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SCRUB TYPHUS - INDIA (12): (MAHARASHTRA) FATAL
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Date: Thu 8 Nov 2012
Source: The Times of India (TOI), Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 136443.cms


A 45-year-old woman from Ashti town in Wardha district, died of scrub typhus on Tuesday [6 Nov 2012] at 7 pm at the Indira Gandhi Government Medical College (IGGMC) where she was undergoing treatment since [13 Oct 2012]. She is the 2nd positive scrub typhus case reported from the region so far.

Dr Sunil Agrawal, associate professor of medicine and the acting department head, told TOI [Times of India] that the patient came to the hospital at a very late stage with severe complications. Since she did not have [the skin] lesion [caused] by the bite of chiggers [that is, the larval stage of] trombiculid mites, which transmit the disease-causing bacterium _Rickettsia [now called _Orientia_] tsutsugamushi_, doctors did not suspect scrub typhus initially.

Dr Agrawal said, "the patient came to us 9 days after suffering from high fever. Her blood sample report became positive for scrub typhus. We had already begun treating her with doxycycline, which is used for scrub typhus." She was kept in medicine ICU after going into multiple organ dysfunction stage. Her condition improved and she was shifted back to the ward. "Her condition deteriorated again and she was kept on a ventilator. She died on Tuesday night [6 Nov 2012] after multiple organ failure and suffering acute respiratory distress syndrome (ARDS)," he said.

[Another woman] of Kolhu in Katol tehsil [administrative division] was the 1st scrub typhus case, which was reported from IGGMC by medicine head Dr PP Joshi and Dr Abhijit Nugurwar, a registrar in medicine ICU. TOI had reported this on [23 Oct 2012]. "We got the [Ashti town] patient's report on [31 Oct 2012] from the National Centre for Disease Control (NCDC), New Delhi. Had she come to us in the initial stages, maybe we could have saved her," said Dr Joshi.

Since this is an uncommon and notifiable disease, Dr Vijay Kargilwar, surveillance officer from Integrated Diseases Surveillance Project of central government for Nagpur district and epidemiologist, conducted a survey at Kolhu on 23 Oct 2012]. "When the Ashti woman tested positive, we went back to the village on [30 Oct 2012] and collected samples from 9 patients," he said.

Ashti district surveillance officer Dr Nilam Somalkar conducted a survey in his area after learning about the patient. "The patient, a farm labourer from ward 6 which is very close to the forest area, stayed alone. Her family lives in Nagpur," he said.

[Byline: Snehlata Shrivastav]

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[For a discussion of scrub typhus, see prior ProMED-mail post: Scrub typhus - India (07): (RJ) fatal, susp. 20120917.1297397. Scrub typhus is caused by _Orientia tsutsugamushi_, a rickettsia-like microorganisms that is transmitted by chiggers, the larval stage of trombiculid mites, which feed on the skin cells of animals, including humans and rodents. After feeding on their hosts, chiggers drop to the ground and become nymphs, which then mature into adults that feed only on plant materials. The cutaneous reaction to chiggers leaves a characteristic black eschar that is useful for making the diagnosis. Humans become infected when they accidentally encroach in an area where the infected chigger-rodent cycle is occurring, most often areas of low-lying scrub brush or transitional vegetation. 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).

The Weil-Felix test is an agglutination test based on the detection of antibodies to various _Proteus_ species, which contain antigens that cross-react with rickettsial antigens. The Weil-Felix test continues to be used for the diagnosis of scrub typhus in resource-poor regions, but it has poor sensitivity and specificity (http://www.japi.org/august2006/O-619.pdf). The gold standard for the diagnosis of scrub typhus is the indirect fluorescent antibody (IFA) assay, but the fluorescence microscopes that are required for performance of this assay are not often available in resource-poor settings where scrub typhus is endemic.

Nagpur is a city located precisely at the geographical center of India and is the winter capital of the state of Maharashtra, the largest city in central India. Nagpur, with a population of 2,405,421 (2011) is the third largest city in Maharashtra after Mumbai and Pune. For a map of India showing the location of Nagpur, see http://maps.google.com/maps?hl=en&sugex ... =nagpur&um. [Ashti is 622km (387 miles) from Nagpur].

Nagpur and Wardha districts can be seen on the map at http://www.mapsofindia.com/maps/maharas ... ashtra.htm - Mod.ML]

[Photos of the eschar & mite: http://4.bp.blogspot.com/_liYunANNUeg/S ... crub2+.JPG.
Scrub typhus life cycle: http://armymedical.tpub.com/MD0152/MD01520183im.jpg. - Mod.JW

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (19): (ODISHA)
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Date: Sat 10 Nov 2012
Source: News Track India [edited]
http://www.newstrackindia.com/newsdetai ... disha.html


Japanese encephalitis, a mosquito-borne disease, has killed at least 24 children in Odisha's Malkangiri district, an official said on Saturday [10 Nov 2012]. A team of experts visited the affected area a few days ago and collected nearly 70 samples after the children, aged between 2-5 years, died in 5 villages of the district in recent months. The team found that 10 samples were positive for Japanese encephalitis virus, according to the Joint Director of the state health department, M. M. Pradhan.

The dead children had symptoms including swelling of the eyes, nose, and ears, and they also had other symptoms characteristic of Japanese encephalitis, a mosquito-borne virus that is responsible for the deaths of thousands of children in India every year. The investigation results of the rest of the samples will come soon, Pradhan said.

Pradhan said that villages had large number of pigs, the amplifying host of the virus.

No new cases of disease have been reported from the district after the affected areas were disinfected and an awareness campaign was launched.

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[So far, 10 of some 70 samples from affected children have tested positive for Japanese encephalitis virus infection. It is not yet clear whether any other virus may be implicated in this outbreak as has been reported elsewhere in India, particularly in the state of Uttar Pradesh.

Japanese encephalitis (JE) is a virus disease that infects animals and humans. It is transmitted by mosquitoes and in humans causes inflammation of the membranes around the brain. It is associated with irrigation and build-up of the mosquito-vector populations. This may cause the circulation of the virus to spill over into humans from its preferred hosts, birds and pigs. An effective inactivated vaccine is available, but it is expensive and requires more than a single injection. As is the case in Odisha, control of the pig population and mosquito eradication may be the best public health options.

Most JE virus infections are mild or without apparent symptoms, but approximately one in 200 infections result in severe disease characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis, and death. The case fatality rate can be as high as 60 percent among those with such disease symptoms. In areas where Japanese encephalitis virus is common, encephalitis is observed mainly in young children, because older children and adults have already been infected and are immune.

Orissa -- now officially rendered as Odisha -- is located on the east coast of India, adjacent to the Bay of Bengal. A map of Odisha/Orrisa showing Malkagigiri district in the far south of the state can be accessed at: http://en.wikipedia.org/wiki/File:Orissa_State_map.svg. - Mod.CP

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

DENGUE/DHF UPDATE 2012 (58) - ASIA
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In this update:

India
- Delhi area
- Assam state
- Ahmedabad, Gujarat state
- Bihar state
- Punjab state


******

Cases in various countries:
India
- Delhi area. 10 Nov 2012. Dengue 1401 cases. Increasing.
http://indiatoday.intoday.in/story/deng ... 28635.html

[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]

- Assam state. 9 Nov 2012. Dengue (susp.) 542 cases, (conf.) 249 cases; Kamrup district 200 cases; deaths 4.
http://timesofindia.indiatimes.com/city ... 150025.cms

- Ahmedabad, Gujarat state. 9 Nov 2012. Dengue last 7 days, 250 cases, as of October [2012] 640 cases. Increasing.
http://daily.bhaskar.com/article/GUJ-AH ... 7-NOR.html

- Bihar state. 8 Nov 2012. Dengue (conf.) more than 1000 cases. Cities affected: Patna 315 cases, Bhagalpur 235 cases; deaths 3.
http://www.rediff.com/news/report/three ... 121108.htm

- Punjab state. 8 Nov 2012. Dengue deaths 12. Increasing
http://punjabnewsline.com/news/Dengue-_ ... es-12.html

East Malaysia (Sibu Division, Sarawak). 5 Nov 2012. Dengue 70 cases, Sibu town 50 cases.
http://www.theborneopost.com/2012/11/05 ... ek-merlin/

[A HealthMap/ProMED-mail map of Malaysia 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 (13): (MANIPUR) FATAL
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Date: Fri 16 Nov 2012
Source: E-Pao, The Sangal Express report [edited]
http://www.e-pao.net/GP.asp?src=16..171112.nov12


Recalling the unknown disease that broke out at Bishnupur district in 2008/2009 and which claimed a number of lives, a medical expert has sounded an alert that the disease is now stalking the populace of Ukhrul district.

Talking to The Sangai Express, the medical expert, a doctor who preferred to remain anonymous, said that the disease is known as scrub typhus and added that he has personally come across around 20 such cases from Ukhrul district. The patient can be cured easily, but the watchword is early detection, he said and added that the schoolgirl who recently passed away in Ukhrul is a case in point.

"Many patients undergo testing for malaria and typhoid, but seldom undergo the test to detect scrub typhus," said the doctor and added that since the tests for malaria and typhoid return negative, the patients are thought to be suffering from viral fever. The symptoms are similar to malaria, typhoid, and viral fever, he said but added that patients suffering from scrub typhus typically carry a scar. The scar is caused by the bite of an insect, he said and added that it is important for the patient to inform the doctor of the presence of such a scar.

Domestic animals are the host carrier of these insects whose bite causes scrub typhus, he added. The test for scrub typhus is a simple procedure, he said and added that suspected patients should undergo the rapid scrub antibody test. The result can be known in a matter of some minutes, he said and added that once this is confirmed, the treatment can start with doxycycline drugs, which is fairly cheap and affordable. With the right treatment and at the right time, recovery rate is as high as 98 per cent, said the doctor and added that recovery process can start within 48 hours of the right medication.

Around 50 such cases were also reported from Senapati this year [2012], he said and added that a medical awareness camp held at the said district went a long way in effectively treating the patients. Awareness programme on the disease may be held at Ukhrul district, he suggested.

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[The following is extracted from moderator ML's comments in ProMED-mail post Scrub typhus - India (12): (MH) fatal 20121109.1402125:

Scrub typhus is caused by _Orientia tsutsugamushi_, a rickettsia-like microorganism that is transmitted by chiggers, the larval stage of trombiculid mites, which feed on the skin cells of animals, including humans and rodents. After feeding on their hosts, chiggers drop to the ground and become nymphs, which then mature into adults that feed only on plant materials. The cutaneous reaction to chiggers leaves a characteristic black eschar that is useful for making the diagnosis. Humans become infected when they accidentally encroach in an area where the infected chigger-rodent cycle is occurring, most often areas of low-lying scrub brush or transitional vegetation. 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).

The Weil-Felix test is an agglutination test based on the detection of antibodies to various _Proteus_ species, which contain antigens that cross-react with rickettsial antigens. The Weil-Felix test continues to be used for the diagnosis of scrub typhus in resource-poor regions, but it has poor sensitivity and specificity (http://www.japi.org/august2006/O-619.pdf). The gold standard for the diagnosis of scrub typhus is the indirect fluorescent antibody (IFA) assay, but the fluorescence microscopes that are required for performance of this assay are not often available in resource-poor settings where scrub typhus is endemic.

A HealthMap/ProMED-mail interactive map showing the north eastern Indian state of Manipur, which borders Myanmar to the east, can be accessed at http://healthmap.org/r/4817. Ukhrul, Senapati, and Bishnupur districts can be seen on the map of Manipur state at http://www.districtsofindia.com/manipur ... trict.aspx. - Mod.ML

Photos of the eschar and mite: http://4.bp.blogspot.com/_liYunANNUeg/S ... crub2+.JPG. - Mod.JW]

FATAL ILLNESS - PAKISTAN: (SINDH) CHILDREN, CONFLICTING DIAGNOSES, REQUEST FOR INFORMATION
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[1]

Date: Mon 19 Nov 2012
Source: The Nation [edited]
http://www.nation.com.pk/pakistan-news- ... n-khairpur


Three children died of smallpox in [Thari Mirwah taluka (sub-district)] in Khairpur district. 3 children [names withheld - Mod.CP] died at village Ajeeb Dasti near Thari Mirwah. According to villagers, a total of 7 children died during the last 48 hours in different villages, but the health department or district administration are still unaware in this regard. They said due to poor services of the health department, medicines are stolen from health centres while the district administration is also not paying attention in this regard.

They have demanded dispatch of doctor teams to their areas as several people including children are suffering from smallpox disease and the people are scared of the rising death toll.

[Almost identical reports report have appeared in the Frontier Post http://www.thefrontierpost.com/article/192722/, and the Lahore Tines http://www.promedmail.org/direct.php?id=20020612.4479.]

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******
[2]
Date: Mon 19 Nov 2012
Source: The International News [edited]
http://www.thenews.com.pk/Todays-News-2 ... n-Khairpur


Some cases of measles have reportedly claimed lives of 8 children in the town of Thari Mirwah in Khairpur during the past one week. 2 of those who died were 5 and the rest under 5 years of age. [2 of the 5 had the same names as 2 of the children identified in part [1] above, who likewise resided in a village near the town of Thari Mirwah. - Mod.CP]

The people of the area have appealed to the provincial Health Department to take notice of the outbreak of measles, which has already claimed 8 lives in a week. Meanwhile, a team of the Health Department visited the area and collected blood samples of some of those suffering from the disease. The people of the area have not heard from the team since then.

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[Khairpur is a district in Sindh province of Pakistan. It can be located in the map of Sindh province at http://pakistan360degrees.com/category/ ... -pakistan/.

Undoubtedly these contradictory reports refer to the same incident. In the absence of a description of the illness a precise diagnosis cannot be proposed with confidence. The suggested diagnosis of smallpox in the 1st report cannot be sustained since this disease has been eradicated and the last confirmed case was identified in Somalia in 1977 (http://www.who.int/csr/disease/smallpox/en/).

There is precedent for misdiagnosing measles as smallpox in Sindh province, Pakistan (see ProMED-mail post: Unexplained deaths, measles? - Pakistan (Sindh): RFI 20020401.3854). Currently measles is widespread throughout Pakistan with significant mortality. Chickenpox is another childhood disease, which by name and symptoms might be confused with smallpox (see http://www.cdc.gov/chickenpox/about/complications.html). Further information is awaited. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/495Q.]

LEISHMANIASIS - PAKISTAN (02): (KHYBER AGENCY)
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Date: Tue 20 Nov 2012
Source: Frontier Post [edited]
http://www.thefrontierpost.com/article/192733/


Leishmaniasis disease on rise in Khyber Agency
----------------------------------------------
The increasing number of leishmaniasis patients in areas of Khyber Agency negates the claims of the Fata Health Department in taking measures to eradicate the disease. Currently there are around 400 to 500 locals and Afghan refugees who are suffering from the disease in the Khyber Agency areas near Pak-Afghan border.

Leishmaniasis is a disease caused by protozoan parasites that belong to the genus Leishmania and is transmitted by the bite of certain species of sand fly. It is a contiguous disease and according to the experts mostly Afghan refugees bring the disease with them when they enter the Pakistani border. Locals showing concern over the spread of the disease said the alarming number of leishmaniasis patients was due to the arrival of Afghan refugees in different areas of Khyber Agency.

Perwaiz Khan of Landikotal Tehsil was of the view that lack of awareness among people regarding the disease not only kept patients away from the hospitals but also created problems for the health department to contact the patients. He flayed Fata Secretariat and health department for not devising plan to eliminate the disease. He remarked that awareness programme at local levels should be initiated and it would help root out the disease from the area. The children all the day long are playing in a stagnant water in which the lethal mosquitoes exist and resultantly they are attacked by mosquitoes, Perwaiz reasoned.

On the other hand the Medical Officer in Torkham BHU Ilyas Afridi when contacted said more than 350 registered patients of leishmaniasis received free medicine and treatment and 80 percent of the patients among them were recovered. Children who are working as laborers are immensely affected because of leishmaniasis illness.

Coordinator of EDWS for Khyber Agency, Dr Shams ur Rehman said all the reported leishmaniasis patients were equipped with medicine and were properly recovered. He went on to say that they had handed over the required medicines and injections to each BHUs and civil dispensaries. Their team is responsible for visiting the spot and facilitating the suffered patients by giving him free medicine even if the case happened anywhere in Khyber Agency; Shams said and adding moving into Bara Tehsil sometimes create impediments in their work.

[Byline: Farid Shinwari]

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[Leishmaniasis, especially cutaneous leishmaniasis, was highly endemic in Afghanistan during the Taliban regime. The high number of leishmaniasis (cutaneous we presume) among refugees from Afghanistan underline the fact that the disease is not under control in Afghanistan and that treatment facilities are inadequate. - Mod.EP

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

DENGUE/DHF UPDATE 2011 (61): ASIA
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In this update:
India (Bengal state)
India (Delhi area)
India (Bokaro, Jharkhand state)
India (Pune Maharashtra state)
India (Odisha state)
Pakistan (Karachi, Sindh province)

*****
Cases in various countries:
- India (Bengal state). 17 Nov 2012. Dengue (conf.) 583 cases; Deaths 9; Affected district metro Kamrup 433 cases, deaths 6; Increasing. http://timesofindia.indiatimes.com/city ... 249714.cms

[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 (Delhi area). 16 Nov 2012. Dengue 1608 cases; Increasing.
http://articles.timesofindia.indiatimes ... -new-cases

- India (Bokaro, Jharkhand state). 16 Nov 2012. Dengue (susp.) 132 cases; Deaths 4. Increasing.
http://timesofindia.indiatimes.com/city ... 234963.cms

- India (Pune Maharashtra state). 22 Nov 2012. Dengue 825 cases; Deaths 7; Decreasing.
http://www.indianexpress.com/news/city- ... l/1034553/

- India (Odisha state). 19 Nov. 2012. Dengue 2051 cases; Deaths 6; Increasing.
http://twocircles.net/2012nov17/22_new_ ... disha.html

- Pakistan (Karachi, Sindh province). 17 Nov 2012. Dengue (conf.) 550 cases; Increasing.
http://www.nation.com.pk/pakistan-news- ... ed-in-city

[A map showing the location of Karachi in Sindh province can be accessed at: http://www.maplandia.com/pakistan/sind/ and a HealthMap/ProMED-mail map of Pakistan can be accessed at: http://healthmap.org/r/1iGJ . - Mod.TY]

KYASANUR FOREST DISEASE - INDIA (03): (KARNATAKA), SUSPECTED
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Date: Wed 28 Nov 2012
Source: Daily News and Analysis, India [edited]
http://www.dnaindia.com/bangalore/repor ... ve_1770767


Veterinary experts suspect an outbreak of Kyasanur Forest disease (KFD), popularly known as monkey fever, in the Maddur range of the Bandipur Tiger Reserve, bordering Mysore district. It is also reported to have affected humans.

The tiger reserve authorities have reported the deaths of 8 bonnet macaques [_Macaca radiata_] and 2 common langurs [_Semnopithecus entellus_], and it has been transmitted to 5 workers of the forest department's anti-poaching camp. The workers are undergoing treatment at Gundlupet government hospital, and the condition of one of them is serious.

Following the outbreak, tiger reserve officials sounded a high alert. Animal and veterinary scientists from the Institute of Animal Health and Veterinary Biologicals (IAHVB) in Bangalore and the National Institute of Virology (NIV) in Pune have rushed to the area for further analysis.

This fever is caused by a viral infection among primates, and the 1st to be affected were bonnet macaques and common langurs. These primates usually move through the trees about 30-50 feet above the ground. When they eventually touch the ground due to various factors, particularly during the cutting of forests, they transmit the virus through ticks on their bodies to rodents, shrews, and reptiles. This usually happens when forests are cut for building roads, among other things. The ticks from infected monkeys get transferred to various domestic animals, including cattle, and then to humans.

The disease was 1st detected in Shimoga district in 1957 and has been appearing every now and then in the thickly wooded areas of Dakshina Kannada, Udupi, Chikmagalur, Shimoga, and Chamarajanagar and has affected humans too.

According to tiger reserve officials, NH 212, passing through the reserve, was one clearing where the monkeys have to touch the ground to cross the road. They said that the anti-poaching camp was also situated just next to the highway, where 5 persons became infected.

An expert team from the health department of Shimoga district has rushed to the area and begun spreading awareness about the infection.

[Byline: M. Raghuram]

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[This posting reports human and monkey cases of KFD in a different locale of Karnataka state. Previously, there have been human KFD cases in the Shimoga district of Karnataka state this year (2012), and in 2011, and 2009.

In the 28 Feb 2009 post on KFD in India (ProMED-mail archive number 20090302.0860), Mod.CP posted the following excellent commentary:

"Kyasanur forest disease (KFD) is caused by Kyasanur forest disease virus (KFDV), a member of the family _Flaviviridae_. KFDV was identified in 1957 when it was isolated from a sick monkey from the Kyasanur forest in Karnataka (formerly Mysore) state, India. The main hosts of KFDV are small rodents, but shrews, bats, and monkeys may also carry the virus. KFD is transmitted from the bite of an infected tick (_Haemaphysalis spinigera_ is the major vector). Humans can get this disease from a tick bite or by contact with an infected animal, such as a sick or recently dead monkey. Larger animals such as goats, cows, and sheep may become infected with KFD, but they do not have a role in the transmission of the disease. Furthermore, there is no evidence of the disease being transmitted via the unpasteurized milk of any of these animals. It occurs principally in the Shimoga and Kanara district of Karnataka, India and is common in young adults exposed during the dry season in the forest.

After an incubation period of 3-8 days, the symptoms of KFD begin suddenly with fever, headache, severe muscle pain, cough, dehydration, gastrointestinal symptoms and bleeding problems. Patients may experience abnormally low blood pressure and low platelet, red blood cell, and white blood cell counts. After 1-2 weeks of symptoms, some patients recover without complications. However, in most patients, the illness is biphasic, and the patient begins experiencing a 2nd wave of symptoms at the beginning of the 3rd week. These symptoms include fever and signs of encephalitis (inflammation of the brain). The diagnosis is made by virus isolation from blood or by serologic testing using enzyme-linked immunosorbent serologic assay. There are approximately 400-500 cases of KFD per year with a case fatality rate of 3-5 percent."

Some of this information has been extracted from the CDC fact sheet (see: http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... estDis.pdf)."

Images of bonnet macaques can be accessed at http://3.bp.blogspot.com/-2W7N10iLy7E/T ... acaque.jpg and common langurs at http://farm4.static.flickr.com/3261/263 ... 120f70.jpg.

A map showing the location of the Mysore district of Karnataka state can be accessed at http://en.wikipedia.org/wiki/Mysore_district and a HealthMap/ProMED-mail interactive map at http://healthmap.org/r/4idB. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/4idB.]

DENGUE/DHF UPDATE 2012 (62) ASIA
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In this update:
Cases in various countries
India
- National
- Tamil Nadu, West Bengal, Maharashtra
- Assam state
- Delhi area
- Melur, Tamil Nadu state


******
Cases in various countries:
- India (national). 27 Nov 2012. Dengue more than 35 000 cases; deaths 216. Increasing. States most affected: Kerala (3674 cases), Karnataka (3482 cases). States with most deaths: Tamil Nadu 60 deaths, Maharashtra 59 deaths.
http://www.prensa-latina.cu/index.php?o ... 1&Itemid=1 [in Spanish]

[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]

- Tamil Nadu, West Bengal, Maharashtra. 24 Nov 2012. Dengue: Tamil Nadu 9249 cases, deaths 60; West Bengal 6067 cases; Maharashtra 59 deaths.
http://www.deccanchronicle.com/channels ... lls-ls-963

- Assam state. 29 Nov 2012. Dengue (susp.) 1051 cases, (conf.) 739 cases; deaths 11.
http://www.assamtribune.com/scripts/det ... v3012/at09

- Delhi area. 29 Nov 2012. Dengue 1997 cases; deaths 4.
http://www.newstrackindia.com/newsdetai ... elhi-.html

- Melur, Tamil Nadu state. 28 Nov 2012. Dengue deaths 17 (officially, not 50 as previously reported).
http://www.dnaindia.com/india/report_17 ... er_1770967

PNEUMONIA - NEPAL: (UDAYAPUR), CHILDREN, REQUEST FOR INFORMATION
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Date: Fri 30 Nov 2012
Source: The Himalayan [edited]
http://www.thehimalayantimes.com/fullNe ... sID=356069


Pneumonia is on the rise in Udayapur district due to cold weather for the past few days. Pneumonia has been seen in children in Triyuga Municipality and in Beltar, in the eastern part of the district.

According to employees at Beltar Primary Health Center, some 50 children from Beltar with pneumonia visited local health institutions for treatment within the past week.

Janak Karki of the Sagarmatha Higher Secondary School said that most of the students at the school have been suffering from pneumonia due to increasing cold weather and have remained absent from school. District Public Health Officer Duniyalal Yadav said that a number of children who were suffering from pneumonia visited the District Hospital in Udayapur for treatment.

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[From the news report above, there has been an apparent increase in the incidence of "pneumonia" in children as winter approaches in a Nepalese district, although the ages of the children are not specified. There are no deaths reported for this outbreak.

In developed countries, because of the non-specific nature of the clinical presentation, the diagnosis of pneumonia is usually confirmed by a chest radiograph. In resource-limited settings where radiography is often not available, the World Health Organization (WHO) established guidelines that rely on simple clinical signs for the diagnosis of childhood pneumonia (WHO recommended surveillance standards. 2nd ed. (WHO/CDS/ISR/99.2) World Health Organization, Geneva). The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness, but these WHO clinical criteria for pneumonia have been reported to demonstrate poor sensitivity in diagnosing radiographic pneumonia in children presenting to a pediatric emergency department (Wingerter SL, Bachur RG, Monuteaux MC, Neuman MI. Application of the World Health Organization Criteria to Predict Radiographic Pneumonia in a US-based Pediatric Emergency Department. Pediatr Infect Dis J. Jun 2012;31(6):561-4.)

In the absence of laboratory diagnostics, it is difficult to assess this situation. The microbial etiologies of pneumonia in childhood are numerous and vary to some extent by the age of the children involved, the season of the year, and the geographic location.

Bacterial causes of childhood pneumonia include _Streptococcus pneumoniae_, _Hemophilus influenzae_, _Staphylococcus aureus_, _Mycoplasma pneumoniae_, and _Chlamydophila pneumoniae_. However, most lower respiratory tract disease in children is viral in origin. These respiratory viruses include respiratory syncytial virus (RSV), parainfluenza types 1, 2, and 3, influenza A and B, adenovirus, and human metapneumovirus (hMPV). RSV infection occurs in the winter and early spring. Parainfluenza type 3 infection occurs in the spring, and types 1 and 2 occur in the fall. Influenza occurs in the winter. Other viruses that cause pneumonia less frequently in infants and young children include adenovirus, enterovirus, rhinovirus, and coronavirus. One or more of these viruses could be involved in the Nepalese outbreak. More detailed clinical, epidemiologic and microbiologic information would be needed to clarify the situation.

Udayapur district, with a population (in 2001) of 287 689, is one of the 75 districts of Nepal. For a map of Nepal on which Udayapur can be located, see http://upload.wikimedia.org/wikipedia/c ... cation.png.

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

KYASANUR FOREST DISEASE - INDIA (04): (KARNATAKA), CONFIRMED
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Date: Mon 3 Dec 2012
Source: Deccan Herald [edited]
http://www.deccanherald.com/content/296 ... irmed.html


A medical report from the National Institute of Virology in Pune has confirmed that the recent death of monkeys in the Bandipur National Park limits was due to 'Kyasanur Forest disease' (KFD).

The blood samples were sent to the centre soon after 12 monkeys died of the suspected fever at Alegowdanakatte camp in Maddur division, said Pushkar, the tiger reserve project director.

The daily wage workers of the Forest department too were affected by the epidemic.

Following the report confirming the prevalence of the KFD virus, a meeting of the veterinarians and the officials of the Forest department has been convened to discuss preventive measures.

Soon, the residents in the surrounding villages will be administered a vaccine to check the spread of the infectious disease, he added.

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[This report provides laboratory confirmation of the 28 Nov 2012 post indicating that 12 monkeys and forest workers were suspected to have been infected by Kyasanur Forest disease virus (see ProMED-mail archive no. 20121129.1431079). That post reported the deaths of 8 bonnet macaques [_Macaca radiata_] and 2 common langurs [_Semnopithecus entellus_], and infection of 5 workers of the forest department. The current report, above, indicated that 12 monkeys were involved, but did not specify which species. The 28 Feb 2009 post on KFD in India (ProMED-mail archive number 20090302.0860), provides an excellent review of KFD virus and its associated disease.

Images of bonnet macaques can be accessed at http://3.bp.blogspot.com/-2W7N10iLy7E/T ... acaque.jpg
and common langurs at http://farm4.static.flickr.com/3261/263 ... 120f70.jpg.

A map showing the location of the Mysore district of Karnataka state can be accessed at http://en.wikipedia.org/wiki/Mysore_district and a HealthMap/ProMED-mail interactive map at http://healthmap.org/r/4idB. - Mod.TY]

DENGUE/DHF UPDATE 2012 (64): ASIA
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ProMED-mail is a program of the
International Society for Infectious Diseases
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In this update:
Cases in various countries:
Asia
---
India
- National
- Madurai area, Tamil Nadu state
- Karnataka state
- Pune, Maharashtra state
Pakistan (Karachi, Sindh province)


******
Cases in various countries:
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- India (National). 4 Dec 2012. Dengue as of 27 Nov 2012, 37 070 cases; Deaths 227. Most affected states: Kerala over 3760 cases, Karnataka 3640 cases, Delhi (mid-November 2012) 1980 cases, Tamil Nadu 60 deaths, Maharashtra 59 deaths, Delhi 4 deaths.
http://health.india.com/news/2012-india ... 27-deaths/

[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 (Madurai area, Tamil Nadu state). 3 Dec 2012. Dengue cases hospitalized on 2 Dec 2012, 72 cases, on 1 Nov 2012, 217 cases; Increasing.
http://timesofindia.indiatimes.com/city ... 458528.cms

- India (Karnataka state). 7 Dec 2012. Dengue (conf.) 3640 cases; Deaths 21; Increasing.
http://www.deccanchronicle.com/121207/n ... rise-state

- India (Pune, Maharashtra state). 4 Dec 2012. Dengue 886 cases; Deaths 9.
http://www.indianexpress.com/news/docto ... r/1039997/

- Pakistan (Karachi, Sindh province). 8 Dec 2012. Dengue 678 cases; Deaths 3.
http://www.thenews.com.pk/Todays-News-4 ... -this-year

[A map showing the location of Karachi in Sindh province can be accessed at: http://www.maplandia.com/pakistan/sind/ and a HealthMap/ProMED-mail map of Pakistan can be accessed at: http://healthmap.org/r/1iGJ. - Mod.TY]

RABIES - NEPAL (02): (SIRAHA), HUMAN FATALITY
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Date: Sun 9 Dec 2012
Source: The Himalayan [edited]
http://www.thehimalayantimes.com/fullNe ... sID=357131


People seeking rabies treatment are turning to traditional healers rather than getting medical help at Gothtole, a Muslim community in Lahan Municipality.

Following the outbreak [?], health workers have not been seen in the village out of fear of getting infected, locals said. "We have been forced to see the local shaman after there were no signs of health workers in the village despite our frequent requests," they said [Shamanism is a practice that involves a practitioner reaching altered states of consciousness in order to encounter and interact with the spirit world. A shaman is a person regarded as having access to, and influence in, the world of benevolent and malevolent spirits, who typically enters into a trance state during a ritual, and practices divination and healing. See: http://en.wikipedia.org/wiki/Shamanism. - Mod.CP].

Tension ran high in the Muslim community after an 18-year-old died of rabies on Wed 5 Dec 2012. According to locals, the shaman uses a dinner plate as a means of treatment. He recites his mantras (spells) after placing the plate on the back of the dog-bitten person. "If the plate gets stuck on the back, it is confirmed that the person is infected, otherwise not," locals said, adding that Saturday, Sunday and Wednesday were considered the appropriate days for treatment.

As many as 20 people had the plate stuck on their backs on Saturday [8 Dec 2012] and 32 people on Sunday [9 Dec 2012], said a local resident. According to him, locals are afraid that they might have been infected and were unaware of the infection, as they always hung out with victim. More than 50 people could be infected with rabies, said another local, adding that they had yet to receive any vaccines or health workers from the District Health Office.

The DHO [District Health Office] is 40-km away from the village. Locals demanded that they be provided with the vaccines through the Lahan hospital. Previously[?], as many as 16 youths had received shots from Lahan Hospital.

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[Siraha town is the headquarters of Siraha District, a part of the Sagarmatha Zone, Nepal. The town is located at an altitude of 64 metres on the border with India at Jayanagar, Bihar with a customs checkpoint. Siraha had a population of 572 399 according to a census in 2001. Its location is shown on the map at: http://www.fallingrain.com/world/NP/00/Siraha.html.

It is not clear from this report how and when the victim was exposed (presumably by dog bite), or the lapse of time between rabies virus exposure and resort to treatment. It is also unclear why so many people sought treatment over a period of 3 days. The report seems to indicate that those seeking treatment believed that they might have contracted rabies as a result of contact with the victim, a belief that also may have been responsible for the flight of health care workers. Clarification would be welcomed. - Mod.CP

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (20): (WEST BENGAL)
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Date: Tue 11 Dec 2012
Source: SciDev [edited]
http://www.scidev.net/en/south-asia/new ... india.html


Researchers in West Bengal have reported a 2nd strain of the Japanese encephalitis virus (JEV) circulating in the eastern Indian state.

According to a study published online in Virology Journal last month [15 Nov 2012, see reference, below], the researchers confirmed genotype I (GI) of JEV coexisting with the predominant genotype III (GIII) strain in over 1/4th of 135 patients hospitalised for acute encephalitis syndrome.

The GI strain was 1st detected in India 3 years ago in the Gorakhpur area of the northern state of Uttar Pradesh.

Led by Shyamalendu Chatterjee at the virus unit of the Indian Council of Medical Research (ICMR) in Kolkata, the researchers have now confirmed the GI strain in the samples of blood and fluid from brain and spinal column of patients admitted to government hospitals in 8 West Bengal districts between July-December 2010.

JE, which causes brain fever, is rampant in West Bengal despite an active vaccination programme.

The ICMR scientists, who were joined by Subhra Kanti Mukhopadhyay from the microbiology department of the University of Burdwan, were unable to ascertain how the GI strain, earlier reported circulating in South Korea, Thailand and China, had reached India.

But, the researchers said the possibilities were that the GI strains were brought in by travellers, migratory birds (such as herons), or mosquitoes blown in by cyclonic winds. Domestic pigs are known reservoirs of JEV.

Transmitted to humans by [several species of] _Culex _ mosquitoes, the symptoms of JE include severe rigors, convulsions and high temperature. Patients may go into coma, and the fatality rate is high among child victims.

1st isolated in Japan in 1935, JEV has become a major public health menace with a worldwide case-fatality rate of 30 per cent, and 30-50 per cent of survivors develop permanent brain damage.

The isolation of the GI strain in West Bengal has cast doubts about the efficacy of vaccines currently used against JE derived from the GIII strain. "In future, a JE outbreak is quite likely in the state if this vaccine fails to protect sufficiently against GI of JEV," the researchers noted in their study.

Other experts said there was no cause for panic. "GIII-derived vaccine is used in countries where the GI strain is prevalent and has been found to be effective. I do not think there is any risk," Komal Kushwaha, a physician at the Baba Raghav Das Medical College in Gorakhpur, told SciDev.Net.

Kushwaha suggested carrying out a study by completely immunising one district and keeping another as control over a period of 2 years.

[Byline: Archita Bhatta]

Reference:
Arindam Sarkar, Debjani Taraphdar, Subhra Kanti Mukhopadhyay, Sekhar Chakrabarti and Shyamalendu Chatterjee. Molecular evidence for the occurrence of Japanese encephalitis virus genotype I and III infection associated with acute Encephalitis in Patients of West Bengal, India, 2010. Virology Journal 9:271. 2012.

Abstract (provisional)

Background:
Japanese encephalitis virus (JEV), a mosquito-borne zoonotic pathogen, is the sole etiologic agent of Japanese encephalitis (JE), a neurotropic killer disease which is one of the major causes of viral encephalitis worldwide, with prime public health concern. JE was 1st reported in the state of West Bengal, India in 1973. Since then, it has been reported every year from different districts of the state, although vaccination has already been done, indicating that there might be either partial coverage of the vaccine or the emergence of a mutated/new strain of JEV. To understand JEV genotype distribution, we conducted a molecular epidemiological study on a total of 135 serum/cerebrospinal fluid (CSF) samples referred and/or collected from clinically suspected patients with acute encephalitis syndrome (AES) admitted in different district hospitals of West Bengal, India, 2010.

Findings:
JEV etiology was confirmed in 36/135 (26 per cent) and 13/61 (21 per cent) 2-15 day febrile illness samples from AES cases by analyzing Mac-ELISA followed by RT-PCR tests, respectively. Phylogenetic analysis based on complete envelope gene sequences of 13 isolates showed the emergence of JEV genotype I (GI) co-circulating with genotype III (GIII).

Conclusion:
This study represents the 1st report of JEV GI with GIII co-circulating in West Bengal. The efficacy of the vaccine (derived from the JEV GIII strain SA-14-14-2) to protect against emerging JEV GI needs careful evaluation. In future, a JE outbreak is quite likely in the state if this vaccine fails to protect sufficiently against GI of JEV.

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[Travelers would not be the source of JEV GI in West Bengal state because viremias in humans are not adequate to infect mosquito vectors that would lead to ongoing virus transmission. It does seem unlikely that the JEV GIII vaccine would fail to protect people from JEV GI infection. Studies using animal models would confirm or discard effective cross-protection. It will be interesting to see which of these genotypes predominates in West Bengal over time and whether individuals who have been vaccinated recently with the GIII vaccine develop clinical disease from JEV infections. If protection is not adequate, the vaccination strategy in eastern India will need to be reevaluated.

Reports of the etiology of acute encephalitis syndrome (AES) in eastern India have been confusing. Some attribute all of the AES cases to JEV infection, others to a small proportion, or to none of them. This report confirms JEV as one of the etiological agents responsible for AES.

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

DENGUE/DHF UPDATE 2012 (67): ASIA
*******************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Cases in various countries:
Asia
----
India
- National
- Pune, Maharashtra state
Pakistan (Karachi, Sindh province)



******
Cases in various countries:
Asia
----
- India:
- National. 10 Dec 2012. Dengue deaths 227; Deaths Maharashtra state 73; Dengue virus circulating in Mahrashtra type 4 predominantly.
http://timesofindia.indiatimes.com/city ... 550168.cms

[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]

- Pune, Maharashtra state. 11 Dec 2012. Dengue last 10 days 74 cases; deaths 2012, 11; decreasing.
http://timesofindia.indiatimes.com/city ... 564873.cms

- Pakistan (Karachi, Sindh province). 15 Dec 2012. Dengue 715 cases, (conf.) 712 cases; increasing.
http://www.nation.com.pk/pakistan-news- ... s-reported

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