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DENGUE/DHF UPDATE (31): ASIA
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- Pakistan (Karachi, Sindh province)´. 17 Apr 2013. Dengue 67 cases.

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (03): (BIHAR)
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Date: Tue 30 Apr 2013
Source: Hill Post, Indo Asian News Service (IANS) report [edited]
http://hillpost.in/2013/04/fear-of-ence ... har/72868/


With this year's [2013] 1st death suspected to be caused by acute encephalitis syndrome (AES) reported in Bihar, the fear of an outbreak of the deadly mosquito borne disease has returned to haunt the state, an official said Tuesday [30 Apr 2013].

[A] one year old child died Monday [29 Apr 2013] of suspected AES at the Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, about 70 km [45 mi] from [Patna].

The child's father, a resident of Sirsia Kalyanpur village in East Champaran district, said she was admitted to the hospital after her condition deteriorated.

A district health official in Muzaffarpur said that 10 children with suspected AES were admitted to various hospitals in the district in the last 2 days. While 3 children have been admitted to the Kejriwal Hospital, 7 are undergoing treatment in SKMCH, the official said.

"Every year, encephalitis hits Muzaffarpur, Gaya and other neighbouring districts in May or June. But this year [2013] it seems to have hit a little early," a health department official [in Patna] said.

Last year [2012], the acute encephalitis syndrome (AES) killed nearly 240 children in Muzaffarpur and Gaya districts.

AES is a severe case of encephalitis characterised by inflammation of the brain.

Last week [week of 22 Apr 2013], the state government had launched a special vaccination drive to cover 1.8 million children against Japanese encephalitis [JE virus infection]

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[Encephalitis cases normally increase during the monsoon season. So fat this year (2013) acute encephalitis (AES) has claimed 38 lives and affected 118 persons even before the onset of the usual disease season.

Interestingly, cases of encephalitis have occurred this year (2013) in several locations in eastern India. A 1 Apr 2013 ProMED-mail post (archive no 20130402.1615081) stated, "Encephalitis cases have already been reported from Andhra Pradesh, Assam, Uttar Pradesh, and West Bengal in India this year, totalling 228 cases and 49 fatalities up to 19 Mar 2013. Of those cases, 7, all from West Bengal, were classified as Japanese encephalitis [virus infections]." There have also been cases in neighboring Bangladesh this year (2013).

AES has been attributed in part or entirely to Japanese encephalitis virus infections in northeastern India. However, in some instances, JE virus infections are reported to be responsible for a minority of the cases. Without knowing the specific etiology of the encephalitis cases above, targeted control measures will not be possible. Fortunately, the effective Japanese encephalitis virus vaccine provides an opportunity for prevention of some of these cases if applied before the main transmission season arrives.

Maps of India and Bihar can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/1*O9. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (15): ASIA
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Cholera - India (Kerala ex Karnataka)
Date: Tue 30 Apr 2013
Source: The New Indian Express [edited]
http://newindianexpress.com/states/kera ... 568044.ece


The district health officials have confirmed that the recent cholera epidemic in Wayanad [District in north east Kerala] was spread through tribal migrant laborers working in the ginger plantations in the southern districts of Karnataka.

The cholera outbreak was detected in most of those districts 2 months ago and the health officials had warned their Kerala counterparts about the high probability of the communicable disease spreading in the northern districts in Kerala, including Wayanad.

Also, a large number of migrant laborers from Karnataka are employed in several sectors across the district. There was a high chance of the spread of such diseases in tribal colonies due to poor environmental hygiene, lack of access to potable water and risk-posing lifestyles of the tribal population, District Medical Officer A Sameera told Express.

Health workers are directed to be alert as patients that have recovered still carry the bacterium for up to 2 weeks. In 2013, the 1st cholera death in the district was reported in January when a tribal laborer from Noolpuzha in Sulthan Bathery taluk died of diarrheal illness. Currently, 18 persons with symptoms of cholera are undergoing treatment at various hospitals in the district and at the Kozhikode Medical College Hospital.

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

JAPANESE ENCEPHALITIS AND OTHER - INDIA (04): (BIHAR)
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Date: Thu 9 May 2013
Source: Health India [edited]
http://health.india.com/news/bihar-ence ... e-disease/


A 6-month-old baby succumbed to a deadly mosquito-borne disease in Bihar on Thursday [9 May 2013], taking the toll from the disease to 3 in 2013, and 16 children have been admitted to hospitals in Muzaffarpur, officials said. The 6-month-old died of suspected acute encephalitis syndrome (AES), at Sakra Referral Hospital, Muzaffarpur Civil Surgeon Gayan Bhusan said.

AES is a severe case of encephalitis characterised by inflammation of the brain. The mosquitoes transmit the infection causing high fever among the children. All the 3 deaths have taken place in Muzaffarpur.

Earlier this week, a 4-year-old boy died of suspected AES at the Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, about 70 km from here. Bhusan said the situation is under control and that there was no need to panic. Last week, a one-year-old girl died of suspected AES at the hospital in Muzaffarpur. It was the 1st death suspected to be caused by AES reported in Bihar.

Bhusan said that, so far, 16 children with symptoms of AES were admitted to various hospitals in the district in the last 10 days. "Every year, encephalitis hits Muzaffarpur, Gaya and other neighbouring districts in May or June. But this year [2013] it seems to have hit a little early," a health department official here said. Last year [2012], AES killed nearly 240 children in Muzaffarpur and Gaya districts. In April [2013], the state government launched a special vaccination drive to cover 1.8 million children against encephalitis.

Japanese encephalitis is a mosquito-borne viral form of encephalitis. Only about 0.4 percent of cases of Japanese encephalitis result in acute encephalitis. Encephalitis is an inflammation of the brain. The patient's central nervous system is affected. This results in fever and/or a sudden onset of mental issues like seizures, confusion, disorientation, etc. Mortality is usually high among children.

Acute encephalitis syndrome is a severe case of encephalitis characterised by inflammation of the brain. The effect on the patient's central nervous system results in fever and/or sudden onset of mental symptoms like seizures, confusion, disorientation, etc. It can be caused due to bacterial or viral infections of the brain, toxic substances or increased complications of an infectious disease.

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[Encephalitis cases can be expected to increase significantly over the coming 3-4 month period in northeastern India. Encephalitis cases normally increase during the monsoon season. So far this year (2013), acute encephalitis (AES) has claimed 38 lives and affected 118 people even before the onset of the usual disease season.

Interestingly, cases of encephalitis have occurred this year (2013) in several locations in eastern India. A 1 Apr 2013 ProMED-mail post (archive no. 20130402.1615081) stated: "Encephalitis cases have already been reported from Andhra Pradesh, Assam, Uttar Pradesh, and West Bengal in India this year [2013], totalling 228 cases and 49 fatalities up to 19 Mar 2013. Of those cases, 7, all from West Bengal, were classified as Japanese encephalitis [virus infections]." There have also been cases in neighboring Bangladesh this year (2013).

AES has been attributed in part or entirely to Japanese encephalitis [JE] virus infections in northeastern India, as indicated in the above report. However, in some instances, JE virus infections are reported to be responsible for a minority of the cases. The above report does not indicate whether the 3 reported cases have been laboratory confirmed as JE virus infections. Without knowing the specific etiology of the encephalitis cases above, targeted control measures will not be possible. Fortunately, the effective Japanese encephalitis virus vaccine provides an opportunity for prevention of some of these cases if applied before the main transmission season arrives.

Maps of India and Bihar can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/1*O9. - Mod.TY]

DENGUE/DHF UPDATE (38): ASIA
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India (Thiruvananthapuram, Kerala state). 9 May 2013. Dengue 750 cases; deaths (susp.) 12, (conf.) 2. Increasing.
http://www.thehindu.com/news/cities/Thi ... 698222.ece

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

KYASANUR FOREST DISEASE - INDIA: (KERALA)
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Date: Tue 14 May 2013
Source: The Hindu [edited]
http://www.thehindu.com/news/national/k ... 712468.ece


A case of Kyasanur Forest disease, a viral disease transmitted to human beings through a species of ticks usually found on monkeys, has been reported from the Noolpuzha-Aalathoor colony in Wayanad district [Kerala]. The 18-year-old patient now at the Government Medical College Hospital, Kozhikode, is reportedly out of the critical state.

This is the 1st time that the zoonotic disease is being reported in Kerala, health officials told The Hindu. The disease has been found in [the neighboring state of Karnataka, in the districts of Shimoga, the district where it was first detected in 1957, Dakshina Kannada, [and] Chikmagalur].

Though a variant of the virus has been identified in Saudi Arabia in recent years, the disease has not been reported elsewhere in the world, according to literature.

The infection, which starts with high fever and body ache, produces a haemorrhagic reaction in the body, similar to that produced by dengue fever, and has a mortality rate of 5-10 percent.

While surveillance activities have been stepped up in the forest areas on the Wayanad-Karnataka border, no other case has been detected, Wayanad District Surveillance Officer Srikumar Mukundan said.

"We detected the case through active fever surveillance and it was first taken for dengue fever. When the blood test was negative for dengue and there was no response to antibiotics, the samples were sent to Manipal Hospital and the National Institute of Virology, Pune. Both institutes have confirmed it to be a case of the Kyasanur Forest disease," Dr Mukundan said.

He said the possibility of this viral infection spilling across the Karnataka-Kerala border had been discussed at an inter-State border meeting of health officials of Kerala, Karnataka, and Tamil Nadu about 3 months ago. An alert was issued to medical officers then.

"We were told that the presence of the virus should be suspected if there is a mass death of monkeys anywhere in the forest area. The case now reported seems to be an isolated one, but we have alerted the Forest Department's range wardens in the district. We are proposing to conduct an awareness class for them," Dr Mukundan said.

Information provided by the Indian Council for Medical Research says the virus is a highly pathogenic member in the family Flaviviridae, which causes dengue and yellow fever. The pathogen was named after the forest area where it was first detected in 1957.

Though the virus has been isolated from 16 species of ticks, the species _Haemaphysalis spinigera_ is the major vector.

Monkeys which come in contact with the infected ticks in the forest get the virus and act as the amplifying host. Some small mammals such as rats and shrews are known to act as hosts for the virus. Campers or others passing through the forest get the disease from the bites of infected nymphs of the tick or through contact with the infected monkey or even a monkey which died recently from the infection.

Health officials said that they did not expect more cases because the infected nymphs of the ticks were active from January to May. Once the rains start, the ticks remain dormant in the forest litter. They come alive post-monsoon when the temperature starts rising.

Till now there is no evidence of man-to-man transmission of the virus. The National Institute of Virology has developed a vaccine for the disease and this is available in Karnataka, where in recent years the number of human cases has been going up.

Once infected, timely supportive management is the only treatment modality, as in the case of dengue fever.

[Byline: C Maya]

--
Communicated by:
Ronan Kelly
<ronankelly@comcast.net>

[ProMED-mail thanks Ronan Kelly for sending in this report.

Sporadic cases of Kyasanur Forest disease (KFD) have occurred in the areas described above, with cases of infection in humans and monkeys. Previously, there have been human KFD cases in the Shimoga district of Karnataka state this year (2012), and in 2011, and 2009. The report above describes the locations of the past cases as well as the cycles of transmission in nature. The report also underscores the importance of laboratory diagnosis, since KFD can be misdiagnosed as dengue hemorrhagic fever. The report also indicates the necessity of inter-state communication and prospective surveillance, as well as the importance of communication between medical and wildlife officials -- a good example of "one health" practice.

A HealthMap/ProMED-mail map showing the location of Kerala and Karnataka states can be accessed at http://healthmap.org/r/6LJS. Wayanad District in the northeast of Kerala can be seen on the map at http://www.ohkerala.com/OhKerala/Bookin ... a_map2.jpg. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (05): (ASSAM)
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Date: Sat 11 May 2013
Source: The Times of India [edited]
http://articles.timesofindia.indiatimes ... -dibrugarh

Health authorities have sounded an alert following the death of 4 persons due to acute encephalitis syndrome (AES) in Dibrugarh district recently.

According to health officials, 38 more people with AES are being treated at the Assam Medical College and Hospital here and various primary health centres in the district. Since April [2013], one person each from Dibrugarh, Barbaruah, Nahoroni and Lahowal succumbed to AES. All types of encephalitis are classified under the term acute encephalitis syndrome.

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[This report provides no information about the etiology of the cases, nor does it indicate if any samples were submitted for laboratory testing. Acute encephalitis syndrome (AES) in previous reports from northeastern India attribute all or a minority of the cases to Japanese encephalitis virus infections. Others reports have associated the cases with polluted water, suggesting enterovirus infections.

A HealthMap/ProMED-mail map showing the location of Assam state in northeastern India can be accessed at http://healthmap.org/r/2yW8. - Mod. TY]

LEISHMANIASIS - PAKISTAN (02): (FEDERALLY ADMINISTERED TRIBAL AREAS), CUTANEOUS
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Date: Thu, 16 May 2013 18:33:46 +0200
Source: Pak Observer
http://pakobserver.net/detailnews.asp?id=206947


Surge of cutaneous Leishmaniasis in Federally Administered Tribal Areas, Pakistan
------------------------------------
Cutaneous leishmaniasis is on the increase in Pakistan's Federally Administered Tribal Areas (FATA), according to reports by FATA's Directorate of Health.

In response, the international medical organisation Medecins Sans Frontieres/Doctors Without Borders (MSF) has donated supplies of medicines to treat the disease.

Cutaneous leishmaniasis is the common form of leishmaniasis, a parasitic disease transmitted by sand flies. It causes ulcer-like lesions and can lead to severe disfigurement. If left untreated, it can complicate by affecting
internal organs.

FATA is endemic to leishmaniasis. The recent surge in cases saw 1335 patients with cutaneous leishmaniasis treated from January to March 2013, according to the FATA Directorate of Health, an increase of over 270 cases compared to the same period last year [2012]. MSF donated 1200 vials of the drug Meglumine Antimoniate (Glucantime) in the last week of April [2013]. This was almost 30 percent of the quantity that had been requested across FATA for an entire year, based on last year's patient numbers.

Since the 1st reported outbreak in FATA in 2002, the Health Directorate launched a national response programme in 2003 to tackle the disease. The World Health Organization's Disease Early Warning System (DEWS) programme has been supporting the treatment of the disease in FATA since 2010. The sudden increase in cases of cutaneous leishmaniasis reverses a trend, which had seen cases fall over recent years.

During 2012, MSF treated 298 patients for the disease at the Sadda Tehsil Headquarter hospital in Kurram Agency - a 50 percent drop on the previous year. "Timely treatment of the disease was a big factor in the significant drop in cases in the area," said MSF medical coordinator Dr Isaac Chikwanha. Using bed nets reduces the risk of being bitten by sand flies and infected with the disease

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[Cutaneous leishmaniasis, CL, is endemic in Pakistan and in Afghanistan. The fall of the Taliban regime showed that the country had experienced a huge increase in cases, with no proper control measures being implemented and treatment facilities grossly inadequate. CL increased in Pakistan with the increase in refugees from Afghanistan. The present increase needs to be analysed further. Were the cases refugees or residents in FATA? When were they exposed? With an incubation period of up to 4 months or even longer a history of movements over the past months is needed to understand the dynamics of the infection.

Prevalence rates are provided in the ProMED posting the 3rd March 2013 (see below). - Mod. EP

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

RABIES - PAKISTAN: (ISLAMABAD) CANINE, HUMAN EXPOSURE
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Date: Tue 21 May 2013
From: Naseem Salahuddin <naseemsal@hotmail.com> [edited]


Lost battle
-----------
Dr Abdus Salam Khan, FACP, Director of the Emergency Department. Shifa International Hospital, Islamabad in Pakistan shares his perspective:

"As emergency room physicians we come across patients who are faced with death and need our help to fight this battle. Most of them are success stories, but when I see a patient with rabies, I know that we have lost the battle without even trying anything.

I recently had sleepless nights over one particular case. A 28 year old lady with a 2 year old child was chased by a stray dog and ultimately the dog bit the child on the face. She was taken to a local doctor in her remote city, and the doctor instructed them to go to the big city hospital for vaccination and immunoglobulins. She [the mother] came to the city hospital with her family and she was vaccinated, but without immunoglobulins. Fast forward 18 days and she presented at our emergency department with signs of rabies. Now it is irreversible. Nothing can be done. How do you tell a 2 year old? Can we comfort them that it is OK?. How do we tell the mother to see her child for the last moments, and then it will be over for her? This case is especially tragic in that the patient and the family came to the hospital on time and the medical community failed them. I am speechless and ashamed.

Although rabies and its devastation have been known for a long time, we are still not able to lessen its impact in my part of the world. We see patients showing the signs of rabies, and we cannot offer them anything. They eventually die in their home or other places.

We have failed as a medical community to address this disease in a meaningful way. Although we run educational campaigns and celebrate World Rabies Day, using print media and electronic media [such as, ER Medicine http://www.emergencymedicineforum.org]. I, we, have not yet been able to put a significant dent in the incidence of rabies. Our emergency responder physicians sometimes don't know the latest guidelines and treat based upon their own understanding, which may result in a bad outcome.

Efforts are needed to educate the public regarding vaccination of their pets and the treatment of bite wounds. Government-run facilities see the majority of dog bite cases, but because of the lack of policy, resources, and most important of all, lack of emergency medicine training, this results in a less than optimal level of care. Private institutions also serve these roles and do a relatively better job, but their care is mostly out of the reach of common people due to the costs.

Being a member of the emergency medicine community and also involved in training of physicians, I am sure that persistent effort will ultimately improve care. I am working on forming a group to offer educational support along with logistic help to people with dog bites. We can start a rabies registry and update it on the net so that we can calculate the burden of disease in a more accurate way. I would also like to start a 24-hour active hotline to generate information and create awareness to act in the responsible way against dog bites and rabies.

Rabies control is a team effort and requires input from all stakeholders, but in the case of Pakistan, unfortunately it has been neglected by too many."

--
Communicated by:
Dr Abdus Salam Khan, FACP
Director of the Emergency Department
Shifa International Hospital
Islamabad
Pakistan

[In the treatment of bites by rabid animals WHO recommendations state that:
- wounds should be washed/flushed and disinfected immediately. Vaccine and immunoglobulin therapy should instituted as soon as possible,
- If rabies immunoglobulin is not available on 1st visit its use can be delayed by a maximum of 7 days from date of 1st vaccine injection,
- initiation of PEP (post-exposure prophylaxis) should not await the results of laboratory diagnosis or be delayed by dog observation when rabies is suspected,
- pregnancy and infancy are never contraindications to PEP,
- persons who present for evaluation and rabies post-exposure prophylaxis even months after having been bitten should be dealt with in the same manner as if the contact occurred recently.

Rabies immunoglobulin (RIG) should be given for all category III exposures [single or multiple transdermal bites, scratches, or contamination of mucous membrane with saliva (that is, licks)], irrespective of the interval between exposure and beginning of treatment. 2 kinds of rabies antibody preparations may be used: human rabies immunoglobulin (HRIG) and equine rabies immunoglobulin (ERIG). A skin test must be performed prior to the administration of ERIG. As much as possible of the recommended dose (20 IU/kg of body weight of HRIG or 40 IU/kg of body weight of ERIG) should be infiltrated around the wounds if anatomically feasible. The remainder should be administered intramuscularly (into the gluteal region) in a single dose and followed by a complete course of vaccine.

Rabies immunoglobulin of human origin (HRIG) is available in some countries; however, it is expensive and only limited amounts are available. Rabies immunoglobulin of equine origin (ERIG) is available in many countries and is considerably cheaper than HRIG. Most of the currently available preparations of ERIG are highly purified and quite safe.

Dr Khan's tragic account above is both a plea for increased efforts in control of animal rabies in Pakistan and for better provision of treatment in Pakistan hospitals. ProMED-mail welcomes the opportunity to further publicise these messages. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/6dG6.]

DENGUE/DHF UPDATE (40): ASIA
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Pakistan (Karachi, Sindh province). 16 May 2013. Dengue 113 cases, 11 cases in the past 2 days.
http://www.brecorder.com/pakistan/gener ... -days.html .

[Maps of Pakistan can be accessed at http://www.ezilon.com/maps/images/asia/ ... kistan.gif and http://healthmap.org/r/1kc-. - Mod.TY]

*****
India (Kottayam, Kerala state). 15 May 2013. Dengue nearly 700 patients have been treated for dengue at the Medical College Hospital from 15 Apr [2013] till Tuesday [14 May 2013?] .
http://timesofindia.indiatimes.com/city ... 056285.cms

[Maps of India can be accessed at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/6Z7x. - Mod.TY]

KYASANUR FOREST DISEASE - INDIA (02): (KERALA)
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Date: Mon 20 May 2013
Source: The New Indian Express [edited]
http://newindianexpress.com/states/kera ... 597777.ece


The increased rate of illegal felling of trees and deforestation is one of the reasons for the outbreak of Kyasanur Forest disease (KFD) or monkey fever, according to health officials. Last week [week of 13 May 2013], a case of KFD had been reported in Noolpuzha Panchayat in Wayanad [district], for the 1st time in the state.

Dr T Jayakrishnan, Associate Professor, Department of Community Medicine, Medical College, Kozhikode, told Express that deforestation is one among the main reasons for the outbreak of KFD. This viral disease is transmitted to human beings through a species of ticks usually found on monkeys. Owing to the shrinking of forest areas, monkeys are entering human habitats and this increases the risk of the disease in future, he added.

The 18-year-old victim, who was admitted to the Kozhikode Medical College, has overcome the critical stage and his condition is now stable.

The infection, which starts with high fever and body ache, has similar symptoms to dengue fever, and has a mortality rate of 4-15 per cent. KFD virus is spread through air or directly through the ticks and is highly contagious [but see comment below]. There is a wide range of natural hosts such as monkeys, rats, shrews, reptiles, and cattle, besides ticks. Man acquires the infection from bites of infected ticks, which suck blood. There is no evidence of human-to-human transmission.

The Health Department officials have stepped up surveillance activities in the forest areas of Wayanad, especially on the Karnataka border, as monkey fever is suspected to have hit parts of Bandipur Tiger Reserve.

The risk is very high as many people choose forest areas for trekking and picnics. Those who are going into the forest should wear long-sleeved dresses and footwear which covers the feet, and should spray insect repellents such as dimethyl phthalate on their clothing, Dr Jayakrishnan added.

[Byline: Arun M]

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[This reported case was posted by ProMED-mail on 14 May 2013 (archive no 20130514.1712790). However, the association of deforestation with the KFD case is new. Sporadic cases of Kyasanur Forest disease (KFD) have occurred in the areas described above, with cases of infection in humans and monkeys. Laboratory diagnosis is important, since KFD can be misdiagnosed as dengue hemorrhagic fever. KFD virus is a member of the _Flaviviridae_ family. Although the virus has been isolated from 16 species of ticks, _Haemaphysalis spinigera_ is the major vector. Contrary to the statement in the report above, KFD virus is not considered highly contagious nor is aerosol transmission important.

A HealthMap/ProMED-mail map showing the location of Kerala and Karnataka states can be accessed at http://healthmap.org/r/6LJS. Wayanad District, where the above case occurred, in the northeast of Kerala, can be seen on the map at http://www.ohkerala.com/OhKerala/Bookin ... a_map2.jpg. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/28JB.]

DENGUE/DHF UPDATE (42): ASIA
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India (Mysore district, Karanataka state) 25 May 2013. Dengue (all suspected) hospitalized currently 14 children; deaths past 10 days 4.
http://www.thehindu.com/news/national/k ... 749870.ece

[Maps of India can be accessed at http://www.mapsofindia.com/ and http://healthmap.org/r/4idB. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (06): (BIHAR)
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Date: Fri 31 May 2013
Source: Health India [edited]
http://health.india.com/news/bihar-ence ... ast-month/


Encephalitis has claimed the lives of 8 children in Bihar in the past month, with 2 of them succumbing to the disease on Thursday [30 May 2013], an official said. Encephalitis causes high fever, irritation, and swelling of the brain. An official said: "2 more children have died in Champaran district."

The 1st encephalitis-related death in the state this year [2013] was reported in the last week of April [2013] in Muzaffarpur, about 70 km [43 mi] from [Patna]. Last year [2012], the disease killed nearly 240 children in Muzaffarpur and Gaya districts.

--
communicated by:
ProMED-mail from HealthMap Alerts
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[The report above provides no indication of the etiological agent responsible for these encephalitis cases. Encephalitis cases have begun to increase in north eastern India. Encephalitis cases normally increase during the monsoon season. So far this year (2013), acute encephalitis (AES) has claimed lives and affected over 100 people even before the onset of the usual disease season.

Interestingly, cases of encephalitis have occurred this year (2013) in several locations in eastern India. At the beginning of April a ProMED-mail post (archive no. 20130402.1615081) stated: "Encephalitis cases have already been reported from Andhra Pradesh, Assam, Uttar Pradesh, and West Bengal in India this year [2013], totalling 228 cases and 49 fatalities up to 19 Mar 2013. Of those cases, 7, all from West Bengal, were classified as Japanese encephalitis [virus infections]. There have also been cases in neighboring Bangladesh this year (2013)."

Maps of India and Bihar can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/77fN. - Mod.TY]

DENGUE/DHF UPDATE (46): ASIA
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India
- Goa state: 27 May 2013. Dengue 30 cases ahead of the monsoon season, with more cases expected.
http://timesofindia.indiatimes.com/city ... 281731.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]

- Kerala state. 2 Jun 2013. Dengue 63 cases; Kottayam municipality 5 deaths on Fri 31 May 2013 only.
http://www.mumbaimirror.com/news/india/ ... 386838.cms

[If these 5 deaths are, in fact, due to dengue virus infections, the number of dengue cases must be significantly higher than the 63 cases reported for the entire state, as suggested in a 2 Jun 2013 Times of India report (http://timesofindia.indiatimes.com/city ... 390245.cms). - Mod.TY]

- Karnataka state. 30 May 2013. Dengue (susp.) 2711 cases, (conf.) 684 cases; deaths 2. Municipality most affected: Bangalore (conf.) 85 cases. Increasing.
http://timesofindia.indiatimes.com/city ... 341497.cms

- Pune, Maharashtra state. 27 May 2013. Dengue 95 cases; deaths since August 2012, 16.
http://timesofindia.indiatimes.com/city ... 281862.cms

Pakistan
- (Sindh province). 31 May 2013. Dengue 182 cases. Municipality most affected: Karachi 174 cases.
http://www.dailytimes.com.pk/default.as ... 13_pg12_11

[Maps of Pakistan can be accessed at http://www.ezilon.com/maps/images/asia/ ... kistan.gif and http://healthmap.org/r/1kc-. - Mod.TY]

TYPHOID FEVER UPDATE (04): INDIA
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


*****
India (Jammu and Kashmir)
Date: Tue 4 Jun 2013
Source: Kashmir Times [edited]
http://www.kashmirtimes.com/newsdet.aspx?q=17959


A typhoid epidemic has broken out in the Wagoora area of north Kashmir's Baramulla district, where more than 300 patients are suffering from this waterborne disease, and the number is increasing with every passing day. On average, 20 patients [a day?] complaining of typhoid fever are treated at different private clinics in the area, which are without basic public health facilities.

The epidemic is directly traceable to the fact that a great proportion of the population had to drink water from the polluted Nalla Ningli [river], which is the main source of drinking water to dozens of villages in the area, medical experts say. They say the reason for typhoid fever is the pollution or infection in the Nalla Ningli, which houses over 100 toilets on its banks.

Cries are getting louder in the area that the villages of Wagoora Block need a storage reservoir to furnish a filtered water supply. The Wagoora Welfare Committee (WCC), which comprises over a dozen (12) members from different villages of the area, is demanding adequate health facilities. "We should have at least a Public Health Centre in Wagoora to keep a check on the waterborne diseases," said a WCC member, Ghulam Nabi Wani.

Medical experts say there has been an outbreak of typhoid fever about this time every year for the past 5 years. A pharmacist, Muteeb Ali, said he has a list of over 30 patients of Wagoora and knew also of 3 cases in Darwa and 15 in Manigam, the villages situated on the banks of Nalla Ningli.

"For the past 2 months, each day, I receive 4 fresh cases of typhoid from different villages of Wagoora area," said Ali. Others in the area estimated that more than 300 cases had occurred in the adjoining villages of Wagoora.

For the past 3 years, typhoid fever has been recurring in the area on a larger scale, said a local physician, Dr Reyaz Ahmad. "The main reason for the spread of typhoid is the infected water of Nalla Ningli, which is used for drinking and cleaning kitchen utensils," said Dr Reyaz.

The chief medical officer of Baramulla said: "It is not an epidemic. The number of these patients increases in every rainy season, and it happens in every district; Wagoora is not an exception."

[Byline: Ulfat Manzoor]

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

[Jammu and Kashmir (http://en.wikipedia.org/wiki/Jammu_and_Kashmir) is the northernmost state of India. It is situated mostly in the Himalayan Mountains. Jammu and Kashmir shares a border with the states of Himachal Pradesh and Punjab to the south and internationally with the People's Republic of China to the north and east, and the Pakistani territories of Azad Kashmir and Gilgit-Baltistan to the west and northwest, respectively.

A HealthMap/ProMED-mail interactive map of India and Jammu and Kashmir state can be seen at http://healthmap.org/r/1_IS. Baramulla is a city and municipality in Baramulla district in the Indian state of Jammu and Kashmir. It is located on the banks of the Jhelum river downstream of Srinagar, the capital city of the state. A map of Kashmir showing the location of Baramulla can be located at http://www.topnews.in/files/state-map-jk_0.jpg. - Mod.LL]