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MALARIA - PAKISTAN: POST FLOODING RISK, 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 23 Sep 2010
Source: Pakistan Times [edited]
<http://www.pakistantimes.net/pt/detail.php?newsId=14880>


Over 40 000 life-threatening malaria cases predicted in flood-hit Pakistan
----------------------------------------------------------------------
A new health crisis is looming in Pakistan as the peak of the deadly
malaria season approaches. As of 17 Sep 2010, the World Health
Organization states that a total of 195 000 cases of suspected
malaria have been reported.

WHO, Merlin [see below], and Save the Children are working in
partnership with the National Malaria Control Program (DoMC) to
address the onset of this emergency. WHO and Merlin estimate 2.2
million new cases of malaria are expected over the course of the next 6 months.

"Action is needed now and over the next 3 weeks before we get to the
peak transmission season in October and November," says Naeem
Durrani, Merlin's malaria expert, said a press release received by
'Pakistan Times' [daily e-Newspaper] from Merlin's Senior
Communications Officer Jacqueline Koch on Wednesday [22 Sep 2010].

"Essential disease control measures need to be in place to reduce the
risk of an epidemic." Merlin is responding and scaling up, working in
close cooperation with partners. Coordinating partners for Pakistan's
malaria response within the UNOCHA [UN Office for the Coordination of
Humanitarian Affairs] health cluster, alongside the DoMC, have
identified a USD 9 million total funding gap for malaria disease
control, surveillance and outbreak response in flood-hit areas. The
USD 9 million needed is in addition to current support from USAID and
the Global Fund."

The DoMC has mobilized all its resources to respond to potential
outbreaks," says DoMC Director Aslam Khan. He adds that at the
national level, malaria control program implementation has been
supplemented with adequate Global Fund support in 19 high-risk
districts in Baluchistan, Khyber Pakhtunkhwa (KPK), Punjab, and
Federally Administered Tribal Areas (FATA).

"Working together over the last 2 years, we've made exceptional
strides, and this has built the foundation for a more effective
emergency response today," Durrani said. By working closely with
national and provincial programmes, Merlin is helping to build and
broaden existing malaria coverage, which in 2 years has expanded
Pakistan's capacity to implement malaria control and effective
outbreak response.

The national programme has established 140 net distribution outlets
for 800 000 nets, 300 rapid diagnostic centres, 276 malaria
microscopy centres, alongside the training of 3800 health care
providers on malaria diagnosis, treatment. and surveillance.

Durrani said: "We have to be prepared for an estimated 40 000 severe
cases that could likely lead to cerebral malaria and very possibly
death. Without these building blocks in place, our response wouldn't
be nearly as effective, and vulnerable populations would pay the high
cost." The coordinating partners have stated that the supply pipeline
for malaria testing and treatment is in place, yet will take 3 to 4
weeks for delivery. However, there is an immediate need for 60 000
doses of malaria treatment.

Urgent support is also needed to establish a surveillance system in
flood-affected areas through 10 sentinel sites in 3 of the 4
provinces. WHO reports that all malaria control and outbreak response
measures are in place and funded, with the exception of indoor
insecticide spray, known as IRS [indoor residual spraying].

The funding shortfall for IRS along amounts to USD 1.7 million. "We
need to secure the funds for this vital component of our malaria
strategy," Durrani stated, noting that IRS is a priority since it is
the most effective way of reducing risk and decreasing the number of
cases, particularly in IDP settings. "People cannot use nets inside
tents, and we know that IRC is the most effective proven vector
control tool available for preventing or reducing outbreaks."

Durrani stressed the need to act before the peak occurs. "This is
exactly the right time for this particular control measure." Mosquito
nets are effective but only for those who are living in houses and we
estimate 1.5 million nets are needed to cover the most vulnerable in
this population.

Merlin has called for greater funding to match a growing need. In
collaboration with national program and other stakeholders Merlin
will respond effectively to prevent a significant proportion of
projected malaria morbidity before it occurs. Continued donor support
will play a vital role in reaching the scale needed for a successful
joint response.

Merlin is an international medical aid organisation delivering
essential health care in Pakistan since the 2005 Kashmir earthquake.
Merlin, with WHO support, is working with the National Malaria
Control Programme (DoMC) and together they have achieved the following:
- provided 100 per cent of case management coverage as sub-recipient
of a Global Fund grant in 8 high-risk districts through 150 diagnosis
and treatment centres;
- established and implemented an effective disease surveillance
system in parts of KPK, Baluchistan, and FATA;
- trained more than 1000 health care providers on malaria case management;
- established an effective outbreak response capacity in 8 districts.

Statistics measuring the sheer scale of the Pakistan flood disaster
continue to climb. Floods have forced 4 million people from their
homes, doubling previous figures. Over 8 million people are in urgent
need of food, shelter, and clean water, and nearly 21 million have
been impacted. Merlin's malaria projects are integrated into an
ongoing primary health care program and emergency flood response,
which includes 28 static health facilities and 17 mobile health units
offering essential health care to conflict- and flood-affected
populations. Merlin health and medical teams, over 800 strong
together with logistics and support staff, are treating over 6500
people a day, the press release said, adding that Merlin has been
working in Pakistan since 2005 and continues to build on extensive
country experience to improve the health of millions of people and save lives.

Merlin is an international aid agency that specialises in improving
health where it is most needed. It's work -- from saving lives in
times of crisis to supporting the long-term delivery of essential
care -- is geared towards building a health system that can cope with
needs on the ground now and in the future.

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

[The efforts to treat almost 6 million flood affected people in
Pakistan is described in the 23 Sep 2010 news release from WHO
available at
<http://www.who.int/mediacentre/news/rel ... index.html>.

The latest data on malaria in Pakistan from WHO (2008) can be found
at
<http://www.who.int/malaria/publications ... pak_en.pdf>.
2 558 998 cases were reported in total. From the slide of positive
cases approximately 40 percent were _Plasmodium falciparum_. The
recommended treatment of confirmed or suspected _P. falciparum_
malaria cases is artesunate in combination with sulfadoxine and pyrimethamine.

ProMED-mail will post evidence of an increasing number of malaria
cases in the flooded areas if available. - Mod.EP]

[Maps of Pakistan can be accessed at
<http://www.asiawaves.net/pakistan-map.htm> and the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00tj>. - Sr.Tech.Ed.MJ]

MALARIA - PAKISTAN (02): POST FLOODING RISK
*******************************************
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 24 Sep 2010
From: James M. Wilson V, MD
<jim.wilson@praecipiointernational.org>


Comment on malaria in Pakistan after the flooding
------------------------------------------------
Our team has been monitoring the situation with ground partners in
Pakistan via the Epidemic Advisory System-Pakistan (EAS-P,
<http://biosurveillance.typepad.com/epid ... y_systemp/>)
using similar approaches to those used in Haiti
(<http://biosurveillance.typepad.com/hait ... l_biosurv/>).

The operational emphasis is on anticipation and rapid identification
of infectious disease crises that may either acutely disrupt medical
response or trigger community disintegration (i.e., voluntary evacuation).

Although increases in malaria cases have been documented in the past
and currently in Pakistan following monsoon-triggered flooding, we
have not found malaria to be acutely disruptive to ground medical
response as, for example, a cholera epidemic might.

The term 'disruption' is defined by strain to the point of acutely
and unexpectedly exceeding personnel and materiel resources.

Currently, despite the increase in cases, we have seen no evidence of
medical responders becoming acutely overwhelmed with malaria cases.

Should anyone on the readership have observed to the contrary, please
do let us know.

This operational emphasis certainly does not detract from the
necessary implementation of public health preventive measures such as
vector control.

Anticipatory analysis released on 24 Aug 2010 by EAS-P suggested that
we were entering peak seasonal malaria activity by October 2010,
which would decrease beginning in November 2010; however, this is a
tremendous generalization for a country with some degree of
variability in peak activity periods for vivax versus falciparum by month.

Clarity in regards to typical peak seasonal activity levels for
Plasmodium species, by specific locale in Pakistan, would better
inform anticipatory assessments such as those used in post-disaster settings.

--
James M. Wilson V, MD
Executive Director
Praecipio International
<jim.wilson@praecipiointernational.org>

[ProMED thanks Dr James M. Wilson V for his comments on the current
malaria situation in Pakistan. We will post further information on
the situation concerning outbreaks of infectious diseases following
the flooding as information becomes available. - Mod.EP]

UNDIAGNOSED FATAL ILLNESS - PAKISTAN: (KHYBER-PAKHTUNKHWA)
**********************************************************
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 27 Sep 2010
Source: PakTribune [edited]
<http://paktribune.com/news/index.shtml?231958>


2 people -- a young doctor and a Chinese engineer -- have died from a
mysterious disease, while a schoolboy was stated to be in a critical
condition at the Ayub Teaching Hospital (ATH) for the last one week,
official sources said.

The sources in the health department revealed that [these] patients
brought to the ATH from the flood-affected areas showed a decrease in
their blood clotting ability. The sources said the patients initially
suffered fever and headache followed by fits, and later their blood
platelets decreased.

The sudden death of a young resident medical officer, Dr H., caused by
the mysterious viral infection, has raised concern among the senior
doctors as well as the administration of the ATH. Deputy Medical
Superintendent of the Casualty Department of the ATH, Dr Junaid
Sarwar, told this [reporter] that Dr H. contracted fever in Bisham.
Later, investigation revealed that his platelet count dropped to the
range of 135 000 compared to the normal range of 150 000 to 300 000.
His fever was finally controlled on Sunday [19 Sep 2010], and he
rejoined the office. But on Tuesday [21 Sep 2010], he [collapsed] in
the washroom of the college hostel. He was rushed to the hospital's
emergency unit.

Another medical officer said that the ailing doctor's blood pressure
at that time was as low as 80/30, and emergency treatment was provided
to him. "Dr H. was conscious but suffering from severe headache at
that time. He fell unconscious after a few minutes and developed
regular fits," he recalled.

Medical specialists were immediately called; who recommended an MRI,
which diagnosed brain haemorrhage. The young doctor later died.

The younger brother of Dr H. has been showing the same symptoms for
the past few days. In a similar case, a Chinese engineer working in
Allai in Battagram district remained hospitalised at the Ayub Teaching
Hospital for a couple of days and later expired.

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

[The Ayub Teaching Hospital or ATH is a public sector, non-profit
tertiary level teaching hospital in Abbottabad, Khyber-Pakhtunkhwa
(previously the North-West Frontier Province), Pakistan. Established
in 1998, it has one of the largest 24-hour emergency centers in
Khyber-Pakhtunkhwa and caters to much of eastern Khyber-Pakhtunkhwa,
the Northern Areas of Pakistan, as well as certain parts of Azad
Kashmir (<http://en.wikipedia.org/wiki/Ayub_Teaching_Hospital>).

The signs and symptoms exhibited by the deceased doctor were similar
to those of Crimean-Congo hemorrhagic fever, and a hospital such as
the Ayub Hospital might be expected to make such a diagnosis rapidly
and take immediate steps to avoid nosocomial infection. It is not
stated whether the deceased doctor, his brother and the deceased
Chinese engineer had any contact with infected livestock or with each
other. Clarification and further information is awaited.

The HealthMap/ProMED-mail interactive map of Pakistan can be accessed
at: <http://healthmap.org/r/00tj>. - Mod.CP]

DENGUE/DHF UPDATE 2010 (50)
***************************
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] Nepal
[2] India (Delhi)
[3] India (Bihar)
[4] Pakistan (Kerachi)


******
[1] Nepal
Date: Mon 20 Sep 2010
Source: Xinhua Net [edited]
<http://news.xinhuanet.com/english2010/h ... 521157.htm>


At least 19 persons have died in a month, and more than 7000 have been
afflicted with dengue and viral fever in Chitwan in central Nepal, The
Himalayan Times daily reported on Monday [20 Sep 2010]. According to
Mahendra Prasad Shrestha, District Public Health Officer, 9 persons
have died of dengue and viral fever in Chitwan Medical College (CMC),
6 in Bharatpur Medical College and 4 in Bharatpur Hospital since the
spread of the diseases in the district in the last week of August 2010.

According to Dr Shital Adhikari, head of the Medical Department of
CMC, 40 patients with dengue fever were visiting the hospital daily,
and at least 12 of them had tested positive for dengue.

[Editor: Deng Shasha]

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

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

******
[2] India (Delhi)
Date: Sun 26 Sep 2010
Source: The Times of India [edited]
<http://timesofindia.indiatimes.com/city ... 31556.cmsl>


Dengue continues to surge in the national capital, with 95 more cases
being reported on Sunday [26 Sep 2010], taking the total number of
people infected with the mosquito-borne disease to 2916, an official
said. This year, 5 people have succumbed to dengue in the capital,
including one from outside Delhi, a Municipal Corporation of Delhi
(MCD) official said.

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

[Since patients coming to private clinics and hospitals may not be
reported officially, this number is probably a significant
under-estimate of the actual number of cases.

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

******
[3] India (Bihar)
Date: Wed 22 Sep 2010
Source: Data News & Analysis [edited]
<http://www.dnaindia.com/india/report_de ... ve_1441588>


In the Munger district of Bihar, 6 people have died so far due to the
outbreak of dengue, while 518 others have tested positive, official
sources said today [22 Sep 2010]. Unofficial sources have, however,
claimed that the number of casualties due to suspected mosquito-bred
[transmitted] fever [virus] stands at 27. As many as 518 out of 1361
people diagnosed for symptoms of the dengue fever have tested
positive, officials said.

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

[A map of India showing the location of Bihar state in the far
northeast can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.
- Mod.TY]

******
[4] Pakistan (Karachi)
Date: Thu 23 Sep 2030
Source: Daily Times [edited]
<http://www.dailytimes.com.pk/default.as ... 010_pg12_5>


Officials said the number of citizens affected with dengue virus has
also increased in the province, as 13 new cases were reported during
the last 24 hours; 9 of them were admitted [to hospital], while 4 were
sent home, they added. According to the Provincial Dengue Surveillance
Cell, the total number of dengue cases reported this year [2010] was
356, of which 216 people were tested positive; while one person, who
was taken to a private hospital on 10 Sep [2010], died on 21 Sep [2010].

[Byline: Irfan Aligi]

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

[The 26 Sep 2010 edition of The Business Recorder
(<http://beta.brecorder.com/section/37/1/ ... rachi.html>) reported a 2nd death in Karachi
city.

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]

Indien - Chikungunya (CHIC), Dengue (DEN)
28.09.2010

Beide grippeähnlichen Erkrankungen kommen in Indien regelmäßig vor. Mit einem stärkeren Übertragungsrisiko und höheren Fallzahlen ist vor allem während und nach den Regenzeiten zu rechnen. Aus Delhi wird ein Ausbruch mit mit mehr als 1.900 Dengue-Erkrankungen und 5 Todesfällen gemeldet. Allein 700 Erkrankungen wurden in den ersten beiden Septemberwochen registriert. Auch in folgenden Bundesstaaten sind Dengue-Fälle aufgetreten: in Orissa (Makangiri-Distrikt) 50 und 7 Todesfälle, in Bihar 169 und 2 Todesfälle und in Assam mindestens 10 Erkrankungen. Während es DEN in Indien schon immer gab, führte CHIC in den letzten drei Jahren zu größeren regionalen Ausbrüchen, im vergangenen Jahr insbesondere im Südwesten des Landes. Schutz vor tagaktiven Überträgermücken (Aedes-Arten) beachten. / Quelle: crm

UNDIAGNOSED FATAL ILLNESS - PAKISTAN (02): (KHYBER-PAKHTUNKHWA)
***************************************************************
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 28 Sep 2010
Source: Express Tribune [edited]
<http://tribune.com.pk/story/55638/ten-d ... se-in-dir/>


10 die of mysterious disease in Dir
-----------------------------------
A total of 10 people have died of an unknown disease in Lower Dir
while another 15 have been shifted to a hospital with the same
symptoms. According to locals, the disease broke out around 15 days
ago, with symptoms of severe temperature and body ache which resulted
in death within 2 weeks. Doctors say the symptoms of the disease are
similar to dengue [fever]. The blood samples of the affected persons
have been sent to the National Institute of Health in Islamabad; 3
critically ill patients have been shifted to Khyber Teaching Hospital,
Peshawar, where they are being kept in an isolation ward.

One [suspected] dengue patient was diagnosed with the Crimean-Congo
hemorrhagic fever (CCHF) virus infection in Karachi, causing alarm in
the city.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The description of the symptoms of the illness responsible for the 10
fatalities and 15 hospitalised cases in Lower Dir is not sufficient to
suggest a diagnosis. Dengue fever appears to have been excluded, but
CCHF virus infection remains a possibility. It is unclear at present
if there is any similarity between this outbreak and the deaths of
patients at the Ayub Hospital Abbottabad, also in Khyber-Pakhtunkhwa
(see the preceding ProMED-mail report, archive number 20100927.3505).
Further information would be welcomed.

Dir is a town in Upper Dir District, Khyber-Pakhtunkhwa province
(formerly North-West Frontier Province), Pakistan. It lies at the foot
of the Lowarai Pass, the main motor road to Chitral, on the Dir River,
a tributary of the Panjkora River. The HealthMap/ProMED-mail
interactive map of Pakistan can be accessed at:
<http://healthmap.org/r/00tj>. - Mod.CP]

CHIKUNGUNYA AND DENGUE - INDIA (02): (DELHI)
********************************************
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] Chikungunya
Date: Thu 23 Sep 2010
Source: Mid Day [edited]
<http://www.mid-day.com/news/2010/sep/23 ... -delhi.htm>


Now adding to its woes, chikungunya [virus infection] has made a
comeback in the national capital. The city reported 6 new cases of the
viral disease on Wednesday [22 Sep 2010], taking the total number of
cases in Delhi to 8. As per the report released by the Municipal
Corporation of Delhi (MCD), the figure last year was nil. According
to health department officials, the vector which carries dengue is
also responsible for spreading chikungunya.

The cases were reported from the Palam area in outer Delhi. They were
initially reported to Public Health Centre Palam. A medical team from
Lady Hardinge Medical College (LHMC) took the samples and found them
to be positive.

MCD has deployed a number of specialists to find the source of the
disease. "We have deputed a team of entomologists and epidemiologists
to find the source of infection. They will take appropriate action to
check breeding of mosquitoes and elimination of adult mosquitoes in
the area. Chikungunya [virus] is also spread by the vector _Aedes_.
But the virus is different from dengue," said Dr V K Monga, chairman
MCD.

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

[The transmission of chikungunya virus in Delhi, along with dengue
virus, is not surprising. India is endemic for both viruses, and
apparently Delhi has an abundance of _Aedes_ mosquito vectors, which
are transmitting both viruses. Since there is no commercially
available vaccine for either of the viruses, the only feasible control
measure is vector control, with emphasis on eliminating breeding sites
in and around buildings. The appearance of chikungunya virus
infections is not good news for the upcoming Commonwealth Games, which
is suffering infrastructure problems as well.

A HealthMap/ProMED-mail interactive map of India, showing the location
of Delhi, can be accessed at
<http://healthmap.org/promed/en?v=22.9,79.6,5>. - Mod.TY]

******
[2] Dengue
Date: Mon 27 Sep 2010
Source: The Times of India [edited]
<http://timesofindia.indiatimes.com/city ... 637164.cms>


With just 5 days left for the Commonwealth Games in Delhi, the city
continued to grapple with a dengue outbreak as cases of the
vector-borne disease reached 3013 after 97 more patients tested
positive. The capital has reported 5 dengue deaths this season. South
Delhi continued to be worst-affected this season recording 437 cases,
followed by MCD Civil Lines Zone (392), Rohini (354) and Central Zone
(337). The civic bodies are attributing the rapid increase in dengue
cases this season to prolonged monsoon and stagnation of water at
Commonwealth Games construction sites.

The dengue outbreak has also raised concern among several countries
which are sending teams to participate in the Games to be held here
next month [October 2010]. India has issued a health advisory for
participants and visitors coming for the event asking them to take
precautions like carrying full-sleeve clothes and bringing mosquito
repellent creams, oils, mats or coils. The government yesterday sought
to play down concerns over dengue during the Games saying the
prevalent variant of the mosquito-borne disease was not very
dangerous. "Dengue count in the country is still low. The type of
vector-borne disease [virus] is subtype 3, which is not very
dangerous," Union health minister Ghulam Nabi Azad had said.

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

[The current outbreak was 1st reported in mid-July 2010 and has been
steadily increasing ever since. Declaring that dengue virus 3 is "not
very dangerous" is not supported by the facts. The hospitalized cases
and the families of the 5 fatal cases in Delhi would certainly not
agree with that statement. The dengue virus 3 Asian subtype has been
especially virulent in South and Central America, although its genetic
relationship to the dengue virus 3 currently circulating is Delhi is
not known. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (21): (UTTAR PRADESH)
*************************************************************
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ProMED-mail is a program of the
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<http://www.isid.org>

******
[1]
Date: Sat 25 Sep 2010
Source: NetIndia 23 [edited]
<http://www.netindia123.com/showdetails. ... &cat=India>


The vector-borne deadly Japanese encephalitis (JE) [virus] toll in
eastern Uttar Pradesh today reached 346, following the death of 5 more
children in the last 24 hours. Official sources said so far 2281
patients had reported at the Baba Raghav Das Medical College here and
other district hospitals in the division, of which 346, including 37
from Bihar and one from Nepal had died. Since yesterday [24 Sep 2010],
50 fresh JE cases had come to light. Almost 270 JE patients were still
convalescing at the various hospitals.

JE patients mostly trickle from Gorakhpur, Maharajganj, Sant
Kabirnagar, Deoria, Kushinagar, Basti, Siddharthnagar, Azamgarh,
Gonda, Bahraich, Mau, Ballia and Balrampur districts of UP.

Gorakhpur has the dubious distinction of being the JE epicentre in the
region. The endemic afflicts eastern Uttar Pradesh during monsoon
every year and continues to take people into its jaws till the onset
of winter.

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

[The death toll from encephalitis in the UP has increased from 319 on
20 Sep 2010 to 346 in this report. This report implies that all cases
are due to Japanese encephalitis (JE) virus. However, previous reports
indicate that not all cases are due to Japanese encephalitis virus
(JEV) and the majority are caused by a different virus (perhaps an
enterovirus).

A map showing the location of Uttar Pradesh state can be accessed at
<http://www.indianorphanages.net/images/ ... al-map.gif>. A
HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/02lp>. - Mod.TY]

******
[2]
Date: Tue 31 Aug 2010
Source: NDTV [edited]
<http://www.ndtv.com/article/india/encep ... e-48374?cp>


Since 2005, more than 3000 children have died of Japanese encephalitis
in the state. Experts believe the reason behind this is a failed
vaccine drive. Every year, the Centre is unable to provide the
required number of vaccines on time. And whatever little arrives, even
that is not fully used by the state. "Yes, it has been some sort of
failure," admits the state's Additional Director (Health), UK Srivastav.

"If the Centre could not provide the vaccine, isn't it the duty of the
state to source it? The vaccines cost barely 30-odd crores [USD
670,600] which is nothing compared to the thousands of crores spent on
building memorials" [a crore is a unit in the Indian numbering system
equal to 10 million. - Mod.TY] says Dr. RMD Agarwal, a paediatrician
and a BJP MLA [Member of Legislative Assembly].

The 1st bad strike of Japanese encephalitis came in the 2005 monsoons.
To stem it, in 2006, a vaccination drive was introduced, but reports
suggest that only 35 percent of children were actually immunized. For
the next 3 years, no child got the vaccine. And now in 2010, as the
disease returns with a vengeance, the vaccines the Centre had rushed
to UP turned out to be of such poor quality that they were completely
unusable. The next vaccination drive is planned for November 2010.

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

[ProMED thanks Ronan Kelly for forwarding the above report. It was in
response to the question posed by Mod.TY about the vaccination efforts
in this area of UP. The above report goes on to further express the
local pediatrician's frustration and criticism about the lack of
effective JE virus vaccination efforts.

JAPANESE ENCEPHALITIS AND OTHER - INDIA (22): (UTTAR PRADESH)
*************************************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
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<http://www.isid.org>

Date: Tue 28 Sep 2010
Source: Net India 123 [edited]
<http://www.netindia123.com/showdetails. ... oll+at+361>


The vector-borne deadly Japanese encephalitis (JE) toll in eastern
Uttar Pradesh today reached 361, following the deaths of 3 more
children in the last 24 hours. Official sources said so far, 2354 JE
patients had reported at the Baba Raghav Das Medical College here and
other district hospitals in the division, of which 361, including 38
from Bihar and one from Nepal had died.

Since yesterday, 31 new JE cases had come to light. Almost 272 JE
patients were still convalescing at the various hospitals. The newest
deaths included one each of Gorakhpur, Kushinagar and Bihar.

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

[The death toll from viral encephalitis in the UP continues to
steadily mount, having increased from 346 on 25 Sep 2010 to 361 in
this report. Once again, this report implies that all cases are due to
Japanese encephalitis (JE) virus. However, previous reports indicate
that not all cases are due to Japanese encephalitis virus (JEV) and
the majority are caused by a different virus (perhaps an enterovirus).

A map showing the location of Uttar Pradesh state can be accessed at
<http://www.indianorphanages.net/images/ ... al-map.gif>. A
HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/02lp>. - Mod.TY]

[It would be interesting to know the age group and JE vaccination
status of the cases. - Mod.JW]

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

Date: Thu 28 Sep 2010
Source: Hindustan Times
<http://www.hindustantimes.com/25-cases- ... 05487.aspx>


The Brihanmumbai Municipal Corporation's health department has
identified 3 areas in the city -- Kurla, Dharavi and Goreagon (East)
-- from where 25 cases of chikungunya [virus infection] have been
reported in September [2010]. "We are taking all precautions to ensure
that the number doesn't increase. We are conducting tests on patients
at Sion Hospital," said Dr GT Ambe, executive health officer. Congress
corporator Vinod Shekhar said: "There has been a sudden spurt of
chikungunya cases at Marine Drive and Cuffe Parade as well. The civic
body must take appropriate measures to ensure that the disease doesn't
spread," said Shekhar.

Chikungunya is a viral disease spread by the _Aedes_ mosquitoes. "We
are continuing the fogging activity that was started during the
monsoons," said Additional Municipal Commissioner Anil Diggikar. "We
are also collecting blood samples and sending them for tests."

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

Brihanmumbai Municipal Corporation (BMC) is the civic body that
governs the city of Mumbai. Reliance on fogging alone is likely to
provide only short-term vector control, if reduction of vector
mosquito breeding sites is not done also.

The 29 Sep 2010 issue of The Times of India
(<http://timesofindia.indiatimes.com/city ... 646690.cms>) reported that the city of Pune [also in Maharashtra state] had 41 cases of chikungunya virus
infection.

A HealthMap/ProMED-mail interactive map showing the location of
Maharashtra state on the west coast of India can be accessed at
<http://healthmap.org/r/00Zs>. - Mod.TY]

DENGUE/DHF UPDATE 2010 (51)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Pakistan (Sindh)
Date: Thu 30 Sep 2010
Source: The Frontier Post, Associated Press of Pakistan (APP) report [edited]
<http://www.thefrontierpost.com/News.asp ... qn&nid=609>


The total number of confirmed cases of dengue positives, during past
few months in Karachi had surged to 339 up to Tuesday [28 Sep 2010],
with the majority recuperated, said Dr Shakil Mallik, coordinator,
Dengue Surveillance Cell-Sindh. He told APP that the number of
DHF-induced deaths has turned [out] to be 4 while 6 other patients
are presumed to be in comparatively serious condition. The
Coordinator Dengue Surveillance Cell said 401 of the total 506
suspected cases were admitted to different hospitals for needed
medical assistance, during past few months.

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

[Providing care, treatment, and prevention of dengue under the
conditions inflicted by the recent terrible flooding would be an
extraordinarily difficult task.

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]

Indien - Chikungunya (CHIC), Dengue (DEN)
05.10.2010

Beide grippeähnlichen Erkrankungen kommen in Indien regelmäßig vor. Mit einem stärkeren Übertragungsrisiko und höheren Fallzahlen ist vor allem während und nach den Regenzeiten zu rechnen. Aus Delhi wird ein Ausbruch mit mit mehr als 2.900 Dengue-Erkrankungen und 5 Todesfällen gemeldet. Allein 700 Erkrankungen wurden in den ersten beiden Septemberwochen registriert. Auch in folgenden Bundesstaaten sind Dengue-Fälle aufgetreten: in Orissa (Makangiri-Distrikt) 50 Erkrankungen und 7 Todesfälle, in Bihar 518 Erkrankungen und 6 Todesfälle und in Assam mindestens 10 Erkrankungen. Während es DEN in Indien schon immer gab, führte CHIC in den letzten drei Jahren zu größeren regionalen Ausbrüchen, im vergangenen Jahr insbesondere im Südwesten des Landes. Aktuell werden vermehrt Fälle aus Delhi (Palam area), sowie dem Bundesstaat Maharashtra (Städte Kurla, Dharavi und Goreagon) gemeldet. Schutz vor tagaktiven Überträgermücken (Aedes-Arten) beachten. / Quelle: crm

UNDIAGNOSED FATAL ILLNESS - INDIA: (UTTAR PRADESH) 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: Mon 4 Oct 2010
Source: The Times of India (TOI), Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/city ... z11X3G4fLd>


Even as 13 persons, mostly minors, fell prey to mystery fever in
Ramabainagar district ([formerly] Kanpur Dehat) on Monday [4 Oct
2010], district officials claimed they were trying to contain the
spread of the disease which has claimed 180 lives so far. "As many as
14 medical teams and paramedical teams are working in the field. The
situation is being monitored in all the 82 affected villages,''
district magistrate Saroj Tewari told TOI. Children are especially
vulnerable to the killer virus, which was evident with 7 deaths of
minors in the district on Monday itself.

The DM [district magistrate] has ordered health authorities to launch
a massive cleanliness drive in all the villages. "Health teams have
been asked to spray insecticide in the affected areas and distribute
medicines to those down with fever,'' he added.

A resident of Akbarpur, said the deaths have created a scare among
the residents of Ramabainagar district. A public campaign has also
been launched and villagers are being asked to report any symptoms of
the disease as soon as possible. Health officials say the earlier it
is detected, the easier it is to cure. Chief medical officer,
Lajjaram said, "We are taking effective steps to curb the disease.''

The health authorities, who till now had been terming these patients
as suspected dengue, malaria, encephalitis, viral fever cases, said
that the campaign to investigate, control, and prevent spread of this
fever were being continuing. Of the 1172 persons who visited the
district hospital on Monday [4 Oct 2010], 207 were running fever. We
have started the treatment of 21 patients here,'' Akbarpur district
hospital authorities told TOI.

The continuous increase in the number of fever cases being reported
everyday is causing concern for the health authorities, more so
because the mystery fever seems to have spread to some more villages
of the district. In fact, the district health authorities are
consulting specialists at the state capital to ascertain the disease.

Meanwhile, medical experts said that the stagnant water after rains
in the region have only aggravated the problem, as mosquitoes would
get more breeding grounds. Though fogging operations have been
undertaken in the entire district particularly in Malasa, Amraudha,
and Akbarpur from where maximum number of patients have come, this
has not helped in stopping the fever from spreading.

[Byline: Faiz Rahman Siddiqui]

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

[The region where the cases are occurring is in mid-Uttar Pradesh,
and not in the eastern region of the state where the cases of
Japanese encephalitis and undiagnosed encephalitis cases have been
occurring recently. The distance between these 2 areas does not
exclude the possibility of JE virus infections in the outbreak above.
However, this report does not provide enough information to even
speculate on what the etiological agent involved in this outbreak
might be. The health authorities are apparently categorizing these
patients as suspected dengue, malaria, encephalitis, and viral fever
cases -- all caused by very different etiological agents. Viral fever
and encephalitis are general diagnoses and could be caused by several
different viruses, if indeed viruses are involved. The emphasis on
mosquito control implies vector transmission. The authorities are not
quoted as indicating which of these etiological agents have been
tested for nor on what basis mosquito transmission is suspected.

It is difficult to understand how health officials can state that "we
are taking effective steps to curb the disease,'' if they do not know
which etiological agent(s) is (are) causing the cases. It would be of
interest to know if Nipah virus infections have been tested for.
Nipah virus is endemic in _Pteropus_ fruit bats in the Indian
subcontinent and Southeast Asia, and transmission does not involve
arthropod vectors. The 7 Oct 2010 edition of the Press Trust of India
(<http://ptinews.com/news/965007_11-die-d ... -in-Kanpur>)
quoted local health authorities as saying that they do not have
adequate facilities to detect dengue cases and have to send the
samples to Lucknow, 150 km (93 mi) from Kampur. The test report takes
at least 3-4 days to come. ProMED-mail hopes that the test result for
dengue and other potential etiological agents will become available
soon and permit local health authorities to focus on appropriate
preventive measures. ProMED will be very interested in receiving
further information as it becomes available.

A map showing the location of the Ramabai Nagar District can be accessed at
<http://en.wikipedia.org/wiki/Ramabai_Nagar_district>.
A map showing the location of Uttar Pradesh state can be accessed at
<http://www.indianorphanages.net/images/ ... al-map.gif>.
A HealthMap/ProMED-mail interactive map showing India and Nepal is available at
<http://healthmap.org/r/0c2H>. - Mod.TY]

[ProMED-mail thanks Andrew S., Philadelphia, PA, USA ,
<mathleteowl@aol.com>mathleteowl@aol.com> for first drawing
our attention to this outbreak. - Mod.DK]

China - Chikungunya
08.10.2010

Anfang Oktober wurde erstmals ein Ausbruch der Virusinfektion in der Provinz Guandong (Wanjiang district) gemeldet. Bisher gibt es 10 bestätigte Fälle, 76 Personen warten noch auf die Testergebnisse. Schutz vor den tagaktiven Stechmücken beachten. / Quelle: crm
____________________

Indien - Chikungunya (CHIC), Dengue (DEN)
08.10.2010

Beide grippeähnlichen Erkrankungen kommen in Indien regelmäßig vor. Mit einem stärkeren Übertragungsrisiko und höheren Fallzahlen ist vor allem während und nach den Regenzeiten zu rechnen. Aus Delhi wird ein Ausbruch mit mit mehr als 3.600 Dengue-Erkrankungen und 5 Todesfällen gemeldet. Allein 700 Erkrankungen wurden in den ersten beiden Septemberwochen registriert. Auch in folgenden Bundesstaaten sind Dengue-Fälle aufgetreten: in Orissa (Makangiri-Distrikt) 50 Erkrankungen und 7 Todesfälle, in Bihar 518 Erkrankungen und 6 Todesfälle und in Assam mindestens 10 Erkrankungen. Während es DEN in Indien schon immer gab, führte CHIC in den letzten drei Jahren zu größeren regionalen Ausbrüchen, im vergangenen Jahr insbesondere im Südwesten des Landes. Aktuell werden vermehrt Fälle aus Delhi (Palam area), sowie dem Bundesstaat Maharashtra (Städte Kurla, Dharavi und Goreagon) gemeldet. Schutz vor tagaktiven Überträgermücken (Aedes-Arten) beachten. / Quelle: crm

China - Chikungunya
08.10.2010

Anfang Oktober wurde erstmals ein Ausbruch der Virusinfektion in der Provinz Guandong (Wanjiang district) gemeldet. Bisher gibt es 10 bestätigte Fälle, 76 Personen warten noch auf die Testergebnisse. Schutz vor den tagaktiven Stechmücken beachten. / Quelle: crm