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CHIKUNGUNYA (26): 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 11 Nov 2011
Source: NBI [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 96219.html


Not only dengue, but another mosquito-borne disease [virus]
chikungunya, is now a cause of worry for Delhiites. Chikungunya [virus
infection] cases have risen to 71 after 8 people tested positive in
the past 24 hours, MCD's [Municipal Corporation of Delhi] public
health committee Chairman V K Monga said. "It is a cause of worry as
chikungunya cases are multiplying even after winter has arrived," he
said.

--
Communicated by:
ProMED-mail from HealthMap Alerts
http://healthmap.org/r/1nkS. - Mod.TY]

CHIKUNGUNYA (26): 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 11 Nov 2011
Source: NBI [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 96219.html


Not only dengue, but another mosquito-borne disease [virus]
chikungunya, is now a cause of worry for Delhiites. Chikungunya [virus
infection] cases have risen to 71 after 8 people tested positive in
the past 24 hours, MCD's [Municipal Corporation of Delhi] public
health committee Chairman V K Monga said. "It is a cause of worry as
chikungunya cases are multiplying even after winter has arrived," he
said.

--
Communicated by:
ProMED-mail from HealthMap Alerts
http://healthmap.org/r/1nkS. - Mod.TY]

MENINGITIS, DRUG-INDUCED - INDIA: (MUMBAI)
******************************************

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


******
[1]
Date: Fri 11 Nov 2011
Source: MidDay [edited]
http://www.mid-day.com/news/2011/nov/11 ... ngitis.htm


Over the past 5 months, 11 patients contracted a rare drug-induced
type of the disease at 3 BMC hospitals; doctors believe it could be
stemming from contaminated samples of anaesthetic drug bupivacaine.

In a shocking reversal of the natural order of things, 11 patients,
who were admitted across 3 civic hospitals over the past 5 months,
ended up contracting a disease which was far more lethal than the ones
that they were seeking treatment for.

Within hours of undergoing their respective procedures, these patients
developed meningitis -- an acute inflammation of the brain.
Anaesthesiologists in KEM, Sion and Bhabha hospital, where the
patients were diagnosed with the infection, suspect that the
administration of an anaesthetic drug -- which is injected into the
spinal cord prior to procedures -- may have been responsible for the
disease.

The suspected drug is bupivacaine, which is supplied to the BMC
hospitals by Ciron, a Jogeshwari-based pharmaceutical company, as per
the civic body's rate contract.

Meningitis is a potentially fatal inflammation of the protective
membranes covering the brain and spinal cord. In some rare cases, it
is drug-induced, caused by the administration of contaminated drugs,
such as anaesthesia.

Mid DAY met one of the unlucky 11 [patients], who recently underwent a
procedure for ligament reconstruction. Soon after the surgery at KEM
hospital, however, [the patient] started showing symptoms of high
fever with chills and a headache. "He fell unconscious and started
convulsing, as a result of which we had to admit him to the ICU," said
a doctor. "Ligament reconstruction allows a patient to go home hours
after the surgery. But [the patient] ended up with meningitis. The
doctors have clearly diagnosed him with post spinal meningitis," said
a doctor.

Post spinal meningitis is a rare medical complication caused by the
introduction of anaesthesia through the spine. The disease may be
caused by the mechanism of administration, the contamination of
equipment used, or the contamination of the drug itself.

[The patient], who has been kept under observation is now undergoing
rigorous antibiotic treatment to cure him. "The doctor had told us
that I could go home on the very day of the surgery, so I was shocked
when I ended up in the ICU," said [the patient] who still suffers from
headaches.

Besides [this patient], 10 other patients who were admitted to the
hospitals to be cured of sundry ailments ended up contracting the
deadly disease. 3 of them were new mothers, who had undergone
C-section deliveries. Out of the 11 patients, 4 cases each have been
reported in Sion and Bhabha hospital, while the 3 others were admitted
at KEM for treatment.

Of the 4 cases reported at Sion hospital, 2 patients were critical,
but were pulled out of infection after rigorous antibiotic treatment.
The others are also stable after receiving treatment.

Ciron supplies approximately 2 lakh ampules of bupivacaine annually,
to various civic hospitals. Dr Sanjay Oak, dean of KEM hospital and
director of major civic hospitals, said, "I have received the
complaints. Anaesthesiologists suspect that an anaesthetic drug used
during procedures is causing the disease. We will refer this matter to
the FDA. To prevent other casualties, we have stopped using the drugs
being delivered by the company to our hospitals."

Dr Shashikant Wadekar, medical superintendent, Bhabha hospital, said,
"After our anaesthesiologists brought this anomaly to my notice, we
stopped using the drug. All the 4 patients had developed post spinal
meningitis, but we treated them here. They are now stable."

Dr Sandhya Kamat, dean of Sion hospital, said, "After doctors
contended that the anaesthesia could be responsible for the
meningitis, we had sent samples of it to FDA for examination. They
have [confirmed] that it is a standard sample of the drug. However, as
a precautionary measure, we have discarded the drug received from our
pharmaceutical company, and have got another sample from a different
company."

Dr Ami Merchant, consultant anaesthesiologist at Lilavati hospital
said, "Bupivacaine is a very common drug used as spinal anaesthesia.
It is very safe. Incidence of drug-induced meningitis is very rare.
There are several ways in which one can contract post-operative
meningitis. In some cases, doctors fail to follow strict aseptic
procedures and equipment, like using antiseptic masks and gear, or
sterile gloves. In other cases, the contamination of a drug during
manufacture can ultimately be responsible for the disease. The
occurrence of 11 cases over 5 months needs to be studied."

--
Communicated by
ProMED-mail from HealthMap Alerts


******
[2]
Date Sat 12 Nov 2011
Source: MidDay [edited]
http://www.mid-day.com/news/2011/nov/12 ... -plant.htm


After Mid DAY's [report] on 11 patients who contracted meningitis
after being administered local anaesthetic drug bupivacaine at 3 civic
hospitals, the Food and Drug Administration (FDA) has inspected the
manufacturing plant of Ciron Pharmaceuticals, which supplies the drug
to the hospitals. It is also collecting bupivacaine samples from the
facilities for testing them.

Civic doctors said they were shocked over the apathy of the
administration. "Even if there was the slightest of doubt about the
anaesthetic, the BMC hospitals should have stopped the drugs, instead
of waiting for 11 patients to get meningitis," said a senior doctor
requesting anonymity.

They also claimed they were compelled to use the drug despite having
doubts as a circular from the director's office prohibited them from
prescribing it from pharmacies outside. After 2 cases of meningitis
surfaced from Sion hospital, the doctors suspected that the drugs had
a role to play in the infection and alerted the FDA, which checked the
drugs and gave it a clean chit.

K B Shende, joint commissioner, FDA (drugs), said, "Sion hospital had
given us the drugs for examination earlier. After testing them, we
found them to be of standard quality. But now, we have started a fresh
investigation and we are looking at all possible causes of infection
as well as contamination."

However, when Sion, Bhabha and KEM hospitals reported cases of post
spinal meningitis (contamination in the body while administration of
the anaesthetic) even after FDA's clean chit, they should have
immediately stopped using it, doctors opine.

Dr Sanjay Oak, dean of KEM hospital and director of major civic
hospitals, was unreachable for comment. Rajul Patel, health committee
chairman, BMC, said, "We will initiate an inquiry. Doctors and the
drug's manufacturing company will have to answer." Kirti Shah,
director, Ciron pharmaceutical, said, "We are cooperating with the FDA
in their investigations."

--
Communicated:
ProMED-mail


[Bupivacaine is an anesthetic drug that can be administered by
epidural or intrathecal injection via lumbar puncture. Intrathecal
drug administration means the introduction of a drug by injection into
the subarachnoid space around the spinal cord. Drug may also enter the
subarachnoid space inadvertently after injection into the epidural
space.

Meningitis that follows drug administration by lumbar puncture can be
either "septic" or "aseptic." The term "septic meningitis" is used to
indicate that infectious agents such as bacteria were introduced
intrathecally at the time of the lumbar puncture. The term "aseptic
meningitis" following intrathecal drug administration usually refers
to meningitis due to the drug itself or due to a chemical contaminant
of the drug or the equipment used to administer the drug.

The clinical presentation of drug-induced aseptic meningitis is very
similar to that of the septic variety, with fever, headache, stiff
neck, and changes in mental status; the prognosis of drug-induced
aseptic meningitis is generally excellent with complete long-term
recovery. A hypersensitivity mechanism is invoked to explain
drug-induced aseptic meningitis.

There are several reports in the literature of drug-induced aseptic
meningitis associated with intrathecal administration of bupivacaine
(http://www.hopkinsguides.com/hopkins/ub ... meningitis]_,
http://www.ncbi.nlm.nih.gov/pubmed/17641986,
http://www.ncbi.nlm.nih.gov/pubmed/20306069, and
http://www.ncbi.nlm.nih.gov/pubmed/19653822). It is unclear from the
news reports above if the 11 patients suffered from the septic or
aseptic variety. More information to clarify this issue would be
appreciated.

Clusters of cases of septic meningitis have been reported as a rare
complication of a lumbar puncture performed for various reasons.
Microorganisms that have caused meningitis following lumbar puncture
include _Streptococcus salivarius_, _Pseudomonas aeruginosa_,
_Staphylococcus aureus_, _Acinetobacter_ spp., and _Aspergillus_ spp.
(http://www.ncbi.nlm.nih.gov/pubmed/15019223).

The following is extracted from the U.S. CDC Morbidity and Mortality
Weekly Report (MMWR). Bacterial Meningitis After Intrapartum Spinal
Anesthesia --- New York and Ohio, 2008-2009. January 29, 2010 /
59(03);65-69. Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a1.htm

"The intrathecal space is entered during several diagnostic and
therapeutic spinal procedures, including lumbar puncture, myelography,
and spinal anesthesia, and can occur inadvertently during epidural
anesthesia. Cases of meningitis have been reported after all of these
procedures, although most published cases have involved spinal
anesthesia (2). A literature review identified only 179 cases of post
spinal procedure meningitis reported worldwide during 1952--2005 (2);
in contrast, approximately 300 000 diagnostic lumbar punctures were
performed on inpatients in the United States in 2007 alone (4). Post
spinal procedure meningitis causes serious infections; in one case
series, one third of cases resulted in death (5).

Potential sources of bacterial introduction into the intrathecal space
during spinal procedures include intrinsic or extrinsic contamination
of needles, syringes, or injected medications; inadequately
decontaminated patient skin; inadequately cleaned health-care provider
hands; a contaminated sterile field; and droplet transmission from the
health-care provider's upper airway. _Streptococcus salivarius_ and
other viridans group streptococci, which are normal mouth flora, are
the most commonly identified etiologies of meningitis after spinal
procedures, accounting for 49 percent and 60 percent of cases in
literature reviews (2,6). Droplet transmission of oral flora has been
suggested as the most likely route of transmission in reports of
clusters associated with a single health-care provider (7,8).

References:
-----------
2. Baer E. Post-dural puncture bacterial meningitis. Anesthesiology
2006;105: 381--93.
3. Moen V, Dahlgren N, Irestedt L. Severe neurological complications
after central neuraxial blockades in Sweden 1990--1999. Anesthesiology
2004;101:950--9.
4. Agency for Healthcare Research and Quality. Healthcare Cost and
Utilization Project (HCUPnet). Available at
http://hcupnet.ahrq.gov/hcupnet.jsp. Accessed January 22, 2010.
5. Pandian JD, Sarada C, Radhakrishnan VV, Kishore A. Iatrogenic
meningitis after lumbar puncture-a preventable health hazard. J Hosp
Infect 2004;56:119--24.
6. Yaniv LG, Potasman I. Iatrogenic meningitis: an increasing role for
resistant viridans streptococci? Case report and review of the last 20
years. Scand J Infect Dis 2000;32:693--6.
7. Schneeberger P, Janssen M, Voss A. Alpha-hemolytic streptococci: a
major pathogen of iatrogenic meningitis following lumbar puncture.
Case reports and a review of the literature. Infection
1996;24:29--33.
8. Veringa E, Van Belkum A, Schellekens H. Iatrogenic meningitis by
Streptococcus salivarius following lumbar puncture. J Hosp Infect
1995;29:316--8."

Another postulated mechanism for post-lumbar puncture meningitis is
bacteremia at the time of the lumbar puncture; the bacteria in the
patient's blood gain access to the intrathecal space because of
microscopic bleeding caused by insertion of the needle
(http://bja.oxfordjournals.org/content/78/6/635.full.pdf).

Brihanmumbai Municipal Corporation (BMC) is the civic body that
governs the city of Mumbai. KEM and Sion are teaching hospitals and
Bhabha is a municipal hospital in Mumbai. A HealthMap/ProMED-mail
interactive map of India, showing the location of Mumbai, can be
accessed at http://healthmap.org/r/1iZ2. - Mod.ML]

MENINGITIS, DRUG-INDUCED - INDIA (02): MUMBAI, 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 13 Nov 2011
From: Nick Beeching [edited]


The recent reports of possible drug-related meningitis in India
highlight the possibility of introduction of bacteria at various
stages in drug manufacture, storage and administration, including a
brief mention of contamination of syringes and needles. A recent
episode in Sri Lanka demonstrated the risk of iatrogenic fungal
infection of the meninges and emphasised the importance of safe
warehousing of basic equipment.

In 2005, an outbreak of _Aspergillus fumigatus_ meningitis resulted in
the deaths of 3 of 6 obstetric patients following spinal anaesthesia
at 2 hospitals in Colombo, Sri Lanka (1-4). _Aspergillus_ meningitis
was also implicated in 5/27 patients with sporadic iatrogenic
meningitis in 2 Indian referral hospitals over a prolonged period (5),
and fungal contamination of drugs has previously been reported by
ProMED-mail [Fungal meningitis, contaminated drug - USA (03)
20021212.6046; Fungal meningitis, contaminated drug - USA: alert (02)
20021117.5831 Fungal meningitis, contaminated drug - USA: alert
20021002.5444].

The Colombo outbreak was linked to contamination of poorly stored
syringes, needles and other equipment donated from many sources after
the tsunami. The precise point at which fungal contamination happened
was not identified, but the equipment had been distributed to both the
hospitals involved. Once the source was identified and remaining
stocks destroyed, there were no further cases.

The dangers of poor quality control of material donated from multiple
sources in disaster settings and of incorrect storage should always be
remembered.

References:
-------------
1. Gunaratne PS, Wijeyaratne CN, Chandrasiri P, Sivakumaran S,
Sellahawa K, Perera P, et al. An outbreak of Aspergillus meningitis
following spinal anaesthesia for caesarean section in Sri Lanka: a
post-tsunami effect? Ceylon Med J 2006 Dec;51(4):137-42.
2. Gunaratne PS, Wijeyaratne CN, Seneviratne HR. Aspergillus
meningitis in Sri Lanka--a post-tsunami effect? N Engl J Med 2007 Feb
15;356(7):754-6.
3. Rodrigo N, Perera KN, Ranwala R, Jayasinghe S, Warnakulasuriya A,
Hapuarachchi S. Aspergillus meningitis following spinal anaesthesia
for caesarean section in Colombo, Sri Lanka. Int J Obstet Anesth 2007
Jul;16(3):256-60. Epub 2006 Sep 1.
4. Lokuhetty MD, Wijesinghe HD, Weerasundra B, Dayapula A. Iatrogenic
Aspergillus infection of the central nervous system in a pregnant
woman. Indian J Pathol Microbiol 2009 Jul-Sep;52(3):427-9.
5. Pandian JD, Sarada C, Radhakrishnan VV, Kishore A. Iatrogenic
meningitis after lumbar puncture-a preventable health hazard. J Hosp
Infect 2004 Feb;56(2):119-24.

--
Communicated by:
Dr Nick Beeching
Senior Lecturer, Liverpool School of Tropical Medicine
Liverpool, UK


[ProMED-mail thanks Dr. Beeching for his references and commentary on
fungal meningitis after lumbar puncture due to contaminated equipment.
- Mod.ML]

DENGUE/DHF UPDATE 2011 (45)
***************************

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 city and Punjab province). 12 Nov 2011. Another
patient fell victim to dengue virus on Thursday [10 Nov 2011],
mounting the total death toll to 306 in Lahore city. According to
Health Department only 23 persons with positive dengue symptoms in
their blood reports were reported in Punjab during last 24 hours; out
of them, 10 are from Lahore. The total number of dengue patients in
the Punjab has risen to 3678, out of them, 2498 belong to Lahore.
http://www.thenews.com.pk/NewsDetail.as ... ngue-fever

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

- Pakistan (Karachi, Sindh province). 12 Nov 2011. A total of dengue
fever patients reached 717 in Sindh, while 9 new patients were
diagnosed dengue positive in Karachi on Friday [11 Nov 2011]. As per
statistics of Sindh Dengue Surveillance Cell (SDSC), a total of 847
patients were admitted at different hospitals in Karachi and of them
717 were found dengue positive. SDSC reported that total 15 dengue
patients had died in Sindh province of them 13 belonged to Karachi.
Some 17 patients are still under treatment at different hospitals in
the metropolis.
http://www.dailytimes.com.pk/default.as ... 11_pg12_11

[A HealthMap/ProMED-mail interactive map of Karachi, Sindh province
can be accessed at http://healthmap.org/r/1kc-. - Mod.TY]

- Pakistan (Rawalpindi, Punjab province). 10 Nov 2011. Data revealed
that the 3 teaching hospitals received less than 40 dengue fever
suspects within past 3 days. Within 24 hours after Eid prayer on
Monday [7 Nov 2011], the allied hospitals received 246 patients with
fever at their dengue fever OPD [out patient departments] counters of
which only 13 were admitted in wards after being suspected as patients
of the infection. Focal person for dengue fever at the allied
hospitals, Dr Javed Hayat, stated that the number of dengue fever
suspects reaching allied hospitals is getting thin mainly because of
the onset of chilly weather.
http://www.thenews.com.pk/TodaysPrintDe ... 11/10/2011

[A HealthMap/ProMED-mail interactive map of Rawalpindi, Punjab
province can be accessed at http://healthmap.org/r/1qVK. - Mod.TY]

- India (Delhi and national). 11 Nov 2011. Hospitals in Delhi have
diagnosed 15 new dengue cases in the past one day, thus indicating
that dengue has started ebbing in the city, MCD's [Municipal
Corporation of Delhi] public health committee chairman VK Monga said.
"The total number of people affected by dengue fever this year [2011]
has reached the 945 mark. 15 cases were reported in the past one day.
Dengue cases are gradually showing a downward trend. Unlike earlier
when 20 and more dengue cases were being reported in just 24 hours,
now it is less," Monga said. Over 10 000 dengue cases have been
detected in the country this year [2011]. According to Union health
ministry figures, states like Sikkim, Manipur, Nagaland, Himachal
Pradesh, and Meghalaya have had no dengue cases this year. In contrast
over 1000 dengue cases were detected in Punjab, Orissa and Tamil Nadu.
"Dengue can be fatal," Monga said.
http://ibnlive.in.com/generalnewsfeed/n ... 96219.html

[The 9 Nov 2011 edition of IBN
(http://ibnlive.in.com/generalnewsfeed/n ... 90746.html)
reported that Punjab tops the list of affected states with 2016 dengue
cases, followed by 1793 cases in Orissa, 1398 in Tamil Nadu, and 963
in Kerala this year [2011].

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

- India (Churachandpur, Manipur state). 9 Nov 2011. 5 new cases of
dengue were reported in Churachandpur [district] even as the district
health officials struggled to contain the disease almost a month after
the presence of its virus was confirmed [in the district]. Excel
Diagnostic Centre reported that 2 blood samples they received on
Sunday [6 Nov 2011] tested positive while all the 3 reports they
received today [9 Nov 2011] from Babina Diagnostic Centre, Imphal were
also found positive.
http://www.e-pao.net/GP.asp?src=4..101111.nov11

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

- India (Tamil Nadu state). 13 Nov 2011. So far in the current year
[2011], 1634 persons were affected with dengue fever. The samples of
8731 persons were tested for dengue fever. The number of people
affected with dengue was high in border areas [with Kerala state] such
as Kanyakumari, Tirunelveli, Coimbatore, Dindugal, Theni, and
Nilgiris.
http://www.thehindu.com/news/cities/Mad ... 622201.ece

[A HealthMap/ProMED-mail interactive map of Tamil Nadu state can be
accessed at http://healthmap.org/r/1mm2. - Mod.TY]

MALARIA - INDIA (21): (JHARKAND)
********************************

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 14 Nov 2011
Source: NetIndia [edited]
http://www.netindia123.com/showdetails. ... in+Koderma


6 people die of cerebral malaria in Koderma, Jharkhand
------------------------------------------------------
A total of 6 people, including 3 of a family have died, because of
cerebral malaria and more than 10 are suffering from the disease in
Karmikund village under Domchanch block of the districrt in past
48-hours.

Civil Surgeon Sunil Oraon confirmed the deaths of 5 people and said 5
others suffering from the disease were admitted to civil hospital. Mr
Oroan said a medical team was camping in the village. So far tests
were conducted on more than 55 people, Mr Oraon said, adding that
adequate facilities were provided to the patients.

--
Communicated by:
ProMED-mail from HealthMap alerts


[Jharkand is an endemic area for malaria, but cerebral malaria is a
sign of advanced disease either due to late treatment or ineffective
treatment. The drugs available are not mentioned in the article, but
resistance against chloroquine is widespread in India. ProMED will be
happy to post information on the of the drugs used for treatment if
any treatment was given before the patients presented with cerebral
malaria.

HealthMap location: http://healthmap.org/r/1r1m - Mod.EP]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (35): (BIHAR)
*****************************************************

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:
2 reports from Gaya district, Bihar state

******
[1]
Date: Wed 16 Nov 2011
Source: CNN-IBN live [edited]
http://ibnlive.in.com/news/gaya-encepha ... 933-3.html


More than 1000 children are feared to have been affected by Japanese
encephalitis [virus] in Bihar's Gaya district. One child has been
dying every day for the last 3 months in the district. This outbreak
comes even as Gorakhpur in Uttar Pradesh battles against viral
encephalitis.

A mother's world has come crashing down on her. Her 2-year old
daughter succumbed to Japanese encephalitis [virus infection], but she
hasn't even had time to mourn her, as her son is fighting for his life
at the hospital. Encephalitis, or brain fever as it is called in Gaya,
has already taken the lives of 84 children in the last 80 days at this
hospital alone in Gaya. The collective figure could be much more
alarming.

Each year, Japanese encephalitis takes hundreds of lives in 10
districts in central Bihar and Jharkhand including Jahanabad,
Aurangabad, Chatra, and a part of Patna.

The one thing that unites all families who are forced to live in slums
with poor sanitation, is utter poverty. A majority of victims belong
to the Musahar caste, a rat-eating community who breeds pigs for a
living.

Dr AK Ravi, HoD [head of department], Pediatrics department, Magadh
hospital, Gaya, said, "It's most common in poor people because of
hygiene conditions and keeping pigs as pet animals."

In last 81 days, the killer disease encephalitis has claimed lives of
84 children in Gaya alone, and is still counting, leaving many
families devastated. But the deaths have failed to wake up the state
government's health department from its deep slumber, which has not
only reacted late, but is still struggling to figure out the ways to
contain this killer disease.

In hospitals it's the same old story with little infrastructure and
barely functioning equipment. For the moment, a team of doctors and a
batch of medicines have been rushed in from Patna, but for the 84
children of Gaya and their families, it's already too late.

[Byline: Prabhakar Kumar]

--
Communicated by:
ProMED-mail


******
[2]
Date: Wed 16 Nov 2011
Source: CNN-IBN live [edited]
http://ibnlive.in.com/news/bihar-81-chi ... 734-3.html


A total of 84 children have died in Gaya in Bihar in the last 80 days
due to symptoms similar to encephalitis.

More than a dozen children are still admitted in the Anugrah Narayan
Magadh Medical College in Gaya. The children aged between 2-8 years
were brought in with high fever.

According to the medical college, 384 children have been admitted so
far, of which 244 have been discharged. While 83 children have died
[in Gaya], 27 are still being treated.

[Byline: Prabhakar Kumar]

--
Communicated by:
ProMED-mail from HealthMap alerts


[The 1st report above, indicates that Japanese encephalitis (JE) virus
is responsible for these encephalitis cases. The 2nd report does not
indicate possible etiologies. Previous recent reports from Bihar and
neighboring Uttar Pradesh states indicate that less than half of the
encephalitis cases are due to Japanese encephalitis virus infection,
the majority being associated with contaminated water and perhaps are
due to enteroviruses. Neither of the reports above mentions past,
current, or planned JE vaccination campaigns.

A HealthMap/ProMED-mail interactive map showing the location of Gaya
district, Bihar state can be accessed at
http://healthmap.org/r/1ix2. - Mod.TY]

CHIKUNGUNYA (28): INDIA (BIHAR)
*******************************

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 17 Nov 2011
Source: Prasar Bharati (Broadcasting Corporation of India) News On Air
[edited]
http://www.newsonair.com/news.asp?cat=state&id=ST7889


The Bihar government has issued an alert following the detection of
the 1st ever outbreak of chikungunya [virus infections] in the state.
The executive director of the State Health Society, Sanjay Kumar, told
AIR [News On Air] that with the detection of 3 fresh cases, the total
number of chikungunya patients has risen to 37.

All civil surgeons have been instructed to take appropriate and timely
measures for management of the mosquito-borne viral fever.

The state government has asked the health officials to monitor all
types of fever where confirmed cases of chikungunya have been
reported.

Chief minister Nitish Kumar directed the health department to start
marathon fogging of areas of higher density on a priority basis.

--
Communicated by:
ProMED-mail from HealthMap alerts


[There have been a few reported small outbreaks of chikungunya virus
infections in India -- the most recent in Delhi and in Uttar Pradesh
state. The report above of cases in Bihar also indicates that a mixed
chikungunya and dengue outbreak is occurring there. Both viruses are
transmitted by the same mosquito, _Aedes aegypti_. Fogging to reduce
adult mosquitoes will provide only temporary reduction in virus
transmission. Elimination of breeding sites in and around houses will
have a longer-lasting effect on control of this mosquito.

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

MEASLES UPDATE 2011 (41)
************************

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


******
India
Date: Sat 19 Nov 2011
Source: Times of India [edited]
http://timesofindia.indiatimes.com/city ... 790593.cms


Following reports of an outbreak of measles among children, the
district administration on Friday [18 Nov 2011] launched a special
campaign to administer anti-measles vaccines among the kids.

Civil surgeon Shashibhushan Singh said 536 000 children would be
covered under the special vaccination programme. He added that the
report received [reports] from the rural areas of Dhanbad suggesting
an outbreak of measles during this time of changing season.

The administration has engaged 8291 health department staff under the
special vaccination programme. On the 1st day, 92 000 children at all
block primary health centres were administered vaccines. Singh himself
visited PHCs at Govindpur, Nirsa and Koylanagar to supervise the
vaccination programme.

--
Communicated by:
ProMED-mail from HealthMap alerts


[This is the 1st report of an outbreak of measles virus infection from
the Indian subcontinent during the current multi-country outbreak.
There is no indication of the number of cases involved, but the
vaccination response is considerable. According to UNICEF, vaccination
coverage in India was high, at 87 percent, in 2010 but not sufficient
to eliminate the disease.

Dhanbad is a city in the Indian state of Jharkhand and is also known
as the Coal Capital of India. Dhanbad is the 79th fastest growing city
in world. According to the 2011 census, Dhanbad is among the 35 cities
of India with a population of more than one million. Maps showing the
location of Dhanbad can be accessed at:
http://dhanbad.nic.in/maps.html. - Mod.CP]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (03): SINDH, HUMAN
*************************************************************

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 19 Nov 2011
Source Dawn, Metropolitan [edited]
http://www.dawn.com/2011/11/19/young-ma ... fever.html


A 29-year-old man admitted to a private hospital with a history of
high-grade fever and fits for 6 days died at the private hospital on
Fri 18 Nov 2011. Sources at the Liaquat National Hospital (LNH) told
Dawn that the patient tested positive for Crimean-Congo haemorrhagic
fever (CCHF) virus infection at a private university hospital.

The patient was a resident of Gazdarabad, Ranchhore Line. Retired Brig
Syed Nasim Ahmed, director of administration at the LNH, told the Dawn
newspaper that the man was said to have lived with a friend for a week
in the cattle market during the Eid days before his illness. However,
information regarding the exact occupation and family details of the
victim could not be obtained from the LNH.

He had been brought to the LNH on 15 Nov 2011 with a high-grade fever
in a state of unconsciousness and bleeding from the mouth. He was
diagnosed as a CCHF case on Thu 17 Nov 2011. It was further learned
that the patient was being treated at the medical intensive care unit
of the LNH.

Three deaths as a result of CCHF virus infection were reported last
year [2010], one each at the Indus Hospital, Aga Khan University
Hospital and Abbasi Shaheed Hospital.

[Byline: Mukhtar Alam]

--
Communicated by:
ProMED-mail from HealthMap alerts


[Crimean-Congo haemorrhagic fever (CCHF) is a tick-transmitted viral
haemorrhagic fever. Although primarily a zoonosis, sporadic cases and
outbreaks of CCHF affecting humans do occur. The disease is endemic in
many countries in Africa, Europe and Asia.

A number of tick genera are capable of becoming infected with CCHF
virus, but the most efficient and common vectors for CCHF appear to be
members of the genus _Hyalomma_. Humans who become infected with CCHF
acquire the virus from direct contact with blood or other infected
tissues from livestock, or they may become infected from a tick bite.
Transmission of infection from domestic stock generally occurs during
slaughter (and not during normal contact with domestic animals, which
are relatively unaffected by the infection).

The majority of human cases have occurred in those involved with the
livestock industry, such as agricultural workers, slaughterhouse
workers and veterinarians. It is likely that the deceased Pakistani
acquired the infection during the course of his residence in the
cattle market during the EID festival period and that he did not seek
treatment early enough to save his life. The mortality rate for human
cases is approximately 30 percent, with death occurring in the 2nd
week of illness. In those patients who recover, improvement generally
begins on the 9th or 10th day after the onset of illness. General
supportive therapy is the mainstay of patient management, although the
antiviral drug ribavirin has been used successfully in treatment of
some cases of established CCHF virus infection.

Gazdarabad is one of the neighbourhoods of Saddar Town in Karachi,
Sindh province, Pakistan. Gazdarabad was formerly known as Ranchore
Line until around the 1950s. The location of Karachi can be found in
the HealthMap interactive map at: http://healthmap.org/r/1kc-. -
Mod.CP]

DENGUE/DHF UPDATE 2011 (46)
***************************

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 (Karachi, Sindh province). 18 Nov 2011. The health
authorities in the city on Thursday [17 Nov 2011] reported another
death due to the dengue, taking the number of deaths from the deadly
viral fever to 17 in the province. Dengue cases continued to emerge in
the city on Thursday when some 19 patients tested positive for the
fever, while on Wednesday [16 Nov 2011] 14 patients had tested
positive for the deadly disease.
http://www.thenews.com.pk/TodaysPrintDe ... 8109&Cat=4

[A HealthMap/ProMED-mail interactive map of Karachi, Sindh province,
can be accessed at http://healthmap.org/r/1kc-. - Mod.TY]

- Pakistan (total cases, Lahore, Punjab province). 17 Nov 2011. The
total number of dengue patients in Punjab has risen to 21 115 out of
which 17 360 belong to Lahore. According to the report, at present 234
patients are under treatment in different hospitals of Punjab; out of
them around 189 patients are admitted in different hospitals of
Lahore.
http://www.brecorder.com/general-news/s ... 2/1251911/

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

- Pakistan (deaths, Lahore, Punjab province). 14 Nov 2011. On Sunday
[13 Nov 2011], 2 more people including a woman lost their battle with
the deadly dengue virus, taking the death toll in the City to 359.
http://www.nation.com.pk/pakistan-news- ... -to-dengue

- India (Raipur, Chhattisgarh state). 18 Nov. 2011. The capital city
witnessed the 5th death of dengue patient on Thursday [17 Nov 2011].
This is the 2nd dengue death this month [November 2011]. Sources at
the Child Medical Health Office said the number of dengue patients in
Raipur has reached 119.
http://daily.bhaskar.com/article/MP-RAI ... 71850.html

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

- India (Delhi). 16 Nov 2011. In the past 24 hours, 16 people have
been diagnosed with dengue fever in different hospitals [in New
Delhi]. With this number, the number of people affected with dengue
[virus infections] went to 992 this year [2011]. The average number of
cases is declining.
http://www.ndtv.com/article/cities/deng ... lhi-150477

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

- India (Bihar state). 17 Nov 2011. The number of cases of dengue are
rising in the state, 6 more dengue cases were detected and the number
of infected has gone up to 20. Chief Minister Nitish Kumar directed
the health department to start marathon fogging of areas of higher
density on a priority basis.
http://www.newsonair.com/News-archive.asp

[A HealthMap/ProMED-mail interactive map of Bihar state can be
accessed at http://healthmap.org/r/18Od. - Mod.TY]

- India (Chandigarh, Haryana and Punjab states). 9 Nov 2011. One
confirmed case of dengue was reported at a government hospital of the
city on Tuesday [8 Nov 2011]. This has taken the number of patients to
64. Since September [2011], 5 dengue deaths -- 3 in Chandigarh and 2
in Mohali were reported.
http://articles.timesofindia.indiatimes ... ngue-cases

[A HealthMap/ProMED-mail interactive map of Chandigarh in Haryana and
Punjab states can be accessed at http://healthmap.org/r/1l5F. -
Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (36): UTTAR PRADESH
***********************************************************

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


Date: Wed 23 Nov 2011
Source: Outlook India [edited]
http://news.outlookindia.com/items.aspx?artid=742311


With 5 more children succumbing to encephalitis in eastern Uttar
Pradesh, the death toll from the viral disease has climbed to 585 this
year [2011], a senior health official said today [23 Nov 2011]. The 5
children suffering from the disease died in the BRD Medical College
hospital here yesterday [22 Nov 2011], Additional Director (Health)
Diwakar Prasad said.

As many as 175 encephalitis patients are undergoing treatment in BRD
and other hospitals in the region, he said.

--
Communicated by:
ProMED-mail from HealthMap alerts


[The encephalitis case count in Uttar Pradesh has risen from 551 on 8
Nov 2011 to 585 as of today [23 Nov 2011]. The 8 Nov 2011 report
indicated that these were Japanese encephalitis virus (JEV) infection
cases (see ProMED-mail archive no. 20111109.3328). However, the above
report does not indicate what the etiological agents involved in these
cases are. Previous reports from Uttar Pradesh and Bihar states this
year (2011) implicate JEV in approximately 1/3rd of the encephalitis
cases, the majority being due to undiagnosed viruses, perhaps
enteroviruses, associated with contaminated water.

The HealthMap/ProMED-mail interactive map showing the location of
Uttar Pradesh state can be accessed at http://healthmap.org/r/1i16.
- Mod.TY]

CHIKUNGUNYA (30): 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: Sat 26 Nov 2011
Source: The Hindustan Times [edited]
http://www.hindustantimes.com/India-new ... 74095.aspx


With 6 new cases this week, the number of chikungunya patients in the
Capital has reached 95 this year. Last year [2010], 65 people had
tested positive to the mosquito-borne [virus] disease. "he
surveillance programme has been expanded to check the spread of the
disease," said Dr VK Monga, chairman, public health committee,
Municipal Corporation of Delhi (MCD).

The maximum number of cases has been reported from Najafgarh. "I was
diagnosed with the disease 4 months ago. I am still not able to walk
as my knees and heels pain," said a man, 67, a resident of the area.

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

[The total number of chikungunya virus infections in Delhi has
increased from 71 on 11 Nov 2011 (see ProMED-mail archive no.
20111112.3355) to 95, 2 weeks later, per the above report. The above
report mentions that Delhi is experiencing a mixed chikungunya and
dengue outbreak. Both viruses are transmitted by the same _Aedes_
mosquitoes. The above report mentions increased surveillance to check
the spread of the disease. Halting spread will only be accomplished if
surveillance is accompanied by reduction in mosquito breeding sites in
and around houses.

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

CHIKUNGUNYA (30): 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: Sat 26 Nov 2011
Source: The Hindustan Times [edited]
http://www.hindustantimes.com/India-new ... 74095.aspx


With 6 new cases this week, the number of chikungunya patients in the
Capital has reached 95 this year. Last year [2010], 65 people had
tested positive to the mosquito-borne [virus] disease. "he
surveillance programme has been expanded to check the spread of the
disease," said Dr VK Monga, chairman, public health committee,
Municipal Corporation of Delhi (MCD).

The maximum number of cases has been reported from Najafgarh. "I was
diagnosed with the disease 4 months ago. I am still not able to walk
as my knees and heels pain," said a man, 67, a resident of the area.

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

[The total number of chikungunya virus infections in Delhi has
increased from 71 on 11 Nov 2011 (see ProMED-mail archive no.
20111112.3355) to 95, 2 weeks later, per the above report. The above
report mentions that Delhi is experiencing a mixed chikungunya and
dengue outbreak. Both viruses are transmitted by the same _Aedes_
mosquitoes. The above report mentions increased surveillance to check
the spread of the disease. Halting spread will only be accomplished if
surveillance is accompanied by reduction in mosquito breeding sites in
and around houses.

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

MALARIA - INDIA (22): UPDATE, BHUTAN
************************************

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


[Malaria reports from India have become more frequent, so ProMED-mail
has decided to collect these reports into regular updates. This is the
1st malaria update for India. - Mod.EP]

In this update:
[1] Assam, Gelephu (Bhutan)
[2] Madhya Pradesh, Sidhi
[3] Madhya Pradesh, Mandsaur

******
[1] Assam, Gelephu (Bhutan)
Date: Sat 26 Nov 2011
Source: BBS.com [edited]
http://www.bbs.com.bt/bbs/?p=7423


Health officials in Gelephu [Bhutan] have intensified efforts to
educate the residents on malaria and its prevention after a malaria
outbreak was reported in the town of Dawsiree in Assam, India.
Dawsiree is just 15 km from Gelephu, with a long porous border.

Recently, a 21-year-old Indian died from malaria in the Gelephu
hospital. Dr Lobzang Dorji, the superintendent of the Gelephu
hospital, said: "People think there is no risk of malaria in the
winter, so they remain complacent. This is very risky."

Officials at the vector-born disease control programme in Gelephu are
also asking people traveling through Assam to take precautions and
visit a hospital if they show malaria-like symptoms. Officials have
already sensitized the residents of Gelephu on the malaria outbreak in
the border town in Assam and urged them to use impregnated mosquito
nets at night and avoid unnecessary visits to malaria prone areas.

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

******
[2] Madhya Pradesh, Sidhi
Date: Thu 17 Nov 2011
Source: The Hindu [edited]
http://www.thehindu.com/news/states/oth ... 633119.ece


The malaria situation in Madhya Pradesh has reached a critical level,
with the death toll consistently increasing every day and the
opposition parties slamming the ruling BJP government for its failure
to contain the epidemic-like situation.

While the exact statewide death toll is not clear, tribal areas are
largely bearing the brunt of the disease.

According to reports, 35 deaths have been reported from the
tribal-dominated, malnutrition-affected Sidhi district alone, which
has emerged as the hub of the malaria epidemic during the last 2
weeks. However, the Communist Party of India-Marxist (CPI-M) claims to
have conducted ground-level investigations to counter the official
death toll of 35.

The CPI(M) has alleged that over 85 deaths have occurred in and around
Sidhi district, citing information that the party's fact-finding team
has gathered from the affected areas, including Nimuch, Mandsaur etc.
"The situation is alarming, and the state government has proved
ineffective in containing it. The health minister should be sacked,"
said CPI(M) state general secretary Badal Saroj.

Leader of Opposition in the state assembly and Congress MLA Ajay Singh
a.k.a. Rahul Bhaiya had staged a dharna [fast conducted at the door of
an offender] before the Sidhi district collectorate a few days back to
protest against government inaction. Chauphal Pawaya and surrounding
villages like Kuthar have seen over 17 deaths including those of
several children.

The villages, just 16 km from the district headquarters, have exposed
the state government's weakness in ensuring health coverage in rural
areas. "All these deaths occurred between 20-30 Oct 2011. We set up a
health camp during the 1st week of November [2011]. Since then, there
have been no deaths," J.N.Kansotia, Commissioner, health department
told The Hindu. Chief Minister Shivraj Singh Chauhan recently visited
the affected villages and offered cash assistance of Rs. 10 000 [USD
190] each to the families of the deceased.

Last week at an event in Bhopal, state health minister Narottam Mishra
told reporters he was not fully aware of the situation, resulting in
opposition parties demanding his resignation. The government recently
removed the district collector, civil surgeon, and the Chief Medical
Health Officer of Sidhi.

[Byline: Mahim Pratap Singh]

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

******
[3] Madhya Pradesh, Mandsaur
Date: Tue 15 Nov 2011
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 740159.cms


A high-powered team of the central ministry visited the
malaria-affected villages of Mandsaur district on Monday [14 Nov
2011]. The team found the deaths were due to fever, and blood samples
had not been collected in most of the cases.

According to records available, 329 persons were affected by malaria.
As per reports, 21 persons have already died due to the disease in the
area. Also, it has come to the notice that there were 6 tribal
villages that were affected by malaria.

On the request of local MP Meenakshi Natrajan, union health minister
Ghulam Nabi Azad had sent a special team to visit the area to find out
the actual position in Mandsaur and Neemuch districts.

The epidemic was spreading very fast in several villages, falling
under both the districts. The local residents and representatives
blamed more than 40 deaths to malaria. On Monday [14 Nov 2011], a
central team comprising Dr Manish Joshi, Dr V Das, and Dr R K Vyas
visited 3 villages named as Sawant Kotary, Bordia and Mauli of Mansaur
district.

Chief medical and health officer of Mandsaur, Dr Mahesh Patni, and
Garoth SDM, Abhay Singh Ahoria accompanied the team. The team visited
several houses in these villages and talked to the people. The team
consulted local doctors including private practitioners on the topic.
They reportedly admitted that a large number of malaria-related cases
were still being detected.

Local Congress MLA and state ex-health minister Subhash Sojatia told
the team that the health department acted quite late, and the disease
had already taken the form of an epidemic by that time. He asserted
that all the 21 deaths were due to malaria and still a large number of
patients were coming to the hospitals.

Sojatia said that due to a lack of health facilities, malaria patients
are moving to Rajasthan for treatment. He said children were dying due
to malnutrition in tribal villages of the area.

Minister of state for health Mahendra Hardia denied the Congress MLA's
allegation, saying there are only 2 deaths due to malaria. "I have
myself visited each and every village, and the situation is now under
control," Hardia said.

Dr Manish Joshi, member of central team, and chief medical and health
officer Dr Mahesh Patni, who visited Mandsaur district, could not be
contacted via phone despite repeated efforts.

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

[Assam is regarded as a highly endemic part of India, with 50-100
malaria cases per 1000 population per year (see country profile, World
Malaria Report 2009:
http://www.who.int/malaria/world_malari ... index.html).
In contrast, Madhya Pradesh has an annual incidence of 1-10 per 1000
population.

HealthMap locator for Assam: http://healthmap.org/r/1tt-.
HealthMap locator for Madhya Pradesh: http://healthmap.org/r/00Vk. -
Mod.EP]