Wüstenschiff

Indien - Malaria
14.06.2011

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. Im Bundesstaat Maharashtra wurden in diesem Jahr bereits vor Beginn des Monsuns im Juni hohe Malaria-Fallzahlen gemeldet. In den ersten 4 Monaten soll es bereits 28.400 Fälle gegeben haben, das sind 8.000 mehr als im selben Zeitraum des Vorjahres. Besonders betroffen ist Mumbai, hier wurden mehr als 16.500 Erkrankungen und 11 Todesfälle gemeldet. Dringend Mückenschutz und ggf. Malariaprophylaxe beachten. / Quelle: crm

Gruß
Birgitt

UNDIAGNOSED ENCEPHALITIS - INDIA: (BIHAR)
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Date: Sun 19 Jun 2011
Source: NDTV [edited]
<http://www.ndtv.com/article/india/encep ... eks-113271>


Encephalitis has claimed the lives of 17 children so far in Bihar's
Muzaffarpur district over the last 2 weeks.

Alarmed by the situation, the Bihar government dispatched the health
secretary to the Shri Krishna Medical College and Hospital. Blood
samples have been collected from 4 children who are said to be in a
serious condition. Another 30 children have been admitted to the same
hospital.

The Bihar government has said they are taking all possible measures
to address the situation, including constant monitoring and supply of
medicines.

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

[There is no indication in this report as to the etiology of these
encephalitis cases. ProMED would appreciate additional information,
particularly when the blood samples are tested in the laboratory. It
is possible that these cases are ones occurring at the beginning of
the Japanese encephalitis virus transmission season.

A HealthMap/ProMED-mail interactive map of Muzaffarpur, Bihar, India
can be accessed at <http://healthmap.org/r/01v2>. - Mod.TY]

[A review of prior ProMED-mail posts reveals recurrent threads on
undiagnosed encephalitis reports in India without clear resolution.
There are also thread reporting outbreaks of Japanese encephalitis.
ProMED-mail would greatly appreciate receiving more information on
both this current outbreak report, as well as prior undiagnosed
encephalitis outbreaks in India. - Mod.MPP]

DENGUE/DHF UPDATE 2011 (25)
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******
- India (Mumbai, Maharashtra state). 17 Jun 2011. In what is being
labelled as the 1st dengue death of the [2011] season, a 46 year old
woman resident of Mumbai died of complications arising out of the
mosquitoborne disease [virus] at Jaslok Hospital on Wednesday [15 Jun
2011]. She was in hospital for less than 24 hours before she died. As
it was DHF, she has had clots in her brain.
<http://articles.timesofindia.indiatimes ... -hospitals>.

[A HealthMap/ProMED-mail interactive map showing the location of
Mumbai in Maharashtra state can be accessed at
<http://healthmap.org/r/00BT>. - Mod. TY]

- India (Kerala state). 18 Jun 2011. Dengue fever has yet again begun
to take a grip on Thiruvananthapuram city with the increase in
rainfall. Fever cases had been going up in many parts of the city in
the past few days since the onset of the monsoon. While only 2-4 cases
of dengue were reported in the district on a daily basis, on Fri 17
Jun 2011], the district health administration's dengue toll for the
day stood at 22. Only laboratory-confirmed cases of the disease end up
as statistics with the health department. Fever cases clinically
suspected as dengue could be much more and these do not figure in
official reports. Case-reporting from private hospitals also has not
been done properly, with the result that the actual number of cases of
dengue is anybody's guess.
<http://www.hindu.com/2011/06/18/stories ... 330300.htm>

[A HealthMap/ProMED-mail interactive map showing the location of
Thiruvananthapuram in Kerala state can be accessed at
<http://healthmap.org/r/00aD>. - Mod.TY]

JAPANESE ENCEPHALITIS - INDIA: (BIHAR) SUSPECTED, REQUEST FOR
INFORMATION
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Date: Mon 20 Jun 2011
Source: The Hindu [edited]
<http://www.thehindu.com/health/policy-a ... 120247.ece>


The Centre [National Centre for Disease Control? - Mod.SH] has
constituted a team to probe the outbreak of suspected Japanese
encephalitis [JE] in Muzaffarnagar district of Bihar that has resulted
in the death of 26 children. The team comprises Dr SK Jain, joint
director, National Centre for Disease Control (Delhi), BR Thapar,
entomologist from the National Vector Borne Disease Control Programme,
Delhi; and IP Choudhary, senior specialist (paediatrics), Safdarjung
Hospital. An expert from the Rajendra Memorial Research Institute of
Medical Sciences, Patna, who is already in the field with the National
Institute of Virology, Pune team, will also coordinate with the
central team. The team will leave for Bihar on Tuesday [21 Jun 2011].

In Muzaffarpur district, 4 more deaths were reported from the
"unknown disease" on Monday [20 Jun 2011] taking the toll to 26. The
disease has now been identified as Japanese encephalitis, which is
common in Uttar Pradesh during this season. 3 children died at
Kejriwal hospital, and another died at Sri Krishna Medical College
Hospital in Muzaffarpur in the past 24 hours. Around 30 children are
still being treated at the 2 hospitals.

The state health department has sent a team of experts from Regional
Malaria Research Institute (RMRI) in Patna to the district. The team
has collected the blood samples which have been sent to a specialised
laboratory in Pune for examination.

[byline: Aarti Dhar]

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

[This report is not clear about the diagnosis. It begins by stating
that JE virus infection was suspected, but later states that, "the
disease has now been identified as Japanese encephalitis".

The identification of JE virus as the etiological agent involved in
these cases is presumably the result of laboratory tests on the sera
of 4 patients submitted to the laboratory last week (see ProMED-mail
archive no 20110619.1879). It would be of interest to know which tests
were used and what their specific results were. It would also be of
interest to know if these patients, or others in the population, had
been vaccinated for JE virus.

A HealthMap/ProMED-mail interactive map of Muzaffarpur, Bihar, India
can be accessed at <http://healthmap.org/r/01v2>. - Mod.TY]

MALARIA - INDIA (13): (ANDHRA PRADESH)
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ProMED-mail is a program of the
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Date: Mon 20 Jun 2011
Source: Times of India [edited]
<http://timesofindia.indiatimes.com/city ... 916404.cms>


Malaria cases on the rise in city of Hyderabad
----------------------------------------------
Malaria is fast spreading its tentacles in Greater Hyderabad. To
date, the Greater Hyderabad Municipal Corporation (GHMC) has recorded
as many as 145 malaria cases in the twin cities. The health department
is ironically observing Anti-Malaria month currently and has planned a
slew of activities throughout June [2011], but has no manpower to
implement them.

Sources say that out of the 107 posts of health assistants, only 22
are on the job for the entire Greater Hyderabad region. The district
health department has identified high risk areas prone to malaria
outbreaks. The list included Jubilee Hills, Banjara Hills, parts of
Indira Park, Sanathnagar, Saidabad, Bholakpur, Amberpet, Uppuguda,
Puranapul, Kurmaguda, Jiyaguda. The highest number of cases, the
officials said. are being reported from Banjara Hills and Bholakpur in
Musheerabad.

Apart from government facilities, even private hospitals are
recording 10-15 cases of malaria every week from the city as well as
the neighbouring districts over the last fortnight, a specialist at a
private hospital in the city said.

Doctors said that potholed roads, stinking streets, and stagnant
water in the city offer many breeding ground for mosquitoes that cause
the spread of the vectorborne disease. While GHMC claims that fogging
and anti-larval operations were being undertaken to curb the mosquito
menace, year after year, there seems to be no respite for denizens.

Sources said that the civic body is concentrating on VIP areas for
the fogging operations. We are unable to cover most of the areas. With
the available manpower, it is highly impossible to cover every area,
said an official. He added that the malaria labs in the 12 districts,
area and teaching hospitals diagnosing the disease are also
understaffed. Out of 17 posts of lab technicians, only 12 are working.


We are unable to identify the cases. Because of the load, the quality
also suffers, said a senior official. He added that patients are
instead going to private hospitals and do not complete the 14-day
treatment, said another official.

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

[According to the World Malaria Report 2010, Andrah Pradesh is a low
endemic area
(<http://www.who.int/malaria/world_malari ... index.html>),
with an annual malaria incidence of 0 to 1 or 1 to 10 cases per 1000
population per year. Hyderabad has around 4 million inhabitants and
even a low incidence of 1 per 1000 population per year could explain
up to 400 cases annually. ProMED-mail would be happy to post data
showing trends over the past years.

Health Map: <http://healthmap.org/r/0_nV>. - Mod.EP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (16): ASIA
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******
Cholera - Iran (southern provinces)
Date: 20 Jun 2011
Source: Trend [edited]
<http://en.trend.az/news/society/1894061.html>


Some 13 people have been infected with cholera in Iran, Disease
Management Center director Hossein Masoumi Asl was quoted as saying by
iribnews.ir. He said the necessary precautions are being taken, and in
general, their condition is satisfactory.

He said the infection cases mainly were revealed in the Iranian
provinces of Sistan-Baluchistan, Fars, Khuzestan, and Hormuzgan.
Doctors took samples from relatives of ill persons, but no infection
was found.

The country has been recording cases of cholera infection for nearly
45 years, he said. The number of such cases was 15 in 2010. Asl said
cholera has not spread throughout the country.

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

[All 4 provinces are located in the southern part of the country. -
Mod.LL

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

MALARIA - INDIA (14): (ANDHRA PRADESH)
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Date: Wed 23 Jun 2011
Source: National Vector Borne Disease Control Programme (NVBDCP)
<http://nvbdcp.gov.in/Doc/Malaria-situation-april11.pdf>


Malaria in Hyderabad: additional data
-------------------------------------
The following information on malaria in Andhra Pradesh comes from the
National Vector Borne Disease Control Programme (NVBDCP):

2007
Blood slide examinations: 8 896 110
Malaria cases: 27 803
Plasmodium falciparum: 16 996
Fatalities: 2

2008
Blood slide examinations: 8 964 918
Malaria cases: 26 424
P. falciparum: 15 947
Fatalities: 0

2009
Blood slide examinations: 9 189 256
Malaria cases: 25 152
P. falciparum: 14 841
Fatalities: 3

2010 (provisional)
Blood slide examinations: 8 907 903
Malaria cases: 33 217
P. falciparum: 22 688
Fatalities: 20

2011 (to April)
Blood slide examinations: 2 535 158
Malaria cases: 8555
P. falciparum: 6237
Fatalities: 0

--
communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[ProMED-mail thanks Ronan Kelly for providing this very informative
additional data. It is notable that the number of fatalities in 2010
is higher than in previous years even though the numbers of fatal
cases are still small. Andra Pradesh has an estimated population of
84.6 million (2011, Wikipedia
<http://en.wikipedia.org/wiki/Andhra_Pradesh>).

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

JAPANESE ENCEPHALITIS - INDIA (02): (BIHAR) SUSPECTED, REQUEST FOR
INFORMATION
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Date: Wed 22 Jun 2011
Source: Rediff News [edited]
<http://www.rediff.com/news/report/suspe ... 110622.htm>


Suspected mosquitoborne encephalitis has killed 36 children in Bihar
in the past week, but the state government is yet to identify the
disease and its health officials are still guessing to diagnose it. 20
children died at Sri Krishna Medical College and Hospital in
Muzaffarpur followed by 10 in Kejriwal Hospital in Muzaffarpur. One
died at a private clinic in Motihari and 2 at Patna Medical College
and Hospital in Patna. Besides, 4 children died in different villages
in Muzaffarpur. "10 children died in last 48 hours at SKMCH and
Kejriwal hospitals in Muzaffarpur. With this, the death toll of
children rose to 36," a health official said.

After 3 dozen children died, mostly belonging to poorest families in
Muzaffarpur, Motihari, Gopalganj, and Patna districts, state
government decided to identify the villages affected and carry out
intensive spraying of DDT to kill mosquitoes, which are responsible
for the suspected disease. Bihar health minister Ashwani Kumar Choubey
told rediff.com in Patna on Wednesday [22 Jun 2011] that health
officials have been directed to start spraying DDT in villages. "All
such villages from where children died due to mysterious disease and
children have been admitted in hospitals will be identified to spray
DDT," Choubey said.

It must be recalled that it was Choubey who described heat-stroke as
the cause of the deaths 4 days ago. To date the state government has
not confirmed officially the real cause behind these deaths. Doctors
in Muzaffarpur treating children in different hospitals suggest that
the symptoms are similar to encephalitis.

Even state BJP [Bharatiya Janata Party] president Dr CP Thakur, a
renowned kala azar [visceral leishmaniasis] expert, disclosed that
test result of one of the 4 blood samples conducted by Patna-based
Rajendra Memorial Research Institute, has confirmed [Japanese]
encephalitis. But principal health secretary Amarjeet Sinha said that
disease was not diagnosed and test samples of blood would be sent to
the National Institute of Virology in Pune for confirmation. "Even
though the disease had not been diagnosed, the government was
providing symptomatic treatment to the patients," Sinha said.

Choubey has made it clear that state government is serious to handle
the situation. "We will bear expenses of all patients undergoing
treatment and teams of doctors will visit villages to provide
immunisation and proper treatment," he said.

Nearly 40 children still suffering from high fever are being treated
at the SKMCH and other hospitals including private clinics in
Muzaffarpur. "Some new patients complaining of high fever, severe
headache, vomiting were admitted to the hospital in the last 24
hours," a staff of SKMCH said. Dr AK Singh, civil surgeon,
Muzaffarpur, denied that encephalitis had claimed the lives of the
children, but admitted that the symptoms were similar. "Medical
authorities have collected samples which have been sent for tests in
virology laboratories at Pune and Kolkata. The medical reports were
still awaited," Singh said.

2 expert teams -- one from Pune-based National Institute of Virology
and another from Union health ministry in New Delhi -- visited SKMCH
and Kejriwal hospital in Muzaffarpur on Tuesday and Wednesday [21 and
22 Jun 2011]. The team members will visit villages hit by the disease
to identify the disease that had killed several children in last one
week. "The expert would also collect samples of local animals to
identify the cause of the disease for which the department of forest
has been approached," Sinha said.

Bihar chief minister Nitish Kumar earlier directed health officials
to take preventive measures to check spread of the unknown disease.
Kumar had also requested Union health minister Ghulam Nabi Azad to
immediately send a central team to Bihar to find out the reasons
behind the disease outbreak.

[byline: MI Khan]

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

[The number of deaths in this outbreak have increased from 26
children on 20 Jun 2011 to 36 fatalities and an additional 40
undergoing treatment in the current report.

The reports of the diagnosis of these cases are still not clear. The
previous report stated that JE virus infection was suspected, but
later in that same report stated that, "the disease has now been
identified as Japanese encephalitis" (see ProMED-mail archive no
20110621.1896). The identification of JE virus as the etiological
agent involved in these cases is presumably the result of laboratory
tests on the sera of 4 patients submitted to the laboratory previously
(see ProMED-mail archive no 20110619.1879).

The 23 Jun 2011 edition of The Times of India
(<http://timesofindia.indiatimes.com/city ... 956481.cms>)
quotes the senior most member of the 3-member central team from Union
health ministry and associate professor in pediatrics department of
Safdarjung Hospital, New Delhi, Dr IP Chaudharatna, investigating the
outbreak, saying, "It is definitely encephalitis. Only the type of the
virus of the disease is to be identified now."

Apparently, the earlier diagnosis of heat exhaustion has been
discarded. One of the physicians in the current report indicated that
the cases are not encephalitis, yet DDT spraying is being conducted,
implicating a mosquito-borne disease, despite the absence of a
diagnosis. Because DDT is not a target-specific insecticide, is a
stable, bioaccumulative organochlorine compound with potential adverse
environmental effects, the wisdom of its use in area application in
the absence of a diagnosis is questionable. If this is a Japanese
encephalitis outbreak, the _Culex_ mosquito vectors are almost
certainly widespread and likely to be abundant, hence difficult to
control with ground spraying of insecticides.

The current report mentions that physicians will be visiting villages
and vaccinating people, but does not mention which vaccines will be
applied (perhaps Japanese encephalitis virus vaccines?). ProMED-mail
would appreciate receiving more information about the results of the
laboratory tests and the establishment of a definitive diagnosis in
patients and presence of virus in the putative mosquito vectors.

A HealthMap/ProMED-mail interactive map of Muzaffarpur, Bihar, India
can be accessed at <http://healthmap.org/r/01v2>. - Mod.TY]

DENGUE/DHF UPDATE 2011 (26)
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ProMED-mail is a program of the
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- India (Bangalore, Karnataka state). 21 Jun 2011. Addressing
reporters on Tuesday [21 Jun 2011], health minister B Sriramulu said
that the department had also recorded 2 dengue deaths in Gadag and
Dakshina Kannada this year [2011]. This year, the department has
received confirmation of 102 dengue cases. Last year [2010], there
were 7 dengue deaths out of 2285 cases.
<http://www.deccanherald.com/content/170 ... engue.html>

[A HealthMap/ProMED-mail interactive map showing the location of
Bangalore in Karnataka state can be accessed at
<http://healthmap.org/r/00bl>. - Mod.TY]

JAPANESE ENCEPHALITIS - INDIA (03): (BIHAR) NOT
***********************************************
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[1]
Date: Mon 27 Jun 2011
Source: The Hindu [edited]
<http://www.thehindu.com/news/states/oth ... 137344.ece>


With 41 children falling prey to the 'mystery disease' ravaging North
Bihar, the Muzaffarpur district administration on Sunday [26 Jun 2011]
recommended that the State government invoke the Epidemic Diseases Act
throughout the afflicted area. While 41 is the official death toll,
unconfirmed reports from different pockets of the Tirhut division put
the figure at 48.

On Sunday [26 Jun 2011], the district magistrate and the civil
surgeon sent a letter to the State Health Department, recommending
that Muzaffarpur be declared an epidemic-zone.

None of the 18 samples sent to the National Institute of Virology,
Pune has tested positive for Japanese encephalitis (JE) [virus], the
Nipahvirus (named after Nipah in Malaysia), or the Chandipura virus
(named after the village in Maharashtra's Nagpur division).

A 5-member expert committee has been constituted to formulate the
kind of treatment to be administered in the district's afflicted
blocks.

[Byline: Shoumojit Bamjaree]

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

******
[2]
Date: Mon 27 Jun 2011
Source: Express India [edited]
<http://www.expressindia.com/latest-news ... ic/809168/>


With the death toll in the mysterious disease rising to 47 on Sunday
[26 Jun 2011], the Bihar government is likely to declare it an
epidemic. Under the epidemic Act, the Health Ministry will be
empowered to take samples of brain tissues of the mystery disease
victims.

During the last 48 hours, 6 deaths have been reported, including 5 at
KD Kejriwal Maternity Hospital. The hospital, which has admitted 82
patients since [11 Jun 2011], reported 24 deaths till Sunday evening
including one on Sunday [26 Jun 2011]. 17 children are being treated
at the hospital. Muzaffarpur's government hospital, Sri Krishna
Medical College and Hospital, reported one death during the last 48
hours. It has been treating 8 patients. Patna Medical College and
Hospital has 7 patients.

At the National Institute of Virology, Pune, and Rajendra Memorial
Research Institute, Patna, 24 blood and cerebral spinal fluid samples
have tested negative for Japanese encephalitis (JE) [virus or
antibody? - Mod.TY]. These institutes now want brain tissue samples to
ascertain the disease that experts describe as a kind of viral
encephalitis. _Culex_ mosquitoes are suspected to carry virus from
animals to humans [if it is JE virus, which apparently it is not, as
indicated in the report above. - Mod.TY]

Muzaffarpur district magistrate recommended the state government late
on Saturday night [25 Jun 2011] to declare Gandak catchment and
suburban areas of Bochaha, Minapur, Mushahari, Kanti, Ahiyapur,
Sahebganj, and Paru as epidemic zone. The district administration has
set up a 5-member doctors' committee to advise line of treatment and
help prepare a contingency plan. Dr Arun Shah, one of the members of
the committee, said Muzaffarpur cases needed the same treatment as
Saharanpur encephalitis that led to a large number of deaths every
year till 2000. "A study by the Indian Council of Medical Research
concluded that a toxin from kasaundhi trees, being transmitted to
humans through insects, caused the disease. The trees were cut and the
disease subsided. Litchi trees and mosquitoes present in the region
should be studied for this disease," suggested Shah.

Health minister Ashwini Kumar Choubey said, "We have received
Muzaffarpur administration's advice to declare the disease as
epidemic. We have started the process. We urgently need brain tissues
to decode the mystery. The government will take a final call on Monday
[27 Jun 2011] after assessing the situation. Experts have given us
enough hints of it being some kind of a viral disease affecting brain
and causing sudden death. Declaration of epidemic would help us get
the exact diagnosis," he said.

Chief minister Nitish Kumar said that irrespective of blood sample
tests ruling out Japanese encephalitis, JE vaccine should be given to
all children below 15 years in affected areas.

[Byline: Santosh Singh]

[3]
Date: Tue 28 Jun 2011
Source: Times of India
<http://timesofindia.indiatimes.com/city ... 031469.cms>

[Mysterious disease hits Darbhanga, claims 2
BY Binay Kumar Jha]

There is not enough information in this report from the Times of
India to even guess what is responsible for the deaths of these
children - possibly poisoning of some kind, but given the outbreak in
Muzaffarpur around 30 miles away, I thought that this may be of
interest.

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

[Unfortunately, there still is not a diagnosis for these cases, with
JE, Nipah, and Chandipura viruses having been ruled out. Although JE
virus has been discarded as the etiological agent in this outbreak,
vaccination against JE in this endemic area is a wise decision.
ProMED-mail awaits with interest further information as tests and
epidemiological studies progress.

An alert ProMED subscriber pointed out that in an earlier report, the
locale of this outbreak was given both as Muzaffarpur and,
incorrectly, as Muzaffarnagar.

A HealthMap/ProMED-mail interactive map of Muzaffarpur, Bihar, India
can be accessed at <http://healthmap.org/r/01v2>. - Mod.TY]

[With reference to the toxic plant:
Source:
<http://childhealthfoundation.net/Procee ... ations.pdf>

"In many districts of western UP, Uttarakhand and Haryana, outbreaks
of an acute â&#128;&#156;encephalopathyâ&#128;

JAPANESE ENCEPHALITIS - INDIA (04): (MANIPUR), SUSPECTED, REQUEST FOR
INFORMATION
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Date: Fri 1 Jul 2011
Source: E-Pao [edited]
<http://e-pao.net/GP.asp?src=9..020711.jul11>


A 15-year old boy suspected to be suffering from Japanese
encephalitis [virus] infection has been admitted to the Intensive Care
Unit of Shija Hospital and Research Institute. According to
information received from the hospital, the patient is a resident of
Lilong Arapti and he was admitted to the hospital on 28 Jun [2011]. To
confirm the case, samples have been sent for test outside Manipur.

Meanwhile, a team of officials from the State Health Department today
visited the hospital and collected a relevant report on the case.

On the other hand, taking serious note over the admission of a
patient suffering from a suspected case of Japanese encephalitis [JE]
and in view of the onset of the rainy season, the Ministry of Health
and Family Welfare as well as the Director of the National Vector
Borne Control Programme has reportedly issued necessary instructions
to the Health Department to take the necessary precautionary measures
against outbreaks of vector borne diseases.

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

[The report does not provide any indication of the basis for
suspecting JE virus infection in this case. However, India is endemic
for JE virus and this is the beginning of the transmission season. No
mention is made regarding the JE virus vaccination status of this
youth, nor specifically if there were plans to carry out vaccination
in this area as part of the precautionary measures called for by the
Ministry of Health and Family Welfare. ProMED would appreciate
receiving additional information with laboratory results as it becomes
available.

A HealthMap/ProMED-mail interactive map showing the location of
Manipur is at:
<http://healthmap.org/r/0*Te>. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (19): ASIA
**************************************************************
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<http://www.promedmail.org>
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<http://www.isid.org>

******
[1] Cholera - India (Mombai)
Date: Sun 3 Jul 2011
Source: DNA India [edited]
<http://www.dnaindia.com/mumbai/report_m ... ai_1561729>


Mumbai is reeling from many cases of waterborne diseases like
jaundice, diarrhea, and gastroenteritis; now cholera has also been
added to that list. Two children have tested positive at the Sion
hospital on Fri 1 Jul 2011.

"The samples of the 2 children have shown the presence of the cholera
organism. One is from Antop Hill and the other from Bhiwandi. They are
presently being treated, and both are recuperating," confirmed a
senior doctor from the Sion hospital. Their reports have been sent to
Kasturba hospital. The patients were hospitalized with complaints of
vomiting, diarrhea, and stomach cramps. Doctors treating them said
that they exhibited classic symptoms of cholera, like sunken eyes,
stomach ache, and severe dehydration.

[byline: Somita Pal]

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[2] Diarrhea - India (Punjab)
Date: Sun 3 Jul 2011
Source: Times of India [edited]
<http://timesofindia.indiatimes.com/indi ... 082297.cms>


Five people, including 2 foreigners, were admitted in Ropar Civil
Hospital on Saturday [2 Jul 2011] in what is turning out to be a
diarrhea outbreak in the city. In all, 46 cases of diarrhea have been
reported from the city in the past week.

A research scholar on the Indian economy from Argentina and an
American man were on the way to Manali from Chandigarh when they
stopped to have food at a dhaba in Ropar on Friday night, 1 Jul 2011.
Soon after dinner, they started feeling nauseous, followed by
vomiting. When their condition did not improve even after a visit to a
local RMP doctor, they were brought to the civil hospital. The
American was being kept in an emergency ward suffering from
dehydration following diarrhea.

Two residents of Ropar were also admitted to the emergency ward on
Sat 2 Jul 2011. According to reports, over 46 patients were found
affected by diarrhea and other gastrointestinal ailments during the
last 7 days. The outbreak has reportedly been triggered by poor
quality water supplied to the residents. A local resident, said:
"People here are deprived of fresh drinking water despite being
located on the banks of the Satluj river."

Ropar district health officer Dr Balbir Singh said: "We have already
instructed MC authorities in Ropar to take preventive measures and
have also set up 2 committees under deputy commissioner and civil
surgeon, Ropar to combat the epidemic." However, there were no reports
of any awareness campaign or preventive measures like providing
chlorine tablets or ORS solution to residents in affected areas,
sources said.

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[3] Cholera - India (Kerala)
Date: Fri 24 Jun 2011
Source: AsiaNetIndia [edited]
<http://www.asianetindia.com/news/man-di ... 80284.html>


A 32 year old man has died of cholera at Kalpetta in Wayanad district
on Friday [24 Jun 2011]. The deceased has been identified as a
resident of Paniya adivasi colony. This is the 1st cholera death that
has been reported in the past 5 years in the state.

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[4] Cholera - India (Kerala)
Date: Wed 29 Jun 2011
Source: Asian Age [edited]
<http://www.asianage.com/india/six-die-c ... kerala-196>


Six people have died of cholera, while 56 have been hospitalized with
diarrhea in the tribal hamlets of Kerala's hilly Wayanad district, a
legislator said on Wed 29 Jun 2011.

Intervening in the debate, state Health Minister Adoor Prakash said:
"We have started supplying clean drinking water to these hamlets. And
where vehicles cannot reach, we are supplying water in bottles. A
medical team has already started conducting check-ups," said Prakash.

Chief minister Oommen Chandy said that everything that needs to be
done for the welfare of people will be done. "Out of the 83 houses in
the affected hamlets, only 31 homes have latrines. During the rainy
season, the wells get contaminated. We have issued orders to the
district authorities to see that latrines are built in all the homes,"
said Chandy.

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[5] Cholera - India (Kerala)
Date: Sat 2 Jul 2011
Source: AsiaNetIndia [edited]
<http://www.asianetindia.com/news/choler ... 81985.html>


As many as 114 people have been admitted in the several hospitals in
Wayanad district with symptoms of cholera on Sat 2 Jul 2011. The
official reports reveal that the patients who have been admitted in
the hospital from 13 colonies in the district were suffering from
cholera.

The condition of 5 people who are under treatment at Kozhikode
medical college hospital with symptoms of cholera is reported to be
critical. It was confirmed after a medical test at the Kozhikode
Medical College Hospital that the patients were suffering from
cholera, Neetha Vijayan, district medical officer, said.

Around 7 people have succumbed to the disease. Preventive measures,
including chlorination of drinking water every 3 days, had been taken
in tribal colonies in the area.

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JAPANESE ENCEPHALITIS AND OTHER - INDIA: (UTTAR PRADESH)
********************************************************
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Date: Thu 7 Jul 2011
Source: Indian Express [edited]
<http://www.indianexpress.com/news/encep ... on/813942/>


The number of cases of Japanese encephalitis [JE] in the 7 high-risk
districts of Uttar Pradesh has shot up with the arrival of the
monsoon, despite the extensive immunisation undertaken by the
government to control it. The state has already seen 79 more cases and
10 more deaths due to encephalitis till 5 Jul [2011], as compared to
last year [2010].

According to reports received by the Medical and Health Department,
last year [2010] the state recorded 371 cases and 67 deaths from acute
encephalitis syndrome (AES), while this year [2011] the number of
cases has already reached 450 and deaths 77. Similar is the case with
JE. Until 5 Jul 2010, the state had seen merely 5 cases and one death
from JE, but this time the number of JE cases is already 20, with 3
deaths.

The worst affected districts are Gorakhpur with 111 cases and 21
deaths of AES so far, closely followed by Deoria (109 cases and 15
deaths), and Kushinagar (103 cases and 22 deaths). JE cases have also
been reported from these 3 districts along with Basti,
Siddharthanagar, Sant Kabir Nagar, and Maharajganj.

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[This is a JE virus endemic area, and so with the onset of the annual
monsoon season, it is not surprising that cases of infection by this
virus are occurring. It would be of interest to know the vaccine
coverage of the large populations in these areas. Again, as in reports
from previous years, there are reported this year (2011) cases of JE
virus infection, mixed with cases of "acute encephalitis syndrome"
(AES) of undetermined etiology.

The 28 Jul 2010 edition of The Pioneer
(<http://www.dailypioneer.com/272045/Myst ... st-UP.html>)
quoted the director general (medical & health), Dr RR Bharti as
saying, "When even the local unit of the National Institute of
Virology (NIV) Pune, based in Gorakhpur, failed to arrive at any
conclusion [about the etiology of non-JE virus AES cases], Bharti
requested the Union Health Ministry to intervene. A team of Union
Health Ministry officials and scientists from the Indian Council of
Medical Research (ICMR) -- along with Bharti and Dr SP Ram -- visited
Gorakhpur on Saturday [24 Jul 2010]. However, they also failed to
diagnose the viral strain causing deaths of children in the region.
"At times, it shows symptoms of an enterovirus [meningitis?] but not
uniformly, so we cannot arrive at any concrete conclusion," said
Bharti (see ProMED-mail archive no 20100728.2535).

There was no indication in any of the previous reports of AES cases
that samples were sent to any of the WHO world reference centers to
determine the etiology involved in these AES cases. Without a
diagnosis, it will not be possible to develop a rational prevention
strategy.

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

The districts mentioned are in eastern Uttar Pradesh and can be seen
on the map at
<http://maps.newkerala.com/Uttar-Pradesh-Travel-Map.jpg>. -
Sr.Tech.Ed.MJ]

RABIES - INDIA (13): (TAMIL NADU), CANINE, HUMAN
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Date: Thu 7 Jul 2011
Source: The Times of India, Chennai [edited]
<http://timesofindia.indiatimes.com/city ... 132104.cms>


At least 20 people have died of rabies at the Government General
Hospital in the city in the last 6 months. Last month [June 2011], 3
died of the virus [infection], spread through dog bites.

The increasing number of such deaths is worrying public health
workers, who are coming together on Sat 9 Jul 2011 to debate the topic
at the conference: "Why should anyone die of rabies in the 21st
century?" The conference, organised by the Association for Prevention
and Control of Rabies in India, will discuss strategies to eliminate
rabies by 2020.

"One big reason for rabies still being around is the lack of
transparency and also severe underreporting of deaths," said former
director of public health Dr S Elango. For instance, though the
records at the general hospital alone point to 12 deaths in 2010 and
13 deaths in 2009, none of these were recorded in the national
registry. In 2009, Tamil Nadu recorded 3 deaths against 263 across the
country, and in 2010, it recorded 2 deaths against 162 nationally
(source: National Health Profile 2010).

"Had we reported all deaths, there would have been pressure on the
civic authorities to initiate action. That would have pushed us to a
stage where we can eliminate the disease. Instead, we choose to bury
deaths under the carpet," said Dr Elango. The Government General
Hospital reported 2 rabies deaths each in April and May this year
[2011].

Rabies is caused by a virus that is transmitted to humans through the
infected saliva of a range of animals. In many cities, dogs have been
the primary cause for spreading the virus. Officials at Chennai
Corporation maintain that the dog population in the city has not been
on the rise. "We have outsourced dog population control to NGOs. They
sterilise the animals, give them anti-rabies vaccines and let them out
in the same area," said a health department official. He said most dog
bites took place in suburban areas outside city corporation limits.

[byline: Pushpa Narayan]

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[This press report sadly reiterates some of the well-known factors
impeding the control of rabies virus infection in India. In this
instance, the problem is compounded by systemic underreporting of
human deaths and the lack of a consistent policy for containment and
control of canine rabies anywhere except in city centres.

Chennai, formerly known as Madras, is the capital city of the Indian
state of Tamil Nadu. The state of Tamil Nadu and the city of Chennai
can be located in the HealthMap/ProMED-mail interactive map of India
at: <http://healthmap.org/r/008o>. - Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (20)
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[1] Cholera - Pakistan (Sindh)
Date: Tue 5 Jul 2011
Source: Daily Times [edited]
<http://www.dailytimes.com.pk/default.as ... 011_pg12_8>


Sindh chief minister Syed Qaim Ali Shah has taken notice of a news
item, which appeared in a section of the Press regarding reported
non-awareness of Sindh government about 4 cholera cases. An official
statement issued here on Monday [4 Jul 2011] said that the paper
alleges that cholera, a waterborne disease, has been reported in
Karachi, but there was no heed to the health threat that may become an
epidemic within a short span of time. The chief minister has directed
Sindh Secretary Health to take preventive, precautionary and
pro-active action and also called for a report of such cases.

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[2] Cholera - Nepal (Kathmandu)
Date: Thu 30 Jun 2011
Source: Republica [edited]
<http://www.myrepublica.com/portal/index ... s_id=32941>


At least a dozen patients admitted in different hospitals of the
capital have tested positive for cholera. Since all the patients are
residents of Kathmandu, the doctors say the disease might have already
spread, making drinking water in several parts of the capital unsafe.

The Sukraraj Tropical and Infectious Disease Control Hospital, Teku
has detected 11 cases of cholera in the past 2 weeks. According to the
hospital's research unit, cholera was confirmed in patients admitted
in the hospital for the treatment of diarrhea. The patients are from
Kritipur, Sitapaila, Kalanki, Kalopul and other locations of the
capital.

Dr Rajesh Shah, a member of the research unit said the "[serotype] 01
[biotype] Ogawa" strain of cholera was detected in all the patients.
Shah warned of more cases in the coming days, as, everyday, more than
15 new patients afflicted with diarrhea come to the hospital for
treatment.

Similarly, a cholera case has been identified at Kanti Children's
Hospital. "Cholera has been detected in a child admitted in the
hospital," Dr Tirtha Raj Burlakoti, director of the hospital, said. He
added that 77 patients with diarrheal disease have been treated in the
hospital within 2 weeks.

Likewise, Patan Hospital also said that cholera has been detected in
some of the diarrheal patients.

[byline: Arjun Poudel]

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[3] Cholera - Afghanistan (Kandahar, Zabul)
Date: Wed 22 Jun 2011
Source: Wakht New Agency [edited]
<http://www.wakht.com/en/020003.php>


Cholera was spreading in Kandahar and Zabul provinces in which 7
people including children had died and as many were under medical
treatment, an official said on Wed 22 Jun 2011.

Expressing concern over the critical spread of the disease, director
for Zabul Provincial Rural Rehabilitation Department RRD, Eng. Ghulam
Qader told Wakht News agency that the disease had been found 6 days
back in the Isqah Zai village of Maroof district of Kandahar province,
where 14 children have died. He said also that 30 people have been
affected by cholera in Salam village, Atghar district Zabul province,
where 5 had died and 24 were under treatment.

Nearly 18 lost their lives as a result of cholera disease outbreaks
in southern Kandahar province last week.

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