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CHIKUNGUNYA (24): INDIA (DELHI)
*******************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 28 Oct 2011
Source: IBN Live, Press Trust of India (PTI) report [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 78954.html


In the national capital [Delhi], mosquito-borne diseases are yet to
subside despite a chill in the air. Doctors have diagnosed 29
[individuals] for chikungunya [virus infection].

--
Communicated by:
ProMED-mail from HealthMap alerts


[This report provided numbers of cases of chikungunya virus infection
in Delhi. There have been scattered cases of chikungunya virus
infection around India recently this year (2011).

A HealthMap/ProMED-mail interactive map showing the location of Delhi
can be accessed at http://healthmap.org/r/1nkS. - Mod.TY]

CHIKUNGUNYA (24): INDIA (DELHI)
*******************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 28 Oct 2011
Source: IBN Live, Press Trust of India (PTI) report [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 78954.html


In the national capital [Delhi], mosquito-borne diseases are yet to
subside despite a chill in the air. Doctors have diagnosed 29
[individuals] for chikungunya [virus infection].

--
Communicated by:
ProMED-mail from HealthMap alerts


[This report provided numbers of cases of chikungunya virus infection
in Delhi. There have been scattered cases of chikungunya virus
infection around India recently this year (2011).

A HealthMap/ProMED-mail interactive map showing the location of Delhi
can be accessed at http://healthmap.org/r/1nkS. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (30): (DELHI)
*****************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 28 Oct 2011
Source: IBN Live, Press Trust of India (PTI) report [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 78954.html


In the national capital [Delhi], mosquito-borne diseases are yet to
subside despite a chill in the air. Doctors have diagnosed 12 people
for Japanese encephalitis [virus; JEV] infection. Japanese
encephalitis, common in the neighbouring states, has surfaced for the
1st time in the city after 4 people tested positive last month
[September 2011].

Four persons came with Japanese encephalitis infection in September
2011 and all of a sudden another 6 were diagnosed during a random
checking," he said. MCD [Municipal Corporation of Delhi] is planning
to hold a meeting on 31 Oct [2011] to mull ways to combat Japanese
encephalitis cases in the city. Said Dr RP Vashishtha, state
surveillance officer, "All are mild cases and not life threatening.
All the 12 cases are of Japanese encephalitis infection. The last 6
cases that were diagnosed of Japanese encephalitis [virus] infection
had shown no external symptoms."

--
Communicated by:
ProMED-mail from HealthMap alerts


[The 1st cases of JEV infection in Delhi were reported on 21 Sep 2011,
and then the total increased to 7 cases as of 25 Oct 2011 (see
ProMED-mail archive no. 20111027.3197]. Only 3 days later, 5 new cases
were reported. This year (2011), most of the JEV cases have occurred
in Uttar Pradesh and Bihar states.

A HealthMap/ProMED-mail interactive map showing the location of Delhi
can be accessed at http://healthmap.org/r/1nkS. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (31): 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


In this update:
[1] Uttar Pradesh
[2] National data

******
[1] Uttar Pradesh
Date: Mon 31 Oct 2011
Source: News 24 [edited]
http://www.news24online.com/ViewDetails ... wsID=35832


In the last 2 months, 40 children have died due to encephalitis in
this district [Mahrajganj], health officials said here today [31 Oct
2011].

"Since September 2011, 230 encephalitis patients were admitted for
treatment, of which 40 children died, while 55 children are still
being treated in the Nehru Chikitsalya of BRD Medical College,
Gorakhpur. The rest have been discharged," Additional Director,
Health, Devaker Prasad said.

Since January 2011, 183 cases of Japanese encephalitis [virus
infection] have come to light, while the rest were that of viral
encephalitis caused by an unknown virus, he said. He said the state
government had undertaken a massive vaccination drive against the
disease.

--
Communicated by:
ProMED-mail from HealthMap alerts


[A map showing the location of Maharajganj district in northeastern
Uttar Pradesh state can be accessed at
http://en.wikipedia.org/wiki/Maharajganj_district.
A HealthMap/ProMED-mail interactive map of Uttar Pradesh state can be
accessed at http://healthmap.org/r/01r4. - Mod.TY]

******
[2] National data
Date: Wed 2 Nov 2011
Source: National Vector Borne Disease Control Programme, Directorate
General of Health Services, Ministry of Health and Family Welfare
[edited]


State / Cases (change since 3 Oct 2011) / Fatalities (change since 3
Oct 2011):

Andhra Pradesh / 59 (-) / 1 (-)
Assam / 1319 (-) / 250 (-)
Bihar / 288 (-) / 54 (-)
Goa / 53 (-) / 1 (-)
Haryana / 20 (20) / 7 (7)
Karnataka / 145 (51) / 0 (-)
Kerala / 88 (-) / 6 (-)
Maharashtra / 4 (-) / 3 (-)
Manipur / 11 (-) / 0 (-)
Nagaland / 44 (-) / 6 (-)
Tamil Nadu / 502 (+19) / 14 (-)
Uttar Pradesh / 3021 (+699) / 462 (+123)
West Bengal / 589 (+182) / 40 (+20)
Total / 6160 (+988) / 844 (+150)

--
Communicated by:
Ronan Kelly for FluTrackers.com

[Japanese encephalitis virus (JEV) continues to be transmitted in this
region of eastern Uttar Pradesh state. Previous reports have
attributed the encephalitis cases to JEV and to undiagnosed viruses
associated with contaminated water, probably enteroviruses. The
encephalitis death toll in the viral disease in eastern Uttar Pradesh
has climbed to 488 this year (2011), according to a statement made by
health officials on 25 Oct 2011 (see ProMED-mail archive no.
20111027.3197). It would be of interest to know the details of the
massive JEV vaccination drive. - Mod.TY]

UNDIAGNOSED ILLNESS - INDIA: (RAJASTHAN) REQUEST FOR INFORMATION
****************************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Mon 31 Oct 2011
Source: The Times of India-Jaipur, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... -labourers


A mystery fever has played havoc at Mandargarh in Kota [Rajasthan] for
the past few days. Residents of Mandargarh, which is a tribal area in
Mandana, are living in fear as sources claimed that 13 people have
died in the area in the past one month. The medical department claimed
only 5 deaths.

Those who died had symptoms like cough, cold, and running nose,
sources said. Initially, the residents suspected the deaths are due to
chikungunya fever or pneumonia, but the medical and health department
denied this. It was not due to a seasonal disease. Teams have been
sent to investigate, said BR Meena, director of health.

"It is not chikungunya but we have found that patients are also
suffering from anaemia, which shows up in blood tests," GS Sisodiya,
Kota's chief medical and health officer, said. He said the people in
the area are mostly anaemic. Now, the department is distributing iron
and folic acid tablets among the residents of the area.

One person died on Sunday [30 Oct 2011] and 3 others were admitted to
the government hospital in Kota. Also, one child has been referred to
JK Lone Hospital in Jaipur, an official said.

The situation worsened as there is no medical department's sub-centre
in the area. The area is neglected in terms of medical facilities.
Mandargarh has a population of around 950 and most of them are mine
labourers.

Now, to control the damage, the medical and health department has set
up a temporary dispensary at a school. "We have sent a team of
doctors, so that the patients with fever could get immediate medical
help," Sisodiya said. Also, teams of doctors made a door-to-door
survey to find out new patients. Moreover, the department also claimed
that 3 people have died last week [week of 24 Oct 2011] and one of
them died of tuberculosis.

--
Communicated by:
ProMED-mail from HealthMap alerts


[The symptoms of the disease associated with these fatalities in Kota,
the number of which is disputed, are not described clearly enough to
suggest an etiology. Anemia is prevalent in the community suggesting
malnutrition may be a factor. Chikungunya fever and a seasonal illness
have been excluded. Fever and respiratory symptoms may be common
features suggesting a respiratory infection. Further information from
the region is requested.

Kota is located along eastern bank of the Chambal River in the
southern part of the state if Rajasthan. It is the 3rd largest city of
Rajasthan after Jaipur and Jodhpur. Its location can be found on the
HealthMap/ProMED-mail interactive map at
http://healthmap.org/r/1oOG. The location of Mandargarh can be found
on the map at http://www.jatland.com/home/Mandalgarh. - Mod.CP]

CHIKUNGUNYA (25): INDIA (DELHI)
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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


Date: Thu 3 Nov 2011
Source: IBN [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 86424.html


With dengue cases on the rise despite a chill in the air, another
mosquito-borne [virus] disease, chikungunya, is becoming a cause of
concern for authorities in the city as the number of affected people
has shot up to 54. According to Municipal Corporation of Delhi (MCD)
officials, there has been an unprecedented increase in the number of
chikungunya cases.

"Dengue no doubt is a cause of worry but there has been a sudden rise
in chikungunya cases. It has reached 54. Last year, around this time,
the number of cases were only 33. People should check for mosquito
breeding in their houses," said Dr V K Monga, chairman of Municipal
Corporation of Delhi's public health committee.

--
Communicated by:
ProMED-mail


[The number of diagnosed chikungunya virus infections has increased
from 24 on 28 Oct 2011 (see ProMED-mail archive no. 20111102.3255) to
the 54 reported above. Advice to find and eliminate vector mosquito
breeding sites is prudent. - Mod.TY]

CHIKUNGUNYA (25): INDIA (DELHI)
*******************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Thu 3 Nov 2011
Source: IBN [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 86424.html


With dengue cases on the rise despite a chill in the air, another
mosquito-borne [virus] disease, chikungunya, is becoming a cause of
concern for authorities in the city as the number of affected people
has shot up to 54. According to Municipal Corporation of Delhi (MCD)
officials, there has been an unprecedented increase in the number of
chikungunya cases.

"Dengue no doubt is a cause of worry but there has been a sudden rise
in chikungunya cases. It has reached 54. Last year, around this time,
the number of cases were only 33. People should check for mosquito
breeding in their houses," said Dr V K Monga, chairman of Municipal
Corporation of Delhi's public health committee.

--
Communicated by:
ProMED-mail


[The number of diagnosed chikungunya virus infections has increased
from 24 on 28 Oct 2011 (see ProMED-mail archive no. 20111102.3255) to
the 54 reported above. Advice to find and eliminate vector mosquito
breeding sites is prudent. - Mod.TY]

WEST NILE VIRUS - EURASIA (13): INDIA (KERALA)
**********************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Thu 3 Nov 2011
Source: The Hindu [edited]
http://www.thehindu.com/news/cities/Koc ... 595151.ece


Solving the mystery that hung over the recent outbreak of fevers
resembling Japanese encephalitis (JE) here, it has been confirmed that
several of these cases were that of the West Nile [WN] fever, an
illness categorized as a 'potentially serious' one across the world.

The exact details of the prevalence of the WN fever and its virus,
which has been found to be spreading slowly along the coastal belt,
are yet to be made public with the study still on. However, the
confirmation that the recent outbreak included cases of WN has been
done at the field station of the National Institute of Virology (NIV)
here.

According to State Health Services Additional Director N. Sreedhar,
there was no official information yet, though unofficial information
reaching him mentioned the presence of WN in Alappuzha. Terming the
fever 'a mild variant of JE', Dr. Sreedhar said an official report on
the situation was expected shortly.

Meanwhile, experts say there are strong reasons to believe that WN
virus could be getting more common in Alappuzha and parts of Kottayam
too, because strong suspicions were raised about WN prevalence back in
2006 itself, during the Chikungunya outbreak here.

It was the present assistant director of the Cherthala unit of the
National Centre for Control of Diseases (NCDC), R. Rajendran, who had
then pointed out the possibility of the WN virus being the main
villain in the fever outbreak that took a toll of 57 lives in
Cherthala alone that year. The present NIV study, which found 40 per
cent of the 208 cases they examined to be WN cases, has substantiated
what Dr. Rajendran said about the presence of the virus here.

The symptoms of WN are similar to those of JE and chikungunya [virus
infections], with patients complaining of high fever, tiredness and
joint pains apart from brain functions being affected. The carriers
are usually the _Monsonia_ and _Culex_ mosquitoes. The mortality rate
of WN, in severe cases, ranged up to 15 per cent. Dr. Rajendran told
The Hindu that WN was 1st noticed in India during an NIV study in
1956. The study, published in 1973, had mentioned presence of WN in
Kerala too. Later, in 1980, at the Sree Chitra Thirunal Institute for
Medical Sciences, Thiruvananthapuram, 856 serum samples were tested
and WN antibodies were found in 48.6 per cent cases. In another
instance, 4 out of 67 samples sent to NIV, Pune centre from the
Kottayam Medical College to check for JE, turned out to be WN.

Chief Minister Oommen Chandy, as the Leader of Opposition then, had
demanded that a public health research institution be set up in
Alappuzha to study water-borne, vector-borne and air-borne diseases
apart from a regional office for the National Institute of
Communicable Diseases. Both are pending, so are the demands to
strengthen the existing units of the NCDC and NIV, though Alappuzha is
turning out to be the headquarters for almost every disease reported
in Kerala.

--
Communicated by:
ProMED-mail from HealthMap Alerts


[This is the 1st ProMED report of West Nile virus occurrence in India.
However, a report of West Nile virus occurrence in Assam published in
Emerging Infectious Diseases stated: "In India, antibodies against WNV
were 1st detected in humans in Bombay in 1952 (2). Virus activity has
been reported in southern, central, and western India. WNV has been
isolated in India from _Culex vishnui_ mosquitoes in Andhra Pradesh
and Tamil Nadu, from _Cx. quinquefasciatus_ mosquitoes in Maharashtra,
and from humans in Karnataka State".

With both Japanese encephalitis virus and West Nile virus circulating
in India, diagnosing which of these 2 virus is responsible for a given
encephalitis case serologically will be a challenge due to cross
reactions between the 2 flaviruses. Virus isolation is more reliable.

Reference
---------
Siraj A. Khan, Prafulla Dutta, Abdul M. Khan, Pritom Chowdhury, Jani
Borah, Pabitra Doloi, and Jagadish Mahanta. West Nile Virus Infection,
Assam, India. Emer Inf Dis 17 (5) May 2011

A HealthMap/ProMED-map showing the location of Alappuzhain, Kerala
state can be accessed at
http://healthmap.org/r/1pqW. - Mod.TY]

ANTIBIOTIC RESISTANCE, SALMONELLA TYPHI - INDIA (02): (MUMBAI)
FLUOROQUINOLONES
********************************************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Thu 3 Nov 2011
From: Amit Arjyal [edited]



Re: ProMED-mail post Antibiotic resistance, Salmonella typhi - India:
(Mumbai) fluoroquinolones 20111031.3235
-----------------------------------------------------------------
Doctors from Lilavati and Hinduja hospitals in Mumbai have reported
cases of resistant typhoid that did not respond to treatment for the
1st 10 days with oral drugs (not stated which drug or at what dose)
and the patients needed hospitalization and treatment with intravenous
antibiotics. We are delighted that the contributors have highlighted
this critical issue.

The treatment of enteric fever (caused by _Salmonella enterica_
serovar Typhi, or _Salmonella enterica_ serovar Paratyphi A) is
becoming increasingly difficult in many part of Asia as drug
resistance spreads. Despite this, few countries make use of available
and affordable vaccines or implement the complex public health
measures to reduce the burden of disease.

Typhoid and paratyphoid fever are both restricted to humans and hence
timely treatment of the individual ensures the patients are cured and
at the same time also ensures that the individual cannot continue to
transmit the infection to others in their community. In this setting,
ensuring the optimal use of antibiotics is absolutely crucial. This
means empirically choosing the right antibiotic at the right dose and
for the appropriate duration on presumptive diagnosis with knowledge
of the circulating drug resistance patterns in the locality, and a
willingness to change that if and when a culture result and
sensitivity testing is available. It is also crucial to follow that
patient up to ensure that they adhered to their treatment and that the
treatment cured the patient and prevented secondary transmission.

There has been a great deal of work aimed at providing an evidence
base for the treatment of enteric fever over the last decade and is
summarized in recent Cochrane reviews. In a series of large randomized
controlled trials in enteric fever, gatifloxacin (a newer generation
fluoroquinolone) has proved to be a safe and highly effective oral
drug with median fever clearance time of < 4 days in about 500
patients with culture proven _Salmonella typhi_ or _Salmonella_
Paratyphi A infection of which more than 80 percent were resistant to
nalidixic acid and some also to the older generation fluoroquinolones
(ofloxacin and ciprofloxacin).

This drug has been associated with dysglycaemia in elderly patients in
North America, a feature predicted from the preclinical studies.
However in the patient population at risk for enteric fever
(predominantly young previously healthy patients of normal or low
weight) no dysglycaemia has been observed despite extensive
investigations. The drug remains available in many parts of Asia, can
be given once a day for 7 days and a treatment course costs
approximately USD 2.00.

Drug resistance is becoming a major problem. This is particularly true
in enteric fever. We have few therapeutic options. We should be very
careful about discarding critical antibiotics whose adverse effects
(dysglycemia in the case of gatifloxacin) are rarely seen in the
affected population at risk and which offer effective and safe
treatment for diseases like typhoid fever. We refer the readers to
these recent articles and ongoing trials and the Cochrane reviews.

Published trials
----------------
Arjyal A, Basnyat B, Koirala S, et al. Gatifloxacin versus
chloramphenicol for uncomplicated enteric fever: a open-label,
randomised, controlled trial. Lancet Infect Dis. 2011
Jun;11(6):445-54.

Dolecek C, Tran TP, Nguyen NR, et al. A multi-center randomised
controlled trial of gatifloxacin versus azithromycin for the treatment
of uncomplicated typhoid fever in children and adults in Vietnam. PLoS
ONE. 2008 May 21;3(5):e2188. PMID: 18493312.

Pandit A, Arjyal A, Day JN, et al. An open randomized comparison of
gatifloxacin versus cefixime for the treatment of uncomplicated
enteric fever. PLoS ONE. 2007 Jun 27;2(6):e542.

Recent Cochrane review
----------------------
Effa EE, Lassi ZS, Critchley JA, et al. Fluoroquinolones for treating
typhoid and paratyphoid fever (enteric fever). Cochrane Database Syst
Rev. 2011 Oct 5;(10):CD004530.

--
Dr. Amit Arjyal
Oxford University Clinical Research Unit, Nepal.


[In contrast to older fluoroquinolones such as ciprofloxacin,
8-methoxy fluoroquinolones, such as gatifloxacin, have similar
activities against both fluoroquinolone enzyme targets, DNA gyrase and
topoisomerase IV, and resistance to 8-methoxy fluoroquinolones
requires mutations in the genes that encode both these fluoroquinolone
enzyme targets. Such an event apparently occurs at extremely low rates
in wild-type strains previously unexposed to fluoroquinolones.

Even in the presence of significant mutations in topoisomerase- and
gyrase-encoding genes, the 8-methoxy fluoroquinolones, such as
gatifloxacin, may retain high levels of in vitro activity. In
addition, overexpression of efflux pumps has a minimal effect on the
MICs of 8-methoxy fluoroquinolones. As a result, there is anticipated
a lower likelihood of selecting resistant strains with antibacterial
agents such as gatifloxacin
(http://cid.oxfordjournals.org/content/3 ... l.pdf+html).
However, it will be important to track changes in the prevalence of
resistance to the 8-methoxy fluoroquinolones, such as gatifloxacin, as
a result of the selective pressures imposed by their increased use. -
Mod.ML]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (32): MAHARASHTRA
*********************************************************

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 5 Nov 2011, 8:00
Source: Daily News and Analysis [edited]
http://www.dnaindia.com/mumbai/report_r ... pe_1607697


The rising numbers of encephalitis cases in Mumbai are becoming a
cause for concern, according to city doctors.

Kasturba hospital, Brihanmumbai Municipal Corporation's (BMC) only
infectious disease hospital, is getting 2-3 cases per week. A senior
doctor from the hospital said: "Encephalitis cases are on the rise
since the last one month. We have been getting 2-3 cases every week."

However, the doctors are unsure whether it is encephalitis or Japanese
encephalitis, which is also a cause of major concern in parts of North
India.

"Japanese encephalitis is a kind of encephalitis [virus] which spreads
through the bite of _Culex_ mosquitoes. We are not sure whether the
cases in Kasturba hospital are Japanese encephalitis, but the cases
are a cause for concern," said the doctor.

Japanese encephalitis has infected 14 people in Delhi so far this year
[2011]. Interestingly, the hospital hasn't sent any samples for
testing at the National Institute of Virology (NIV), Pune. "Ideally,
they should have sent the samples to NIV, but it has not been done so
far," he added.

According to the doctor, the patients presently hospitalised in
Kasturba hospital are from various parts of the city, and some are
from outside Mumbai.

Dr Pratit Samdhani, a consulting physician at Jaslok hospital, said:
"Maharashtra generally sees sporadic cases of Japanese encephalitis.
Otherwise, we keep getting viral encephalitis on and off."

--
Communicated by:
ProMED-mail

[This report differentiates "encephalitis" of unspecified etiology and
Japanese encephalitis, caused by a mosquito-borne flavivirus. There is
no hint concerning what the etiology of this unspecified encephalitis
might be.

Earlier reports from northeastern Indian states, especially Uttar
Pradesh and Bihar, relate unspecified encephalitis to contaminated
water, suggesting that enteroviruses might be involved. One hopes that
the results of the laboratory tests come in soon so that the public
might be informed about avoiding mosquito bites, and vaccination in
focal areas could be considered should these cases prove to be due to
Japanese encephalitis virus infections. Another possible etiological
agent is West Nile virus infection, which has occurred sporadically in
various parts of India, most recently in Kerala state last month
(October 2011; see ProMED-mail archive no. 20111105.3295).

A HealthMap/ProMED-mail map showing the location of Mumbai can be
accessed at http://healthmap.org/r/00BT. - Mod.TY]

MALARIA - INDIA (20): (MADHYA PRADESH)
**************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Sun 6 Nov 2011
Source: Times of India [edited]
http://articles.timesofindia.indiatimes ... ical-camps


Doctors from neighbouring districts were pressed into service in
tribal areas of Sidhi district where 21 persons, mostly children, died
due to an outbreak of malaria in the past fortnight in Vindhya
region.

"The situation is now under control in Choupal Povai and neighbouring
villages. Four temporary medical camps are functioning in the area to
identify people suffering from illness and screen the population in
the area for malaria parasite infection," a Sidhi district
administration spokesman said.

--
Communicated by:
ProMED-mail from HealthMap alerts


[According to the map of malaria in India in the WHO World Malaria
Report 2010, the annual incidence rate in Madhaya Pradesh is 1-10
cases per 1000 population per year. Thus, according to the report,
Madhaya Pradesh is a low-endemic area.

In the map of malaria in India published in the New Scientist in 2010
(http://www.newscientist.com/data/images ... 1_1070.jpg),
Madhaya Pradesh is still a low-endemic area, but with up to 5 percent
of deaths attributable to malaria and up to 1.5 percent of blood films
being malaria positive.

For the ProMED-mail HealthMap of the location of this outbreak, see:
http://healthmap.org/r/00Vk. - Mod.EP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (33): MAHARASHTRA, COMMENT
******************************************************************

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 6 Nov 2011
From: Prabhjot Singh


[Re: ProMED-mail Japanese encephalitis & other - India (32): (MA)
20111106.3302]
----------------------------------------------------------------------
It's not strange to see these cases of encephalitis appearing in
Mumbai. Mumbai, being a hub, has a high number of people from the
affected states of UP and Bihar that work as temporary workers in the
city. The appearance of disease after Diwali [festival of lights], in
the last week of October, when a large number of these migrant workers
visit their homes in the north of the country, should point towards
imported cases than actual transmission in the city. Also, it might
point towards the higher than estimated transmission of the yet
undiagnosed etiological agent in the Northern states of the country.

--
Communicated by:
Prabhjot Singh


[ProMED-mail thanks Prabhjot Sing for these interesting comments. It
would be of interest to know the recent travel histories of the
patients involved to know, as Dr Singh suggests, if these are all
imported cases or have been locally acquired. Ronan Kelly of
FluTrackers suggested that Chandipura virus infection should be
considered as a possible etiologic agent in some of these recent
(2011) encephalitis cases in India (see ProMED-mail archive no.
20100807.2690). Laboratory tests are needed to confirm or rule out
this possibility.

A HealthMap/ProMED-mail interactive map showing the location of Mumbai
can be accessed at http://healthmap.org/r/1pr7. - Mod.TY]

UNDIAGNOSED FEBRILE ILLNESS - INDIA (02): (WEST BENGAL) 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: Fri 4 Nov 2011
Source: The Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... anta-virus


Fear stalks the dusty, pot-holed lanes of Nilkanthapur -- a poor
village on the East and West Midnapore border, 170 km [106 mi] from
Kolkata. A killer virus, that has taken half-a-dozen lives in the last
3 years, is back to torment the area and its poor inhabitants who have
little access to proper healthcare. It could be [a] deadly hantavirus
or Korean haemorrhagic fever that has a 50 per cent mortality rate,
some experts fear. Even though a confirmation is awaited from the
National Institute of Virology (NIV), Pune and the School of Tropical
Medicine (STM) in Kolkata that had sent teams to collect blood samples
from the affected area on Wednesday [2 Nov 2011], the symptoms of the
fever that has been striking villagers have been chillingly similar to
that of [a] hantavirus [infection]. NIV and STM teams will visit the
village on Fri 4 Nov 2011.

A 10 year old boy and his neighbour, a boy of 6, have had a narrow
escape. The 2 young boys, in a critical state, had to be taken to the
Institute of Child Health (ICH) in Kolkata for treatment. They have
survived but still have a low fever that has kept their parents
worried and neighbours in anxiety. While one was released a fortnight
back, the other returned from Kolkata on Thursday [3 Nov 2011]. Both
are frail and can barely walk. Scores of others in the village are
suffering from a similar fever. Since 2008, there has been an outbreak
in the area every October.

"Initially, we took it to be a normal fever, but it refused to go
away. After a week, he turned very weak and then started having these
bouts of delirium and a splitting headache. It was followed by several
spells of convulsion. One of the boys would scream out in pain and
fall unconscious. We were terrified since the symptoms were close to
the mystery fever that has plagued our village so we rushed him to the
local Bhagabanpur health centre. They failed to do anything and
referred us to Kolkata," said the boy's father.

For the next one week, the boy's temperature kept fluctuating and he
went on slipping into spells of unconsciousness. Several blood and
biochemical tests failed to diagnose the illness. His release report
says the boy has enteric encephalopathy or ..... His parents have no
idea if the boy is indeed suffering from ..... for doctors have not
told them anything. "It seems to be that mystery fever. We are scared
and have been using mosquito nets. The experts who came here on
Wednesday [2 Nov 2011] have asked us to be cautious about insect bites
and rats. But is that enough?" asked [a villager]. He recalled how he
had rushed to Kolkata last year [2010] with a neighbour suffering from
the fever but she died at the Beliaghata ID Hospital. "She never
regained consciousness once the fever struck," said [the villager].

[The 10 year old] has not been able to move without his mother's
support ever since he returned home early on Thursday [3 Nov 2011].
Feeble and thin -- he has lost 4 kg [9 lbs) over last fortnight -- he
could just stare from his mother's lap as the local quack checked his
reports from ICH. It says the boy's fever is "under investigation".
The viral culture report is pending from STM.

"We can only keep our fingers crossed and hope for the best. Let's
hope the worst is over," said the boy's mother. She has never heard of
hantavirus but knows the mystery fever. "It's dangerous. We have seen
our neighbours die within hours," she mumbled, widening her eyes in
horror.

The fever has been striking in neighbouring Mongorajpur as well, a
village in Sabang of West Midnapore -- 3 have succumbed to it since
2009. A patient from Patashpur is now admitted in a Kolkata hospital.
The symptoms have been identical -- low fever for a week followed by a
sudden spell of delirium, vomiting, and convulsion. A farmer lost his
wife to the fever in 2009. "She had this slight temperature for about
a fortnight. One afternoon, she fainted and then started vomiting. By
the time it stopped, she was hardly breathing. We rushed her to a
Tamluk hospital and from there to the ID Hospital in Kolkata. No
medicine worked," said [the farmer]. Doctors told him that [his wife]
'possibly' had Japanese encephalitis. "It was the mystery fever, for
sure," said the farmer. [2 of] his neighbours fell prey to the fever
in 2010.

The visit by experts has failed to assure villagers. It would be
difficult to contain the virus, given the unhygienic environment of
the village and the areas around it, they pointed out. If it's
hantavirus, then it could spread through rodents and cattle [rodents
and perhaps other small mammals, not cattle, are reservoirs should
this prove to be a hantavirus. - Mod.TY], they have been warned.
"There's no way we can do away with either. While every household has
got cattle, rodents can't be checked since there is filth all around.
We must wait for November to pass without further deaths. That's the
best we can hope for," said a villager.

The district health administration said it was monitoring the
situation. "The experts will visit once again on Fri 4 Nov 2011. There
is yet no confirmation on the virus and we are waiting for the reports
from STM and NIV," said chief medical officer (CMOH) Sukumar Das.

[Byline: Prithvijit Mitra, Suman Mondal]

--
Communicated by:
ProMED-mail from HealthMap alerts


[This report does not provide enough information to hazard a
diagnosis. Since there is no mention of hemorrhagic or renal signs,
Puumala (known to be in India), Seoul (likely to be there also), and
Hantaan hantaviruses seem unlikely. Chandipura, Japanese encephalitis,
and West Nile viruses are other possible pathogens that might be
involved in these cases, but will need to be confirmed or ruled out by
laboratory tests. ProMED-mail would appreciate receiving additional
information, especially laboratory results, as additional reports
become available.

A map showing the location of Midnapore, the district headquarters of
Paschim Medinipur district of West Bengal state can be accessed at
http://en.wikipedia.org/wiki/Midnapore. - Mod.TY]

[West Bengal can be located on the HealthMap/ProMED-mail interactive
map of India at http://healthmap.org/r/1pFe. - Sr.Tech.Ed.MJ]

DENGUE/DHF UPDATE 2011 (44)
***************************

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 (Lahore, Punjab province). 2 Nov 2011. On Tuesday [1 Nov
2011], 3 women died at different hospitals in the City [Lahore],
taking the death toll till Tuesday to 330.
http://nation.com.pk/pakistan-news-news ... lls-3-more

[A HealthMap/ProMED-mail interactive map showing the location of
Lahore, Punjab province can be accessed at
http://healthmap.org/r/1kdh. - Mod.TY]

- Pakistan (national). 6 Nov 2011. With 4 more deaths reported on
Friday [4 Nov 2011], the total number of fatalities has risen to at
least 337. Health officials said 118 new cases of dengue fever were
confirmed on Friday in Punjab's provincial capital of Lahore, which
has been the most affected area. With hundreds of new cases this week
alone, nearly all of them in Lahore, the dengue fever outbreak has now
affected at least 31 979 people in the country, including 20 399 in
Punjab, of which 17 006 are in Lahore. Punjab Health Department
officials told the Nation that 308 of the fatalities were in Punjab,
including 268 in Lahore alone.
http://www.newkerala.com/news/2011/worl ... 00830.html

[It is not clear why there is a discrepancy in the numbers of dengue
deaths in Lahore, Punjab between this report and the earlier one
above, with the earlier one indicating that there were 61 more dengue
deaths than in the later one. - Mod.TY

- India (national). 2 Oct 2011. Ministry of Health and Family Welfare,
National Vector Borne Disease Control Programme, official figures
released 2 Nov 2011 covering the period to October 2011.
State / Cases (change since last month) / Fatalities (change since
last month)
Andhra Pradesh / 672 (+437) / 3 (-)
Assam / 1 (-) / 0 (-)
Bihar / 6 (+4) / 0 (-)
Chhattisgarh / 43 (+43) / 3 (+3)
Goa / 7 (-) / 0 (-)
Gujarat / 744 (+251) / 1 (+1)
Haryana / 184 (+145) / 2 (+1)
Jammu & Kashmir / 1 (-) / 0 (-)
Jharkhand / 12 (-) / 0 (-)
Karnataka / 315 (+52) / 4 (+1)
Kerala / 963 (+106) / 10 (+2)
Madhya Pradesh / 28 (+14) / 0 (-)
Maharashtra / 331 (+108) / 10 (+8)
Orissa / 1793 (+96) / 32 (+7)
Punjab / 2016 (+1,407) / 5 (+5)
Rajasthan / 234 (+153) / 0 (-)
Tamil Nadu / 1398 (+307) / 6 (+2)
Uttar Pradesh / 76 (+26) / 4 (+3)
Uttarakhand / 68 (+64) / 0 (-)
West Bengal / 240 (+91) / 0 (-)
Chandigarh / 40 (+39) / 0 (-)
Delhi / 757 (+512) / 5 (+2)
Puducherry / 106 (+72) / 0 (-)

Total 10 035 (+3937) / 85 (+35)
http://nvbdcp.gov.in/den-cd.html

[ProMED-mail thanks Ronan Kelly of FluTrackers for forwarding this
report.

A map showing the states in India can be accessed at
http://healthmap.org/r/1pSH. - Mod.TY]

- India (Churachandpur district, Manipur state). 5 Nov 2011. The
[Health] Department has listed 12 cases of suspected dengue fever,
with a single case of fatality, that tested positive, but the exact
figure is expected to be much higher.
http://e-pao.net/GP.asp?src=13..061111.nov11

[A HealthMap/ProMED-mail interactive map showing the location of
Churachandpur district, Manipur state can be accessed at
http://healthmap.org/r/1pSI. - Mod.TY]

- India (Gurgaon, Haryana state). 5 Nov 2011. On Friday [4 Nov 2011],
24 fresh cases of dengue were reported from the city. So far, Gurgaon
has registered 9 dengue deaths this year [2011]. Adding the 24 new
cases, the total number of dengue patients has touched 127.
http://www.hindustantimes.com/India-new ... 64998.aspx

[A HealthMap/ProMED-mail interactive map showing the location of
Gurgaon in Haryana state can be accessed at
http://healthmap.org/r/1pSJ. - Mod.TY]

- India (Delhi). 4 Nov 2011. With 17 more testing positive for dengue
in the city, a total of 837 people have been affected by the
mosquito-borne disease so far, officials said today [4 Nov 2011].
http://ibnlive.in.com/generalnewsfeed/n ... 88124.html

[A HealthMap/ProMED-mail interactive map showing the location of Delhi
can be accessed at http://healthmap.org/r/1nkS. - Mod.TY]

- India (Chennai, Tamil Nadu state). 4 Nov 2011. At Lister Metropolis
Laboratories, the rainy season is the busiest time of the year. "In
the last 10 days, there has been a spurt of monsoon-related ailments.
In a week we test 20 to 25 positive cases of dengue fever at
facilities around the city," said Ms Monika Prabhakaran, consultant
pathologist at the laboratory.
http://www.deccanchronicle.com/node/67626

[A HealthMap/ProMED-mail interactive map showing the location of
Chennai in Tamil Nadu state can be accessed at
http://healthmap.org/r/1pU2. - Mod.TY]

- India (Jaipur, Rajasthan state). 4 Nov 2011. In Jaipur the number of
dengue cases reported this year [2011] so far is much less than last
year. From January-October [2011], 140 dengue cases have been reported
compared to 254 last year [2010].
http://articles.timesofindia.indiatimes ... ily-report

[A HealthMap/ProMED-mail interactive map showing the location of
Jaipur, Rajasthan state can be accessed at
http://healthmap.org/r/1pX1. - Mod.TY]

- India (Mumbai, Maharashtra state). 4 Nov 2011. Dr ND Moulick, head
of medicine at the Sion Hospital, said: "The number of dengue cases is
unusually high. Between 24 and 31 Oct [2011], we have reported 34
positive cases of dengue. In the last 2 days (1-2 Nov 2011), we have
registered 34 positive dengue cases again. In contrast to 2-3 dengue
cases that we used to get in a week, we are now getting 4 dengue cases
in a day on an average."
http://www.dnaindia.com/mumbai/report_d ... ai_1607155

[A HealthMap/ProMED-mail interactive map showing the location of
Mumbai can be accessed at http://healthmap.org/r/1pAp. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (34): (UTTAR PRADESH, BIHAR)
NEPAL
**************************************************************************

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 8 Nov 2011
Source: NetIndia23 [edited]
http://www.netindia123.com/showdetails. ... +UP+at+480


Five more children died of deadly disease of Japanese encephalitis
(JE) at BRD Medical colleges, Gorakhpur taking the toll to 551 in
eastern parts of Uttar Pradesh during this year [2011]. The children
who died during the last 24 hours included 2 from Deoria district and
one each from Maharajaganj, Gorakhour, and neighbouring state of
Bihar, the medical college sources said. A total of 3395 patients had
been admitted to BRD Medical college since 1 Jan 2011, out of which
551 died this year.

During the last 24 hours, 18 new patients were admitted while
presently 205 patients are under treatment at medical college and
other hospitals of eastern UP. The patients admitted to Gorakhpur
medical college included 7 from neighbouring country of Nepal and 369
of Bihar. The patients who have so far died of encephalitis included
67 from Bihar and 2 from Nepal.

--
Communicated by:
ProMED-mail from HealthMap alerts


[In this report, Japanese encephalitis virus (JEV) is the only
etiological agent mentioned as responsible for these encephalitis
cases. Previous reports from Uttar Pradesh and Bihar states this year
(2011) implicate JEV in approximately one-third of the encephalitis
cases, the majority being due to undiagnosed viruses, perhaps
enteroviruses, associated with contaminated water. One hopes that as
the season changes, these cases will end.

HealthMap/ProMED-mail interactive maps showing the location of Uttar
Pradesh and neighboring Bihar states can be accessed at
http://healthmap.org/r/1i16 and Nepal at
http://healthmap.org/r/1q5H. - Mod.TY]