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CHIKUNGUNYA (04): INDIA (KERALA)
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Date: Fri 9 Mar 2012
Source: Times of India [edited]
http://timesofindia.indiatimes.com/city ... 201800.cms


Chikungunya [virus] has popped up once again in Thiruvananthapuram, especially in the coastal belt. According to sources, 10 chikungunya cases were reported from the coastal region of Anchuthengu alone where over 500 cases of fever have been reported in the past 2 weeks.

The district medical officer told TOI that blood samples would be collected from this area on Monday [12 Mar 2012] and sent for testing to the National Institute of Virology in Pune for confirmation.

Chikungunya [virus infection] cases came to light when samples collected from this area by the Rajiv Gandhi Centre for Biotechnology (RGCB) tested positive. Sources said that of the 20 odd samples collected, 10 had tested positive [positive for antibody or for virus? - Mod.TY].

"The fever is spreading. The district medical administration has been holding medical camps here at regular intervals. Even on Thursday [8 Mar 2012], our team was there following the RGCB findings. However, symptoms of chikungunya [virus infection] have not been found here. Anyway, we have decided to send the samples to the Pune institute for detailed examination," said Dr Peethambaran, DMO.

He said health workers were on the vigil in the region and were constantly reporting from the field. "It is a fact that the fever is spreading, but there is no fear of an outbreak," the DMO said.

According to health workers manning Anchuthengu, people cutting across all age groups have been affected by the fever. Fear also looms large, as 3 years ago this region was badly affected by chikungunya.

"We have strengthened our activities for source reduction and have provided adequate quantities of drugs to be distributed in the area. We are also in the process of finding the density of mosquitoes here," said the DMO.

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[This area is likely endemic for chikungunya virus. Concern about the spread is justified because although the case fatality rate is extremely low or nil, morbidity can be high. The severe arthralgia from the infection can be incapacitating, and in some cases may last for weeks or months after the acute infection. Last year (2011) there were many reports of chikungunya virus infections from various parts of India (cited in the see also section below), including Thiruvananthapuram in Kerala state in December 2011. There is no commercially available vaccine for chikungunya virus, so mosquito vector control and avoidance of mosquito bites is the only preventive measure available.

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

DENGUE/DHF UPDATE 2012 (11)
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- India (various states). February 2012. [Ronan Kelly () provided the following information taken from official India government statistics http://nvbdcp.gov.in/je-cd.html
State -- Cases/Fatalities (Change from previous month)
Haryana 1(+1)/0
Karnataka 422(+18)/0
Kerala 324(+143)/0
Maharashtra 25(+22)/0
Orissa 2(+2)/0
Tamil Nadu 434(+261)/1(+1)
Puducherry 64(+64)/1(+1)
Total 872(+512)/2(+2)

[A HealthMap/ProMED-mail interactive map of India showing the states mentioned above can be accessed at http://healthmap.org/r/1ZWf. - Mod.TY]

UNDIAGNOSED ILLNESS, CHILDREN - INDIA (JAMMU & KASHMIR) REQUEST FOR INFORMATION
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Date: Tue 13 Mar 2012
Source: Greater Kashmir [edited]
http://www.greaterkashmir.com/news/2012 ... age-55.asp


At least 8 children in [the frontier village of Tumina], about 32 km [20 mi] from Kupwara, have been disabled in the past one month due to an outbreak of a mysterious disease.

Residents of snowbound Tumina village nestled in Shamsbari mountain range are finding it hard to tackle the crisis as more and more children are getting disabled with each passing day. "Doctors are unable to diagnose the disease properly and treat the patients. People are making rounds of SKIMS [Sher-i-Kashmir Institute of Medical Sciences] and other medical institutions but to no avail," parents of 2 patients told Greater Kashmir.

They said their children are unable to speak and it seems that their nervous system, liver, eyes, and brain have got affected. Similarly parents of 3 other children said, "Hands and feet of our children have started bending and their arms and legs have stopped working; as a result they are unable to stand, work, and eat." Parents said they have been running from pillar to post to get their children treated but doctors are unable to treat them. "We rushed these patients to SKIMS Soura. Doctors told us to get some tests done but technicians at SKIMS expressed their inability saying that there are no facilities in the hospital for these tests," said a parent, adding, "Our children have been badly hit by this mysterious disease. Authorities are not paying any heed towards our plight."

Residents said that after repeated reminders and representations a team of doctors comprising Dr Nazir Ahmad and Dr Masrat Iqbal Nodal officer Integrated Disease Surveillance Project (IDSP) Kupwara visited the village 10 days ago and took the water samples from the bore wells and blood samples of the affected children and their parents. "Neither any medicine was given nor was report of the samples returned," they said.

Locals are up in arms against the officials of PHE [Public Health Engineering] department. "Our area has vast water resources like Chowkibal stream but the PHE department dug 8 bore wells around 250 feet [75 m] deep each at the whopping cost of Rs 2.50 crore [1 crore=10 million; about USD 500 000]. Without testing the water of bore wells they handed these to the residents of Tumina village with a population of 1500 souls. There could be several more cases of same disease as the entire village has been using the water of these bore wells since 2009."

The Sarpanch [elected head] of Tumina village appealed to Chief Minister Omar Abdullah and Union Health Minister Ghulam Nabi Azad to intervene and send a special team of doctors to the affected village and treat the children so that their lives are saved.

When contacted, Director Health Dr Saleem-ul-Rehman said, "The Directorate has not received any report from the concerned CMO [Chief Medical Officer], BMO [Block Medical Officer], or concerned IDSP unit. I have shot a letter to them. We are planning to send a team of doctors to the area to asses the ground situation."

[Byline: Shahid Rafiq]

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[An apparently disabling illness is affecting a number (at least 8) of children in this rural area of Kashmir. It is difficult to discern the nature of the illness from the scant details available in this report, but it appears to be evading diagnosis at medical facilities. There is no mention of fatalities. The illness affecting mentation suggests an encephalitis, but the mention of "bending" of hands and feet might suggest arthritis or arthralgias. Given the elevation of the region and time of year, mosquito-borne infections seem unlikely. An intoxication or nutritional cause might be possible. ProMED-mail would like to hear from anyone with knowledge of the situation.

The HealthMap/ProMED-mail interactive map of India can be seen at http://healthmap.org/r/1_R2. Kupwara is located about 90 km [56 mi] from the state capital Srinagar. - Mod.LM]

[India reports half-a-dozen outbreaks of undiagnosed disease every year -- see below-- and we never see a final diagnosis. If the National Institute of Virology does not have the capability to diagnose them, CDC Atlanta or the Institut Pasteur of Paris would be glad to receive samples. - Mod.JW]

UNDIAGNOSED ILLNESS, CHILDREN - INDIA (02):(JAMMU & KASHMIR) WILSON'S DISEASE
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Date: 13 Mar 2012
Source: Rising Kashmir [edited]
http://www.risingkashmir.com/news/rare- ... 23072.aspx


Rare disease grips Kupwara village
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State IDSP lab unable to check metal content of water

People of Tumina village of north Kashmir's Kupwara district are worried with at least 5 local children, including a class 10 girl student, catching a rare disease.

Authorities are yet to come out with a report of water samples they took a week back from the village wells to ascertain the copper content. When contacted, State Nodal Officer Integrated Disease Surveillance Project (IDSP), Dr Rehana told Rising Kashmir that the state IDSP lab is not able to check even the metal content of the water. She added that the disease is not water borne.

Some of the symptoms shown by the affected people are: abnormal posture of arms and legs, difficulty in moving arms and legs, impairment of speech, shaking arms or hands, uncontrollable movement and weakness.

Based on the symptoms, experts declared that it was a rare disease called Wilson's disease. The disease, according to them, causes the body to take in and keep too much of copper.

"The deposits of copper cause tissue damage, which causes the affected organs to stop working properly," they say.

Suffering from speech and limb impairment, Rizwan Farooq (10) of Sarpanch Mohall Tumina has been discharged untreated from neurology department of SKIMS Soura a fortnight ago while as Danish Mehmood (11) of Haji Mohala Tumina, suffering from uncontrolled movement and weakness for the past 10 days, is presently receiving treatment at SKIMS.

While declaring the disease as Wilsons' Disease, diagnostic reports received from Lal Path Labs Delhi has revealed 99.22 per cent copper rate in the body of one of the patients, which as per the physicians can lead to permanent disability.

A team from department of communication and capacity development unit in association with WENTEP declared water of the village wells unfit for drinking purposes owing to overconcentration of ammonia, and iron content and unpleasant taste/odor of the water.

IDSP was launched by Union Minister of Health & Family Welfare in November 2004. It is a decentralized, State based Surveillance Program in the country. It is intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner.

Major components of the project are : (1) Integrating and decentralization of surveillance activities; (2) Strengthening of public health laboratories; (3) Human Resource Development - Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team, other medical and paramedical staff; and (4) Use of Information Technology for collection, collation, compilation, analysis and dissemination of data.

Tumina residents allege that the PHE department throw bore wells open for public in the village without checking copper content of the water.

A local physician, wishing not to be named, suggested that the health department should carry out intensive and mass surveillance of the local populace so that the disease could be controlled as quickly as possible.

As the health department has prohibited use of bore well water, locals in the absence of water, boil snow piled in their backyards for drinking purpose.

MLA Kupwara, Mir Saifullah lashed out at health authorities for "half hearted" measures. Questioning the delay in the IDSP report, he demanded that an expert team of doctors be sent to the area to carry out extensive examination of whole population immediately.

He also demanded alternative water supply for the locality.

Meanwhile, CMO Kupwara assured that a team of doctors will visit the area soon to take stock of the situation.
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Communicated by:
Ronan Kelly" http://www.wilsonsdisease.org/wilson-di ... rrings.php

Portions of this comment have been extracted from:
http://digestive.niddk.nih.gov/ddiseases/pubs/wilson/ and http://www.wilsonsdisease.org/wilson-di ... atment.php


References:
(1)Olivarez M, Caggana M, Pass KA, Ferguson P, Brewer GJ. Estimate of the frequency of Wilson's disease in the US Caucasian population: a mutation analysis approach. Annals of Human Genetics. 2001;65:459–463. -- Mod.TG]

TYPHOID FEVER UPDATE 2012 (07)
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India (Karnataka)
Date: Tue 13 Mar 2012
Source: The Soft Copy [edited]
http://www.thesoftcopy.in/city_deepashri_health.html


The number of typhoid cases recorded in a government hospital in rural central Karnataka almost tripled to 757 in 2011 from the 2009 figure of 260. The Harapanahalli Town government hospital is one of 16 such health centers spread across the Harapanahalli Taluk [subdistrict].

The taluk is located in Davanagere District. As of mid-February 2012, over 360 patients had been treated for typhoid in the Harapanahalli Town government hospital and Harapanahalli specialty clinic, a private practice in the area.

"5 to 10 patients are tested positive every day," said Jagadish, a lab technician at the Harapanahalli Town government hospital. Some patients have recurrent attacks.

Municipal Councillor G. Bashusaheb of Agasena Katte, Third Ward, Harapanahalli Town, said work is in progress for the construction of underground drains in slums, where typhoid is common, to improve sanitation. "Only in rural areas do you find cases of typhoid," said Senior Health Inspector H. Kantharaj. He said he is only responsible for the town and not the villages beyond. The taluk health officer is responsible for rural health care, he said.

[Byline: Deepashri Varadharajan]

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DENGUE/DHF UPDATE 2012 (12)
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- Pakistan (Lahore, Punjab province). 14 Mar 2012. Some 60 patients with dengue symptoms have been admitted in Lahore's different hospitals as the deadly mosquito-borne disease has reemerged in Punjab.
http://www.brecorder.com/pakistan/gener ... unjab.html

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

LEPROSY - INDIA (03)
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Date: Wed 21 Mar 2012
Source: The Indian Express [edited]
http://www.indianexpress.com/news/new-l ... ik/926373/


New cases of leprosy coming up across Maharashtra, Uttar Pradesh, and Bihar should serve as a wake up call for the government to take proper action, Ram Naik, former Petroleum Minister said at a press conference on Tuesday [20 Mar 2012].

The government had declared that leprosy had been eliminated in 2005 but new cases have been detected. While there are 126 800 leprosy-affected persons in India, the highest numbers are in Uttar Pradesh, Bihar, and Maharashtra. Maharashtra State Leprosy Officer Dr Pradeep Gaikwad had recently said that 2440 new cases have been identified in 19 districts of Maharashtra.

According to Dr SD Gokhale, president, International Leprosy Union, an action plan has been worked out to work for leprosy-affected people in colonies at Dapodi, Pandharpur, Kolhapur, Ahmadnagar, and Ulhasnagar. They will set up Bal Vikas Kendras [child development centres] which will look into education, health, and nutrition of children, integration of leprosy-affected persons in the main stream of society, creation of awareness about human rights, and help for the groups of women.

Naik said they had submitted a petition to Parliament to empower leprosy-affected persons way back on 5 Dec 2007. The petition had been signed by Dr SD Gokhale, Dr PK Gopal of National Forum of Leprosy, Uday Thakar of Kusht Rog Nivaran Samiti, Baliram Tambade of Maharashtra Kushthapidit Sangathna, and others.

Several recommendations were made on empowering leprosy-affected persons and were submitted to President Pratibha Patil on [14 Sep 2011]. Demands included formulation of a comprehensive socio-economic rehabilitation policy for empowerment of leprosy-affected persons, enhancement of pension to Rs. 2000/- [USD 39] per month and provision of civic amenities to self-settled colonies of these persons.

According to Gokhale a demand was also made to conduct a new country-wide survey to assess the increase or elimination of leprosy. But no demands were addressed. On [13 Mar 2012] Health Minister Ghulam Nabi Azad admitted that India's share of leprosy-affected persons was 55 percent, which was alarmingly high.

"The new cases are a wake up call to the governments to take concerted action. It is also necessary that various NGOs working on all India basis as well as in Maharashtra for elimination of leprosy and empowerment of LAPs [leprosy-affected persons] should work together," Gokhale added.

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[A map of the states of India can be accessed at http://www.globalsecurity.org/military/ ... ourism.gif. The HealthMap/ProMED-mail interactive map of India can be accessed at http://healthmap.org/r/1pSH.

Leprosy is a chronic disease caused by a bacillus, _Mycobacterium leprae_ (http://www.who.int/mediacentre/factsheets/fs101/en/). _M. leprae_ multiplies very slowly and the incubation period of the disease is about 5 years. Symptoms can take as long as 20 years to appear. Leprosy is not highly contagious. But because lepromatous patients with the lepromatous form of leprosy excrete enormous numbers of leprosy bacilli in their nasal secretions, a case of untreated lepromatous leprosy poses increased risk for infection for close, long-term contacts, such as household members. Casual and short-term contact does not seem to spread the disease. As the organism is also present in lepromatous skin lesions, skin contact is thought to be another mode of spread. Because the organisms that are shed by lepromatous patients can persist on surfaces in the environment, fomites are also a potential source of infection.

Drugs used to treat leprosy (dapsone, rifampin, and clofazimine) are provided by WHO free to all patients in the world since 1995 (see http://www.novartis.com/corporate-respo ... rosy.shtml). Patients are no longer infectious after the 1st dose of the treatment regimen. Patients with paucibacillary leprosy treated with rifampin and dapsone are cured within 6 months and multibacillary patients treated with rifampin, dapsone, and clofazimine are cured within 12 months.

When WHO says that leprosy has been "eliminated" in a region, they do not mean eliminated completely. WHO defines elimination of leprosy as a public health problem if the prevalence is less than one case per 10 000 population. The global disease burden fell from 5.2 million in 1985, to 805 000 in 1995, to 753 000 at the end of 1999, to about 219 826 cases at the end of 2005, with a prevalence rate of about 0.2 per 10 000 population.

The Southeast Asia Region (SEAR), including India and Sri Lanka, achieved the elimination goal in December 2005. The SEAR prevalence rate steadily declined from 4.6 per 10 000 population in 1996 to 0.82 per 10 000 population as of July 2006. The SEAR new case detection also declined from a peak of 47.8 per 100 000 in 1998 to 11.9 per 100 000 as of March 2006 (http://www.searo.who.int/en/Section10/S ... on2293.htm). The 2005 prevalence rate in India was 0.88 per 10 000 (http://www.searo.who.int/en/Section10/S ... _12162.htm) and in Sri Lanka 0.65 per 10 000 (http://www.searo.who.int/en/Section10/S ... _12169.htm).

However, 2 countries in the SEAR, Nepal and Timor-Leste (East Timor) are yet to achieve elimination (http://www.searo.who.int/en/Section10/S ... on2293.htm).

However, pockets of high endemicity still remained in some areas of Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and the United Republic of Tanzania. India, Brazil, and Indonesia are the 3 countries that have the greatest number of leprosy cases. The top 10 countries in new case detections in 2005 are India, Brazil, Indonesia, DR Congo, Bangladesh, Nepal, Mozambique, Nigeria, Ethiopia, and Tanzania. Together, they constitute about 96 percent of year 2005's global new case detections. The SEAR contributed about 69 percent of 2005 global new case detections. Globally, 296 499 new cases of leprosy were detected during 2005. In 2008, about 213 000 people mainly in Asia and Africa were infected, with approximately 249 000 new cases reported worldwide. In 2010, Southeast Asia continues to account for the most of the global leprosy burden, with more than 50 percent of the world's cases reported from India (ProMED-mail Leprosy - India (02): background 20120127.1024258). New cases of leprosy among children, as reported in the news above, from India and Sri Lanka, would be an indication of ongoing transmission in the community.

WHO emphasizes that sustained political commitment and adequate resources for leprosy services are required, especially for currently under-served population groups such as those in remote rural areas and urban slums, and migrant laborers, to sustain elimination at national levels and to progress towards further reducing the burden of leprosy. Also strengthening integration of leprosy services into the general health system through capacity building and skill development is required to ensure and sustain quality leprosy services, including diagnosis and treatment and prevention/care of disabilities (http://www.searo.who.int/en/Section10/S ... on2293.htm). - Mod.ML]

MALARIA - INDIA (02): (GUJARAT)
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Date: Wed 4 Apr 2012
Source: Daily News & Analysis (DNA) [edited]
http://www.dnaindia.com/health/report_m ... 12_1671443


Malaria cases double in Ahmedabad in 2012
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Mosquitoes are back with their menace in Ahmedabad [Gujarat state] as the number of patients suffering from the disease [malaria] has doubled this year [2012]. The city has reported 630 cases of the disease in January-March 2012, up from 300 during same time last year [2011].

Civic body officials attribute this increase to re-occurrence of the disease and increase in areas under their surveillance. However, there is hardly any difference in number of _Plasmodium falciparum_ (Pf) but there is almost a 100 percent increase in cases of _Plasmodium vivax_ (Pv) strain of malaria.

According to IK Patel, deputy municipal commissioner, AMC [Ahmedabad Municipal Corporation] health department, re-occurrence of malaria in the last couple of months of 2011 is the reason for a surge in number of cases reported in January-March, 2012. "We have asked health officials to submit exact data of re-occurrence so that necessary action can be taken," said Patel.

Meanwhile, AMC has chalked out an action plan to combat the increased incidences of Pv malaria in the city. Around 500 people have been recruited by the civic body to conduct door-to-door survey to get a definite number of malaria cases in the city. This will increase area under surveillance of AMC from 40 percent to almost 100 percent. There will also be a substantial increase in number of patients screened from the current 30 percent after this surveillance, said sources in AMC's health department.

Apart from the vector-borne disease, a large number of people in the city are suffering from gastroenteritis, jaundice, typhoid, dengue, and cholera. However, there is 50 percent reduction in number of these cases compared to last year [2011].

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[Ahmedabad is the largest city in the state of Gujarat, between Pakistan and Mumbai. _P. vivax_ is endemic and _P. falciparum_ is seen. According to the National Vector Borne Diseases Control programme (http://nvbdcp.gov.in/Doc/mal-situation-Feb12.pdf), Gujarat has reported 3095 malaria cases in 2012 of which 728 were from _P. falciparum_, with no deaths. On this background 150 cases alone in the main city, Ahmedabad, seems many. Furthermore, malaria is most probably underreported.

Ahmedabad can be located on the HealthMap/ProMED-mail interactive map of India at http://healthmap.org/r/1iSU. - Mod.EP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (11): ASIA
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Chila - India (Karnataka)
Date: Thu 5 Apr 2012
Source: Daily News and Analysis (DNA) [edited]
http://www.dnaindia.com/health/report_m ... es_1671799


If you are planning to visit Mysore, ensure that you carry safe drinking water and stick to eating homemade food. The city has reported 34 cases of cholera, said Mysore City Corporation officials on Wed 4 Apr 2012. The Epidemic Hospital is treating the patients.

Health officer Dr Nagaraj said cases have been reported from Metagalli, Kumbarakoppal to Kuvempunagar to Gangotri Layout. He attributed the outbreak of cholera to the poor quality of water supplied in hotels.

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SCRUB TYPHUS - INDIA (04): (KERALA) FATAL
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Date: Wed 4 Apr 2012
Source: Yentha [edited]
http://www.yentha.com/news/view/1/alarm ... ub-typhus-


The death of a 5-year-old child from the coastal area of Poonthura [Thiruvananthapuram, Kerala] has triggered panic over the possibility of scrub typhus. Health officials however declined to confirm saying that it was difficult to diagnose, although they too suspect this fever.

"Scrub typhus is not so common in Trivandrum [Thiruvananthapuram]. We have come across many suspected cases, but nothing has been diagnosed beyond doubt. This type of fever is more common in Calicut, Kannur, Wayanad, and Kasargod [Kerala]. The child from Poonthura is only a suspected case but it was not detected completely.

However reliable sources in Trivandrum Medical College said a few cases had tested positive for the fever but were unable to give out the details. "Even though this is a very rare disease, a few cases have been found positive to be scrub typhus over the past 4 months," said an official from Medical College.

Scrub typhus is one of the most common infectious diseases of rural southern Asia, south eastern Asia, and the western Pacific, caused by the microorganism _Orientia tsutsugamushi_. Experts from Trivandrum Medical College say that almost 12 states in India have reported an increase in the number of the disease in the past 6 years.

Also known as tsutsugamushi fever, scrub typhus is treatable but it can get out of hand when diagnosis is delayed or the incorrect antimicrobial agent is used. "If detected early, we can cure it with doxycycline or azithromycin but if not diagnosed, there are chances that the patient may die of circulatory failure or related complications," added the district medical officer [DMO].

This fever was first identified in Kerala in 2006 in the Malabar areas. "It is difficult to diagnose through clinical symptoms. Doctors usually look for scabs or black scars caused by arthropod bite. The Weil-Felix test can confirm the infection, but sometimes it might show falsely positive due to some urinary tract infections," said the DMO.

Scrub typhus occurs most commonly among people in contact with overgrown terrain, forest clearings, reforested areas, and new settlements in certain areas of Kerala. The disease is seen after rains when arthropod carriers that live in shrubs are disturbed.

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[Scrub typhus is an acute febrile illness characterized by a typical eschar, generalized lymphadenopathy, skin rashes, and vague non-specific symptoms such as myalgia, headache, and cough. It is characterized by focal or disseminated vasculitis and perivasculitis, which may involve the lung, heart, liver, spleen, and central nervous system. Acute respiratory distress syndrome (ARDS) is a serious complication of scrub typhus; encephalitis, interstitial pneumonia, myocarditis and pericarditis, acute renal failure, acute hepatic failure, and acute hearing loss can also occur in patients with scrub typhus. In a review of 297 cases of the disease (Lee CS, Hwang JH, Lee HB, Kwon KS: Risk factors leading to fatal outcome in scrub typhus patients. Am J Trop Med Hyg 2009; 81: 484-8; http://www.ajtmh.org/content/81/3/484.long), a case-fatality rate of 6.7 percent was reported.

Weil and Felix described the classical assay for rickettsial antibody detection in 1916. The methodology took advantage of heterophilic (cross-reacting) antigens of members of the genus _Rickettsia_ and several species of the Gram negative bacillus _Proteus_. In the Weil-Felix test, bacteria of _Proteus vulgaris_ OX-19 agglutinate with sera of those infected with typhus group organisms as well as from the Rocky Mountain spotted fever (RMSF) organism _Rickettsia rickettsii_. Cells of _P. vulgaris_ OX-2, on the other hand, agglutinate with sera from individuals with spotted fever infection, except RMSF. The OX-19 agglutination is seen in epidemic typhus, but usually not in Brill-Zinsser recrudescent disease. _P. mirabilis_ OX-K can be similarly used in the serological diagnosis of scrub typhus. Because of the relatively poor sensitivity and specificity of this test, more specific assays can be used for diagnosis, including one for complement fixation antibodies. - Mod.LL

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

DENGUE/DHF UPDATE 2012 (15)
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- India (Srivilliputhur, Tamil Nadu state). 6 Apr 2012. The medical team camping at Managaseri village in Srivilliputhur diagnosed 2 more children with suspected dengue on Thursday [5 Apr 2012]. Five children who were suspected to have dengue were admitted to a private hospital, and the medical team, which was camping in the village, diagnosed 2 others on Wednesday [4 Apr 2012] evening.
http://articles.timesofindia.indiatimes ... ngue-fever

[A map showing the location of Srivilliputhur, Tamil Nadu state can be accessed at http://en.wikipedia.org/wiki/Srivilliputhur. - Mod.TY]

- Pakistan (Karachi, Sibndh province). 3 Apr 2012. Karachi is the only district in the province that has continued to register dengue fever positive cases during the current year [2012]. A senior official of Sindh Dengue Surveillance Cell told APP on Monday [2 Apr 2012] that 16 patients suspected to be suffering from dengue fever had to be admitted to different hospitals in the city, while another 17 were attended to at outpatient departments since 1 Jan 2012. "Relevant laboratory investigations identified all these 33 cases to be positive [for dengue virus infection] during necessary investigation," he said in reply to a question.
http://www.thefrontierpost.com/article/155346/

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

Indien - Malaria
10.04.2012

Von Jahresbeginn bis Ende Februar wurden landesweit 92.467 Fälle registriert, der Anteil an Erkrankungen durch Plasmodium falciparum (Malaria tropica) ist auffallend hoch (58.034 bzw. 63%). 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 im vergangenen Jahr offiziell etwa 1.278.760 Fälle bestätigt. Mindestens 463 Menschen sind an der Erkrankung verstorben. Es ist davon auszugehen, dass die tatsächlichen Fallzahlen mehrfach höher sind. Dringend Mückenschutz und ggf. Malariaprophylaxe beachten. / Quelle: crm

Gruß
Birgitt

CHICKENPOX - INDIA (02): (CHENNAI)
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Date: Sun 15 Apr 2012
Source: The Times of India, Chennai [edited]
http://timesofindia.indiatimes.com/city ... 668517.cms


Chickenpox cases on the rise
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CHENNAI: As the temperature in the city soars, doctors say they are seeing an increase in the number of chickenpox cases. That's usual for summer, but this time, doctors say, more pregnant women and newborn babies have been infected.

Chickenpox is a mild, but highly infectious condition caused by the Varicella-Zoster virus. The virus is highly contagious, especially between March and May. It spreads through the air when an infected person coughs or sneezes, or through contact with the fluid from chickenpox blisters. While it is most commonly found in children under 10, doctors say one can contract the disease at any age.

Pregnant women and newborns, who tend to have a weaker immune system, are the most at risk. Unlike children, pregnant women can't be vaccinated against the disease. When infected, those in the early stages of pregnancy are advised abortion and those infected a week before labour are closely monitored. "In the last 10 days, I have seen three cases. One of them went in for abortion. We are monitoring the other who is 24 weeks pregnant," said Apollo Hospital obstetrician gynaecologist Dr Jayashree Gajaraj.

If the infection occurs in the early stages of pregnancy, it can cause serious problems to the child's development -- it may be blinded by cataract formation or have serious nervous problems. If it occurs a week before delivery, it can be passed on to the child. Such children are also generally very sick, said neo-natologist Dr Deepa Hariharan of Sooriya Hospitals. "One infected infant was less than a week old. It had severe shock and liver dysfunction. We had to work hard to help her survive and she was just lucky," she said.

The incubation period for chickenpox is generally 14 to 16 days. It begins with rashes resembling "crops" of multiple, small red bumps similar to insect bites. These quickly develop into fluid-filled blisters which burst. Rashes usually appear on the upper body before spreading. Blisters can also appear in the mouth, throat and genital area. Groups of blisters can appear for several days with all stages of the rashes simultaneously being present.

But the disease is harmless in most children, says paediatrician Dr S Balasubramaniam. "I advised most patients to be vaccinated. Even if vaccinated children are infected, the severity of the disease isn't very high," he said. Those infected are advised to take lots of fluids and be quarantined at home.

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[Chickenpox is a very contagious disease caused by varicella-zoster virus (VZV), a herpes virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox nor received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters. VZV also causes shingles. A person with shingles can spread the virus to others who have never had chickenpox or received the chickenpox vaccine. In these cases, the exposed person might develop chickenpox.

Chickenpox can be prevented by vaccination. In many countries there is a policy of universal vaccination of all children by the age of 14 to 15 months. However, in India, although chickenpox vaccine is available in private practice, it does not yet form part of the National Immunisation Schedule.

In February of this year an increase in cases of chickenpox virus infection was reported also in the in city of Mumbai on the opposite coast of India, similarly attributed to the onset of summer [see: Chickenpox- India: (Mumbai) 20120225.1052634. Ultraviolet (UV) rays should help prevent the spread of chickenpox, therefore people in milder climates should be more at risk of catching the disease. However the peak incidence of chickenpox in India and Sri Lanka appears to be during the hot, dry, sunny season. This anomaly has been explained because UV rays are actually much lower in the dry season compared with the monsoon period. In the dry season, the pollution in the atmosphere reflects the UV rays back into space. Whereas in the monsoon season, the rains wash away the pollution, and UV irradiation is increased. (For further discussion see: Science Daily 15 Dec 2011
http://www.sciencedaily.com/releases/20 ... 094921.htm.

Chennai, formerly known as Madras, is the capital city of the Indian state of Tamil Nadu. It is located on the Coromandel Coast off the Bay of Bengal. It is a major commercial, cultural, and educational centre in South India, and the port of Chennai is the second largest port in India. The location of Chennai can be found in the interactive HealthMap at: < http://healthmap.org/r/2bxj>. - Mod.CP]

DENGUE/DHF UPDATE 2012 (16)
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- Pakistan (Karachi, Sindh province). 13 Apr 2012. Dengue epidemic is once again raising its ugly head in Karachi as more than 100 patients have been confirmed dengue-positive in the city's different hospitals so far, whereas Sindh Health Department insists that there are only 34 cases on record, Geo News reported.
http://www.geo.tv/GeoDetail.aspx?ID=44286

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (12): AFRICA
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Cholera - India (Bangalore, Karnataka State)
Date: Thu 12 Apr 2012
Source: Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... pital-h1n1


Close on the heels of a H1N1 scare, cholera and gastroenteritis have sparked an epidemic scare in Bangalore. 5 cases of cholera have been reported from a private hospital in Chikkalalbagh area, near Majestic, said Dr Manoranjan Hegde, nodal officer, communicable disease, BBMP.

When contacted, Dr Chandrashekar Malagi, Joint Director, Communicable Diseases, State Health and Family Welfare Department, said there were 2 more cholera cases reported from Isolation Hospital. "However, in a city like Bangalore it is not a huge number. The climate is such that there could be more cases of cholera. Unless, there are too many cases reported, there is no need to panic," he said.

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[The HealthMap/ProMED-mail interactive map of India can be seen at http://healthmap.org/r/1Hg8. - Sr.Tech.Ed.MJ]