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CHIKUNGUNYA AND DENGUE - INDIA (03): (DELHI)
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A ProMED-mail post
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 9 Oct 2010
Source: OneIndia News [edited]
<http://news.oneindia.in/2010/10/09/deng ... orted.html>


After a gap of one month, dengue fear hit the capital once again on Friday,
8 Oct [2010], when 79 new cases were reported. The total number of dengue
cases mounted to 3938, stated a hospital official on 8 Oct [2010]. [Thus
far] in 2010, 7 people have died of the mosquitoborne disease.

Along with the dengue cases, 20 new chikungunya cases have been reported
recently in the capital, which has been claimed to be one of the cleaned
cities for being the Commonwealth Games' organiser.

--
communicated by:
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<promed@promedmail.org>

[The previous ProMED-mail post (archive no. 20100929.3524) reported the
total number of chikungunya cases in Delhi at 8, as of 22 Sep 2010. Now,
the report above indicates that the total has reached 20. This is a mixed
chikungunya/dengue outbreak that shows no indication of slowing. Both
viruses are transmitted by the same _Aedes_ mosquito vector.

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

MALARIA - INDIA (09): (HARYANA)
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 11 Oct 2010
Source: Indian Express [edited]
<http://www.indianexpress.com/news/malar ... ed/695489/>


With more than 600 cases being reported from Bhatu Kalan, Ratia and Tohana
areas of the district, a malaria epidemic is under way. Stagnant water at
several places, mostly in the rural areas after heavy rains and floods, is
being blamed for the outbreak. The actual number of cases may be higher,
however, as many patients are being treated in private hospitals and clinics.

The health department has started measures to create awareness among the
people. "The most number of cases have been reported from Bhattu Kalan. We
have managed to contain the spread of malaria in other parts of the state,"
said Dr Narbir Singh, director general, Health Services (DGHS), Haryana.

Besides malaria, as many as 237 cases of dengue, 348 cases of Japanese
encephalitis and 127 cases of swine flu have been reported from various
parts of the state, mostly from Gurgaon and Faridabad districts.

--
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[Fatehabad district is located in the south western part of Haryana. It is
surrounded by Punjab in the north, district Hisar in the south, district
Jind in the east, and Rajasthan and district Sirsa in the west.

According to the World Malaria Report 2009
(<http://www.who.int/malaria/publications ... index.html>),
Fatenabad is a high risk area (defined as having between 1-100 malaria
cases per 1000 population per year). - Mod.EP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (23): (UTTAR PRADESH)
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Date: Tue 12 Oct 2010
Source: The Indian Express [edited]
<http://www.indianexpress.com/news/aes-t ... th/696116/>


Acute encephalitis syndrome (AES) has taken a heavy toll in the state [of
Uttar Pradesh], with 125 deaths reportedly caused by the disease in the
last one month alone. In 2009, by October, the total cases of AES in the
state were reported to be 2300 with 357 deaths. However, this year [2010],
the cases have already risen to 2538, with 369 deaths. In the last one
month, more than 950 patients of AES have tested positive across 14
districts of the state [tested positive for what? - Mod.TY]

The largest number of deaths -- 105 -- have occurred in Gorakhpur district,
while the toll in Kushinagar is 96. Deoriya has reported 57 deaths and
Maharajganj around 40. Of the 2538 cases, more than 2400 patients were
admitted in BRD Medical College, Gorakhpur alone. "These are not exact
figures as we don't track patients going to private practitioners," said Dr
KP Kushwaha of BRD Medical College, Gorakhpur.

[byline: Surbhi Khyati]

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[The numbers of cases continue to increase, and the reports of this
outbreak continue to be confusing. The last report (28 Sep 2010,
ProMED-mail archive no. 20101001.3568) attributed the cases to Japanese
encephalitis virus (JEV) infections. However, reports before that indicated
that less than half the "acute encephalitis syndrome" cases were shown to
be caused by JEV infection. One earlier report associated the cases with
water, suggesting enterovirus infections. The report above simply
classifies them as "acute encephalitis syndrome" with no indication of what
etiological agent(s) might be involved, nor if samples have been sent to a
reference laboratory for testing, although the report states that they
"tested positive".

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]

UNDIAGNOSED FATAL ILLNESS - INDIA (02): (UTTAR PRADESH) REQUEST FOR
INFORMATION
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Date: Sun 10 Oct 2010
Source: The Times of India (TOI), Times News Network (TNN) [summ., edited]
<http://timesofindia.indiatimes.com/city ... 725356.cms>


The total toll from "mysterious" fever has continued to escalate with 13
more deaths reported from Ramabai Nagar district ([formerly] Kanpur Dehat)
on Sunday [10 Oct 2010]. More and more people infected with the
unidentified virus have flocked the district hospital in Akbarpur. So far,
256 people have already died during the past few days. A team of district
officials visited the affected villages on Sunday [10 Oct 2010] to
ascertain the facts and figures of human casualties. It has been learnt
during the visit that as many as 400 people, most of whom are minors, are
down with fever.

The disease started from Ahrauli Sheikh village in Amraudha block and
within a month spread to 48 villages, housing 3000 families. It was also
learnt that the infants who fell victim to the disease were suffering from
acute malnutrition. "The infants were suffering from malnutrition and that
made some of them vulnerable to the killer virus," said district nodal
officer (epidemic) Arvind Sachan.

[byline: Faiz Rahman Siddiqui]

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[This report provides no additional information about the nature of the
disease (other than fever), nor its likely etiological agent (other than
"killer virus") beyond similar statements in the 1st report of 4 Oct 2010
(cited below). There has been a significant increase in the number of fatal
cases, from 180 in the 4 Oct 2010 report to 256 indicated above. In the
absence of additional information, it is impossible to speculate rationally
about what is going on in this outbreak. Sadly, the complete article goes
on at some length about complaints by local people charging inadequate
availability of medical facilities and attention in this area. If samples
have been collected and sent to a reference laboratory, ProMED-mail would
be interested in receiving information about the results as they become
available.

A map showing the location of the Ramabai Nagar District can be accessed at
<http://en.wikipedia.org/wiki/Ramabai_Nagar_district>. A
HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/0c2H>. - Mod.TY]

MALARIA - PAKISTAN (03): POST FLOODING RISK
*******************************************
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 13 Oct 2010
Source: UN.org [edited]
<http://www.un.org/apps/news/story.asp?N ... istan&Cr1=>


Nearly 300 000 suspected malaria cases, including some confirmed cases of a
severe form of the disease, have been recorded in flood-affected areas of
Pakistan since the end of July 2010, with the overall incidence slightly
above the average seasonal outbreak, the United Nations health agency said
today [13 Oct 2010].

The UN World Health Organization (WHO) is supporting the Pakistan health
ministry's malaria control programme, as well as aid agencies working in
the health sector, to control the epidemic. The agency is coordinating the
deployment of preventive and curative measures.

Malaria is endemic in rural areas of Pakistan where there are 2 seasonal
peaks, in August, when the milder vivax-malaria is mostly seen, and
October, when the potentially fatal falciparum-malaria is common.

More than one million malaria cases are registered annually, but 12 per
cent of people living in rural areas are infected by malaria parasites
without showing symptoms of the disease.

Balochistan province has recorded the largest number of consultations for
suspected malaria, while an increasing number of cases are also being
reported in Punjab and Sindh provinces, according to WHO's Disease Early
Warning System and the ministry of health.

The rising number of cases is the result of the floods that have displaced
millions of people, forcing many into poor shelter, where they are exposed
to mosquito bites. Pools of stagnant water are ideal breeding sites for
_Anopheles_ mosquitoes, the malaria vector.

"The total number of suspected malaria cases reported in flood-affected
districts is only slightly higher than at the same period in previous
years. However, falciparum-malaria needs special consideration as it is
responsible for severe cases, and it can be fatal," said Guido Sabatinelli,
the WHO Representative in Pakistan.

Communicable disease surveillance of all epidemic-prone diseases has been
strengthened, and malaria experts are currently visiting Sindh, Punjab and
Balochistan provinces to assist the health ministry in conducting outbreak
investigation, training and other malaria control activities.

The United States Agency for International Development has donated USD 5
million, through WHO, for malaria prevention and control activities in
flood-affected districts of Pakistan. As part of its response, WHO has
provided 320 700 rapid diagnostic tests kits and procured 145 000
long-lasting insecticidal nets. The agency last week dispatched 55 000
arthemisine-based combination treatments (ACT) for falciparum-malaria and
30 000 primaquine tablets to treat vivax-malaria.

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[It is comforting that the number of malaria cases is just slightly above
average despite the flooding. - Mod.EP

The HealthMap/ProMED-mail interactive map of Pakistan is available at
<http://healthmap.org/r/0cco>. - Mod.SH]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (24): (UTTAR PRADESH)
*************************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 13 Oct 2010
Source: NDTV, Press Trust of India report [edited]
<http://www.ndtv.com/article/india/uttar ... -414-59554>


In Gorakhpur during the last 24 hours, 4 people succumbed to encephalitis
at Baba Raghav Das Medical College hospital [BRD MCH], taking the death
toll to 414 in the eastern region of Uttar Pradesh, a health official said
on Wednesday [13 Oct 2010]. Additional director (Health) UK Srivastav said
the dead include one each from Gorakhpur, Mahrajganj, Gonda, and Ballia
districts. A total of 34 new patients have been admitted to this hospital
during the same period, he said.

Of the total 414 deaths so far, 386 deaths occurred in BRD MCH while the
remaining were reported from other state-run hospitals of the region --
Gorakhpur, Basti, Deoria, Siddharthnagar, Kushinagar, and Maharajganj
districts. As many as 290 patients are presently undergoing treatment at
the BRD MCH and 19 in other government hospitals for the disease, he said.

--
communicated by:
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[The number of fatalities continues to increase -- from 369 reported on 12
Oct 2010 to 414 just one day later (13 Oct 2010) in the current report. If
these reported figures and dates are accurate, the outbreak appears to be
accelerating. There is still no indication of identification of a specific
etiological agent responsible for the encephalitis cases.

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]

LEISHMANIASIS - AFGHANISTAN
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu, 14 Oct 2010
Source: Government of the Islamic Republic of Afghanistan; World Health
Organization [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


13 million Afghans at risk of contracting leishmaniasis
-------------------------------------------------------
The World Health Organization (WHO) today launched its 1st global report on
neglected tropical diseases. In the light of an ongoing leishmaniasis
outbreak in Herat, Afghanistan, WHO -- along with the Ministry of Public
Health and the Afghan Red Crescent Society -- used this opportunity to
raise awareness about and advocate for neglected diseases in Afghanistan,
with special emphasis on leishmaniasis, a disease that threatens the health
of 13 million vulnerable Afghans, especially women and girls.

In Kabul, commonly considered as the world capital of [cutaneous]
leishmaniasis, the number of new reported cases rose dramatically from the
estimated yearly figure of 17 000 to 65 000 in 2009, mainly among women and
girls.

"This number is likely to be the tip of the iceberg as cases are grossly
underreported owing to poor diagnostic tools and the stigma that is
attached to this disease," said Peter Graaff, WHO representative to
Afghanistan.

[Cutaneous] leishmaniasis is a parasitic disease transmitted through the
bite of certain species of sandfly. The major symptom is skin sores which
erupt weeks to months after the person has been bitten.

Leishmaniasis is both preventable and curable. Preventable through bed
nets, and curable through medical treatment. "The high cost of treatment
makes it difficult to integrate anti-leishmaniasis drugs into the Basic
Package of Health Services," said Her Excellency Dr Suraya Dalil, acting
minister of public health. "I urge donors to take this cause seriously, as
it causes unnecessary suffering amongst a large number of Afghans."

"Addressing stigma, early diagnosis and early treatment is the way to go
about tackling this disease," said Fatima Gilani, director of the Afghan
Red Crescent Society. "Protecting people from leishmaniasis is affording
them the right to life with dignity."

For more information, please contact:
Dr Kargar Nooroghli, Ministry of Public Health
Walid Akbar Sarwary, Afghan Red Crescent Society
Aanchal Khurana, World Health Organization
<KhuranaA@afg.emro.who.int>

--
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[In ProMED-mail's last posting on leishmaniasis in Afghanistan, we cited a
study finding that 8.3 per cent of children had signs of cutaneous
leishmaniasis (Leishmaniasis ­ Afghanistan 20070508.1487). The estimated
population of Afghanistan is about 30 million, with an expected lifespan at
birth of 44 years for both males and females
(<http://data.worldbank.org/country/afghanistan>). Leishmania was ignored
under the Taliban regime and appeared as a major health problem after the
fall of that regime. - Mod.EP

The HealthMap/ProMED-mail interactive map of Afghanistan can be accessed at
<http://healthmap.org/r/0c2A>. - Mod.SH]

LEISHMANIASIS - AFGHANISTAN (02)
********************************
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: 15 Oct 2010
Source: Yahoo [edited]
<http://news.yahoo.com/s/ap/20101015/ap_ ... ng_disease>


An outbreak of a leishmaniasis caused [transmitted] by sand fly bites that
leaves disfiguring skin sores has hit Afghanistan, with tens of thousands
of people infected, health officials said on Friday [15 Oct 2010].

Cutaneous leishmaniasis is a parasitic disease transmitted by the female
phlebotomine sand fly. Treatable with medication and not life-threatening,
cutaneous leishmaniasis can leave severe scars on the bodies of victims.

The disease threatens 13 million people in Afghanistan, the World Health
Organization (WHO) said, and many impoverished Afghan victims can't afford
the medication to treat it.

In Kabul -- described by WHO as "the world capital of cutaneous
leishmaniasis" -- the number of cases jumped from an estimated 17 000 a
year in the early 2000s to 65 000 in 2009, WHO said.

Most victims are women and children. WHO said women and children are more
vulnerable because they mostly live indoors at night, where the sand flies
prefer to bite, and are therefore more susceptible than men who are
generally outside the home.

Peter Graaff, WHO representative to Afghanistan, told The Associated Press
on Friday that the stigma and shame attached to the disfiguring disease
results in underreporting, and the number of infected people is likely much
higher. "This number is likely to be the tip of the iceberg as cases are
grossly underreported," said Graaff. An outbreak has occurred in a small
village in western Herat province's Kohsan district with 63 people infected
since August [2010], Graaff said. The cause of the outbreak was unknown and
a WHO team has been dispatched to investigate, he said.

The sand flies proliferate from June to September. They thrive in
unsanitary conditions such as piles of garbage and debris, though bed nets
offer protection from their bites. As the disfiguring sores grow larger,
many suffer social stigmatization.

"The high cost of treatment makes it difficult to integrate
anti-Leishmaniasis drugs," said Dr Suraya Dalil, acting minister of public
health. "I urge donors to take this cause seriously, as it causes
unnecessary suffering amongst a large number of Afghans."

According to WHO as many as 12 million people are infected worldwide with
the with about 1 million to 2 million new cases annually.

[byline: Joe Shea, Editor-in-Chief, The American Reporter <amreporter@aol.com>]

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[ProMED-mail thanks Joe Shea for forwarding further information. The
increase in cases in Kabul coincide with the increasing number of
inhabitants in Kabul and leishmaniasis has been endemic in Afghanistan for
decades. - Mod.EP

The HealthMap/ProMED-mail interactive map of Afghanistan can be accessed at
<http://healthmap.org/r/0c2A>. - Mod.SH]

RABIES, CANINE, HUMAN - INDIA (03): (MUMBAI)
*******************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 17 Oct 2010
Source: The Times of India, Mumbai [edited]
<http://timesofindia.indiatimes.com/city ... 765705.cms>


In what seems to be a case of negligence on the part of parents, a
4-year-old girl from Saki Naka [suburb] succumbed to rabies a month
after she was bitten by a dog. She was only recently admitted to Nair
Hospital, where she died on Friday [15 Oct 2010], the police said.

However, the parents, who claimed that they were not able to afford
the rabies vaccine, have been given a clean chit by the police. This,
despite the BMC [Brihanmumbai Municipal Corporation] officials
claiming that the vaccine is available free of cost at all civic
hospitals in the city. The father of the victim said that the child
had been bitten by a stray [dog] in September 2010 when she was
playing outside their residence at Yadav Nagar on Khairani Road. "We
gave her first aid then. We also gave her medicines. The child
started behaving abnormally on Thursday [14 Oct 2010]. She would bark
and scratch the walls," he told the police.

According to the police, the father works with a private firm and
hails from a lower-middle class family. "The girl's parents could not
afford the cost of the rabies vaccine, so they treated her at home,"
said a police officer. The Saki Naka police learnt about the girl's
death from the hospital authorities. After investigating the matter,
the police issued a no-objection certificate (NOC) to the family to
perform the girl's last rites. "The NOC has to be submitted to the
crematorium office before one can carry out the last rites," senior
inspector S R Dhanedhar said. A police officer said that the girl's
parents completed the formalities and even submitted the doctor's
certificate before the NOC was issued. "We found that the family
claims were genuine, and there was no foul play in the matter," said
the officer.

According to Dr Sameer Dalwai of the Indian Academy of Paediatrics,
"Though we rarely see rabies patients in the city, such incidents
show that there is still a need to create awareness about this
disease." Public sector hospitals offer anti-rabies injection for
free. It costs Rs 250 [about USD 5.70] per shot at private hospitals.
Dr G Ambe, executive health officer of the BMC, said, "All our
hospitals give the vaccine free of cost. It is also available at some
of our dispensaries." He added that on an average, there are only
around 19 cases of rabies per year. "About 1/3rd of these cases of
rabies are from Mumbai, while the rest come to the city from
elsewhere for specialized treatment available at Nair and KEM
Hospitals," he added.

[Byline: V. Narayan]

--
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[A tragic tale of the unnecessary death of a child in the conurbation
of Mumbai, following a dog-bite, due directly to apparent parental
and official (the police) ignorance, despite the availability of free
anti-rabies vaccine in all city hospitals. ProMED-mail hopes that
this Times of India story will help to avoid such incidents in the
future.

The central suburb of Saki Naka can be located in the map of the city
of Mumbai at
<http://www.mapsofindia.com/maps/maharas ... ai-map.htm>. The
HealthMap/ProMED-mail interactive map of India is available at:
<http://healthmap.org/r/008o>. - Mod.CP]

UNDIAGNOSED FATAL ILLNESS - INDIA (03): (UTTAR PRADESH) REQUEST FOR INFORMATION
**************************************************************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 18 Oct 2010
Source: FluTrackers.com, Media Alert report from the Media Scanning &
Verification Cell, IDSP-NCDC (Integrated Disease Surveillance Project,
National Centre for Disease Control [edited]
<http://www.flutrackers.com/forum/showth ... p?t=153918>


9 deaths due to mystery fever in Lucknow district, Uttar Pradesh
----------------------------------------------------------------
At least 9 people died of a mysterious fever in Lucknow on Saturday [16 Oct
2010]. A team of doctors from the health department has reached Khadra on the
outskirts of Lucknow on Sunday [17 Oct 2010] but hasn't been able to ascertain
what has caused the outbreak.

A 22-year-old man, who had been suffering from mild fever for the past 3 days,
was the 1st casualty. He died about 5 pm at his residence in Roopnagar colony,
Khadra. Subsequently, 8 individuals ([ages] 5, 25, 26, 28, 40, 41, 56, and 60),
who were also suffering from fever, died. The majority of victims had been
undergoing treatment at government hospitals. Chief medical officer AK Shukla
confirmed the deaths. He said the 26-year-old had been suffering from malarial
fever, while the 5 and 40-year-old died because of wrong treatment. "Both were
suffering from a common form of viral fever but the line of medication
administered to them was wrong. We are trying to find out the reasons behind
the death of the other patients as well. It is a serious lapse. We have
deployed a team of doctors there to diagnose all the residents who were down
with fever," Dr Shukla said.

"At least 200 people are suffering from fever in Khadra. Registered medical
practitioners have treated many of them. They are within our reach," he said.
The child's father said the residents had also informed the health department,
the municipal corporation, and the district administration about the outbreak.
According to him, more than 30 locals had died in the past 2 weeks. The team of
doctors reached the area only on Sunday [17 Oct 2010] though. " They claimed
the 25-year-old died of malaria. But we know he had no symptoms of the disease
and the health department has no facility to diagnose the other diseased [other
diseases? the other diseased individuals? - Mod.TY]," the 5-year-old's father
added.

--
Communicated by:


[Apparently, this is not just an increase of the undiagnosed fatal fever
outbreak that has been occurring in the Ramabai Nagar District of Uttar
Pradesh. It appears to be a 2nd focal outbreak. There are no detailed reports
of symptoms, other than fever and death, in either of these outbreaks.
ProMED-mail awaits with interest the report of the medical team that visited
the above outbreak site.

A map of the districts of Uttar Pradesh, showing the location of Lucknow
district can be accessed at
<http://en.wikipedia.org/wiki/File:Uttar ... Detail.svg>.
A HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/0dW6>. - Mod.TY]

CHIKUNGUNYA AND DENGUE - INDIA (04): (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>

Date: Tue 19 Oct 2010
Source: Prensa Latina [in Spanish, trans. Corr.SB, edited]
<http://www.prensa-latina.cu/index.php?o ... 5&Itemid=1>



At least 33 cases of chikungunya, a mosquito-borne virus, were
reported today [19 Oct 2010] in the Indian capital [Delhi], whose
health authorities already have their hands full with an outbreak of
dengue. According to the chairman of the Delhi Public Health
Committee, VK Monga, all patients identified so far, except one, are
people who have not left the city, so we could be in the presence of
local transmission of the virus.

Last year [2009] only 12 cases of chikungunya were found in Delhi,
and all were individuals who had traveled to Kerala and other
southern states of India which have a high incidence of chikungunya,
Monga said, quoted on Tuesday [19 Oct 2010] by the local media.

He also said that the capital's health authorities to begin to
educate people about the characteristics of the virus, whose symptoms
are similar to those of dengue fever, another disease that had by
yesterday [18 Oct 2010] infected 4614 people in the Indian capital.
[Doubtless significantly underreported, as cases attended in private
clinics are not required to be reported, which may be the situation
for chikungunya virus infections as well. - Mod.TY]

Chikungunya was 1st isolated in 1953, in Tanzania, and since then has
appeared repeatedly in parts of Africa and Southeast Asia. It has
also been reported in some Indian Ocean islands. The disease, whose
symptoms are headache and joint pain, fever, nausea, vomiting and
dizziness, is transmitted to humans by mosquitoes of the genus _Aedes
(aegypti_, albopictus_ and _polynesiensis_). Monkeys and other wild
animals that abound in the Indian capital are natural reservoirs of
chikungunya [virus].

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Communicated by:
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<promed@promedmail.org>

[A previous ProMED-mail post (archive no. 20100929.3524) provided the
1st 2010 report of chikungunya cases in Delhi numbering 8, as of 22
Sep 2010. Now, the report above indicates that the total has reached
33, a month later. No evidence is provided to state that monkeys and
other wild animals are, indeed, chikungunya virus reservoirs in Delhi
city. It is much more likely that a viremic person came from an
endemic area in southern India and triggered the outbreak in Delhi.

There are certainly ample _Aedes_ mosquito chickungunya virus vectors
present in the city, since they have been transmitting dengue virus
there for several weeks. The public information effort is reported to
be focused on "virus characteristics" that may, or may not, include
control of the vector -- the only feasible approach to halting both
the dengue and the chikungunya outbreaks. An alert ProMED-mail
subscriber pointed out that the term "chikungunya" is not a Swahili
word, rather a Makonde Bantu word for "contortion."

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

MALARIA - INDIA (10)
********************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this posting:
[1] Karnataka
[2] Andhra Pradesh
[3] National

******
[1] Karnataka
Date: Tue 19 Oct 2010
Source: Express News Service [edited]
<http://expressbuzz.com/states/karnataka ... 16228.html>


A total of 4 persons reportedly died of malaria in Bhuvanahalli in
Hospet taluk [an administrative subdivision of a district] on Sunday
[17 Oct 2010].

District health officer Dr Srikanth Dasanur, who confirmed the deaths
in Bhuvanahalli, said that some people were suffering from fever in
Kotaginahal and Bhuvanahalli for some days. Unhygienic conditions and
contaminated water in rural areas is said to be the reason for the
deaths. He also said that a 16 member health team was camping in the
village and blood samples of around 290 persons have been sent for
testing.

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

[Malaria is common in north eastern Karnataka, and the recent WHO
World Malaria Report 2009 (latest) shows more than 100 cases per 1000
population in this area
(<http://www.who.int/malaria/world_malari ... t_2009/en/>). The
fatal cases here, presumed to be malaria, highlight that the area is
a high risk area for malaria.

Hospet (Kannada also called Hosapete, is a city in Bellary District
in northern Karnataka, India. It can be located on the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0d*c>.
Hospet is on the Tungabhadra River, 12 km (7.5 mi) from Hampi, the
World Heritage site consisting of the ruins of the medieval city of
Vijayanagara, former capital of the Vijayanagar Empire
(<http://en.wikipedia.org/wiki/Hospet>). - Mod.EP]

******
[2] Andhra Pradesh
Date: Wed 20 Oct 2010
Source: Deccan Chronicle [edited]
<http://www.deccanchronicle.com/hyderaba ... s-rise-909>


Cases of _Plasmodium falciparum_ malaria are on the rise in Adilabad
district, especially in tribal areas and slums.

As many as 310 cases out of a total 525 malaria positive cases were
detected in 237 550 tests conducted at PHCs [primary health centres]
level till now since January 2010 in the district.

Falciparum malaria is dangerous as it leads to cerebral malaria and
affects the brain. Children under the age of 15 years are the main
victims of the falciparum malaria.

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

[Adilabad is at the most northern tip of Andhra Pradesh and can be
located via the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0d*M>.

Andhra Pradesh is regarded a low risk area in the WHO World Malaria
Report 2009 with 0-1 case per 1000 population per year. However,
malaria is found in neighboring states of Maharashtra and
Chhattisgarh (more than 100 cases per 1000 population per year) and
could be spreading into Andhra Pradesh. - Mod.EP]

******
[3] National
Date: Wed 20 Oct 2010
Source: BBC News [edited]
<http://www.bbc.co.uk/news/health-11588212



The number of people dying from malaria in India has been hugely
underestimated, according to new research.

The data, published in the Lancet, suggests there are 13 times more
malaria deaths in India than the World Health Organization (WHO)
estimates.

The authors conclude that more than 200 000 deaths per year are
caused by malaria. The WHO said the estimate produced by this study
appears too high.

The research was funded by the US National Institutes of Health, the
Canadian Institute of Health Research, and the Li Ka Shing Knowledge
Institute.

The new figures raise doubts over the total number of malaria deaths worldwide.

Difficult diagnosis
-------------------
Calculating how many people die from malaria is extremely difficult.
Most cases that are diagnosed and treated do not result in
fatalities. People who die of extremely high fevers in the community
can be misdiagnosed and the cause of death can be attributed to other
diseases and vice versa.

As most deaths in India occur at home, without medical intervention,
cause of death is seldom medically certified. There are about 1.3
million deaths from infectious diseases, where acute fever is the
main symptom in rural areas in India.

In this study, trained field workers interviewed families, asking
them to describe how their relative died. 2 doctors then reviewed
each description and decided if the death was caused by malaria. This
method is called verbal autopsy.

Some 122 000 premature deaths between 2001 and 2003 were
investigated. The data suggests that 205 000 deaths before the age of
70, mainly in rural areas, are caused by malaria each year.

'Serious doubts'
----------------
The WHO estimated that malaria caused between 10 000-21 000 deaths in
India in 2006. The UN health agency welcomed new efforts to estimate
the number of malaria deaths. Dr Robert Newman, the director of its
global malaria programme, said: "It is vital to evaluate cause of
death correctly because different diseases require different
strategies for control." He concedes that WHO current evaluation
methods have their limitations, but has serious doubts about the high
estimates from this study.

Verbal autopsy, he said, was not a trustworthy method for counting
malaria deaths because the symptoms of malaria are shared with many
other common causes of acute fever. This, he said, along with what
the WHO called "implausibly high case incidence rates", indicates
that the findings of this study cannot be accepted without further
validation. He added that the WHO is working closely with the Indian
government in the fight against the disease.

Work needed
-----------
The authors say these figures, as well as global estimates, require
urgent revision. Professor Prabhat Jha, director of the Centre for
Global Health Research in Toronto, Canada, is one of the study's lead
authors.

He told BBC News: "Malaria kills not just children, but adults too in
surprisingly large numbers. India is the most populous country where
malaria is common, and it is a surprisingly common cause of death."

He added that there is a real need to reconsider how malaria deaths
are calculated and that similar analysis needs to be done in other
highly populated malaria endemic countries. There may also be
considerable under-reporting of malaria deaths in other highly
populated countries like Bangladesh, Pakistan, and Indonesia.

The authors say that aggressive malaria control programmes are
needed, as well as scaling up treatment -- particularly in adult
rural populations.

[Byline: Ania Lichtarowicz]

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

[The BBC article refers to: N Dhingra et al: Adult and child malaria
mortality in India: a nationally representative mortality survey.
Lancet. 2010 Oct 21 Online First; doi:10.1016/S0140-6736(10)60831-8,
available at
<http://download.thelancet.com/flatconte ... 608318.pdf>

ProMED-mail agrees with the statement of Dr Robert Newman cited
above, that verbal autopsy is not a reliable method to estimate
malaria mortality. Malaria causes unspecific symptoms and can
therefore easily be confused with many other febrile illnesses.

What is needed in India in proper, good quality diagnosis of malaria
in cases of febrile illness. In our 2nd report (above), 525 malaria
positive cases were detected in 237 550 blood films, which suggests
that at least in this area, malaria is rare. The question then arises
if the test results are correct and proper quality control and
assurance systems are need to ensure that. - Mod. EP]

Indien - Chikungunya (CHIC), Dengue (DEN)
21.10.2010

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 mehr als 4.000 Dengue-Erkrankungen und 7 Todesfällen gemeldet. Allein 700 Erkrankungen wurden in den ersten beiden Septemberwochen registriert. Auch in folgenden Bundesstaaten sind Dengue-Fälle aufgetreten: Tamil Nadu 986 Erkrankungen, Orissa (Makangiri-Distrikt) 50 Erkrankungen und 7 Todesfälle, Bihar 518 Erkrankungen und 6 Todesfälle und 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 (04): (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: Sat 23 Oct 2010
Source: Yahoo India [machine trans., edited]
<http://in.jagran.yahoo.com/news/local/u ... 42217.html>


On Saturday [23 Oct 2010], 9 people stopped breathing. The number of
people who died in the grip of the disease has gone up to 347. The
ages of the people who died of the fever were 8 months and 2, 12, 35,
45, 50 (2 individuals) and 60 years. No [health] team reached the
village. In the district, 167 fever victims came to the hospital on
Saturday 16 [Oct 2010]. [They] were found suffering from malaria.
They recruited a dozen serious patients and started treatment.

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

[The number of fatal cases in this area has increased from 180 on 4
Oct 2010 to 347 in the above report, nearly 3 weeks later. Local
residents were quoted in the above report as complaining about the
lack of health care personnel in the village area. This report is the
1st indication that malaria may be involved in at least some of these
fever cases. However, it seems curious that a malaria diagnosis was
not made earlier when the outbreak began. Previous reports mentioned
a virus disease as the cause of the so called "mystery fevers." There
still appears to be no diagnosis of the etiologies of these cases.
The cases in the above report are in the same area as the previous
outbreak reports.

A map showing the location of Ramabal Nagar (also known as Kanpur
Dehat) district in Uttar Pradesh can be accessed at
<http://en.wikipedia.org/wiki/Ramabai_Nagar_district>. A map of the
districts of Uttar Pradesh, showing the location of the affected
Kanpur Dehat and Lucknow districts can be accessed at
<http://en.wikipedia.org/wiki/File:Uttar ... Detail.svg>.
A HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/0dW6>. - Mod.TY]

Crimean-Congo haemorrhagic fever (CCHF) and Dengue in Pakistan
25.10.2010 - WHO

As of 15 October, the IHR National Focal Point, Ministry of Health (MoH), Pakistan, has notified WHO of 26 cases, including 3 deaths, of Crimean-Congo haemorrhagic fever (CCHF). In addition, over 1500 laboratory-confirmed cases of dengue fever including 15 deaths have also been reported from Pakistan so far.

Both CCHF and dengue fever are endemic in Pakistan with seasonal rise in cases. However, recently, the transmission of both CCHF and dengue fever has intensified in the country with increased incidence and geographic expansion. The recent Pakistan floods may have contributed to this upsurge as a result of changes in risk factors for these diseases.
Operational response

The MoH has scaled up response activities to prevent and mitigate CCHF and dengue fever, including awareness-raising campaigns on exposure risks and preventive measures for the general public, strengthening clinical and case management of patients with haemorrhagic fevers, stockpiling appropriate drugs and personal protective equipment, and implementing targeted vector control activities.

Upon request from the MoH in Pakistan, WHO is mobilizing experts in the clinical management of severe dengue fever and in infection control in health care settings through the Global Outbreak Alert and Response Network (GOARN). WHO is also assisting the country with resource mobilization, strengthening disease surveillance, laboratory diagnostics, and training of health care providers.