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DENGUE/DHF UPDATE 2008 ( 48 )
**************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Pakistan (Punjab)
Date: Fri 7 Nov 2008
Source: GEO Pakistan [edited]
<http://www.geo.tv/11-7-2008/28321.htm>


Within 48 hours, 154 fresh cases of dengue fever have been confirmed in the
government hospitals here on Thursday [6 Nov 2008].

Punjab Health Department said that, following the new dengue cases coming
to the fore in the city, the number of dengue patients has shot up to 292,
while in Punjab, [dengue cases have] soared to 437.

In the backdrop of fast rising dengue cases, the Punjab chief minister has
asked for a report from the health department, while doctors have advised
citizens to take preventive measures from dengue [virus infection].

CM Punjab has also formed a 3-member committee to stop the alarming
increase of the cases, the health department said.

--
communicated by:
ProMED-mail rapporteur Susan Baekeland

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

MALARIA, FALCIPARUM - INDIA (02): (WEST BENGAL)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 10 Nov 2008
Source: Express India [edited]
<http://www.expressindia.com/latest-news ... ta/383706/>


Falciparum malaria in Bengal
----------------------------
The government has taken over the job of making public the data on Bengal's
vectorborne diseases. But inside the Kolkata Municipal Corporation [KMC],
which is to provide the raw figures to the government, some reshuffling has
been done as well.

Chief municipal health officer (CMHO) Deb Dwaipayan Chattopadhyay had his
wings clipped for fudging figures and was told that no data will now be
given to him. Everything will be routed through the Integrated Disease
Surveillance Programme (IDSP) department of KMC, headed by Basudeb
Chattopadhyay.

After being accused by the government of deliberately suppressing data,
Chattopadhaya was forced to issue an inter-departmental circular, asking
all reports from 83 malaria clinics of the civic body and several private
clinics to be sent to the IDSP department, where the figures of the KMC
malaria clinics will be compiled with the data received from several
state-run hospitals and private nursing homes. The compiled data will be
sent to the state health department for scrutiny by the state health officials.

Earlier, the KMC was asked to reveal the actual data by Sanchita Bakshi,
director, state health services, who said that no figure on the vectorborne
diseases coming from the KMC was authentic.

Chattopadhaya has been forced to reveal the actual data after several KMC
health officials complained to Municipal Commissioner Alapan Bandyopadhaya.
They had reportedly said that Chattopadhaya deliberately suppressed to
cover up the failure of the KMC health department in preventing and
combating the outbreak.

Significantly, the report till [29 Sep 2008], sent to the state health
department, reveals that 25 109 people have been afflicted with vectorborne
diseases, with 1476 positive cases of falciparum malaria. But after the
actual data were released, figures of afflicted cases went up to 41 223,
with 4781 cases of falciparum [malaria].

The contradiction clearly points out how the facts have been fudged. Mayor
Bikash Ranjan Bhattacharya, however, is not yet ready to accept that any
fact has been suppressed by the KMC health department. "Facts related to
vectorborne diseases have not been suppressed deliberately. Earlier, we did
not receive some data from the private clinics and private nursing homes.
As of now, we have received reports from some private clinics and nursing
homes. So, the data took a jump," he said.

"Compared to the previous years, the situation in the state is not that
grave. But the danger is there and there is no need to be complacent. We
are carrying regular audits as cases are being reported to us," said state
health minister Surjya Kanta Mishra. "There was a lot of backlog, which has
been cleared and KMC's data report has got the updated figure," he added.

[byline: Mohana Dam, Madhuparna Das]

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

[India reported 725 502 cases of _Plasmodium falciparum_ malaria in 2007
out of a total of 1 476 562 cases (World Malaria Report 2008;
<http://www.who.int/malaria/wmr2008/>).

East Bengal has always had higher _P. falciparum_ rates than the eastern
parts of India. West Bengal is close to Chhattisgarh, where we reported an
outbreak of malaria last month (Malaria, falciparum - India: (Chhattisgarh)
20081022.3344). These 2 reports indicate that _P. falciparum_ malaria is
emerging in eastern India and indicate that reported numbers are much lower
than the real numbers.

A map of West Bengal can be accessed at
<http://www.mapsofindia.com/maps/westben ... strict.htm>. The
HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/promed?v=22.9,79.6,5>. - Mod.EP]

JAPANESE ENCEPHALITIS - INDIA (08 ): (UTTAR PRADESH)
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 15 Nov 2008
Source: The Hindu News [edited]
<http://www.thehindu.com/holnus/004200811150942.htm>


4 die of encephalitis, toll rises to 447
----------------------------------------
Official sources said that 4 children succumbed to deadly
encephalitis at BRD Medical College Hospital here and adjoining
district hospitals during past 24 hours, mounting the death toll due
to deadly disease to 447.

As many as 14 new patients of suspected encephalitis or brain fever
have been admitted to BRDMCH and other hospitals on Friday [14 Nov
2008], the sources said, adding that a total of 122 patients of
suspected encephalitis are at present being treated at the medical
college and different district hospitals of the region.

The patients are from Gorakhpur, Kushinagar, Deoria, Mahrajganj, Sant
Kabir Nagar and Siddharthanagar districts.

As many as 2426 cases of encephalitis have been registered at BRDMCH
and other district hospitals since January this year. Of this, 447
died, the health department sources said.

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

[The encephalitis outbreak in Gorakhpur continues. In previous posts
(see below), only a small proportion of these cases is considered due
to Japanese encephalitis virus, and the attending physicians
suggested that enterovirus, echovirus, Coxsackie-B virus, Saharanpur
encephalitis, and a killer weed that took 600 lives in 2006 might be
involved. Again, there is no indication that any of these etiological
agents have been laboratory confirmed or ruled out. ProMED would
appreciate receiving any further information on additional cases and,
especially, laboratory results establishing a diagnosis of the
etiology of these cases.

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

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): (PUNJAB), SUSPECTED
********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 17 Nov 2008
Source: The News, International [edited]
<http://www.thenews.com.pk/print1.asp?id=147281>


Crimean-Congo fever suspect admitted to Benazir Bhutto Hospital
---------------------------------------------------------------
Benazir Bhutto Hospital (BBH) received a male patient, aged 27, with
severe bleeding disorder on Saturday night [15 Nov 2008]. Senior
doctors at the hospital on Sunday evening [16 Nov 2008] suspected him
to be a case of deadly Crimean-Congo hemorrhagic fever (CCHF).

The patient, who belongs to Hazro, Attock, reached the BBH with
continued, uncontrolled, nasal and throat bleeding. On Saturday night
[15 Nov 2008], his platelets count was recorded as 2000 [whereas]
that for a normal person ranges from 150 000 to 400 000. He was
brought to the BBH from his native town [as] a suspected case of
dengue hemorrhagic fever.

"His condition is becoming more and more critical with the passage of
time while his bleeding disorder has got more intense convincing us
to suspect CCHF," said the head of the medical unit at the BBH,
Professor Dr Shoaib Shafi, who is supervising the patient's
treatment. While talking to 'The News' on Sunday evening [16 Nov
2008], Dr Shoaib said, the patient's bleeding disorder is so much
more intense that he starts bleeding when touched by a doctor. I
believe that his blood vessels have been blocked, however we have
started a treatment protocol for CCHF." He added that they are going
to give the patient high dosage of the antiviral drug, oral ribavirin.

He said the hospital is going to send a blood sample to the National
Institute of Health, Islamabad, for [CCHF] serology. "I have informed
the principal-in-charge allied hospitals Dr Mohammad Mussadiq Khan
about the status of the patient," he said adding that the patient has
already been shifted to an isolation unit.

It is important [to remember] that nearly 5 years back, Dr Farzana
Altaf of Holy Family Hospital died after developing CCHF while
treating a CCHF patient.

"Immediate (close) family members, attendants, and medical staff
involved in treatment of a CCHF patient might be at risk if proper
preventive measures are not taken and for that purpose, we have
notified all attendants of the patient of his status," said Dr
Shoaib. He said that doctors who had contact with the patient have
started taking medicines [ribavirin?] as a preventive measure, and
medication for attendants has also been started.

Viral hemorrhagic fever such as CCHF and Ebola are zoonotic diseases
that animals [transmit] to humans. The mortality rate of hemorrhagic
fevers ranges from 50 to 90 percent. Dr Shoaib said that the patient
has a history of animal contact, as some of his family members are
butchers by profession. CCHF is caused by a nairovirus of the family
_Bunyaviridae_, which is transmitted to humans by the bite of
Hyalomma species ticks or by direct contact with blood from an
infected animal or human. CCHF [virus] was first described in Crimea
in 1944 and identified in 1956 in Congo.

According to World Health Organization (WHO) data, nearly 300
confirmed cases of CCHF have so far been reported in Pakistan from
1976 to 2003. The disease was first reported in Pakistan in 1976 but
the number of cases has shown a dramatic rise since 2000 with 50 to
60 patients being reported annually.

[Byline: Muhammad Qasim]

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

[Crimean-Congo hemorrhagic fever is prevalent throughout rural
regions of Pakistan, although the majority of reports reaching
ProMED-mail have originated from Baluchistan.

The signs and symptoms of the patient's illness are consistent with
the suspected diagnosis of CCHF, as is his background of possible
exposure to contaminated animal blood.

Laboratory confirmation of the diagnosis is awaited. According to the
US CDC (Centers for Disease Control and Prevention) laboratory tests
that can be used to diagnose CCHF include antigen-capture
enzyme-linked immunosorbent assay (ELISA), real time polymerase chain
reaction (RT-PCR), virus isolation attempts, and detection of
antibody by ELISA (IgG and IgM). Laboratory diagnosis of a patient
with a clinical history compatible with CCHF can be made during the
acute phase of the disease by using the combination of detection of
the viral antigen (ELISA antigen capture), and viral RNA sequence
(RT-PCR) in the blood.

Attock district and city are located on the northern border of Punjab
province of Pakistan and can be located on the HealthMap/ProMED-mail
interactive map of Pakistan at
<http://healthmap.org/promed/en?g=1176948&v=34,71.8,7>. - Mod.CP]

DENGUE/DHF UPDATE 2008 (50)
***************************
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:
[1] India (West Bengal)
[2] India (Punjab)
[3] Pakistan (Punjab)


******
[1] India (West Bengal)
Date: Wed 12 Nov 2008
Source: The Statesman [edited]
<http://www.thestatesman.net/page.arcvie ... &usrsess=1>


Dengue has surfaced in Jalpaiguri. The virus has been detected in a
boy today [12 Nov 2008] following blood tests, causing tension in the
district. The district health department has been alerted and
preparations are on to meet any adverse situation. The CMOH [chief
medical officer of health] Jalpaiguri, Mr Malay Ghosh, said "We are
keeping a watch on the surrounding areas of Hakimpara, the
neighbourhood from where the dengue patient hails. We would also take
necessary steps to prevent fresh cases of dengue in the district."

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Interactive maps of West Bengal, showing the location of Jalpaiguri
can be accessed at
<http://www.maplandia.com/india/west-bengal/jalpaiguri/>
and the HealthMap/ProMED-mail map at
<http://healthmap.org/promed/en?g=126938 ... 7,88.733,5>. - Mod.TY]

******
[2] India (Punjab)
Date: Tue 11 Nov 2008
Source: Express India [edited]
<http://www.expressindia.com/latest-news ... il/383858/>


Fearing that dengue might grip Bathinda Central Jail, a team of
district health officials, led by civil surgeon Dr Neelam Bajaj,
today [11 Nov 2008] visited the prison and instructed the staff to
adopt precautionary measures.

The Health Department has been on tenterhooks due to a large number
of dengue cases reported in the city. "In Bathinda city alone, 10
confirmed cases have been reported and about 100 are suspected
cases," said district epidemiologist, Dr MS Gill, adding that the
number of confirmed cases in the district stood at 205 till date [up
to 11 Nov 2008].

Notably, the required machine for dengue treatment in Bathinda
hospital had developed a snag and could be made operational only in
mid-October [2008], before which patients were forced to go to Ludhiana.

"Today's [11 Nov 2008] visit was aimed at spreading awareness in the
jail, where dengue [mosquito virus vector] larvae were found a few
days ago," said Dr Bajaj. She said, "There was a suspected case of
dengue in the jail, which later tested negative. The inmate had a fatty liver."

Meanwhile, the Health Department carried out fogging inside the jail.
"We do not want to take chances. Even if it is viral fever, I have
instructed the jail's medical officer to conduct a test for dengue as
well," said Bathinda Jail superintendent captain LS Jakhar.

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

[It is not clear what the dengue treatment machine mentioned above
is. Perhaps it is a machine for diagnostic purposes, such as PCR
(polymerase chain reaction) or ELISA (enzyme-linked immunosorbent
assay) tests. Interestingly, there is a dengue outbreak across the
border in Pakistan (see the next item in this post).

Interactive maps showing the location of Bhatinda in Punjab,
northwestern India, can be accessed at
<http://www.maplandia.com/india/punjab/b ... /bhatinda/>
and the HealthMap/ProMED-mail map at
<http://healthmap.org/promed/en?g=1276070&v=30.2,74.95,7>. - Mod.TY]

******
[3] Pakistan (Punjab)
Date: Wed 12 Nov 2008
Source: The Post (Lahore) [edited]
<http://thepost.com.pk/Arc_MainNews.aspx ... &fcatid=14>


In the Punjab capital, Lahore, the number of the dengue fever
[cases], an infectious [virus] disease of the tropics transmitted by
mosquitoes and characterized by rash and aching head and joints, has
[reached] up to 684 with 91 fresh cases reported on Tuesday [11 Nov 2008].

According to the latest reports, at least 684 patients of dengue
fever have been admitted to different hospitals including 91 fresh
cases in Sir Ganga Ram Hospital in the metropolis. A report pointed
out that only 20 percent [of the] area could be sprayed against the disease.

The Institute of Public Health in its latest report has confirmed the
dengue virus in the blood of 91 patients who have been admitted to
the Ganga Ram Hospital. Dr Ranjha declared 50 areas of the Lahore
City as dangerous for dengue virus.

He stated that the northern city areas were the most dangerous for
dengue virus [transmission], while Farooq Gunj, Misri Shah, Ghorray
Shah, Chahmiran, Badr Colony, Shaadbagh, Sanda, Ravi Road, Choburji,
Baghbanpura, Gujjarpura Township, and Guwalmandi are also included in
the dangerous list.

In different hospitals, special seminars have also been organized to
make [staff] aware of the dengue attack.

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

[The dengue outbreak in Lahore continues, with the number of cases
increasing from 437 in a 7 Nov 2008 report (ProMED-mail archive no.
20081111.3545) to 684 in the current report, above.

A map of Pakistan showing the location of Punjab state can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>
Lahore can be located on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?g=117245 ... 5,74.344,7>. - Mod.TY]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (03): (PUNJAB), SUSPECTED
********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 18 Nov 2008
Source: The News International, Pakistan [edited]
<http://thenews.jang.com.pk/daily_detail.asp?id=147458>


Suspected Crimean-Congo haemorrhagic fever patient dies
-------------------------------------------------------
The 27-year-old patient, who was taken to Benazir Bhutto Hospital
(BBH) with severe bleeding disorder Saturday night [15 Nov 2008] and
was suspected of being infected with Crimean-Congo Haemorrhagic Fever
(CCHF) virus, died Sunday midnight [16 Nov 2008] at Pakistan
Institute of Medical Sciences (PIMS), Islamabad. Sunday evening
senior doctors at the BBH suspected the patient, a native of Hazro,
Attock [district], a case of deadly CCHF due to uncontrolled bleeding
disorder. The patient was brought to the BBH from his native town
after being suspected, as a case of dengue hemorrhagic fever. "After
bleeding disorder became intense, the patient was taken to Shifa
International Hospital Sunday night but the hospital refused to admit
him," said a relative of the patient. He said that later the patient
was taken to PIMS where he was admitted but he could not survive due
to his poor condition.

"During the whole time that he spent at the BBH, his bleeding could
not be stopped, convincing doctors and surgeons to suspect him a CCHF
patient," said head of medical unit at the BBH professor Dr Shoaib
Shafi while talking to 'The News' Monday [17 Nov 2008] adding he had
informed National Institute of Health, Islamabad on the patient's
status through proper channel, however, his blood sample could not be
taken by the NIH officials for Congo serology.

According to sources, the patient died Sunday night [16 Nov 2008] at
around 1:00 a.m. and his dead body was handed over to his family
after taking precautionary measures to save his family from exposure
to CCHF virus if that was in his body. "The deceased patient was
buried in his native town, Hazro, Monday morning [17 Nov 2008] and
the World Health Organisation's guidelines were strictly followed
during his burial," said district health officer Attock Dr Sultan
Mehmood Khan while talking to 'The News'.

He added that the patient's dead body was wrapped up in plastic
sheets as per the WHO guidelines and his family was also provided
masks, gloves, and lime that they needed at the time of his burial.
"We also made family members of the deceased understand that what
preventive measures they would have to take at the time of burial,"
he responded to a query adding that all the apparent signs were
hinting strongly that the patient was infected with CCHF virus.

The patient was a resident of Mohalla Muslim Gunj in Hazro city.
"Residual spraying has already been done in and around his house and
we have established a medical camp in the area for surveillance,"
claimed Dr Sultan adding staff of his office has also started
educating residents of the area on the subject. He added that the
main reason behind suspecting tat the patient had contracted CCHF was
his severe bleeding disorder and his involvement in extensive cattle handling.

"We have incinerated the patient's clothes and other belongings, as a
precautionary measure," said Dr Sultan adding the NIH should perform
CCHF serology on the patient's blood sample after taking it from the
BBH. "Another main reason for taking matter more seriously is that we
had witnessed a confirmed case of CCHF in the village of Mararia
adjacent to Hazro city in 2004," said Dr Sultan.

To a query, he said he had notified in written to secretary health,
Punjab, DG Health Punjab and concerned officials at the NIH of the
patient's death and its apparent reason, as CCHF is a notifiable
disease. He said that his office also informed district officer,
Livestock Attock of the incident and asked him to take necessary
precautionary measures including spraying for elimination of ticks in
cattle farms.

[Byline: Muhammad Qasim]

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

[As of Fri 21 Nov 2008 there has been no laboratory confirmation of
the CCHF diagnosis, and no report of spread of infection to family,
workmates or healthcare staff. Further information is awaited.

Attock district and city are located on the northern border of Punjab
province of Pakistan and can be located on the HealthMap/ProMED-mail
interactive map of Pakistan at
<http://healthmap.org/promed/en?g=1176948&v=34,71.8,7>. - Mod.CP]

Pakistan - Dengue
24.11.2008

Aus Karachi und Lahore werden Ausbrüche dieser grippeähnlichen Viruskrankheit gemeldet. Bis Mitte November erkrankten landesweit mindestens 1.000 Patienten. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm

DENGUE/DHF UPDATE 2008 (51)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Pakistan (Punjab)
Date: Thu 20 Nov 2008
Source: China View, Xinhua News Agency report [edited]
<http://news.xinhuanet.com/english/2008- ... 389306.htm>


On Thursday [20 Nov 2008], 25 new dengue patients were admitted to
different government hospitals in the eastern Pakistani city of
Lahore, bringing the total number of the dengue cases in the city to
1099. The total number of dengue patients admitted to various
hospitals of the Punjab province stands at 1150.

The private Geo TV quoted the Punjab Health Department as saying
Thursday [20 Nov 2008] that efforts were being made to control the
disease in the coming days ahead.

[Editor: Yan]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The dengue outbreak in Lahore appears to be accelerating. The number
of cases reported there has increased from 681 on 11 Nov 2008
(see ProMED-mail archive no. 20081118.3636) to 1099 on 20 Nov 2008.
It would be interesting to know what measures are being taken to deal
with dengue virus transmission.

Karachi Dawn (<http://www.dawn.com/2008/07/30/local9.htm>) of 30 Jul
2008 reported that health authorities have now decided to shift the
unused cell separator, which was procured by the Sindh government in
its drive against dengue about a year back, to the Civil Hospital
Karachi at the earliest possible time. The high cost of platelet bags
has been an impediment to its use. A cell-separating machine was no
doubt the same dengue treatment machine referred to in the
ProMED-mail post no. 20081118.3636 on dengue in Punjab, India.

A map of Pakistan showing the location of Punjab state can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>
Lahore can be located on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?g=117245 ... 5,74.344,7>. - Mod.TY]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY (16)
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 25 Nov 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... &bolum=101>


147 fall victim to CCHF over past 6 years in Turkey
---------------------------------------------------
Last year [2007], 55 people in Turkey died from Crimean-Congo
hemorrhagic fever (CCHF), a viral disease carried by certain tick
species. With the latest deadly incidents, the total number of CCHF
deaths has risen to 147 for the past 6 years in the country,
according to research conducted by the Turkish Health Care Workers'
Union.

The study also mapped the fatalities caused by CCHF in Turkey. CCHF
was responsible for deaths in 24 provinces of Turkey last year
[2007], with the highest number of deaths occurring in the northern
province of Corum, where 9 people died. In the province of Karabuk 7
people died, and in Tokat province 5 people fell victim to the fatal
virus. A total of 4 people lost their lives to the virus in Sivas
last year [2007].

In addition, the study revealed that in 2007, the disease struck only
in the 5-month period between May and September, when temperatures
were high -- mostly occurring in June, which recorded 18 deaths. In
May 15 people died and in July 16; 4 died in August and 2 in
September.

Those over 55 were the demographic [group] with the most deaths from
ticks carrying the CCHF virus last year [2007]. According to the
research, 8 people aged below 30, 15 people aged 30-55, and 27 people
above the age of 55 died from CCHF. While the youngest person dying
from the disease was 12 years old, the oldest was 84.

Speaking about the results of the study, Onder Kahveci, the chairman
of the Turkish Healthcare Workers Union, said: "The number of CCHF
casualties is increasing every year. In large hospitals in the places
where incidents mostly occur, units for tick-borne disease must be
formed and the hospital staff must be properly educated about the
disease. In this way, a more effective struggle against the disease
can be achieved and problems, such as [the exposure] of health staff,
can be prevented."

[Byline: Kazim Canlan]

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

[As of 30 Jun 2008, 688 confirmed cases have been reported -- see
ProMED ref. (14) below. The reason for the increasing incidence of
CCHF in Turkey is unclear. In view of the increase with age, it would
be interesting to know the occupations of the CCHF patients and the
proportion engaged in agricultural occupations as opposed to leisure
activities.

The HealthMap/ProMED-mail interactive map of Turkey is available at
<http://healthmap.org/promed?v=39.1,35.2,5>
and a map showing the locations of the provinces of Corum, Karabuk,
Tokat, and Sivas can be accessed at
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]

Indien - Chikungunya(CHIC), Dengue(DEN), Japanische Enzephalitis(JE)
01.12.2008

Diese, vom mückenübertragenen Viruskrankheiten sind in Indien verbreitet. Vor allem während der Monsunregen muss mit einem erhöhten Infektionsrisiko gerechnet werden, auch in den Städten. In diesem Jahr war bisher die Südwestküste mit Teilen von Kerala und Karnataka betroffen. Derzeit wird eine Krankheitswelle von CHIC aus Bangalore gemeldet. Auch aus den Bundestaaten Gujarat, Andhra Pradesh, Goa, Tamil Nadu und Haryana werden Infektionen gemeldet. DEN: Im Punjab (NO) gibt es seit Oktober einen größeren Ausbruch mit ca. 700 Erkrankten. Insgesamt wurden landesweit 12.000 bestätigte Erkrankungen gemeldet (2007:5.500). Die Dunkelziffer dürfte um ein Vielfaches höher liegen. Schutz vor tag- und nachtaktiven Stechmücken beachten. Im Mai begann die Übertragungssaison für die JE. Sie endet normalerweise Ende Oktober, jedoch werden immer noch vereinzelt Fälle registriert. Aktuell bestehen erhebliche Probleme mit der Impfstoffversorgung in den betroffenen Gebieten. Risiko-Reisende sollten geimpft sein. / Quelle: crm

HEPATITIS B AND HEPATITIS C - PAKISTAN: (SINDH)
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 1 Dec 2008
Source: The Post (Pakistan) [edited]
<http://thepost.com.pk/NatNewsT.aspx?dtl ... 03&catid=2>


Hepatitis on the rise in Badin
------------------------------
Hepatitis B and C is on the rise in [Badin] district [Sindh province]
as 45 percent of people are suffering from the disease in Badin and
its adjoining villages, a report said. According to Civil Hospital
sources, there were 30 percent of patients [with] hepatitis C. When
contacted [a physician] in charge of a private blood bank said [that]
35 percent patients tested [positive for] hepatitis C and 10 percent
of them were believed to have contracted hepatitis B.

Dr Abdullah said the people were suffering from the disease due to
lack of basic health facilities, unhygienic and polluted atmosphere
[not responsible for blood-borne infections such as hepatitis B and
C. - Mod.CP], use of recycled syringes, and blood transfusion.

He said the hepatitis tests cost about [PKR] 3000 [USD 38.26] to PKR
5000 [USD 63.77] and [the] common man could not afford it. The people
have demanded of the government to constitute special medical teams
and provide medicines to eradicate the disease from the district.

EDO [Executive District Officer] (Health) Dr Abdul Sattar Channa said
there was no centre to treat hepatitis patients.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The incidence of hepatitis B and C virus infection in Badin is
extraordinarily high, and indicative of inadequacies in the provision
of reliable blood transfusion and basic medical services. Hepatitis B
virus infection is preventable by vaccination and hepatitis C virus
infection responds to treatment with interferon and/or ribavirin.

The organisation and provision of such services, however, is a task
for Central government rather than local authorities.

Badin District is located in Sindh province east of the river Indus.
Its location can be found by accessing the map at
<http://www.maplandia.com/pakistan/sind/badin/>.
The region is swampy, but fertile for growing rice. Badin is the main
town of Badin District.
The HealthMap/ProMED-mail interactive map of Pakistan is available at
<http://healthmap.org/promed/en?g=1184051&v=28.667,69,5>. - Mod.CP]

HEPATITIS B AND HEPATITIS C - PAKISTAN (02): (SINDH)
****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 3 Dec 2008
Source: The News International online [edited]
<http://www.thenews.com.pk/print1.asp?id=150272>


200 people have died of hepatitis in the district over the last 3
years, and thousands more at risk face death. Medical Superintendent,
Civil Hospital, Naushahro Feroze, Dr Abdul Qadir Panhwar, told this
correspondent that about 500 registered hepatitis patients were
waiting for medicines for the last 10 months, and only 300 patients
had been supplied with the medicine. He said 33 constables of the
police headquarters, Naushahro Feroze, were found suffering from
hepatitis B and C after 178 samples of police constables [18.5
percent] were scanned. About 1800 police constables remain to be
scanned, he said. He said around 1000 samples of various villages
could not be tested due to shortage of staff in the Civil Hospital.
He said villages including Aacher Khoso, Dhegano Chandio, Lukar
Brohi, Shakar Brohi, Ramzan Brohi, Ghar Gajoo and Moosa Panhwar were
most affected by the disease in the district.

Talking to this correspondent, Abdul Haleem Chandio, a resident of
village Laiq Chandio, said 35 people, including women and children,
had died due to the disease during the last 3 years, and 39 people
out of the population of 85 were suffering from Hepatitis B in the
village.

Haji Khan Chandio, a resident of village Dhegano Chandio, said 7
people, including women and children of a family, had died due to
this disease in the last 3 years, and 200 people out of the
population of 800 [25 percent] were suffering from Hepatitis B in the
village.

Abdul Riaz Khoso, a resident of village Aacher Khoso, said 20 people,
including women and children, had died of the disease during the last
3 years. 80 people out of a population of 200 [40 percent] are
suffering from Hepatitis B in the village, he said.

A survey conducted by this correspondent revealed that thousands of
cases of hepatitis B and C exist in the district, but there was no
one to scan them. People have been left to die, and there seems to be
no help forthcoming. There is a dire need that the Health Ministry
take immediate notice of the situation and send medical teams to
combat this scourge. A large quantity of medicine [for treatment] of
hepatitis B and C is also required immediately.

It has been learned that PKR 1.5 lakh [about USD 1900] are required
for one patient's treatment, which poor patients cannot afford and so
are worried about their dark future. When this correspondent visited
the affected villages of the district, the villagers complained that
they had not received even one tablet from the Civil Hospital and
that the tests were also not being conducted free of cost. The tests
are expensive and beyond the reach of poor villagers.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The hepatitis B and C disease situation in the Naushahro Feroze
District of Sindh province of Pakistan is remarkably similar to that
in Badin District of Sindh province (see: Hepatitis B & C - Pakistan:
(SD) 20081201.3773). It is evident that hepatitis B and C disease is
at least a provincial problem, and possibly a national problem.

Hepatitis B is a potentially life-threatening liver infection caused
by hepatitis B virus. It is a major global health problem and the
most serious type of viral hepatitis. It can cause chronic liver
disease and puts people at high risk of death from cirrhosis of the
liver and liver cancer. Hepatitis B virus is transmitted between
people by contact with the blood or other body fluids (i.e. semen and
vaginal fluid) of an infected person. In developing countries, common
modes of transmission include: perinatal (from mother to baby at
birth), early childhood infections (non-apparent infection through
close interpersonal contact with infected household contacts), unsafe
injections practices, blood transfusions, and sexual contact. A
vaccine against hepatitis B has been available since 1982. Hepatitis
B vaccine is 95 percent effective in preventing HBV infection and its
chronic consequences. A more detailed description is available at:
<http://www.who.int/mediacentre/factshee ... index.html>.

Hepatitis C virus is a major cause of acute hepatitis and chronic
liver disease, including cirrhosis and liver cancer. Hepatitis C
virus is spread primarily by direct contact with human blood. The
major causes of hepatitis C virus infection worldwide are use of
unscreened blood transfusions and re-use of needles and syringes that
have not been adequately sterilized. No vaccine is currently
available to prevent hepatitis C, and treatment for chronic hepatitis
C is too costly for most persons in developing countries to afford.
Thus, from a global perspective, the greatest impact on hepatitis C
disease burden will likely be achieved by focusing efforts on
reducing the risk of hepatitis C virus transmission from nosocomial
exposures (e.g. blood transfusions, unsafe injection practices) and
high-risk behaviors (e.g. injection drug use). A more detailed
account is available at:
<http://www.who.int/mediacentre/factshee ... index.html>.

Naushahro Feroze District is a district in the northern part of the
province of Sindh, Pakistan. Naushahro Feroze has a population of 1
087 571. The location of Naushahro Feroze District can be found on
the map of Sindh province at:
<http://pamirtours.pk/maps/sindh%20map.htm>.
The HealthMap/ProMED-mail interactive map of Pakistan is available at:
<http://healthmap.org/promed/en?g=1184051&v=28.667,69,5>.
- Mod.CP]

DENGUE/DHF UPDATE 2008 (52)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[We apologize for the lateness of this report, which was filed on 1
Dec 2008 but inadvertently not posted. - Mod.LM]

******
Pakistan (Punjab)
Date: Fri 28 Nov 2008
Source: The Daily Times [edited]
<http://www.dailytimes.com.pk/default.as ... 008_pg13_4>


In Lahore, 17 more people have been diagnosed with dengue fever in
the past 24 hours, a Health Department spokesman said.

He said 2 patients have been admitted to the Mayo Hospital and 6
others to the Sir Ganga Ram Hospital. The Jinnah Hospital and the
Services Hospital have one patient each. Similarly, 3 patients were
rushed to the Lahore General Hospital and 4 others were admitted to
the Children's Hospital. The Institute of Public Health diagnosed
blood samples of 14 patients with dengue fever.

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

[The dengue virus outbreak in Lahore continues. An article in the 26
Nov 2008 edition of The Times
(<http://www.thenews.com.pk/updates.asp?id=61000>) quotes a ministry
of health spokesperson indicating that so far 1149 patients of dengue
fever had been reported in Lahore while total of 1219 dengue patients
had been reported in Punjab province. A week ago, Lahore had 1099
dengue cases and Punjab province had 1150 (see ProMED-mail archive
no. 20081124.3710). There is no information about measures taken to
control the _Aedes_ mosquito vector of dengue virus, nor an
indication of which of the 4 dengue virus serotypes is involved in
this outbreak.

A map of Pakistan showing the location of Punjab state can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>
Lahore can be located on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?g=117245 ... 5,74.344,7>. - Mod.TY]

MALARIA - INDIA (02): (CHANDIGARH)
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 6 Dec 2008
Source: Tribune India [edited]
<http://www.tribuneindia.com/2008/20081207/cth1.htm#7>


While illegal mining in the Ghaggar of the town remains a concern for
the local administration and environmentalists, the huts set up by
migrant laborers along the Ghaggar river have posed a grave danger to
the health of locals.

While a death was reported due to cholera in the month of July 2008
from the region, the health authorities were alarmed when a total of
26 cases of deadly falciparum malaria were detected during a survey
of the area recently.

In fact, out of 29 cases of falciparum malaria reported from all over
the district, 26 were reported from this small stretch of 10 km
spanning Burj Kotian and Diwan wala village.

The region commonly known as crusher zone on Jalla Road on the bank
of river Ghaggar, has provided a livelihood to thousands for decades,
including labourers, vegetable vendors, and dhaba wallas.

The majority of workers employed at the crushers, washing plants and
quarrying at the riverbed come from different parts of the country,
including Bihar, Rajasthan and Uttar Pradesh. While the labourers
living along the river and nearby forest areas are prone to
vector-borne diseases, it was also found that falciparum malaria had
entered the region with the migrants from eastern Uttar Pradesh.

There were more than 5000 labourers, and, including their families,
there were more than 20 000 people who settled along the riverbed
spanning over 5 km.

Dr Anil Ailawadhi, deputy civil surgeon, (malaria) said that while 4
types of the plasmodium parasite can infect humans, the most serious
forms of the disease are caused by _Plasmodium falciparum_ and
_Plasmodium vivax_, but other related species, _Plasmodium ovale_ and
_Plasmodium malaria_ can also affect humans, he said.

However, severe malaria is almost exclusively caused by _Plasmodium
falciparum_ infection and usually arises 6-14 days after infection,
said Dr Ailawadhi. In fact, it results in several health
complications, including coma and death if untreated, he added.

While the cases of _Plasmodium falciparum_ kept increasing, it was
decided to conduct the survey before it could spread in the nearby
towns of Pinjore and Panchkula, said Dr Ailawadhi. The teams under Dr
Surinder Nain, CHC, Kalka and Dr Anup Jain, PHC, Pinjore were
constituted for the purpose, and patients were given medicines, he
said.

The medics were shocked to find that 3 members from 2 of the families
living in the area were infected with the deadly disease.

[Byline: Arun Sharma]

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

[Chandigarh is located near the foothills of the Shivalik range of
the Himalayas in northwest India and is 321 meters above sea level.
The winters (November to Mid-March) are cool, and the average
temperatures in winter remain at a maximum of 7-15 C and a minimum of
-2-5 C. Transmission of _P. falciparum_ requires an average 24 hour
temperature of 20 C or above for the development of the parasite in
the mosquito to take place. If the winter in Shinagar is not
exceptionally warm, the winter temperatures exclude local
transmission of _P. falciparum_, and if the species diagnosis is
correct, these must be cases imported with the migrant laborers
infected elsewhere.

See Wikipedia:
<http://en.wikipedia.org/wiki/Chandigarh#Geography>.
Map:
<http://www.healthmap.org>.
- Mod.EP]

RABIES, HUMAN, CANINE - KYRGYZSTAN (JALAL-ABAD)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 17 Dec 2008
Source: Regnum News Agency [trans. by Corr.BA, edited]
<http://www.regnum.ru/news/1100480.html>


Fatal case of rabies
--------------------
In the south of Kyrgyzstan a teenager who contracted rabies has died.
A 12-year-old boy from Sahaydan village in the Jalal-Abadsky Oblast
had been bitten by a rabid dog.

The press service of the Emergencies Ministry stated that physicians
have screened 657 families, and the veterinary service has vaccinated
a total of 158 cattle, 83 small ruminants, and 646 dogs and cats.

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

[This is not 1st case of rabies in a child in Kyrgyzstan in 2008.
This year 8 children and 2 adults have died of rabies in southern
Kyrgyzstan. It testifies to insufficient awareness of the population
concerning prevention of this disease. - Corr.BA.

A map of Kyrgyzstan showing Jalal-Abad in the south of the country is
available at:
<http://www.lonelyplanet.com/maps/asia/kyrgyzstan/>. - Mod.CP]