," said Kuldeep
Singh, Assistant Commissioner, Ludhiana.

Within 5 days, gastroenteritis has already taken 19 lives.

[Byline: Karan Kapoor]

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JAPANESE ENCEPHALITIS AND OTHER - INDIA (16): (UTTAR PRADESH, BIHAR)
********************************************************************
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: Thu 2 Sep 2010
Source: Chennaionline.com [edited]
<http://news.chennaionline.com/newsitem. ... YNAME=NATL>


9 more persons today succumbed to Japanese encephalitis, taking the
toll in Uttar Pradesh's eastern region to 231, officials said. The 9
were undergoing treatment at BRD Medical College Hospital here,
Additional Director (Health) U K Srivastava said. Of the deceased, 4
hailed from Gorakhpur, 2 from Kushinagar and one each from Sant Kabir
Nagar and Siddharth Nagar. One victim hailed from neighbouring Bihar,
Srivastava said.

As many as 26 encephalitis patients have been admitted in BRD Medical
Hospital since yesterday [1 Sep 2010]. At present, 227 patients were
being treated in various government hospitals.

--
Communicated by:
HealthMap Alerts via ProMED-mail
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[The number of deaths has increased from 215 on 28 Aug 2010 to 231 in
this report (2 Sep 2010). Previous reports indicate that the majority
of these encephalitis cases are not caused by Japanese encephalitis
virus (JEV) infections, but the above report attributes all of them
to JEV. The virus(es) involved in the non-JEV cases have not been
specified, but may be enteroviruses.

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/02lp>. - Mod.TY]

DENGUE/DHF UPDATE 2010 (46)
***************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Asia
[1] India (Delhi)
[2] Pakistan (Karachi)


******
[1] India (Delhi)
Date: Sun 5 Sep 2010
Source: The Med Guru [edited]
<http://www.themedguru.com/20100905/news ... 40149.html>


With 71 fresh cases surfacing Saturday [4 Sep 2010], the total number of
dengue cases in the city went up to 1226. According to official sources,
out of the total cases so far, 1061 have been reported from Municipal
Corporation of Delhi (MCD) areas and 125 from New Delhi Municipal Committee
(NDMC) areas. The remaining cases have emerged from other parts of the city
while some are from some outstation. The total number of deaths due to
dengue has been 3 this season [2010].

What is cause for concern is that in comparison to previous years, the
number of infections this year has crossed the 1000 mark within 3 months
when even in years which were the worst for the disease the 1000-mark was
attained only at the very end of the season. According to statistics
released by the MCD, the number of cases till August end in 2009 was only
12 while the infections were 136 and 24 in the same periods in 2008 and
2007 respectively. The total number of dengue cases and deaths were 1312
and 2 (2008), 548 and 1 (2007), and 3366 and 36 (2006).

What is baffling the civic authorities is that besides the unauthorized
colonies and low-lying areas of the capital, affluent regions and
establishments have been found to be conducive for mosquito breeding.

Directorate of National Vector Borne Disease Control Programme (NVBDCP),
the department that implements antilarval measures in Delhi, detected 40
per cent of the total breeding sites in posh south and central Delhi
colonies. A massive cleaning up campaign to tackle the dengue menace will
begin from Monday [6 Sep 2010].

The MCD and the NDMC will start spraying operations for killing of larva in
all stagnant pools of water in public places.

[byline: Neharika Sabharwal]

--
communicated by:
HealthMap Alerts via ProMED-mail
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[This report is an example of how dengue virus vector mosquitoes can breed
in more affluent neighborhoods as well as in poorer ones. Given the steady
increase in dengue cases in Delhi for over a month, one wonders why the
vector mosquito control effort is just now getting started.

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

******
[2] Pakistan (Karachi)
Date: Mon 30 Aug 2010
Source: The Express Tribune [edited]
<http://tribune.com.pk/story/44204/uptic ... gue-cases/>


The monsoons have always been welcomed by the people of Karachi but the
pleasant showers have a flipside -- a sharp rise in dengue fever cases. So
far this year [2010], 93 cases have been reported to the government in
Sindh, with up to 20 cases reported directly after the rains, said Dr
Shakeel Malik, who is in charge of the Dengue Surveillance Cell. The cell
was activated on Tuesday [24 Aug 2010] given the rise in numbers. Out of
this year's patients [2010], 70 tested positive for the virus and were
treated. Only one of them was from Thatta and the rest of them were from
Karachi.

As with most information gathering in Pakistan, however, these numbers are
only the official statistics. Haematologist Dr Tahir Shamsi, who is the
director of National Institute of Blood Diseases (NIBD), warns that the
government's data is incomplete as the dengue cell isn't receiving numbers
from all of the hospitals in the city. "[The NIBD] alone received 9
patients in the last 24 hours," he said to prove his point. "There have
been a total of 21 cases reported this month [August 2010]."

Dr Bushra Jamil of the AKUH [Aga Khan University Hospitals], said that the
months between May and October are peak months for the outbreak of the
viral fever. "We get patients in the hundreds during this time every year
but fortunately the mortality rate is not very high," she said.

[byline: Samia Saleem]

--
communicated by:
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[The Aug 2010 edition of The Nation
(<http://www.nation.com.pk/pakistan-news- ... in-Karachi?>)
noted that the dilemma of the extensive flooding in the country, especially
in Sindh, may aggravate the situation. This situation illustrates the
dilemma of where best to invest time and limited resources in the face of
the national disaster of the extensive floods. It is not surprising that
dengue takes a back seat when more than a million people are adversely
impacted by the floods.

A map showing the locations of Sindh province and Karachi can be accessed
at
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>
A HealthMap/ProMED-mail interactive map of Pakistan can be accessed at
<http://healthmap.org/r/05Pd>. - Mod.TY]

RABIES, HUMAN - AFGHANISTAN: (NURESTAN)
***************************************
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 6 Sep 2010
Source: War On Terror News [edited]
<http://waronterrornews.typepad.com/home ... -dogs.html>


The Nuristan Provincial Reconstruction Team [PRT] is fighting an outbreak
of rabies in the province's Titin Valley that has claimed the lives of 4
Afghan citizens, but they are not going at it alone. The PRT is getting
help from the Iowa National Guard's 734th Agri-Business Development Team,
which provided 300 doses of rabies vaccine. The vaccine will be used to
inoculate dogs in the area and will help avoid the slaughter of Titon
Valley's canines.

"We were going to have to go to the villages in the valley, and if we saw
any suspicious animals, we were basically going to have to put them down,"
said United States Navy Lt. Kyle N Burditt, a physician's assistant with
the PRT from Dodge City, Kansas. "We were going to end up killing a lot of
animals that wouldn't have to die if we didn't have this vaccine."

US Army Maj. Loren Adams from New Liberty, Iowa is the 734th ADT's
veterinary officer. One of his areas of expertise is veterinary public
health, and he provided technical advice to the Nuristan PRT, which does
not have a veterinarian on staff. According to Adams, vaccinating animal
populations is the only effective way to bring a rabies outbreak like the
one in Nuristan's Titon Valley under control. "It's really important that
we vaccinate the dogs," Adams said. "You can't kill your way out of a
rabies problem. There's just no way to kill them all, so vaccinating the
animals is really the way to go."

"We are trying to push out the vaccine to the local villages as soon as we
can, so we can quell those outbreaks and stop any more people from dying of
rabies in our area," Burditt said.

[byline: Capt Peter Shinn]

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[One hopes that the 300 doses of rabies vaccine is sufficient to cover at
least 70 per cent of the dog population in the area. No mention is made of
the availability of post exposure treatment for people bitten by dogs.
There have been 2 previous reports of human rabies in Afghanistan posted on
ProMED-mail. The one in 1999 was particularly serious, with reports of
rabid dogs roaming parts of Kabul and 90 fatal cases in the month of May
1999 alone.

A map showing the location of Nurestan (Nuristan) in north eastern
Afghanistan, along the Pakistan border, can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... n_2008.jpg>.
A HealthMap/ProMED-mail interactive map of Afghanistan can be accessed at
<http://healthmap.org/promed/en?v=33.8,66,5>. - Mod.TY]