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DENGUE/DHF UPDATE 2012 (33)
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- Pakistan (Karachi, Sindh province). 6 Aug 2012. As per the report of the Provincial Dengue Surveillance Cell of Sindh Health Department, issued on Saturday [4 Aug 2012], as many as 138 cases have been reported in the city during the ongoing year. Out of the total cases, 136 cases were found positive with the virus. As per the report, as many as 83 patients have been admitted to various hospitals in the City, while 3 patients are still housed in various health facilities. 2 more new confirmed dengue cases have been reported on Saturday [4 Aug 2012] in the City.
http://www.nation.com.pk/pakistan-news- ... e-outbreak

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

MALARIA - INDIA (07): (JHARKHAND, RAJASTHAN), UPDATE
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[1] Date: Thu, 9 Aug 2012
Source: http://articles.timesofindia.indiatimes ... laria-cell

Health officials on alert after 3 malaria deaths in Jamshedpur district, Jharkhand
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Three casualties in the past 48 hours have put the district health department on alert with malaria officials trying to rein in the spread of viral brain malaria disease in the district.

"According to the available reports, two persons died of brain malaria in the Tata Motors http://economictimes.indiatimes.com/tat ... -12934.cms hospital and one in MGM College Hospital so far," said district surveillance officer Swaran Singh adding that adequate measures were being taken to check the spread of the disease.

Manisha, a college student, and her brother Ranjit, a school-goer, residents of Patel Nagar, Govindpur died of brain malaria in Tata Motors hospital while a 45-year-old man succumbed to the same disease in the
government-run hospital on Monday.

The Steel City, which experienced abnormal rise in vector-borne disease in 2011, caught unawares on Monday when three death cases of brain malaria came to the light.

The malaria officials on Tuesday said they were carrying out awareness campaign to explain the people about anti-malaria measures along with the cleaning exercise at malaria-prone sites.

"Polluted water is the favorite breeding ground for the cerebral malaria so we are paying more attention to this point immediately," said an officer in the malaria cell of the health department.

"The effective way of preventing oneself from falling victim to brain malaria is to keep ourselves and the surroundings clean," said casualty ward doctor at MGM Hospital Sandeep Singh.

The health department has appealed to the citizens to keep their air coolers clean regularly and ensure there is no garbage piled up in their surroundings and also to see that water does not get accumulated in
potholes, petty wells and drains. Suspected cases of brain malaria are coming to MGM Hospital since the incessant rain began last week, said hospital sources.

"Certain zones in the rural areas have been outside the cleaning sweep. Several places under Mango and Jugsalai notified areas (in urban periphery) continues to be prone to malaria diseases," said JMM district president Ramesh Hansda, who submitted a memorandum to the district administration on Tuesday, seeking special cleaning drive in the malaria prone zones.

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Honduras
drprabhjot@gmail.com

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[2] Date: Mon, 16 Jul 2012
Source: http://daily.bhaskar.com/article/RAJ-JP ... 29275.html [Edited]

Malaria on the raise in Jaipur, Rajasthan
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Malaria cases have also been recorded in large numbers as in comparison of July 1-7 last year where only 44 positives, in the same period the number has crossed the 200 mark this year.

"In the rainy season, mosquitoes find breeding ground due to water logging and both dengue and chikungunya cases increase. Both the diseases are caused by Aedes mosquitoes," Director Public Health Dr BR Meena said. "Seeing the rainy season, we are conducting anti-larva activities and door-to-door surveys are being conducted.

The rapid response teams have been alerted in Jaipur and across the state. All the CMHOs have been instructed to undertake spraying of anti-mosquito medicines in their respective areas," she added.

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[Malaria is endemic in both states, and without more data it is not possible to determine whether the transmission has increased or decreased compared to previous years. - Mod. EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2iz*.]

DENGUE/DHF UPDATE 2012 (34)
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- India (West Bengal state). 11 Aug 2012. A senior health official on Friday [10 Aug 2012] informed that over 100 confirmed cases of dengue have been reported so far in West Bengal. Director of health services BR Satpathy told, "So far there are 80 patients who have been confirmed as suffering from dengue. We are keeping a close watch on the situation." According to him, 64 of these are from Kolkata, 14 from North, 24 from Parganas district, and 2 from other parts of the state. For the last few days, several people from in and around Kolkata have been admitted to several hospitals with symptoms similar to dengue.
http://www.pardaphash.com/news/dengue-e ... 95568.html

[A HealthMap/ProMED-mail interactive map showing the location of West Bengal state can be accessed at http://healthmap.org/r/2iyC. - Mod.TY]

- India (Kolkata and Salt Lake, West Bengal state) Suspected. 10 Aug 2012. An outbreak of a vectorborne disease similar to dengue has afflicted many in the metropolis and the satellite town Salt Lake with the delayed arrival of monsoon, officials said today [10 Aug 2012]. Over 100 people have been admitted to hospitals and nursing homes in Kolkata and Salt Lake in the last week with symptoms of dengue, Kolkata Municipal Corporation (KMC) officials said. Since January-7 Aug [2012], as many as 144 positive dengue cases have been detected in the metropolis.
http://www.business-standard.com/genera ... ake/42628/

[A HealthMap/ProMED-mail interactive map showing the location of Kolkata and Salt Lake, West Bengal state can be accessed at http://healthmap.org/r/1xip. - Mod.TY]

- India (Pune, Maharashtra state). 12 Aug 2012. Representative data of 3 hospitals and one accredited pathology laboratory have revealed 73 dengue cases in last 40 days. However, the actual number of patients down with dengue is likely to be higher as only about 20 per cent of such cases need hospitalisation.
http://timesofindia.indiatimes.com/city ... 453961.cms

[A HealthMap/ProMED-mail interactive map showing the location of Pune, Maharashtra state can be accessed at http://healthmap.org/r/2gZV. - Mod.TY]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2012 (37): ASIA
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Cholera - Pakistan (Khyber Pakhtunkhwa province)
Date: Tue 7 Aug 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/418579/cont ... -in-swabi/


A cholera outbreak in a village of Swabi district [Khyber Pakhtunkhwa Province] has claimed a man's life while dozens of villagers were admitted to hospitals. The outbreak was reported in Takeel Village of the district's Gadoon area.

Dr Muhammad Riaz, in charge of the Expanded Programme on Immunization (EPI), said the disease spread among the villagers because of drinking contaminated water from a spring in the area. He said that more than a dozen patients from the village were rushed to the District Headquarters Hospital (DHQ) while more than 20 patients were sent to the Tehsil Headquarters Hospital in Topi.

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Cholera - Nepal (Doti region)
Date: Tue 7 Aug 2012
Source: China Daily [edited]
http://www.chinadaily.com.cn/life/2012- ... 649180.htm


Cholera has claimed 2 more lives in Doti district in far western Nepal, bringing the death toll to 12 since the outbreak of the disease about a month-and-a- half ago.

According to the District Public Health Office, a 9 month old child and a 70 year old succumbed to the disease on Thursday night [2 Aug 2012], The Himalayan Times reported Sat 4 Aug 2011.

Cholera is sweeping across some villages in the district, putting more lives at risk. The majority of those succumbing to the disease were children and elderly.

Locals accused the government of failing to understand the gravity of the situation, the daily reported.

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[A ProMED-mail HealthMap for the area is available at http://healthmap.org/r/355c. - Mod.LL]

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Cholera - Nepal (Kathmandu district)
Date: Sun 132 Aug 2012
Source: The Himalayan Times [edited]
http://www.thehimalayantimes.com/fullNe ... sID=343294


Since the onset of monsoon 15 cholera cases have been confirmed in Kathmandu district. Sukraraj Tropical and Infectious Disease Hospital has confirmed 14 cases, while one case is reported in Kanti Children's Hospital. Contaminated water is the main cause of cholera and diarrhoea in Kathmandu, doctors said.

The cholera patients, between 3 and 88 years of age, were from Teku, Tahachal, Kalimati, Swayambhu, Baneshwor, Rabibhawan, Dallu, Bhimsengola, Kalanki, and Pinglasthan in Kathmandu, the hospitals involved in the patients' treatment reported.

According to Dr Indra Prasad Prajapati, the hospital director, cholera cases have gone up in 2012 compared to corresponding periods in the preceding years. "Only 8 cases were reported in 2011 during this time," the director said and feared of focal outbreak if the number kept on rising. However, the epidemic could be limited to small focal area with people drinking the same contaminated water, Dr Prajapati said. He further said that 3 of the total cholera cases were based in Swayambhu.

Dr Prajapati said leakage of drainage pipes and water pipelines is mainly responsible for the contamination of water.

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[A HealthMap/ProMED-mail interactive map for the area is available at http://healthmap.org/r/2Pf_. - Mod.LL]

DENGUE/DHF UPDATE 2012 (35)
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- India (Bangalore, Karnataka state). 14 Aug 2012. A senior city health official said that the city had recorded 315 positive cases of dengue since January [2012]. Although several deaths have been reported in the last one month, officials said that there were only 3 deaths due to dengue.
http://www.thehindu.com/news/states/kar ... epage=true

[A HealthMap/ProMED-mail interactive map showing the location of Bangalore, Karnataka state can be accessed at http://healthmap.org/r/2Azn. - Mod.TY]

CHIKUNGUNYA (12) - INDIA (ODISHA), SUSPECTED
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Date: Tue 21 Aug 2012
Source: The Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... r/33301995


Chikungunya [virus infection] is suspected to have resurfaced in Ganjam district with several persons in Boxipalli village reporting its clinical symptoms. It can only be confirmed after laboratory tests, doctors said on Tuesday [21 Aug 2012] after visiting Boxipalli.

"A team of doctors led by district malaria officer (DMO) Uma Shankar Mishra along with the paramedics visited Boxipalli on Monday [20 Aug 2012] and collected the blood samples," official sources said. The blood samples of 5 persons were sent to MKCG Medical College and Hospital. These samples will also be tested for malaria.

An outbreak of chikungunya in Boxipalli, a predominantly fishing village, was reported 2 days ago [19 Aug 2012], when a number of people were suffering from fever with joint pain. Doctors said during their visit they did not find any fever cases but people with joint pain. Fishermen had reported similar symptoms in May [2012] but the blood samples tested negative for chikungunya [virus infections].

However, 9 chikungunya cases were reported in Golabandh, another fishermen dominated village, in April [2012]. "Out of 22 blood samples from Golabandh, 9 tested positive," a senior doctor said.

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[Chikungunya virus is endemic in India, and cases appear sporadically in diverse locations, such as the Ganjam district. If the chikungunya virus vector mosquitoes, _Aedes aegypti_, are present, as is likely, and if the cases prove to be chikungunya virus infections, the occurrence of additional cases can be expected. There is no commercially available chikungunya virus vaccine. - Mod.TY

A HealthMap/ProMED-mail interactive map of India can be seen at http://healthmap.org/r/39-r. - Sr.Tech.Ed.MJ]

UNDIAGNOSED ILLNESS - NEPAL: (SAGARMATHA) REQUEST FOR INFORMATION
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Date: Thu 23 Aug 2012
Source: eKantipur [edited]
http://www.ekantipur.com/2012/08/23/hea ... ts/359180/


The only community hospital in Okhaldhunga district has been flooded with viral fever and typhoid patients in the last few days. Doctors have said viral fever and typhoid cases have been rising due to the contamination of drinking water in the rainy season.

The inflow of patients has been so high that the hospital has not been able to cope this number. Some of the patients have been kept in the training hall and even on corridors for lack of beds. The hospital has only 32 beds whereas the number of patients admitted is in the range of 45-50 daily, said a doctor at the hospital.

More than 150 patients a day have been coming for treatment at the OPD [outpatient department] alone. More than 3200 patients came for treatment in July 2012 alone.

Meanwhile, 2 schools at Mainaghat of Nawalparasi district have been closed after the spread of viral fever in the area. The schools had to be closed since most of the students have been affected by the disease. The people are worried that the viral fever might take epidemic proportion as there is lack of health workers at the local health posts and primary health centre.

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[The posting spends much of its narrative regarding the illness referred to as "viral fever" which is allegedly spread by contaminated water. It is unclear what the etiology of this "viral fever" is and ProMED-mail would appreciate more information regarding the outbreak which apparently is differentiable from typhoid. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3bMU.]

UNDIAGNOSED FATAL ILLNESS - NEPAL (02): (KALIKOT) REQUEST FOR INFORMATION
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Date: Fri 24 Aug 2012
Source: The Himalayan, Himalayan News Service [edited]
http://thehimalayantimes.com/fullNews.p ... sID=344743


Four die of mystery disease in Kalikot
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An unknown disease in Kalikot has claimed the lives of four girl students of Kalikot's chhalaha-based Kalika Lower Secondary School and as many as 90 students have been taken ill. According to head teacher Man Bahadur Budha, the students had been complaining of fever, common cold, headache and swelling on the body for the past one month.

The identities of the four deceased students are yet to be ascertained. Twenty more people from the village are said to be taken ill due to the unknown disease. The disease has infected people from 6-month-old to 20 years of age. Locals accused the government for being indifferent towards the outbreak.

"The lack of citadel [probably an analgesic and anti-pyretic equivalent of acetaminophen/paracetamol. - Mod.CP] at Khinneta Health Post had added to the patients' woes," local Bhati Bam said. Chief District Officer, Jagat Bahadur Basnet, said health workers would be deployed to the incident site on Sat 25 Aug 2012.

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[From the information available it is not certain that the illness responsible for the 4 deaths among 90 school-children is a consequence of an infectious disease. Reports of undiagnosed disease in Nepal have been frequent in the past and 'Requests For Information' have been unproductive. Kalikot District is a one of the seventy-five districts of Nepal. This district covers an area of 1,741 km² and has a population (2001) of 105,580. A map showing the location of Kalikot District within Nepal can be accessed at: http://en.wikipedia.org/wiki/Kalikot_District, and the interactive HealthMap of Nepal is available at: http://healthmap.org/r/1COd.

Part (5) of ProMED-mail 'Measlese update 2012 (33) 20120825.126334' describes the almost simultaneous occurrence of the deaths of four infants in the Doli District of Nepal. The fatalities of the children in these two Districts are unlikely to be related, since the deaths of the infants in Doli district were attributed to administration of defective measles virus vaccine. - Mod.CP]

DENGUE/DHF UPDATE 2012 (36): ASIA
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- Pakistan (Lahore, Punjab province). 23 Aug 2012. A patient tested positive for the dengue virus at Mayo Hospital while 2 others are suspected of having contracted the virus.
http://tribune.com.pk/story/424911/deng ... ted-cases/

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

- India (East Siang district, Arunachal Pradesh state). 25 Aug 2012. A team of scientists from the Regional Medical Research Centre at Dibrugarh in neighbouring Assam is visiting East Siang district of Arunachal Pradesh to conduct detailed investigation into the outbreak of dengue at Pasighat and its adjoining areas. Of 118 blood samples collected from Pasighat recently, 4 tested positive for dengue [virus infections].
http://www.business-standard.com/genera ... gue/48095/

[Maps of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/1pSH. - Mod.TY]

- India (Bhandara district, Maharashtra state). 25 Aug 2012. The outbreak of dengue and chikungunya across the district, including Bhandara town, since the last 14 days is threatening to spread further. Around 1500 patients are taking treatment from private doctors in a week. Most of the patients are from rural areas.
http://articles.timesofindia.indiatimes ... lets-count

[This is a mixed dengue and chikungunya outbreak, and there is no indication about numbers or relative proportions of each pathogen.

- India (West Bengal state). 23 Aug 2012. As many as 109 confirmed cases of dengue have been reported so far in West Bengal, a senior health official said Friday [17 Aug 2012]. When the endemic 1st came in force in the 2nd week of August 2012, the number of confirmed cases was 80.
http://twocircles.net/2012aug23/109_cas ... engal.html

- India (Bellary district, Karnataka state). 21 Aug 2012. Hospitals in the district have seen a sharp rise in the number of patients getting admitted with symptoms of dengue in recent days. People in the thousands, especially children, are showing symptoms of dengue like high fever, cough, fatigue, and body pain. Of the total 149 suspected dengue cases, 65 have tested positive and all the patients are undergoing treatment.
http://www.deccanherald.com/content/273 ... llary.html

MALARIA - INDIA (08): (WEST BENGAL, ASSAM, MAHARASHTRA), UPDATE
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In this posting:
[1] West Bengal
[2] Pune, relief camps
[3] Pune, Maharashtra

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[1] West Bengal

Date: Sun 26 Aug 2012
Source: Times of India [edited]
http://timesofindia.indiatimes.com/city ... 723267.cms


Malarial patients die at Bankura Medical College
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The death of 4 malaria patients at Bankura Medical College has prompted the health department to initiate an internal probe to find out the lacunae in the referral system for treating malaria patients.

"Bankura Medical College is the highest referral centre at Bankura District [West Bengal]. 4 patients dying in quick succession at that facility is really a reason for introspection," said a senior official in-charge of the malaria section. "Our officials of the public health department and vector borne disease surveillance section have gone to the hospitals to gather a clear picture of the treatment procedure," said a senior official.

Officials spent the whole day studying bed tickets to figure out the treatment given to the patients who had died from malaria, said hospital sources.

"Senior officials from health secretariat had come for a routine inquiry and they spent the whole day talking to the doctors and nurses of the department. They also collected information about the when these patients had come and in what stage," said a senior administrative official of the hospital.

Health department sources further revealed that the situation of malaria deaths in Bankura and Purulia has improved quite a lot in 2012. "The main purpose is to find out the fault and where it occurred. A patient dying of malaria at the medical college is not acceptable.

We wish to find where the delay occurred and in which place of network it happened," said Shankar Saha, deputy director in charge of malaria section. With dengue sweeping Kolkata and adjoining districts, the malaria deaths have led to major concern. In Kolkata and Salt Lake, the administration spent weeks trying to play down the dengue menace but it can no longer ignore the threat now. "We are investigating these malaria deaths. It is a routine process," said Asit Biswas, health department spokesperson.

[Byline: Jhilam Karanjai, TNN]

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[2] Pune, relief camps
Date: Wed 15 Aug 2012
Source: Times of India [edited] http://timesofindia.indiatimes.com/city ... 497939.cms


Malaria in relief camp: 59 cases
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Cases of malaria are being reported in the relief camps of the riot-hit BTC area, but doctors and other health officials claim that the number of cases is very small and there is no reason to panic. They added proper measures are being taken to ensure that the disease doesn't reach the status of an epidemic in the camps.

The total number of malaria cases reported from the camps of Kokrajhar, Chirang, Dhubri and Bongaigaon is 59. PJ Gogoi, regional director, health and family welfare, said, "We are conducting screening programmes and proper medicines are being administered and DDT is being sprayed in the camps regularly." Jayanta Narlikar, DC Kokrajhar, said, "There are only about 50-60 cases reported till now and we are spraying a lot of DDT in and around the camps.

We have also distributed over 2000 mosquito nets in the camps. So far, we are taking utmost care to ensure that the situation doesn't go out of hand and we are doing our best to prevent an outbreak."

Uttam Brahma, district programme manager, Kokrajhar, said, "Though the situation is improving now, this is the monsoon season and during this time we do get reports of malaria outbreaks. In the camps too, a few malaria cases have been reported, but there is nothing to be worried about."

Malaria has always been a problem for the people of the state, especially during the monsoon, even though the health department claims to carry out awareness programme every year, besides spreading DDT and distributing mosquito nets. The official said that proper measures are being taken to ensure that the number of cases does not increase.

"We are trying to maintain proper hygiene in the camps and we have distributed specially-treated mosquito nets for the inmates recently," he said.

Other than malaria, cases of dysentery, diarrhoea and respiratory tract infection were also reported amongst the children from 2 to 4 years in the camps, after which a special kit and medicines were distributed among the camp inmates. "Malaria is very normal in the season and it is not occurring only in the camps. Proper measures are being taken and things are under control," he added.

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[3] Pune, Maharashtra
Date: Sun 12 Aug 2012
Source: Times of India [edited]
http://timesofindia.indiatimes.com/city ... 453961.cms


Malaria cases on the rise in Pune, Maharashtra
----------------------------------------------
Representative data of 3 hospitals and one accredited pathology laboratory has revealed 73 dengue and 41 malaria cases in last 40 days. However, the actual number of patients down with dengue and malaria is likely to be higher as only about 20 percent of such cases need hospitalisation.

Surgeon Dhananjay Kelkar, medical director of the Deenanath Mangeshkar hospital added: "Since July [2012], we have found 18 positive dengue cases and 7 malaria cases till date. All of these tests were carried out at our in-house pathology laboratory."

Sahyadri Hospital, Deccan branch, also reported steady flow of dengue and malaria cases. "Since July, we have treated 17 positive dengue cases and 21 malaria cases at our hospital till date. The blood samples were tested at our in-house pathlab of our hospital's Deccan branch," said Rajkumar Ambad, chief operative officer of the Sahyadri group of hospitals.

Lajpatrai Arya, chief operating officer, Jehangir hospital, said they had treated 13 positive dengue cases and 11 confirmed malaria cases since June.

Health officials of the Pune Municipal Corporation also admit to the rise in mosquito-borne infections. "There is definitely a rise in dengue and malaria cases in Pune. But, the situation is not alarming," said S T Pardeshi, medical officer of health, PMC.

According to PMC's records, there are only 6 dengue and 25 malaria cases in the city between June and August. "The PMC has asked private hospitals and pathology labs for data of patients, but they do not submit daily case reports of dengue, malaria and other communicable diseases," Pardeshi said.

"Precautionary measures are being taken in slums, with insecticides sprayed at mosquito breeding sites. But since the mosquito, Aedes aegypti, which spreads dengue, breeds in fresh water, it is imperative for every household to observe one day a week as 'dry day,' when all utensils and tanks are emptied and cleaned. This is an effective measure at the domestic level," Pardeshi said.

The civic administration undertakes fogging and spraying in all wards at least twice a week. "The health department has been put on alert and civic hospitals have been instructed to be ready in case the number of patients rises," he added. "A record of mosquito breeding sites is maintained by the staff through the year. It was found that most breeding grounds for dengue mosquito are inside homes," Pardeshi said.

"Vector mosquitoes breed mostly in earthenware, metal drums and concrete cisterns used for domestic water storage as well as discarded plastic food containers, old tyres and other items that collect rainwater. Proper disposal of solid waste and improved water storage practices, which includes covering containers, should be followed," Pardeshi said.

Keep mosquitoes away:
* Discard unwanted things lest they become breeding ground for mosquitoes
* Keep water vessels clean and covered
* Take prompt medical advice in case of fever
* Remove water collected in plates under potted plants. Avoid using plates
* Loosen soil in pots to prevent accumulation of water
* Do not keep tray or receptacles under or on top of air-conditioners
* Change water in flower vases daily. Clean and scrub the inside of vases
* Prevent accumulation of water
* Use repellents

About malaria:
* Caused by Plasmodium parasites, which is spread to humans by Anopheles mosquitoes. Infected mosquitoes bite mainly between dusk and dawn
* Symptoms: fever, shivering, pain in joints, headaches, repeated vomiting, convulsions and coma

[Byline: Umesh Isalkar, TNN]

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[The reports emphasize that malaria is still a considerable risk in several states of India. Both Assam and West Bengal are known risk areas, whereas Pune in Maharashtra State is not regarded as a high risk area. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2iyC.]

UNDIAGNOSED FEBRILE ILLNESS - NEPAL (02): (PANCHTHAR AND GUMDA), REQUEST FOR INFORMATION
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Date: Wed 29 Aug 3012
Source: The Himalayan, Himalayan News Service [edited]
http://www.thehimalayantimes.com/fullNe ... sID=345346


Over 50 cases of fever have been reported so far in the District Hospital, Panchthar. A viral fever outbreak has hit hard Prangbung, Lungrupa, Memeng, Angsarang VDCs [Village Development Committees] and their headquarters, Phidim. In fact, Angsarang has been the most affected VDC. The number of students attending schools has dropped in the Angsarang-based Jyoti Secondary School after children suffered from the disease.

In the same way, Prangbung-based Kalika Secondary School also faced similar problems after a number of students fell sick.

According to the Principal Lungrungpa Parbat Lal Dangal of the Siddheshwori Secondary School, more than 60 students have remained absent in their terminal examinations.

Health workers said when the symptoms of viral fever are found, then the disease will affect the patient for a week. However, since it is transmissible, most of the people in the village have taken ill.

The number of viral fever patients has increased in the District Hospital. Over 50 cases of fever are reported so far. The viral outbreak which spread in Parbat's southern Barrachaur and Ranipani VDCs has not been controlled.

With the spread of viral fever and typhoid since a week, hundreds of people are being affected daily. A team of health workers along with the medicine has been sent to the affected areas.

Barrachar-based Jana Sewa Secondary School has been closed after the outbreak, while the numbers of students in the Ambari Secondary School and surrounding schools have decreased by 50 per cent. Ambari School's Principal, Ganesh Poudel, said that schools could not be conducted for the whole day as there are very few students, and most of them have been ill. More than 100 patients are reported in local clinics. Health worker Surya Bahadur Karki reported that among them, 80 per cent are fever patients and 20 per cent typhoid.

Similarly, maternal health worker Kopila Sharma said that over 80 cases of fever are reported in the Barrachaur Health Post. Dr Sagar Rajbhandari of the District Hospital, Parbat said viral fever has spread due to climate change and unclean drinking water consumption.

Likewise, Lamjung's Duipiple-ba-sed Bhairavkali Higher Secondary School has been shut after most students were affected by viral fever. The number of students going to school has dropped since a week, so the school has been closed after an emergency meeting of the School Management Committee held today [29 Aug 2012], reported committee chairperson Nirmal Gautam. He said that after the suggestions of doctors and health workers of the nearby health posts, they have decided to shut the school.

Viral fever has spread in Gorkha's Gumda 6, 7, 8 and 9 since Sunday [26 Aug 2012]. With its spread, the local Suryodaya Secondary School was shut for 3 days as the teachers and students have taken ill, reported the school's management committee chairperson Bhim Prasad Gurung. According to him, over 250 households have been affected with at least one member in each family taken ill. Patients have the symptoms of runny nose, headache and fever, reported Gurung. Local health centres have started to face the shortage of medicine after fever spread in their areas.

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[The description of the symptoms of the illness is insufficient to suggest a possible diagnosis. It appears to be prevalent in 2 separate districts of Nepal and to involve both children and adults, necessitating closure of schools. No fatalities are reported. More specific information from the region would be appreciated.

The interactive HealthMap of Nepal can be accessed at: http://healthmap.org/r/1COd. - Mod.CP]

DENGUE/DHF UPDATE 2012 (39): ASIA
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- India (Chennai, Tamil Nadu). 31 Aug 2012. Doctors say there has been an increase in dengue cases, particularly among children, in the last few months. The Chennai Corporation recorded 329 cases of dengue so far this year [2012], including 299 cases till 25 Aug [2012]. Most children's hospitals in the city say they see at least one suspected case of dengue every day with children coming with complaints of high fever and body ache.
http://articles.timesofindia.indiatimes ... ngue-cases

[Maps of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/1pSH. - Mod.TY]

- India (Koraput district, Odisha). 30 Aug 2012. In southern Odisha, 3 cases have been detected in the tribal dominated Koraput district, health officials said. These cases involve a 19-year-old, an 18-year-old, and a 14-year-old.
http://articles.timesofindia.indiatimes ... rd-koraput

- India (Ganjam district, Odisha). 28 Aug 2012. Dengue has spread to newer areas in Ganjam district. It was reported from Berhampur and Hinjili towns. With this the number of dengue cases in the district has gone up to 7, said additional district medical officer (public health) LK Rath. He said 3 cases each were reported from Berhampur and Hinjili.
http://articles.timesofindia.indiatimes ... od-samples

- India (Guntur district, Andhra Pradesh). 29 Aug 2012. Dengue fever is on the rise in Guntur district and 6 dengue positive cases were registered so far in the district, 2 in Guntur city, and one each in Narasaraopet town, Pedakurapadu, Tadepalli, and Bellamkonda mandals.
http://www.deccanchronicle.com/channels ... guntur-012

- India (Kolkata, West Bengal). 28 Aug 2012. Kolkata is reeling under an outbreak of dengue, 2 people have died and many are flooding hospitals and clinics for treatment.
http://ibnlive.in.com/news/kolkata-deng ... 3-231.html

[No numbers of total dengue cases or DHF cases are given. - Mod.TY]

- Pakistan (Karachi, Sindh). 29 Aug 2012. A total of 157 cases of dengue virus have been reported in Sindh, of which 156 cases were reported in Karachi while one is from Hyderabad.
http://www.brecorder.com/pakistan/gener ... /75859.htm

[Maps of Pakistan can be accessed at http://www.mapsofworld.com/pakistan/pak ... l-map.html and http://healthmap.org/r/1kc-.- Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (13): (UTTAR PRADESH)
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Date: Mon 3 Sep 2012
Source: CNN-IBN [edited]
http://ibnlive.in.com/news/encephalitis ... 023-3.html


Encephalitis is back again to haunt the children of eastern Uttar Pradesh as 21 deaths have been reported in the past 3 days itself from 4 district hospitals in and around Gorakhpur.

The maximum number of deaths is being reported from the BRD Medical College in Gorakhpur. So far, 241 encephalitis deaths have been reported since the beginning of the year [2012].

Encephalitis is an air and water-borne viral that mostly affects children under the age of 6 [years]. Estimates suggest that the deadly virus has killed more than 50 000 children in the last 3 decades.

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[The numbers of deaths from encephalitis in eastern Uttar Pradesh state in 2012 continue to climb from 129 on 12 Jul 2012, to 146 as of 30 Jul 2012, to 241 cited above on 3 Sep 2012. The reports concerning the etiology of these cases continue to be confusing, sometimes mentioning Japanese encephalitis virus infections for some or all of the cases and at other times associating the cases with contaminated water suggesting enteroviruses. Still another report proposes heat stroke as the cause of these cases. The report above makes mention of airborne factors for the 1st time, without suggesting the pathogen that might be involved. Until there is a definitive diagnosis of the cause of these illnesses and deaths, it will be difficult to implement effective preventive efforts.

A HealthMap/ProMED-mail interactive map of India showing the location of Uttar Pradesh state and Gorakhpur can be accessed at http://healthmap.org/r/3h8J. - Mod.TY]

SCRUB TYPHUS - INDIA (06): (HIMACHAL PRADESH) FATAL
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Date: Tue 4 Sep 2012
Source: Jagran Post [edited]
http://post.jagran.com/two-people-died- ... 1346766519


In Himachal Pradesh 2 people have died of scrub typhus, a disease caused by the bite of an infected mite, an official said on Tuesday [4 Sep 2012]. With these deaths, the [death] toll in the state due to the disease increased to 3 this year [2012].

KS Rana, edictal superintendent of Shimla's Indira Gandhi Medical Collage and Hospital, said: "2 people died in the past 2 days and 30 people have tested positive for the disease." He said one of the victims belonged to Chopal area in the interior of Shimla district, while another belonged to Hamirpur town. Shimla, Mandi, Solan, and Sirmaur are the worst scrub typhus-affected districts.

In the last 3 years, more than 60 people have died of it in the state, health officials said.

Its symptoms are fever, headache, muscle pain, cough, and gastroenteritis -- inflammation of the mucous membrane of the stomach and intestines.

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

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

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

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

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

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

Himachal Pradesh is a mountainous state in northwestern India with an elevation ranging from about 350 meters (1148 ft) to 7000 meters (22 966 ft) above sea level and has one of the highest per capita incomes of any state in India (http://en.wikipedia.org/wiki/Himachal_Pradesh).

Himachal Pradesh can be located on a map of India at http://en.wikipedia.org/wiki/File:India ... or_map.svg. A HealthMap/ProMED-mail interactive map of India that shows the state of Himachal Pradesh can be found at http://healthmap.org/r/3kii. - Mod.ML]

DIPHTHERIA - INDIA: (HARYANA) FATAL, SUSPECTED
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Date: Thu 6 Sep 2012
Source: Hindustan Times [edited]
http://www.hindustantimes.com/News-Feed ... 25334.aspx


Following death of 5 children due to a suspected outbreak of diphtheria here [in the city of Panipat] in the past week, the Haryana health authorities have sounded an alert to control the bacterial disease. The deaths have been reported from the urban slum areas - Davar Colony and Ashok Vihar - located adjacent to Kutani road.

Panipat chief medical officer Dr SP Gupta told the Hindustan Times on Wednesday that the situation was quite serious and the authorities had taken appropriate steps. He said: "More than 500 children have been medicated in these colonies and special isolation wards have been set up at Bhim Sain Sachhar Civil Hospital for those who are ill." On Tuesday [4 Sep 2012], 9 children were referred to a New Delhi hospital for further treatment.

All those who died were reportedly below 5 years of age and the chief medical officer said medical teams were camping in the areas to handle emergency situations. "So far 5 deaths have been reported from these 2 areas since [30 Aug 2012]. No death has been reported in the past 2 days. Though samples of 24 patients have been sent to a national laboratory in New Delhi for the confirmation of diphtheria, prima facie all patients, including those who died, were suffering from diphtheria and we are treating them accordingly," the chief medical officer said. He said reports would reach the town in next 2 or 3 days.

The health officials admitted that the outbreak confirmed that the victims were not administered DPT vaccinations. A visit to the areas revealed the sorry state of hygiene. Hundreds of workers engaged in various handloom and other units of the industrial area were residing in these illegal colonies, which lack any provision of sewer and drains.

The district officials said residents were migrant workers and a large population residing here frequently moved to and from Panipat in search of unskilled jobs.

Meanwhile, deputy commissioner Mona Sriniwas directed the health and sanitation authorities to remove filth and drain water accumulated all over the area. Sriniwas said the chief minister had been approached to grant financial assistance to those who died of the disease.

[Byline: Vishal Joshi]

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[A discussion of diphtheria can be found in ProMED post Diphtheria - Paraguay: (Asuncion) alert 20110614.1814.

Diphtheria is a vaccine-preventable disease. In India, under the Universal Immunization Programme (UIP), vaccines for 6 vaccine-preventable diseases (tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, and measles) are available for free of cost to all. UIP was launched in 1985 to attain the target to immunize all eligible children by 1990. However, the UIP has chronically failed to meet its goals (http://www.isical.ac.in/~wemp/Papers/Pa ... nPatra.pdf).

Data from WHO/UNICEF revealed that the estimated national coverage rates for India for 1 dose of diphtheria/tetanus/pertussis vaccine for the years 2000-2008 was 77 to 83 percent. However, estimated national coverage rates for India for receipt of all 3 initial doses of childhood diphtheria/tetanus/pertussis vaccine fell to only 58 to 66 percent for the years 2000-2008 (http://www.unicef.at/fileadmin/medien/p ... 2008_r6.pd).

Migrant workers and their families, as illustrated in the current outbreak in the city of Panipat, as well as high absenteeism rates among health care providers and unreliable supplies of vaccines, are said to contribute to low vaccination rates in India (http://www.povertyactionlab.org/evaluat ... ives-india). A lack of understanding of the benefits of vaccination and even a suspicion of government health services are thought to be contributing factors.

Diphtheria toxoid vaccine is not manufactured as a monovalent vaccine; it is available combined with tetanus toxoid, both in full-strength doses (denoted by upper case letters "DT") in pediatric formulations and in reduced-strength dose combined with full-strength dose of tetanus toxoid (denoted by upper case T and lower case d, "Td") in adult formulations. These are combined with acellular or whole-cell pertussis antigens in full strength in pediatric formulations (DTaP, DTwP) or in reduced strength in the adolescent/adult-formulations (Tdap).

In the United States, a total of 5 DTaP doses are recommended to be given to children, one dose each at ages 2 months, 4 months, 6 months, with booster doses at ages 15-18 months, and 4-6 years (http://www.cdc.gov/vaccines/recs/schedu ... hedule.htm). The fully immunized person who is exposed can become a carrier of the bacterium but may only develop a mild case, or may not get sick at all. But if not fully vaccinated, the risk of getting severely ill is 30 times higher (http://www.immunizationinfo.org/vaccines/diphtheria).

The following has been extracted from http://wwwnc.cdc.gov/travel/yellowbook/ ... theria.htm:

Adolescents aged 11-18 years should receive a dose of Tdap instead of Td for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood DTwP/DTaP vaccination series (see Table 7-03). Adults aged 19-64 years who have not previously received Tdap should receive a single dose of age-appropriate Tdap to replace a single dose of Td for active booster immunization against tetanus, diphtheria and pertussis. Adults aged greater than or equal to 65 years who have or who anticipate having close contact with an infant aged less than 12 months and who have not previously received Tdap should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission; all other adults aged greater than or equal to 65 years who have not previously received Tdap may be given a single dose of Tdap instead of Td. Thereafter, routine booster doses with Td should be given to all adults every 10 years to maintain seroprotection against diphtheria, as well as tetanus. This booster is particularly important for travelers who will live or work with local populations in countries where diphtheria is endemic.

Panipat is a historic city, with a population of 1.2 million in 2011, in Haryana state, India (http://en.wikipedia.org/wiki/Panipat#cite_note-2). Panipat is a center for textiles and carpets and has a handloom weaving industry with a supply of migrant workers from other states of India in search of employment (http://www.panipatcity.net). It is 90 km (56 miles) north of Delhi and 169 km (105 miles) south of Chandigarh. Panipat can be located on a map of India at: http://maps.google.com/maps?client=safa ... &q=panipat.

The HealthMap/ProMED-mail interactive map of India can be accessed at: http://healthmap.org/r/008o. - Mod.ML]