Wüstenschiff

Indien - Chikungunya, Dengue
15.08.2011

Beide grippeähnlichen Erkrankungen kommen in Indien regelmäßig vor. Während es DEN in Indien schon immer gab, führte CHIC in den letzten drei Jahren zu größeren regionalen Ausbrüchen, im vergangenen Jahr insbesondere im Südwesten des Landes. Im Juli dieses Jahres wurde ein Ausbruch beider Erkrankungen in Jamshedpur (NO) gemeldet. In Goa (SW) wurden in diesem Jahr bis Anfang August 39 bestätigte Erkrankungen an CHIC registriert. Schutz vor tagaktiven Überträgermücken (Aedes-Arten) beachten. / Quelle: crm

JAPANESE ENCEPHALITIS AND OTHER - INDIA (12): (UTTAR PRADESH, BIHAR,
NAGALAND)
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this posting:
[1] Uttar Pradesh
[2] Bihar
[3] Nagaland

******
[1] Uttar Pradesh
Date: Wed 17 Aug 2011
Source: Hindustan Times, Press Trust of India (PTI) report [edited]
<http://www.hindustantimes.com/Encephali ... 34236.aspx>


In the last 4 days, 7 persons have died due to suspected encephalitis
in the Purvanchal region of the state, taking this year's [2011] toll
to 148, health officials said. "These deaths occurred during past 4
days and 47 new patients of suspected encephalitis have been admitted
to the hospital during this period," sources in additional director
(Health)'s office said.

As many as 891 patients of brain fever have been admitted to the BRD
Medical College Hospital since January this year [2011]. At present,
there are 170 patients undergoing treatment, they said.

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

[Unfortunately, one cannot tell if the etiologic agent in these cases
is Japanese encephalitis virus, as previously reported; undiagnosed
"acute encephalitis syndrome," also previous reported; or something
else entirely. ProMED-mail would be interested in receiving further
information as it becomes available.

A HealthMap/ProMED-mail interactive map showing the location of Uttar
Pradesh can be seen at <http://healthmap.org/r/01r4>. Purvanchal is a
geographic region comprised of the eastern end of Uttar Pradesh state
and borders Nepal to the north, the state of Bihar to the east,
Bagelkhand region of Madhya Pradesh state to the south, the Awadh
region of Uttar Pradesh to the west, and the end of Doab (at
Allahabad) in Uttar Pradesh to its south west. A map of the Purvanchal
region can be accessed at
<http://en.wikipedia.org/wiki/File:UP_region_map.gif>. - Mod.TY]

******
[2] Bihar
Date: Tue 16 Aug 2011
Source: Sify News, Indo Asian News Service (IANS) report [edited]
<http://www.sify.com/news/encephalitis-c ... dgaai.html>


As many as 55 people, mostly children, have died in Bihar in the last
1.5 months due to encephalitis, the Rajya Sabha [Indian Council of
States] was informed Tuesday [16 Aug 2011]. Health and Family Welfare
Minister Ghulam Nabi Azad said clinical and epidemiological data
suggests that it was an outbreak of acute encephalitis syndrome
resulting in 150 cases and 55 deaths, mostly among children.

In a written reply, the minister said these cases were reported early
June to middle July [2011]. He said cases of encephalitis, a rare
brain inflammation caused by a virus, were reported from Muzaffarpur
and its bordering areas in Bihar. Azad said rapid response teams
(RRTs) consisting of experts in epidemiology, entomology,
microbiology, and medicine have been trained and positioned at
district, state, and central levels to mount rapid response to disease
outbreaks. He said RRTs at central level are dispatched to affected
areas as and when the need arises to support local health authorities
in prevention, control, diagnosis, and treatment of outbreak-prone
diseases.

--
Communicated by:
ProMED-mail from HealthMap alerts
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[The proportion of individuals in this area who are immunized against
JE virus is not stated in this or the previous report. The etiology of
the "acute encephalitis syndrome" mentioned above remains unknown.
Until the etiology of these cases is established, implementation of
preventive measures will not be possible.

The HealthMap/ProMED-mail map showing the location of Bihar state in
can be accessed at <http://healthmap.org/r/18Od>. - Mod.TY]

******
[3] Nagaland
Date: Fri 19 Aug 2011
Source: New Kerala [edited]
<http://www.newkerala.com/news/2011/worldnews-51064.html>


Altogether 5 persons have been killed in the dreaded Japanese
encephalitis so far in Nagaland, Chief Medical Officer of Dimapur
Civil Hospital Dr Sukhato A Sema said today. He said that 23 people
were detected to be suffering from the disease.

The CMO also advised to avail the Japanese encephalitis [virus]
vaccination free of cost from Japanese Encephalitis Sentinel
Surveillance Site Laboratory at the District Hospital, here.

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

[Japanese encephalitis virus infections are being diagnosed widely in
northeastern India. One hopes that people in the areas where the
cases are occurring will take advantage of the free vaccination
program.

A HealthMap/ProMED-mail interactive map showing the location of
Nagaland in far eastern India can be accessed at
<http://healthmap.org/r/19IC>. - Mod.TY]

DENGUE/DHF UPDATE 2011 (33)
***************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


******
- India (Orissa state). 20 Aug 2011. The death toll due to dengue has
risen to 19 from 17 with 2 more deaths reported today [20 Aug 2011].
Up to today (20 Aug 2011), a total of 482 samples have been found
positive out of a total 1163 samples tested.
<http://orissadiary.com/CurrentNews.asp?id=28656>

[A HealthMap/ProMED-mail interactive map of Orissa state can be
accessed at <http://healthmap.org/r/07gd>. - Mod.TY]

******
- Pakistan (Faisalabad, Punjab province). 17 Aug 2011. Health
officials have confirmed that 2 dengue patients have been admitted to
the local Allied Hospital. A teaching institution of the Punjab
Medical College has also stated that 8 similar cases have been
reported from rural areas, where they are seeking treatment from
private clinics. "We have begun to get confirmed reports of the virus,
and we have already placed all DHQ hospitals on alert. Vaccines are
being ordered," said Dr Azhar Rauf [This is an odd statement; no
commercial dengue virus vaccines are available. - Mod.TY].
<http://tribune.com.pk/story/233156/heal ... -detected/>

[A HealthMap/ProMED-mail interactive map of Faisalabad, Punjab
province can be accessed at <http://healthmap.org/r/19Mu>. - Mod.TY]

******
- Pakistan (Lahore, Punjab province). 16 Aug 2011. On Tuesday [16 Aug
2011], 24 dengue cases were reported in Lahore, bringing the total
number of reported dengue cases to 91. According to the Punjab Health
Department, 27 fresh cases were reported from across the province. Out
of these, 24 were from Lahore, 2 from Faisalabad and one from
Muzaffargarh.
<http://tribune.com.pk/story/232806/deng ... ise-to-91/>

[A HealthMap/ProMED-mail interactive map of Lahore, Punjab province
can be accessed at <http://healthmap.org/r/19Mt>. - Mod.TY]

******
- Pakistan (Karachi, Sindh province). 16 Aug 2011. The Sindh Health
Department has confirmed 6 more dengue virus cases in Karachi this
week. In charge of Sindh Health Department's Dengue Surveillance Cell,
Dr Suresh Kumar said that out of these 6 dengue fever cases, 2
patients have recovered, while 4 others are under treatment in
different hospitals. He said that 14 new cases of dengue fever have
been confirmed this month [August 2011]. He further reported that out
of 142 suspected dengue patients, 138 have been confirmed positive in
the province this year [2011].
<http://www.thenews.com.pk/NewsDetail.as ... med-in-Khi>

[A HealthMap/ProMED-mail interactive map of Karachi, Sindh province
can be accessed at <http://healthmap.org/r/05Pd>. - Mod.TY]

JAPANESE ENCEPHALITIS - NEPAL: (KANCHANPUR)
*******************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 21 Aug 2011
Source: All Voices [edited]
<http://www.allvoices.com//contributed-n ... tern-nepal>


At least 2 persons have died of Japanese encephalitis [virus
infection] in the past 2 days in Kanchanpur district in far-western
Nepal. The 2 died Friday [19 Aug 2011].

They were admitted in hospital on Friday [19 Aug 2011] and died while
undergoing treatment in Mahakali Zonal Hospital.

Although the government has started a campaign to eradicate Japanese
encephalitis from Nepal by vaccinating all against the disease, the
programme hasn't been able to address all. Dozens of people still die
of the disease contracted particularly through pigs and ducks.

In the same month [August 2011], one more death was reported. Hence,
the death toll has reached 3 in the district due to encephalitis.

One person from Dang died due to the same cause last month [July
2011], and over a dozen patients are undergoing treatment for the
disease at Bheri Zonal Hospital, Nepalgunj.

[Byline: Surya Gaire]

--
Communicated by:
ProMED-mail from HealthMap alerts
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[Vaccination will certainly reduce the number of clinical cases in
humans. The proportion of the population immunized is not mentioned.
Meanwhile, avoidance of mosquito bites is the obvious preventive
measure. The virus circulates between birds transmitted by _Culex_
mosquitoes. Pigs are amplifying hosts.

A HealthMap/ProMED-mail interactive map of Kanchanpur can be accessed
at <http://healthmap.org/r/19VQ>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (13): (ASSAM)
*****************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 23 Aug 2011
Source: Bombay News [edited]
<http://www.bombaynews.net/story/831428>


More than 350 cases of Japanese encephalitis and nearly 90 deaths due
to the viral disease were reported in Assam this year [2011], the
Rajya Sabha was told Tuesday [23 Aug 2011]. There were 351 cases and
89 deaths due to Japanese encephalitis [virus infection] reported in
Assam till 9 Aug [2011] in the current year, Minister of State for
Health and Family and Welfare Sudip Bandyopadhyay said.

Japanese encephalitis is a viral disease transmitted by mosquitoes,
causing inflammation of the membrane around the brain, often fatal if
not treated soon.

"For the prevention and control of the vector-borne disease [virus],
including Japanese encephalitis, the Indian government is implementing
an integrated National Vector Borne Disease Control Programme (NVBDCP)
under the National Rural Health Mission," the minister added.

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

[Unlike other reports on encephalitis cases coming out of India over
the past 3 months, this report makes no reference to cases of "acute
encephalitis syndrome" of undetermined etiology. Rather, all cases are
attributed to Japanese encephalitis virus. ProMED would be interested
in learning more about the National Vector Borne Disease Control
Programme. Vaccinating susceptible people in areas of risk may be more
feasible technically and more cost-effective than attempting to
control populations of _Culex_ mosquito vectors over large areas.

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

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

Date: Fri 19 Aug 2011
Source: Tengri News, Kazakhstan [In Russian, translated by ATS,
edited]
<http://tengrinews.kz/events/195085/>


Young boy dies of rabies in Kyzylorda
-------------------------------------
A 5-year-old boy has died in hospital in Kyzylorda from rabies virus
infection. It has become clear that 2 months ago he had been bitten by
a dog. His parents decided to take him to hospital when he developed
signs of the infection. It was too late for immunization
[post-exposure prophylaxis] and it was not possible to save him.

Stray dogs are increasing in numbers in Kyzylorda city. According to
an official report since the beginning of the year 200 people have
been bitten by stray dogs, including 70 children. According to a city
official, they have no budgetary resources to enable them to
"eliminate" stray dogs. The magnitude of the problem is illustrated by
the fact that 177 homeless dogs had been collected from just 2 streets
in the course of a single day.

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

[Kyzylorda Oblast is a province of Kazakhstan. Its capital is the city
of Kyzylorda, which has a population of 159 000 approximately. The
whole province has a population of about 590 000. The
Russian-administered Baikonur, which houses the Baikonur Cosmodrome is
located in this province. A map of Kazakhstan, showing the location of
Kyzylorda Oblast can be accessed at:
<http://en.wikipedia.org/wiki/Kyzylorda_Province>.

In designing a control strategy it will be relevant to establish the
proportion of homeless dogs transmitting rabies virus infection. -
Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (26): ASIA
*****************************************************
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ProMED-mail is a program of the
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<http://www.isid.org>

In this update:
[1] Cholera - Afghanistan (Ghor, Ghazni)
[2] Cholera - India (Gujarat)
[3], [4] Cholera - India (Maharashtra)
[5] Diarrhea - Pakistan (Khyber Pakhtunkhwa)
[6] Cholera - Pakistan (Khyber Pakhtunkhwa)

*****
[1] Cholera - Afghanistan (Ghor, Ghazni)
Date: Wed 24 Aug 2011
Source: Wakht News Agency
<http://www.wakht.com/en/021514.php>


Recent outbreak of cholera-type diarrhea cases mostly created from
lack of potable water and hot summer had concerned the people in the
central Ghazni province, officials said on Wed 24 Aug 2011.

A cholera type diarrhea cases increase by the arrival of warm climate
of summer each year, but the mortality cases are increased among the
children compared to 2010, mostly due to lack of drinking water
originated from the 2011 drought, director for provincial public
health, Dr. Ghulam Nabi Yagana told Wakht News Agency adding that more
than 1000 people affected by diarrhea had been put under treatment
only in Chaghcharan, the capital city of Ghor province.

Head of provincial council, Fazul Haq Ihsan told Wakht News Agency
that the central hospital of the province had only housed 80 beds
while more than 200 patients are referring from the remote districts
of the province. A Ghor citizen told Wakht News Agency that there was
only a single clinic in each district of the province insufficient for
up to 30 000 residents.

--
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*****
[2] Cholera - India (Gujarat)
Date: Sun 21 Aug 2011
Source: Indian Express [edited]
<http://www.indianexpress.com/news/chole ... ra/834909/>


Days after 20 laborers working at a construction site near Vadodara
were reported to be affected by diarrhea, the district administration
has declared the area as cholera affected and rushed medical teams to
put in place preventive measures in the periphery of 8 kilometers [5
miles].

Between 17 and 19 Aug 2011, more than 20 labourers working at a
construction site of L&T near Ankhol village located on the National
Highway 8 complained about diarrhoea and were brought to a government
hospital for treatment. Most of them are migrants from Dahod, Godhra,
Madhya Pradesh and Bihar.

"Of the 20, 3 were diagnosed positive for cholera. We immediately
started preventive measures. 8 teams comprising 4 doctors and 20
paramedic staff are working in the area. We are examining every
resident in the periphery of 8 kilometers and medical services are
being provided round-the-clock. We have also taken water samples from
tankers provided by the company," said epidemic control officer
Vijaykumar Bidla.

--
Communicated by:
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*****
[3] Cholera - India (Maharashtra)
Date: Wed 10 Aug 2011
Source: DNA India [edited]
<http://www.dnaindia.com/mumbai/report_c ... um_1574423>


While the municipal corporation has kept mum about the cholera cases
in the city, patients testing positive for the infectious disease and
being admitted to Kasturba Hospital are increasing. Ward number 15 of
Kasturba Hospital, the city's only infectious disease hospital, has
been reserved for cholera, severe diarrhea and hepatitis patients.

According to a nurse in charge of the ward, 60 percent of the patients
in the ward have tested positive for hanging drop test, the primary
test for cholera. A 60-year-old man was tested positive for cholera on
Saturday. "I had severe stomach cramps, vomiting and loose motions. I
was 1st taken to Noor Hospital. But after the hanging drop test was
positive, I was shifted to Kasturba hospital," he said. Most of the
cholera positive patients in Kasturba Hospital are from Byculla,
Bhendi Bazaar areas and Bandra.

Dr Daksha Shah, head of epidemiology cell, Kasturba Hospital, refuted:
"We don't have any patients who have tested positive for hanging drop
test." Kasturba Hospital doctors said they are not cases of classic
cholera but the rising number of positive cases of hanging drop is
definitely a matter of concern.

"None of these cases are classic cholera, which is deadly. Many times,
the mild cholera goes undetected as they are not tested. But a
majority of cases in the out-patient department is of stomach
ailments. Byculla and Mohammed Ali Road, Bandra, Kurla are the
worst-affected areas," said the doctor.

While there is a rising number of cholera and severe diarrhea cases,
the hospital's infrastructure is not able to handle the load.

"72 patients have severe diarrhea symptoms. The ward has only 2
toilets," said a 25-year-old Byculla resident admitted to hospital on
Sat 7 Aug 2011.

[Byline: Somita Pal]

--
Communicated by:
ProMED-mail from HealthMap alerts
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[Denying that it is not classical cholera is silly since the strains
in the current pandemic are El Tor, not Classical ones, or so-called
Matlab variants with some phenotypic characteristics of both. -
Mod.LL]

*****
[4] Cholera - India (Maharashtra)
Date: Sat 6 Aug 2011
Source: Times of India [edited]
<http://timesofindia.indiatimes.com/city ... 501813.cms>


The spurt in gastroenteritis cases this monsoon has worsened with the
city registering its 1st case of cholera, the deadliest form of
diarrhea. A 4-year-old boy from Bainganwadi slum in Govandi has tested
positive for cholera. State-run J J Hospital 1st admitted His
8-month-old brother on Monday [1 Aug 2011], as he was suffering from
severe loose motions and dehydration. A day later, his 6-year-old
sister was admitted over similar symptoms. On Wed 3 Aug 2011 the
patient and his other brothers, aged 4 and 3, were also admitted.
Stool samples of all the 4 siblings were sent for testing; only the
4-year-old tested positive for cholera.

"The child tested positive not only in the hanging drop test, but also
in the ELISA test, which confirmed cholera," said Dr T P Lahane, dean,
J J Hospital.

As in the case of this family, there has been a sudden outbreak of
gastroenteritis cases in the Mumbai. While cholera is a severe form of
gastroenteritis, south Mumbai doctors said that gastroenteritis is
especially rampant in the Byculla, Dongri and Mumbai Central belt.

[Byline: Pratibha Masand]

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

*****
[5] Diarrhea - Pakistan (Khyber Pakhtunkhwa)
Date: Sun 21 Aug 2011
Source: Express Tribune [edited]
<http://tribune.com.pk/story/236119/dise ... -epidemic/>


The Swat Valley has been hit hard by a diarrhea epidemic, with
thousands of children and women falling victim to the fatal illness.
Contaminated water from ponds and streams is suspected to have caused
the outbreak.

Hundreds of patients have been admitted in different parts of the
valley; however, the situation in Bahrain, Swat is particularly
serious. The valley has only one basic health unit (BHU) which is not
only short of medicines and staff, but is also lacking space to
accommodate the patients.

"The situation in Bahrain is indeed very serious, with more than 300
people suffering from diarrhea. To add to their miseries, there is a
shortage of vaccines, physicians and even beds at the BHU," said
Zubair Torwali, a local civil society and human right activist. "The
people don't know where to go. We appeal to the concerned authorities
to take immediate action," he added.

Gut Bella, a remote area of Malam Jabba, is also in the grip of the
disease, where a woman and a child died because they could not get
access to medical facilities. Almost 250 people are have been affected
by diarrhea in the region.

[Byline: Fazal Khaliq]

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

[Many of these cases may well be cholera-related. - Mod.LL]

*****
[6] Cholera - Pakistan (Khyber Pakhtunkhwa)
Date: Mon 22 Aug 2011
Source: Express Tribune [edited]
<http://tribune.com.pk/story/231487/dise ... er-agency/>


A cholera outbreak has been reported in Khyber Agency, infecting
hundreds of people in Paseedkhel, Charbagh, and Landikotal areas. An
official of Landikotal Tehsil's political administration, Abdul Nabi
Bangash, on Sun 21 Aug 2011, confirmed that the disease has turned
pandemic in Paseedkhel and Charbagh.

He said that measures are being taken to control the spread of the
disease and medical teams, ambulances and required funds are being
provided to the local health departments to ensure free treatment to
patients.

--
Communicated by:
ProMED-mail from HealthMap alerts
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MALARIA - PAKISTAN: PUNJAB
**************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Fri 26 Aug 2011
Source: The News [edited]
<http://www.thenews.com.pk/TodaysPrintDe ... 4704&Cat=6>


During the last month, a significant number of malaria cases,
including black water fever, have been reported at the allied
hospitals in town.

According to data collected by The News, the District Headquarters
Hospital received over 50 patients with complications of malaria.
Benazir Bhutto Hospital received over 40 patients, while 35 plus
patients with malaria reached the Holy Family Hospital. Meanwhile,
some 22 cases of black water fever were reported at the allied
hospitals, of which 4 died of complications.

Most of the cases admitted at tertiary care hospitals with malaria are
with complications of the protozoal infection, said a medical
specialist serving at BBH on condition of anonymity. He added that
mosquitoes have increased in twin cities, which are causing malaria.

Registrar, Medicine Unit at BBH, Dr Umar Saeed was of the view that
overprescription of antimalarial drugs by local general physicians and
quacks along with self medication are major causes of the increase in
drug-resistant malaria cases.

Black water fever is an ancient term given to falciparum malaria in
which the colour of urine of a patient gets dark. Its symptoms include
high-grade fever on alternate days, fits, and shivering and black
urine. If left untreated, it may cause complications including organ
failure.

The onset of malaria should not be taken as non-serious, and patients
should avoid self-medication, said medical specialist at BBH Dr
Muhammad Mujeeb Khan while talking to The News on Thursday [25 Aug
2011]. He added that in case of having symptoms, a patient should
immediately consult a qualified physician to avoid complications of
the disease.

It is important to stress that the parasite causing malaria, once
injected into the blood by mosquito bite, reproduces into millions of
baby parasites that grow to adults within 2 hours and obstruct blood
flow in small arteries and veins, which might cause organ damage.

Dr Mujeeb said that, in case of improper medication, mutation occurs,
and the next generation of the protozoa causing malaria becomes drug
resistant. The best way to avoid malaria and its complications is to
avoid mosquito bites, he said.

He said that it is time to create awareness among the public that
malaria and dengue fever are caused by mosquito bites and that
preventive measures by individuals are required to prevent the
diseases. The concerned government authorities can eliminate
mosquitoes only in open spaces, while individuals should take measures
to eliminate mosquitoes in houses, said Dr Mujeeb.

[byline: Muhammad Qasim]

--
communicated by:
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[Rawalpindi and the neighboring city of Islamabad are usually regarded
as low risk areas for malaria.

The epidemiology of malaria in Pakistan has recently been reviewed:
Kakar Q, et al. Malaria control in Pakistan: new tools at hand but
challenging epidemiological realities. East Mediterr Health J.
2010;16(suppl):S54-60.

According to WHO's Regional Office for the Eastern Mediterranean
[EMRO], Pakistan had 1.5 million malaria cases in 2008 (latest
reported year) of which 24 per cent were _P. falciparum_
(<http://www.emro.who.int/rbm/CountryProf ... es-pak.htm).

The malaria control programme in Pakistan has struggled to contain the
infection, and a recent estimate from Integrated Regional Information
Networks [IRIN -- a service of the UN Office for the Coordination of
Humanitarian Affairs] found that only about 25 per cent of cases
receive qualified medical care and treatment
(<http://www.irinnews.org/InDepthMain.asp ... ountry=Yes>).

Chloroquine resistance is widespread in Pakistan, and a recent study
(Ghanchi NK, et al. Prevalence of resistance associated polymorphisms
in _Plasmodium falciparum_ field isolates from southern Pakistan.
Malar J. 2011;28;10:18) found the pfcrt 76T mutation, recognized as a
marker of chloroquine resistance, in 93 per cent of samples.
Blackwater fever is caused by hemolysis and excretion of hemoglobin in
the urine.

For the HealthMap of the location of this outbreak, see
<http://healthmap.org/r/1b2L>. - Mod.EP]

LEPTOSPIROSIS, FATAL - INDIA: (GUJARAT)
***************************************
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ProMED-mail is a program of the
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Date: Sat 27 Aug 2011
Source: The Times of India [edited]
<http://articles.timesofindia.indiatimes ... e-and-rats>


With 2 more deaths due to leptospirosis, one each in Valsad and
Navsari, the total number of deaths due to the deadly disease reached
46 on Saturday [27 Aug 2011]. The number of patients reached 228 with
the addition of 6 new patients on Saturday. The patient from Valsad
was under treatment in Surat's New Civil Hospital [for the past
week].

In south Gujarat, leptospirosis cases are reported in rural areas
among those working in farms. The cases are reported during monsoon
and in the 3 months of the rainy season. The disease kills more than
100 people of working age every year. According to experts, a human
gets leptospirosis [by contact with urine of infected cattle and rats
that has contaminated water-logged farms] during monsoon. Medical
research reveals that leptospirosis infection spreads to humans though
wounds, eyes, and mouth. Rats and cattle are permanent carriers of
leptospira bacteria. Medical science observed some effects of
leptospira bacteria on cattle, but it recovers without medication in a
majority of cases.

According to experts working on leptospirosis, currently there is no
accurate preventive method to stop the infection of the disease in
humans, but it is possible to vaccinate cattle. Along with rats,
cattle are major carrier of leptospira bacteria in the south Gujarat
region and vaccines are available in foreign countries, but not yet
used in India. Surat city became victim of leptospirosis within a week
after August 2006 floods when 100 people died of leptospirosis in the
city area.

The disease was reported for the 1st time within city limits in south
Gujarat as it spreads mostly in rural areas. It is believed that the
infection spreads across the city [during the 5 days that the entire
city was flooded]. Due to flooding, urine of rats, which normally live
in drainage ditches or underground, infected humans.

[byline: Yagnesh Mehta]

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[Bacteria of the genus _Leptospira_ cause leptospirosis. More than 200
pathogenic leptospiral serovars, distinguished on the basis of
bacterial surface antigens, have been identified. Different
leptospiral serovars are prevalent in particular geographical regions.
The disease is transmitted to humans from wildlife species, such as
rats, sometimes domestic animals, such as dogs, and livestock, such as
cattle and pigs. When these animals are infected, they may have no or
minimal symptoms of the disease, but develop a renal carrier state
associated with long term urinary shedding. The infection is
transmitted to humans by contact with water, soil, or food
contaminated with the urine of these chronically infected animals.
Outbreaks of leptospirosis are usually associated with exposure to
contaminated floodwater. Leptospira survive for weeks to months in
warm, fresh water or soil flooded with fresh water. The bacteria can
enter the body through skin or mucous membranes, especially if the
skin is broken from a cut or scratch. Drinking contaminated water or
food can also cause infection. Person to person transmission is rare.

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. For further discussion of
leptopsirosis, see ProMED-mail post: Leptospirosis - India: (KA,KL)
20110709.2079.

The southern districts of Surat, Valsad, and Navsari are 3 of the 26
districts in the western Indian state of Gujarat. The city of Surat is
the commercial capital of the Indian state of Gujarat and is one of
the fastest growing cities in India with a population now of about 5
million, which has nearly doubled in the past 10 years
(<http://en.wikipedia.org/wiki/Surat>). The rainy summer monsoon
season begins in Gujarat in late June and lasts until the end of
September, with flooding every year, the worst being the flood of
August 2006 (<http://www.mapsofindia.com/surat/flood.html>).

A map of the districts of Gujarat can be found at
<http://upload.wikimedia.org/wikipedia/c ... _South.png>,
and 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

Serovars of leptospira associated with disease in cattle include
hardjo, pomona, grippotyphosa, canicola,and ictero-haemorrhagiae.

Leptospirosis vaccines are available for pigs, cattle, and dogs.
Leptospiral vaccines for veterinary use are suspensions of one or more
strains of pathogenic leptospira inactivated in such a manner that
immunogenic activity is retained. While experimental vaccines based on
cellular extracts have been tested, commercial vaccines are, with few
exceptions, whole-cell products.

Although the vaccines prevent disease in the vaccinated animals, they
do not completely prevent infection or the shedding of the organisms;
a percentage of vaccinated animals will become infected with the
relevant serovar and may shed the organism in their urine despite a
lack of clinical signs of disease. Immunity is largely serovar
specific: vaccines are protective only against the included serovars
or closely related serovars.

Information on the requirements for leptospira animal vaccines are
available in OIE's Terrestrial Manual, Chapter 2.1.9."Leptospirosis"
at
<http://www.oie.int/fileadmin/Home/eng/H ... _LEPTO.pdf>
(pp. 255-8).

According to India's annual OIE report for 2010, vaccination is not
included among the measures applied to control leptospirosis in farm
animals. - Mod.AS]

DENGUE/DHF UPDATE 2011 (35)
****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

*****

- Pakistan (Punjab province). 24 Aug 2011. The number of dengue cases
in the province has reached 762 while the confirmed number of dengue
cases in Lahore has reached 681. The recent spell of heavy rainfall
has led to the increase in the number of dengue cases.
<http://tribune.com.pk/story/238554/deng ... in-punjab/>

[A HealthMap/ProMED-mail interactive map of Punjab province can be
accessed at <http://healthmap.org/r/0cco>. - Mod.TY]

- Pakistan (Lahore, Punjab province). 28 Aug 2011. As many as 122
dengue fever cases, 118 from Lahore and 4 from other cities, have been
reported during the last 24 hours throughout the province.
<http://www.thenews.com.pk/TodaysPrintDe ... 5043&Cat=5>

[A HealthMap/ProMED-mail interactive map of Lahore, Punjab province
can be accessed at <http://healthmap.org/r/19Mt>. - Mod.TY]

- Pakistan (Khyber Pakhtunkhwa, formerly known as the North West
Frontier Province). 25 Aug 2011. The Khyber Pakhtunkhwa health
department has alerted the district health authorities after
confirmation of death of a man from DHF in Nowshera last week [week of
15 Aug 2011], officials said. 2 suspected cases have also been
reported from the Khyber Teaching Hospital. The Khyber Pakhtunkhwa had
recorded 43 cases and 7 deaths from dengue fever in 2009, which meant
that the virus was prevalent and could pose serious threat if timely
measures were not taken immediately. As many as 58 deaths had been
recorded of the total 2098 confirmed cases in the country in 2009, the
officials said.
<http://www.dawn.com/2011/08/26/dengue-a ... shera.html>

[A HealthMap/ProMED-mail interactive map of Khyber Pakhtunkhwa
province can be accessed at <http://healthmap.org/r/1b77>. - Mod.TY]

- Pakistan (Karachi, Sinincedh prov). 22 Aug 2011. Dr Suresh Kumar, in
charge of Sindh's dengue surveillance cell, said 138 dengue viral
fever cases have been confirmed in the province this year [2011], 119
of which were from Karachi. Fortunately, no dengue death has been
reported so far in the province, he said.
<http://news.in.msn.com/international/ar ... id=5384269>

[A HealthMap/ProMED-mail interactive map showing the location of
Karachi, Sindh province can be accessed at
<http://healthmap.org/r/05Pd>. - Mod.TY]

- India (Raipur, Chhattisgarh state). 28 Aug 2011. Every day, new
dengue cases are being reported from the Raipur city hospitals.
Furthermore, 2 dengue patients were admitted to Ekta Hospital.
<http://daily.bhaskar.com/article/MP-RAI ... 85056.html>

[A HealthMap/ProMED-mail interactive map showing the location of
Raipur, Chhattisgarh state can be accessed at
<http://healthmap.org/r/1b6V>. - Mod.TY]

- India (Delhi). 26 Aug 2011. 3 fresh cases of dengue have been
reported in the national capital, taking the total number of people
affected by the mosquitoborne disease to 56. The total number of
dengue cases has risen to 56. Last year [2010] on this date, the total
number of dengue cases was 589.
<http://ibnlive.in.com/generalnewsfeed/n ... 02422.html>

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

- India (Lucknow, Uttar Pradesh state). 22 Aug 2011. At least 20
people have tested positive for dengue in the city, health officials
today said. "As per figures of the government hospital, more than 20
people have tested dengue positive," they said.
<http://ibnlive.in.com/generalnewsfeed/n ... 96335.html>

[A HealthMap/ProMED-mail interactive showing the location of Lucknow,
Uttar Pradesh state can be accessed at <http://healthmap.org/r/00K2>.
- Mod.TY]

- India (Orissa state). 26 Aug 2011. The death toll rise to 23 from 20
[in Orissa state], with 3 more deaths. 838 samples have been found
[dengue] positive.
<http://orissadiary.com/CurrentNews.asp?id=28766>

[A HealthMap/ProMED-mail interactive map of Orissa state can be
accessed at <http://healthmap.org/r/07gd>. - Mod.TY]

- India (Angul, Orissa state). 23 Aug 2011. Panic has spread in the
town [Angul] with about 40 patients being detected with dengue at the
Nehru Centenary Central Hospital at Talcher and the number of
fatalities increasing every day. Though official figures say 259
people have tested positive so far, unofficial sources say the figure
is 600. The Nehru Centenary Central Hospital itself tested 300
positive, while over 200 villagers are suffering from dengue, said
sources.
<http://articles.timesofindia.indiatimes ... her-dengue>

[A HealthMap/ProMED-mail interactive map showing the location of Angul
in Orissa state can be accessed at <http://healthmap.org/r/1bbP>. -
Mod.TY]

CHIKUNGUNYA (21): INDIA (ORISSA)
********************************
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 29 Aug 2011
Source: IBN Live, Press Trust of India (PTI) report [edited]
<http://ibnlive.in.com/generalnewsfeed/n ... 04580.html>



The number of chikungunya [virus infection] patients in Orissa's
Ganjam district rose to 10; 5 patients were tested positive for
chikungunya [virus infection] in Nimina, Sodaka, Gudialli, Gada
Damodaraplli, Sinduripada villages. Chief district medical officer
(Ganjam) SK Patnaik said school students in village were engaged in a
sanitation drive and to clean the human habitats, along with other
programmes to create awareness among the people. "We have seen the
sanitation drive was very effective when the school students joined in
the drive," he said. Besides cleaning the bushes and nalahs [drainage
ditches] in the villages, the students have cleaned front and
backsides of each and every house in some of the villages. The youths
from the dengue-hit Sodaka and K Nuapalli villages also joined in the
sanitation drive.

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

[Chikungunya virus is endemic in India, so sporadic cases and
outbreaks are not surprising.

Maps showing the location of Ganjam district in Orissa state can be
accessed at <http://healthmap.org/r/1cb7> and
<http://www.mapsofindia.com/maps/orissa/orissa.htm>. - Mod.TY]

MALARIA - INDIA (16): (HARYANA)
*******************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 2 Sep 2011
Source: Tribune India [edited]
<http://www.tribuneindia.com/2011/20110902/haryana.htm#3>


Malaria cases in Yamunanagar district
-------------------------------------
The Health Department has detected about 2900 malaria cases at
government and private hospitals of Yamunanagar district in the past
one month.

There could be a large number of patients getting cholera treatment at
private hospitals or with some private medical practitioners as well.
Vijay Mohan Atreja, deputy civil surgeon and malaria officer,
Yamunanagar, said here today [2 Sep 2011] that about 1450 cases
[malaria] had been detected in the Khijrabad belt in Pipli Majra,
Bahadurpur, and Bambepur. About 300 cases had been detected in
Naharpur, 300 cases in Sadhaura, 125 cases in Bilaspur, and about 725
cases in other parts of the district, including Radaur and
Mustafabad.

During a survey of about 51 places of the district, including
government hospitals, government colonies and private hospitals, it
was found that waterlogging in some parts of the district after floods
was found to be a home for hundreds of mosquitoes.

Official sources said there was a problem of patients moving from
these villages to the adjoining UP [Uttar Pradesh] since these were
located on the border of the 2 states. They said it was difficult to
treat patients since many of them moved over to UP without completing
the treatment.

The deputy civil surgeon said that a survey had been launched in the
district. Teams comprising medical officers, lab technicians, health
inspectors, health workers, and ANMs [auxiliary nurse midwife? -
Mod.SH] would go from village to village and prepare slides and get
results on the spot. This could help identify the malaria cases, he
said.

Meanwhile, the State Health Department has taken a serious note of the
problem of malaria outbreak. The Health Department also issued notices
to some private hospitals, private colonies, and government hospitals
to ensure their cleanliness, where larva of malaria was found.

[byline: Attar Singh, Tribune News Service, Yamunanagar]

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

[As of 2011 [update] India census Yamuna had a population of 1 214
162. A paper in the New Scientist (2010) estimates that the number of
malaria cases officially reported by the Indian authorities is 10
times lower than the real numbers. The article also provide a map of
malaria in India
(<http://www.newscientist.com/data/images ... 1_1070.jpg>)
in which Haryana State is a low risk area.

The latest map of malaria in India is provided in the World Malaria
Report 2009
(<http://www.who.int/malaria/publications ... ind_en.pdf>).
Here, Haryana State has a malaria annual incidence rate between 1 and
100 cases per 1000 population.

HealthMap location: <http://healthmap.org/r/1cZv>. - Mod.EP]

DENGUE/DHF UPDATE 2011 (36)
****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
- Pakistan (Punjab province). 3 Sep 2011. Dengue fever cases reach
1419 in Punjab.
<http://news.xinhuanet.com/english2010/p ... 095819.htm>

[A HealthMap/ProMED-mail interactive map of Punjab province can be
accessed at <http://healthmap.org/r/0cco>. - Mod.TY]

- India (Delhi). 2 Sep 2011. 7 new cases of dengue were reported in
the city on Thursday [1 Sep 2011], taking the total number of cases of
the disease to 73 this season. However, the number of dengue cases was
less compared to last year, when 1014 cases and 3 deaths were reported
until 1 Sep 2010.
<http://articles.timesofindia.indiatimes ... l-mosquito>

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

- India (Ludhiana, Punjab state). 1 Sep 2011. Dengue is spreading its
tentacles with almost 4 cases being reported every day in the last 2
months. Dr Sandeep Puri, DMCH [Dayanand Medical College and Hospital]
medical superintendent, said, "On Wednesday, 20 suspected patients
were admitted. Of 153 patients treated for the ailment from July
onwards, 63 were from Ludhiana. As many as 37 are still admitted
here.''
<http://articles.timesofindia.indiatimes ... l-hospital>

[A HealthMap/ProMED-mail interactive map showing the location of
Ludhiana, Punjab state can be accessed at
<http://healthmap.org/r/0Y*N>. - Mod. TY]

- India (Ahmedabad, Gujarat state). 1 Sep 2011. On Wednesday [31 Aug
2011], 6 more cases of dengue were registered in the city. This has
taken the total number of dengue cases registered in Ahmedabad to 112.
But sources closely associated with the health department said that
actual number of cases has crossed 150 during the current year
[2011].
<http://daily.bhaskar.com/article/GUJ-AH ... 94577.html>

[A HealthMap/ProMED-mail interactive map showing the location of
Ahmedabad, Gujarat state can be accessed at
<http://healthmap.org/r/1d5o>. - Mod.TY]

- India (Orissa state). 31 Aug 2011. The death toll rose to 24 from 23
with one more death reported today [31 Aug 2011]. Out of 182 samples
tested today, 14 samples were found dengue positive [antibody?
virus?]. [This year] 927 samples have been found positive.
<http://orissadiary.com/CurrentNews.asp?id=28864>

[A HealthMap/ProMED-mail interactive map showing the location of
Orissa state can be accessed at <http://healthmap.org/r/07gd>. -
Mod.TY]

HEPATITIS B - INDIA: (KERALA), KOCHI CITY, 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 7 Sep 2011
Source: The Times of India [edited]
<http://articles.timesofindia.indiatimes ... -new-cases>


Eight more cases of hepatitis-B were reported on Tuesday [6 Sep 2011]
from Aluva and Paravoor districts. As the epidemic is spreading to
other parts of the Ernakulam district, health authorities have adopted
various measures to check the spread (of the infection). But the new
cases reported put a big question mark on how effective the measures
taken by the health department are.

After various cases were reported from different parts of
Kothamangalam [another town located in an eastern part of Ernakulam
district], the authorities started various health camps and fever
clinics in the area. The health officials also initiated field visits,
which they claim have helped reduce the spread of hepatitis B. "For
the last one week, things [have been] under our control. No fresh
cases have been reported in Kothamangalam in the last 2 days," said
district medical officer Dr. R Sudhakaran. "Even though the health
department is taking several measures, without public cooperation, we
cannot stop the spread of this epidemic," he added.

[Byline: Anto Thermadam]

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

[A map of Kochi city can be accessed at:
<http://www.mapsofindia.com/maps/kerala/kochi.htm>. The
HealthMap/ProMED-mail interactive map of the Indian state of Kerala in
the south of India can be accessed at: <http://healthmap.org/r/1dR5>.

This press report does not indicate the route of spread of hepatitis B
virus infection nor the specific measures employed by the authorities
to contain this outbreak. Clarification is requested.

Hepatitis B is a viral infection that attacks the liver and can cause
both acute and chronic disease. The virus is transmitted through
contact with the blood or other body fluids of an infected person, not
through casual contact. According to the World Health Organisation
(WHO), about 2 billion people worldwide have been infected with the
virus, and about 350 million live with chronic infection. An estimated
600 000 persons die each year due to the acute or chronic consequences
of hepatitis B. About 25 percent of adults who become chronically
infected during childhood later die from liver cancer or cirrhosis of
the liver caused by the chronic infection. The hepatitis B virus is 50
to 100 times more infectious than HIV.

Hepatitis B virus is an important occupational hazard for health
workers, but hepatitis B is preventable with a safe and effective
vaccine. A vaccine against hepatitis B has been available since 1982.
This vaccine is 95 percent effective in preventing hepatitis B virus
infection and its chronic consequences. Hepatitis B is endemic in many
parts of Asia. Most people in the region become infected with
hepatitis B virus during childhood. In these regions, 8-10 percent of
the adult population are chronically infected.

Hepatitis B virus is transmitted between people by contact with the
blood or other body fluids (i.e. semen and vaginal fluid) of an
infected person. Modes of transmission are the same for the human
immunodeficiency virus (HIV), but hepatitis B virus is 50 to 100 times
more infectious. Unlike HIV, hepatitis B virus can survive outside the
body for at least 7 days. During that time, the virus can still cause
infection if it enters the body of a person who is not infected.

Common modes of transmission in developing countries are: perinatal;
early childhood infections, inapparent infection through close
interpersonal contact with infected household contacts, unsafe
injections practices; blood transfusions and sexual contact. Further
information can be obtained from the WHO Factsheet at:
<http://www.who.int/mediacentre/factshee ... index.html>. -
Mod.CP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (14): (BIHAR)
*****************************************************
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ProMED-mail is a program of the
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<http://www.isid.org>

[1]
Date: Wed 7 Sep 2011
Source: India Express [edited]
<http://www.indianexpress.com/news/encep ... ny/842929/>


The state government, which is already struggling to handle the
increased number of acute encephalitis syndrome (AES) cases in eastern
Uttar Pradesh, now faces the fresh challenge of the acute rise in the
number of cases from Bihar. At BRD medical college in Gorakhpur, about
190 cases have already been reported from Bihar this year [2011].
Doctors at the hospital said the cases are mainly from Siwan and
Gopalganj districts of Bihar. Despite special measures taken by the
government this year like launching special sanitation campaigns to
counter the spread of the disease, about 15 percent rise in the number
of AES cases has already been reported this year in the state.

"About 1360 cases of AES have already been reported this year, out of
which about 190 cases are from Bihar. We get cases from Bihar and
Nepal each year but this year, the number of cases from Bihar has gone
up by 40 percent," said KP Kushwaha, senior doctor from BRD medical
college.

[Byline: Maulshree Seth]

--
Communicated by:
ProMED-mail from HealthMap alerts
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[Curiously, no mention of Japanese encephalitis is made in the above
report. Previous reports from northeastern India indicated that
Japanese encephalitis virus infections were involved in some of the
encephalitis cases. It was encouraging to learn that the Indian
National Institute of Virology and, apparently, the USA CDC were
attempting to determine the etiology of the acute encephalitis
syndrome (AES) cases that are not Japanese encephalitis virus
infections. Apparently, no further information on determination of the
etiology of AES cases has been announced, since the term AES continues
to be used. Control and prevention will remain elusive until the
etiology is defined.

A HealthMap interactive map of Bihar can be accessed at
<http://healthmap.org/r/18Od>. - Mod.TY]

******
[2]
Date: Wed 7 Sep 2011
Source: Gulf Today [edited]
<http://gulftoday.ae/portal/1158d859-ba3 ... 8e34c.aspx>


In the last 2 weeks, 9 children have died of suspected encephalitis,
an acute brain infection, in Bihar's Gaya district, a health official
said on Tuesday [6 Sep 2011]. The district health official said that
in the last 72 hours 4 children died of suspected encephalitis, an
infection that causes inflammation of the brain, at Anugrah Narain
Medical College and Hospital in Gaya. "Three children are battling for
life," he said. Ajay Kishor Ravi, who heads the hospital's children's
department, said that till date 36 children with suspected
encephalitis were admitted for treatment; 9 of them died. The children
reported high fever, followed by bouts of unconsciousness, and
convulsions.

Local people termed the mysterious disease as "chamki ki bimari" and
claimed that the symptoms were similar to encephalitis. Bihar Health
Minister Ashwini Kumar Choubey said he was not aware of any death due
to encephalitis in Gaya. 2 months ago 51 children died in Muzaffarpur
district but the state government is yet to confirm these as
encephalitis deaths. Union Health and Family Welfare Minister Ghulam
Nabi Azad had informed the Rajya Sabha that it was an outbreak of
acute encephalitis syndrome.

--
Communicated by:
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[Ronan Kelly of FluTrackers (<ronankelly@comcast.net>) pointed out
that the Indian Ministry of Health and Family welfare has summarized
national totals of cases of AES and Japanese encephalitis virus (JEV)
infections together (<http://nvbdcp.gov.in/je-cd.html>) as of 23 Aug
2011. The total for 2011 for that period is 3445 and 450 deaths. The
Bihar totals are 288 cases with 54 deaths. Assam Uttar Pradesh states
have had the most with 1189 cases with 228 deaths and 1071 cases with
150 deaths, respectively. It is not possible to determine the
proportion of these cases due to JEV infections. - Mod.TY]