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DENGUE/DHF UPDATE 2011 (47)
***************************

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 (Delhi). 26 Nov 2011. With 7 fresh cases reported on Friday
[25 Nov 2011], the number of dengue patients has reached 1071. "Though
the temperature has dipped, afternoons are still warm, which provide
suitable conditions for mosquito breeding. I am still getting a few
dengue cases daily," said a senior doctor from the department of
medicine at the Ram Manohar Lohia Hospital." This year [2011], 5
persons, including a one-and-a-half-year-old boy, have succumbed to
the disease.
http://www.hindustantimes.com/India-new ... 74095.aspx

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

- India (Churachandpur, Manipur state). 22 Nov 2011. The situation of
the dengue outbreak in the district of Churachandpur has become more
acute, with more and more people being reportedly suffering from
dengue with each passing day, and more so with the death toll
increasing to a high of 10 so far.
http://kanglaonline.com/2011/11/unoffic ... ervention/

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

- India (Tamil Nadu state). 22 Nov 2011. The state is seeing a spurt
in the number of dengue cases this year [2011] with the health
department recording as many as 1845 cases across TN till date. 8
persons have died so far due to the disease. "We had only 2060
confirmed cases and 8 dengue-related deaths reported for the entire
year of 2010 and considering that there is one more month to go for
this year to end, the numbers are expected to increase," said a senior
health official. The union health ministry has said that more than 10
000 dengue cases have been detected in the country so far. This ranks
Tamil Nadu as the 3rd state with the highest number of dengue cases
for the year after Punjab and Orissa.
http://www.deccanchronicle.com/channels ... l-nadu-291

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

- Pakistan (Lahore city and Punjab province). 21 Nov 2011. No death
was caused by dengue fever in any hospital of the City on Sunday [20
Nov 2011]. The downward trend of new patients of dengue fever also
continues in Lahore as a total of 50 patients have been tested
positive in different hospitals in the City on Sunday [20 Nov 2011],
which brought the total number of patients to 33 182 in Lahore alone
[for 2011]. Meanwhile, the Health Department has confirmed one death
in Punjab due to dengue fever during the last 24 hours, which brought
total figure of deaths to 335 in Punjab and 289 in Lahore. According
to Health Department's report released on Sunday [20 Nov 2011] , the
total number of dengue patients reported in Punjab from January 2011
to-date has reached 21 275 out of which over 17 454 were diagnosed in
Lahore alone. A total of 30 patients, confirmed of dengue fever, have
been reported in the province out of which 23 fresh cases have been
reported in Lahore during the last 24 hours. The number of deaths
caused by the epidemic remained at 365 in the provincial metropolis.
At present 186 dengue patients are under treatment in different
hospitals of Punjab out of which 157 are admitted in different
hospitals of Lahore.
http://www.thenews.com.pk/TodaysPrintDe ... 11/21/2011

[The reason for the significant discrepancy in the numbers of dengue
cases and deaths between apparently unofficial figures in the popular
press and those of the Ministry of Health are not clear. In any event,
there has been a significant dengue outbreak in Lahore city and Punjab
province over the past 4 months.

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

CHIKUNGUNYA (31): INDIA (GOA)
*****************************

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 Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... lth-centre


A status report on the vector borne disease from 12-24 Nov 2011,
released by the directorate of health services, states that ...68
samples were tested during this period for chikungunya [virus?
antibody?] and only one was confirmed positive, from the jurisdiction
of UHC [Urban Health Center] Panaji. With this the total number of
samples tested for chikungunya [virus infection] from January [2011]
is 611 and a total of 45 cases were tested positive.

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

[The number of diagnosed chikungunya virus infections in Goa has
increased from 39 on 14 Aug 2011 (see ProMED-mail archive no
20110814.2466) to 45, 3 months later, per the report above. There have
been cases in Goa since the 1st week of the year (2011). Sporadic
cases of chikungunya virus infection have been occurring in various
parts of India this year (2011). The report above is of an apparent
ongoing, small mixed dengue-chikungunya outbreak in the capital of Goa
state. Both viruses are transmitted by the same _Aedes aegypti_ vector
mosquito.

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

CHIKUNGUNYA (32): 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 2 Dec 2011
Source: IBN [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 21444.html


Chikungunya is yet to subside in the city despite the onset of winter.
As against 70 cases of chikungunya [virus infection] reported in 2010,
100 people have tested positive for chikungunya fever this year. "Last
year we had 70 cases of chikungunya. But this year it is 100. We are
taking all precautionary steps to prevent mosquito breeding and we
have advised people to keep their surroundings clean," MCD's Public
Health Committee chairman VK Monga said.

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

[The number of chikungunya virus infections in Delhi has increased
slightly from 95 on 26 Nov 2011 (see ProMED-mail archive no.
20111126.3455) to the 100 cases 6 days later reported above. It is
difficult to explain why dengue cases are declining yet chikungunya
virus infections continue, since the viruses are transmitted by the
same _Aedes_ mosquito vector. Perhaps a greater proportion of the
population is already immune to dengue viruses but has not had
previous chikungunya virus infections and would be susceptible. With
continuing colder weather, transmission of both viruses should slow or
perhaps stop.

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

CHIKUNGUNYA (31): INDIA (GOA)
*****************************

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 Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... lth-centre


A status report on the vector borne disease from 12-24 Nov 2011,
released by the directorate of health services, states that ...68
samples were tested during this period for chikungunya [virus?
antibody?] and only one was confirmed positive, from the jurisdiction
of UHC [Urban Health Center] Panaji. With this the total number of
samples tested for chikungunya [virus infection] from January [2011]
is 611 and a total of 45 cases were tested positive.

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

[The number of diagnosed chikungunya virus infections in Goa has
increased from 39 on 14 Aug 2011 (see ProMED-mail archive no
20110814.2466) to 45, 3 months later, per the report above. There have
been cases in Goa since the 1st week of the year (2011). Sporadic
cases of chikungunya virus infection have been occurring in various
parts of India this year (2011). The report above is of an apparent
ongoing, small mixed dengue-chikungunya outbreak in the capital of Goa
state. Both viruses are transmitted by the same _Aedes aegypti_ vector
mosquito.

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

DENGUE/DHF UPDATE 2011 (48)
****************************
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 (national). 3 Dec 2011. The latest official figures released
3 Dec 2011 covering the period to Nov 2011. [The change calculations
below are by contributor Ronan Kelly].

State-by-state cases (change since last month)/Fatalities (change
since last month)

Andhra Pradesh 672 (-) /3 (-)
Assam 1 (-) / 0 (-)
Bihar 21 (+15) / 0 (-)
Chhattisgarh 43 (-)/ 3 (-)
Goa 21 (+14) / 0 (-)
Gujarat 1327 (+583) / 1 (-)
Haryana 239 (+55) / 4 (+2)
Jammu & Kashmir 1 (-) / 0 (-)
Jharkhand 12 (-) / 0 (-)
Karnataka 330 (+15) / 5 (+1)
Kerala 1051 (+88) / 10 (-)
Madhya Pradesh 50 (+22) / 0 (-)
Maharashtra 434 (+103) / 10 (-)
Orissa 1811 (+18) / 32 (-)
Punjab 3475 (+1,459) / 6 (+1)
Rajasthan 773 (+539) / 0 (-)
Sikkim 2 (+2) / 0 (-)
Tamil Nadu 1654 (+256) / 9 (+3)
Uttar Pradesh 125 (+49) / 4 (-)
Uttarakhand 68 (-) / 0 (-)
West Bengal 415 (+175) / 0 (-)
Chandigarh 68 (+28) / 0 (-)
Delhi 1085 (+328) / 5 (-)
Puducherry 340 (+234) / 1 (+1)

Total 14,047 (+4,012) / 93 (+8)
http://nvbdcp.gov.in/den-cd.html

[ProMED thanks Ronan Kelly for sending in these data.
A map showing the location of states in India can be accessed at
http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg.
- Mod. TY]

- India (Delhi). 2 Nov 2011. MCD's Public Health Committee chairman V
K Monga said 7 people have tested positive for dengue in the capital
since yesterday [1 Dec 2011], taking the total number of those
afflicted by the mosquito-borne [virus] disease this year to 1097.
"The average number of dengue cases reported per day, however, is
declining. Earlier, 20 and above dengue cases were being reported in
a span of just 24 hours, now it is less," he said.
http://ibnlive.in.com/generalnewsfeed/n ... 21444.html

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

- India (Coimbatore, Tamil Nadu state). 1 Dec 2011. With the rainy
season setting in, the city is preparing for another winter of
possible calamity. But so far the news is good. The dengue fever in
the city has been restricted to just 2 government nursing college
students and fears of a major outbreak seem to be somewhat assuaged.
http://articles.timesofindia.indiatimes ... water-cmch

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

- India (Chandigarh, Haryana & Punjab states). 29 Nov, 2011. With the
onset of winter, a sudden decline has been witnessed in the number of
dengue fever cases reported in the city. So far, Chandigarh has
witnessed 68 confirmed cases in different government hospitals during
this season, which is substantially less than what it was last year.
By this time in 2010, UT Health Department had recorded 138 confirmed
cases of dengue.
http://www.indianexpress.com/news/With- ... ve/881852/

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

- India (Panaji, Goa state). 26 Nov 2011. During the last 10 days, 3
persons tested positive for dengue [virus infection]. A status report
on the vector-borne disease from 12 - 24 Nov [2011], released by the
Directorate of Health Services, states that 98 samples were tested for
dengue and 3 were confirmed positive.
http://timesofindia.indiatimes.com/city ... 875845.cms

[A HealthMap/ProMED-mail interactive map showing the location of
Panaji, Goa state can be accessed at http://healthmap.org/r/18i*. -
Mod. TY]

- Pakistan (Sindh province). 1 Dec 2011. One new dengue fever case
was
reported in Sindh on Wednesday [30 Nov 2011] raising the number of
confirmed dengue patients in the province to 1022 during the ongoing
year [2011]. Sindh Health Department’s Dengue Surveillance Cell
reported
that currently 14 dengue patients have been admitted in different
hospitals of Karachi. He said so far [this year (2011)] 17 dengue
patients had died in the province.
http://www.dailytimes.com.pk/default.as ... 11_pg12_13

[A HealthMap/ProMED-mail interactive map showing the location of Sindh
province can be accessed at http://healthmap.org/r/02SY. - Mod. TY]

- Pakistan (Islamabad). 29 Nov 2011. The 3 hospitals received only
171 new suspects of the [dengue] infection during last 3 weeks that
took the total number of dengue fever suspects registered at the 3
hospitals to 2632 of which 810 tested positive for the infection by
the National Institute of Health, Islamabad, while 1482 negative. It
is important that during the recent dengue fever spike, the allied
hospitals admitted a total of 2632 dengue fever suspects of whom 810
tested positive while 1482 [were] negative. Results in as many as 340
cases are awaited by the 3 hospitals. Of 810 patients who tested
positive for dengue fever, 808 have been discharged after cure while 2
died of the infection.
http://www.thenews.com.pk/TodaysPrintDe ... 9941&Cat=6

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (37): 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: Fri 2 Dec 2011
Source: Indian Express [edited]
http://www.indianexpress.com/news/chang ... ocs/883200


Certain changes in the clinical profile of encephalitis patients in
eastern UP this year have become a new cause of concern for the
doctors. Apart from the usual high fever and convulsions, the doctors
have noticed that most patients are now taking longer to recover,
having rashes all over their body and also heart inflation [sic].

As encephalitis patients are given symptomatic treatment, changes in
the clinical profile have been noticed by the doctors at Gorakhpur’s
BRD Medical College, which receives patients from all over eastern UP.
They are now planning to bring out a clinical paper on the subject and
also study the subject.

"Patients coming to us this year are more serious as their illness has
become prolonged now. Till last year [2010], the average stay of an
encephalitis patient at the hospital used to be 2 weeks, but the
recovery time has increased to 3 weeks this year. Symptoms like high
fever and convulsions continue for 3 weeks now. Besides, children are
coming with rashes all over their body and inflation of the heart,"
said Dr KP Kushwaha, head of the Pediatrics Department at BRD Medical
College. "Rashes used to be there in some cases and even heart
inflation, but it was very rare. Now more and more patients are coming
in with these complaints and we are observing and analysing the
situation," said Dr Kushwaha.

Over the last few years, after Japanese encephalitis (JE) [virus
infection] cases started declining following regular vaccination, the
clinical profile of the patients had remained almost the same; the
only change has been a slight increase in the number of adult
patients. This is for the 1st time that doctors have noticed major
changes in the clinical profile of the patients.

Denying any possibility of mutation in the virus, Dr MM Gore, senior
scientist at the National Institute of Virology, who is also in charge
of the NIV field laboratory at Gorakhpur, said: "It is too early to
come to any conclusion, because even doctors are still observing the
clinical changes". He added: "As far as I have come to know, symptoms
of JE patients remain the same and it is the other forms of
encephalitis where doctors have observed changes in the clinical
profile."

The problem with the experts is that apart from the JE virus, the
viruses affecting the majority of the patients have not yet been
identified. For this reason, all non-JE patients are grouped together
in a category called acute encephalitis syndrome (AES). The lack of
identification of AES viruses makes it difficult to ascertain the
causes behind these clinical changes.

"It is too early to conclude anything. After the outbreak is over in
the next few days, we will analyse the data. The treatment in the
meantime will not be a problem because patients are given symptomatic
treatment which can change with the change in the clinical profile,"
said a health official.

[Byline: Maulshree Seth]

--
Communicated by:
Ronan Kelly from FluTrackers




[The above comments point out the problem with the reports on acute
encephalitis syndrome coming out of northeastern India and are on
target -- there is no etiological diagnosis for many, perhaps the
majority, of encephalitis cases that have occurred there this year
(2011). Previous reports often mention an association of non-JE virus
cases with contaminated water, suggesting one or more enteroviruses.
Other reports indicate that all cases are due to JE virus infection.
Adequate virological diagnosis is critically needed to understand the
situation there, and plan for prevention and control, as well as to
better understand the changes in the clinical picture described in the
above report.

ProMED thanks Ronan Kelly for sending in this report.

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

SCRUB TYPHUS - INDIA (04): (MEGHALAYA)
**************************************

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 1 Dec 2011
Source: Onion Live, Indo Asian News Service (IANS) report [edited]
http://onionlive.com/2011/12/01/mite-di ... ve-deaths/


At least 5 people have died of scrub typhus, a disease caused by the
bite of an infected mite, in Meghalaya in the past 3 weeks, an
official said here [Shilong] Thursday [1 Dec 2011]. However, a
private-run hospital here put the toll at 12.

"Over 40 people were tested positive for the disease and admitted in
hospitals and 5 people died of it," Meghalaya Integrated Disease
Surveillance Project (IDSP) officer RR Lanong told IANS [Indo-Asian
News Service]. "We have verified and found out that 5 people died -- 4
in H Gordon Roberts Hospital and one in Nazareth Hospital," the
medical official said. Smit, Lad Mawreng, Tyrsad, Mawkyrwat,
Moodymmai, Sohkymphor, Sutnga, Mawlein, Umsning, and Ummat villages --
all in eastern Meghalaya -- were the most affected, the official
said.

Though treatment is available at health centres, due to ignorance, the
disease has turned fatal, Lanong said. To avoid this, the health
department has launched a vigorous campaign to create awareness among
the rural masses.

Medical superintendent of H Gordon Roberts Hospital, David Tariang,
said 12 people have died in his hospital alone due to scrub typhus and
25 are undergoing treatment. The symptoms of the disease include
fever, headache, muscle pain, cough, and gastroenteritis --
inflammation of the mucous membrane of the stomach and intestines.

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

[The following is excerpted from: Demma LJ, McQuiston JH, Nicholson
WL, et al. Scrub typhus, Republic of Palau. Emerg Infect Dis. 2006; 12
(2): 290-5. Available at
http://wwwnc.cdc.gov/eid/content/12/2/pdfs/v12-n2.pdf):

"Scrub typhus is a zoonotic illness caused by _Orientia
tsutsugamushi_. The pathogen is transmitted through the bite of larval
mites (chiggers) of the _Trombiculidae_ family, which serve as both
the vector and the reservoir (1,2). Rodents of the family _Muridae_
(rats and mice) are common hosts for trombiculid mites and may support
_O. tsutsugamushi_. Geographically specific foci of scrub typhus are
thus determined by the distribution of vector mites and their rodent
hosts and by interactions of mites and rodents with humans (3). Scrub
typhus has been reported from many regions of Asia and the Pacific
islands, and known disease-endemic regions extend from Japan and
eastern Russia southward to Australia and westward to Pakistan and
Afghanistan (4,5).

"Scrub typhus is typically a nonspecific febrile illness; its severity
may be influenced by the strain of _O. tsutsugamushi_, a person's
immune status, and other factors. Diagnosis may be complicated in
areas where the disease has not been documented recently or in regions
lacking the capacity for laboratory confirmation. Illness develops
after an incubation period of 6 to 21 days and usually begins with an
eschar at the site of a chigger bite. Fever, headache,
[lymphadenopathy], and myalgias are common, and a maculopapular rash
may also be present. Nausea, vomiting, diarrhea, or lower respiratory
symptoms can also occur. Manifestations such as pneumonitis,
meningoencephalitis, jaundice, renal failure, and myocarditis can
develop during the prolonged clinical course of untreated illness (6).
Establishing the diagnosis and initiating prompt antimicrobial drug
therapy are important, because death rates for untreated scrub typhus
patients are 1-30 per cent (5). Scrub typhus is effectively treated
with doxycycline, and treatment should begin immediately upon
suspicion of illness without awaiting laboratory confirmation."

References
----------
1. Traub R, Wisseman CL, Jones MR, O'Keefe JJ. The acquisition of
_Rickettsia tsutsugamushi_ by chiggers (trombiculid mites) during the
feeding process. Ann NY Acad Sci. 1975; 266: 91-114.
2. Traub R, Wisseman CL. The ecology of chigger-borne rickettsiosis
(scrub typhus). J Med Entomol. 1974; 11(3): 237-303.
3. Lerdthunsee K, Khuntirat B, Leepitakrat W, Tanskul P, et al. Scrub
typhus: vector competence of _Leptotrombidium chiangraiensis_ chiggers
and transmission efficacy and isolation of _Orientia tsutsugamushi_.
Ann N Y Acad Sci. 2003; 990: 25-35; abstract available from
http://www.ncbi.nlm.nih.gov/pubmed/12860596.
4. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr
Opin Infect Dis. 2003; 16(5): 429-36; abstract available from
http://www.ncbi.nlm.nih.gov/pubmed/14501995.
5. Silpapojakul K. Scrub typhus in the Western Pacific region. Ann
Acad Med Singapore. 1997; 26(6): 794-800; abstract available from
http://www.ncbi.nlm.nih.gov/pubmed/9522982.
6. Corwin AL, Soeprapto W, Widodo PS, Rahardjo E, et al. Short report:
surveillance of rickettsial infections in Indonesian military
personnel during peace keeping operations in Cambodia. Am J Trop Med
Hyg 1997; 57(5): 569-70; abstract available from
http://www.ncbi.nlm.nih.gov/pubmed/9392597.

Rodents may serve as reservoirs, although transovarial transmission in
mites is the dominant mechanism for maintenance of _O. tsutsugamushi_
(http://www.cdc.gov/ncidod/EID/vol9no12/03-0212.htm). Humans become
infected when they accidentally encroach in an area where the
chigger-rodent cycle is occurring, most often areas of low-lying scrub
brush or transitional vegetation.

Patients with severe scrub typhus can develop multiorgan failure and
disseminated intravascular coagulopathy with hemorrhage.

Meghalaya, a mountainous Indian state, is located between the north
eastern border of Bangladesh and the Indian state of Assam. A
HealthMap/ProMED-mail interactive map of India that shows the state of
Meghalaya can be found at http://healthmap.org/r/1w9_. - Mod.ML]

SCRUB TYPHUS - INDIA (05): BACKGROUND
*************************************

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


Date: Wed 7 Dec 2011
Source: Gideon (Global Infectious Disease & Epidemiology Network)
[edited]
http://www.gideononline.com/


[re: ProMED-mail post Scrub typhus - India (04): (ML) 20111207.3544]
--------------------------------------------------------------------
The following background information on scrub typhus in India is
abstracted from Gideon http://www.GideonOnline.com and the Gideon
e-book series: [1] (primary references available on request)

_Orientia tsutsugamushi_ is one of 7 _Rickettsia_ and
_Rickettsia_-like organisms that have been associated with human
infection in India; (the others are _Rickettsia sibirica_, _Rickettsia
conorii_ subsp. indica, _Candidatus Rickettsia kellyi_, _Rickettsia
typhi_, _Rickettsia prowazekii_ and _Coxiella burnetii_).

Epidemics of scrub typhus were previously reported among troops
stationed in the north and east. Risk factors include living close to
bushes and wood piles, work on farms, reports of rodents at home and
at work, and raising domestic animals (Darjeeling, West Bengal, 2009
publication).

Exported cases
--------------
- 3 cases of imported scrub typhus were reported in the United States
during 1983 to 1988 -- all originating in India.
- In 2002, a Belgian traveler developed scrub typhus following a trip
to India.
- 17 fatal cases were reported in Himachal during 2001 to 2002.
- 21 cases (3 fatal) were reported in Himchal Pradesh during 2004.
- 9 cases were confirmed in Uttarakhand (2010 publication).
- 29 cases were reported from a hospital in Manipal, Karnataka during
2009.

Prevalence surveys
------------------
- 24.1 per cent of febrile hospitalized patients in Vellore (2006
publication).
- 15 per cent of children below age 14 hospitalized for fever in Tamil
Nadu (2003 to 2004).
- 14.3 per cent of children hospitalized with fever and at least one
suggestive feature of rickettsial infection (central India, 2011
publication).
- 37.5 per cent of febrile malaria-negative patients in Tamil Nadu in
2004, and 9.2 per cent in 2005.
- 47.5 per cent of patients hospitalized for acute undifferentiated
febrile illness in Vellore, Tamil Nadu (2010 publication).

The principal vector is _Leptotrombidium deliense_ [a species of
mite].
- _Schoengastiella ligula_ mites infesting shrews (_Suncus murinus_)
were identified as vectors during an outbreak in Kurseong, Darjeeling
[http://www.ncbi.nlm.nih.gov/pubmed/21941043].

Notable outbreaks
-----------------
- 2001 to 2002: an outbreak (28 cases, 3 fatal) was reported in Tamil
Nadu.
- 2003: an outbreak (225 cases, 19 fatal) was reported in Himachal
Pradesh.
- 2006 to 2008: an outbreak (50 cases) was reported in Pondicherry.
- 2007: an outbreak (38 cases) was reported in Bishnupur district,
Manipur.
- 2009 to 2010: an outbreak (80 cases, 5 fatal) was reported in
Meghalaya.
- 2011: outbreaks were reported in Himachal Pradesh (200 cases, 13
fatal) and Nagaland (9 cases, 3 fatal).

References
----------
1. Berger SA: Infectious Diseases of India, 2011. 480 pp, 65 graphs,
3503 references. Gideon e-books,
http://www.gideononline.com/ebooks/coun ... -of-india/.

--
communicated by:
Dr Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel


[ProMED-mail thanks Steve Berger for his background report.

A HealthMap/ProMED-mail interactive map of India that shows the state
of Meghalaya can be found at http://healthmap.org/r/1w9_. - Mod.ML]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (38): (UTTAR PRADESH, 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:
[1] Uttar Pradesh
[2] Bihar

******
[1] Uttar Pradesh
Date: Thu 8 Dec 2011
Source: Press Information Bureau, Government of India [edited]
http://pib.nic.in/newsite/erelease.aspx?relid=78300


The National Commission for Protection of Child Rights (NCPCR) has
received a report from the government of Uttar Pradesh regarding
deaths of children in the state, the Minister of Women & Child
Development Smt. Krishna Tirath revealed in Rajya Sabha [Council of
States] today [8 Dec 2011] in written reply to a question.

As per the report, 462 children died from acute encephalitis syndrome
(AES) and 27 children died from Japanese encephalitis (JE) [virus
infection] in 2011 (as on 31 Oct 2011). The state has further reported
that a special immunization drive was carried out in 2006 and again in
2010 for Japanese encephalitis (JE) in Gorakhpur district. Thereafter
a regular immunization programme has covered 32 421 children till
September 2011.

Smt. Krishna Tirath also said that, as per the report, the reason for
AES in more than 50 per cent of the cases is not known [27 0f 462
total is just 6 per cent for JE virus infection and 94 per cent
undiagnosed cases]. Investigation for the reasons is continuing in the
Gorakhpur Unit of the National Institute of Virology, Pune. Once the
reason is known, effective initiatives can be planned.

--
communicated by:
Ronan Kelly
for FluTrackers.com


[These cases of non-JE undiagnosed acute encephalitis syndrome have
been occurring for over 6 months, yet no results of virologic
investigations have been reported. The report above does indicate that
there has been an ongoing JE virus vaccination effort in the affected
area.

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

******
[2] Bihar
Date: Thu 8 Dec 2011
Source: Rediff News [edited]
http://www.rediff.com/news/report/encep ... 111208.htm


The dreaded encephalitis, a mosquitoborne disease [virus], has killed
92 children, mostly Mahadalits, while more than half a dozen are still
fighting for their life in Bihar's Gaya district, state health
officials said on Thursday [8 Dec 2011]. "In the last 24 hours, 3 more
children died due to encephalitis," Anugrah Narain Medical College and
Hospital [ANMCH] paediatrics head AK Ravi said.

All the children died at ANMCH in Gaya, about 100 km [62 mi] from
Patna.

"With the deaths of 3 children in the last 24 hours and 4 children in
the past few days, the death toll has risen to 92," Ravi said.

According to health officials, the disease started claiming lives of
children since 23 Aug [2011]. Superintendent of ANMCH, Sitaram Prasad,
said that the government had employed several medical teams to control
the disease. He said that more than 384 children with suspected
encephalitis were admitted for treatment. "Some children are still
battling for life as their condition remains critical. However, some
are showing signs of improvement," he said.

Prasad said those children who died mostly belonged to the poorest
families in Gaya and its neighbouring districts.

A district administration official said that encephalitis hit Gaya in
2009, 2007 and 2005, and killed dozens of children.

Nearly 4 months ago 51 children died in Muzaffarpur district but the
state government is yet to confirm these as encephalitis deaths.

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

[A 16 Nov 2011 report indicated that there were 1000 encephalitis
cases in Bihar state (see ProMED-mail archive no 20111116.3381). That
report also stated, "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 number of
fatal cases has increased from 84 on 16 Nov 2011 to 92 mentioned
above. The previous report indicated that Japanese encephalitis virus
was the cause of the encephalitis. No etiology of the cases above is
given, however, so one does not know if they are due to Japanese
encephalitis virus infection or to something else.

The Civil Liberties Monitoring Committee of India is quoted saying,
"Mahadalits [the group mentioned above], the poorest of the socially
marginalised people in Bihar, are living in starvation in 2 villages
in Gaya district."
(http://civillibertiesindia.org/mahadali ... starvation).

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]

Indien - Malaria
08.12.2011

Bislang unbestätigten Berichten zufolge sind im Oktober im Bundesstaat Rajasthan (NW) ungewöhnlich viele Malariafälle aufgetreten. Bei Reisen in diese Region ist aktuell eine Prophylaxe mit Malariamedikamenten nach Rücksprache mit dem Arzt zu erwägen. Auch in großen Städten (Delhi, Mumbai) ist ein guter Mückenschutz wichtig, da in Indien nicht nur im ländlichen Bereich Malaria-Erkrankungen auftreten. In ganz Indien sank die Zahl der bestätigten Malaria-Fälle/Jahr von ca. 2. Mio. im Jahr 2000 auf ca. 1,6 Mio. im Jahr 2009 ab, die Zahl der malariabedingten Todesfälle stieg im gleichen Zeitraum von ca. 900 auf ca. 1.100 an. Es ist davon auszugehen, dass die tatsächlichen Fallzahlen mehrfach höher sind. Dringend Mückenschutz und ggf. Malariaprophylaxe beachten. / Quelle: crm

Gruß
Birgitt

HEPATITIS A - INDIA: (KERALA) MONSOON RELATED
*********************************************

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 12 Dec 2011
Source: The Hindu [abbrev., edited]
http://www.thehindu.com/news/cities/Koc ... 708629.ece


Sharp rise in waterborne diseases in Kochi district of Kerala state
-------------------------------------------------------------------
The waterborne communicable disease hepatitis A that prevailed during
the monsoon [season] almost like an epidemic had created most of the
problems for the district Health department during the year.

Compared to last year when only 36 cases of hepatitis A were reported,
this year (as of 8 Dec 2011) the number of confirmed cases were 237,
with another 726 cases reported as suspected, making it about a
thousand cases of jaundice. There were also 5 deaths, which the Health
authorities categorised as death due to complications of other
diseases, as hepatitis A is usually not found to be the cause of
death.

The number of jaundice cases did not stop with hepatitis A. 3 other
types of hepatitis [caused by either hepatitis B, C or E virus] were
also reported this year. In fact, 24 cases of confirmed and 32
suspected of hepatitis B virus infection were found in the district; 2
deaths were also reported. A [separate] expert panel is investigating
the cases of hepatitis B and hepatitis C virus infections which are
both transmitted through blood transfusion and unprotected sexual
contact.

There have also been 2 cases of hepatitis C virus infection, which
takes the same route of transmission as hepatitis B, and one case of
hepatitis E (transmitted by the same route as hepatitis A).

Controlling the hepatitis outbreak took some time as the rains
continued for a long time. The people's personal hygiene, lack of
cleanliness, low quality of water used in households and street foods
in certain areas, the accumulating solid waste on the streets and lack
of precaution by the people working in risk areas became some of the
most important factors that promoted the spread jaundice [i.e.,
hepatitis A virus infection].

Other water-borne disease that were reported at high levels this year
were leptospirosis, typhoid, and the vector-borne dengue fever and
malaria. In spite of a surge in these water-borne diseases, common
water-borne diseases which are categorised as diarrhoeal diseases were
comparatively less this year at 19 066 cases against 25 448 cases last
year. There were only 2 cases of influenza A/H1N1 reported this year
compared to 223 cases last year.

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

[Hepatitis A is a viral liver disease that can cause mild to severe
illness. The disease is closely associated with poor sanitation and a
lack of personal hygiene habits. The symptoms of hepatitis A range
from mild to severe, and can include fever, malaise, loss of appetite,
diarrhoea, nausea, abdominal discomfort, dark-colored urine and
jaundice. Recovery from symptoms following infection may be slow and
take several weeks or months. Hepatitis A vaccine is available for use
where improvements in sanitation and provision of clean water are
challenging.

Kochi (city and district) is part of the district of Ernakulam in the
Indian state of Kerala. It can be located in the HealthMap interactive
map of Kerala at: http://healthmap.org/r/1xie. - Mod.CP]

DENGUE/DHF UPDATE 2011 (49)
****************************

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 (Uttar Pradesh state). 9 Dec 2011. As per reports of the CMO
[Chief Medical Officer] office, a total of 33 confirmed dengue cases
have been reported from different government hospitals, representing
various districts of eastern UP region this year. Out of them, about a
dozen cases have been reported from the Varanasi district. In
addition, around 40 suspected cases of dengue have been also reported
from other parts with patients from eastern UP and West Bihar flocking
city government hospitals this year [2011].
http://articles.timesofindia.indiatimes ... ount-aedes

[A HealthMap/ProMED-mail map showing the location of Uttar Pradesh
state can be accessed at http://healthmap.org/r/01r4. - Mod.TY]

- India (Sirsa district, Haryana state). 7 Dec 2011. The death of 4
persons in a week and 27 cases of dengue have triggered a scare in
Pakka Sahidhan village of Sirsa district.
http://articles.timesofindia.indiatimes ... ever-sirsa

[A HealthMap/ProMED-mail interactive map showing the location of Sirsa
district in Haryana state can be accessed at
http://healthmap.org/r/1xh1. - Mod.TY]

- India (Churachandpur district, Manipur state). 6 Dec 2011. Declared
by the State Government as an outbreak, the cases of dengue in
Churachandpur district stands at 202 as of today, informed a source in
Health Department. "Over 800 people showing symptoms similar to the
deadly virus have been tested till date," Dr F Thienkhogin, the
District Malaria officer said.
http://www.e-pao.net/GP.asp?src=16..071211.dec11

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

- India (Delhi). 7 Dec 2011. Dengue cases in the capital went up to
1111 as 3 more people tested positive for the disease in the past one
day. "Dengue has become a cause of worry as the epidemiology of dengue
fever is changing. Dengue cases have surfaced in places that did not
report of them over years together. It subsides during winters but
then here in the city it continues.
http://ibnlive.in.com/generalnewsfeed/n ... 23083.html

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

- Pakistan (Karachi, Sindh province). 8 Dec 2011. A sudden surge in
dengue viral fever cases was seen on Tuesday [6 Dec 2011] when another
15 new dengue fever patients were diagnosed with dengue fever in
Karachi. Sindh Dengue Surveillance Cell elaborated that 20 patients in
suspicion of dengue fever were brought to different hospitals in
Karachi on Tuesday. Of them, 15 were tested positive for the disease
after laboratory tests, while rest of 5 patients were yet to be
confirmed. A total of 823 dengue fever patients were reported in
Karachi from January - 7 Dec 2011, whereas over 15 people have died of
dengue in the metropolis.
http://www.dailytimes.com.pk/default.as ... 11_pg12_10

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

UNDIAGNOSED FEBRILE ILLNESS - INDIA (03): (WEST BENGAL)
*******************************************************

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 9 Dec 2011
Source: The Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... joint-pain


The mystery fever continues to elude civic authorities and experts. A
Kolkata Municipal Corporation (KMC) [West Bengal] team, which visited
3 blocks in New Alipore, from where it had been reported, failed to
confirm either chikungunya or dengue [virus infections] on Thursday [8
Dec 2011]. Even though the symptoms are close to both diseases,
hundreds suffering from the fever have not been confirmed to be
suffering from either. Cases have been reported from upmarket areas of
Alipore, New Alipore, Chetla, Behala, and parts of Tollygunge.

"Our team spoke to the victims' families and collected blood samples.
Tests have not revealed dengue or chikungunya [virus infections]. So,
it's obviously the mystery fever. We are keeping a tab on the
situation," said a civic health official.

For the last 3 weeks, KMC clinics and city hospitals have been flooded
with patients suffering from high fever and excruciating joint pain.
Most have also had body rashes, headache, and numbness in the limbs.
Blood tests, however, have not confirmed either chikungunya or dengue
[virus infections]. "The symptoms appear to be somewhere in between
the two diseases. While the joint pain points at chikungunya, body
rashes seem to suggest dengue. But it's probably neither of the 2.
Instead, it's more likely to be one of those mystery fevers which have
been striking Kolkata frequently this year [2011]," said paediatrician
Shantanu Ray, who himself suffered a bout of the undetected fever last
month. On Thursday [8 Dec 2011], state industries minister Partha
Chatterjee was admitted to a private hospital with fever. He was later
diagnosed as suffering from viral infection.

Civic officials interacted with a few senior doctors in the New
Alipore-Behala area on Thursday [8 Dec 2011]. They collected data and
case histories. "The idea is to follow up and get tests done to detect
if these are chikungunya or dengue. So far, we have not been able to
confirm any disease. The vigil will continue," said Atin Ghosh, MMiC
(health).

The KMC has sent blood samples to the School of Tropical Medicine,
ICMR [Indian Council of Medical Research], and even to a WHO
laboratory. Reports are yet to reach the KMC. "Civic officials spoke
to me about the mystery fever and sought my help. They seem to be
taking an initiative to check the disease, whatever it might be. Let
us hope the spread of this fever will be checked," said Tarun
Praharaj, a resident of New Alipore.

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

[With dengue and chikungunya viruses ruled out, it is difficult to
determine which pathogen might be the cause of these cases.
Accordingly, ProMED-mail consulted with Dr Steve Berger
() who replied that he, "ran the following
past Gideon (Global Infectious Disease & Epidemiology Network;
http://www.GideonOnline.com: Large outbreak, India, Fever, Rash,
Joint pain, Headache"
The differential list contains 40 diseases, with highest ranking given
to enterovirus infection, followed by chikungunya and dengue.
Less likely -- but compatible diseases -- include:
Endemic typhus
Rubella
Parvovirus B19 infection
Hantavirus
Measles
Leptospirosis
West Nile fever
Relapsing fever
Q-fever
Old-world phleboviruses
Crimean-Congo hemorrhagic fever
Brucellosis
Ornithosis
Bunyaviridae infection

Gideon indicates that additional findings which would significantly
focus the differential diagnosis include presence of lymphadenopathy,
nature of the rash, or history of common animal/food exposure. The
program also lists several diseases, which are clinically compatible,
but heretofore not reported in India. The most interesting of these
are Zika virus, ehrlichiosis, and anaplasmosis."

ProMED thanks Dr Berger for providing the information above. It is
obvious that laboratory tests will be critical to determine what is
going on in this outbreak.

A HealthMap/ProMED-mail map showing the location of Kolkata in West
Bengal state can be accessed at http://healthmap.org/r/1xiq. -
Mod.TY]

METHANOL POISONING, FATAL - INDIA
*********************************

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: 14 Dec 2011
Source: BBC [edited]
http://www.bbc.co.uk/news/world-asia-india-16174531


India toxic alcohol kills 50 in West Bengal
-------------------------------------------
More than 50 people have died after consuming toxic alcohol in India's
West Bengal state, police say. Several residents of the Magrahat,
Usthi and Mandirbazar areas in South 24 Parganas district fell ill
after drinking the alcohol on Tuesday night [13 Dec 2011]. 4 people
have been arrested. Some 100 others are being treated in hospital in
the Diamond Harbour area, with fears the death toll could rise.

Toxic alcohol deaths are a regular occurrence in India. Last week, the
state of Gujarat brought in a new law making the illegal manufacture
and sale of toxic alcohol there punishable by death.

Ransacked
---------
About 70 people are in a critical condition, state government minister
Shyamal Mandal told the BBC.

"More and more people are turning up with symptoms of liquor poisoning
and one local hospital is now overcrowded," district administrator NS
Nigam told the AFP news agency.

Gujarat is one state that has taken drastic action to try to prevent
toxic alcohol deaths. Some of the critically ill had been transferred
to Calcutta, he said. Medicine and doctors were being rushed to the
Diamond Harbour hospital.

4 breweries were ransacked after the deaths began to be reported, AFP
quoted officials as saying.

Illegal alcohol -- commonly called desi daroo or country-made liquor
in India -- usually costs as little as 10 rupees (20 US cents) and the
majority of the consumers are poor, daily-wage workers.

The liquor is usually spiked with methyl alcohol and industrial
spirits which can lead to fits, vomiting and death.

India has witnessed many incidents of toxic alcohol deaths.
- At least 10 people killed in Tamil Nadu in February 2010
- At least 30 people killed in Uttar Pradesh in September 2009
- Some 107 people killed in Gujarat in July 2009
Gujarat has taken the strongest action on toxic liquor with its new
law, which it says is intended to deter those involved in the illegal
trade.

Gujarat is the only state in India where alcohol is totally prohibited
by law.

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

******
[2]
Date: 6 Dec 2011
Source: BBC [edited]
http://www.bbc.co.uk/news/world-asia-india-16044845


Gujarat introduces death penalty for toxic alcohol
--------------------------------------------------
The illegal manufacture and sale of toxic alcohol in the western
Indian state of Gujarat will now be punishable by death. The governor
of the state, Kamala Beniwal, has given her assent to the new law
after keeping it on hold for more than 2 years. Gujarat has witnessed
many incidents of people dying after consuming poison alcohol. The
government says the law will deter those involved in the illegal
trade. Gujarat is the only state in India where alcohol is totally
prohibited by law.

The state legislative assembly passed the new stringent bill after
scores of people died in one incident in 2009. But the governor
refused to sign it into law. Correspondents say she wanted the
provision of the death penalty to be dropped from the bill, but the
state government did not agree.

It was then referred to the central government for "legal opinion,"
and the governor gave her approval only after getting the nod from
Delhi. The law will also allow the authorities to impound and auction
vehicles used for transporting contraband.

Poor victims
------------
Illegal alcohol -- commonly called desi daroo or country-made liquor
in Gujarat -- is usually sold in 200ml plastic pouches for 10 rupees
(20 cents) each. The majority of the consumers are poor, daily wage
workers.

The pouches are transported into the state's main city, Ahmedabad, by
couriers on motorcycles and scooters. Sometimes they slip into the
state capital carrying jerry cans containing the alcohol. The alcohol
is then sold from shantytown shacks which dot the city.

Local residents and journalists allege that the police are on the take
and collect "protection money" from the dealers.

Gujarat's toxic liquor is usually spiked with methyl alcohol and
industrial spirits which can lead to fits, vomiting and death.

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

[Methanol is a clear, colorless liquid with a faint odor like alcohol,
making it impossible to detect when mixed in alcohol.

Methanol toxicity remains a common problem in many parts of the
developing world, where methanol is often a component of bootleg
alcohol, which is made in rural regions. Because of its low cost, it
is often consumed by those in lower socioeconomic classes, or is
mistaken for desired alcohol. Methanol has a relatively low toxicity,
hence the adverse effects are thought to result from the accumulation
of formic acid, a metabolite of methanol metabolism. Formic acid
metabolism is very slow, therefore it accumulates in the body, leading
to metabolic acidosis.

Drinking methanol causes the same effects as excessive drinking, with
the addition of pronounced vision problems. However, after the effects
disappear, they reappear 6-30 hours later with much greater severity.
The most seriously poisoned lose consciousness and die of respiratory
or heart failure. Others may linger in a coma for as long as a week
and may be left blinded.

Initial symptoms occur 12-24 hours after ingestion and in general
correlate with the volume of methanol ingested and the amount of
ethanol concomitantly ingested. The minimal lethal dose is believed to
be 1 mg/kg body weight. Initial symptoms include disinhibition and
ataxia followed by headache, nausea, and vomiting or epigastric pain.
These are then followed by drowsiness, seizures, and eventually coma.
Visual symptoms like flashes of light, blurring, scotomas, and
scintillations occur and may progress to complete visual loss. Prompt
medical care is vital to avoid complications secondary to methanol
intoxication.

Supportive therapy is aimed at initiating airway management,
correcting electrolyte disturbances, and providing adequate hydration.
The metabolic acidosis may necessitate administration of bicarbonate
and assisted ventilation. Bicarbonate potentially may reverse visual
deficits. In addition, bicarbonate may help to decrease the amount of
active formic acid. The amounts may be thought of as less than a
teaspoon of methanol can cause blindness and more than 4 teaspoons can
be fatal.

Antidote therapy is directed towards delaying methanol metabolism
until the methanol is eliminated from the system, either naturally or
via dialysis, often accomplished in 2 ways: ethanol or fomepizole.
Ethanol is also metabolized by alcohol dehydrogenase (ADH), and the
enzyme has 10-20 times higher affinity for ethanol compared with
methanol. Fomepizole is also metabolized by ADH; however, its use is
limited because of high costs and lack of availability.

Portions of this comment have been extracted from
http://emedicine.medscape.com/article/1174890-overview. - Mod.TG]

DENGUE/DHF UPDATE 2011 (50)
****************************

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 (Delhi). 6 Dec 2011. Chairman, health committee, Dr VK Monga
said that the total count of dengue cases in the city had gone up to
1108. "The total toll due to dengue haemorrhagic fever has gone up to
6 this year [2011].
http://www.mid-day.com/news/2011/dec/06 ... -Delhi.htm

[A HealthMap/ProMED-mail interactive map showing the location of Delhi
can be accessed at http://healthmap.org/r/0G3P. - Mod.TY]