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DENGUE/DHF UPDATE 2012 (41) ASIA
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*****

[With the substantial increase in reports of dengue coming into ProMED, only outbreaks of 50 or more cases will be included in the weekly updates. In order to limit posts to key facts, individual reports will give its date, total number of dengue cases, indicating confirmed cases as (conf.) and unconfirmed cases as (unconf.), if known. DHF cases also include those termed serious cases. If the numbers of cases are increasing or decreasing that will be indicated. The dengue virus type is noted if available. The URL of the original report will be given, and the language of the report indicated if it is other than English. URLs for map locations of the country will be included. - Mod.TY]

*****

- India, West Bengal state. 5 Sep 2012. Dengue 789 (conf); Kolkata 497; Deaths 4 (conf.) 23 (unconf.); Increasing. http://twocircles.net/2012sep05/bengal_ ... _four.html

Map of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm - Mod.TY
Weat Bengal is on the Bay of Bengal in the east, not west, of the country. - Mod.JW]

- India, Pune, Maharashtra state. 6 Sep 2012. Dengue 75; Increasing. http://timesofindia.indiatimes.com/city ... 272535.cms [This is no doubt an underestimate of cases because only 20 per cent of private hospitals report cases. - Mod.TY
A location map of Pune, India can be accessed at:
http://www.punehotels.info/wp-content/u ... ne-map.gif - Mod.JW]

- Pakistan, national. 8 Sep. 2012. Dengue 200 or more cases. http://www.presstv.ir/detail/2012/09/08 ... -pakistan/

[A location map of Pakistan can be accessed at http://www.mapsofworld.com/pakistan/map ... on-map.jpg. - Mod.JW]

MALARIA - TURKEY: (MARDIN)
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Date: Sat 8 Sep 2012
Source: Flutrackers.com [edited]
http://www.flutrackers.com/forum/showth ... post467632


Malaria diagnosed in 12 people in Mardin district
-------------------------------------------------
The Ministry of Health reports that 12 cases of malaria were found during a survey in Mardin district.

The Ministry of Health stated that malaria was carefully surveyed and a few cases were found over the last 2.5 years. Other cases had been infected abroad. The Ministry of Health had assigned spraying teams [indoor residual spraying we presume]. All patients were in good condition and receiving appropriate treatment.

[Byline: Gazet Evatan]

--
Communicated by:
Gert van der Hoek

http://www.flutrackers.com

[Plasmodium vivax malaria is well known in southern Turkey. Turkey reported 84 345 probable and confirmed cases in 1994, but only 84 cases in 2009 (World Malaria Report, WHO 2010. http://www.who.int/malaria/world_malari ... index.html).

If the report signals an increase in southern Turkey, it could reflect an increase in Syria with increased transmission in the border areas from refugees who fled to Turkey. - Mod.EP

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (14): (UTTAR PRADESH)
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Date: Tue 11 Sep 2012
Source: Firstpost [edited]
http://www.firstpost.com/fwire/encephal ... 51496.html


With encephalitis claiming one more life, the death toll due to the viral disease in eastern Uttar Pradesh has mounted to 275, health officials said in Gorakhpur today [11 Sep 2912].

Additional Director (Health) Diwakar Prasad said a child from Deoria district died of the disease on Monday night [10 Sep 2012] at Baba Raghav Das Medical College Hospital in Gorakhpur.

During the weekend [7-8 Sep 2012] 30 new patients were admitted, he said, adding, about 270 encephalitis patients were being treated at BRD Medical College Hospital and the adjoining district hospitals.

As many as 1650 encephalitis patients were admitted this year [2012] to various government hospitals, out of which 275 have succumbed to the deadly disease.

--
Communicated by:
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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 on 3 Sep 201, and now to 275 in the report above on 11 Sep 2012. The etiology of the encephalitis cases mentioned in the report is not specified. The previous reports concerning the etiology of these cases are 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. If effective control and prevention measures are to be taken, it is essential to know which pathogens are involved.

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

MALARIA - INDIA (09): UPDATE
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[1] Goa
Date: Tue, 4 Sep 2012
Source: News Track India [edited]
http://www.newstrackindia.com/newsdetai ... -Goa-.html


Malaria cases on the rise in Goa, India
----------------------------------------
The coastal state expects to see a larger number of malaria cases after the free fall in the incidence over the past 5 years. From more than 6000 cases in 2007, the number dropped to barely 900 cases last year, the state directorate of health services reported. "But the bad news is that with 4months to go, we have already scaled last year's peak of 900 cases," Dr Sachin Govekar told reporters Tuesday [4 Sep 2012]. Dr Govekar is in charge of vector-borne diseases at the state directorate of health services.

What is worse, health authorities expect the number to climb in the monsoon, when mosquito infestation is higher. "In July, we had a tough time, there were lots of cases. In the backdrop of the monsoon showing a resurgence towards the fag end of August [2012], there is the possibility of more cases," Dr Govekar said.

Goa reported no malaria deaths this year. Last year, there were 2 deaths attributed to malaria.

[Communicated to ProMED-mail
from Health Map alerts]

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[2] Eastern India
Date: Mon, 3 Sep 2012
Source: Times of India [edited]
http://timesofindia.indiatimes.com/city ... 231593.cms


High incidence of renal failure linked to falciparum malaria, Jharkand, Eastern India
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Doctors in Jharkhand have linked a high incidence of renal failure in the state with falciparum malaria, a particular strain of malaria prevalent in this part of the country, and have expressed concern over the lack of preparedness on the part of the government and private medical institutions in case of an epidemic.

While the premier medical institution of the state, Rajendra Institute of Medical Science (RIMS) in Ranchi, has no super-speciality department for treating problems related to the kidney, there are only five qualified nephrologists in the state and most renal cases are dealt by general physicians in both government as well and private medical institutions. Dr A K Mahato, head of the department of medicine at RIMS, admitted that a large number of patients suffering from various renal disorders visit the hospital every day. "At present, the hospital has 4 dialysis machines and there is a long queue of patients. We are in the process of procuring and installing more machines. Some new machines will be installed shortly," he said.

When asked about the reason for the increase in the number of kidney-related ailments in the state, Mahato said though diabetes and hypertension affect renal functions, the bulk of the new cases is directly linked to malaria and food adulteration. "Malarial infection involves the brain and the kidney. If left untreated, it often affects the kidney more," he said, adding that various dyes used in colouring vegetables and other food items also affect normal functioning of the kidney, leading to renal failure in some cases.

Dr Ghanashyam Singh, nephrologist at Apollo Hospital in Ranchi, said that since renal disorders do not have symptoms for early detection, most cases reach doctors when they are in advanced stages. "Neither the government nor private medical institutions have any facility or awareness about detecting renal problems early. A renal profile is essential if a patient has been infected with malaria falciparum," he said. Singh said that more than 30 000 dialysis procedures and 65 kidney transplants have been performed at their hospital over the past few years.

When asked if early detection of renal infection can prevent kidney failure, Singh said medication helps prolong the life of an infected kidney depending upon the stage in which the ailment is diagnosed. "If detected in the 3rd stage, a patient can be advised medication that delays the need for dialysis," he said.

Narendra Sinha, doctor of medicine at Apollo, said chances of recovery of the kidney in case of being affected by malarial infection are higher if properly diagnosed. "In case of malaria, early and proper treatment can avert chances of renal issues. Unfortunately, most malarial cases in Jharkhand are ignored set aside [sic] follow up diagnosis of kidney and its condition," he said.

[Byline:
Jaideep Deogharia, TNN ]

Communicated by:
ProMED

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[3] Madhya Pradesh
Date: Mon, 3 Sep 2012
Source: Daily Bhaskar [edited]
http://daily.bhaskar.com/article/MP-IND ... 32916.html


One malaria case found every day in Indore, Madhya Pradesh
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Indore: At least one malaria patient is being identified every day in the district. So far, more than 290 patients have been identified, of which 33 are suffering from falciparum malaria.

As per the figures of the district malaria department, of these 290 patients, 95 normal malaria patients were identified through government facilities, while 166 normal cases were reported from private hospitals of the city. In case of falciparum malaria, only 2 cases were identified at government facilities against 31 cases at private hospitals. Falciparum malaria, which is commonly referred to as cerebral malaria, is the most dangerous form of malaria that can also lead to neurological abnormalities.

District malaria officer Dr MC Jinwal said, "This is the season when cases of malaria increase. We have increased our fever surveys and insecticide sprays."

The density of mosquitoes has also increased in the city. "The average mosquito density is hovering around 30-35 per cent as per the current estimate whereas it was just below 5 per cent in January," said Jinwal. "It is one of the reasons for the increase in cases of malaria in the district, though no deaths have been reported so far," he added. "Even in the positive cases which are detected from private hospitals, we are sending our teams to those areas for fever survey and insecticide spray, where these cases were detected," said Jinwal.

--
[Communicated to ProMED-mail
from Health Map alerts]

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[4] Gujarat
Date: Sat 1 Sep 2012
Source: Times of India [edited]
http://articles.timesofindia.indiatimes ... department


Malaria in Vadora, Gujarat
--------------------------
The health department in the city is on its toes for last month as the cases of malaria have been rising.

Irregular monsoons and cloudy weather in the city are being considered as the major reasons for the sudden rise in malaria and falciparum malaria. The government and private hospitals in the city are flooded with cases of the diseases.

In August, over 13 000 blood samples have been collected for malaria and falciparum malaria tests. Of the samples, over 380 have tested positive for malaria and 50 tested positive for falciparum malaria.

Chaitanya Dashrath
Vadodara Municipal Corporation
[Byline: Tushar Tere, TNN ]

--
Communicated to ProMED-mail
from Health map alerts]

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[5] Karnataka
Date: Wed, 29 Aug 2012
Source: Deccan Herald [edited]
http://www.deccanherald.com/content/274 ... total.html


Malaria in Mangalore, Karnataka
-------------------------------
Mangalore City Corporation, MCC, will intensify the malaria eradication campaign
as the total number of malaria positive cases reported in the district crossed 4000 in the month of August [2012]. Out of the total malaria cases reported in the district, till July [2012], 85.6 per cent have been identified in the city limits alone.

According to sources in the District Vector Borne Disease Control Office, the total number of cases reported till the month of July [2012] is 3823. Out of the total positive malaria cases, 3272 have been reported in Mangalore City Corporation limits alone. In the month of July [2012], the cases reported in the city are 470, whereas the total cases reported in the other parts of the district is 131.

The city is also leading in the cases where the most dangerous form of malaria, _Plasmodium falciparum_, is identified. Out of the total 229 cases identified with _Plasmodium falciparum_ in the district during the year, 210 are in the city limits.

Eradication campaign
--------------------
The MCC has already appointed 42 multi-purpose workers (MSW) to find and destroy the breeding sites of Anopheles mosquitoes. MCC in-Charge Health Officer Dr Sudarshan said that the workers are appointed in each corporate ward under the Urban Family Welfare centre and are visiting 50-70 houses per day. So far, these workers have covered more than 70 000 houses since they started the operation in July [2012].

The hotel owners' association has donated a mobile unit to the MCC to conduct tests for hotel workers. The unit, under a retired health officer, will visit the hotels and check the workers. The Association is also providing mosquito nets to their workers.

Separate teams for construction sites
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Since the main breeding ground for malaria has been identified as the various construction sites in the city, the Mangalore City Corporation (MCC) has formed 2 separate teams for inspecting construction sites. "Currently, 386 construction projects are going on in Mangalore. The teams are visiting these sites, inspecting them, destroying breeding sites and creating awareness among the workers," said Dr Sudarshan. "We have already asked construction site owners to provide proper facilities to the workers. If they fail in implementing the directions, we will take necessary actions," he added.

CREDAI to give 10 mobile units
------------------------------
MCC sources said that the Confederation of Real Estate Developers' Associations of India (CREDAI) has expressed their willingness to donate 10 mobile units, which will be exclusively for inspecting construction sites in the city. Each unit will have a retired health officer as in-Charge.

Single day campaign
-------------------
MCC Health department is also planning for a one-day awareness campaign with the help of National Service Scheme (NSS) volunteers. The campaign will cover all the houses in city in one day.

--
[Communicated to ProMED-mail
from Health map alerts]

[Malaria is well-known in Eastern India, Gujarat and parts af Madhya Pradesh. Karnataka and Goa are usually considered low endemic states. Goa has a large tourist industry. - Mod. EP]

[A person I know well contracted lab-confirmed malaria in Goa in 2010; she was advised to take prophylaxis, but stopped because of side effects of the drug.
Previous ProMED posts on malaria in Goa began in 2007:
Malaria - India (06): (GA, New Delhi, MH, AP) update 20120711.1198090
Malaria, falciparum - India: (GA) 20101122.4227
Malaria, falciparum - EU ex India (GA) 20090125.0325
Malaria, falciparum - EU ex India (Goa) (02) 20080202.0418
Malaria - India (Goa, Rajastan) 20070716.2287
Malaria - EU ex India (Goa) (02): UK 20070301.0728
Malaria - EU ex India (Goa) 20070112.0150
Malaria - Germany, Sweden ex India (Goa) 20070102.0014
Malaria - Denmark ex India (Goa): RFI 20070101.0001

A map showing the states of India can be seen at:
http://www.mapsofindia.in/images/india- ... al-map.jpg - Mod.JW

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

RABIES - INDIA, HUMAN (GOA) 2009
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Date: Sun 16 Sep 2012
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 415870.cms


A 48-year-old man from Karnataka working in Goa was diagnosed with rabies 25 years after the dog bite he received, Annals of Indian Academy of Neurology has reported in its latest issue. The unusual case has been recorded at the Goa Medical College (GMC) and hospital, Bambolim.

The patient was admitted to GMC in November 2009 and was reported to have been bitten by a dog at the age of 23. He had not received medical attention at that time.

The publication states that in cases around the world incubation periods of 14 - 19 years have been reported between the dog bite and the manifestation of symptoms of rabies. It could, however, not be established definitely that in this case there was no subsequent exposure to a dog, such as by way of licking etc.

The man was admitted to GMC with a history of fear of water and air.

He gave a definite history of dog bite on the leg 25 years ago and no other contact with a known rabid canine subsequently. He could not provide history of vaccination or medical attention at that time. During the clinical examination, he was anxious and scared at the sight of water, flow of air under a fan, as noted by the medical residents and consultants, the study states.

The patient's phobia seemed to have reduced 2 days after admission in GMC, as he suddenly went to the bathroom to wash his face and drank a glass of water as well. He was reported to be conscious, alert and well-oriented in time and space. This cast doubt on the diagnosis even though the features of hydrophobia and photophobia [more bcorrectly aerophobia. - Mod.JW] suggested rabies encephalitis.

"He was then referred to the general hospital for further management. However, he went to a private hospital in the zone. Within a few hours, he succumbed. Following the allegation of medical negligence by the guardian because of sudden deterioration and death, the body was shifted to the forensics department at Goa Medical College to establish the cause of death," the study states. The forensic report established the definitive diagnosis of rabies encephalitis.

The journal states that rabies accounts for over 20 000 deaths in India and that the disease can be easily mistaken in the early stages for other conditions and often has to be established after death through a postmortem.

Explaining the prolonged incubation period in the case reported in Goa, the study states, "In rabies, the incubation period (the interval between exposure and the first symptom) is more variable than any other acute infection. During the incubation period, it is suggested that the virus is probably sequestered in the skeletal muscle at the site of bite, while the exposed person remains asymptomatic."

The study notes that the man came to Goa in search of a livelihood 25 years ago and lived in a semi-urban area of the state. He was employed to deliver milk in nearby areas and residents of the colony reported that he suffered a dog bite at this stage. Residents said the victim was a lover of dogs and would caress dogs. At the same time that he suffered the dog bite, the carcasses of 2 dogs were lifted from the area, residents remembered.

"I was also part of the team that conducted the postmortem following the death. We had also sent some samples to Bangalore for testing and it was confirmed to be a case of rabies. The male patient was residing in and around Dona Paula and was seen to be suffering from hydrophobia. For an incubation period of close to 25 years, it's a highly unusual case," said Dr R G W Pinto, head of the department of pathology at GMC and one of the authors of the study. The other authors are Dr S K Shankar, Dr Anita Mahadevan, Dr Silvano Dias Sapeco, Dr M S G Ghodkirekar and Dr S N Madhusdana.

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

[Reference
Shankar SK, Mahadevan A, Sapico SD, Ghodkirekar MS, Pinto RG, Madhusudana SN. Rabies viral encephalitis with proable 25 year incubation period!. Ann Indian Acad Neurol. 2012 Jul;15(3):221-3.

The unfortunate man evidently had a history of frequent physical contact with dogs. Thus, subsequent exposure to rabies virus cannot be definitively ruled out following the dog bite of 25 years ago. If there was no later exposure, the 25 year incubation period is extraordinarily long.

According to the World Health Organisation (WHO) approximately 36 percent of the world's rabies deaths occur in India each year. Interestingly, the National Health Profile of India [records that] human rabies deaths number [only] in the 100s, considerably lower than the 20 000 mentioned in the above report (see the ProMED-mail archives listed below for a more detailed discussion of actual human rabies numbers). - Mod. TY

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

DENGUE/DHF UPDATE 2012 (43): ASIA
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ProMED-mail is a program of the
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Date: 17 Sep 2012

[With the substantial increase in reports of dengue coming into ProMED, only outbreaks of 50 or more cases will be included in the weekly updates. In order to limit posts to key facts, individual reports will give an outbreak's date, total number of dengue cases indicating confirmed cases as (conf.) and unconfirmed cases as (unconf.) if known. DHF cases also include those termed serious cases.

If the numbers of cases are increasing or decreasing, that will be indicated. The dengue virus type is noted if available. The URL of the original report will be given, and the language of the report indicated if it is in other than English. URLs for map locations of the country will be included. - Mod.TY]

*****
- India, West Bengal state. 11 Sep 2012. Dengue in state 1224, in Kolkata city 766, in Parganas 188; Deaths 5 (all Kolkata).
http://health.india.com/news/west-benga ... -in-cases/

Map of India can be seen at
http://www.mapsofindia.com/maps/india/i ... al-map.htm
- Mod.TY

[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1yAq, http://healthmap.org/r/1pq_, http://healthmap.org/r/1pSH, http://healthmap.org/r/2iyC.
- Mod.TY]

SCRUB TYPHUS - INDIA (07): (RAJASTHAN) FATAL, SUSPECTED
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Date: Mon 17 Sep 2012
Source: Deccan Herald [edited]
http://www.deccanherald.com/content/279 ... sthan.html


A rare disease suspected to be 'scrub typhus' has claimed 30 lives in Alwar district of Rajasthan this season. Another 6 have died due to a disease with similar symptoms in Dausa.

Concerned over the high death count recorded since 22 Aug this year [2012], the health department has sought the help of the National Centre for Disease Control (NCDC) based in New Delhi. A team has reached the spot to collect blood samples, according to official sources.

Scrub typhus can be cured but only if it is timely diagnosed. It is caused by the bite of mites especially during the monsoon season and is reported in areas close to jungles or urban shrubs. Since fever is one of the early symptoms of this disease, wrong or delayed diagnosis is a major worry.

Residents claim that the death toll is over 50, but the chief medical health officer (CMHO) in Alwar, Dr K K Meena, puts the official figure at 30.

In Dausa, 6 people died recently after showing symptoms similar to that of scrub typhus, which include high fever and low platelet count. "In the initial investigation, we have found that some of them had low platelet count accompanied by fever," said Dr O P Bairwa, CMHO, Dausa.

--
Communicated by:
ProMED-mail rapporteur Kunihiko Iizuka

[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
----------
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.

Rajasthan is India's largest state located in northwestern India; it is bordered by Pakistan to the west. Alwar district has a population of 3 671 999 (2011 census) (http://en.wikipedia.org/wiki/Alwar_District), and the adjacent Dausa District has a population of 1 316 790 (2001 census) (http://en.wikipedia.org/wiki/Dausa_district). For a map showing the location of the Alwar District, see http://en.wikipedia.org/wiki/File:Rajas ... strict.png, and Dausa District, see http://en.wikipedia.org/wiki/File:Rajas ... strict.png. A map of India on which the state of Rajasthan can be located is available at http://en.wikipedia.org/wiki/File:India ... or_map.svg.

A HealthMap/ProMED-mail interactive map of India can be found at
http://healthmap.org/r/3kii. - Mod.ML]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (15): UTTAR PRADESH
***********************************************************
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Date: Wed 19 Sep 2012
Source: The New Indian Express [edited]
http://newindianexpress.com/nation/article609550.ece


With encephalitis claiming 6 more lives, the death toll due to the disease in eastern Uttar Pradesh has mounted to 322 this year [2012].

Health officials said today [19 Sep 2012] that 6 persons died due to the disease yesterday [18 Sep 2012].

Additional Director (Health) Diwakar Prasad said 44 people suffering from encephalitis have been admitted to Baba Raghav Das Medical College Hospital (BRD MCH) and other government hospitals.

He said 354 people suffering from the disease are undergoing treatment in various government hospitals including BRD MCH.

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

[The death toll in eastern Uttar Pradesh state has climbed from 274 reported on 11 Sep 2012 (see ProMED-mail archive number 20120912.1291540) by 48 fatal cases to the 322 indicated above. With another 354 people under treatment for encephalitis currently, that number can be expected to climb still further. As with many previous reports, the etiological agent responsible for these cases is not indicated.

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

DENGUE/DHF UPDATE 2012 (45) ASIA
********************************
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*****

- India, Mumbai, Maharashtra state. 22 Sep 2012. Dengue (conf.) 398 cases; Deaths 1; Increasing. http://timesofindia.indiatimes.com/city ... 497296.cms

[A map of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm, and HealthMap/ProMED-mail maps can be accessed at: http://healthmap.org/r/1yAq, http://healthmap.org/r/1pq_, http://healthmap.org/r/1pSH, and http://healthmap.org/r/2iyC. - Mod.TY]

- India, West Bengal state. 18 Sep 2012. Dengue 2033 cases; Deaths 7; Cities: Kolkata 1024 cases; North 24 Parganas district 242 cases; Increasing. http://health.india.com/news/west-benga ... 033-cases/

- Pakistan, Punjab province. 19 Sep 2012. Dengue 140 cases. Increasing. http://www.thenews.com.pk/article-68285 ... -in-Punjab

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

SCRUB TYPHUS - INDIA (08): (HIMACHAL PRADESH) FATAL, MORE CASES
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Date: Sat 22 Sep 2012
Source: Zee News [edited]
http://zeenews.india.com/news/himachal- ... 01139.html


The death toll in a hospital here from a disease caused by infected mites has risen to 10, a doctor said on Saturday [22 Sep 2012].

Two more people have died due to scrub typhus at the Indira Gandhi Medical College and Hospital, the doctor told a news agency. One patient belonged to Bilaspur district and the other to Solan.

Scrub typhus is a disease caused by the bite of an infected mite. Its symptoms are fever, headache, muscle pain, cough and gastroenteritis.

A total of 155 people have tested positive for the disease, the doctor said.

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[For a discussion of scrub typhus, see a prior ProMED-mail post on this outbreak: Scrub typhus - India (06): (HP) fatal 20120906.1282795.

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. Establishing the diagnosis and initiating prompt antimicrobial drug therapy are important, because death rates for untreated scrub typhus patients are 1-30 per cent (http://wwwnc.cdc.gov/eid/content/12/2/pdfs/v12-n2.pdf). Scrub typhus is effectively treated with doxycycline, and treatment should begin immediately upon suspicion of illness without awaiting laboratory confirmation.

Himachal Pradesh is a mountainous state in northwestern India with an elevation ranging from about 350 meters (1148 feet) to 7000 meters (22 966 feet) 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]

RABIES - INDIA (09): (PUNJAB) STRAY DOGS, HUMAN, SUSPECTED, REQUEST FOR INFORMATION
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Date: Mon 24 Sep 2012
Source: Times of India, Times News Network (TNN) [summ., edited]
http://timesofindia.indiatimes.com/city ... 521461.cms


The canine terror prevailing among people in villages of [Patiala] district and city has intensified even as government hospitals have reported non-availability of anti-rabies medicines for the past 3 years.

Residents of many villages of this district have been facing stray dog terror and don't dare to venture out late in the evening, for some time now. Groups of stray dogs can be seen at any time in Patiala city and surrounding villages as authorities have failed to find a solution to this ever increasing problem, despite many school students and others having been attacked by the canines.

Since January 2009, around 7500 cases of dog bites have been reported at various hospitals of the district. Of these, around 3500 have come to Govt Rajindera Hospital, Patiala while dispensaries and health centers of the district have received the remaining cases, sources said.

In many surrounding villages like Banera, Bursat, Surajpur, and other villages, residents have stopped going out in late evening and early morning as many villagers have faced repeated attacks. During the last 2-3 months, around 30 villagers have been attacked by stray dogs. An elderly labourer of Bursat village died after struggling for life in government hospital for many days, while a 5-year girl died in a local government hospital 2 days back.

Deputy medical superintendent of Rajindera Hospital, Patiala, Dr Harshinder Kaur, confirmed that the hospital has not received any anti-rabies medicine for the last 3 years.

"In many villages, people don't go out of their houses for fear of stray dogs. The dogs roam in groups and suddenly attack whenever anyone is moving alone late in the evening. We have requested health authorities to work out a solution for this problem, but there is no action so far," alleged [a resident] of Bursat village.

The school-going children of these villages don't go out alone anywhere and parents have to accompany the children always. The majority of parents don't allow their children to attend evening tuitions. "Without tuitions, getting good marks is impossible in these times. But my father has to accompany me always, with a stick in his hand, to save me from stray dogs," said a 9th class student from Banera village. Despite such a high number of dog bite cases, government hospitals continue to remain without the required medicines and patients are forced to purchase it from private hospitals, sources said.

[Byline: Parvesh Kumar Sharma]

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[For the location of Patiala, Punjab, India see http://healthmap.org/r/3wl3. - Mod.AS]

[The statistics are puzzling. Out of 7500 dog bites, at the rate of 30 people in the last 2-3 months, which is apparently an alarming incidence, or say 200 people a year, it would take 38 years to accumulate 7500 bites, not 3. And with nobody vaccinated, only 2 people have died recently of suspected rabies -- perhaps out of those 30 people, not 7500? While it is indeed terrible that no human rabies vaccine has been avaiable, can you imagine the expense if 7500 bitten people had received rabies vaccine? While it is indeed awful to be at risk of dog bites at night, the dogs must be remarkably rabies-free. Can anybody tell us what the numbers of bites and suspected rabies deaths have been recently there? - Mod.CP/JW]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (44): ASIA
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Cholera - India (Jammu and Kashmir State)
Date: Mon 24 Sep 2012
Source: Greater Kashmir News [edited]
http://www.greaterkashmir.com/news/2012 ... mir-73.asp


In a matter of grave concern for health officials in the Kashmir Valley, at least 238 patients were diagnosed with cholera in north Kashmir's Baramulla district with Public Health Authorities saying that all the water samples collected from the areas are "grossly contaminated" and tested positive for fecal matter.

"We have treated over 500 patients for different water-borne diseases in Baramulla and 238 patients were declared as cholera cases after clinical suspicion by the doctors in various district hospitals. They mostly live in Tangmarg, Kunzer, and Pattan areas," sources told Greater Kashmir. The clinical suspicion emerged from the microbiological analysis by the public health officials in the district.

[Byline: Manzoor-Ul-Hassan]

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[A HealthMap/ProMED-mail map of the area can be accessed at http://healthmap.org/r/1_IS. - Mod.LL]

DENGUE/DHF UPDATE 2012 (47): ASIA
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*****

- India, Punjab state. 27 Sep 2012. Dengue 99 cases, (suspected) 9 more cases; Deaths at least one; Increasing. http://www.hindustantimes.com/Punjab/Lu ... 36426.aspx

[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, Maharashtra state. 28 Sep 2012. Dengue 451 cases; Deaths one. http://articles.timesofindia.indiatimes ... elet-count

- India Odisha state. 24 Sep 2012. Dengue 575 cases; Deaths 5; Increasing. http://timesofindia.indiatimes.com/city ... 522104.cms

- India, Delhi. 30 Sep 2012. Dengue 65 cases (locally acquired); Deaths 2. http://www.indianexpress.com/news/38yea ... n/1009837/

- Pakistan, Karachi, Sindh province. 20 Sep 2012. Dengue 203 cases; Increasing. http://dunyanews.tv/index.php?key=Q2F0S ... Q9MTAyNTkw

[A HealthMap/ProMED-mail interactive map showing the location of Sindh province can be accessed at http://healthmap.org/r/2NT8
and a map showing the location of Karachi in Sindh province at http://www.lib.utexas.edu/maps/middle_e ... n_2010.jpg. - Mod.TY]

SCRUB TYPHUS - INDIA (09): (HARYANA, PUNJAB)
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Date: Mon 1 Oct 2012
Source: The Indian Express [edited]
http://www.indianexpress.com/news/scrub ... s/1010163/


After malaria, dengue and swine flu, now the residents of the tricity also need to watch out for scrub typhus, warn doctors. [Chandigarh, Mohali, and Panchkula are collectively referred to as the Tricity.] A fever known to only spread in the hill regions has now started spreading to the plains as well owing to various climatic reasons. The scrub typhus patients earlier only found in hilly regions of the Himalayas including Shimla, Assam, West Bengal are now reporting at PGI [Postgraduate Institute, Chandigarh] from Chandigarh, Panchkula, and the surrounding areas.

"This year [2012] in August and September, 62 blood samples were received from adults as well as children in PGI. Out of these, 50 were found positive for scrub typhus by Weil Felix assay," says Dr Sunil Sethi, Department of Medical Microbiology, PGIMER [Postgraduate Institute of medical Education and Research]. Most of the patients had fever, cough, and myalgia, he adds.

Says Dr Rajesh Kumarm, head of the Department of Community Medicine, PGIMER, "There can be various reasons for the disease to spread here in [the] plains. First, there are climatic changes. Secondly, the agricultural practices in Punjab and Haryana have also changed and the habitat may have been conducive for the mite to breed here and thus find a favourable habitat. Also, residents keep migrating from one place to another and someone infected with the disease came in contact of the mite here and then the infection spread from one mite to another. Indeed it is an unusual finding in the past few years."

The disease recently took lives of 14 patients from different regions in Himachal Pradesh, says Dr Ramesh, deputy medical superintendent, Indira Gandhi Medical College and Hospital, Shimla. "At present, we have 30 patients admitted to the hospital, and on average, we had been receiving over 100 cases a day from various districts of Himachal Pradesh in our hospital in the past couple of days," he adds.

Explaining its health complications, Dr Sethi says severe scrub typhus usually presents as multiple-organ damage including carditis, acute respiratory distress syndrome, hepatitis, renal failure. encephalitis, disseminated intravascular coagulopathy (DIC), and septic shock.

The disease is caused by bacteria known as _Orientia tsutsugamushi_ that live primarily in mites (the primary reservoir) belonging to the species _Leptotrombidium akamushi_ (chigger mite).

The infection is called scrub typhus because it generally occurs after exposure to areas with secondary (scrub) vegetation. It has recently been found, however, that the disease can also be prevalent in such areas as sandy beaches, mountain deserts, and equatorial rain forests, according to Dr Sethi.

Human beings are infected accidentally, usually during the rainy season. [An eschar is formed on the site of the mite bite.] It resembles a skin burn caused by a cigarette butt. The lesions are painless and without any itching sensation in most cases, causing the infection to be undetected by most patients.

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Communicated by:
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[For a discussion of scrub typhus, see a prior ProMED-mail post on this outbreak: Scrub typhus - India (06): (HP) fatal 20120906.1282795.

_Orientia tsutsugamushi_, a rickettsia-like microorganism that is the cause of scrub typhus, is transmitted by the bite of a chigger. Chiggers are the 6-legged juvenile form (larvae) of the 8-legged mite. More mature stages of the mite are not parasitic and feed on plant materials. 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. Establishing the diagnosis and initiating prompt antimicrobial drug therapy are important, because death rates for untreated scrub typhus patients are 1-30 per cent (http://wwwnc.cdc.gov/eid/content/12/2/pdfs/v12-n2.pdf). Scrub typhus is effectively treated with doxycycline, and treatment should begin immediately upon suspicion of illness without awaiting laboratory confirmation.

The Weil-Felix test, an agglutination test for the diagnosis of rickettsial disease, is based on the detection of antibodies to various _Proteus_ species, which contain antigens that cross-react with rickettsial antigens. This test has poor sensitivity and specificity, but continues to be used in resource-poor regions (http://www.japi.org/august2006/O-619.pdf).

Chandigarh, a city with a population of almost 1 million, is located near the foothills of the Shivalik range of the Himalayas in northwest India; the city serves as the capital of 2 states, Haryana to the south and Punjab to the north (http://en.wikipedia.org/wiki/Chandigarh). The surrounding districts are of Panchkula and Ambala in Haryana and Mohali, Patiala, and Roopnagar in Punjab. Chandigarh has a humid subtropical climate characterized by a seasonal rhythm: very hot summers, mild winters, unreliable rainfall, and great variation in temperature (-1 to 41.2 deg C, or 30.2 to 106.2 deg F).

A HealthMap/ProMED-mail interactive map of India that shows the Indian states of Haryana and Punjab and the city of Chandigarh, as well as Himachal Pradesh state, can be found at http://healthmap.org/r/2dpO. - Mod.ML]

HEPATITIS C - INDIA: (PUNJAB), HIGH INCIDENCE
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Date: Mon 1 Oct 2012
Source: Hindustan Times [edited]
http://www.hindustantimes.com/Punjab/Ba ... 38460.aspx


3100 hepatitis C cases, only 87 stated
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A deadly virus has gripped people battling a more serious disease of poverty. Down with hepatitis C, more than 1600 poor people in Baghapurana, 600 in Langeana village, 900 in Badhni Kalan town and many more in the surrounding areas in this district are in a lonely struggle. Instead of installing hepatitis test facilities at the civil hospitals of Baghapurana, Badhni Kalan and Nihal Singh Wala, the Health Department has tried to cover up the epidemic. Its survey teams recorded only 87 cases of the disease.

"The survey was an eyewash and done in haste for the sake of filing a report," said Charanjit Sharma, a teacher at Langeana, a [badly] affected village that no team ever visited.

The ruling Shiromani Akali Dal (SAD) party had made an election promise of solving Moga's 10-year-old hepatitis-C problem, recalls social worker Gurtej Singh Brar of Langeana. "Where's the solution?" said Charan Singh of Baghapurana, former subedar [junior commissioned officer] in the army.

A total of 4 residents of Langeana found out they had hepatitis when they went to donate blood at a camp in their village. That was 3 years ago. "In the past 10 years, the Health Department has never organised any camp for the hepatitis-C examination," said one of them. 5 people from 2 poor families of Sukhanand village visit a baba (witch doctor) every Sunday to get rid of the curse.

"We have no money for treatment," said one of the people seeking relief. "We are a family of 6; how can my 2 sons and I get any medicine for hepatitis-C from any private hospital."

Additional deputy commissioner Joram Beda accepted the seriousness of the situation. "The health department does hold examination camps from time to time," he said. "Many private doctors, however, do not report all the hepatitis cases to us. I will seek a detailed report and do an investigation."

[Byline: Surinder Mann]

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[Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C virus is usually spread when blood from an infected person enters the body of a susceptible person. It is among the most common viruses that infect the liver. Hepatitis C is found worldwide. Countries with high rates of chronic infection are Egypt, Pakistan and and China.

Hepatitis C virus is most commonly transmitted through exposure to infectious blood. This can occur through receipt of contaminated blood transfusions, blood products and organ transplants; injections given with contaminated syringes and needle-stick injuries in health-care settings; and being born to a hepatitis C-infected mother. Hepatitis C may be transmitted through sex with an infected person or sharing of personal items contaminated with infectious blood. Hepatitis C is not spread through breast milk, food or water or by casual contact.

It is unclear why the incidence of hepatitis C appears to be high in the Indian state of Punjab. Treatments for hepatitis C virus infection are becoming available, but remain beyond the resources of most countries with large populations. The WHO recommends that the risk of infection can be reduced by avoiding unnecessary and unsafe injections, unsafe blood products, use of illicit drugs and sharing of injection equipment, unprotected sex with hepatitis C-infected people, and tattoos, piercings and acupuncture performed with contaminated equipment.

Punjab is a state in the northwest of the Republic of India, forming part of the larger Punjab region. The state is bordered by the Indian states of Himachal Pradesh to the east, Haryana to the south and southeast and Rajasthan to the southwest as well as the Pakistani province of Punjab to the west. It is also bounded to the north by Jammu and Kashmir.

A map of the districts of Punjab state can be accessed at: http://en.wikipedia.org/wiki/File:Punja ... ct_map.png. The interactive ProMED/HealthMap of Punjab state is available at: http://healthmap.org/r/3yzA. - Mod.CP]