Wüstenschiff

UNDIAGNOSED HEMORRHAGIC FEVER - INDIA (03): (MAHARASHTRA), 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 24 Jan 2011
Source: TopNews New Zealand [edited]
<http://topnews.net.nz/content/211408-co ... d-negative>


Crimean-Congo hemorrhagic fever suspect tested negative
--------------------------------------------------------
A resident of Bhiwandi has tested negative for Crimean-Congo
haemorrhagic fever (CCHF) virus infection, much to the relief of his
doctors and his family. The patient has been treated at BMC's
[Bhiwandi-Nijampur Municipal Corporation] Kasturba Infectious Disease
Hospital since Friday [21 Jan 2011], after the fever scare was
strongly suspected. But when his urine and blood samples were sent to
the National Institute of Virology (NIV), they tested negative for
CCHF virus infection. With the earlier reports of CCHF claiming the
lives of 3 in Ahmedabad, this [negative test result] came as a
pleasant surprise for the clinicians.

Dr Om Shrivastava said: "[The patient's] condition is critical and he
is still on a ventilator. Even if he has tested negative for the CCHF,
it is a case of viral haemorrhagic fever and we will have to treat him
accordingly."

[In view of the CCHF risk] the Health Departments have issued
guidelines to send the samples from suspected cases of CCHF to the NIV
for thorough [laboratory] examination. CCHF is a widely-spread viral
disease, and is carried by wild as well as domestic animals. It has a
whopping 30 percent mortality rate in infected humans. This disease is
commonly characterized by nosebleeds, bloody urine, vomiting and black
stools.

[Byline: Neeraj Shahane]

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

[Bhiwandi is a city in the district of Thane, in the Indian state of
Maharashtra, located 20 km to the north-east of Mumbai and 15 km to
the north-east of Thane city. Thus the patient who is now being
treated in Kasturba Infectious Disease Hospital comes from the same
district of Maharashtra as the 1st suspected case of CCHF. Fortunately
clinical samples from both patients have tested negative for CCHF virus.

The illness of the 1st case is thought now not to have had an
infectious cause. The 2nd case, described above, is still considered
to be suffering from a so far unidentified viral haemorrhagic fever.
Further information on the cause of this patient's illness is awaited.

A map of the states of India, showing the location of Maharashtra, can
be accessed at:
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>. The
HealthMap/ProMED-mail interactive map of India is available at:
<http://healthmap.org/r/008o>. - Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (03)
************************************************
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 (Maharashtra)
Date: Wed 26 Jan 2011
Source: Mid-day.com [edited]
<http://www.mid-day.com/news/2011/jan/26 ... l-Pune.htm#>


Cholera has arrived in Pune [formerly called Poona - Mod.LL]. 2
persons have tested positive for cholera after their stool samples
were sent to the Sassoon General Hospital. Officials at the hospital
confirmed that the culture tests at the microbiology lab have
indicated _Vibrio cholerae_ of the El Tor type, which doctors said is
generally a milder form of the infectious bacterial disease.

Dr Anju Kagal, head of the microbiology department, said the 1st
sample was of a 16-year-old girl, who was traveling to Jharkand with
friends. "She developed severe diarrhea and dehydration and had to
stop in Pune. She was admitted to Sassoon hospital and was treated
here after her sample tested positive for cholera.

The 2nd person's stool sample was sent to Aditya Birla Memorial
Hospital for confirmation of cholera," said Kagal. Kagal said the
patient was a 65-year-old and refused to divulge further details
citing patient confidentiality.

[Byline: Alifiya Khan]

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

UNDIAGNOSED ENCEPHALITIS - INDIA: (RAJASTHAN) REQUEST FOR INFORMATION
********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 9 Feb 2011
Source: The Times of India (TOI), Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/city ... 455795.cms>


A 22-year-old youth from Jodhpur who is suffering from viral
encephalitis has been brought to a city hospital. Doctors said his
condition is critical and samples of his blood have been sent to the
National Institute of Virology [NIV], Pune.

Doctors at the Sterling Hospital said this is the 4th case of viral
encephalitis from Jodhpur, Rajasthan, in the hospital. The youth is
suffering from high fever, vomiting, and head ache, and also fell
unconscious. The test carried out on the cerebral spinal fluid shows
inflammation in the brain due to the virus [infection]. There is a
possibility of a viral outbreak in the district of Rajasthan. "We have
collected his samples and have sent them to NIV to find out which
virus is affecting him," said infectious diseases consultant Dr Atul
Patel. He said that ascertaining the kind of virus is important as a
viral encephalitis outbreak in Bangladesh has claimed 29 lives.
Earlier, there were reports of viral encephalitis fever in Chhota
Udepur [Gujarat state], which claimed 2 lives.

Neurophysician Dr Sudhir Shah said he has seen 4-5 cases from the
same area in the past and had also spoken to local physicians about
the possibility of a viral outbreak. "A young girl with viral allergy
has also been taken to a hospital and earlier too, there were cases of
viral encephalitis," said Dr Shah.

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

[An outbreak of encephalitis in Gujarat in mid-August (2010) was
later confirmed as due to infection by Chandipura virus. The outbreak
in Bangladesh mentioned above was confirmed subsequently as due to
Nipah virus infections. This is the season for Nipah virus
transmission from giant fruit bats (genus _Pteropus_).

It will be interesting to see what the National Institute of Virology
in Pune comes up with in these Jodhpur cases. ProMED-mail would
appreciate receiving information about the laboratory test results
when they become available.

A map showing the location of Jodhpur in Rajasthan state can be
accessed at
<http://www.maplandia.com/india/rajastha ... r/jodhpur/>. A
HealthMap/ProMED-mail interactive map can be accessed at
<http://healthmap.org/r/0s7h>. - Mod.TY]

HEPATITIS B AND HEPATITIS C - INDIA: (PUNJAB)
***********************************
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 10 Feb 2011
Source: The Tribune online, Bathinda edition [edited]
<http://www.tribuneindia.com/2011/201102 ... inda.htm#3>


Cases of hepatitis B & C reported in Moga villages
--------------------------------------------------
A number of cases of hepatitis B and C have been reported in some
villages of the Baghapurana and Nihalsinghwala sub-divisions of the
Moga district. The medical authorities have sprung into action
creating awareness among the masses besides launching a campaign
against quacks.

In the Baghapurana sub-division, as many as 142 patients have been
found infected with the deadly viruses of hepatitis B and C, sources
in the health department revealed. The worst affected villages include
Samadh Bhai, Samalsar, Marhi Mustafa and Patto Hira Singh. Such cases
have also been reported from 10 other villages in the area.

Chief medical officer (CMO) Dr Amarjit Singh Sidhu, while talking to
The Tribune by phone, said the cause of infection is the use of
inadequately sterilised needles and syringes by unqualified medical
practitioners and intake of drugs through injections by drug addicts.
He emphasised the need to strengthen the routine surveillance system
and organise an education campaign targeting all the health care
workers including private practitioners. While appealing to the people
not to panic, he said there is nothing to worry as the hepatitis B and
hepatitis C infections could easily be treated in the initial stage by
taking adequate precautionary measures.

In reply to a question, the CMO said he would form a committee of
senior medical officers along with the drug inspector to conduct a
survey and take legal action against the quacks operating in the
far-flung areas of the district.

[byline: Kulwinder Sandhu]

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

[Hepatitis B and hepatitis C are bloodborne viral infections easily
transmitted from person-to person via unsterilised or multiple-use
syringes. The number of individuals infected in these rather remote
rural communities is alarming and suggests medical malpractice by
local community doctors rather than as a result of transmission of
disease among drug addicts. While some forms of hepatitis C virus
infection respond to treatment with expensive drugs such as pegylated
interferon and ribavirin, the reassurance reportedly offered by the
chief medical officer appears to be inappropriate and the source of
the outbreak must be eradicated.

Moga district is one of 19 districts in the state of Punjab in north
west India. Its location can be viewed in the map of Punjab at
<http://en.wikipedia.org/wiki/File:Punja ... ct_map.png>. The
HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/008o>. - Mod.CP]

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

Date: Wed 2 Mar 2011
Source: Times of India, Varanasi [edited]
<http://timesofindia.indiatimes.com/city ... z1FXGwNRqr>


Is turning a blind eye to measles vaccination responsible for
occurrence of post-measles encephalitis (PME), an infectious and
life-threatening disease affecting young children in the region? It
would seem so if latest cases are taken into consideration. Though
authorities concerned blame people, they are unable to answer how
skipping vaccine is possible when it is a part of the routine
immunisation programme.

While Japanese encephalitis (JE) is already known to create havoc in
some parts of east UP [Uttar Pradesh], particularly in the belts of
Gorakhpur, Maharajganj and Deoria districts, the occurrence of PME in
a number of children in the region, with some still undergoing medical
treatment in city hospitals, has caused concern.

"The preliminary reports indicate PME conditions in a number of
children from the region, out of which 4 children have even reached
coma stage," said the Secretary of Indian Academy of Paediatrics (IAP)
UP, Alok Bhardwaj. "Two of them have been discharged, but the others
are still kept under medical supervision. However, the concerning part
of the exercise is the fact that the region has never reported such a
large number of such cases," pointed out the senior paediatrician.

It may be mentioned here that out of 4 critical cases of PME, one
each has been reported from Varanasi, Chandauli, Ballia and the Buxar
district of neighbouring Bihar state. Similarly, a number of PME cases
have been also reported from Bhadohi, Mirzapur, Jaunpur and Ghazipur
districts in the region.

"We are conducting investigation in these cases, and initial reports
suggest a possibility of failure of sticking to the routine
immunisation programme, which includes measles immunisation at the age
of 9 months. Such type of outbreak has been reported already in some
areas of southern states, and there are hints of laxity in measles
immunisation in these cases," said Bhardwaj. Saying immunisation was
mandatory to eliminate chances of measles infection for the lifetime
in children, he also emphasised that an outbreak of measles infection
could not be ruled out if it [immunisation] was avoided on a large
scale.

It is also worth mentioning that the World Health Organisation
expanded programme on immunisation recommends immunisation at 9 months
of age. This age can be lowered to 6 months if there is a measles
outbreak in the community.

"Vaccination for measles is part of the government immunisation
programme, and people must come forward to complete the course of
immunisation," said chief medical officer RS Verma on Wednesday [2 Mar
2011]. Saying the vaccines were available at all government health
centres, the CMO emphasised that vaccination against measles provided
protection against natural measles along with other complications
associated with the infectious disease in children. Similarly, Alok
Bhardwaj added measles vaccine should be combined with other live
attenuated vaccines, such as mumps and rubella vaccines (MMR vaccine),
as such combinations were highly effective.

[Byline: Naveen Kumar]

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

[Measles vaccine coverage (a mononvaalent vaccine at 9 months of age)
in India has been good, but measles incidence remains high in parts of
India. Measles even in previously healthy children can be a serious
illness requiring hospitalization. As many as one in 20 children with
measles develops pneumonia, and about one child in every 1000 who get
measles will develop encephalitis, which may leave a child deaf or
even mentally retarded. In developing countries, where malnutrition
and vitamin A deficiency are common, mortality from measles virus
infection can be considerable. Sub-acute sclerosing pan-encephalitis
(SSPE), a fatal degenerative disease of the central nervous system,
can be a very rare consequence of measles infection early in life.

The above account of encephalitis in the state of Uttar Pradesh
attributes many cases of encephalitis to measles virus infection as a
consequence of deficiencies in measles vaccine coverage. However a
recent publication by F.k. Beig et al. in the International Journal of
Infectious Disease (25 Jan 2010) describes an investigation of the
etiology of viral encephalitis (VE) in the children of western Uttar
Pradesh. Both cerebrospinal fluid and serum samples were collected
from pediatric patients suffering from encephalitis hospitalized at
Jawaharlal Nehru Medical College, Aligarh from July 2004 to November
2006. Viral isolation was done on RD cells, HEp-2 cells, and Vero
cells from the cerebrospinal fluid samples of children with suspected
VE. A microneutralization test was performed for enterovirus 71. An
enzyme immunoassay for IgM antibodies was performed for measles virus,
mumps virus, varicella zoster virus, herpes simplex virus 1, and
Japanese encephalitis virus. 87 patients were enrolled in the study.
The most common etiology of VE was enterovirus 71 (42.1 percent),
followed by measles (21.1 percent), varicella zoster virus (15.8
percent), herpes simplex virus (10.5 percent), and mumps (10.5
percent). Japanese encephalitis virus was not found in any case.
Enterovirus 71 infection caused significant morbidity in children;
mortality occurred in 50 percent. A preponderance of cases occurred in
December. In their study, generalized convulsions along with altered
sensorium were the significant findings in patients with VE. The
authors concluded that enterovirus 71, the major etiology of VE in the
study, was associated with significant mortality and morbidity.

It is likely, therefore, that improved measles vaccine coverage may
reduce the incidence of VE in Uttar Pradesh but will not eliminate
it.

The location of Uttar Pradesh can be found on the map of the states
of India at <http://www.fpaindia.org/FinalWeb/5/statesunder.htm>. -
Mod.CP]

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

Date: Wed 9 Mar 2011
Source: Headlines India [edited]
<http://headlinesindia.mapsofindia.com/h ... 77409.html>


As many as 47 people died of malaria in Chhattisgarh in 2010, health
minister Amar Agrawal told the state assembly on Tuesday [8 Mar 2011].
As many as 152 303 people, mostly in rural areas, were afflicted with
malaria in 2010. In 2009, 129 397 people were hit by the disease and
11 people died, he said in reply to a question.

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

[Malaria is endemic in Chhattisgarh, with an annual incidence in the
local population of 10-50 cases per 1000 population per year (WHO
World Malaria Report 2010
<http://www.who.int/malaria/publications ... ind_en.pdf>).
The province has about 20 million inhabitants, so the reported 152 303
cases give an estimated incidence of 7.6 cases per 1000 population.

For the HealthMap of Chhattisgarh state, see
<http://healthmap.org/r/0iw4>. - Mod.EP]

Indien - Malaria
10.03.2011

Anfang Dezember wurden aus dem Bundesstaat Chhattisgarh allein für das vergangene Jahr über 122.000 positiv getestete Patienten und 24 Todesfälle gemeldet. Aus dem Bundesstaat Chhattisgarh wurden im Jahr 2010 über 152.000 Malaria-Fälle mit 47 Todesfällen gemeldet. Malaria ist im Bundesstaat Chhattisgarh endemisch. In Mumbai wurden für 2010 bisher 185 Todesfälle und 22.128 Erkrankungen gemeldet. Auch in Goa gab es Ende letzten Jahres wieder einen Ausbruch von Malaria tropica mit 22 bestätigten Fällen. In ganz Indien sank die Zahl der bestätigten Malaria-Fälle/Jahr von ca. 2. Mio. im Jahr 2000 auf ca. 1,6 Mio. im Jahr 2009 ab, die Zahl der malariabedingten Todesfälle stieg im gleichen Zeitraum von ca. 900 auf ca. 1.100 an. Dringend Mückenschutz beachten, außerdem standby-Therapie. / Quelle: crm

RABIES - KYRGYZSTAN: (NARYN), BOVINE, HUMAN EXPOSURE
***********************************************
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 16 Oct 2011
Source: 24.kg News Agency [edited]
<http://eng.24.kg/community/2011/03/16/16879.html>


According to the press service of the Emergency Situations Ministry
of the Kyrgyz Republic, on Sat 12 Mar 2011, a bull belonging to a
resident of the village of Ornok in Natyn [Naryn] district died as a
result of rabies virus infection. A cow belonging to the same
villager then died on Tue 15 Mar 2011.

Staff of the district veterinary and epidemiological service have
sent tissue samples for confirmatory laboratory diagnosis. The Press
Service reported that results of these tests are not available yet,
but all members of the villager's family have been vaccinated. As an
additional measure, 36 stray dogs have been shot.

[Byline: Tolgonai Osmongazieva]

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

[Rabies is endemic in Kyrgyzstan, and the following information on
rabies infection in bovines is reproduced from a commentary by Mod.AS
accompanying a report of a similar incident in Ukraine (see: Rabies -
Ukraine: (VI) bovine, human exposure 20101009.3668):

"Generally, rabies in herbivores is, like in humans, a dead-end
disease. An owner, handler or an attending veterinarian may become
exposed to rabies themselves by searching, bare handed, for an
offending foreign body in a choking animal. Rabies may present in
cattle in either of 2 forms. In the furious form, normally docile
animals may attack humans and other animals, though biting is rather
rare. Milk production ceases abruptly in dairy cattle. The cow may
appear hypersensitive and will follow sounds and movements intensely.
The affected cattle may exhibit abnormal bellowing which may continue
intermittently, or voiceless attempts to bellow described as yawning.
Those who have heard this sound once will recognize it readily. In
the paralytic form, the 1st sign may be paralysis of the throat.
Drooling of saliva, grinding of the teeth, extension of the head, and
bloat may occur. The cow may appear to be choking. Laryngeal
paralysis can cause a change in vocalizations, including the
aforementioned abnormal bellow, though this is more common in the
furious form. Weakness in the hindquarters may occur and is always
accompanied by decreased sensation to the affected area. Paralysis of
the anus and penis in the bull may be seen. Eventually, the animal
will go down and be unable to get up as paralysis becomes complete.
These animals do not attack others."

The HealthMap/ProMED-mail interactive map of Kyrgyzstan can be
accessed at: <http://healthmap.org/r/0APV>. The location of Naryn
district can by found by accessing the map at:
<http://en.wikipedia.org/wiki/Naryn>. - Mod.CP]

MALARIA - INDIA (06): (ANDHRA PRADESH)
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 18 Mar 2011
Source: The Siasat Daily [edited]
<http://www.siasat.com/english/news/mala ... ency-areas>


Malaria is fast spreading in agency areas
-----------------------------------------
Malaria is fast spreading in tribal villages in Bhadrachalam division
due to lack of preventive measures. So far, 2 persons died of malaria
fever in Kunavaram and VR Puram mandals. And people of VR Puram,
Kunavaram, Chintur mandals are suffering with malaria for the last a
few days. The disease is fast spreading in Jeediguppa, Pedamittapalli
and Pochavaram villages in VR Puram mandal.

Tribals in these villages allege that anti-larval operations were not
being carried out properly. Medical staff also were not visiting the
villages regularly, they said. It may be noted that the health
department survey revealed the severity of malaria in tribal villages
in the district.

According to survey reports, as many as 355 cases were tested
positive for malaria out of the 24 144 blood samples taken in the
agency area in January this year [2011].

And some 311 positive cases were detected in February [2011] out of
the 25 360 blood samples under scanner. With the 79 101 malaria
positive cases were detected in January and February respectively,
Tulasipaka village in VR Puram mandal was identified as one of the
most malaria-prone village in the district.

District malaria officer S Bikshapathi said they had identified
Tulasipaka as highly vulnerable to malaria. The health department said
that they had introduced Pyrethrum, a liquid spray to kill mosquitoes.


He said that spraying operation was in progress in all the
malaria-prone areas. The anti-malaria wing is considering an action
plan to scale down the incidence of the disease to a minimum in agency
areas, he said.

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

[Malaria in endemic in Andhra Pradesh (World Malaria Report 2010
(<http://www.who.int/malaria/publications ... ind_en.pdf>)
with an endemicity between 10 and 50 new cases per 1000 population per
year. It is stated that a program using spraying with a pyrethroid.
Pyrethroids are not usually used for indoor residual spraying, and are
better used for impregnating bed nets.

The interactive HealthMap/ProMED map is available at:
<http://healthmap.org/r/0BjL>.

ProMED has over the past 2 years reported malaria outbreaks in 10
states in India (see below). - Mod.EP]

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

Date: Wed 16 Mar 2011
Source: The Times of India [edited]
<http://articles.timesofindia.indiatimes ... es-disease>


More than 200 people have been infected by scrub typhus in villages
of Jogindernagar in Mandi district of Himachal with few of them in a
critical condition, said an official. According to Jogindernagar SMO
Dr Jitender Kaul, there may be many patients in the villages around
the town but only around 40 patients were getting treatment in the
hospital, while a few were admitted to primary health centers (PHC) in
villages.

"Some scrub typhus patients were reported from PHCs across the
villages while some critical cases were admitted to town hospital.
However, no casualty is reported so far but the disease can prove
fatal if not treated on time," he said. Usually the disease spreads
due to the negligence in cleanliness and improper handling of the
cattle. "Villagers usually enter into cowsheds barefooted which they
clean after several days."

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

[The following is excerpted from a US CDC report (Demma LJ, McQuiston
JH, Nicholson WL, et al. Scrub typhus, Republic of Palau. Emerg Infect
Dis [serial on the Internet]. 2006 Feb [date cited]. Available from
<http://www.cdc.gov/ncidod/EID/vol12no02/05-0967.htm>):

"Scrub typhus is a zoonotic illness caused by _Orientia
tsutsugamushi_. The pathogen is transmitted through the bite of larval
mites (chiggers) of the _Trombiculidae_ family, which serve as both
the vector and the reservoir (1,2). Rodents of the family _Muridae_
(rats and mice) are common hosts for trombiculid mites and may support
_O. tsutsugamushi_. Geographically specific foci of scrub typhus are
thus determined by the distribution of vector mites and their rodent
hosts and by interactions of mites and rodents with humans (3). Scrub
typhus has been reported from many regions of Asia and the Pacific
islands, and known disease-endemic regions extend from Japan and
eastern Russia southward to Australia and westward to Pakistan and
Afghanistan (4,5).

"Scrub typhus is typically a nonspecific febrile illness; its
severity may be influenced by the strain of _O. tsutsugamushi_, a
person's immune status, and other factors. Diagnosis may be
complicated in areas where the disease has not been documented
recently or in regions lacking the capacity for laboratory
confirmation. Illness develops after an incubation period of 6 to 21
days and usually begins with an eschar at the site of a chigger bite.
Fever, headache [lymphadenopathy], and myalgias are common, and a
maculopapular rash may also be present. Nausea, vomiting, diarrhea, or
lower respiratory symptoms can also occur. Manifestations such as
pneumonitis, meningoencephalitis, jaundice, renal failure, and
myocarditis can develop during the prolonged clinical course of
untreated illness (6). Establishing the diagnosis and initiating
prompt antimicrobial drug therapy are important, because death rates
for untreated scrub typhus patients are 1-30 per cent (5). Scrub
typhus is effectively treated with doxycycline, and treatment should
begin immediately upon suspicion of illness without awaiting
laboratory confirmation."

References
----------
1. Traub R, Wisseman CL, Jones MR, O'Keefe JJ. The acquisition of
_Rickettsia tsutsugamushi_ by chiggers (trombiculid mites) during the
feeding process. Ann NY Acad Sci 1975; 266: 91-114.
2. Traub R, Wisseman CL. The ecology of chigger-borne rickettsiosis
(scrub typhus). J Med Entomol 1974; 11: 237-303.
3. Lerdthunsee K, Khuntirat B, Leepitakrat W, Tanskul P, et al. Scrub
typhus: vector competence of _Leptotrombidium chiangraiensis_ chiggers
and transmission efficacy and isolation of _Orientia tsutsugamushi_.
Ann N Y Acad Sci 2003; 990: 25-35; abstract available from
<http://www.ncbi.nlm.nih.gov/pubmed/12860596>.
4. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr
Opin Infect Dis 2003; 16: 429-36; abstract available from
<http://www.ncbi.nlm.nih.gov/pubmed/14501995>.
5. Silpapojakul K Scrub typhus in the Western Pacific region. Ann
Acad Med Singapore 1997; 26: 794-800; abstract available from
<http://www.ncbi.nlm.nih.gov/pubmed/9522982>.
6. Corwin AL, Soeprapto W, Widodo PS, Rahardjo E, et al. Short
report: surveillance of rickettsial infections in Indonesian military
personnel during peace keeping operations in Cambodia. Am J Trop Med
Hyg 1997; 57: 569-70; abstract available from
<http://www.ajtmh.org/cgi/content/abstract/57/5/569>.

Rodents may serve as reservoirs, although transovarial transmission
in mites is the dominant mechanism for maintenance of _O.
tsutsugamushi_
(<http://www.cdc.gov/ncidod/EID/vol9no12/03-0212.htm>). Humans become
infected when they accidentally encroach in a area where the
chigger-rodent cycle is occurring, most often areas of low-lying scrub
brush or transitional vegetation.

Patients with severe scrub typhus can develop multiorgan failure and
disseminated intravascular coagulopathy with hemorrhage.

Joginder Nagar is a town in Mandi district in the northwest Indian
state of Himachal Pradesh, with a population of about 5000 in 2001.
The town is situated in a valley surrounded by mountains on all sides;
it has an average elevation of 1010 metres (3314 feet)
(<http://en.wikipedia.org/wiki/Jogindernagar>). Himachal Pradesh is
bordered by the Indian states of Jammu and Kashmir on the north,
Punjab on the west and south-west, Haryana and Uttar Pradesh on the
south, Uttarakhand on the south-east and by the Tibet Autonomous
Region on the east.

The state of Himachal Pradesh can be found on a map at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.
A HealthMap/ProMED-mail interactive map of India that shows the state
of Meghalaya can be found at
<http://healthmap.org/r/010T>. - Mod.ML]

MALARIA - INDIA (07): (LUNGLEI DISTRICT, MIZORAM STATE)
*******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 30 Mar 2011
Source: YahooNews [edited]
<http://my.news.yahoo.com/6-die-cerebral ... 0-225.html>


6 die of cerebral malaria in Lunglei
------------------------------------
A total of 6 people died of cerebral malaria in south Mizoram's
Lunglei district in March [2011], the Minister of State for Animal
Husbandry and Veterinary Nihar Kanti Chakma today [30 Mar 2011]
informed the state assembly.

The deaths were diagnosed to have been caused by cerebral malaria at
Thanzamasora, Chakma said. He added that during his visit to the area
on 26 Mar 2011 he had tried to dispel the beliefs of the villagers
that they were cursed by black magic and were fleeing from the area.

"Many people migrated to other villages while some of them hid in the
nearby forests for fear of the spell," he said, adding that he
implored the people not to believe in superstition.

Chakma also lauded the role of Christian missionaries in their
efforts to dispell the superstition and for providing medical care to
the affected families along with the government. He said three
Malaria-affected persons were still under treatment at hospital in
nearby Chawngte.

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

[Lunglei in Mizoram State is endemic for malaria, being located
between Bangladesh and Myanmar. Cerebral malaria is a late state of
the malaria infection and means that either the patients presented
late in the course of the infection to the health care facilities, or
that the treatment was not effective. Treatment failure could be due
to drug resistance; for instance, chloroquine resistance is widespread
in India. Thus drug resistance or sub-standard drugs should be
suspected when cerebral malaria is suddenly seen in an endemic area
where this condition previously had been rare.

The interactive HealthMap/ProMED map is available at:
<http://healthmap.org/r/0DRY>
- Mod.EP]

MALARIA - INDIA (07): (LUNGLEI DISTRICT, MIZORAM STATE)
*******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 30 Mar 2011
Source: YahooNews [edited]
<http://my.news.yahoo.com/6-die-cerebral ... 0-225.html>


6 die of cerebral malaria in Lunglei
------------------------------------
A total of 6 people died of cerebral malaria in south Mizoram's
Lunglei district in March [2011], the Minister of State for Animal
Husbandry and Veterinary Nihar Kanti Chakma today [30 Mar 2011]
informed the state assembly.

The deaths were diagnosed to have been caused by cerebral malaria at
Thanzamasora, Chakma said. He added that during his visit to the area
on 26 Mar 2011 he had tried to dispel the beliefs of the villagers
that they were cursed by black magic and were fleeing from the area.

"Many people migrated to other villages while some of them hid in the
nearby forests for fear of the spell," he said, adding that he
implored the people not to believe in superstition.

Chakma also lauded the role of Christian missionaries in their
efforts to dispell the superstition and for providing medical care to
the affected families along with the government. He said three
Malaria-affected persons were still under treatment at hospital in
nearby Chawngte.

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

[Lunglei in Mizoram State is endemic for malaria, being located
between Bangladesh and Myanmar. Cerebral malaria is a late state of
the malaria infection and means that either the patients presented
late in the course of the infection to the health care facilities, or
that the treatment was not effective. Treatment failure could be due
to drug resistance; for instance, chloroquine resistance is widespread
in India. Thus drug resistance or sub-standard drugs should be
suspected when cerebral malaria is suddenly seen in an endemic area
where this condition previously had been rare.

The interactive HealthMap/ProMED map is available at:
<http://healthmap.org/r/0DRY>
- Mod.EP]

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

Date: Fri 1 Apr 2011
Source: Novosti-Kazakhstan [in Russian, trans. Mod.NR, edited]
<http://www.newskaz.ru/incidents/20110401/1286560.html>


A border guard in Southern Kazakhstan has been hospitalized on
suspicion of rabies virus infection. The information was given by
Galimjan Abish, deputy minister of the health department.

According to him, the border guard has been admitted to the
Infectious Diseases Department of Saryagash District Hospital [South
Kazakhstan province]. The border guard is under medical surveillance,
but the clinical assessment strongly suggests that he has rabies, said
Abish.

On 26 Mar 2011 the 25-year-old border guard attended a Health Post
complaining of symptoms of osteochondrosis, On 28 Mar 2011 he felt
worse and when exhibiting other symptoms he was transferred to
hospital. According to Abish, the young man had not been bitten by a
dog. However in 2010 his father was bitten by a dog. The young man
killed the dog and sent the head for medical examination. However,
medical authorities concluded that that dog did not have rabies.

Currently the young man remains in hospital in very severe
condition.

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

[This may be the 2nd of case of human rabies recorded in Southern
Kazakhstan in 2011. A previous case occurred in March in Shymkent
where a 51-year old woman died from rabies. - Corr.BA]

[The report above does not indicate whether the father of the young
man actually contracted rabies, or alternatively whether he received
post-exposure prophylaxis. - Mod.NR]

[Further information on the outcome of the patient's illness and
final confirmation of the diagnosis of rabies are awaited. A map of
Kazakhstan showing the location of Saryagash in South Kazakhstan
province can be accessed at
<http://en.wikipedia.org/wiki/Saryagash_District>. The
HealthMap/ProMED-mail interactive map of Kazakhstan is available at
<http://healthmap.org/r/0Eh9>. - Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (06): ASIA
****************************************************************
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 - Pakistan (Sindh)
Date: Sun 27 Mar 2011
Source: Tribune [edited]
<http://tribune.com.pk/story/138185/one- ... irpurkhas/>


An 8-year-old boy has been confirmed with cholera in Mirpurkhas after
samples of 3 suspected cases were sent to Islamabad for testing.

Dr Kamran Ahmed, a public officer with the Disease Early Warning
System (Dews) which is part of the World Health Organization, told The
Express Tribune that 3 cases were being investigated. "We mainly look
into cases of acute watery diarrhea," he explained.

Such cases are at a point of severe dehydration and, therefore, of
primary concern, he added. Dews was formed in response to the health
threats from last summer's floods. The other 2 cases of a 12-year-old
boy and 7-month-old girl were provided oral hydration and have now
recovered, Dr Ahmed said.

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

[The interactive HealthMap/ProMED map for Pakistan is available at:
<http://healthmap.org/r/00tj> - CopyEd.EJP]

RABIES - INDIA (02): (MIZORAM) CANINE CONTROL, HUMAN EXPOSURE
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 6 Apr 2011
Source: The Telegraph, Calcutta [edited]
<http://telegraphindia.com/1110406/jsp/n ... 813970.jsp>


Section 144 CrPC [Criminal Procedure Code] has been clamped on dogs
in Lunglei town, the headquarters of Lunglei district in south
Mizoram, for 2 months. [Section 144 confers powers to issue an order
absolute at once in urgent cases of nuisance or apprehended danger. -
Mod.CP]

The prohibitory step was taken last week [week of 28 Mar 2011] after
dogs bit at least 10 persons, Lunglei district deputy commissioner
Margaret Zomingthangi said over the telephone today [Wed 6 Apr 2011].

The administration has asked the residents of the headquarters town
to keep their dogs, raised as pets or reared for meat, inside their
home compounds and not to allow them into the streets under any
circumstances.

The inhabitants of Mizoram relish canine meat and rear dogs for that
purpose. These dogs are often left to roam the streets, as they find
their way back on their own. Some of these dogs had bitten the 10
people.

Zomingthangi said all the persons bitten by dogs had been admitted to
Lunglei civil hospital. She said in case of 4 very poor patients, the
administration had asked the hospital authorities to supply free
medicines and proper nursing to them [post-exposure vaccination?].
She, however, denied reports that a shoot-at-sight order had been
issued to prevent rogue canines from biting pedestrians.

Zomingthangi said no head count of the canine population had ever
been done in her district, but a rough estimate put the number of dogs
in the town at 4800.

--
Communicated by:
Merritt Clifton
Editor, Animal People
PO Box 960
Clinton, WA 98236
USA
<anmlpepl@whidbey.com>
<http://www.animalpeoplenews.org>

[Merritt Clifton has offered the following comment:
"The report above published in Kolkata (formerly Calcutta), pertains
to a rabies outbreak far to the northeast, in Assam, located in the
tongue of India which lies between China to the north, Myanmar to the
east, and Bangladesh to the south.

It is the 1st news report I have seen which links raising dogs for
meat in northeast India to rabies, although I have heard rumors to
this effect from animal advocates in Assam and Mizoram state, just
south of Assam, for about a dozen years. (Northeast India is the only
part of India where dog-eating is reputedly common. Many Assamese
swear that only Mizorans eat dogs, but regardless of who does it,
historically the practice does seem to occur in both states.)

The article describes a method of dog-rearing for sale which is
similar to the common practice of goat, dairy cattle, and pig farmers
all over India, of simply turning animals loose to fend for themselves
each day, then rounding them up in the evening so as to maintain the
degree of "ownership" necessary to establish title to sell the
animals, or their products and byproducts.

This is quite different from the dog-rearing practice in southern
China, also associated with rabies outbreaks, in which dogs are
essentially factory-farmed by the multi-hundreds, perhaps thousands.
In either place, though, dogs meant for human consumption are not
vaccinated.

The mode of raising dogs for human consumption in the smaller nations
of Southeast Asia and in Korea usually follows yet another pattern. In
those regions, typically small numbers are kept in pens, more-or-less
in the traditional pre-factory farm manner of pig-raising --
essentially as an adjunct to other types of farming, or fishing, not
as the farmer's whole business. These dogs are not vaccinated
either."

Maps showing the location of Mizoram state and the town of Lunglei
can be accessed at
<http://www.indnav.com/servlet/DMap?mt=s ... ge&stId=84> and
<http://healthmap.org/r/0Fax>. - Mod.CP]