Wüstenschiff

Cholera in Pakistan
25.10.2010 - WHO

On 12 October 2010, the Ministry of Health in Pakistan reported laboratory confirmation of 99 cases of Vibrio cholera 01 in the country. These cases were laboratory-confirmed by the National Institute of Health since the beginning of the flood until 30 September 2010. These cases have been reported sporadically from a wide geographical area in the flood-affected provinces of Sindh, Punjab and Khyber Pakhtunkhwa.

The Ministry of Health in Pakistan supported by the World Health Organization and other local and international partners are collaborating closely to prevent outbreaks of any disease, including cholera, and treat people affected by such illnesses. More than 60 diarrhoeal treatment centres are either operating or are soon to start functioning in the 46 most affected districts of the country.

Diarrhoeal diseases including cholera are among the most reported health conditions in many locations affected by the recent floods disaster in the country.

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (25)
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******
Cholera - India (Kashmir)
Date: Sat 25 Sep 2010
Source: The Daily Rising Kashmir [edited]
<http://www.risingkashmir.com/news/chole ... -1760.aspx>


One person died and 15 others were hospitalized after an outbreak of
cholera in the remote village of Hallan in Verinag of south Kashmir's
Islamabad district on Sat 25 Sep 2010.

Locals said that the disease occurred 2 days ago after consuming
tap-water from a tank constructed by the Public Health Engineering
[PHE] Department. However, PHE officials denied the sayings of
public. "The locals are using water from a nearby spring whose water
got contaminated by the recent heavy downpour in the hills, while the
water supplied by PHE from the tank reservoir is completely safe. The
entire reservoir is closed from all sides, so there is no question of
water getting contaminated in it," said assistant executive engineer,
PHE sub-division Dooru-Verinag.

[Byline: Ishfaq Mir]

--
Communicated by:
ProMED-mail
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[Maps of India are available at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0ecy>. - Sr.Tech.Ed.MJ]

UNDIAGNOSED FATAL ILLNESS - INDIA (05): (UTTAR PRADESH) REQUEST FOR INFORMATION
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[1]
Date: Wed 27 Oct 2010
Source: Yahoo India [in Hindi, machine trans., summ. & edited]
<http://in.jagran.yahoo.com/news/local/u ... 55343.html>


On Wednesday [27 Oct 2010] 3 more people died in the Ramabai Nagar
district. The death toll from the disease so far has reached 363 in
the last 3 months of this strange fever outbreak that the health
department could not control.

DM Saroj Kumar Tiwari the district chief medical officer said that
the village health team will be sending the facts with respect to
deaths and disease and anti-larval spraying of DDT in the affected
villages will be made.

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

[The implementation of DDT spraying to control mosquito larvae
mentioned in this report suggests that the etiological agent is
mosquito borne, but without indicating what that agent might be.

A map showing the location of Ramabai 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]

******
Date: Thu 28 Oct 2010
Source: The Times of India, Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/city ... 824850.cms>


The mystery has been solved. Majority of deaths due to "viral" fever
in the city [Lucknow] were due to dengue or a virus similar to it.
This has been confirmed by a 2-member committee comprising experts of
Chhatrapati Shahuji Maharaj Medical University (CSMMU). The committee
was formed by the state government to probe the cause of deaths in
Khadra locality. The tests were conducted by the Sanjay Gandhi
Institute of Medical Sciences (SGPGIMS).

The CSMMU committee comprising Dr Kausar Usman and Dr Uday Mohan
submitted its report to the state administration on Wednesday [27 Oct
2010]. The report probed the cause of death of 13 persons on 14 and
15 Oct 2010 in Khadra. According to the findings of the report, while
9 persons died of dengue or dengue like virus, 2 deaths occurred due
to gastroenteritis, one from heart attack, while the cause of one
death could not be ascertained. Similarly, of the 10 blood samples
sent to the SGPGIMS for testing, 6 [patients] were found to be
infected with dengue, one with malaria, while 3 were normal. The
samples were collected by the chief medical officer Dr AK Shukla from
Khadra, Gwari, and other localities in the state capital [Lucknow]
from where "viral" fever deaths were reported. Dr Shukla has also
sent 10 samples to the National Institute of Communicable Diseases in
Delhi for testing.

The significant part of the CSMMU committee was that it indicated
mutation in dengue virus. The team recommended further research to
identify the changed strain. The mutated viruses this year [2010] has
turned deadly. It is causing deaths within short span. Apart from
causing decline in platelet count in blood, the virus hits the liver
and kidney. This has resulted in increase in casualties and many
doctors do not know how to tackle it.

"We also found that living conditions in the slums of Khadra were
unhygienic. The piles of garbage all around can make such a locality
a centre of epidemic in the city," said Dr Kausar Usman, stressing on
the need of regular cleaning and proper garbage disposal. He added
that the [genetic] code of the mutated virus should be identified at
the earliest so that doctors can apply new protocol to treat the
patients. Similar were the views of the experts from SGPGIMS.

Interestingly, the health department has so far denied dengue deaths
in the city. According to official figures released by director
general health recently, Lucknow reported only 237 dengue cases and 8
deaths due to dengue [virus infection]. However, the investigations
by 2 premier institutes of the state have proved health department's
theory wrong. In fact, doctors in CSMMU said that on an average they
receive over 40 dengue patients from all over the state. Tests
conducted at CSMMU's microbiology department have also confirmed over
500 confirmed dengue patients so far. An equal number of dengue
patients can be found in the private hospitals and clinics. All major
government hospitals are packed with fever cases. Doctors said that
instead of hiding deaths, if the health department had focused on
cracking the virus code and anti-larva spray, over 90 percent of the
patients would have been saved.

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

[The reports of the "mystery fever" cases grow ever more confusing. A
previous report attributed the cases to malaria. In the report above,
there was only one malaria case in the small sample tested. One
wonders what "a virus like dengue" might mean, in the absence of
definitive laboratory test results. If the laboratory results were
based on serology, there is always the risk of cross-reactions among
the flaviviruses. Without genetic analysis, stating that the virus
has mutated cannot be confirmed. The committee was wise in calling
for virus isolates to be sequenced.

Apparently, the basis for stating that a mutant dengue virus is
involved is based on clinical observations. No case fatality rate is
given, so it is not possible to know if the number of deaths from
dengue virus infection is higher than usual.

This well may be an outbreak of mixed etiologies, with dengue,
malaria, and gastroenteritis having been mentioned. Fever is a
symptom of all of these infections, and many more pathogens. Further
information about this outbreak will be welcomed. - Mod.TY]

Indien - Chikungunya (CHIC), Dengue (DEN)
29.10.2010

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 5.000 Dengue-Erkrankungen und 8 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, Uttar Pradesh 924 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
_________________________

Indien - Malaria
29.10.2010

Da der Monsun langsam zu Ende geht, reduzieren sich auch die wöchentlich gemeldeten Malaria-Fälle. Während im August noch 5.551 Fälle und im September 2.160 Fälle gemeldet wurden, waren es nur noch 1.860 registrierte Fälle im Oktober dieses Jahres. Dringend Mückenschutz beachten, außerdem standby-Therapie. / Quelle: crm

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (26)
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******
Cholera - India (Assam)
Date: Thu 28 Oct 2010
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... f234c73.91>


A total of 16 people have died in a cholera outbreak in a tea-growing
area of northeastern India, prompting the local state government to
sound a health alert, officials said Wed 27 Oct 2010.

Some 150 others tested positive since the disease was reported last
week [week of 18 Oct 2010] in 6 tea gardens in Sonitpur district,
about 230 km (140 mi) north of Guwahati, the main city in the state of Assam.

"Most of the casualties were reported from tea garden areas and it
appears the victims were down with cholera due to poor hygiene,"
senior local health official Anup Bhattacharyya told AFP in Guwahati.

The deaths occurred since Tuesday [26 Oct 2010], he added, with local
doctors blaming delays in bringing the ill to hospitals for the toll.

"A general health alert has been sounded and all steps are being
taken to deal with the outbreak," Assam health minister Himanta Biswa
Sarma told AFP.

The disease, which is primarily transmitted through contaminated food
and water, causes severe diarrhoea and vomiting, and can fatally
dehydrate a victim in a matter of hours.

Healthcare facilities in most of India's 7 insurgency-riven
northeastern states including Assam are primitive. Tea pickers often
live in dirty, cramped conditions without electricity or access to
clean drinking water.

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

[Maps of India showing the location of Assam state in the far north
east can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>
and the HealthMap/ProMED-mail interactive at
<http://healthmap.org/r/0eVk>. - Sr.Tech.Ed.MJ]

CHIKUNGUNYA (32): INDIA (UTTAR PRADESH)
***************************************
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<http://www.promedmail.org>
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<http://www.isid.org>

Date: Mon 1 Nov 2010
Source: The Indian Express [edited]
<http://www.indianexpress.com/news/First ... te/705401/>


The 1st case of chikungunya, a vector borne disease caused by the
same mosquitoes which carry dengue virus, in the state has been
reported from Lucknow. A patient from Shyama Prasad Mukherjee Civil
Hospital, Apoorva, has tested positive for chikungunya [virus
infection]. This is the 1st case of the disease in the state in last
2 years. The report came from the samples collected by the central
team of doctors who had come to review the dengue situation in the
state last week [week of 25 Oct 2010]. The samples were sent to
National Center for Disease Control, New Delhi, for testing and the
reports were sent to the state government on Friday [29 Oct 2010].
"Though this is the 1st case in the state, we will be taking more
samples from the area where this case has been detected, and if the
virus is found to be spreading in the state, immediate steps will be
taken to control the disease," said Dr SP Ram, Director General,
Health and Family Welfare.

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

[This area has been experiencing cases of a recently reported
"mystery fever" with mortality. Dengue and malaria have been
implicated, but with very limited diagnostic testing. Chikungunya
virus infections may account for some fever cases, but not for the
mortality. This year (2010), there have been chikungunya virus
infections in Delhi, Tamil Nadu, and Maharashtra states.

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (25): (UTTAR PRADESH)
*************************************************************
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Date: Thu 4 Nov 2010
Source: MSN News, Press Trust of India (PTI) report [edited]
<http://news.in.msn.com/international/ar ... id=4536478>


A health official said that 2 more persons succumbed to encephalitis
[in Gorakhpur], taking the death toll to 469 in eastern Uttar Pradesh
this year [2010]. The 2 patients succumbed at the Baba Raghav Das
Medical College Hospital (BRDMCH) [in Gorakhpur], which has admitted
14 fresh cases since yesterday [3 Nov 2010], additional director
(Health) UK Srivastava said. One of the deceased was from Mahrajganj,
while the other was a resident of Deoria. As many as 194 patients are
undergoing treatment at the BRDMCH and 22 in other government
hospitals in the region, he said.

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

[This outbreak has been going on at least since mid-April 2010. The
number of fatalities from encephalitis has increased from 414 on 13
Oct 2010 (see ProMED-mail archive no. 20101014.3727) to the 469
reported above. As with several of the previous reports, there is no
indication of which etiological agent involved in these 2 cases.
ProMED-mail would be interested in receiving information about
definitive diagnoses of these and any new 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]

HEPATITIS A - KAZAKHSTAN: (PAVLODAR) SCHOOLCHILDREN
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Date: Mon 1 Nov 2010
Source: Vesti.kz, News Agency [in Russian, trans. Corr.ATS, edited]
<http://vesti.kz/society/67941/>


Hepatitis A outbreak in schoolchildren
--------------------------------------
An outbreak of hepatitis A has affected schoolchildren in Ekibastuz [a city
of 14 000 inhabitants in Pavlodar province, which is located in north
eastern Kazakhstan]. Today [1 Nov 2010] another school [school no. 12] has
been placed under quarantine in order to contain the outbreak. Previously
school no. 11 was closed after 18 pupils were diagnosed with hepatitis A.
The newly closed school [no. 12] has so far only had a single case,
nevertheless the school will remain under quarantine until 29 Nov 2010. An
epidemiological analysis has established that the new case in school No. 12
had been in contact with some of the pupils in school no. 11 who were
diagnosed subsequently as hepatitis A cases.

The public health authorities of Pavlodar province have announced that all
those who have been contact with the affected schoolchildren will be kept
under observation for 35 days and all will receive hepatitis A vaccine.
Administrative fines have been imposed on the school staff [probably for
improper or delayed reporting or actions]. The original case was a 7th form
schoolgirl, who is believed to have contracted the infection from
contaminated watermelon.

Hepatitis A virus is transmitted via fecally contaminated food and water,
and annually affects about 10 million people worldwide. The incubation
period for hepatitis A virus infection ranges from 2 to 6 weeks, with an
average period of 28 days.

--
communicated by:
ProMED-RUS
<promed-rus@promedmail.org>

[Hepatitis A is a liver infection caused by hepatitis A virus. The virus is
spread when an uninfected (or unvaccinated) person eats or drinks something
contaminated by the stool of a hepatitis A virus-infected person. The
disease is closely associated with inadequate sanitation and poor personal
hygiene.

Adults have signs and symptoms of illness more often than children, and the
severity of disease and mortality increases in older age groups. Infected
children under 6 years of age do not usually experience noticeable
symptoms, and only 10 per cent develop jaundice. Among older children and
adults, infection usually causes more severe symptoms, with jaundice
occurring in more than 70 per cent of cases. Most people recover in several
weeks -- or sometimes months -- without complications. For further
information, see the WHO hepatitis A fact sheet at
<http://www.who.int/mediacentre/factshee ... index.html>.

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

DENGUE/DHF UPDATE 2010 (56)
***************************
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In this update:
[1] Pakistan
[2] Cases in various countries: Singapore, India, Nepal, Pakistan, Taiwan,
Australia, US Virgin Islands, Venezuela, Brazil

******
[1] Pakistan
Date: Wed 3 Nov 2010
Source: The Nation [edited]
<http://www.nation.com.pk/pakistan-news- ... ing-Dengue>


More and more people are falling prey to the dengue outbreak. In Lahore,
157 more cases were reported on Monday [1 Nov 2010]. The total number of
patients in Punjab alone has reached a staggering 1959. The situation in
Sindh and Karachi is equally dismal where so far around 1700 patients have
been registered. However, some doctors believe that the actual number of
patients is far bigger than what is officially stated by the health
authorities. Likewise, the hospitals seem to be running short of medical
kits necessary for the treatment of the dengue fever. Worse still, in
Karachi, some of the government hospitals were found to be treating
patients with fake and substandard medical kits.

--
communicated by:
Thomas James Allen
<tjallen@pipeline.com>

[Interestingly, a report issued a week later reports fewer dengue cases in
Punjab province, making one wonder how reliable case statistics are in the
face of this widespread outbreak in the country (see brief reports below).
If the report of the use of fake medical materials is true, that is
alarming news, indeed.

A map showing the provinces of Pakistan 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/promed/index.php?v=30,69.4,5>. - Mod.TY]

******
[2] Cases in various countries: Singapore, India, Nepal, Pakistan, Taiwan,
Australia, US Virgin Islands, Venezuela, Brazil

- Singapore. 4 Nov 2010. An average of about 105 cases have been recorded
every week this year (2010) and this is expected to continue, said the
National Environment Agency (NEA). So far, a total of 4364 cases of the
vectorborne diseases have been reported in Singapore this year, up from
3775 in the same period last year (2009).
<http://news.xinhuanet.com/english2010/h ... 590724.htm>

- India (Delhi). 1 Nov 2010. The national capital Monday reported 40 more
cases of dengue, taking the total number of people infected with the
vectorborne disease in Delhi to 5553 this season, with 8 deaths.
<http://www.prokerala.com/news/articles/a178622.html>

- India (Kerala). 7 Nov 2010. The district medical officer here has urged
the public to take precautions against dengue fever in the wake of the
finding that 32 of the 119 suspected cases of dengue in the district were
tested positive. The cases tested positive included 4 cases of death. As
many as 20 more deaths from suspected dengue fever were also reported. The
vector-borne disease was reported from eastern hill areas and coastal areas.
<http://www.asianetindia.com/news/dengue ... 08362.html>

India (Assam). 1 Nov 2010. A total of 117 dengue cases were registered in
the Biswanath Chariali hospital from 10 to 27 Oct 2010, with 20 deaths
[this is an extraordinarily high case fatality rate. - Mod.TY]
<http://www.telegraphindia.com/1101102/j ... 127814.jsp>

- Nepal. 4 Nov 2010. A total of 127 cases of dengue virus have been
detected in the district, according to an official of the Public Health
Office, Bhairahawa.
<http://www.thehimalayantimes.com/fullNe ... sID=264456>

- Pakistan (Sindh). 9 Nov 2010. 285 people with dengue fever are currently
inpatients at different hospitals in Karachi besides 68 in the interior
parts of the province. Dengue Surveillance Cell -- Sindh in its report
issued on Monday (8 Nov 2010) said the hospitalized patients included 64
admitted to hospitals on Monday only; 4 of these were from places other
than Karachi. Total cases of dengue reported during past few months are
4303, including 270 from interior parts. Sources said 19 dengue fever
induced deaths were registered in the province during past more than a
month, 15 from Karachi only.
<http://www.pakobserver.net/detailnews.asp?id=61208>

- Pakistan (Punjab). 8 Nov 2010. 195 more cases of dengue virus have been
detected in Lahore City. So far 2632 patients had been treated
successfully, with 73 patients being discharged on 6 Nov 2010.
<http://www.nation.com.pk/pakistan-news- ... -confirmed>

- Pakistan (Khyber Pukhtoonkhwa province). 2 Nov 2010. So far, more than
150 cases of dengue fever have been confirmed in the Ayub Teaching Hospital
(ATH) Abbottabad. Hazara commissioner Sahibzada Muhammad Anees has also
confirmed the presence of 37 cases of dengue fever other than those being
treated in the ATH. Blood samples of 167 suspected patients were sent to
the National Institutes of Health (NIH), and 37 of those have been
confirmed as being positive for dengue fever.
<http://tribune.com.pk/story/71184/dengu ... bbottabad/>

- Pakistan (national). 4 Nov 2010. According to Pakistan's National Health
Department (NHD), the number of confirmed dengue patients in the country
has risen to 5050. Of these, 2350 patients are in Sindh, 1885 in Punjab and
at least 158 dengue patients are present in Khyber Pakhtunkhwa. There are
at least 380 patients in Rawalpindi and 230 in Islamabad.
<http://news.dawn.com/wps/wcm/connect/da ... stan-qs-04>

- Taiwan. 9 Nov 2010. More than 1000 Taiwan residents have been infected
with dengue fever since August 2010, the island's health department said on
Tuesday (9 Nov 2010). Kaohsiung City in southern Taiwan was the worst hit
with 589 dengue virus infections, said a health department statement. Last
week the island reported 128 new cases of dengue fever, mostly in the
southern cities of Kaohsiung and Tainan.
<http://news.xinhuanet.com/english2010/h ... 598630.htm>

- Australia (Northern Queensland). 3 Nov 2010. Queensland Health (QH) says
2 people in Cairns have been diagnosed with the illness, taking the number
of cases in the region to 19.
<http://au.news.yahoo.com/a/-/australian ... north-qld/>

- American Virgin Islands. 2 Nov 2010. The number of dengue fever cases in
a St Thomas/St John District outbreak continued to climb in October, but
new reports of possible cases seem to be slowing, a VI Health Department
official said. Overall, the total number of reports the Health Department
has received since June of suspected, probable and confirmed dengue fever
cases in the territory is 105.
<http://virginislandsdailynews.com/news/ ... -1.1057825>

- Venezuela (Miranda). 4 Nov 2010. The health epidemiologist, Miranda
state, noted that the municipality with the highest number of dengue cases
is Guaicaipuro with 366, followed by 294 in Carrizal and Brion with 192.
<http://www.diariolaregion.net/seccion.a ... tid=100682>

- Brazil (Ceara). 9 Nov 2010. This year (2010), 10 689 dengue cases were
confirmed in 116 municipalities, and 14 people died of DHF or of dengue
with complications.
<http://verdesmares.globo.com/v3/canais/ ... modulo=178>

- Brazil (Goias). 6 Nov 2010. The number of dengue cases registered in
Goias this year (2010) has reached 100 427. In comparison with the same
period last year (2009), this is an increase of 207 per cent. Up to now, 66
people have died of of the disease, with 39 from dengue with complications
and 27 of DHF.
<http://oglobo.globo.com/pais/noblat/pos ... os-de-deng>

CHIKUNGUNYA AND DENGUE - INDIA (05): (MAHARASHTRA, DELHI)
*********************************************************
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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] Maharashtra (Pune)
[2] Delhi

******
[1] Maharashtra (Pune)
Date: Wed 10 Nov 2010
Source: The Times of India, Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/city ... 897684.cms>


Laboratory data of the Golwilkar Metropolis Pvt Ltd, an accredited lab in
the city [Pune], reveal that October [2010] saw highest number of dengue
and chikungunya cases. The lab alone found 484 positive cases of dengue and
267 positive cases of chikungunya between June and October [2010].

"Patients showing chikungunya-like symptoms are testing negative when
specific antibody tests like IgG, IgM are conducted on them. This is
unusual," said Avinash Bhondwe, former president of the city chapter of the
Indian Medical Association. Such cases have been seen since August [2010],
he added.

"Since viral fever and other infections are very common in India, most
patients visit doctors only after they have been febrile for 3 to 4 days.
This is the time to collect blood samples for investigations before
starting antibiotics. This is also the time when the IgM antibodies to an
infectious agent start rising and they keep increasing over the next few
days. This initial small level of antibody will be best detected by an
ELISA-based test not only for chikungunya but for other infections," said
consulting microbiologist Siddhartha Dalvi.

[byline: Umesh Isalkar]

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

[It would be of interest to know what other pathogens are being tested for,
that may be responsible for the febrile cases that test negative for
chikungunya and dengue virus antibodies. Were these negative samples
forwarded to a reference diagnostic laboratory for additional testing?

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

******
[2] Delhi
Date: Tue 9 Nov 2010
Source: Hindustan Times [edited]
<http://www.hindustantimes.com/With-41-c ... 24188.aspx>


With the city [Delhi] reporting 8 new cases of chikungunya [virus
infection], and 41 cases in all this season [2010], the mosquitoborne
infection [virus] seems to be on a constant rise. Last year [2009], there
were only 5 chikungunya cases during the corresponding period. Chikungunya
fever is a viral disease transmitted to humans by the bite of infected
_Aedes aegypti_ mosquitoes.

"While the infection was initially restricted to Palam village, it is now
being detected in other parts of the city as well, which is not a very
healthy sign," said Dr VK Monga, chairman, public health committee,
Municipal Corporation of Delhi [MCD]. "So far, the highest number of cases
of chikungunya [virus infection] has been reported from Najafgarh, which is
a worrisome trend. We are awaiting the results of two more suspected
chikungunya cases," he said.

With the morning and evening temperatures dipping gradually over the last
couple of days, the numbers of dengue cases have seen a gradual decline in
Delhi. Till about 10 days ago, the city was reporting an average of 70
cases of dengue daily. On [Tue 9 Nov 2010], 35 new cases of dengue were
reported, taking the total number of people infected with the vectorborne
disease to 5837, according to the MCD report. Shahdara (North) zone with
786 dengue patients has the highest number of cases, followed by 742 in
Rohini, and 642 in Civil Lines. There have been 8 dengue deaths in the city
so far.

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

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (28 )
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Cholera - India (Orissa)
Date: Wed 10 Nov 2010
Source: Press Information Bureau [edited]
<http://pib.nic.in/release/release.asp?relid=66908>


41 deaths in Rayagada district and 8 deaths in Kalahandi district due to
acute diarrheal diseases have been reported in recent months in Orissa.

A Central team comprising experts from National Centre for Disease Control
(NCDC) Delhi and National Institute of Cholera & Enteric Diseases (NICED),
Kolkata was deputed by Ministry of Health and Family Welfare to assist the
state/district health authorities in the investigation and control of
outbreaks. The team visited the affected areas of Rayagada and Kalahandi
districts during the period 17-21 Sep 2010.

The recommendations made to the State Government in order to minimize the
risk of further outbreaks of cholera include provision of safe water,
adopting safe practices in food handling, sanitary disposal of human waste,
personal and domestic hygienic practices, availability of ORS in all the
habitations, making all tube wells functional to ensure that people use
safe water for drinking and domestic purposes, and promoting hand washing
with soap and water (with earth and water, if soap is not available) after
defecation and before preparing and eating meals.

The cases and deaths declined in the 2nd half of September 2010.

--
communicated by:
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Kasachstan - Orale Infektionen
15.11.2010

Risiko für Durchfallerkrankungen landesweit, desgleichen für Hepatitis A. Anfang November wurde ein Ausbruch von Hepatitis A in zwei Schulen in Ekibastuz (im Nordosten des Landes) gemeldet. Bisher sind 18 Schüler erkrankt, einige Kontaktpersonen stehen unter Beobachtung und erhalten eine Impfung. Der Hundebandwurm (Echinokokkus) ist vor allem in den südlichen Landesteilen mit der ehemaligen Hauptstadt Almaty verbreitet und kann beim Menschen zu schweren Leber- und Lungenerkrankungen führen. Hygiene und Impfschutz (Hepatitis A) beachten. / Quelle: crm

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

Date: Sun 21 Nov 2010
Source: The Navhind Times [edited]
<http://www.navhindtimes.in/content/dete ... e-been-det>


The detection of 22 malaria cases in Bicholim has jolted health authorities
into action; most of the cases have been detected at the construction site
of a new primary health center. The authorities have launched preventive
steps against the disease.

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

[Malaria has been reported repeatedly in travelers from Goa since 2007.
This report shows that there is still a risk of malaria in Goa even though
malaria has not been reported in travelers since 2008. - Mod.EP

Goa, on the west coast of India, can be located on the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed?v=22.9,79.6,5>. - Mod.SH]

Reisende nach Indien müssen sich vor Malaria schützen

Das Malaria-Risiko in Indien ist regional verschieden. Aktuelle Ausbrüche im Süden sind ungewöhnlich. mehr...

Grüsse
Alexander

JAPANESE ENCEPHALITIS AND OTHER - INDIA (26): (UTTAR PRADESH)
*************************************************************
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 4 Dec 2010
Source: Hindustan Times [edited]
<http://www.hindustantimes.com/rssfeed/u ... 34223.aspx>


In Eastern Uttar Pradesh, 2 [more] people succumbed to encephalitis
here, taking the toll in the viral infection this year to 516. Health
officials said today that the 2 died at the Baba Raghav Das Medical
College Hospital here yesterday [3 Dec 2010]. The victims hailed from
Gorakhpur and Sant Kabrinagar.

Yesterday, 9 patients suffering from encephalitis were admitted to
the hospital, Additional Director (Health) U K Srivastava said. As
many as 103 patients are presently undergoing treatment at various
government hospitals in the region, he said.

The vaccination drive to contain Japanese encephalitis [JE virus
infection] is on in 24 development blocks of Gorakhpur, Deoria,
Kushinagar, Mahrajganj, Basti, Siddharthanagar and Sant Kabir Nagar,
Srivastava said.

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

[The 2 Dec 2010 edition of the Indian Express
(<http://www.indianexpress.com/story-print/719044/>) reports an
increase Uttar Pradesh, Bihar, Assam, and some other states in the
north-east, with a shift in age-specific incidence and 70 percent of
cases being over 15 years and in UP between 25 and 40 years of age.

Regarding the situation in UP, Dr KP Kushwaha, Head of Pediatrics
Department at Gorakhpur's BRD Medical College, said: "It is true that
in our record, we have noticed this trend that the number of JE as
well as acute encephalitis syndrome cases among adults is increasing
since last year [2009]. About 700 AES cases have been reported among
adults this year -- of these around 100 were JE."

Kushwaha said some parts of the increase could be "because the total
number of AES cases has increased from about 2100 last year to about
3000 cases this year." But there is another disturbing trend: while
the mortality rate of the disease among children has been around 13.7
percent, the mortality rate among adults was close to 16 percent this
year, he said.

The 2 Dec 2010 edition of
(<http://in.jagran.yahoo.com/news/local/u ... 72559.html>
in Hindi) mentions both Japanese and waterborne encephalitis are
involved in these outbreaks.

The 29 Nov 2010 edition of the Indian Express
(<http://www.indianexpress.com/news/JE-va ... ast/717544>)
reports that after 6 months after the Centre and the state government
disagreed over the use of "unusable" Japanese encephalitis vaccine
for a special vaccination drive in the eastern Uttar Pradesh, the
drive would finally begin on 30 Nov 2010 with the state getting a
fresh stock of the vaccine.

The etiologies of the apparent majority these cases are still not
defined. Both JE virus and unnamed water-borne virus (enterovirus?)
are reportedly involved. There is no explanation offered in any
reports thus far of why the non-JE virus(es) have not been identified
after several months. Apparently, the campaign with fresh JE virus
vaccine was initiated several months after the outbreak began and JE
virus infection was diagnosed.

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/promed/index.php?v=22.9,79.6,5>. - Mod.TY]