Wüstenschiff

MALARIA - INDIA (23), UPDATE (GUJARAT, CHHATTISGARH)
****************************************************

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] Gujarat
Date: Mon 19 Dec 2011
Source: Time of India [edited]
http://timesofindia.indiatimes.com/city ... 161632.cms


Gujarat records 5th highest number of malaria cases in India
------------------------------------------------------------
If the figures given out by the directorate of national vectorborne
disease control program (NVBDCP) are to be believed then there were
just 14 malaria deaths in the state between January and October this
year [2011]. What may startle you is the fact that the Ahmedabad
Municipal Corporation (AMC) alone has officially reported 59 malaria
deaths between January and September this year. One could figure what
other Gujarat cities and towns may have reported.

For some reason the state health department has been under-reporting
the total malaria cases and even deaths that have occurred in the
state. If there were 71 121 malaria positive cases in 2007, the state
health department has reported just a marginal increase of 76 088
malaria cases in the state this year.

This is contrary to the state government's earlier claims of 2011
being an 8-year peak in mosquito related illnesses. Even with these
suspected underreported figures Gujarat has clocked the 5th highest
number of malaria cases in the country this year. Also till October,
the state reported a 49.3 percent in malaria cases when compared to
the same period last year, while in the case of falciparum the state
has shown a 48.6 percent jump.

While looking at the state figures over the last 2 weeks -- that is
between 28 Nov 2011 and 11 Dec 2011 -- a total of 2475 confirmed
malaria cases were recorded. The number of falciparum cases registered
during the same period is 1524 cases. An alert was also issued within
the municipal corporation limits of Ahmedabad, Surat and Vadodara
along with districts like Dahod and Rajkot.

"As and when we receive lab confirmation for malaria or dengue we send
these figures to NVBDCP. There may be occasions where we may not have
send the weekly data at all to the centre. We will look into the
matter," a senior health department official said. "There has been an
overall decrease in vector borne diseases in the state. A few pockets
in the state are still infested with mosquito-related ailments. We
have alerted the respective district health officials," added the
official.

[Byline: Paul John, TNN]

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

******
[2] Chhattisgarh
Date: Sun 4 Dec 2011
Source: Bhaskar News [edited]
http://daily.bhaskar.com/article/MP-RAI ... 12790.html


Malaria kills 6 in Raipur
-------------------------
Rising cases of malaria has set the alarm bell ringing in the state
capital with 6 deaths reported so far. The figure is likely to rise in
coming days with more than a dozen being tested positive.

The deceased all comes from Talnar village in Chindgarh block. "The
patients in the village approach quack before coming to us. By the
time they came to us their conditions were critical. The late
treatment explain their death," said Dr Ritendra Dev of Mekaj
Hospital.

Meanwhile, the municipal corporation has intensified its drive to
check mosquito breeding. Also, the state government has set up a
malaria control room that will work round the clock.

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

[Malaria is endemic in Gujarat, situated northwest of Mumbai and
bordering Pakistan. And malaria is also endemic in Chhattisgarh.
ProMED will be glad to post more detailed information from the 2
states.

Ahmedabad HealthMap location: http://healthmap.org/r/1iSU
Raipur HealthMap location: http://healthmap.org/r/1shg. - Mod.EP]

Indien - Methanolvergiftung
19.12.2011

Im Bundesstaat Westbengalen (NO) sind Mitte Dezember mehr als 50 Menschen gestorben, nachdem sie mit Methanol versetzten Alkohol getrunken hatten. Hunderte weiterer Menschen werden in Krankenhäusern aufgrund von Vergiftungssymptomen behandelt. In ganz Indien kommt es regelmäßig zu Methanolvergiftungen. Sie können zu schweren gesundheitlichen Schäden (z.B. Gehirnschädigungen und Nierenversagen) führen und schlimmstenfalls tödlich verlaufen. Illegal gebrauter Alkohol wird häufig in Plastiksäckchen angeboten. Gekauft wird er aufgrund des billigen Preises häufig von Niedriglohn-Arbeitern. Im Bundesstaat Gujarat (W) wurde kürzlich per Gesetz beschlossen, dass das illegale Alkoholbrauen mit der Todesstrafe geahndet werden kann. Alkoholische Getränke aus obskuren Quellen stellen ein hohes Risiko dar und sollten prinzipiell gemieden werden. / Quelle: crm

Gruß
Birgitt

JAPANESE ENCEPHALITIS AND OTHER - INDIA (39): UTTAR PRADESH
***********************************************************

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


Date: Tue 20 Dec 2011
Source: Money Control [edited]
http://www.moneycontrol.com/news/wire-n ... 36391.html


With 3 more children succumbing to encephalitis in eastern Uttar
Pradesh, the death toll from the viral disease has climbed to 635 this
year [2011], a senior health official said today [20 Dec 2011]. "Three
children have succumbed to the viral disease over the last 24 hours.
The victims belonged to Gorakhpur, Basti and Mahrajganj districts,
respectively," Additional Director (Health) Diwakar Prasad said.

Prasad said that 5 new patients with encephalitis were admitted to
various government hospitals of Gorakhpur and Basti divisions
yesterday [19 Dec 2011]. As many as 101 patients are undergoing
treatment in these hospitals, he added.

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

[As with many of the previous reports of encephalitis coming from
eastern Uttar Pradesh this year (2011), there is no indication of the
etiological agent responsible for the above cases of encephalitis. A
report from the Minister of Women & Child Development indicated that
as of 31 Oct 2011, 462 children died from undiagnosed acute
encephalitis syndrome, and 27 children died from Japanese encephalitis
virus infection in 2011 (see ProMED-mail archive no. 20111209.3555).

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 (33): INDIA (KERALA)
********************************

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International Society for Infectious Diseases
http://www.isid.org


Date: Wed 21 Dec 2011
Source: Mathrubhumi [edited]
http://www.mathrubhumi.com/english/story.php?id=118148


After a long period, chikungunya [virus infections] are back again. In
December 2011, 14 persons sought treatment for chikungunya [virus
infections], and among them, 13 are in Thiruvananthapuram and one in
Ernakulam.

Health department officials said that the virus still remains in
people affected with chikungunya earlier.

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

[Most of the chikungunya virus infections within the past 2 months
have been reported in northern India (Delhi and Uttar Pradesh state).

Symptoms (particularly joint pain) may persist for weeks to months
after chikungunya virus infections. The pain can be incapacitating.
There is no evidence that the virus itself persists, but the symptoms
certainly can, perhaps due continued joint inflammation or autoimmune
responses triggered by the infection.

A HealthMap/ProMED-mail map showing the location of Thiruvananthapuram
in Kerala state can be accessed at http://healthmap.org/r/00aD. -
Mod.TY]

HEPATITIS E - INDIA (2): (GUJARAT), WATER-BORNE
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Thu 22-12-2011
Source: Times of India, Rajkot [edited]

Hepatitis E cases on rise in Mehsana town
-----------------------------------
There has been an increase in the number of patients suffering from
hepatitis E and jaundice in Mehsana town since September [2011].
Kasba, Hydri Chowk, Babi Vado, Faiza No Vado and Siddhapuri Bazaar
localities in old Mehsana town have recorded over 400 cases so far.
However, the health department has put the number at 68.

A resident of Babi Vado said there are as many as 400 people affected
by stomach ailments and seven are from his family alone. A
thirty-year-old patient said, "Water supply pipelines were damaged in
September when telephone cables were being replaced in our locality.
This led to contamination of drinking water. The civic body was
alerted, but it paid no heed to our complaints. The resident said, "We
picketed the municipal office on Wednesday, thus forcing,it to act on
the matter." Municipal chief officer R P Joshi said, "We have begun
replacing the pipes from Thursday though we have not found leakage
anywhere. Water in the affected area is being supplied through
tankers."

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

[Hepatitis E virus is transmitted via the faecal-oral route. Hepatitis
E is a waterborne disease, and contaminated water or food supplies
have been implicated in major outbreaks. Consumption of faecally
contaminated drinking water has given rise to epidemics, and the
ingestion of raw or uncooked shellfish has been the source of sporadic
cases in endemic areas. There is a possibility of zoonotic spread of
the virus, since several non-human primates, pigs, cows, sheep, goats
and rodents are susceptible to infection. The risk factors for
hepatitis E virus infection are related to poor sanitation in large
areas of the world, and shedding in faeces. Person-to-person
transmission is uncommon. There is no evidence for sexual transmission
or for transmission by transfusion. According to the GIDEON database,
around 2 million cases per year are estimated to occur nationwide in
India.

In general, hepatitis E is a self-limiting viral infection followed by
recovery. Prolonged viraemia or faecal shedding are unusual.
Symptomatic HEV infection is most common in young adults aged 15-40
years. A more fulminant form of hepatitis occasionally develops, with
mortality rates ranging between 0.5% - 4.0%. Fulminant hepatitis
occurs more often in pregnancy with a mortality rate of 20% among
women in late pregnancy. Further information can be obtained from the
WHO website at:
http://www.who.int/mediacentre/factshee ... index.html.

Mehsana is situated in Gujarat state near Ahmedabad and Gandhinagar.
It can be located in the map of Gujarat at:
http://www.mapsofindia.com/maps/gujarat/gujarat.htm.

If this outbreak is due to fractured water supply pipes as suggested,
but refuted by the local authority, one might expect hepatitis A virus
infection to be equally prevalent. - Mod.CP.

A HealthMap/ProMED-mail map can be accessed at:
http://healthmap.org/r/1zT1]

DENGUE/DHF UPDATE 2011 (51)
***************************

A ProMED-mail post
http://www.promedmail.org
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http://www.isid.org

*****

- Pakistan (Lahore, Punjab province). 19 Dec 2011. The Pakistan
Medical Association (PMA) has vowed to support the Punjab government
in an anti-quackery drive, claiming that thousands of quacks were
running clinics in the city and were responsible for the deaths of 200
dengue patients.
http://www.dailytimes.com.pk/default.as ... 011_pg7_19.

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (40): (DELHI, MADHYA PRADESH)
*********************************************************************

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ProMED-mail is a program of the
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http://www.isid.org


Date: Sat 24 Dec 2011
Source: Daily Bhaskar, DNA (Daily News & Analysis) report [edited]
http://daily.bhaskar.com/article/MP-BHO ... 71571.html


In New Delhi, 14 positive cases of Japanese encephalitis put the
health officials in the national capital on overdrive, prompting
large-scale testing of humans and animals alike. Over 140 people have
died due to encephalitis at a government hospital in Indore [Madhya
Pradesh] in the last 8 months, but the Madhya Pradesh health officers
are neither aware of the deaths, nor are in a position to negate
possibilities of Japanese [encephalitis] virus spread in the city.

The fears about spread of a Japanese encephalitis epidemic in Indore
gains ground after test reports of laboratories in New Delhi claimed
that 17 pigs were found infected with Japanese encephalitis virus.
Delhi health minister AK Wadia had confirmed that several of the pigs
were supplied from Indore.

Japanese encephalitis [JE virus] can easily spread from pigs to human
beings [not directly. JE virus is transmitted by _Culex_ mosquitoes
that may have acquired the virus from pigs, which are amplifying
hosts, and subsequently transmit it to humans. Wild birds are
reservoir hosts. - Mod.TY]

As per the official records, an average of 17 deaths have occurred in
the MY Hospital [in Indore] every month over the last 8 months. In
April and May each, 20 persons died due to encephalitis. "The majority
of the deceased includes children. Though the data is yet to be
analysed for the month of November 2011, 2 children have died this
month [December 2011] also due to encephalitis," said a hospital
official on condition of anonymity.

The health department officials tried to shy away from the issue by
claiming that the MY Hospital -- an auxiliary medical facility of the
MGM Medical College that comes under the medical education department
-- had failed to inform them about the developments. State director of
health services JN Kansotiya said, "We have not been informed. MY
Hospital comes under directorate of medical education. If so many
deaths have occurred due to a particular disease then it's an issue of
serious concern," he added.

Medical College community medicine department head Dr Sanjay Dixit
claimed that encephalitis may be of different kinds which leads to
inflammation of brain cells, but both the Japanese [encephalitis virus
infections] and cerebral encephalitis due to bacteria could break into
an epidemic.

The office of joint director health services had decided to put a
check on vector-borne diseases, but no particular drive for containing
encephalitis has been initiated yet. No blood sample testing of pigs
has been carried out in the entire division.

Joint director health services Dr Sharad Pandit claimed that the
magnitude of deaths due to encephalitis is alarming and that
appropriate measures would be taken.

--
Communicated by:
Ronan Kelly
ronankelly@comcast.net

[There have been scattered reported JE virus infections around India
and repeated reports of Japanese encephalitis cases along with even
more undiagnosed "acute encephalitis syndrome" cases in northern and
northeastern India this year (2011). These are the 1st JE virus cases
reported from Madhya Pradesh this year, although the report above
implies that cases have been occurring since April 2011. The report
mentions only JE virus infections as the etiological agent in these
cases.

ProMED-mail thanks Ronan Kelly for sending in this report.

Maps showing the location of the Indore region in Madhya Pradesh state
can be accessed at http://en.wikipedia.org/wiki/Indore and
http://healthmap.org/r/1A1F. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (41): 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 30 Dec 2011
Source: Zeenews [edited]
http://zeenews.india.com/news/uttar-pra ... 49500.html


Encephalitis has claimed the lives of 2 children, taking the death
toll in the viral infection in eastern Uttar Pradesh to 643 this year
[2011]. The 2 children died in the last 2 days, Additional Director
(health) Diwakar Prasad said today [30 Dec 2011].

As many as 82 people suffering from encephalitis are undergoing
treatment in various government hospitals in Basti and Gorakhpur, he
said.

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

[The numbers of encephalitis cases in children continue to climb in
Uttar Pradesh state. The year-to-date case count as of 20 Dec 2011 (10
days ago; see ProMED-mail archive no. 20111220.3643) was 635 and now
has reached 643, as indicated in the report above. This report does
not indicate the etiological agent involved in these cases, but
previous reports attribute them to Japanese encephalitis and other
undiagnosed virus infections.

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (42): (UTTAR PRADESH) 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: 29 Dec 2011
Source: Zee News [summ. and edited]
http://zeenews.india.com/news/health/ex ... 15072.html



The government on Thursday [29 Dec 2011] admitted that 25 percent of
children affected by Japanese encephalitis [virus with clinical
encephalitis] die while 40 per cent of those who survive become
mentally or physically handicapped, but maintained that effective
steps were being taken to tackle the disease.

Minister of Health and Family Welfare Ghulam Nabi Azad said during a
Calling Attention Motion in the Lok Sabha ["House of the People" is
the lower house of the Parliament of India] that Japanese encephalitis
[virus infection; JE] is a major public health challenge which has
affected children in Gorakhpur and Basti districts of Uttar Pradesh,
parts of Orissa and Chattisgarh.

"25 per cent of children affected by this disease die while 40 per
cent of those who survive become physically challenged or lose their
mental balance," Azad said.

Sharing data, Azad stated that 1133 deaths were reported in 2011
alone. Of these, 575 deaths were reported in Gorakhpur and Basti
divisions of UP, 250 in Orissa and 197 in Bihar. He maintained that
since 2006 vaccines have been introduced and these have brought down
the number of JE cases from 36 per cent [of total encephalitis cases?
- Mod. TY] to 6.4 per cent of the population.

A Group of Ministers (GOM) has been appointed by Prime Minister to
deal specifically with the issue and it has held 3 meetings to date,
Azad said.

Yogi Adityanath (BJP), who had moved the Calling Attention Motion,
expressed dissatisfaction with the Minister`s contention and said
although over one lakh [100 000] deaths have taken place in the last
33 years in just 7 districts of UP, the government has not done
anything substantial. It is still not clear if these deaths are caused
by JE [virus] or something else, he said.

Adityanath alleged that though the vaccine should be given thrice, the
government delivers it only once. "Government is only concentrating on
curing the affected instead of eradicating the disease," he said. He
also alleged that JE deaths were being caused also due to shortage of
medicines in government hospitals. "95-99 per cent of those children
who die are from families of dalits, poor and farmers," he said
[Dalits are a group of people traditionally regarded as Untouchables.
They are a mixed population, consisting of numerous castes from all
over South Asia, speak a variety of languages and practice a multitude
of religions.]

He demanded that the Centre for Excellence in JE which has been opened
in Lucknow should ideally be located in Gorakhpur as 75-80 per cent of
the cases are reported there.

Ramesh Bais (BJP) said basic needs like clean water and nutrition
should be provided and effective steps taken to deal with mosquitoes
[and water-born pathogens] which cause several diseases.

---
Communicated by:
Prabhjot Singh
drprabhjot@gmail.com

{ProMED thanks Prabhjot Singh for providing the above report. His own
comments are given below. As in previous reports of encephalitis in
UP state, the etiologies of many of these encephalitis cases has not
been established.

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

******
Date: Sat 31 Dec 2011
From: Prabhjot Singh


A special session in the Lok Sabha (lower house) was convened where
the problem of encephalitis was discussed. As per Government
clarification, the proportion of JE cases among the reported
encephalitis cases was only 6 per cent with the majority of the rest
of the cases being due to enteroviruses. This decrease in JE cases is
being attributed to vaccination campaigns in previous years. One
vaccination drive has been carried out this year [2011] in most
affected districts. Owing to poor sanitation and use of hand pumps
that do not go deep into the ground, continued transmission [of
enteroviruses] has been seen this year in almost all of eastern UP
districts. Almost 19 states of India are affected by this problem.

---
Communicated by:
Dr. Prabhjot Singh
Epidemiologist
PAHO-WHO
Honduras



[Providing infrastructure to provide safe, potable water and systems
for treatment of human wastes is expensive and requires public
education as well, but is necessary to prevent enterovirus
transmission. Treatment of hundreds of cases of encephalitis in
hospitals annually and support by their families of incapacitated
convalescent patients with neurological sequelae, often for life, is
also expensive. - Mod. TY]

DENGUE/DHF UPDATE 2012 (01): END DECEMBER 2011 REPORTS
******************************************************

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 (Sindh province). 29 Dec 2011. In Sindh [province], 8 new
dengue fever cases were reported from 19-29 Dec [2011], raising the
number of confirmed dengue patients in the province to 1074 during the
year. Sindh Health Department's Dengue Surveillance Cell informed that
so far 18 dengue patients had died in the province. Presently, no
dengue patient is admitted in any hospital of the province.
http://www.dailytimes.com.pk/default.as ... 11_pg12_11

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

HEPATITIS C - PAKISTAN: (PUNJAB) SUSPECTED, REQUEST FOR INFORMATION
*******************************************************************

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


Date: Mon 2 Jan 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/315192/hepa ... r-village/


At least 15 people have died of [suspected] hepatitis C in a Rajanpur
village over the past month while around 500 more are suffering from
the disease, the residents say. Talking to The Express Tribune, Basti
Jakaani villagers complained that there were no public health
facilities for treatment and diagnosis of hepatitis C in the area.

They alleged that facilities at the Rajanpur district headquarters
(DHQ) hospital were only available through references from influential
people. They said most of them had had to go to private laboratories
for hepatitis C tests, where they were tested positive for the
disease. They said they could not afford the treatment and most of
them returned to the village after getting their test reports. They
said people from nearby villages had refused to come to their village
fearing that they too might get infected by the disease.

Residents said there was no sanitation system in the village and the
only source of drinking water was underground water. They said the
water was contaminated and demanded that the government install a
filtration plant in the village. The casualties from the disease have
included twins born to a woman who has been diagnosed with hepatitis
C. She said she and her babies had tested positive for the disease
over a month ago. She said she could not afford treatment. A
70-year-old woman said she had lost her husband and 2 grandsons to the
disease. District Officer (Health) Dr Musa Kalim expressed ignorance
of a hepatitis C epidemic in the area. He said he would look into the
matter and take action to address the grievances of the Basti Jakaani
villagers.

The District Officer, however, rejected the suggestion that anybody
was declined treatment at the Rajanpur DHQ hospital. He said they had
a hepatitis C unit at the hospital where diagnostic facilities were
available. He said those diagnosed with the disease were given
hepatitis C kits [?] and vaccines [no such vaccine exists - Mod.CP]
and only those in critical condition were admitted at the hospital.

Basti Jakaani [village] was among the Rajanpur villages affected by
the floods in 2010.

[Byline: Owais Jaffery, Yasir Qureshi]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Hepatitis C is a contagious liver disease that results from infection
with hepatitis C virus (HCV). It can range in severity from a mild
illness lasting a few weeks to a serious, lifelong illness. HCV is
usually spread when blood from a person infected with HCV enters the
body of someone who is not infected. The outbreak in Rajanpur
District, Punjab province of Pakistan, is unlikely to be a result of
HCV infection as poor sanitation and faecal contamination of drinking
water are suggested to be responsible. Hepatitis as a result of
hepatitis A or E virus infection is a more likely explanation, if
indeed the disease is hepatitis.

There are conflicting statements about the availability of diagnostic
tests for hepatitis C. The Rajanpur District Health Officer denies
knowledge of an outbreak of hepatitis C in the district. The diagnosis
of HCV infection was obtained by villagers from unidentified private
laboratories and no treatment was provided. The diagnosis is
questionable in view of the high mortality observed and absence of
information on the diagnostic tests employed. Clarification of the
disease situation in Basti Jakaani village is awaited.

A HealthMap/ProMED-mail interactive map of Pakistan can be seen at
http://healthmap.org/r/1orI. Rajanpur is a district of Punjab
province. Its administrative centre is the town of Rajanpur. Rajanpur
district is situated on the right bank (west side) of the River Indus.
A map of Punjab province of Pakistan, showing the location of Rajanpur
in the south west of the province can be accessed at
http://pamirtours.pk/maps/punjab%20map.htm. - Mod.CP]

ALCOHOL POISONING - INDIA: (ANDHRA PRADESH, WEST BENGAL) METHANOL
SUSPECTED
***************************************************************************

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


Date: Mon 2 Jan 2012
Source: Le Figaro, Agence France-Presse (AFP) report [in French,
trans. Mod.MPP, edited]
http://www.lefigaro.fr/flash-actu/2012/ ... -morts.php


At least 17 people died after drinking adulterated alcohol in southern
India. 15 people died in a tribal village in Andhra Pradesh during the
New Year's weekend [31 Dec 2011-1 Jan 2012] and 2 others died today [2
Jan 2012].

"All the victims were workers. 3 women are also among the dead," said
a local official from the Ministry of Taxes in the state capital,
Hyderabad. 2 officials of Andhra Pradesh, responsible for the
regulation of alcohol sales, were suspended after the deaths over the
weekend. Samples of the alcohol were taken for analysis.

170 dead in mid-December
------------------------
The beverages may have been contaminated with methanol, a highly toxic
solvent sometimes used as a fuel but also added to liquor made
clandestinely to increase the alcohol content. This product [methanol]
can cause blindness, even death when it is present in high
concentrations. In mid-December [2011], 170 people were fatally
poisoned in the state of West Bengal after drinking adulterated
alcohol that without a doubt contained methanol. The victims were
farmers and [rickshaw drivers] too poor to buy branded liquor
[non-locally brewed].

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

[Andhra Pradesh and West Bengal can be seen on the
HealthMap/ProMED-mail interactive map at
http://healthmap.org/r/1ob7. - Sr.Tech.Ed.MJ]

[Methanol (wood alcohol) is produced from the destructive distillation
of wood. Epidemics of methanol toxicity have resulted from the
consumption of methanol-contaminated whiskey or other alcohol
products. The formation of 2 toxic metabolites, formaldehyde and
formic acid, causes methanol poisoning. The elimination rate depends
upon the folate pool. In primates it is generally small, and
consequently primates (including humans) are more sensitive to
methanol toxicity than other animals.

Methanol is widely available in formulations including antifreeze,
windshield washer fluid, Sterno canned heat, shellacs, various paints,
paint removers, varnishes, duplicating fluids, and gasoline
additives.

Fatalities have been reported after ingestion of 15 ml or 3 teaspoons
of a 40 percent solution, although 30 ml is generally considered a
minimal lethal dose. With aggressive medical care it is possible to
survive the ingestion of 500-600 ml. However, consumption of as little
as 10 ml may cause blindness, depending on the amount and individual
tolerance.

Methanol is well absorbed from the gastrointestinal tract, and peak
levels occur generally within 30-90 minutes. It is distributed into
tissues, so concentrations in the vitreous humor and optic nerve are
high. The highest concentrations are found in the kidney, liver, and
gastrointestinal tract, with smaller concentrations in the brain,
muscle, and adipose tissues.

Methanol is oxidized 10 times more slowly than ethanol. Consequently
there is a longer elimination half-life.

Onset of symptoms varies between 40 minutes and 72 hours
post-ingestion. Co-ingestion with alcohol will delay the appearance of
symptoms, but the absence of symptoms does not exclude serious
toxicity. The usual latent period is 12-24 hours.

Clinical signs may include headache, vertigo, lethargy, and confusion,
which are common in mild to moderate ethanol intoxications. Coma and
convulsions appear in severe cases, probably as a result of cerebral
edema. Methanol produces little to no euphoria, unlike ethanol.

Blurred vision, decreased visual acuity, and photophobia (sensitivity
to light) are common complaints. Constricted visual fields, fixed and
dilated pupils, retinal edema, and hyperemia of the optic disk are
common clinical findings. Prompt initial therapy is necessary to
reverse symptoms, though visual defects have persisted in up to 25
percent of severe cases.

Methanol is a mucosal irritant and may produce nausea, vomiting, and
abdominal pain, not unlike large doses of ethanol.

Early in the clinical course, gut decontamination with ipecac or
lavage may be indicated. However, if the methanol is mixed with
ethanol, these patients may not realize something is out of the
ordinary until it is too late for this type of treatment to be
helpful.

Intravenous administration of ethanol in a 10 percent dextrose
solution may be helpful. As ethanol prolongs the elimination half-life
of methanol, the treatment may take several days and the patient
should be hospitalized. Dialysis may be necessary to prevent kidney
failure as well. Hemodialysis remains an effective treatment. -
Mod.TG]

MALARIA - INDIA: UPDATE
***********************

A ProMED-mail post
http://www.promedmail.org
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International Society for Infectious Diseases
http://www.isid.org


In this update:
[1] Rajasthan
[2] Multistate

******
[1] Rajasthan
Date: Tue 3 Jan 2012
Source: The Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 344727.cms


Prolonged spells of rain in 2011 increased the number of malaria cases
in the state compared to 2010. However, the cause for concern was the
increase in the cases of fatal _Plasmodium falciparum_ (PF). It
increased by almost 30 percent in 2011 as compared to the
corresponding period in 2010.

In Rajasthan, malaria cases registered from January 2010 to December
2010 were 51 000 but by the end of November 2011 (from January 2011),
the number increased to 53 000.

By the end of November 2011, there was an increase of 2000 malaria
cases. But, the fact that worries the medical, health, and family
welfare department is that among the 2000 increased cases, there were
around 1000 increased cases of dangerous _Plasmodium falciparum_
malaria.

Last year [2010], among the total 51 000 malaria cases there were 2000
PF malaria cases. But, in 2011 (till November) the PF cases increased
to 2900. The medical, health, and family welfare department claimed
that the prolonged rainfall is the cause of more malaria cases
reported this year. Additional director (RH) Dr JP Dhamija said, "This
year there was prolonged rain for 2 more months. The mosquitoes got
conducive environment for breeding due to waterlogging. But, we tried
our best through anti-larvae activities and controlled malaria from
spreading."

In Jaipur, the cases of malaria cases increased this year [2011]. A
department official said that between January 2010 and November 2010
the total malaria cases were 1192, but during the corresponding period
in 2011 the figure increased to 1763.

[Byline: JP Dhamija]

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******
[2] Multistate
Date: Wed 21 Dec 2011
Source: Zimbio, Samay Live report [edited]
http://www.zimbio.com/Breakbone+Dengue+ ... +personnel
[Edited]


in the past 10 months, 13 CRPF [Central Reserve Police Force]
personnel died and 11 others became seriously ill due to dengue and
malaria in Naxal-hit states [Chhattisgarh, Orissa, West Bengal, and
Jharkhand], Rajya Sabha [Council of States] was informed.

Minister of State for Home Jitendra Singh said adequate preventive
measures are being taken for the safety of the force from these
diseases.

Singh said apart from other measures, a clear cut plan has been made
and kept at each unit for casualty evacuation in case of emergency.

It consists of details of the nearest hospitals, their phone numbers,
distance, stretcher etc. Also, the men have been trained to rise to
any emergency situation for early evacuation of seriously ill
patients.

[Byline: Arkanoid Legent blog]

--
Communicated by:
ProMED-mail from HealthMap alerts
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[Malaria is endemic in Rajasthan and parts of Chhattisgarh, Orissa,
West Bengal, and Jharkhand. Reports from India are so frequent that
ProMED-mail will bring the reports from the past week once or twice a
month.

The phrase "Naxal" refers to a violent Maoist movement.

The states mentioned can be located on the HealthMap/ProMED-mail
interactive map at http://healthmap.org/r/1pX1. - Mod.EP]

Indien - Malaria
06.01.2012

Im Bundesstaat Rajasthan (NW) sind aufgrund verstärkter Regenfälle 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 2010 ab, die Zahl der malariabedingten Todesfälle stieg leicht an. In ganz Indien wurden bis Ende Oktober 2011 offiziell etwa 1.059.500 Fälle bestätigt. Mindestens 313 Personen sind an der Erkrankung verstorben. Es ist davon auszugehen, dass die tatsächlichen Fallzahlen mehrfach höher sind. Dringend Mückenschutz und ggf. Malariaprophylaxe beachten. / Quelle: crm
__________

Indien - Methanolvergiftung
06.01.2012

Im Bundesstaat Westbengalen (NO) sind Mitte Dezember 170 Menschen gestorben, nachdem sie mit Methanol versetzten Alkohol getrunken hatten. Weitere 17 Todesfälle gab es in Südindien am Silvesterwochenende. In ganz Indien kommt es regelmäßig zu Methanolvergiftungen. Sie können zu schweren gesundheitlichen Schäden (z.B. Gehirnschädigungen und Nierenversagen) führen und schlimmstenfalls tödlich verlaufen. Illegal gebrauter Alkohol wird häufig in Plastiksäckchen angeboten. Gekauft wird er aufgrund des billigen Preises häufig von Niedriglohn-Arbeitern. Im Bundesstaat Gujarat (W) wurde kürzlich per Gesetz beschlossen, dass das illegale Alkoholbrauen mit der Todesstrafe geahndet werden kann. Alkoholische Getränke aus obskuren Quellen stellen ein hohes Risiko dar und sollten prinzipiell gemieden werden. Quelle: crm

Gruß
Birgitt

DENGUE-CHIKUNGUNYA VIRUS CO-INFECTIONS - INDIA
**********************************************
A ProMED-mail post
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ProMED-mail is a program of the
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Date: Mon 9 Jan 2012
Source: Deccan Chronicle [edited]
http://www.deccanchronicle.com/channels ... gnosis-081


Cases of dengue-chikungunya [virus] co-infection are on the rise, causing concern to health planners and doctors. About 3 per cent of dengue-chikungunya cases fall under the co-infection category, with the patient suffering from both the diseases at the same time.

Incidentally, the same _Aedes aegypti_ mosquito transmits both the dengue and the chikunguniya virus; chances of co-infection are higher if the mosquito carries the viruses of both the diseases. A detailed analysis of dengue and chikungunya cases by the department of microbiology, Sri Venkate-swara Institute of Medical Sciences, Tirupati has revealed that the problem of co-infection is more pronounced in areas where both viruses co-circulate.

Where co-infection strikes, doctors find it hard to diagnose the problem. Though symptoms of these diseases are common, their outcome differs. Tests for both dengue and chikungunya [virus infections] will help in finding whether a patient is suffering from one disease or both of them. Chikungunya is non-fatal, while dengue may lead to severe complications including death. The common symptoms of both the diseases include fever, joint and bone pain, nausea, vomiting, headache, and fatigue [However, acute joint pain that may persist for weeks or months is more characteristic of chikungunya virus infections. - Mod.TY].

A team of researchers comprising Usha Kalawat, Krishna K. Sharma and G. Satishkumar Reddy analysed 331 samples for dengue and 170 samples for chikungunya [antibodies]. About 12 per cent of dengue samples and 20 per cent of chikungunya samples were positive. The team tested 72 samples for the presence of both dengue and chikungunya antibodies. About 3 per cent of these samples tested positive for both the diseases [virus infections].

"Areas affected by the chikungunya virus overlap with dengue fever-endemic areas and provide opportunities for mosquitoes to become infected with both the viruses," the team pointed out. They added that missing out signs of one disease is always plausible if diagnostic tests for both are not performed, and the presence of one does not rule out the other.

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

[It would not be surprising if individuals residing in areas where both dengue and chikungunya outbreaks are occurring were infected with both viruses as the authors of this study indicate. However, this study is based on the results of tests with commercial kits that measure IgM antibodies (see original article cited below).

Firstly, it is necessary to show that the serological reactions observed were specific for dengue and chikungunya viruses. Serological tests with ELISA kits alone, without demonstration of virus presence by isolation or RT-PCR or confirmation by other, more specific serological tests, should be interpreted with caution. Serological cross reactions among different flaviviruses such as dengue, Japanese encephalitis, West Nile virus and others can further complicate interpretation of results. The USA CDC always confirms these types of positive serological test results with more virus-specific, 90 per cent plaque-reduction neutralization tests, which were not done in the above study.

Secondly, IgM can persist for months or even beyond a year in some individuals following an acute dengue or chikungunya virus infection. The authors presume that because IgM was detected that reacted with both dengue and chikungunya virus antigens, those individuals were simultaneously infected with both viruses. That may not necessarily have been the case in all or even most of them. It is possible that some of these individuals in the above study were, in fact, infected with both dengue and chikungunya viruses but serially, not simultaneously. The authors of the study are correct in that both viruses should be considered when the clinical picture that they mention is observed. Mixed outbreaks can and do occur.

Reference for the original above report:
Kalawat U, Sharma KK, Reddy SG. Prevalence of dengue and chickungunya fever and their co-infection. Indian J Path Microbiol 2011. 54 (4):844-6. http://www.ijpmonline.org/article.asp?i ... st=Kalawat.

References for IgM persistence provided by Dr. Charles Calisher:

Dengue:
Prince HE, Matud JL. Estimation of dengue virus IgM persistence using regression analysis. Clin Vaccine Immunol. 2011 18(12):2183-5.

Nogueira RM, Miagostovich MP, Cavalcanti SM, Marzochi KB, Schatzmayr HG. Levels of IgM antibodies against dengue virus in Rio de Janeiro, Brazil. Res Virol. 1992 143(6):423-7.

Other flaviviruses:
Roehrig JT, Nash D, Maldin B, Labowitz A, Martin DA, Lanciotti RS, Campbell GL. Persistence of virus-reactive serum immunoglobulin m antibody in confirmed West Nile virus encephalitis cases. Emerg Infect Dis. 2003 9(3):376-9.

Chikungunya:
Malvy D, Ezzedine K, Mamani-Matsuda M, Autran B, Tolou H, Receveur MC, Pistone T, Rambert J, Moynet D, Mossalayi D. Levels of IgM antibodies against dengue virus in Rio de Janeiro, Brazil. Res Virol. 1992 143(6):423-7.

Calisher, C.H., A.O. El Kafrawi, M.I. Al D. Mahmud, A.P.A. Travassos da Rosa, C.R. Bartz, M. Brummer Korvenkontio, S. Haksohusodo, and W. Suharyono. Complex specific immunoglobulin M antibody patterns in humans infected with alphaviruses. J Clin Microbiol 1986 23:155-9.
- Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH, http://healthmap.org/r/1pSH]