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LEPTOSPIROSIS - INDIA: (KARNATAKA, KERALA)
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******
[1]
Date: Thu 7 Jul 2011
Source: The Times of India [edited]
<http://articles.timesofindia.indiatimes ... ease-fever>


The 1st ever case of leptospirosis has been reported from the
[Belgaum] district. According to sources in the district surveillance
department, a patient from Mamadapur village in Chikkodi taluk [a town
in the Belgaum district], who is undergoing treatment in Kolhapur
district government hospital in Maharashtra [a neighboring Indian
state to the north], has tested positive for the disease.

--
communicated by:
HealthMap Alerts via ProMED-mail
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******
[2]
Date: Fri 8 Jul 2011
Source: ibnlive.in [edited]
<http://ibnlive.in.com/news/state-regist ... 0-116.html>


The number of patients with rat fever [leptospirosis] in the state
[Kerala] is on the rise. There are as many as 11 with rat fever
according to the update on 5 Jul [2011].

The health services director has warned against washing and bathing
in murky waters and has instructed the use of gloves and socks for
animal caretakers and agricultural workers to prevent the spread of
rat fever. They have also been directed to take a weekly preventive
medicine [doxycycline], which is available at the primary health
centres, free of cost. The symptoms of rat fever are high fever,
headache, body ache, red eyes, and muscle cramps.

Pregnant women, affected with fever, should consult a doctor at the
earliest [opportunity] and get the appropriate treatment. Those with
kidney trouble, liver functioning problems, and diabetes have also
been advised utmost caution.

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

[Leptospirosis is a zoonosis caused by exposure to _Leptospira_
bacteria, in fresh (not salty) water, wet soil, or vegetation that has
been contaminated by urine of animals chronically infected with one of
the several hundred serovars of the spirochete _Leptospira
interrogans_. Rodents, dogs, cattle, and pigs are the usual reservoirs
for this organism.

The symptoms in humans appear after a 3-14 day incubation period.
Because of the relatively nonspecific nature of the clinical
presentation of leptospirosis, its diagnosis cannot be made
confidently without laboratory confirmation. The news release from
Kerala above fails to note if the diagnosis of leptospirosis was
confirmed in any of the 11 cases.

The disease occurs worldwide and frequently follows flooding after
heavy rains. Karnataka, and the neighboring state of Kerala to the
south, are located on the south west coast of India. They are subject
to the southwestern summer monsoons, which begin around the 1st of
June (<http://en.wikipedia.org/wiki/Monsoon>). In fact, heavy rain has
been reported in this region with a flooding alert in Kerala this week
(<http://www.indiatribune.com/index.php?o ... Itemid=400>,
and
<http://www.deccanherald.com/content/408 ... nsoon.html>).

Karnataka is heavily involved in the cultivation of sugar cane and is
one of the largest producers of sugar in India. Leptospirosis is also
known as canecutter's disease or sugar cane fever, because of the
spread of the disease by canefield rats. The news release from
Karnataka does not specify if the confirmed case in that state was a
sugar cane field worker.

Doxycycline in a single 200 mg oral dose, (or weekly, in cases of
prolonged exposure) has been used to prevent leptospirosis in exposed
people. The single dose of doxycycline is thought to provide
protection for about a week. However, different clinical trials to
assess the efficacy of chemoprophylaxis of leptospirosis have had
conflicting results
(<http://www.cdc.gov/ncidod/eid/vol9no6/02-0751.htm>,
<http://www.wiziq.com/tutorial/40553-Dox ... ief-review>).

The results of one randomized placebo-controlled trial study
indicated that doxycycline prophylaxis did not prevent leptospiral
infection in an endemic area during a seasonal outbreak, but had a
significant protective effect in reducing the morbidity and mortality
(<http://www.ncbi.nlm.nih.gov/pubmed/10755239>). Another randomized
placebo-controlled study of US soldiers training in Panama
demonstrated a 95 per cent protective efficacy with a weekly dose of
200 mg doxycycline for 3 weeks, compared to placebo (Takafuji ET et
al: An efficacy trial of doxycycline chemoprophylaxis against
leptospirosis. N Engl J Med. 1984; 310(8): 497-500; abstract available
at <http://www.nejm.org/doi/full/10.1056/NE ... 2233100805>).

A Cochrane review of clinical research testing whether taking
doxycycline can prevent leptospirosis found that data from trials,
which "targeted different kinds of people -- travellers and people who
live in at risk areas, encompassing soldiers, farmers, and students,"
"did not support the practice in all cases, though short term
travellers with a potential for high risk exposure may be helped."
(<http://www.thecochranelibrary.com/userf ... 007342.pdf>).

A map of the states of India can be found at
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>. For
the interactive HealthMap/ProMED map of India, see
<http://healthmap.org/r/008o>. - Mod.ML]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (22): ASIA
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[1] Cholera - South Korea ex India
Date: Mon 11 Jul 2011
Source: Yonhap News Agency [edited]
<http://english.yonhapnews.co.kr/busines ... 0320F.HTML>


A South Korean traveler returning home from an overseas trip was
found to have contracted cholera, local health authorities said Mon 11
Jul 2011, the country's 1st case of the disease in 2011.

The unidentified patient, who recently visited Delhi and Varanasi in
India, showed symptoms of the disease upon arrival at Incheon
International Airport, the Korea Centers for Disease Control and
Prevention (KCDC) said. The person tested positive for the _Vibrio
cholerae_ O1, Ogawa it said.

The KCDC said it has acquired a list of 10 other people who traveled
with the cholera patient to check if they had caught the disease as
well. It stressed that people traveling to India and Southeast Asian
countries during the summer months should be on guard against the
disease.

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

[South Korea and India can be seen on the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/r/11MC>. - Sr.Tech.Ed.MJ]

******
[2] Cholera - India (Gujarat)
Date: Fri 8 Jul 2011
Source: The Indian Express [edited]
<http://www.indianexpress.com/news/Chole ... ge/814531/>


Navsari district [Gujarat state] health office has declared Sarai
village as cholera affected after 66 of its residents were
hospitalized with complaints of vomiting and diarrhea. After being
given preliminary treatment at the primary health centre, the 66
affected villagers have been shifted to Navsari Civil Hospital.

District health officials who visited the village found a leakage in
the borewell supplying the drinking water, as a result of which it got
contaminated by the drainage water. The leakage was repaired. Health
officials have also collected samples of contaminated water and sent
these to laboratory for analysis. Tests were also carried out on
samples collected from various patients and these turned out to be
positive.

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

[The state of Gujarat can be seen on the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/r/11MD>. - Sr.Tech.Ed.MJ]

******
[3] Cholera - Pakistan (Khyber Pakhtunkhwa)
Date: Fri 8 Jul 2011
Source: The News International (Pakistan) [edited]
<http://www.thenews.com.pk/TodaysPrintDe ... t=7/8/2011>


A health official said on Thu 7 Jul 2011 that 2 cases of cholera have
been confirmed in Mansehra district [Khyber Pakhtunkhwa province,
previously known as the North West Frontier province]. "The National
Institute of Health Islamabad has confirmed 2 cases of cholera in
Mansehra," Executive District Officer (Health) [EDO] Dr Mohammad Javed
Tanoli told reporters [in Mansehra].

He said over 520 people including children and elderly people were
visiting the hospitals with the symptoms of gastroenteritis in the
district on a daily basis. The EDO urged the people to take the
precautionary measures against the diseases.

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

[The HealthMap/ProMED-mail interactive map of Pakistan can be seen at
<http://healthmap.org/r/11ME>. - Sr.Tech.Ed.MJ]

RABIES - INDIA (14): (KERALA), SQUIRREL, HUMAN
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Date: Fri 8 Jul 2011
Source: The Hindu [edited]
<http://www.thehindu.com/todays-paper/tp ... 209999.ece>


A bite by a wild squirrel is suspected to be the cause of the death
of a 7-year-old boy after contracting rabies. The child, hailing from
Pavithreshwaram in the district [of Kollam], succumbed to the viral
attack at the Thiruvananthapuram Medical College Hospital on Wednesday
night [6 Jul 2011]. He [had been] admitted in the hospital 4 days
[previously].

The parents of the child said that 3 months ago one afternoon while
sleeping, they heard the boy cry. They rushed to him and saw a
squirrel running out of the room. On examining the child, they found
that the squirrel had bitten him. Some traditional medicine was
administered to him then. The boy attended school after the vacations
and did not show any signs of being infected with rabies. But, 5 days
ago, he showed symptoms of fever, drooling, and weakness. The parents
rushed him to a nearby hospital, from where he was referred to the
medical college hospital, relatives said.

--
Communicated by:
Merritt Clifton
Editor, Animal People
P.O. Box 960
Clinton, WA 98236
<anmlpepl@whidbey.com>

[Merritt Clifton comments: "I'm a bit skeptical of this report:
Squirrels are not a common rabies vector anywhere, since they tend to
die quickly if infected, but there are other fatal diseases that they
could transmit which would also produce a very high fever. The victim
could very well have had contact with a rabid dog. However, the victim
does not appear to have received proper post-exposure rabies
vaccination."

On the other hand, although some species of squirrels are docile and
easily tamed, others can be aggressive. Remarkably, in a study of
animal bites undertaken in Iran, squirrels ranked 3rd after dogs and
cats in terms of frequency of human bites, ahead of monkeys and other
potential rabies vectors (Eslamifar A, et al., Arch Iran Med. 2008
Mar;11(2):200-2). Since squirrels are susceptible to rabies, it is not
inconceivable that, on occasion, they may transmit rabies virus
infection to humans.

A map showing the location of Kollam district in the Indian state of
Kerala can be accessed at:
<http://www.mapsofindia.com/maps/kerala/kerala.htm>. The
HealthMap/ProMED-mail interactive map of India is available at:
<http://healthmap.org/r/008o>. - Mod.CP]

HEPATITIS E - INDIA: (RAJASTHAN), JAIPUR, WATER-BORNE
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Date: Tue 12 Jul 2011
Source: The Times of India [edited]
<http://articles.timesofindia.indiatimes ... tamination>


Hepatitis E, a water-borne disease, is gradually becoming a scare in
Jaipur. But, if the disease is spreading in the city, blame it on
40-year-old sewerage pipelines, which contaminate drinking water.
Experts said that around 60-65 percent youths are carriers of
hepatitis E virus in the city and that one of the major reasons for
the spread of the disease is the contaminated [drinking] water
supplied through the pipeline. Also, pregnant women are easily
infected with the disease.

The former head of the department of gastroenterology at the Sawai
Man Singh Hospital and former president of the Indian Society of
Gastroenterology, Dr Ramesh Roop Rai, said: "In Jaipur, the number of
hepatitis E patients [is] increasing and the reason could be water
contamination. Due to erosion in the water pipelines, sewer water
enters the [fresh] water pipelines, which is why infected water enters
every house."

Explaining the contamination process, the expert said that through a
combination of old sewer pipelines, which are laid down [alongside]
water pipelines, overflow of the sewer lines, and breakage in the
drinking water pipelines, the drinking water gets mixed and is then
supplied to the houses. Many reports in the newspapers have already
been published about water contamination.

Out of every 100 adults infected with the disease, 95 of them develop
encephalopathy, after which the patients become unconscious and
critical. Doctors claimed that the disease does not have a high
mortality rate. "Out of 1000 persons infected, only one could [die]
due to hepatitis E [virus infection], but it makes a bad impact on the
body," Rai said.

In Sawai Man Singh Hospital, around 8-10 patients with hepatitis E
come in for treatment every now and then. SMS medical college
principal and gastroenterologist Subhash Nepalia said: "Around 10
patients, mostly pregnant woman, with hepatitis E come to the hospital
for treatment regularly. The disease takes a fecal-oral transmission
route. So, it spreads through contaminated food and water."

Another gastroenterologist, C S Sharma, said the disease has become
common like hepatitis A. "Both hepatitis A and hepatitis E have become
common now. But, hepatitis A has a vaccine, which is administered to
children 10 years after birth. But there is no vaccine for hepatitis E
so far. Mostly, within 45 days, a patient recovers from the disease,
but there are chances that the case could become complicated, and the
patient dies," Sharma said.

Reacting on the project of replacing old sewer pipelines in the old
Walled City area, a senior JMC official said: "Since the project is
worth more than Rs 300 crore [USD 300 million], a proposal has been
sent to the state government for financial assistance. The state
government has also sent it to the Centre to seek funds under the
Jawaharlal Nehru Urban Renewal Mission. But, the state has not
received the funds yet. The project has been pending for more than 3
years."

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

[Hepatitis E virus is transmitted via the faecal-oral route.
Hepatitis E is a waterborne disease, and contaminated water or food
supplies have been implicated in major outbreaks. Consumption of
faecally contaminated drinking water has given rise to epidemics, and
the ingestion of raw or uncooked shellfish has been the source of
sporadic cases in endemic areas. There is a possibility of zoonotic
spread of the virus, since several non-human primates, pigs, cows,
sheep, goats and rodents are susceptible to infection. The risk
factors for hepatitis E virus infection are related poor sanitation in
large areas of the world, and shedding in faeces. Person-to-person
transmission is uncommon. There is no evidence for sexual transmission
or for transmission by transfusion.

The highest rates of infection occur in regions where low standards
of sanitation promote the transmission of the virus. Epidemics of
hepatitis E have been reported in Central and South-East Asia, North
and West Africa, and in Mexico, especially where faecal contamination
of drinking water is common. According to the Gideon database, around
2 million cases per year are estimated to occur nationwide in India.

In general, hepatitis E is a self-limiting viral infection followed
by recovery. Prolonged viraemia or faecal shedding are unusual, and
chronic infection does not occur. Occasionally, a fulminant form of
hepatitis develops, with overall patient population mortality rates
ranging between 0.5-4.0 percent. Fulminate hepatitis occurs more
frequently in pregnancy and regularly induces a mortality rate of 20
percent among pregnant women in the 3rd trimester.

Hepatitis E virus causes acute sporadic and epidemic viral hepatitis.
Symptomatic HEV infection is most common in young adults aged 15-40
years. Although HEV infection is frequent in children, it is mostly
asymptomatic or causes a very mild illness without jaundice
(anicteric) that goes undiagnosed. Typical signs and symptoms of
hepatitis include jaundice (yellow discoloration of the skin and
sclera of the eyes, dark urine and pale stools), anorexia (loss of
appetite), an enlarged, tender liver (hepatomegaly), abdominal pain
and tenderness, nausea and vomiting, and fever, although the disease
may range in severity from subclinical to fulminant. Further
information can be obtained from the WHO website at:
<http://www.who.int/mediacentre/factshee ... index.html>.

Certain features of the description of the outbreak in Jaipur are not
typical of hepatitis E virus infection, namely the 60-65 percent
carriage rate and the 95 percent encephalopathy rate. It is likely
that other agents or factors are involved in this outbreak of
water-borne disease.

Jaipur is the capital and largest city of the Indian state of
Rajasthan. The city has a population of more than 3.9 million. The
location of Jaipur is shown in the map of Rajasthan at:
<http://en.wikipedia.org/wiki/Jaipur>. The HealthMap/ProMED-mail
interactive map of India can be accessed at:
<http://healthmap.org/r/008o>. - Mod.CP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (02): (ASSAM)
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<http://www.isid.org>

Date: Thu 14 Jul 2011
Source: The Telegraph [edited]
<http://www.telegraphindia.com/1110715/j ... 240141.jsp>


The Sivasagar district [Assam state] administration has sent an SOS
to Dispur, seeking help in battling encephalitis, which has claimed 21
lives this year [2011], including 10 in the past 10 days. Altogether
79 cases have been reported since January this year [2011].

In Jorhat district [Assam state], the health department is carrying
out a massive drive following the detection of about 20 cases of
encephalitis and 8 deaths. Only last night [13 Jul 2011], a professor
of the crop physiology department of the Assam Agricultural University
died of encephalitis.

The joint director of health in Sivasagar, Sadhana Dutta, told The
Telegraph that the department through the district administration had
urged Dispur to send stocks of chemicals like melatheon [sic.
malathion] and K-othreon [sic. K-Othrine, a contact pyrethroid
insecticide. - Mod.TY] immediately to control the rising number of
cases of encephalitis. She said 2 trucks were expected to reach
Sivasagar soon.

Dutta said the health department was spraying and fogging chemicals
in areas under all the 8 public health centres (PHCs) across the
district regularly, exhausting the stocks. She said long-lasting
insecticide-treated bed nets, too, were distributed in the vulnerable
areas. K-Othrine was pasted on bed nets of people residing along the
inter-state border and also in other villages from where cases were
reported.

She said Sivasagar deputy commissioner Jatindra Lahkar had yesterday
[13 Jul 2011] convened a meeting with health department officials to
review the situation. The chief medical health officer of Sivasagar
district, Akhil Hazarika, said of the 79 cases of acute encephalitis
syndrome (AES), 15 had symptoms similar to Japanese encephalitis (JE).
Of the 21 deaths in Sivasagar district, 6 were from Japanese
encephalitis and 15 from AES.

Hazarika said among the 8 PHC areas of the district, Geleki, near the
Assam-Nagaland border, was the worst hit.

--
Communicated by:
Ronan Kelly for FluTrackers.com

[Once again, there are reports of Japanese encephalitis (JE) virus
infections in northeastern India, but as a minor component of "acute
encephalitis syndrome" (AES) of unspecified etiology. Reports from
this general area in India last year (2010) implied a waterborne
pathogen or pathogens, perhaps enteroviruses. No mention is made of
the JE virus vaccine status of the populations where the current cases
are occurring, nor of plans to mount a vaccination campaign. Until
there is a definitive diagnosis of these unspecified AES cases,
prevention will be difficult and more cases can be anticipated.

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

DIPHTHERIA - INDIA: (RAJASTHAN) LOW IMMUNIZATION RATE
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Date: Thu 14 Jul 2011
Source: dailybhaskar.com [edited]
<http://daily.bhaskar.com/article/RAJ-JP ... 61591.html>


The death of a 6-month-old child from Sawai Madhopur and 4 other
persons found suffering from diphtheria in the city's JK Lone Hospital
last fortnight [2 weeks] has raised serious questions on the efficacy
of immunisation programmes in the state.

A combination vaccine against diphtheria, pertussis (whooping cough)
and tetanus is given to every child under various immunisation
programmes. "Few children, who were in post-diphtheria stage, were
admitted in the JK Lone Hospital but no case has been reported as
diphtheria is reported by eye and throat unit at SMS Hospital. At JK
Lone Hospital, few children came in post-diphtheria stage," said Dr SD
Gupta, superintendent, JK Lone Hospital.

Authorities now say they will fix the responsibility on the health
workers in the areas from where such cases and patients have been
reported. "We will inquire into who is responsible for these cases,"
said Dr ML Jain, assistant director, reproductive and child health.

The health department data regarding immunisation programmes in the
state shows the lethargy in dealing with the disease. In the 1st 2
months of year 2011-12, only 10 per cent target of immunisation has
been achieved which is around 5 per cent lower than last year. In
2010-11, the health department could achieve only 83.18 per cent of
its annual target, which shows a glaring gap between the need and
action taken. Districts that are falling behind in achieving targets
under immunisation programmes are Jaipur zone II (7.13 per cent),
Jodhpur (8.03 per cent), Sriganganagar (8.75 per cent), Nagaur (8.87
per cent), Hanumangarh (9.725 per cent), Sikar (9.89 per cent) and
Jaipur zone.

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

[A discussion of diphtheria can be found in ProMED post Diphtheria -
Paraguay: (Asuncion) alert 20110614.1814.

In India, under the Universal Immunization Programme (UIP), vaccines
for 6 vaccine-preventable diseases (tuberculosis, diphtheria,
pertussis (whooping cough), tetanus, poliomyelitis, and measles) are
available for free of cost to all. UIP was launched in 1985 to attain
the target to immunize all eligible children by 1990. However, the UIP
has chronically failed to meet its goals
(<http://www.isical.ac.in/~wemp/Papers/Pa ... nPatra.pdf>).

High absenteeism rates among health care providers and unreliable
supplies of vaccines contribute to low vaccination rates
(<http://www.povertyactionlab.org/evaluat ... ives-india>).
A lack of understanding of the benefits of vaccination and even a
suspicion of government health services are thought to be contributing
factors.

Sawai Madhopur is a city in the Sawai Madhopur District in the Indian
state of Rajasthan; As of the 2001 India census, Sawai Madhopur had a
population of 97 491
(<http://en.wikipedia.org/wiki/Sawai_Madhopur>). Sawai Madhopur can
be located on a map at
<http://maps.google.com/maps?client=safa ... i+Madhopur>.
The HealthMap/ProMED-mail interactive map of India can be accessed
at:
<http://healthmap.org/r/008o>. - Mod.ML]

RABIES - KAZAKHSTAN: (KYZYLORDA) HUMAN SUSPECTED
************************************************
A ProMED-mail post
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: Thu 14 Jul 2011
Source: Novosti-Kazakhstan [in Russian, trans Corr. ATS, edited]
<http://www.newskaz.ru/incidents/20110714/1691023.html>


According to the press office of the Ministry of Emergencies of
Kazakhstan, a 10-year-old boy has been hospitalized in the Kyzylorda
Oblast [region] as a suspected case of rabies. Currently his condition
is deteriorating.

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

[The press report above provides no further information. It is not
stated whether the victim had been bitten by a rabid dog or a wild
animal. According to ProMED-RUS Corr.BA the rabies situation in
Kazakhstan is serious. The disease is widespread in foxes. There have
been 39 human rabies cases during the past 5 years (as of April 2011).
30 of these cases occurred in the south of Kazakhstan. Only 7 of these
patients sought or received medical treatment.

The Kyzylorda Oblast of Kazakhstan is situated in southern
Kazakhstan. It is an arid region bordering on Uzbekistan. Its location
is illustrated in the map of Kazakhstan at
<http://en.wikipedia.org/wiki/Kyzylorda_Province>. The
HealthMap/ProMED-mail interactive map of Kazakhstan can be accessed at
<http://healthmap.org/r/01w6>. - Mod.CP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (03): (UTTAR PRADESH)
*************************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 19 Jul 2011
Source: News 24 [edited]
<http://www.news24online.com/ViewDetails ... wsID=30436>


With 2 more persons succumbing to encephalitis, the death toll in the
viral disease spread in eastern Uttar Pradesh has crossed the 100 mark
this year [2011]. This year, 101 patients succumbed to the deadly
brain fever out of which 75 were from Gorakhpur Mandal, doctors at the
BRD Medical College said [in Gorakhpur] today [19 Jul 2011].

Since 1 Jan [2011], a total of 626 encephalitis patients were
admitted to the BRD Medical College and other government hospitals in
the region. Out of these, 101 succumbed to the disease, they said. At
present, there are 74 patients undergoing treatment in Nehru Hospital
of BRD Medical College.

Gorakhpur and Kushinagar are the worst affected districts. There were
141 patients from Gorakhpur out of which 24 died. 25 deaths were
reported from Kushinagar out of 127 reported cases. The fever is
caused by a virus found in pigs and is transferred to humans by
mosquito bite.

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

[The report doubtless refers to Japanese encephalitis (JE) virus,
which is maintained in wild birds and _Culex_ mosquitoes with domestic
pigs as amplifying hosts. The number of reported cases has increased
over the past 2 weeks. The 7 Jul 2011 ProMED-mail report (archive no
20110707.2055) indicated that there were 450 acute encephalitis
syndrome cases and 77 deaths, with 111 cases and 21 deaths in
Gorakhpur. In the current report, that number in the Gorakhpur
district has increased to 141 cases with 24 deaths. In previous
reports from this region, the disease is referred to as "acute
encephalitis syndrome", with less than half confirmed as JE virus
infections. There is no mention about the number of confirmed JE virus
infections among the cases mentioned above. In previous reports, the
etiology of the majority of the encephalitis cases has not been
determined, but there are implications that water-associated viruses,
perhaps enteroviruses, are responsible.

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]

[Gorakhpur and Kushinagar districts 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]

MALARIA - INDIA (15): NEW 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>

Date: Tue 19 Jul 2011
Source: rediff news [edited]
<http://www.rediff.com/news/report/malar ... 110718.htm>


Malaria threat in Delhi, 53 positive cases
------------------------------------------
The threat of Malaria is looming large over the national capital,
with the city registering 53 positive cases of the mosquito-borne
disease, outnumbering Dengue cases, which is only 5, in the current
monsoon season.

As per the Municipal Corporation of Delhi on vector borne diseases,
53 cases of Malaria have been reported so far in the current season as
against 13 cases registered in the same period last year [2010].

"Malaria cases are more than Dengue this year. Last year we had 13
cases of malaria till now as against 53 this year. The Municipal
Corporation of Delhi has already adopted all anti-mosquito measures,"
MCD Health Committee Chairman V K Monga said. "We have strengthened
malaria detection Clinics, and these figures clearly reflect that
breeding of Anopheles mosquito is on the rise," he said.

According to MCD's Mosquito Breeding Checkers, as many as 18 844
houses are detected as breeding ground for mosquitoes. MCD's health
workers have already sent legal notices to 23 750 people and
prosecuted 969 of them.

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

[The data from the last 5 years can be found at the website
<http://nvbdcp.gov.in/Doc/Malaria-situation-may11.pdf> of the
National Vector Borne Disease Control Programme, Ministry of health
and Family Welfare, New Delhi. The number of reported cases for the
past 5 years are: 2007 "182"; 2008 "253"; 2009 "169" 2010 "251"
(preliminary and 2011 "45" including May. New Delhi has an estimated
12.8 million inhabitants.

If the surveillance is identifying the majority of cases the numbers
reported could represent cases infected in other areas of India and
does not necessarily indicate local transmission.

If the surveillance especially in the slum areas are not identifying
most cases, there could be transmission ongoing in slum areas without
being reported.

HealthMap location: <http://healthmap.org/r/0G3P> - Mod.EP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (04): (ASSAM)
*****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 19 Jul 2011
Source: The Assam Tribune [edited]
<http://www.assamtribune.com/scripts/det ... 2011/at092>


Altogether, 51 people have died, and 226 others have been affected by
encephalitis and allied diseases in Assam since the beginning of this
month [July 2011], a senior health department official said today [19
Jul 2011], reports PTI.

Sivasagar district was the worst-hit, with 21 dead so far and 100
others affected, Joint Director (Malaria) Dr Abani Kumar Goswami said
here.

The patients were stated to be suffering from acute encephalitis
syndrome, which included Japanese encephalitis, cerebral malaria,
scrub typhus and tuber[culosis] meningitis, Dr Goswami said. Of the 51
dead, he said that 31 were confirmed Japanese encephalitis cases. In
Sibsagar district, 15 of the 21 dead were confirmed Japanese
encephalitis cases. The affected districts, among others, were
Darrang, Jorhat, Dhemaji, Tinsukia, Kamrup, Nalbari and Sonitpur, the
health official said.

The 4 medical colleges and civil hospitals across the state were
equipped to provide treatment for the disease, Dr Goswami added.

--
Communicated by:
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[In this report, the majority of the fatal "acute encephalitis
syndrome" (AES) cases were due to Japanese encephalitis virus
infections. The number of AES cases due to scrub typhus, tuberculosis
and other etiological agents is not given. Previous reports have
associated AES cases with water-borne viruses, presumably
enteroviruses, but they have never been definitively diagnosed.

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

CHIKUNGUNYA (18): INDIA (JHARKHAND), REQUEST FOR INFORMATION
************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 23 Jul 2011
Source: Anonymous Physician


I am a doctor living in London. My whole family living in Jamshedpur
in the state of Jharkhand in India is ill with Chikungunya fever. All
the local hospitals are full. But the public has been given no
information about precautions/treatment etc. Anecdotally, this looks
like an epidemic but no reports from the Ministry of Health in India.
[This is] disappointing. Please add to your map as this might help.

--
Communicated by:
HealthMap via ProMED-mail


[Chikungunya virus is endemic in India, and there are sporadic
outbreaks there. This anecdotal report suggests that there is an
outbreak going on in Jamshedpur. ProMED would be interested in
receiving additional information about the number of cases and the
dates and places where cases are occurring.

A HealthMap/ProMED-mail interactive map of India showing the location
of Jamshedpur in Jharkhand state can be accessed at
<http://healthmap.org/r/14Bt>. - Mod.TY]

DENGUE/DHF UPDATE 2011 (30)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


Asia - India (Delhi). 23 Jul 2011. Dengue fever has returned to the
city as the Municipal Corporation of Delhi today [23 Jul 2011]
reported one death due to the infection and 6 new cases in the past
one month, taking the total count of people affected by the virus this
year to 11. Last year [2010], a total of 6229 dengue cases had been
reported from the city, out of which 8 patients had died
<http://news.outlookindia.com/item.aspx?728676>. [A
HealthMap/ProMED-mail interactive map of Delhi can be accessed at
<http://healthmap.org/r/01Jf>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (05): (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: Sun 24 Jul 2011
Source: The Times of India (TOI), Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/city ... 340775.cms>


Monsoon heralds the season of death in Poorvanchal [Purvanchal,
eastern Uttar Pradesh]. With the deadly combo of Japanese encephalitis
[JE] and acute encephalitis syndrome (AES) claiming its 106 victim
last Friday [22 Jul 2011], the scenario threatens to turn ugly once
again this year.

BRD Medical College in Gorakhpur is overflowing with patients pouring
in from neighbouring districts of Siddharthnagar, Maharajganj,
Kushinagar, Sant Kabirnagar, Deoria, Maharajganj, Gonda, and from
Bihar and neighbouring Nepal as well.

The rice bowl of UP has lost nearly 3500 lives to the vicious killers
over the past 6 years. And though health officials celebrate the
'statistical victory' that JE figures have plummeted to a mere 2 per
cent from 35.88 per cent as reported in 2005, the sudden spurt in AES
cases has them in knots.

Experts explain, "AES is a severe neurological condition with high
mortality rate. For the semi-literate or illiterate victims and their
families, it is a "plain mystery fever that brings sure death." The
virus, which has moved into the killer slot, could prove particularly
worrisome this year [2011]. It has already overtaken JE much before
the peak season in August.

"Cases of AES, which has no vaccine have shown a definite climb this
year," said Dr SP Ram director general health UP. Talking to TOI, Dr
Ram said that 85 AES deaths have been reported in UP till July [2011].
The number last year [2010] at this time of year was 75. In contrast,
the casualty figure of JE reads 21. The official attributes the later
phenomenon largely to a sustained vaccination programme. The bigger
issue of how the department proposes to tackle the AES, however,
leaves him floundering.

Admitting that the particular strain has not been identified, Dr Ram
said, "The National Institute of Virology is working on it . It could
be an enterovirus, meningitis, malaria, or any other water-borne
virus," he said, and added that the process could take time.

Then there have been other attempts like the visit by an expert team
from Centre for Disease Control and Prevention, Atlanta. The team took
150 samples, but forgot to send the report or the pilot project in
Kushinagar undertaken by the Union Ministry of Health and Family
Welfare for prevention and control of AES, which sources say is
largely confined to papers.

"The state health department has launched an awareness campaign to
introduce the populace to hygiene and cleanliness practice and written
to the chief secretary UP to sanction mark 2 hand pumps for the
affected belt to ensure safe drinking water," Dr Ram said. Whether
this would ever become a priority agenda with a government busy
fire-fighting at this time, remains a mute point though.

"The only lasting solution is to declare JE eradication a national
programme like the malaria or polio eradication programmes," says Dr
RN Singh, convener of the encephalitis eradication movement in
Gorakhpur. Dr Singh is leading a campaign to make JE an election issue
this time. "With 125 MLAs [members of the legislative assembly] out of
403 hailing from Poorvanchal, what is needed is a committed push," he
said.

[Byline: Manjari Mishra]

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

[It is encouraging to learn that the Indian National Institute of
Virology and, apparently, the USA CDC are attempting to determine the
etiology of the acute encephalitis syndrome cases that are not
Japanese encephalitis virus infections. Eradication of Japanese
encephalitis virus in its endemic cycle in wild birds and _Culex_
mosquitoes is not possible with currently available control measures.
An aggressive and sustained vaccination program could reduce human
cases significantly.

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

HEPATITIS C - INDIA: (PUNJAB), 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: Sun 24 Jul 2011
Source: The Times of India [edited]
<http://timesofindia.indiatimes.com/indi ... 341545.cms>


In the border village of Marhi Megha, more than 4 confirmed cases of
hepatitis C [virus infection] have been reported within a short span
of time. However, a district epidemiologist officer denied any
confirmed case yet. A team [from the] civil surgeon office is visiting
Marhi Megha on Monday [25 Jul 2011] to verify the claims of
villagers.

Sarpan (council leader) Gursewak Singh of Marhi Megha village,
situated close to Bhikiwind, told The Times of India on Saturday [23
Jul 2011] that: "According [to] my rough estimate, more than 30
percent of the population of my village is suffering from hepatitis
C."

Gursewak, who himself is a hepatitis C patient and is undergoing
treatment, squarely blames the spread of the disease on registered
medical practitioners (RMP) and drug addicts. He said nobody was
willing to get himself examined for fear of expensive treatment.
"People have closed their eyes and prefer taking general medicines
whenever they have any problem," he said.

A farmer and local politician, Kiranbir Singh Mithha, said on
Saturday [23 Jul 2011] that his medical tests confirmed hepatitis C.
He blamed the civil surgeon office for not giving the correct figures
to the public to save their own skins.

"We have decided to hold a private medical camp to get to know the
gravity of the situation. At least 8 village [residents] are taking
expensive treatment, while those who can't afford [the treatment] are
still taking regular medicines." He said a single injection for
treatment of hepatitis C costs Rs 13 500 [USD 300], and they had to
take around 20 such injections, which is not affordable for everyone.
"Three to 4 years ago, the RMPs used to boil the syringe before
injecting. I think that had led to spread of diseases, besides drug
addicts who still use the same syringes out of ignorance," he said.

District epidemiologist officer S J Dhawan said: "We don't have any
single case of confirmed hepatitis C." Many a times, he said, people
confuse simple jaundice with hepatitis C [virus infection], but the
department will hold a survey on Monday [25 Jul 2011].

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

[Further information about this outbreak is requested to resolve the
conflict of evidence in this press report and to indicate the nature
of the treatment options available locally.

Hepatitis represents a major global health problem, with 170 million
hepatitis C virus (HCV) carriers worldwide, and at least 12-13 million
carriers in India. At least 6 distinct HCV genotypes and more than 50
subtypes have been identified. Hepatitis C genotypes are of clinical
significance in indicating drug responsiveness and prognosis of the
patient. Previously, genotype 3 has been reported to predominate in
northern and eastern regions of India. Genotypes 2, 4, 5, and 6 were
detected rarely (Narahari S, Juwle A, Basak S, Saranath D India.
Infect Genet Evol 2009 Jul ;9(4):643-5.).

Combination therapy with pegylated interferon and ribavirin is the
treatment of choice, resulting in sustained virologic response
(defined as undetectable HCV RNA in the patient's blood 24 weeks after
the end of treatment) rates of 40-80 percent (up to 50 percent for
patients infected with genotype 1, and up to 80 percent for patients
infected with genotypes 2 or 3). Treatment success rates are now being
improved with the addition of polymerase and protease inhibitors to
standard pegylated interferon/ribavirin combination therapy.

Patients with genotypes 2 and 3 are almost 3 times more likely than
patients with genotype 1 to respond to therapy with alpha interferon
or the combination of alpha interferon and ribavirin. When using
combination therapy, the recommended duration of treatment depends on
the genotype. For patients with genotypes 2 and 3, a 24-week course of
combination treatment is adequate, whereas for patients with genotype
1, a 48-week course is recommended. For further information on
treatment of hepatitis C virus infection see:
<http://www.cdc.gov/hepatitis/Resources/ ... CTable.pdf>.

Bhikhiwind is a town in Tarn Taran district in the state of Punjab,
India. Its location is indicated on the map at:
<http://en.wikipedia.org/wiki/Bhikhiwind>. - Mod.CP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (06): (ASSAM)
*****************************************************
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: Sun 24 Jul 2011
Source: The Assam Tribune [edited]
<http://www.assamtribune.com/scripts/det ... l2511/at08>


Even though encephalitis (Japanese encephalitis (JE)) has taken a
heavy toll and affected 20 out of the 27 districts of the state, the
State Health Department has claimed that due to the measures it has
taken to prevent spread of the disease, it has remained under control,
or else, the disease would have claimed more lives, claimed sources in
the Health Department. However, sources in the National Vector-borne
Disease Control Programme (NVBDCP) of the Central Government contest
the above claim of the State Health Department as not true.

Sources in the Health Department told this newspaper the department
has taken steps like distribution of long lasting insecticidal nets in
high risk areas and conducting awareness programmes against
vector-borne diseases all over the state. These awareness programmes
have been undertaken generally on malaria and particularly on JE in
the high-risk areas of the disease.

Around 35 lakh [3.5 million] long lasting insecticidal nets were
distributed by the department in 2010 and 2011. Spraying of DDT also
continued in the state between 15 Feb [2011] till July 2011, and
fogging has also been done at places, said the Health Department
sources.

In the meantime, children in the age group of 1-15 have been
vaccinated against Japanese encephalitis infection in the 11 districts
of Dibrugarh, Sivasagar, Golaghat, Jorhat, Tinsukia, Dhemaji,
Sonitpur, Lakhimpur, Kamrup, Nagaon and Udalguri. Routine immunization
of the children who were below one year of age during the vaccination
campaign in these 11 districts has also been done, sources said. The
vaccination programme is conducted by the Assam government with
support from the Union Health Ministry's Immunisation Wing, said the
sources. This time, the state government has projected 5 more
districts for vaccination during the current year. These districts
include Morigaon, Darrang, Nalbari, Barpeta and Goalpara, said the
sources.

Since the adults are becoming vulnerable to Japanese encephalitis
[virus] infection, the government of Assam is now considering an
immunisation programme for the adults on priority basis, according to
the number of JE cases found in the districts. It is expected that by
September next [2011?], vaccination of adults against JE infection
could be started.

The sovernment of Assam has set up 8 laboratories to diagnose JE
infection at the Assam Medical College, Jorhat Medical College,
Gauhati Medical College, Lakhimpur Civil Hospital, Sivasagar Civil
Hospital, Golaghat Civil Hospital, Tezpur Mission Hospital and at the
Dibrugarh Lahowal-based Regional Medical Research Centre, sources
said. Better facilities for diagnosing JE [virus] infection and better
treatment facilities for the patients suffering from JE infection have
been providing scope for better planning to control the disease, and
the detection of so many cases is the result of all such facilities,
said the sources.

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

[The JE virus transmission season in Assam is well underway. The
vaccination campaign should prove helpful in preventing additional
cases. Interestingly, there is no mention made of non-JE encephalitis
cases categorized as "acute encephalitis syndrome" of unknown
etiology, as had been reported last year (2010) and again recently in
Uttar Pradesh state.

It is not clear whether DDT is being applied only in houses for
malaria control in Assam or more widely for control of JE virus
vectors. The application of DDT for mosquito control illustrates the
dilemma that public health authorities face. Use of DDT for control of
the _Culex_ mosquitoes that are the JE virus vectors would requite its
application over large areas where they breed. Because DDT and its
breakdown products are very stable compounds that bioaccumulate in
organisms in natural food chains, its use has been banned in many
countries due to the adverse ecological effects it causes. Landscape
application is not _Culex_ target-specific and will reduce populations
of other insects, including beneficial ones. There is also the risk
that DDT is no longer as effective for control if the target mosquito
populations have become resistant to it.

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