Wüstenschiff

Kasachstan - Milzbrand
22.09.2008

Am 12. September wurde bei 5 hospitalisierten Patienten im Süden Kasachstans die Diagnose Milzbrand bestätigt. In Zentralasien wird häufig das Fleisch verendeter Tiere ohne veterinärmedizinische Kontrolle auf den Markt gebracht. Nahrungsmittelhygiene beachten.
_______________________

Kirgisistan - Milzbrand
22.09.2008

Mitte September werden zwei Ausbrüche von Milzbrand bestätigt. Hierbei sind 14 Personen in der Region Batken erkrankt, 6 in Jalal-Abad. In Zentralasien wird häufig das Fleisch verendeter Tiere ohne veterinärmedizinische Kontrolle auf den Markt gebracht. Nahrungsmittelhygiene beachten.

JAPANESE ENCEPHALITIS - INDIA (03): (UTTAR PRADESH): REQUEST FOR INFORMATION
***************************************************************************
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Date: Mon 22 Sep 2008
Source: Thaindian News, ANI report [edited]
<http://www.thaindian.com/newsportal/ind ... 98485.html>


Japanese encephalitis outbreak feared in Uttarakhand
----------------------------------------------------
Doctors of Haldwani district in Uttarakhand fear an outbreak of the
much-dreaded Japanese encephalitis fever, as 5 patients complaining
about fever have been admitted in a local hospital.

The medical officials have sent few blood samples of the infected
patients to National Institute of Communicable diseases in New Delhi
for examination.

The officials are eagerly awaiting the results so that they can
ensure proper immunization before the disease grips the state.

"Few blood samples of the patients have been sent to Delhi of which
[3 are from patients from the medical division and 2 are from
[Memorial Forest division]. After their reports come [we will be
able] to say whether they are suffering from Japanese encephalitis or
not," said Balbir Chabbra, medical superintendent, Sushila Tiwari
Memorial Forest Hospital, Haldwani.

The symptoms of Japanese encephalitis virus [infection] are seemingly
mild, but the disease can cause meningitis and inflammation of the
heart in newborn babies.

India's worst encephalitis outbreak in 2005 claimed over 1500 lives.

According to doctors, the death rate due to Japanese encephalitis
[infection] is 28-56 percent.

The deadly Japanese encephalitis fever is caused by a virus found in
pigs and wild birds and transferred to humans by mosquito bite. It
affects the brain and causes headaches, convulsions, high fever, and
respiratory distress.

Many survivors are left mentally or physically handicapped.

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

[Establishing a diagnosis of Japanese encephalitis virus (JEV)
infection in these cases will require laboratory confirmation.
ProMED-mail requests information concerning the laboratory results
when they become available.

Uttar Pradesh is experiencing an outbreak of encephalitis cases,
presumably due to JEV infection.

Uttarakhand is approximately 210 km (130 miles) north of Delhi, and
nearly 500 km (310 miles) northwest of Gorakhpur, where an
encephalitis outbreak, also presumably due to JEV, has caused almost
372 cases and 88 deaths.

The Uttar Pradesh state health minister indicated that vaccine sent
to the state was unfit for human use, with a resulting delay in the
JEV vaccination drive, leaving many individuals unimmunized and
susceptible to JEV infection (see ProMED-mail archive no. 20080918.2924).

For a map of India with states, see
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.

For the interactive HealthMap/ProMED map of India with links to other
recent ProMED-mail postings on events in India and surrounding areas,
see <http://healthmap.org/promed?v=22.9,79.6,5>. - Mod.TY]

CHIKUNGUNYA (43): INDIA (WEST BENGAL)
*************************************
A ProMED-mail post
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Date: Tue 14 Oct 2008
Source: The Times of India (TNN) [edited]
<http://timesofindia.indiatimes.com/Kolk ... 592197.cms>


Tests have confirmed that 4 patients have chikungunya and 2 dengue in
Budge Budge and Bishnupur II blocks of South 24-Parganas. The 6 are
from Moukhali village in South Bishnupur.

Numerous others from the village show symptoms of these diseases with
complaints of high fever, body and joint pain, vomiting, and rashes
on their bodies. Though official figures put the number of ailing at
250-300, local leaders claimed at least 2500-3000 were suffering.

The district's chief medical officer health (CMOH) Sachidananda
Sarkar said, "More than 100 people have been admitted to the local
Muchisa Hospital in Nodakhali." Others are admitted to nearby
hospitals and to the only nursing home in the area. Hospitals are
forced to turn away patients for the lack of beds.

The authorities have set up 3 medical camps in the 2 blocks. Sarkar
said the number of medical camps will be increased and more medical
teams spread out in the villages and make door-to-door visits from
Wednesday [15 Oct 2008]. "We are monitoring the situation and will
take all necessary steps to tackle it," said Sarkar.

[Byline: Monotosh Chakraborty]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[This confirms that both dengue and chikungunya viruses are
circulating in the same locality, and not far distant where a recent
chikungunya outbreak was reported on 1 Oct 2008 (see ProMED-mail
archive no. 20081002.3112) in the district to the immediate east. The
6 cases (4 of chikungunya virus infection and 2 of dengue virus
infection) appear to be the very small tip of a large iceberg.

Differentiating dengue cases from chikungunya cases will not be
easily accomplished without laboratory support. Measures to control
virus transmission for both viruses are the same -- reduction of
populations of the vector _Aedes_ mosquito with emphasis on
elimination of water catchments that serve as breeding sites in
houses and other buildings.

A map of India showing the location of West Bengal state can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>
and a map of West Bengal state showing the location where these cases
occurred, can be accessed at
<http://en.wikipedia.org/wiki/Bishnupur_ ... _Parganas)>.
The HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/promed?g=1252881&v=22.9,79.6,5>. - Mod.TY]

FOOD POISONING, LIQUID SWEETS - INDIA: (MAHARASHTRA) TOXIN SUSPECTED,
REQUEST FOR INFORMATION
*********************************************************************************************
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Date:10 Oct 2008
Source: WebIndia123.com [edited]
<http://news.webindia123.com/news/articl ... 74405.html>


More than 200 affected by food poisoning
----------------------------------------
More than 200 people, most of them children, were admitted to various
hospitals due to the poisoning after consuming Basundi (a form of
liquid sweet), which was purchased from Pradeep Sweet Mart at Nigdi
area of the city [Pune, Maharashtra state] here this evening [10 Oct 2008].

Police said that 3 persons who [were] reported to be [in] serious
[condition] have been admitted to government hospital at Nigdi.
Police said around 190 people have been admitted in various
hospitals. 8 members of Sharangadhar family were affected in the
incident. The PCMC medical officials have send the sample for
inspection. Police have sealed the shop, and arrested the owner of
the sweet mart.

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

[While not specifically mentioned in the newswire, the above event
occurred in Pune, located in Maharashtra state. The above newswire is
vague in terms of a description of the symptoms associated with
ingestion of the sweet liquid product, and epidemiologic information
other than suggesting that the symptoms had onset presumably soon
after ingestion of the implicated product, a severe illness requiring
hospitalization and a predominance of children affected. This paucity
of information makes any speculation regarding the actual cause
rather difficult. The implicated etiologic "agent" (?toxin) is most
likely something that is water soluble as it appears to have been in
the sweet liquid. The preponderance of children affected may well
reflect the contaminated product, a sweet liquid, being a product
preferred by children, although that information is not provided in
the above newswire.

Some heavy metals are water soluble as are other toxins like ethelene
glycol and blue-green algae toxins. The sweet liquid could
potentially contain a variety of bacterial toxins.

Hopefully some test on the substance is being conducted. We look
forward to some more authoritative information when available.
For a map of India with states, see
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.
For a map of Pune showing the Nidgi area where the event is reported
to have occurred, see
<http://maps.google.com/maps?hl=en&q=map ... 1&ct=image>.
The Nidgi area is in the northwest of Pune, further out from the
center along route MH4 past Pimpri.

For the interactive HealthMap/ProMED map of India with links to other
recent ProMED-mail postings on events in India and surrounding
countries, see <http://healthmap.org/promed?v=22.9,79.6,5>. - Mods.TG/MPP]
......................mpp/tg/mpp/ejp/mpp

JAPANESE ENCEPHALITIS - INDIA (06): (WEST BENGAL, UTTAR PRADESH)
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
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<http://www.isid.org>

In this update:
[1] West Bengal - Kolkata
[2] Uttar Pradesh

******
[1] West Bengal - Kolkata
Date: Thu 16 Oct 2008
Source: Sundh Today.net [edited]
<http://www.sindhtoday.net/health/28771.htm>


A [34-year-old] man died of Japanese encephalitis 9 Oct [2008]. He is
the 1st victim of the disease in the city [Kolkata] in 10 years. The
man, a resident of Behala, was tested positive for Japanese
encephalitis in the confirmatory IgM test Sep 9 [2008]. He was
suffering from high fever and convulsions over the past 3 months and
died at the School for Tropical Medicine (STM) at Thakurpukur in
south Kolkata Oct 9 [2008], said his brother-in-law.

However, despite the IgM report, chief civic health officer
Debdaipayan Chattopadhyay said that the man did not die of Japanese
encephalitis. "The STM report shows that he died of pneumonia. He was
suffering from Japanese encephalitis one-and-a-half months ago,"
Chattopadhyay said.

--
Communicated by:
ProMED Rapporteur Brent Barrett

[Interestingly, dengue and chikungunya viruses are also circulating
in this area and causing human disease. This illustrates the need to
be alert to the possibility of multiple etiological agents occurring
in the same place at the same time.

A map of India showing the location of West Bengal state can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>, and
a map of West Bengal state showing the location where this case
occurred can be accessed at
<http://en.wikipedia.org/wiki/Bishnupur_ ... _Parganas)>.
The HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/promed?g=1252881&v=22.9,79.6,5>. - Mod.TY]

******
[2] Uttar Pradesh
Date: Thu 16 Oct 2008 17:19:51 -0700
From: Deborah Phillips
<dphillips@path.org>


Subject: Response to RFI on Japanese encephalitis in India
----------------------------------------------------------
With regard to reports on Japanese encephalitis cases and vaccines in
Uttar Pradesh, the situation has been confusing and reports somewhat
conflicting. In response to the moderator's request for further
details (ProMED post 20081014.3260), we would like to provide the
following information.

MOD: "If one understands the ongoing situation in Uttar Pradesh,
there has been a major outbreak of Japanese encephalitis this year,
with a large proportion of cases with a history of adequate
vaccination, and probably data that demonstrated a much lower than
expected vaccine efficacy in the state.... Further investigations in
the state revealed that many of the vaccine vial temperature monitors
had changed color, confirming that the vaccines had been exposed to
high temperatures for a period of time known to be associated with
significant potency loss."

* The encephalitis outbreak in Uttar Pradesh (UP) this year has not
actually been linked to JE infection. As of September 2008, as noted
in Dr T. Jacob John's posting (ProMED post 20080901.2738), the
outbreak was not thought by the Government Medical Officers to be JE.
Due to the similarity of symptoms between JE and other acute
encephalitis infections, clinical diagnosis is not reliable and
therefore laboratory confirmation is needed. While a small proportion
of samples have tested positive for JE (5 percent mentioned in ProMED
post 20080828.2697), there has been no confirmation at this point
that it is the cause of the larger outbreak. It was noted in a
previous posting (ProMED post 20080830.2718) that a team including
doctors from the Union Government, as well 2 from the US Centers for
Disease Control and Prevention, Atlanta, were visiting UP in late
August to investigate possible causes of the outbreak.

* Physicians in Uttar Pradesh have noted a substantial decrease in JE
cases admitted to hospitals since mass vaccination campaigns were
initiated in 2006 (ProMED post 20080901.2738)

* We are not aware of any data that demonstrate diminished vaccine
efficacy in UP in 2008.

* It is important to note there has been no evidence of any vaccines
with expired vaccine vial monitors (VVMs) reaching health centers or
being administered to any children. Changed vaccine vial monitors
(VVMs) were spotted immediately upon the states' receipt of shipments
at the cold stores, and appropriate officials were promptly notified.

MOD: "If the entire shipment is being deemed unworthy of use in Uttar
Pradesh as is suggested in the above newswire, it is hard to
understand why it will be okay to use in another state....
Clarification of the rationale here would be greatly appreciated --
but what is the definition of good vials -- stage II color indicator change."

* As noted in the article, officials have determined in accordance
with WHO guidelines that the vaccines in Stage II can still be used
and are viable for up to 2 months, so therefore will still be
suitable for use in states with campaigns to be completed within that
timeframe.

* One value of having different stages of heat exposure is to guide
vaccine management. Vials with heat exposure that causes VVMs to
change to Stage II are still well within the potency levels needed
but should be used sooner than those with little or no heat exposure.

* Also noted in the news article, a replacement shipment of JE
vaccines that have not had substantial heat exposure and therefore
have a longer time frame for use will be sent to the states for use
in routine immunization over the coming year (ProMED post 20081014.3260).

--
Deborah Phillips
PATH, USA
<dphillips@path.org>

[ProMED-mail would like to thank Deborah Phillips from PATH, an
organization that is collaborating with the Ministry of Health in
India in their control of Japanese encephalitis program, for
responding to our RFI with a more detailed explanation of the
circumstances not well covered in the original newswire. She has
clarified the timing of the various vaccination activities in India
as well as the time frame implications for utilization of the JE
vaccine based on current status of the vaccine vial monitors (VVMs).
A well thought out strategy optimizes the use of good vaccine before
the shelf life expiration date. The original newswire of the posting
was misleading in its presentation of the rationale for use or
non-use of the JE vaccine in distribution, suggesting a different
rationale: "Following the controversy over the vaccine in the state,
the Centre has decided to withdraw the supply and replace it with the
fresh stock. The previous stock will be used for the JE vaccination
campaign rather than the routine immunisation programme.

"We will not use this supply in any case for the children in the
state. The vaccine sent by the Centre was to be used under the
routine immunisation in the most sensitive areas for JE. Thus, any
reduction in the potency could be lethal for the children," said Dr.
M L Khatloiya, the Director General, Medical and Health Uttar Pradesh."

As Deborah Phillips suggests, there has been significant confusion as
to the etiology of the acute encephalitis picture that has been seen
in Uttar Pradesh (UP) this year, especially with a very low rate of
JE seroconfirmation (in one report, of 100 acute encephalitis
syndrome patients tested, only 5 (5 percent) were positive for recent
JE infection). In Dr. T. Jacob John's excellent discussion on the
situation in UP [Undiagnosed fatal illness - India (07): (UP)
20080901.2738], he made the disquieting observation that "Testing for
JE virus infection [by the] health system in Uttar Pradesh leaves
much to be desired from quality and equity angles." If there are
questions concerning the reliability of the serological tests being
employed on which the JEV diagnosis is based, it would be prudent to
have duplicate serological samples tested in 2 different reference
laboratories. The results of parallel tests and other tests that the
article indicates are being carried out may provide more solid
information on which to exclude or include JEV infection as the major
cause of the encephalitis being observed, or implicate another
etiological agent.

ProMED-mail looks forward to hearing the results of further studies
on the acute encephalitis syndrome cases in UP, and hopefully for the
identification of the etiologic agent. - Mod.MPP]

ANTHRAX, HUMAN - KYRGYZSTAN (12): NATIONAL UPDATE
*************************************************
A ProMED-mail post
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ProMED-mail is a program of the
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Date: Fri 10 Oct 2008
Source: Fergana Information Agency [in Russian, trans. Corr.ATS, edited]
<http://www.ferghana.ru/news.php?id=10382>


Anthrax infected patients are being identified in south of country
------------------------------------------------------------
New patients with anthrax are being registered in Kyrgyzstan.
Recently, a 36-year-old habitant of Aksiskiy [Aksy district] region
of the Jalal-Abad oblast has been hospitalized on suspicion of skin
anthrax. He is the 45th patient with anthrax in the south of the
country and 47th in all Kyrgyzstan this year [2008]. One patient has
died and dozens are under medical supervision.

The alarming epizootic situation in Kyrgyzstan, especially in the
southern regions of country, was the reason to call a multiagency
meeting in Bishkek. Leading specialists of several agencies stated
that the current problems are the result of neglect by officials of
their duties in many agencies, lack of security measures, and
indifference of people towards their health.

The head sanitary doctor of the republic, Sabirjan Abdilarimov,
listed several delinquencies: for example, vaccines in the Naukatskoe
[Naukat district] region [of Osh oblast] were kept in a cellar at 20
deg C (68 deg F); in some cases an unknown liquid was used as a
solvent for the vaccine; and single-use syringes were used several times.

There has been much criticism of the fact that after the appearance
of suspected anthrax, measures have been taken only after 15 days.
Burial of dead animals is not perfect and safety measures are not
being implemented. In addition, a large problem is soil niduses of
anthrax. There are 245 of those in the Osh oblast and 353 in
Jalal-Abad. Many dangerous areas are swept by flooding and
landslides. Many infected areas are uncontrolled, as in the
Nookenskoe [Nooken district] region of Jalal-Abad oblast, where only
3 out of 50 burial sites are covered by concrete.

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

[The above situation as reported in the newswire is an effort on the
part of the public health community to identify the shortcomings in
programmatic areas that have led to the continued occurrence of both
human as well as veterinary cases of anthrax. The impact of these
deficiencies is seen in the multiple reports of disease occurrence as
seen in the prior ProMED-mail postings referenced in the see also
section below. - Mod.MPP]

DENGUE/DHF UPDATE 2008 (45)
***************************
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******
India (West Bengal)
Date: Thu 16 Oct 2008
Source: Sindh Today, Indo-Asian News Service (IANS) report [edited]
<http://www.sindhtoday.net/health/28771.htm>


Chikungunya, dengue, and Japanese encephalitis have affected at least
300 people in West Bengal in the last 8 days, killing 3 people,
health authorities said Thursday [16 Oct 2008]. [The article does not
indicate how many of the 300 people and 3 fatalities were due to the
specific virus infections cited, although 2 deaths were attributed to
dengue. - Mod.TY]

"We have detected dengue and chikungunya viruses [viruses, or
antibodies to the viruses? - Mod.TY] in blood samples of about 250
people since 9 Oct [2008]," district chief medical officer (health)
of South 24 Parganas Sachchidananda Sarkar said.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Dengue, chikungunya, and Japanese encephalitis viruses (JEV) have
all hit West Bengal. Dengue and chikungunya viruses are transmitted
by the same _Aedes_ mosquito vector, most likely _Ae. aegypti_. JEV
is transmitted by _Culex_ spp., which makes timely vector control for
all 3 viruses challenging for public health authorities.

A map of India showing the location of West Bengal state can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>, and
a map of West Bengal state showing the location where this case
occurred can be accessed at
<http://en.wikipedia.org/wiki/Bishnupur_ ... _Parganas)>.
The HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/promed?g=1252881&v=22.9,79.6,5>. - Mod.TY]

UNDIAGNOSED DISEASE - INDIA: (ORISSA), 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 20 Oct 2008
Source: The Statesman News Service [edited]
<http://www.thestatesman.net/page.news.p ... &usrsess=1>


Undiagnosed viral disease in Jajpur district of Orissa state
------------------------------------------------------------
The outbreak of a mysterious fever in Bari, Korei, Rasulpur and
Dharmasala blocks has led to fear of bird flu here. But district
health authorities say it is not bird flu but some other virus which
is yet to be diagnosed.

"Initially the patients complained to be suffering from high fever
and later severe pain following swelling of all joints of the body.
They [were] initially treated as malaria patients and then
antibiotics meant for typhoid [were] also given to the patients,"
said Mr Surendra Kumar Panda, a social worker of Rasulpur block.
Sources said the fever was 1st reported from Brahmabarada village
under Rasulpur block. Later it spread to residents of many gram
panchayats [an administrative group of villages] in Bari, Korei and
Dharmasala block of the district.

"It is viral fever and not bird flu. Earlier, we had collected blood
slides and serum from many patients and sent them to the state
laboratory for test," said doctors attending to patients at the block
health care centre.

"Medical teams are treating and collecting the blood sample. There is
no need of panic as the fever is a seasonal viral fever," said Mr
Raghunath Padhy, chief district medical officer of Jajpur.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[From the meagre description of the symptoms it is unlikely that this
outbreak is a consequene of avian influenza virus infection. The
symptoms, seasonal nature, and absence of fatalities are features
more compatible with an outbreak of the mosquito-borne chikungunya
virus infection. Further information on the outbreak and the results
of the diagnostic tests would be welcomed. - Mod.CP/MPP]

[There appears to be no connection between this outbreak and another,
which caused some deaths, in a different part of Orissa state in
August 2008 -- see ProMED ref. below.
Jajpur is the administrative center of Jajpur distict in the Indian
state of Orissa. A map showing the location of Orissa state can be
accessed at:
<http://en.wikipedia.org/wiki/Jajpur#Politics>
Dharmasala and Bari are in the middle of this Orissa state map, on the river:
<http://www.mapsofindia.com/maps/orissa/ ... jajpur.htm>.
More information is available at:
<http://jajpur.nic.in>.
(Dharmasala block (panchayat) in Jajpur district, Orissa, is not to be
confused with DharAMsala district in the state of Himachal Pradesh
(HP), the home in exile of the Dalai Lama.) - Mod.JW]

MALARIA, FALCIPARUM - INDIA: (CHHATTISGARH)
*******************************************
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Date: 19 Oct 2008
Source: India ENews [edited]
<http://www.indiaenews.com/health/20081019/152059.htm>


Nearly 90 para-military troopers are suffering from malaria in
Dantewada and Bijapur districts. They have been deployed in one of
the most difficult hilly terrains of Chhattisgarh to take on the
Maoists, but they are fighting malaria instead.

"This is not for the 1st time that a large number of malaria cases
have been reported from cops deployed in forested Bijapur and
Dantewada. In fact, 22 Naga and Mizo policemen died of the disease in
2006, while 7 were casualties in Maoist attacks during the period," a
source said.

He said: "These 88 cases among CRPF (Central Reserve Police Force)
men, including 40 cops of 55th battalion, have been confirmed. We
believe dozens more have been infected and have advised them to go
for immediate check up if they have the symptoms."

Troopers based in school complexes, close to thick forested belts,
have also been asked to use mosquito nets.

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

[In the just published "World Malaria Report 2008" from the WHO
<http://www.who.int/malaria/wmr2008> (see page 75),
Chhattisgarh is marked as an endemic area with an annual incidence in
the population of 1-100 malaria cases per 1000 population per year,
predominantly _P. falciparum_. We do not know how many CRPF personnel
have been exposed to malaria, so we cannot estimate the rate of
infection. It must be assumed that the soldiers have not received
chemoprophylaxis.

A map of Chhattisgarh can be found here:
<http://en.wikipedia.org/wiki/Chhattisgarh>.
- Mod.EP]

UNDIAGNOSED DISEASE - INDIA (03): (ORISSA), REQUEST FOR INFORMATION
*******************************************************************
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ProMED-mail is a program of the
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Date: Thu 23 Oct 2008
Source: The Statesman News Service [edited]
<http://www.thestatesman.net/page.arcview.php?

date=2008-10-19&usrsess=1&clid=9&id=254272>


On 19 Oct 2008 the state government pressed into service
epidemiologists from the Regional Medical Research Centre and Science
Research Centre to visit [Kendrapara] district in the wake of reports
of the outbreak of a mysterious fever. Nearly 1500 patients from
thickly populated villages in Garadpur, Marshaghai and Mahakalpada
block are hit by the virus disease. The epidemiologists from the
research centre are making a symptomatic study of the disease. They
have stationed themselves at the worst hit villages at Mahakalpada
block and are extending clinical treatment to the people with fever
and pain in the joints.

"We will not be able to say anything about the disease till we get
confirmatory reports from the National Virology Institute," said a
member of the research team. "The symptoms vary from person to person;
while the majority encounter fever and joint pain, there are cases
where the patients showed signs of swelling in thigh and lower leg,"
he added. "We are not [sure] of the exact nature of the disease. But
it can certainly be said that the disease is not fatal. Under clinical
treatment, the disease is curable after the incubation
period is over," said the team member.

The disease is still firmly entrenched in Teragaon village where the
1st case of the fever was detected. Fever cases have also been
reported in the villages of Beadri, Chanda, Gadaramita, Bacharai,
Ramchandrapur, Nadi-abarei, Akhua, Ghans-hyampur, Pentha, Dahi-macha
and Karanja.

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

[A map of the Indian state of Orissa, showing the location of the
coastal district of Kendrapara can be accessed at:
<http://www.mapsofindia.com/maps/orissa/orissa.htm>. The
HealthMap/ProMED-mail interactive map of India, showing the location
of the eastern state of Orissa can be accessed at:
<http://healthmap.org/promed?v=22.9,79.6,5>.

The symptoms, seasonal nature, and absence of fatalities are features
compatible with an outbreak of the mosquito-borne chikungunya virus
infection, comparable to a similar outbreak in the neighboring
district of Jaipur (see: Undiagnosed disease - India: (Orissa)
RFI 20081021.3337). Confirmation of this suggested diagnosis, or
otherwise, is awaited.

There appears to be no connection between these outbreaks of
non-fatal febrile illness and a recent outbreak that caused some
deaths in a different part of Orissa state in August 2008 -- see
ProMED ref. below). Nor is there likely to be any connection with a
contemporaneous outbreak of fatal disease in buffalo, also in
Kendrapara district. This disease has been provisionally diagnosed as
bovine foot-and-mouth disease, which cannot be contracted by
humans -- see ProMED ref.20081025.3369 below. - Mod.CP]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN: (BALOCHISTAN)
*********************************************************
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: Thu 16 Oct 2008
Source: Dawn internet edition [edited]
<http://www.dawn.com/2008/10/16/top17.htm>


A total of 3 victims of [Crimean-Congo haemorrhagic fever (CCHF)]
virus, from Quetta, Chaman, and Sanjavi areas, have been admitted to
the Chest Hospital [in Quetta, Balochistan province -- previously
spelled Baluchistan] over the past 4 days. Hospital sources said a
35-year-old woman from Sanjavi area in Ziarat district, who was
bleeding from nose and mouth, was admitted on Tuesday [14 Oct 2008]
and kept in the isolation ward. Another woman from Quetta and a
26-year-old man from Chaman also had symptoms of CCHF virus
[infection]. "We have put them under observation in the isolation ward."

They said most of [CCHF] virus cases usually came from Loralai, Zhob,
and Musakhail. The sources said over a dozen patients had been
admitted over the past 2 months and 3 of them died. "Most of the
patients were shepherds."

Around 100 people have [contracted CCHF virus infection] in the
province over the past 2 years. The health department has established
an isolation ward in the Fatima Jinnah Chest Hospital for [CCHF virus
infection] and other viral diseases.

[Byline: Saleem Shahid]

--
Communicated by:
Keisuke Kubo, MD, PhD, DTMPH
Consul and Medical Attache
Consulate-General of JAPAN
6/2 Civil Lines, Abdullah Haroon Road
Karachi, 75530, Pakistan
<keisuke.kubo@gmail.com>

********
[2]
Date: Sat 20 Sep 2008 [one month earlier than the report above]
Source: Dawn internet edition [edited]
<http://www.dawn.com/2008/09/20/nat7.htm>


During the last 2 weeks, 3 people have died [in Quetta, Balochistan
province] of Crimean-Congo haemorrhagic fever (CCHF). Several others
have been admitted to the Fatima Jinnah Chest Hospital.

"We received a new case of the disease just this morning [19 Sep
2008]. The patient belongs to Zhob district," an official of the
hospital told Dawn on Friday [19 Sep 2008]. He said the patient -- [a
22-year-old male] -- was bleeding when he was brought to the
hospital. So far, 6 patients had been brought to the hospital from
Loralai and Zhob and 3 of them had died. "One of the patients died
yesterday [18 Sep 2008]." The condition of [another patient] from the
Murgha Kibzai area of Zhob district, was quite critical when he was
brought to the hospital, he added; 2 other patients died last week
[week of 15 Sep 2008]. They were from Loralai.

The virus, first isolated in the African country of Congo, is carried
and transmitted by ticks. Hospital sources told Dawn that all the
victims of CCHF were shepherds.

A team of specialist doctors has been sent to Loralai, Zhob, and other
affected areas to identify and then assist patients.

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

******

[CCHF is endemic in this region and Pakistan is one of the countries
most affected by the disease. The causative agent is a bunyavirus
belonging to the genus _Nairovirus_. CCHF virus is transmitted from
cattle and sheep to humans via a tick vector and can also spread from
person to person via infected blood. Cases usually occur singly among
shepherds or among small groups of individuals in contact with
livestock or animal products. Occasionally, clusters of cases occur
as a result of nosocomial transmission in hospitals. Mortality can be
as high as 40 percent in extreme situations but is normally in the
region of 15 percent. The distribution of CCHF follows that of the
principal tick vector (_Hyalomma _ spp.), and CCHF is maintained both
by alternation between mammalian hosts and ticks and by vertical
transmission in ticks.

An image of a _Hyalomma_ tick, a map of the limits of its
distribution, and other information relating to CCHF can be found at
<http://www.who.int/csr/disease/crimean_congoHF/en/>.

The HealthMap/ProMED-mail interactive map of Pakistan is available at
<http://healthmap.org/promed?g=1183606&v=30,66,5>.
A map of Balochistan can be accessed at
<http://pakistanmaps.fortunecity.com/BAL ... 20_MAP.jpg>.
Quetta, Ziarat, Loralai, Zhob, and Musakhail are located in the
northeastern region of the province. - Mod.CP]

DENGUE/DHF UPDATE 2008 (46 )
***************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Pakistan (Karachi)
Date: Tue 21 Oct 2008
Source: The News [edited]
<http://www.thenews.com.pk/daily_detail.asp?id=142250>


Around 17 new suspected dengue fever cases were reported from
different parts of the city [Karachi] on Monday [20 Oct 2008],
according to the health department spokesman. About 11 patients were
shifted to Abbasi Shaheed Hospital, 2 each at Ziauddin Hospital and
Jinnah Post-Graduate Medical Centre, respectively, and one each at
Civil Hospital, Karachi and Sindh Government Qatar Hospital. The
spokesman said that, so far, around 953 suspected dengue fever cases
have been reported this year [2008], out of which 324 were positive
dengue fever cases.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[A map of Pakistan showing the location of Karachi on the coast of
the Arabian Sea can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>.
- Mod.TY]

MUSHROOM POISONING - GEORGIEN (KHASHURSKY)
*****************************************
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: 31 Oct 2008
Source: IA Regnum [trans. Mod.NP, edited]
<http://www.regnum.ru/news/1077747.html>


Three children died, and more than 50 people are in critical
condition in hospitals in Tbilisi in connection with mushroom
poisoning.

They were delivered to Tbilisi from the Khashaursky district.
Physicians say that the poisonings were caused by one specific type
of mushroom that has not yet been identified. Physicians warn the
public not to consume unknown mushrooms.

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

[As stated in another source
<http://www.vz.ru/news/2008/10/31/225052.html>,
the mushrooms were bought in the market of Khashauri, west of Tbilisi.

As of 1 Nov 2008, there are about 100 people in hospitals in Georgia
who have suffered from mushroom intoxication. Cases of mushroom
poisoning have been seen in Borjomi, Khashuri, Sachkhere, Chiatura,
Zestaphoni and Kvarel. See also
<http://www.apsny.ge/news/1225584761.php>.
- Mod.NP]

[There are numerous toxic mushrooms. Some cause neurological
symptoms; some cause gastrointestinal disturbances. There are not
enough clinical signs mentioned here to hazard a guess as to which
toxic mushroom may have been involved. However, with so many people
involved, it sounds like there was access to some distribution chain,
or the mushrooms were misidentified as being edible and routed
through a normal process and distribution chain. - Mod.TG]

UNDIAGNOSED DISEASE - INDIA (ORISSA): 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: Wed 5 Nov 2008
Source: The Islamabad Daily Mail [edited]
<http://dailymailnews.com/200811/05/news/dmbrn05.html>


A mysterious disease [thought to be vectorborne] has gripped several
villages of Indian State of Orissa's coastal district Kendrapara and
doctors suspect migrant labourers and truck drivers to be the suspected
carriers. There have been widespread reports of the disease in all the 9
blocks of the district. Since the past one month, more than 1000 people,
including children, were infected by the mystery fever, Hindustan Times
reported quoting Health Department sources. Doctors said the disease
afflicting the people could either be chikungunya or dengue and it comes
under highly infectious category of fever. This region records annual
exodus of its human resources to country's other parts in search of employment.

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

[Since local physicians have speculated that the disease could be either
dengue or chikungunya, this is presumed to be a febrile disease, although
no symptoms are mentioned, nor is the basis for concluding that the disease
is vectorborne mentioned. Dengue is active in the adjacent state of West
Bengal (ProMED-mail archive no. 20081104.3459), and a chikungunya outbreak
occurred there last month (Oct 2008; ProMED archive no. 20081014.3248).
Highly mobile individuals such as itinerant laborers or truck drivers could
certainly disseminate either virus to areas where _Aedes_ mosquitoes,
vectors of both viruses, are abundant. ProMED-mail requests additional
information about the disease, results of diagnostic tests carried out, and
any control measure being implemented.

A map showing the location of Orissa state in India can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>. A
HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/promed?v=22.9,79.6,5> - Mod.TY]

JAPANESE ENCEPHALITIS - INDIA (07): (UTTAR PRADESH)
***************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 10 Nov 2008
Source: Times of India [edited]
<http://timesofindia.indiatimes.com/Indi ... 693091.cms>


Death stalks the dingy corridors of Baba Raghav Das (BRD) Medical College
in Gorakhpur. Fear and anxiety are palpable, particularly in the medicine
and paediatrics wards on Friday afternoon [7 Nov 2008]. Loud wails rent the
air as ward boys cart away yet another victim of a mystery disease.

The death toll in the medical college alone since this May 2008 has risen
to 421, and there's no sign of letup. But, away from the chaos that has in
its grip the entire endemic pocket of Purvanchal, experts carry on academic
debates to fix the identity of the killer virus, which has in some form or
other claimed more than 3000 lives in the past 5 years.

Interestingly, there is a marked sense of relief among the group that
Type-B Arbo, which causes Japanese encephalitis (JE) cannot be blamed
solely. It could be another mutant [virus], offers Dr K P Kushwaha, head
and professor of paediatrics at the BRD medical college.

There is, in any case, a wide variety to pick from: enterovirus, eco virus
[echovirus? - Mod.SH], Coxsackie-B mutant, Saharanpur encephalitis, and the
killer weed that took 600 lives in 2006, or the convenient [uncommitted]
acute encephalitis syndrome.

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

[This report adds to the uncertainty of which etiological agent is involved
in these cases. Since late July 2008, the number of fatal encephalitis
cases in this hospital has risen from 88 to 421, apparently without a
laboratory-confirmed diagnosis for most of them (ProMED-mail archive no.
20080731.2345). The elimination of Japanese encephalitis "Type-B Arbo" (JEV
flavivirus) as the etiological agent of all of the cases implies that JEV
infection may be responsible for some of the deaths, although this report
does not indicate how many. Previous reports indicate that 5 per cent of
earlier cases have been shown to be caused by JEV. It is not clear whether
laboratory tests have been carried out to identify which of the suspected
viruses mentioned in the report have been involved or ruled out in these cases.

Dr Deborah Phillips of PATH, USA <dphillips@path.org> in her comments in
ProMED-mail archive no. 20081017.3295 indicated that the outbreak was not
thought by the government medical officers to be JE, but due to the
similarity of symptoms between JEV and other acute encephalitis virus
infections, clinical diagnosis is not reliable, and therefore laboratory
confirmation is needed. ProMED-mail would appreciate receiving further
information about case numbers and laboratory test results as they become
available.

An interactive map showing the location of Gorakhpur in Uttar Pradesh,
India can be accessed at
<http://www.travelpost.com/AS/India/Utta ... ap/6756589>. -
Mod.TY]