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TYPHOID FEVER UPDATE 2012 (09)
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India (Punjab)
Date: Mon 16 Apr 2012
Source: Times of India [edited]
http://timesofindia.indiatimes.com/arti ... 682650.cms


With the sudden change in temperature, typhoid has reared its ugly head in the city. And hospitals have started getting 40-45 cases of typhoid accompanied with diarrhea daily, especially in children.

"We have been getting cases of typhoid and 10 to 12 children are being diagnosed with the disease every day. With the rise in temperature, the bacteria causing it are expected to only multiply," said Dr Sadbhavna Pandit, a paediatrician at Government Multispecialty Hospital, 16.

Typhoid can be treated with antibiotics. However, resistance to common antimicrobials is widespread.

"Unhygienic food and cut fruits are one of the prime causes of typhoid. Also, sources where contaminated water supply exists must be checked from time to time," said Dr Vikas Goyal, a city-based physician.

[Byline: Shimona Kanwar]

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[The interactive HealthMap/ProMED map for Punjab is available at:
http://healthmap.org/r/2ey1 - CopyEd.EJP]

LEISHMANIASIS – PAKISTAN: (KHYBER PAKHTUNKHWA) CUTANEOUS
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Date: Sat, 28 Apr 2012
Source: Central Asia Online [edited]
http://centralasiaonline.com/en_GB/arti ... wsbrief-07


Cutaneous leishmaniasis outbreak
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Peshawar: The Khyber Pakhtunkhwa (KP) Health Department has sought help from the World Health Organization (WHO) to contain an outbreak of cutaneous leishmaniasis (CL), an official said.

WHO is to spend USD 9.6m to help residents of KP, FATA KP to set up 700 community health centres. "During the last three months, about 889 cases of CL have been recorded from 14 districts," Dr Muhammad Iqbal of the Health Department told Central Asia Online on 25 April. "We have requested the WHO to intervene." Nowshera District had the most cases, 214, he said.

KP is requesting injectable medicines and help with insecticide spraying, he said, adding that patients cannot afford the 3500 Pak rupees (USD 39) cost of CL treatment. CL is a skin infection, transmitted by sand flies.

[byline: Ashfaq Yusufzai]

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[Leishmaniasis is endemic in Pakistan, where cutaneous leishmaniasis, CL, is either caused by _Leishmania major_ (zoonotic reservoir) or _L. tropica_ (human reservoir). A review of clinical presentation of leishmaniasis in Pakistan can be found here: Bari AU. Clinical spectrum of cutaneous leishmaniasis: an overview from Pakistan. Dermatol Online J. 2012;18:4 (http://dermatology.cdlib.org/1802/02_re ... ticle.html). Another recent paper discusses the distribution of leishmaniasis in Pakistan: Afghan AK, et al. Clinical manifestations and distribution of cutaneous leishmaniasis in Pakistan. J Trop Med. 2011;2011:359145. (http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed).

It should be noted that leishmaniasis is also highly prevalent in Afghanistan and cross border traffic of infected humans could contribute to the outbreak in the Khyber province, bordering Afghanistan.

HealthMap location: http://healthmap.org/r/1oq8. - Mod.EP]

DENGUE/DHF UPDATE 2012 (18)
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- Pakistan (Khyber Pakhtunkhwa province). The 1st dengue fever death has been reported in Khyber Pakhtunkhwa province. The Khyber Pakhtunkhwa (KP) health department has confirmed that a 35-year-old man died of dengue fever on [21 Apr 2012].
http://centralasiaonline.com/en_GB/arti ... wsbrief-01

[The total number of dengue cases in the area is not given, but presumably there are tens of dengue virus infections.

A HealthMap/ProMED-mail interactive map showing the location of Khyber Pakhtunkhwa province (formerly Northwest Frontier Agency) can be accessed at http://healthmap.org/r/02S_. - Mod.TY

RABIES - INDIA: (WEST BENGAL)
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[1] Date: Sun 29 Apr 2012
Source: IBN Liven, Press Trust of India (PTI) [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 92221.html

West Bengal leads in snakebite and rabies deaths
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West Bengal accounted for the maximum snakebite and rabies deaths in India last year. A total of 1440 persons died of snakebite and another 223 of rabies during 2011 in the country, out of which as many as 380 and 73 deaths were reported on the 2 counts respectively in West Bengal. Health and Family Welfare Ghulam Nabi Azad told the Lok Sabha that following West Bengal, Orissa reported 296 snakebite deaths, while 258 were in Andhra Pradesh and 119 in Madhya Pradesh. He said 58 deaths due to snakebite had also taken place in Maharashtra and 50 in Uttar Pradesh, while Karnataka reported 49 and Gujarat 48 such deaths and Himachal Pradesh 40 and another 39 in Tamil Nadu.

In rabies deaths, Andhra Pradesh followed West Bengal with 45 deaths. There were also 24 rabies related deaths taking place in 2011 in Orissa and 21 in Tamil Nadu, besides 18 in Karnataka, 17 in Delhi and 16 in Gujarat. Delhi also reported 3 deaths due to snakebite. The Minister said to prevent human deaths due to rabies, a pilot project was carried out in the 11th 5-year Plan in the five cities of Ahmedabad, Bangalore, Pune, Madurai and Delhi to help create awareness in the community about timely action and post-exposure treatment in such cases and medical and paramedical personnel were also trained in providing timely animal bite management.

Azad said since Health is a state subject, it is the primary responsibility of the state governments to ensure availability of anti-rabies vaccine and anti-snake venom serum in the health care facilities, but the Centre was providing funds to states under the National Rural Health Mission (NRHM) for purchase of drugs and vaccines to make up for shortages and strengthen primacy health care centres.

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Editor, ANIMAL PEOPLE
P.O. Box 960
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[2] Date: Tue 1 May 2012
From: Chinny Krishna [edited]

Rabies Deaths in India
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While even one death from rabies is unacceptable since rabies can be totally prevented and eradicated, the answer of the Health Minister, Gulam Nabi Azad in the Lok Sabha recently should at least show the massive contribution made by non-governmental organizations (NGOs) and the Animal Welfare Board of India (AWBI) in this field.

Whether the number of deaths as estimated by the WHO between 1992 and 2002 was indeed approximately steady at 20 000 *per year* is another matter, the figure given by the Union Minister for Health and Family Welfare is in the opinion of many of us working on the ground much closer to reality. This figure is 223 human deaths in 2011 from rabies as compared to 1440 from snakebite. The figure reported for Tamil Nadu of 21 agrees perfectly with every other figure I have received.

If the Union Government sets its mind to it, we can make rabies in India history.

--
S. Chinny Krishna
Secretary (retired)
Blue Cross of India
1-A Eldams Rd., Chennai
Tamil Nadu 600018,
India

[Venomous snakes occur throughout many regions of the world and are a threat to public health, especially in the rural tropics where they are most abundant. Out of more than 3000 species of snakes in the world, some 600 are venomous and over 200 are considered to be medically important. The risk of snakebite envenoming is a public health hazard that many people in the rural tropics face on a daily basis. In these areas, snakebite envenoming is a common cause of occupational injury affecting agricultural workers and hunters with important socioeconomic implications. Open-plan housing and the practice of sleeping on the floor, common in tropical regions, also exposes people to bites from nocturnal snakes. Overall women, children and farmers are the most common victims of snakebites. Children often suffer more severe effects than adults, due to their smaller body mass.

Snake antivenom immunoglobulins (antivenoms) are the only specific treatment for envenoming by snakebites. Antivenoms can prevent or reverse most of the snakebite envenomings effects, and play a crucial role in minimizing mortality and morbidity. A database and image library has been created by WHO to enable users to easily identify the most important venomous snakes in their country, territory or area; see the distributions of each species; and find information about antivenom products for treating envenoming caused by their bites (see: http://apps.who.int/bloodproducts/snake ... /database/.

The production of antivenins is hazardous and requires the use living animals. The complexity of the production of antivenoms, in particular the importance of preparing appropriate snake venom mixtures for the production of hyperimmune plasma (the source of antivenom immunoglobulins), the decreasing number of producers and the fragility of the production systems in developing countries further jeopardize the availability of effective antivenoms in Africa, Asia, the Middle East and South America.

Consequently while the high mortality from snake bite in India is understandable and excusable, the high mortality from from rabies virus infection is less so. Potent and effective cell-produced anti-rabies vaccine and immunoglobulin are available and completely protective if administered soon after exposure. Furthermore the vectors of rabies virus are predominantly urban and feral dogs which could be eliminated or controlled by a variety of means. Consequently S. Chinny Krishna's comment is justified and hopefully will be heeded.

West Bengal is a state in the eastern region of India and is the nation's 4th-most populous. It is also the 7th-most populous sub-national entity in the world, with over 91 million inhabitants. Covering a total area of 34 267 sq mi (88 750 km2), it is bordered by the countries of Nepal, Bhutan, and Bangladesh, and the Indian states of Orissa, Jharkhand, Bihar, Sikkim, and Assam. The state capital is Kolkata (formerly Calcutta).

The HealthMap interactive map of West Bengal can be accessed at: http://healthmap.org/r/2iyC. - Mod.CP]

HEPATITIS B - INDIA: (KERALA)
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Date: Mon 30 Apr 2012
Source: The Hindu [edited]
http://www.thehindu.com/news/states/ker ... 371075.ece


Hepatitis-B cases on the rise in Pathanamthitta villages
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The growing number of cases of Hepatitis-B infection at Pramadom, Mallasserry, Thengumkavu and surrounding villages, near here, is causing concern for the district administration and the Health Department. L. Anithakumari, Deputy District Medical Officer for Communicable Disease Control, told The Hindu here on Monday that 9 cases had been confirmed through ELISA (enzyme-linked immunosorbent assay) test in the past 3 months. 30 more cases tested positive in the antigen card test. However, unofficial reports say the number is much higher. When the official data show that only 2 died of the infection in the past 4 months, the unofficial figure puts it at 5 at least.

Dr. Anithakumari said Hepatitis-B infection had been a major health problem at Pramadom and surrounding villages from 2003. The graph rose in 2011, with 14 patients testing positive in the ELISA test and 50 others in the card test. She said an expert team from the Government Medical College, Alappuzha, would visit the affected areas on Wednesday [2 May 2012] to study the cause of infection. She said a policy should be evolved to extend psychological support to the affected people and others. The Health Department had launched public awareness programmes and disease prevention measures. The doctor said the infection resolved itself in most people. But 5 to 10 per cent of the people developed chronic infection.

Kurien Oommen, former District TB Officer, says about two-thirds of the people with chronic Hepatitis-B infection are carriers of the virus who do not develop symptoms, but can transmit it to others. Children are at a much higher risk for chronic infection. The Health Department organised a public awareness camp at the indoor stadium at Pramadom on Monday [30 Apr 2012]. Leela Rajan, block panchayat president, inaugurated the camp. H. Salimraj, Additional District Magistrate, delivered the keynote address. P.N. Vidyadharan, District Programme Manager, National Rural Health Mission, who were among the doctors who took classes at the camp, said Rs. 119 000 lakh [USD 3 602 834] had been allocated for the ward-level health care committees in the Pramadom panchayat for disease-prevention activities.

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[Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person, not through casual contact. According to the World Health Organisation (WHO), about 2 billion people worldwide have been infected with the virus, and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. About 25 percent of adults who become chronically infected during childhood later die from liver cancer or cirrhosis of the liver caused by the chronic infection. The hepatitis B virus is 50 to 100 times more infectious than HIV.

Hepatitis B is preventable with a safe and effective vaccine that has been available since 1982. This vaccine is 95 percent effective in preventing hepatitis B virus infection and its chronic consequences. Hepatitis B is endemic in many parts of India. Most people in the region become infected with hepatitis B virus during childhood. In these regions, 8-10 percent of the adult population are chronically infected.

Hepatitis B virus is transmitted between people by contact with the blood or other body fluids (i.e., semen and vaginal fluid) of an infected person. Modes of transmission are the same for the human immunodeficiency virus (HIV), but hepatitis B virus is 50 to 100 times more infectious. Common modes of transmission in developing countries are: perinatal; early childhood infections, inapparent infection through close interpersonal contact with infected household contacts, unsafe injections practices; blood transfusions and sexual contact. Further information can be obtained from the WHO Factsheet at: http://www.who.int/mediacentre/factshee ... index.html.

The interactive HealthMap of the Indian state of Kerala can be accessed at: http://healthmap.org/r/28JB. - Mod.CP]

MALARIA - INDIA (03): (KARNATAKA, JHARKHAND) UPDATE
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[1] Karnataka

Date: Tue 1 May 2012
Source: Daijiworld Media Network-Bantwal (RD) [edited]
http://www.daijiworld.com/news/news_dis ... _id=136596


Malaria reported from Bantwal, Karnataka, blamed on migrant workers
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Despite the monsoon rains not arriving in [Bantwal] taluk [administrative division], 28 cases of malaria have been detected already. This was revealed during the taluk quarterly KDP [Karnataka Development Programme] meeting held at SGSY auditorium, BC Road, on [Mon 30 Apr 2012].

Taluk health officer Dr Deepa Prabhu revealed this at the KDP meeting chaired by MLA [Member of Legislative Assembly] Ramanath Rai [in Bantwal] on Mon 30 Apr 2012. "Out of the 28 cases of malaria detected in the taluk, 7 were reported from Kurnad primary health centre, and 21 from different primary health centers across the taluk," added Dr Prabhu.

"The migrant labourers from Bagalkot, Bijapur, and other districts [in Karnataka] engaged in building construction in the taluk are spreading malaria. 2 cases of leprosy have been reported in the limits of Vamadapadav primary health center. Both malaria and leprosy cases are undergoing treatment by the department," she added.

[Byline: Mounesh Vishwakarma]

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[The state of Karnataka can be seen on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/2izS. - Mod.EP]

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[2] Jharkhand
Date: Tue 10 Apr 2012
Source: The Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 600912.cms


Jamshedpur, Jharkhand, malaria cases on the rise
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After a lull of a few months, the district [East Singhbhum] health department is back on alert in the wake of the rise in cases of malaria over the last week. The district, which had recorded 4000 malaria cases including about 20 deaths in 2011, has geared up its health mechanism after reports of 2 deaths from the disease in the last couple of days.

The government-run Mahatma Gandhi Memorial Hospital (MGMH) [in Jamshedpur, also known as Steel City and Tata] is getting visits from about 15 malaria patients every day. "At this stage, the bed capacity is adequate to admit the malaria patients but in case the number increases we will confront problems in admitting the patients," said MGMH superintendent Dr SS Prasad.

In the last 30 hours, 2 people died of malaria fever in MGMH. Similarly, malaria patients are queuing up in several city-based private hospitals and nursing homes.

In the last 24 hours, over 50 patients with symptoms of the disease were diagnosed at various hospitals and nursing homes. Civil surgeon Vibha Sharan said multi-purpose workers (MPW) have been pressed into service in the malaria-affected areas and announced the carrying out of cleaning drives in malaria-prone areas. In his letter to all the hospitals and nursing homes, including Tata Main Hospital, Telco Hospital, and MGMH, the district health surveillance officer, Swaran Singh, has asked respective hospital managements to maintain data of such patients. "And also keep updating the daily figure with the anti-malaria cell of the district health department," was Dr Singh's request.

Apart from the several slums in the city periphery, Dhalbhumgarh, Potka, Musabani, and Patamda blocks have a number of malaria patients. As part of the anti-malaria measures, the department has announced the speedy spraying of disinfectants and larvicides at identified places.

In the wake of high number of malaria and dengue cases that came to light in 2011, a team of entomologists from the National Institute of Virology (NIV), Pune, which arrived [in Jamshedpur] on the request of the district administration, detected a large number of the dengue-spreading larvae of _Aedes aegypti_ in the city. Besides, teams from Delhi's National Communicable Disease Centre and Kolkata's School of Tropical Medicines that came [to Jamshedpur] in 2011 confirmed the presence of dengue and chikungunya [virus infections].

[Byline: B Sridhar]

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[The state of Jharkhand can be seen on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/2iz*.

Karnataka is a low risk area whereas Jharkhand is considered one of the states with the highest risk of transmission in the WHO 2010 World Malaria Report (http://www.who.int/malaria/publications ... ind_en.pdf). - Mod.EP]

DENGUE/DHF UPDATE 2012 (19)
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- India (Ahmedabad, Gujarat state) state). 5 May 2012. Dengue cases have increased from 48 in January-April last year [2011] to 60 this year [2012].
http://daily.bhaskar.com/article/GUJ-AH ... 21702.html

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

RABIES - INDIA (02): (TAMIL NADU), CANINE, HUMAN
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Date: Wed 9 May 2012
Source: The Times of India, Chennai [edited]
http://timesofindia.indiatimes.com/city ... 058744.cms


A 4.5-year-old boy bitten by a stray dog 3 weeks ago died of rabies at the Institute of Child Health (ICH) in Egmore on Monday [7 May 2012]. This is the 3rd rabies death at the hospital this year [2012]. Doctors said the boy from Samdharya Nagar in Ambattur was admitted to the ICH with rabies on Sunday [6 May 2012].

The boy's relatives told doctors that on 18 Apr 2012, the boy was playing with a stray dog when it pounced on him and bit him in the face and hands. "He was taken to a nearby private hospital and given an anti-rabies vaccine. They did not follow it up with the other doses of the vaccine," said ICH director Dr P Jeyachandran.

On 6 May 2012, he was found behaving strangely and brought to the ICH. "His parents said he turned away when given water and often became breathless. These were classical symptoms of rabies. We confirmed the diagnosis when they told us he was bitten by a dog. Rabies is 100 percent fatal," said one of the treating doctors. He died at 9.25 am on Monday [7 May 2012], Dr Jeyachandran said.

Corporation of Chennai health officer P Kuganantham said corporation officials caught hold of more than 20 stray dogs from the Ambattur area on Tuesday [8 May 2012]. The boy's relatives were given preventive doses of infection [! -- presumably vaccine/immunoglobulin?], and the house was cleaned with disinfectants.

"We will conduct screening camps in the area to test other residents on Wednesday [9 May 2012]," Kuganantham said. According to statistics available [from] the corporation, 40 446 people in 2010 and 38 454 people in 2011 were bitten by dogs across the city. Some residents of Ambattur complained that they were on their own when it came to tackling stray dogs. Two-wheeler riders are often chased by stray dogs during late nights, and the corporation's dog-catching squad has been dysfunctional for more than a year, they said.

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[In view of the short interval between injury and death, it is likely that the unfortunate child must have been severely injured, receiving bites on his head as well as his body. Nonetheless, a contributory factor was the failure to administer a series of follow-up injections and treatment of his wounds with rabies immune globulin. Lack of urban dog control was not the determining factor. The standard schedule for treatment of rabies infection recommends that previously unvaccinated individuals should receive the vaccine intramuscularly at 0, 3, 7, and 14 days. For adults, the vaccine is given in the deltoid area; for children, it may be given in the anterolateral aspect of the thigh. In addition to rabies vaccine, injured people should also receive rabies immune globulin at the same time as the 1st dose of the vaccine to provide rapid protection that persists until the vaccine acts.

Chennai (formerly Madras), is the capital city of the Indian state of Tamil Nadu. Located on the Coromandel Coast off the Bay of Bengal, it is a major commercial, cultural, and educational centre in South India, while the port of Chennai is the 2nd largest port in India. As of the 2011 census, the city had 4.68 million residents, making it the 6th most populous city in India; the urban agglomeration, which comprises the city and its suburbs, was home to approximately 8.9 million, making it the 4th most populous metropolitan area in the country. The interactive HealthMap/ProMED map of Chennai can be accessed at: http://healthmap.org/r/2kP2. - Mod.CP]

RABIES - CHINA: (SICHUAN), CANINE, HUMAN
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Date: Thu 10 May 2012
Source: China Daily [edited]
http://www.chinadaily.com.cn/china/2012 ... 259411.htm


More than 700 dogs have been put down in Jiajiang county, Sichuan province, in the wake of a rabies case that resulted in the death of a woman. On her way back home from a local market on 24 Apr 2012, the woman, a 63-year-old inhabitant of Taiping village, Mucheng town, was bitten twice by a neighbour's dog on 24 Apr 2012, according to the West China Metropolis Daily. "Because she did not feel ill, my wife only cleaned the wounds with alcohol," recalled her husband.

While working in the fields 5 days later, the woman's shoulders became numb but the feeling relapsed after she raised both her hands. The next day she went to the public health center in Mucheng where a doctor gave her some traditional Chinese medicine for rheumatism. "But before she took the medicine, she felt worse -- on 1 May 2012. She was scared of the sight of water and wanted to vomit," her husband was quoted as saying by the West China Metropolis Daily.

That morning, the woman was hospitalized in the public health center in Mucheng but medics could not find the cause of her symptoms. Her condition deteriorated and she was transferred to the Jiajiang county hospital in the early hours of 3 May 2012. Her husband stated that: "As she did not take a turn for the better, at noon on 4 May 2012 my wife was transferred to an armed police hospital in Leshan, which has Jiajiang under its administration". Doctors there diagnosed the woman was suffering from rabies. She died early in the morning of 5 May 2012.

"It was the 1st case of death from rabies in Mucheng town in 5 years," said Xue Huaijun, chief of the Mucheng town government. The town then launched an emergency response system. It began to put down dogs within a 3 km [2 mi] range of Zhang's home in line with Sichuan provincial regulations pertaining to the prevention and control of rabies. Since then, the town has organized more than 100 people to put down more than 700 dogs in its Taiping and Baimian villages.

"Officials have counted the number of dogs in their villages and owners have been asked to send their dogs to designated sites to be killed," Xue said. The dead dogs have been buried deep in 2, 6 m [20 ft] deep pits after being burned with gasoline and covered with lime, he said.

[Byline: Huang Zhiling]

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[A tragic tale of an inadequate response. The delayed diagnosis of the woman's condition and the absence of prompt post-exposure prophylaxis made the woman's death inevitable. It seems unlikely that the destruction of the 700 dogs in the woman's village of residence will provide any greater security for the inhabitants.

The death of the victim within 12 days after being bitten is unusual and suggests that her injury may have been severe, or that there were other contributory factors.

Sichuan province can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/2lQ9. - Mod.CP]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN: (BALOCHISTAN)
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Date: 11 May 2012
From: WHO Pakistan


NIH, Pakistan, a WHO collaborating center for virology, has sent the following alert to all provincial disease surveillance focal points regarding the peak season for Crimean-Congo hemorrhagic fever (CCHF):

There has been an outbreak of 8 cases of CCHF in Pakistan including 3 deaths which have date of onset between 5 Apr to 28 Apr 2012.

While the 8 cases have been identified in all 4 provinces and Afghanistan, they are all linked to Balochistan, a known endemic focus of CCHF:
- 2 cases from DI Khan, Khyber-Pakhtoonkhwa, trade in animals from District Zhob, Balochistan, and wife of one also became ill with confirmed CCHF.
- Coal miner from District Harnai, Balochistan
- Tannary worker from District Quetta, Balochistan, presented at hospital in Karachi
- Butcher from District Pishin, Balochistan
- Cattle farmer from Multan, Punjab, also trades in animals from Balochistan.
- Afghan working in Kandahar, Afghanistan, but living in Quetta, Balochistan
All above cases have been confirmed by PCR.

All hospital staff need to be reminded to use precautions - at least gloves - when patients present with epistaxis or other hemorrhage. CCHF is up to 50 percent fatal. Oral ribavirin is available to treat with physician supervision. Joint health and veterinary teams are advocating preventive measures in the field.

--
WHO Pakistan


[Borrowing from Mod. CP's comments from an earlier post on Crimean-Congo hemorrhagic fever in Pakistan (see Crimean-Congo hem. fever - Pakistan: (BA) 20081027.3392):

"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.

As can be seen from the prior ProMED-mail posts, outbreaks of CCHF have been reported from Pakistan annually over the past decade or so, with cases occurring in all provinces of the country. - Mod.MPP]

UNDIAGNOSED FEBRILE ILLNESS - NEPAL: (WESTERN REGION) REQUEST FOR INFORMATION
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Date: 12 May 2012
Source: Xinhuanet
http://news.xinhuanet.com/english/healt ... 583933.htm


Around 200 people at Neta of Arman Village Development Committee in Myagdi district in western Nepal were sicken by an unidentified disease in the last 4 days, local media reported on Saturday [12 May 2012].

The disease affected a majority of 50 families in Neta, said Harka Bahadur Chhantyal, a local resident. The sick suffered from shaking body, reeling, fever and unconsciousness, he added.

Elderly people and children have been mostly affected by the disease. The villagers have been panic-stricken as they suffered from the disease in turn having the similar symptoms among them, said Chhantyal, who is also the teacher of local Mangala Higher Secondary School.

According to THT Online report [the original newswire is from the Himalayan Times, available at http://www.thehimalayantimes.com/fullNe ... sID=331699], the District Public Health Office have urged the local health post to examine and distribute medicine in an effective manner after the unidentified disease was severe in the village, said District Public Health Officer Dr Jhalak Gautam Sharma.

Meanwhile, the Arman Health Post organized a health camp to examine and distribute medicine to the villagers affected by the disease.

[Editor: Chen Zhi]

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ProMED-mail Rapporteur Mary Marshall

[The above newswire report mentions an as yet undiagnosed illness associated with fever, rigor (chills) and loss of consciousness, occurring in approximately 200 individuals over a reported 4 day period, affecting most severely the elderly and children. In the absence of additional information, the differential diagnosis list is rather extensive, involving viral, bacterial and parasitic etiologies. One wonders what the medication is that was distributed to the population and the success of the health camp in mitigating the illness. There is no mention of fatalities, suggesting the disease may be relatively mild.

In the past, ProMED-mail has covered a number of "undiagnosed" outbreaks in Nepal, of which several were identified as due to known endemic/epidemic agents such as influenza, malaria and Japanese encephalitis. A number of these outbreaks occurred in somewhat more remote villages without regular access to medical services, and the media were helpful in getting medical services to these areas. According to Wikipedia, according to the 1991 Nepal census, Armon had a population of 3867, with 767 households. http://en.wikipedia.org/wiki/Arman,_Nepal, showing a map of Nepal with the location of Arman.)

ProMED-mail would greatly appreciate more information on the above mentioned outbreak including clinical syndrome, likely etiology and epidemiologic evaluation from knowledgeable sources in the region.

Myagdi district is located in the Western Region of Nepal. Beni as the district headquarters. The district has an area of 2297 sq.km. with the 2001 estimated population of 114 447 (of note, the 2012 preliminary census report is available online, but this moderator does not read Nepali, nor is an online machine translation for websites available to permit an updating of this population estimate http://census.gov.np/images/pdf/Populat ... 202011.pdf.) - Mod.MPP]

CHIKUNGUNYA (05): INDIA (ORISSA)
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Date: Sun 13 May 2012
Source: The Times of India [edited]
http://articles.timesofindia.indiatimes ... cephalitis


Chikungunya [virus] is suspected to have resurfaced in Ganjam district with many persons in Boxipalli village exhibiting symptoms of the mosquito-borne viral disease. It will be confirmed after medical tests, doctors said on Saturday [12 May 2012].

"Doctors and para-medical staff led by district malaria officer (DLO) went to the affected village on Saturday. They treated patients and collected blood samples for diagnostic tests," said S K Patnaik, chief district medical officer [CDMO] of Ganjam. MLA [Member of the Legislative Assembly] (Gopalpur) Pradip Panigrahi asked the CDMO to deploy a medical team in the affected village till the disease is controlled.

The disease was reported from this fishing village 2 days ago. The number of those affected has increased to a dozen with 2 more suffering from fever on Saturday, the CDMO said.

Last month, 9 chikungunya cases were confirmed in Golabandh [in the Balangir district, Orissa state] . "Out of the 22 blood samples tested in Golabandh last month, 9 were found to be positive," the CDMO said. The situation in Golabandh is now normal, he added.

Chikungunya, malaria, dengue and Japanese encephalitis spreads because of stagnant water as the mosquito larva survives in it, a medical officer of social medicine department, MKCG Medical College and Hospital, said. People should prevent water from stagnating, he added. The CDMO said health personnel would create awareness to destroy the stagnant water sources and to dry the water-logging spots in the village. He also said that there is no need to panic as the number of affected persons in the village was very small compared to the population of 2100.

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[Chikungunya is endemic in many parts of India, and sporadic cases occur there frequently. One hopes that this small outbreak does not spread and become a large one. This alphavirus is transmitted by _Aedes aegypti_ and _Ae. albopictus_ mosquitoes. 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, including one small outbreak in Ganjam district (see ProMED-mail archive no. 20110831.2671). There is no commercially available vaccine for chikungunya virus, so mosquito vector control and avoidance of mosquito bites are the only preventive measures available.

A HealthMap/ProMED-mail interactive map showing the location of Ganjam district in Orissa state can be accessed at http://healthmap.org/r/1cb7 and a map of Golabandh at http://www.onefivenine.com/india/villag ... Golabandha. - Mod. TY]

DENGUE/DHF UPDATE 2012 (20)
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- India (Nellai, Tamil Nadu state). 9 May 2012. Deputy Director of Health Services Meera Mohideen said 8 persons have died of dengue in the district so far. He said the deaths occurred at Kadayanallur, Vadakarai, Tenkasi. An official said 90 dengue and suspected dengue patients were undergoing treatment at the Tirunelveli Medical College Hospital, 15 at Tenkasi GH and 5 at Kadayanallur GH.
http://ibnlive.in.com/news/8-die-of-den ... 0-118.html

[A HealthMap/ProMED-mail interactive map showing the location of Tamil Nadu state can be accessed at http://healthmap.org/r/00dV. - Mod.TY]

Indien - Malaria
18.05.2012

Von Jahresbeginn bis Ende März wurden landesweit 140.212 Fälle registriert, der Anteil an Erkrankungen durch Plasmodium falciparum ist auffallend hoch (84.170 bzw. 60%). 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. Mit der ab Juni im Land beginnenden Monsunzeit wird es zu einer weiteren Zunahme der Fallzahlen kommen und damit steigt natürlich auch das Risiko für Reisende, sich zu infizieren. Sehr guter Mückenschutz ist daher immer zu beachten, die Mitnahme einer Notfallmedikation (standby-Therapie) in der Regel sinnvoll und je nach Ausbruchslage und Risikoprofil auch eine Chemoprophylaxe zu diskutieren. / Quelle: crm

Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (17): ASIA
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Cholera - India (Maharashtra)
Date: Sat 5 May 2012
Source: IBN Live [edited]
http://ibnlive.in.com/generalnewsfeed/n ... 94899.html


District authorities have suspected an outbreak of cholera in Kalamb town, following the death of 2 senior citizens and hospitalization of over 50 persons.

Confirming the outbreak of cholera, Yavatmal Zilla Parishad CEO Navalkishor Ram said a team of employees from the district health department are moving door-to-door to create awareness among the people and also to identify patients. "Deployment of tankers has been ordered to supply potable water to the affected areas," he said.

The villagers have alleged that the pipelines supplying water to households in the town are old and that there are leakages at many places. "The water is being contaminated due to impure water mixing with the water in the pipe lines through the cracks. We have made complaints to the Gram Panchayat on a number of occasions but to no use," one villager said.

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[A ProMED-mail HealthMap for Maharashtra state in India can be found at http://healthmap.org/r/1*Oa.]