CHOLERA, DIARRHEA AND DYSENTERY UPDATE (23): ASIA
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In this update:
Asia
[1] Cholera - India (Uttarakhand State)
[2] Cholera - India (Maharashtra State)
[3] Cholera - India (Madhya Pradesh State)
[4] Dysentery - India (Orissa State)
[5] Gastroenteritis, foodborne - India (Jammu and Kashmir State)
[6] Diarrhea, waterborne - India (Gujarat State)
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[1] Cholera - India (Uttarakhand State)
Date: Sat 29 Jun 2013
Source: Deccan Herald [edited]
http://www.deccanherald.com/content/341 ... olera.html
Fears of epidemic in flood-ravaged Uttarakhand were realized as the state reported many cases of cholera. In the aftermath of the devastating floods, the state is continuing to cope with poor sanitation, which, coupled with open defecation and consumption of contaminated food, could have resulted in cholera and diarrhoea, according to experts.
A member of the National Disaster Response Force from Shimoga, Dr Kumar VLS, who has been part of rescue operations in the flood-hit state since 21 Jun 2013, said around 15 cholera cases were reported in Dehradun and Uttarkashi. Some diarrhea cases were also reported. However, medical test report is yet to confirm any significant increase in the number of cholera cases.
In an exclusive chat with Deccan Herald, Dr Kumar, a practicing dental surgeon in Shimoga, said: "With the sole intention of preventing the outbreak of water-borne diseases in the flood-ravaged state, we are purifying water through 2 kinds of mobile water treatment machines. One is attached to a trailer and the other is portable." The team is using 5 such machines in Uttarkashi. 3 of them are portable and 2 are mobile water treatment machines, Dr Kumar said. "They function on 3-way process. The cartridge filter clears particles more than 50 microns, carbon filter removes odor and taste, and ultra violet rays inactivate bacteria and viruses and purify water," Dr Kumar said.
Purified water is being supplied to the tourists who are trapped in Pithoragarh district and Uttarkashi. "We have a team of experts to operate these machines. In this way, we are doing our best to rescue the stranded pilgrims and protect their health," he added.
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[A map of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm. An interactive map of the Uttarakhand State can be found at http://healthmap.org/r/3_OH. - Mod.LL]
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[2] Cholera - India (Maharashtra State)
Date: Fri 28 Jun 2013
Source: Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... alth-files
It's just the 1st month of the monsoon and 6 suspected cholera cases have come to light in the city [Mumbai], all of them in this week. While 3 patients were registered in the state-run JJ Hospital, others were admitted to the civic-run Kasturba Hospital. All patients were residents of south Mumbai.
A 55-year-old man was suffering from loose motions and vomiting since Sat 22 Jun 2013. It was only after his condition worsened and he started to feel giddy that he went to JJ Hospital. "My stomach muscles would quiver and ache, but the motions would not stop. Nothing I ate would remain in my stomach. It was only when I was admitted and the doctors administered medicines and saline that I felt better," said the plumber living in Gulalwadi, Bhuleshwar. "I still feel very weak," he added.
JJ Hospital authorities said the man was only 1 of the 3 suspected cholera patients. "They have tested positive for the hanging drop test. Their stool samples have been sent for the ELISA test and reports are awaited. However, 2 of these had already recovered and were discharged," said Dr TP Lahane, dean of JJ Hospital, adding the BMC [Brihanmumbai Municipal Corporation also known as the Municipal Corporation of Greater Mumbai (MCGM)] was informed about these patients. "We tried to get the patients shifted to Kasturba Hospital, but we were told that the beds in Kasturba were full. So we kept the patients in isolation here," said Dr Lahane.
However, the BMC denied receiving any notification from JJ Hospital. "None of the 3 cases have tested positive for the ELISA test. These are thus only severe gastroenteritis cases and not cholera cases," said Mangala Gomare, head of BMC's epidemiology cell.
Additional municipal commissioner (health), Manisha Mhaiskar said the 3 patients admitted to Kasturba were from the B, C, and D wards (Sandhurst Road, Kalbadevi, Mohammad Ali Road, and Nana Chowk areas). "The patients are doing fine. Water samples from these areas have already been sent for testing. If the water is found unfit for consumption, then the required measures will be taken by the hydraulic department," she said.
Cholera has never been mentioned in BMC health files as officials say "its mere occurrence could attract international travel sanctions". BMC has refrained from naming it. While New Delhi and Chennai record hundreds of cholera cases every year, BMC records always reflect zero cases.
Experts say water contaminated because of the city's old pipelines-especially in the island city-can be blamed for cholera. "The water pipes are structured in such a way that clean and waste water pipes run side-by-side. They are so old that if rusted, there may be mixing of water. Water is thus not contaminated from the source," said a hydraulic department official.
[Byline: Pratibha Masand]
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[An interactive map of the state can be found at http://healthmap.org/r/2GIs. - Mod.LL]
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[3] Cholera - India (Madhya Pradesh State)
Date: Sun 23 Jun 2013
Source: Times of India, Times News Network (TNN) [edited]
http://articles.timesofindia.indiatimes ... holera-myh
Within a week, a 3rd case of cholera surfaced in city on Sun 23 Jun 2013. The patient was identified as a 70-year-old female, resident of Yadav Nand Nagar. She was admitted to Maharaja Yeshwantrao Hospital (MYH) on 19 Jun 2013 and the medical investigation confirmed that the patient was suffering from cholera. Though by the time health department got the confirmatory reports, the patient was discharged from the hospital.
District health officer Dr GL Sodhi said, "The patient was admitted in MYH. Test reports confirmed that she was suffering from cholera. We have alerted zonal medical officer of the area to send a team to check the contamination in water source." The team will also provide counselling and guidance and distribute chlorine tablets so that the disease spread can be checked in the area, he added.
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[An interactive map of the state can be found at http://healthmap.org/r/3qbl. - Mod.LL]
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[4] Dysentery - India (Orissa State)
Date: Mon 1 Jul 2013
Source: The New Indian Express [edited]
http://newindianexpress.com/states/odis ... 661780.ece
Over 70 persons in Bikrampur village under Khallikote block of Ganjam district are suffering from dysentery for past one week. With the increase of dysentery cases, a team of doctors of Khallikote hospital has been camping in the village and are treating the affected persons. Despite all preventive measures, new cases are reported almost everyday. 2 days ago, a team from MKCG Medical College and Hospital had collected water and blood samples of the patients, but the test reports are yet to be received.
Though the cause of spread of the disease has not been ascertained, doctors suspect use of contaminated water as the reason. While water bodies are being disinfected, doctors are facing problems in treating patients because of lack of infrastructure.
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[The classical causes of dysentery are bacterial (usually shigellosis) and amoebic.
An interactive map of the state can be found at http://healthmap.org/r/3MKs. - Mod.LL]
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[5] Gastroenteritis, foodborne - India (Jammu and Kashmir State)
Date: Thu 27 Jun 2013
Source: Greater Kashmir.com [edited]
http://www.greaterkashmir.com/news/2013 ... an--77.asp
More than 150 people have fallen ill after consuming Wazwan [a multi-course meal in Kashmiri cuisine] at a marriage party in Kachwa Muqam village in north Kashmir's Baramulla district. Reports said the villagers complained of vomiting and dysentery soon after they consumed the feast at the marriage party.
"All the people who had consumed the food fell sick," locals said. According to locals, they were immediately referred to nearby hospitals including Primary Health Centre Kalantara, Sub District Hospital [SDH] Chandoosa and Sub District Hospital Kreeri.
"People who consumed the Wazwan complained of vomiting and dysentery soon after they finished the meals. We treated more than 75 patients here," said Dr Bilal posted at PHC Kalantara. Talking to Greater Kashmir BMO [block medical officer] Kreeri, Dr Bilkees Shah, admitted that the people have fallen sick due to food poisoning.
"We received more than 130 patients who complained of vomiting, diarrhea, and dysentery. We treated 65 patients at the PHC Kalantara, 25 at Sub Centre Kachwa Muqam and more than 40 patients at SDH Kreeri," she said. She said a team was sent to collect food samples from the village.
"We sent a team comprising Health educators to collect food samples from the village but those who had cooked the Wazwaan have not provided the samples to the team," she said.
[Byline: Peerzada Aarif]
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[The cause of this outbreak is unclear and may be a preformed bacterial toxin, a chemical, or infection. A well-defined incubation period and the presence or absence of fever are useful in generating a differential diagnosis.
An interactive map of the state can be found at http://healthmap.org/r/7bVf. - Mod.LL]
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[6] Diarrhea, waterborne - India (Gujarat State)
Date: Fri 28 Jun 2013
Source: Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 807802.cms
A major outbreak of water-borne diseases has taken place in Sama area of Vadodara. Nearly 150 people are ill in the area in various residential localities. Water contamination that took place about 10 days ago is believed to be the reason for the outbreak. Residents of the area had complained regarding this to Vadodara Municipal Corporation (VMC) officials.
According to VMC officials, 88 cases of diarrhea and gastroenteritis have been detected in the area during the last 3 days. The localities that have been affected are located between Chanakyapuri crossroads and Narmada branch canal located ahead.
VMC medical officer (health) Dr Devesh Patel said extensive screening of the residents had been done and they had been given chlorine tablets to purify water and oral rehydration solution packets. He added that the water samples collected now were uncontaminated.
Sources said that work on a pipeline was conducted in the area about 10 days ago. Even as this was being done there were heavy rains while the pipeline was still open and this may have contaminated water. Residents had complained of dirty water supply around the same time.
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[No information regarding the etiology or etiologies of this cluster (also associated with icteric illnesses in other residents, which is likely caused by another agent; see ProMED-mail posting 20130629.1798872) is given.
An interactive map of the state can be found at http://healthmap.org/r/7rEt. - Mod.LL]
Aktuelle Epidemien in Asien/Seidenstraße
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RABIES - INDIA (06): (MADHYA PRADESH): CANINE, HUMAN-TO-HUMAN TRANSMISSION SUSPECTED
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Date: Fri 5 Jul 2013
Source: Bhaskar News [edited]
http://daily.bhaskar.com/article/MP-OTC ... 5-NOR.html
After being bitten by a 6-year-old rabid boy, 5 members of a family are battling for their lives. The boy was attacked by a dog in January [2013] in Agar Road in Ujjain [Madhya Pradesh state]. The rabies-affected dog died a day after biting the boy. According to family members, the 6-year-old boy developed rabies and bit 5 of them before his death in June [2013]. His uncle is said to have developed symptoms of rabies.
According to a source, he [the boy] died because he was treated by a quack. The boy developed symptoms of rabies 3 days after the dog bit him. He was rushed to MY Hospital when his condition became worse. However, the doctors refused to treat him because he was very critical.
The boy had bitten his father, mother, grandmother and an uncle and aunt before his death. The boy's aunt said, "We all received rabies inoculations after the boy's death. But my brother fell sick and we think he is also affected by rabies now. I don't know if anybody else in the family has developed rabies or not."
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[An unusual account of suspected transmission of rabies from a 6-year-old boy to a family member (by bite) despite timely administration of post-exposure prophylaxis to all family members bitten by the sick child. The story lacks independent corroboration, and time frames are confusing. In particular, it was not unequivocally confirmed that the boy actually died as a result of rabies virus infection. The diagnosis seems to be based on the biting behavior of the sick child before his death. Likewise it has not been established that the boy's sick uncle has actually contracted rabies virus infection. Further information is awaited.
Ujjain is an ancient city in Malwa region in central India, on the eastern bank of the Kshipra River, today part of the state of Madhya Pradesh. It is the administrative centre of Ujjain District and Ujjain Division (http://en.wikipedia.org/wiki/Ujjain). - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7wFC, http://healthmap.org/r/7wFC.]
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Date: Fri 5 Jul 2013
Source: Bhaskar News [edited]
http://daily.bhaskar.com/article/MP-OTC ... 5-NOR.html
After being bitten by a 6-year-old rabid boy, 5 members of a family are battling for their lives. The boy was attacked by a dog in January [2013] in Agar Road in Ujjain [Madhya Pradesh state]. The rabies-affected dog died a day after biting the boy. According to family members, the 6-year-old boy developed rabies and bit 5 of them before his death in June [2013]. His uncle is said to have developed symptoms of rabies.
According to a source, he [the boy] died because he was treated by a quack. The boy developed symptoms of rabies 3 days after the dog bit him. He was rushed to MY Hospital when his condition became worse. However, the doctors refused to treat him because he was very critical.
The boy had bitten his father, mother, grandmother and an uncle and aunt before his death. The boy's aunt said, "We all received rabies inoculations after the boy's death. But my brother fell sick and we think he is also affected by rabies now. I don't know if anybody else in the family has developed rabies or not."
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[An unusual account of suspected transmission of rabies from a 6-year-old boy to a family member (by bite) despite timely administration of post-exposure prophylaxis to all family members bitten by the sick child. The story lacks independent corroboration, and time frames are confusing. In particular, it was not unequivocally confirmed that the boy actually died as a result of rabies virus infection. The diagnosis seems to be based on the biting behavior of the sick child before his death. Likewise it has not been established that the boy's sick uncle has actually contracted rabies virus infection. Further information is awaited.
Ujjain is an ancient city in Malwa region in central India, on the eastern bank of the Kshipra River, today part of the state of Madhya Pradesh. It is the administrative centre of Ujjain District and Ujjain Division (http://en.wikipedia.org/wiki/Ujjain). - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7wFC, http://healthmap.org/r/7wFC.]
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UNDIAGNOSED FEBRILE ILLNESS - INDIA (TAMIL NADU): REQUEST FOR INFORMATION
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Date: Tue 2 Jul 2013
Source: Times of India [edited]
http://articles.timesofindia.indiatimes ... s-symptoms
In the past few weeks, many hospitals have been seeing several cases of undiagnosed fever with patients showing symptoms similar to those of malaria, dengue, Japanese encephalitis and typhoid. However, physicians are in a spot as the infectious diseases test results turn out to be negative, making it difficult for them to understand the ailment and prescribe medicines.
Doctors said the symptoms could not be brushed aside as common flu, as most antibiotics proved ineffective [sic, antibiotics are ineffective against viral illnesses], but said the disease was self-limiting. The fever takes a week to 10 days to disappear and has the patient running high temperature, cold, sore throat and body pain.
"It seems to target the gastric area, causing nausea and vomiting. This results in severe dehydration and weakness, and patients need to be admitted without delay for IV fluid administration," said a senior gastroenterologist at the GH, adding that he saw about 5 patients daily with symptoms of typhoid.
[Byline: Janani Sampath]
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ProMED-mail Rapporteur Kunihiko Iizuka
[The etiology of these cases has not been determined. Although some pathogens have apparently been ruled out, the limited information provided does not permit reasonable speculation concerning which agents might be involved in these cases. An earlier series of cases of undiagnosed febrile disease were reported in Tamil Nadu state in December 2012. No further reports indicating the etiology of the disease in that outbreak were received. ProMED-mail would appreciate receiving more details, and especially any additional laboratory results for the current outbreak, as they become available.
A HealthMap/ProMED-mail interactive map showing the location of Tamil Nadu state can be accessed at http://healthmap.org/r/2kP3. - Mod.TY]
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Date: Tue 2 Jul 2013
Source: Times of India [edited]
http://articles.timesofindia.indiatimes ... s-symptoms
In the past few weeks, many hospitals have been seeing several cases of undiagnosed fever with patients showing symptoms similar to those of malaria, dengue, Japanese encephalitis and typhoid. However, physicians are in a spot as the infectious diseases test results turn out to be negative, making it difficult for them to understand the ailment and prescribe medicines.
Doctors said the symptoms could not be brushed aside as common flu, as most antibiotics proved ineffective [sic, antibiotics are ineffective against viral illnesses], but said the disease was self-limiting. The fever takes a week to 10 days to disappear and has the patient running high temperature, cold, sore throat and body pain.
"It seems to target the gastric area, causing nausea and vomiting. This results in severe dehydration and weakness, and patients need to be admitted without delay for IV fluid administration," said a senior gastroenterologist at the GH, adding that he saw about 5 patients daily with symptoms of typhoid.
[Byline: Janani Sampath]
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Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The etiology of these cases has not been determined. Although some pathogens have apparently been ruled out, the limited information provided does not permit reasonable speculation concerning which agents might be involved in these cases. An earlier series of cases of undiagnosed febrile disease were reported in Tamil Nadu state in December 2012. No further reports indicating the etiology of the disease in that outbreak were received. ProMED-mail would appreciate receiving more details, and especially any additional laboratory results for the current outbreak, as they become available.
A HealthMap/ProMED-mail interactive map showing the location of Tamil Nadu state can be accessed at http://healthmap.org/r/2kP3. - Mod.TY]
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Denguefieber in Indien und Pakistan
DENGUE/DHF UPDATE (56): ASIA
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- India (Maharashtra state). 6 Jul 2013. Dengue 727 cases; Deaths 15; Municipality most affected, Mumbai; Dengue virus circulating predominantly type 2.
http://timesofindia.indiatimes.com/city ... 937248.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]
- Pakistan (Sindh province). 2 Jul 2013. Dengue 360 cases; Municipality most affected: Karachi 350 cases; Increasing.
http://www.thenews.com.pk/Todays-News-4 ... s-reported
[Maps of Pakistan can be accessed at
http://www.ezilon.com/maps/images/asia/ ... kistan.gif
and http://healthmap.org/r/2NT8. - Mod.TY]
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- India (Maharashtra state). 6 Jul 2013. Dengue 727 cases; Deaths 15; Municipality most affected, Mumbai; Dengue virus circulating predominantly type 2.
http://timesofindia.indiatimes.com/city ... 937248.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]
- Pakistan (Sindh province). 2 Jul 2013. Dengue 360 cases; Municipality most affected: Karachi 350 cases; Increasing.
http://www.thenews.com.pk/Todays-News-4 ... s-reported
[Maps of Pakistan can be accessed at
http://www.ezilon.com/maps/images/asia/ ... kistan.gif
and http://healthmap.org/r/2NT8. - Mod.TY]
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RABIES - INDIA (07): (PUNJAB), CANINE, HUMAN-TO-HUMAN TRANSMISSION SUSPECTED
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Date: Sun 7 Jul 2013
Source: The Times of India [edited]
http://articles.timesofindia.indiatimes ... ite-victim
In a unique case of its kind, a person from the CMCH [Christian Medical College & Hospital] area "bitten by a street dog" got rabid and started running after other patients to bite them at the Civil Hospital, where he was undergoing treatment. The patient was, meanwhile, referred to Rajindra Hospital in Patiala after he was confirmed to be suffering from rabies.
Dr Avinash Jindal, specialist physician who treated the patient at Civil Hospital, said: "The patient was brought to our hospital yesterday [Fri 6 Jul 2013] to the emergency department after he got aggressive. He was 1st checked by the psychiatrist as he reported severe aggression symptoms. This morning [7 Jul 2013], while we were checking him, he got more aggressive and started running after people there. He, in fact, bit a 25-year-old patient at the hospital. When I took his history, his attendant told me that he was bitten by a stray dog about 10 days ago. Suspecting him to be suffering from hydrophobia [rabies], we did a simple test and brought water in front of the patient. He got convulsions and suffered from laryngeal spasms, thus confirming that he indeed is suffering from rabies. I later gave him antibiotics and anti-convalescents." [sic, possibly a misprint for anticonvulsants -- Mod.JW] [Rabies is a virus infection and unlikely to respond to treatment with antibiotics, and less so to "anti-convalescents". - Mod.CP]
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[This press report bears close similarities to a report from Ujjain [Madhya Pradesh state] reproduced previously in ProMED-mail (Rabies - India (06): (MP) canine, human-to-human transmission susp. 20130706.1810755).
Both reports describe victims exhibiting rabies-like symptoms following a dog bite and in turn transmitting rabies by bite to other human victims. Neither incident has been corroborated independently. Likewise, rabies virus infection has not been confirmed by laboratory diagnostics in the case of either of the dogs responsible for the initial bites, or the initial human victims, or the hospitalised patients reputed to have been bitten by the supposedly rabid humans. Transmission of rabies from one human to another by bite, although not impossible, is unlikely, and, according to the US CDC, has not happened (http://www.cdc.gov/rabies/transmission/exposure.html).
Ludhiana is a city and a municipal corporation in Ludhiana district in the Indian state of Punjab. It is the largest city in the state, with an estimated population of 1 613 878 as per census 2011. The population increases substantially during the harvesting season due to the migration of labourers from eastern states like Uttar Pradesh, Bihar, Odisha and Delhi. It has an area of about 3787 square km. - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]
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Date: Sun 7 Jul 2013
Source: The Times of India [edited]
http://articles.timesofindia.indiatimes ... ite-victim
In a unique case of its kind, a person from the CMCH [Christian Medical College & Hospital] area "bitten by a street dog" got rabid and started running after other patients to bite them at the Civil Hospital, where he was undergoing treatment. The patient was, meanwhile, referred to Rajindra Hospital in Patiala after he was confirmed to be suffering from rabies.
Dr Avinash Jindal, specialist physician who treated the patient at Civil Hospital, said: "The patient was brought to our hospital yesterday [Fri 6 Jul 2013] to the emergency department after he got aggressive. He was 1st checked by the psychiatrist as he reported severe aggression symptoms. This morning [7 Jul 2013], while we were checking him, he got more aggressive and started running after people there. He, in fact, bit a 25-year-old patient at the hospital. When I took his history, his attendant told me that he was bitten by a stray dog about 10 days ago. Suspecting him to be suffering from hydrophobia [rabies], we did a simple test and brought water in front of the patient. He got convulsions and suffered from laryngeal spasms, thus confirming that he indeed is suffering from rabies. I later gave him antibiotics and anti-convalescents." [sic, possibly a misprint for anticonvulsants -- Mod.JW] [Rabies is a virus infection and unlikely to respond to treatment with antibiotics, and less so to "anti-convalescents". - Mod.CP]
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[This press report bears close similarities to a report from Ujjain [Madhya Pradesh state] reproduced previously in ProMED-mail (Rabies - India (06): (MP) canine, human-to-human transmission susp. 20130706.1810755).
Both reports describe victims exhibiting rabies-like symptoms following a dog bite and in turn transmitting rabies by bite to other human victims. Neither incident has been corroborated independently. Likewise, rabies virus infection has not been confirmed by laboratory diagnostics in the case of either of the dogs responsible for the initial bites, or the initial human victims, or the hospitalised patients reputed to have been bitten by the supposedly rabid humans. Transmission of rabies from one human to another by bite, although not impossible, is unlikely, and, according to the US CDC, has not happened (http://www.cdc.gov/rabies/transmission/exposure.html).
Ludhiana is a city and a municipal corporation in Ludhiana district in the Indian state of Punjab. It is the largest city in the state, with an estimated population of 1 613 878 as per census 2011. The population increases substantially during the harvesting season due to the migration of labourers from eastern states like Uttar Pradesh, Bihar, Odisha and Delhi. It has an area of about 3787 square km. - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]
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Japanische Enzephalities in Indien
JAPANESE ENCEPHALITIS AND OTHER - INDIA (10): (BEHAR)
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Date: Sat 13 Jul 2013
Source: New York Times [edited]
http://www.nytimes.com/2013/07/14/world ... =true&_r=0
The children begin arriving every year in mid-May, brought to an overburdened hospital here in one of India's most impoverished areas by their panic-stricken mothers. Seemingly healthy hours earlier, most have lapsed into a coma punctuated by convulsions.
Doctors work to calm the convulsions and keep the children hydrated, but then have to watch helplessly along with the anguished parents as a 3rd of their young patients die, often within hours. Then, as suddenly as it started, the mysterious outbreak stops with the onset of the monsoon rains this month [July 2013]. No one knows why.
The mud-and-bamboo huts in this part of India cradle more dying children than anywhere in the world, with diarrhea and malnutrition long ranking as the region's great scourges. But now, this unknown killer is stalking the very young.
Although public health statistics are unreliable here, the disease is believed to infect tens of thousands of people a year and kill thousands.
All doctors know is that the illness is a form of brain swelling, or encephalitis, but that is a huge category, covering a wide spectrum of diseases. Doctors have tested for known causes of brain swelling, including meningitis and Japanese encephalitis, but the tests almost always come back negative. India's top health officials say the disease, known officially as acute encephalitis syndrome, has them stumped.
"This outbreak happens every year, and we have not been able to identify the cause or link even a single factor responsible," Dr. L. S. Chauhan, the director of the National Center for Disease Control in India, said in an interview.
Dr. Chauhan hopes to change that. With help from the Centers for Disease Control and Prevention in Atlanta, he started a program this year [2013] to train an elite cadre of disease sleuths, part of a recently organized Epidemic Intelligence Service in India, that he hopes will eventually undertake the investigations of India's estimated 1500 epidemics.
But the outbreak in Muzaffarpur is slowly spreading to neighboring areas, and Dr. Chauhan has thrown everything he can at it, assigning all 7 of his trainees, each already an accomplished physician. Experts from the C.D.C. are advising them, and their work is being closely followed by concerned officials in the United States.
The 1st reports of this mysterious illness date to 1995, when nearly 1000 children were sickened and 300 died in Muzaffarpur's 3 hospitals. Smaller epidemics have followed almost every year since.
Officials say they do not know whether the illness began in 1995 or had simply gone unnoticed before. Not only has it spread to nearby areas, but researchers have also recently found similar cases in neighboring Nepal. Some outbreaks in India have gone unreported because officials suppressed any mention for fear of prompting panic or criticism.
"India has a huge problem with encephalitis," said Dr. Rajesh Pandey, one of the epidemiologists camped out in Muzaffarpur, "and it's not something almost anyone knows about."
The illness is often confused with Japanese encephalitis [virus infection], which generally arrives just after the start of the monsoons and peaks in the fall, as it is spread by mosquitoes that breed in standing water. But this affliction starts a couple of months earlier and ends with the monsoon.
"This is a real mystery," Dr. Thomas R. Frieden, the CDC director, said in a telephone interview. "We're not sure we'll be able to solve it, but at least we can unleash the best epidemiological tools we have to try to answer the question."
Dr. Chauhan's team has been given a rustic guesthouse next to a hospital here. There is no air-conditioning; the beds sag, and the electricity is fitful. But there is an urgency to the doctors' work. They gather almost every night in a small dining room to update crude posters with information about each case and debate their theories. A new virus, an old bacteria, litchis, alcoholic tree sap, heat, pesticides, rats, bats and sand flies are among the suspected causes.
In the nearby hospital, parents say in hushed tones that a ghost must be angry. Some paint black spots on siblings' foreheads to ward off the evil eye.
Given the suddenness with which the illness strikes, their superstition is understandable. At 11:30 p.m. on 10 Jun 2013, a 3-year-old boy was sleeping beside his mother and 2 brothers in their hut in the village of Ganti Vishanpur when he let out a scream and went into convulsions. The boy's father took him to a hospital. Several hours later, the boy's brother, age 5, screamed louder, convulsed and went limp. His panicked mother left her 2-month-old with a relative and took the boy to the hospital. Intensive medication and intravenous fluids stopped the boy's convulsions and cured his dehydration, said Dr. Mohan Kumar, a member of the team.
"I thought the child was O.K.," Dr. Kumar said [but] the 3 year old died that afternoon. His brother was moved to Sri Krishna Medical College Hospital, the region's best hospital, but one so overrun that its hallways are lined with sleeping patients, and its power blinks out almost hourly. Four days later, the father was still sitting beside the 5 year old's limp body, holding his hand.
But something the boys did, ate, drank, breathed in or encountered led to the 3 year old's death and the 5 year old's coma.
Investigators have collected samples of blood, urine and spinal fluid from each of this year's [2013] sick children -- there were 133, 59 of whom died -- and they asked their parents more than 150 questions about the children's food, water, sleeping arrangements and villages.
Since cases tend to be isolated, the illness probably does not spread in the traditional person-to-person way, like the flu or tuberculosis. So the researchers are looking not only for the cause (virus, bacteria or toxin), but also for a carrier (rats, livestock or bats) and perhaps even for a vehicle (sand flies, drink or fruit). The investigation is like a highly complex puzzle in which every piece must be solved.
A day in the field with Dr. Pandey revealed the magnitude of the task. It took him to a tiny cluster of brick-and-bamboo huts that made up the village of Chotta Sindhwari and the home of a 10-year-old boy hospitalized 2 weeks earlier with brain swelling. Dr. Pandey asked to see where he slept. His parents showed him a small room in a brick building with a mud floor, a bamboo roof and a wooden sleeping platform. Flies buzzed around; a young goat wandered in. Sacks of corn and rice, a magnet for rats, were piled near the bed. There was little ventilation, which could create excess heat. Mango, banana, palm and litchi trees were nearby. Dr. Pandey took notes on it all.
[In the building,] 5 siblings slept on the platform, and there was mosquito netting above it. But the boy's mother said she sometimes found him sleeping on the mud floor outside the netting.
Water came from a nearby pump. There was standing water with mosquito larvae, which Dr. Pandey collected in a small plastic bottle. They will be grown later for identification.
"This well is probably shallow, and they drink from it directly," Dr. Pandey said, making it a possible source of fecal contamination. Some have guessed that the disease is an intestinal virus carried in contaminated water. But patients with such infections usually have enlarged spleens, something not seen in the affected children, Dr. Pandey said.
He asked about the village's use of pesticides. (A separate team of environmental experts will soon test villages for pesticide and toxin residues.) He visited its grove of litchi trees. One theory is that infected bats contaminate the fruit, which ripen in May and June.
As if on cue, a cheerful old man walked through the grove carrying a clay pot of palm sap, which becomes mildly alcoholic in the summer heat. The pot was filled with a milky brew, dead insects and perhaps some bat feces and urine. Maybe children find a way to drink it, Dr. Pandey speculated, or their parents, inured to its effects, drink it and somehow pass along an infection.
Then Dr. Pandey walked down the village's dirt road to find a random child of the 10 year old's age and perform the same survey. He was pursued by a pack of curious children, one of whom eventually stepped forward like an army recruit -- chest out, head up -- to answer the doctor's questions.
The village visit took 5 hours, and the study will need about 360 subjects. The epidemiologists say they have been working 14-hour days.
"I'm here until we finish," Dr. Pandey said.
[Byline: Gardiner Harris]
--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The reports of encephalitis (usually termed acute encephalitis syndrome (AES) in India) continue to be confusing. The above report seems to rule out Japanese encephalitis virus (JEV) infections on seasonal grounds, yet other reports in this and previous years of AES in northeastern India have been attributed in part or entirely to JEV infections. However, in some instances, JEV infections are reported to be responsible for a minority of the cases. A 1 Apr 2013 ProMED-mail report (archive no. 20130402.1615081) indicated that encephalitis cases had already been reported from Andhra Pradesh, Assam, Uttar Pradesh, and West Bengal in India this year (2013), totaling 228 cases and 49 fatalities up to 19 Mar 2013. Of those cases, 7, all from West Bengal, were classified as JEV infections. An additional report on 11 May 2013 (archive no. 20130628.1798059) stated that there were 24 cases of JEV encephalitis in Assam state this year [2013], along with 53 deaths due to encephalitis and 362 other cases of AES.
It seems curious that cases in Uttar Pradesh state have not been mentioned in the current report, as that has been a locality of a large number of reported JEV and AES cases in the past. There is no indication in these or previous reports this year (2013) whether individuals, especially the children, have been vaccinated recently against JEV infection. The arrival of the USA CDC team is good news indeed. With a vigorous field epidemiological study and the strong laboratory support of the CDC, one hopes that the etiology of these undefined AES cases can be resolved definitively.
ProMED thanks Kunihiko Iizuka for sending in these and other related reports.
Maps of India and Bihar state can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/77fN. - Mod.TY]
*****************************************************
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http://www.promedmail.org
ProMED-mail is a program of the
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Date: Sat 13 Jul 2013
Source: New York Times [edited]
http://www.nytimes.com/2013/07/14/world ... =true&_r=0
The children begin arriving every year in mid-May, brought to an overburdened hospital here in one of India's most impoverished areas by their panic-stricken mothers. Seemingly healthy hours earlier, most have lapsed into a coma punctuated by convulsions.
Doctors work to calm the convulsions and keep the children hydrated, but then have to watch helplessly along with the anguished parents as a 3rd of their young patients die, often within hours. Then, as suddenly as it started, the mysterious outbreak stops with the onset of the monsoon rains this month [July 2013]. No one knows why.
The mud-and-bamboo huts in this part of India cradle more dying children than anywhere in the world, with diarrhea and malnutrition long ranking as the region's great scourges. But now, this unknown killer is stalking the very young.
Although public health statistics are unreliable here, the disease is believed to infect tens of thousands of people a year and kill thousands.
All doctors know is that the illness is a form of brain swelling, or encephalitis, but that is a huge category, covering a wide spectrum of diseases. Doctors have tested for known causes of brain swelling, including meningitis and Japanese encephalitis, but the tests almost always come back negative. India's top health officials say the disease, known officially as acute encephalitis syndrome, has them stumped.
"This outbreak happens every year, and we have not been able to identify the cause or link even a single factor responsible," Dr. L. S. Chauhan, the director of the National Center for Disease Control in India, said in an interview.
Dr. Chauhan hopes to change that. With help from the Centers for Disease Control and Prevention in Atlanta, he started a program this year [2013] to train an elite cadre of disease sleuths, part of a recently organized Epidemic Intelligence Service in India, that he hopes will eventually undertake the investigations of India's estimated 1500 epidemics.
But the outbreak in Muzaffarpur is slowly spreading to neighboring areas, and Dr. Chauhan has thrown everything he can at it, assigning all 7 of his trainees, each already an accomplished physician. Experts from the C.D.C. are advising them, and their work is being closely followed by concerned officials in the United States.
The 1st reports of this mysterious illness date to 1995, when nearly 1000 children were sickened and 300 died in Muzaffarpur's 3 hospitals. Smaller epidemics have followed almost every year since.
Officials say they do not know whether the illness began in 1995 or had simply gone unnoticed before. Not only has it spread to nearby areas, but researchers have also recently found similar cases in neighboring Nepal. Some outbreaks in India have gone unreported because officials suppressed any mention for fear of prompting panic or criticism.
"India has a huge problem with encephalitis," said Dr. Rajesh Pandey, one of the epidemiologists camped out in Muzaffarpur, "and it's not something almost anyone knows about."
The illness is often confused with Japanese encephalitis [virus infection], which generally arrives just after the start of the monsoons and peaks in the fall, as it is spread by mosquitoes that breed in standing water. But this affliction starts a couple of months earlier and ends with the monsoon.
"This is a real mystery," Dr. Thomas R. Frieden, the CDC director, said in a telephone interview. "We're not sure we'll be able to solve it, but at least we can unleash the best epidemiological tools we have to try to answer the question."
Dr. Chauhan's team has been given a rustic guesthouse next to a hospital here. There is no air-conditioning; the beds sag, and the electricity is fitful. But there is an urgency to the doctors' work. They gather almost every night in a small dining room to update crude posters with information about each case and debate their theories. A new virus, an old bacteria, litchis, alcoholic tree sap, heat, pesticides, rats, bats and sand flies are among the suspected causes.
In the nearby hospital, parents say in hushed tones that a ghost must be angry. Some paint black spots on siblings' foreheads to ward off the evil eye.
Given the suddenness with which the illness strikes, their superstition is understandable. At 11:30 p.m. on 10 Jun 2013, a 3-year-old boy was sleeping beside his mother and 2 brothers in their hut in the village of Ganti Vishanpur when he let out a scream and went into convulsions. The boy's father took him to a hospital. Several hours later, the boy's brother, age 5, screamed louder, convulsed and went limp. His panicked mother left her 2-month-old with a relative and took the boy to the hospital. Intensive medication and intravenous fluids stopped the boy's convulsions and cured his dehydration, said Dr. Mohan Kumar, a member of the team.
"I thought the child was O.K.," Dr. Kumar said [but] the 3 year old died that afternoon. His brother was moved to Sri Krishna Medical College Hospital, the region's best hospital, but one so overrun that its hallways are lined with sleeping patients, and its power blinks out almost hourly. Four days later, the father was still sitting beside the 5 year old's limp body, holding his hand.
But something the boys did, ate, drank, breathed in or encountered led to the 3 year old's death and the 5 year old's coma.
Investigators have collected samples of blood, urine and spinal fluid from each of this year's [2013] sick children -- there were 133, 59 of whom died -- and they asked their parents more than 150 questions about the children's food, water, sleeping arrangements and villages.
Since cases tend to be isolated, the illness probably does not spread in the traditional person-to-person way, like the flu or tuberculosis. So the researchers are looking not only for the cause (virus, bacteria or toxin), but also for a carrier (rats, livestock or bats) and perhaps even for a vehicle (sand flies, drink or fruit). The investigation is like a highly complex puzzle in which every piece must be solved.
A day in the field with Dr. Pandey revealed the magnitude of the task. It took him to a tiny cluster of brick-and-bamboo huts that made up the village of Chotta Sindhwari and the home of a 10-year-old boy hospitalized 2 weeks earlier with brain swelling. Dr. Pandey asked to see where he slept. His parents showed him a small room in a brick building with a mud floor, a bamboo roof and a wooden sleeping platform. Flies buzzed around; a young goat wandered in. Sacks of corn and rice, a magnet for rats, were piled near the bed. There was little ventilation, which could create excess heat. Mango, banana, palm and litchi trees were nearby. Dr. Pandey took notes on it all.
[In the building,] 5 siblings slept on the platform, and there was mosquito netting above it. But the boy's mother said she sometimes found him sleeping on the mud floor outside the netting.
Water came from a nearby pump. There was standing water with mosquito larvae, which Dr. Pandey collected in a small plastic bottle. They will be grown later for identification.
"This well is probably shallow, and they drink from it directly," Dr. Pandey said, making it a possible source of fecal contamination. Some have guessed that the disease is an intestinal virus carried in contaminated water. But patients with such infections usually have enlarged spleens, something not seen in the affected children, Dr. Pandey said.
He asked about the village's use of pesticides. (A separate team of environmental experts will soon test villages for pesticide and toxin residues.) He visited its grove of litchi trees. One theory is that infected bats contaminate the fruit, which ripen in May and June.
As if on cue, a cheerful old man walked through the grove carrying a clay pot of palm sap, which becomes mildly alcoholic in the summer heat. The pot was filled with a milky brew, dead insects and perhaps some bat feces and urine. Maybe children find a way to drink it, Dr. Pandey speculated, or their parents, inured to its effects, drink it and somehow pass along an infection.
Then Dr. Pandey walked down the village's dirt road to find a random child of the 10 year old's age and perform the same survey. He was pursued by a pack of curious children, one of whom eventually stepped forward like an army recruit -- chest out, head up -- to answer the doctor's questions.
The village visit took 5 hours, and the study will need about 360 subjects. The epidemiologists say they have been working 14-hour days.
"I'm here until we finish," Dr. Pandey said.
[Byline: Gardiner Harris]
--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The reports of encephalitis (usually termed acute encephalitis syndrome (AES) in India) continue to be confusing. The above report seems to rule out Japanese encephalitis virus (JEV) infections on seasonal grounds, yet other reports in this and previous years of AES in northeastern India have been attributed in part or entirely to JEV infections. However, in some instances, JEV infections are reported to be responsible for a minority of the cases. A 1 Apr 2013 ProMED-mail report (archive no. 20130402.1615081) indicated that encephalitis cases had already been reported from Andhra Pradesh, Assam, Uttar Pradesh, and West Bengal in India this year (2013), totaling 228 cases and 49 fatalities up to 19 Mar 2013. Of those cases, 7, all from West Bengal, were classified as JEV infections. An additional report on 11 May 2013 (archive no. 20130628.1798059) stated that there were 24 cases of JEV encephalitis in Assam state this year [2013], along with 53 deaths due to encephalitis and 362 other cases of AES.
It seems curious that cases in Uttar Pradesh state have not been mentioned in the current report, as that has been a locality of a large number of reported JEV and AES cases in the past. There is no indication in these or previous reports this year (2013) whether individuals, especially the children, have been vaccinated recently against JEV infection. The arrival of the USA CDC team is good news indeed. With a vigorous field epidemiological study and the strong laboratory support of the CDC, one hopes that the etiology of these undefined AES cases can be resolved definitively.
ProMED thanks Kunihiko Iizuka for sending in these and other related reports.
Maps of India and Bihar state can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/77fN. - Mod.TY]
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Birgitt
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- Beiträge: 35259
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Denguefieber in Indien und Pakistan
DENGUE/DHF UPDATE (58): ASIA
**************************************************
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*****
India (Bangalore, Karnataka state). 9 Jul 2013. Dengue (susp.) total number of cases not stated; deaths (susp.) in one hospital 5.
http://www.deccanherald.com/content/343 ... alore.html
[Report submitted by Dr Javeed Ahmed, <drjaveedahmed@yahoo.com>; received with thanks.]
[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]
Pakistan (Sindh province). 14 Jul 2013. Dengue 432 cases; increasing.
http://www.pakistantoday.com.pk/2013/07 ... confirmed/
[Maps of Pakistan can be accessed at
http://www.ezilon.com/maps/images/asia/ ... kistan.gif
and http://healthmap.org/r/2NT8. - Mod.TY]
**************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
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http://www.isid.org
*****
India (Bangalore, Karnataka state). 9 Jul 2013. Dengue (susp.) total number of cases not stated; deaths (susp.) in one hospital 5.
http://www.deccanherald.com/content/343 ... alore.html
[Report submitted by Dr Javeed Ahmed, <drjaveedahmed@yahoo.com>; received with thanks.]
[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]
Pakistan (Sindh province). 14 Jul 2013. Dengue 432 cases; increasing.
http://www.pakistantoday.com.pk/2013/07 ... confirmed/
[Maps of Pakistan can be accessed at
http://www.ezilon.com/maps/images/asia/ ... kistan.gif
and http://healthmap.org/r/2NT8. - Mod.TY]
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Birgitt
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- Beiträge: 35259
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- Kontaktdaten:
Cholera in Indien
CHOLERA, DIARRHEA AND DYSENTERY UPDATE (26): ASIA
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Cholera - India (Maharashtra)
Date: Wed 10 Jul 2013
Source: Mumbai Mirror [edited]
http://www.mumbaimirror.com/mumbai/othe ... 998393.cms
Eight Mumbaikars have tested positive for cholera in just 8 days this month [July 2013], raising concerns of the civic authorities who have asked citizens to take precautions, though they maintain there is no need to panic.
While not entirely uncommon during monsoon, the surge in cholera cases has worried civic officials, given the fact that only 12 people had tested positive in the entire month of June 2013.
"We are slightly concerned about the cholera cases this month [July 2013]," said Additional Municipal Commissioner Manisha Mhaiskar, who has urged Mumbaikars to take preventive measures by boiling water before drinking and avoiding roadside food.
According to Mhaiskar, 3 of the positive cases diagnosed this month [July 2013] are from B ward, which includes the areas of Dongri, Pydhonie, Yellow Gate, etc. Two cases are from E ward, which comprises Byculla, Agripada, Sewree and Kalachowkie areas, while the remaining 3 are isolated cases in other parts of the city.
The BMC's health workers, she said, have already begun the process of screening people with symptoms from across the city. Meanwhile, experts have cautioned people suffering from gastroenteritis, as they are more prone to cholera. This month [July 2013], the city has already recorded 686 cases of gastroenteritis.
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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2GIs.]
*********************************************************
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******
Cholera - India (Maharashtra)
Date: Wed 10 Jul 2013
Source: Mumbai Mirror [edited]
http://www.mumbaimirror.com/mumbai/othe ... 998393.cms
Eight Mumbaikars have tested positive for cholera in just 8 days this month [July 2013], raising concerns of the civic authorities who have asked citizens to take precautions, though they maintain there is no need to panic.
While not entirely uncommon during monsoon, the surge in cholera cases has worried civic officials, given the fact that only 12 people had tested positive in the entire month of June 2013.
"We are slightly concerned about the cholera cases this month [July 2013]," said Additional Municipal Commissioner Manisha Mhaiskar, who has urged Mumbaikars to take preventive measures by boiling water before drinking and avoiding roadside food.
According to Mhaiskar, 3 of the positive cases diagnosed this month [July 2013] are from B ward, which includes the areas of Dongri, Pydhonie, Yellow Gate, etc. Two cases are from E ward, which comprises Byculla, Agripada, Sewree and Kalachowkie areas, while the remaining 3 are isolated cases in other parts of the city.
The BMC's health workers, she said, have already begun the process of screening people with symptoms from across the city. Meanwhile, experts have cautioned people suffering from gastroenteritis, as they are more prone to cholera. This month [July 2013], the city has already recorded 686 cases of gastroenteritis.
--
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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2GIs.]
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Lepra in Indien
LEPROSY - INDIA: (UTTAR PRADESH)
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Date: Tue 9 Jul 2013
Source: Times of India [edited]
http://articles.timesofindia.indiatimes ... r-colonies
Although the government considers leprosy to be almost eradicated as its prevalence rate has reached less than one for the past few years, the district leprosy office fears that stopping the active search of leprosy patients is increasing leprosy cases in the district.
According to district leprosy officer (DLO) Rahul Singh, as many as 35 fresh cases of leprosy were detected from the district in June [2013]. In normal trends, some 15 to 25 cases are detected every month. The 3 indicators of leprosy that are multibacillary [MB], MB percentage, disability and child leprosy cases have also increased over time.
"More than 50 percent of all leprosy cases in Varanasi are MB cases, while ideally its figure should be less than 40 percent. The disability in new leprosy patients is around 9 percent in the city in place of 3 percent. The new cases with deformity or disability is also increasing, the pressure on the leper colonies as most of these patients are ostracized. Government has no scheme or planning to rehabilitate such people. The leper colonies are mostly looked after by non-profit organisations. Alarmingly, 15 percent of cases are of children while the children leprosy cases should not be more than 7 percent of the total cases," Singh said.
According to records, as many as 35 new cases were detected out of which 18 were paucibacillary (PB) while 17 cases were MB; 6 of these patients were found with deformity, while 5 out of 35 were children.
"The active search for leprosy patients had been stopped since 2005 when the prevalence rate reached less than one. However the indicators that determine the prevalence rate are increasing in the region. In active search, our staff reaches out to patients. They make efforts [to ensure] that healthy people coming in contact with leprosy patient are not infected. But since the government has stopped active detection, it is the patients who are approaching us. However, the alarming figures point to the fact that there is need of active detection again," he said.
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[Leprosy is a chronic disease caused by a bacillus, _Mycobacterium leprae_ (http://www.who.int/mediacentre/factsheets/fs101/en/). _M. leprae_ multiplies very slowly and the incubation period of the disease is about 5 years, but symptoms can take as long as 20 years to appear. Although leprosy is not highly contagious, because patients with the lepromatous form of leprosy excrete enormous numbers of leprosy bacilli in their nasal secretions (that is, are multibacillary), a patient with untreated lepromatous leprosy poses increased risk for transmission of the infection to close, long-term contacts, such as household members. As the organism is also present in skin lesions in these patients, skin contact is thought to be another mode of spread. Because the organisms that are shed by lepromatous patients can persist on surfaces in the environment, fomites are also a potential source of infection. Casual and short-term contact does not seem to pose a risk for spread the disease.
In the absence of a significant insect vector or non-human reservoir, antimicrobial therapy of the infectious human reservoir is an effective strategy to control transmission. Leprosy is treated with dapsone, rifampin, and clofazimine. These drugs are provided by WHO free to all patients in the world since 1995; see http://www.novartis.com/corporate-respo ... rosy.shtml. Patients are no longer infectious after the 1st dose of the treatment regimen. Patients with paucibacillary leprosy treated with rifampin and dapsone are cured within 6 months and multibacillary patients treated with rifampin, dapsone, and clofazimine are cured within 12 months.
India, Brazil, and Indonesia are the 3 countries that have the greatest number of leprosy cases. The WHO South East Asia Region (SEAR) that includes India contributed about 69 per cent of 2005 new cases detected globally (http://health.groups.yahoo.com/group/so ... ssage/5378). SEAR achieved what WHO refers to as "the elimination of leprosy as a public health problem" (that is, a prevalence of less than one case per 10 000 population) in December 2005 (http://209.61.208.233/en/Section10/Section20_16172.htm). With a population of about 1.1 billion people, there were 83,000 patients registered with leprosy in India in 2011 (http://209.61.208.233/en/Section10/Section20_16172.htm). Between 1985 and 2005, more than 15 million leprosy cases were cured globally. Of these, about 12.8 million were from the SEA Region, of which India accounted for about 11.8 million (http://apps.searo.who.int/pds_docs/B0343.pdf).
The "new" cases of leprosy with deformity or disability in the news report above are likely cases that were missed in prior efforts at case finding in Varanasi. The high proportion of cases with lepromatous leprosy is an indication of the number of contagious cases in the community and leprosy among children is an indication of ongoing disease transmission.
Varanasi, also known as Benares, is a city in northeastern India with a population (2012) of about 3.7 million on the banks of the Ganges in Uttar Pradesh state, 320 km (200 miles) southeast of the state capital, Lucknow and 797 km (495 miles) southeast of New Delhi. For a map of India showing the location of Varanasi, see https://upload.wikimedia.org/wikipedia/ ... ocator.png. - Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1-k3.]
********************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Tue 9 Jul 2013
Source: Times of India [edited]
http://articles.timesofindia.indiatimes ... r-colonies
Although the government considers leprosy to be almost eradicated as its prevalence rate has reached less than one for the past few years, the district leprosy office fears that stopping the active search of leprosy patients is increasing leprosy cases in the district.
According to district leprosy officer (DLO) Rahul Singh, as many as 35 fresh cases of leprosy were detected from the district in June [2013]. In normal trends, some 15 to 25 cases are detected every month. The 3 indicators of leprosy that are multibacillary [MB], MB percentage, disability and child leprosy cases have also increased over time.
"More than 50 percent of all leprosy cases in Varanasi are MB cases, while ideally its figure should be less than 40 percent. The disability in new leprosy patients is around 9 percent in the city in place of 3 percent. The new cases with deformity or disability is also increasing, the pressure on the leper colonies as most of these patients are ostracized. Government has no scheme or planning to rehabilitate such people. The leper colonies are mostly looked after by non-profit organisations. Alarmingly, 15 percent of cases are of children while the children leprosy cases should not be more than 7 percent of the total cases," Singh said.
According to records, as many as 35 new cases were detected out of which 18 were paucibacillary (PB) while 17 cases were MB; 6 of these patients were found with deformity, while 5 out of 35 were children.
"The active search for leprosy patients had been stopped since 2005 when the prevalence rate reached less than one. However the indicators that determine the prevalence rate are increasing in the region. In active search, our staff reaches out to patients. They make efforts [to ensure] that healthy people coming in contact with leprosy patient are not infected. But since the government has stopped active detection, it is the patients who are approaching us. However, the alarming figures point to the fact that there is need of active detection again," he said.
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[Leprosy is a chronic disease caused by a bacillus, _Mycobacterium leprae_ (http://www.who.int/mediacentre/factsheets/fs101/en/). _M. leprae_ multiplies very slowly and the incubation period of the disease is about 5 years, but symptoms can take as long as 20 years to appear. Although leprosy is not highly contagious, because patients with the lepromatous form of leprosy excrete enormous numbers of leprosy bacilli in their nasal secretions (that is, are multibacillary), a patient with untreated lepromatous leprosy poses increased risk for transmission of the infection to close, long-term contacts, such as household members. As the organism is also present in skin lesions in these patients, skin contact is thought to be another mode of spread. Because the organisms that are shed by lepromatous patients can persist on surfaces in the environment, fomites are also a potential source of infection. Casual and short-term contact does not seem to pose a risk for spread the disease.
In the absence of a significant insect vector or non-human reservoir, antimicrobial therapy of the infectious human reservoir is an effective strategy to control transmission. Leprosy is treated with dapsone, rifampin, and clofazimine. These drugs are provided by WHO free to all patients in the world since 1995; see http://www.novartis.com/corporate-respo ... rosy.shtml. Patients are no longer infectious after the 1st dose of the treatment regimen. Patients with paucibacillary leprosy treated with rifampin and dapsone are cured within 6 months and multibacillary patients treated with rifampin, dapsone, and clofazimine are cured within 12 months.
India, Brazil, and Indonesia are the 3 countries that have the greatest number of leprosy cases. The WHO South East Asia Region (SEAR) that includes India contributed about 69 per cent of 2005 new cases detected globally (http://health.groups.yahoo.com/group/so ... ssage/5378). SEAR achieved what WHO refers to as "the elimination of leprosy as a public health problem" (that is, a prevalence of less than one case per 10 000 population) in December 2005 (http://209.61.208.233/en/Section10/Section20_16172.htm). With a population of about 1.1 billion people, there were 83,000 patients registered with leprosy in India in 2011 (http://209.61.208.233/en/Section10/Section20_16172.htm). Between 1985 and 2005, more than 15 million leprosy cases were cured globally. Of these, about 12.8 million were from the SEA Region, of which India accounted for about 11.8 million (http://apps.searo.who.int/pds_docs/B0343.pdf).
The "new" cases of leprosy with deformity or disability in the news report above are likely cases that were missed in prior efforts at case finding in Varanasi. The high proportion of cases with lepromatous leprosy is an indication of the number of contagious cases in the community and leprosy among children is an indication of ongoing disease transmission.
Varanasi, also known as Benares, is a city in northeastern India with a population (2012) of about 3.7 million on the banks of the Ganges in Uttar Pradesh state, 320 km (200 miles) southeast of the state capital, Lucknow and 797 km (495 miles) southeast of New Delhi. For a map of India showing the location of Varanasi, see https://upload.wikimedia.org/wikipedia/ ... ocator.png. - Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1-k3.]
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Cholera und Diarrhoe in Pakistan, Indien und Nepal
CHOLERA, DIARRHEA AND DYSENTERY UPDATE (27): ASIA
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[1] Cholera - Pakistan (Balochistan Province)
Date: Tue 16 Jul 2013
Source: Dawn [edited]
http://dawn.com/news/1029567/cholera-claims-five-lives
At least 5 people, 2 of them children, have recently died of cholera, and over 20 people are suffering from it in Panjpai tehsil of Quetta district [Balochistan Province] near the Afghan border.
The deaths have occurred in Pashtoon Kot area, some 70 km [about 43 miles] from here, in the absence of any emergency medical aid, according to sources. The condition of 20 people suffering from the disease is said to be critical.
A local tribal elder expressed the fear that outbreak of cholera might cause loss of life at large scale. "The doctor and paramedics deployed at the basic health centre in Panjpai live in Quetta and are rarely seen at the centre," he complained.
Officials of the provincial health department are unaware about the outbreak of cholera and loss of lives in Panjpai, as they have sent no medical teams to the affected area.
Last year [2012], outbreak of the disease had killed hundreds of people, mostly children, in flood-hit districts of Nasirabad, Jaffarabad and Jhal Magsi where waterborne diseases were reported at a large scale because of consumption of contaminated water by local people.
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[2] Cholera - India (Mumbai, Maharashtra State)
Date: Wed 17 Jul 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 113575.cms
Waterborne diseases continue to ail Mumbaikars as 8 more cholera cases have been detected in the past 7 days. Gastroenteritis, too, has seen an overwhelming rise at more than 1300 cases in the 1st 15 days of July [2013].
Lately, several patients suffering from acute gastroenteritis have suffered renal failure, requiring dialysis.
Manisha Mhaiskar, BMC's [Brihanmumbai Municipal Corporation] additional municipal commissioner, said, "There has been a visible increase in cases of cholera and gastroenteritis. We have 16 cases of cholera in all. The fresh cases are from the same areas where the previous ones were reported." Mhaiskar added that volunteers have been collecting water samples.
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[3] Diarrhea - Nepal (Kathmandu, Central Region)
Date: Tue 16 Jul 2013
Source: Republica [edited]
http://www.myrepublica.com/portal/index ... s_id=57921
Sukraraj Tropical and Infectious Disease Hospital (STIDH) said that the hospital has crossed its occupancy limit with all beds packed with the patients suffering from diarrhea, snake bites, viral fever, typhoid and other diseases.
Doctors at the hospital say that the rise in the number of patients suffering from different communicable diseases is caused by monsoon and the rising temperature. "The beds at our hospital are mostly occupied. Every day over 20 diarrheal patients visit the hospital," Dr Rajesh Shah of the hospital said. He said that the diarrheal patients tend to visit hospitals only when they become serious. In normal stage, they consume medicines and oral rehydration at home.
According to Dr Shah, poor people are more vulnerable to communicable disease. "Most of the patients admitted in our hospital are from the poor background, who cannot afford hygienic food and water," he added. Such people usually do not have access to proper sanitation and are more likely to eat at cheap hotels that serve unhygienic foods.
With the rise in diarrheal patients, the hospital has been operating separate gastro ward. Diarrheal disease and the viral fever result from adulterated food and water.
Likewise, cases of snake bites have been soaring in recent days. On Monday [15 Jul 2013] alone, 23 snake bite patients have been admitted at the hospital. "On an average, over 15 snake bite victims visit the hospital every day," Shankar Pandey, a senior auxiliary health worker at the hospital, said. Pandey said that mostly people who work in the fields become victims of snake bites.
He asked the people to be conscious about the snakes while working in the fields. He also asked people not to be careless about what they are consuming.
Meanwhile, administration of the Kanti Children Hospital said that children suffering from viral fever and diarrhea have been thronging the hospital.
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[1] Cholera - Pakistan (Balochistan Province)
Date: Tue 16 Jul 2013
Source: Dawn [edited]
http://dawn.com/news/1029567/cholera-claims-five-lives
At least 5 people, 2 of them children, have recently died of cholera, and over 20 people are suffering from it in Panjpai tehsil of Quetta district [Balochistan Province] near the Afghan border.
The deaths have occurred in Pashtoon Kot area, some 70 km [about 43 miles] from here, in the absence of any emergency medical aid, according to sources. The condition of 20 people suffering from the disease is said to be critical.
A local tribal elder expressed the fear that outbreak of cholera might cause loss of life at large scale. "The doctor and paramedics deployed at the basic health centre in Panjpai live in Quetta and are rarely seen at the centre," he complained.
Officials of the provincial health department are unaware about the outbreak of cholera and loss of lives in Panjpai, as they have sent no medical teams to the affected area.
Last year [2012], outbreak of the disease had killed hundreds of people, mostly children, in flood-hit districts of Nasirabad, Jaffarabad and Jhal Magsi where waterborne diseases were reported at a large scale because of consumption of contaminated water by local people.
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******
[2] Cholera - India (Mumbai, Maharashtra State)
Date: Wed 17 Jul 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 113575.cms
Waterborne diseases continue to ail Mumbaikars as 8 more cholera cases have been detected in the past 7 days. Gastroenteritis, too, has seen an overwhelming rise at more than 1300 cases in the 1st 15 days of July [2013].
Lately, several patients suffering from acute gastroenteritis have suffered renal failure, requiring dialysis.
Manisha Mhaiskar, BMC's [Brihanmumbai Municipal Corporation] additional municipal commissioner, said, "There has been a visible increase in cases of cholera and gastroenteritis. We have 16 cases of cholera in all. The fresh cases are from the same areas where the previous ones were reported." Mhaiskar added that volunteers have been collecting water samples.
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******
[3] Diarrhea - Nepal (Kathmandu, Central Region)
Date: Tue 16 Jul 2013
Source: Republica [edited]
http://www.myrepublica.com/portal/index ... s_id=57921
Sukraraj Tropical and Infectious Disease Hospital (STIDH) said that the hospital has crossed its occupancy limit with all beds packed with the patients suffering from diarrhea, snake bites, viral fever, typhoid and other diseases.
Doctors at the hospital say that the rise in the number of patients suffering from different communicable diseases is caused by monsoon and the rising temperature. "The beds at our hospital are mostly occupied. Every day over 20 diarrheal patients visit the hospital," Dr Rajesh Shah of the hospital said. He said that the diarrheal patients tend to visit hospitals only when they become serious. In normal stage, they consume medicines and oral rehydration at home.
According to Dr Shah, poor people are more vulnerable to communicable disease. "Most of the patients admitted in our hospital are from the poor background, who cannot afford hygienic food and water," he added. Such people usually do not have access to proper sanitation and are more likely to eat at cheap hotels that serve unhygienic foods.
With the rise in diarrheal patients, the hospital has been operating separate gastro ward. Diarrheal disease and the viral fever result from adulterated food and water.
Likewise, cases of snake bites have been soaring in recent days. On Monday [15 Jul 2013] alone, 23 snake bite patients have been admitted at the hospital. "On an average, over 15 snake bite victims visit the hospital every day," Shankar Pandey, a senior auxiliary health worker at the hospital, said. Pandey said that mostly people who work in the fields become victims of snake bites.
He asked the people to be conscious about the snakes while working in the fields. He also asked people not to be careless about what they are consuming.
Meanwhile, administration of the Kanti Children Hospital said that children suffering from viral fever and diarrhea have been thronging the hospital.
--
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[A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/2Pf_.]
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Japanische Enzephalities in Indien
JAPANESE ENCEPHALITIS & OTHER - INDIA (11): (ASSAM)
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Date: Mon 22 Jul 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 231860.cms
The district health department has stepped up surveillance after some cases of Japanese encephalitis (JE) were reported in Kokrajhar [Assam state].
The health department kicked off an awareness campaign to prevent the spread of the disease.
An 11 year old girl is the latest victim of JE. The district health surveillance officer, Amal Mushahary, said the girl is undergoing treatment at a private hospital in Guwahati and that her condition is improving. He said another case has been reported from the Gossaigaon area of the district. In June [2013], 2 people were diagnosed with JE [virus infections].
Mushahary said the infectious disease has been on the rise in the district over the years and villagers should urgently take steps to arrest its spread. Last year [2012], 13 people were diagnosed with acute encephalitis syndrome (AES). Of the 13 cases, 7 were found to be JE positive, he added; "3 persons died last year [2012], while others could not be traced due to inappropriate addresses of the patients," he said.
In 2011, 25 AES cases were reported in the district, of which 7 were diagnosed with JE [virus infections]; 4 succumbed to the disease.
"People should be most careful during June and July as these are months when spread of the disease is high," Mushahary said.
He urged the administration to take steps to control [transmission] of the disease in the district. "If no adequate steps are taken immediately, the disease will increase further as pigs, which are the amplifying hosts of the disease, are reared in most of the tribal households," he said.
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[The etiologies of all the current cases above are given as Japanese encephalitis virus (JEV) infections. In previous years in Assam the etiologies of the encephalitis cases have not been clearly indicated. Some have been reported as JEV infections, others as AES. However, the total number of AES cases and deaths exceeds that reported for JEV infections. As in the situation in Bihar and Uttar Pradesh states, the etiologies of the AES cases are not given and apparently have not been determined.
A HealthMap/ProMED-mail interactive map showing the location of Assam state can be accessed at http://healthmap.org/r/00J-. - Mod.TY]
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Date: Mon 22 Jul 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 231860.cms
The district health department has stepped up surveillance after some cases of Japanese encephalitis (JE) were reported in Kokrajhar [Assam state].
The health department kicked off an awareness campaign to prevent the spread of the disease.
An 11 year old girl is the latest victim of JE. The district health surveillance officer, Amal Mushahary, said the girl is undergoing treatment at a private hospital in Guwahati and that her condition is improving. He said another case has been reported from the Gossaigaon area of the district. In June [2013], 2 people were diagnosed with JE [virus infections].
Mushahary said the infectious disease has been on the rise in the district over the years and villagers should urgently take steps to arrest its spread. Last year [2012], 13 people were diagnosed with acute encephalitis syndrome (AES). Of the 13 cases, 7 were found to be JE positive, he added; "3 persons died last year [2012], while others could not be traced due to inappropriate addresses of the patients," he said.
In 2011, 25 AES cases were reported in the district, of which 7 were diagnosed with JE [virus infections]; 4 succumbed to the disease.
"People should be most careful during June and July as these are months when spread of the disease is high," Mushahary said.
He urged the administration to take steps to control [transmission] of the disease in the district. "If no adequate steps are taken immediately, the disease will increase further as pigs, which are the amplifying hosts of the disease, are reared in most of the tribal households," he said.
--
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[The etiologies of all the current cases above are given as Japanese encephalitis virus (JEV) infections. In previous years in Assam the etiologies of the encephalitis cases have not been clearly indicated. Some have been reported as JEV infections, others as AES. However, the total number of AES cases and deaths exceeds that reported for JEV infections. As in the situation in Bihar and Uttar Pradesh states, the etiologies of the AES cases are not given and apparently have not been determined.
A HealthMap/ProMED-mail interactive map showing the location of Assam state can be accessed at http://healthmap.org/r/00J-. - Mod.TY]
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Hepatitis C in Indien
HEPATITIS C - INDIA (02): (PUNJAB) VILLAGE OUTBREAK
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Date: Mon 22 Jul 2013
Source: Hindustani Times [edited]
http://www.hindustantimes.com/Punjab/Pa ... 96556.aspx
Fear and anguish prevails at Kalala village [Barnala district, Punjab state] as the majority of the inhabitants have tested positive for hepatitis C virus (HCV) infection. The village has a population of 2358 living in 428 houses. The health department has taken 41 samples, 28 of which have been found positive.
In December 2012, in a medical camp, 370 people out of 870 were found to be hepatitis C positive. Going by that ratio, the actual number of infected people might be in the range of 800 to 1000. HCV has taken the lives of 25 people of the village. The village has no clinical laboratory or government dispensary. Health facilities are virtually non-existent in the village. Most of the newly elected panchayat [village council] members are victims of the dreaded disease.
Recently a blood donation camp was organised in the village by Dayanand Medical College and Hospital, Ludhiana; 90 units were donated by villagers. Of these, 28 units were found to be HCV positive. A 24 year old villager said he had lost his grandfather, father, and uncle to HCV. Now he, his sister, and cousin are infected. The treatment cost is over INR 200 000 (about USD 3400), so few can afford treatment.
HCV was identified in 1989. The World Health Organization (WHO) compares HCV to a "viral time bomb". HCV is responsible for 50-76 per cent of all liver cancer cases worldwide. In 2010, 98 hepatitis C cases were reported from Kalala, Chananwal, Chinniwal, and Sehjra villages. Recently, 13 cases have been reported from Kube village. These villages are in close proximity. The villagers still say unhygienic water is responsible for the epidemic. Health authorities have not made villagers aware not to use contaminated and unsterilised needles, the main source of HCV.
Civil surgeon Dr Renu passed the buck on to unregistered RMPs [rural medical practioners?], holding them responsible for re-using syringes, making people vulnerable to infections. However, she failed to answer why her department had not taken action against such RMPs so far. Such outbreaks are required to be notified to the Integrated Disease Surveillance Project immediately by the health department. The civil surgeon said she was not aware of the previous outbreaks since she joined only 4 months ago. "We are instructing the civil surgeon to take effective steps and refer patients to Government Medical College, Patiala, and the PGI [Postgraduate Institute of Medical Education and Research] in Chandigarh. The civil surgeon is also being asked to take action against unregistered RMPs," said deputy commissioner Indu Malhotra.
[byline: BB Goyal]
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[The extent of hepatitis C virus infection in Kalala village is exceptional. According to WHO (http://www.who.int/mediacentre/factshee ... index.html), hepatitis C is found worldwide, with some countries having chronic infection rates as high as 5 per cent and above. The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipment. Hepatitis C is not a waterborne infection as believed by the Kalala villagers. Hepatitis C virus is most commonly transmitted through exposure to infectious blood. This can occur through receipt of contaminated blood transfusions, blood products and organ transplants; injections given with contaminated syringes and needlestick injuries in health care settings; injection drug use; or by being born to a hepatitis C infected mother. Hepatitis C may be transmitted through sex with an infected person or sharing personal items contaminated with infectious blood, but these are less common. Hepatitis C is not spread through breast milk, food, or water, or by casual contact with an infected person.
About 75-85 per cent of newly infected persons develop chronic infection and 60-70 per cent of chronically infected people develop chronic liver disease; 5-20 per cent develop cirrhosis and 1-5 per cent die from cirrhosis or liver cancer. In 25 per cent of liver cancer patients, the underlying cause is hepatitis C.
Combination antiviral therapy with interferon and ribavirin has been the mainstay of hepatitis C treatment. Unfortunately, interferon is not widely available globally, it is not always well tolerated, some virus genotypes respond better to interferon than others, and many people who take interferon do not finish their treatment. This means that while hepatitis C is generally considered to be a curable disease, for many people this is not a reality.
Scientific advances have led to the development of new antiviral drugs for hepatitis C, which may be more effective and better tolerated than existing therapies (involving combined use of interferon and ribavirin). However, these drugs are too expensive for widespread use.
Kalala village is in Barnala district in India's Punjab state. A map of the states of India can be accessed at: http://www.theindiatravelguide.com/test/main1.htm. - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2ey1.]
***************************************************
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ProMED-mail is a program of the
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Date: Mon 22 Jul 2013
Source: Hindustani Times [edited]
http://www.hindustantimes.com/Punjab/Pa ... 96556.aspx
Fear and anguish prevails at Kalala village [Barnala district, Punjab state] as the majority of the inhabitants have tested positive for hepatitis C virus (HCV) infection. The village has a population of 2358 living in 428 houses. The health department has taken 41 samples, 28 of which have been found positive.
In December 2012, in a medical camp, 370 people out of 870 were found to be hepatitis C positive. Going by that ratio, the actual number of infected people might be in the range of 800 to 1000. HCV has taken the lives of 25 people of the village. The village has no clinical laboratory or government dispensary. Health facilities are virtually non-existent in the village. Most of the newly elected panchayat [village council] members are victims of the dreaded disease.
Recently a blood donation camp was organised in the village by Dayanand Medical College and Hospital, Ludhiana; 90 units were donated by villagers. Of these, 28 units were found to be HCV positive. A 24 year old villager said he had lost his grandfather, father, and uncle to HCV. Now he, his sister, and cousin are infected. The treatment cost is over INR 200 000 (about USD 3400), so few can afford treatment.
HCV was identified in 1989. The World Health Organization (WHO) compares HCV to a "viral time bomb". HCV is responsible for 50-76 per cent of all liver cancer cases worldwide. In 2010, 98 hepatitis C cases were reported from Kalala, Chananwal, Chinniwal, and Sehjra villages. Recently, 13 cases have been reported from Kube village. These villages are in close proximity. The villagers still say unhygienic water is responsible for the epidemic. Health authorities have not made villagers aware not to use contaminated and unsterilised needles, the main source of HCV.
Civil surgeon Dr Renu passed the buck on to unregistered RMPs [rural medical practioners?], holding them responsible for re-using syringes, making people vulnerable to infections. However, she failed to answer why her department had not taken action against such RMPs so far. Such outbreaks are required to be notified to the Integrated Disease Surveillance Project immediately by the health department. The civil surgeon said she was not aware of the previous outbreaks since she joined only 4 months ago. "We are instructing the civil surgeon to take effective steps and refer patients to Government Medical College, Patiala, and the PGI [Postgraduate Institute of Medical Education and Research] in Chandigarh. The civil surgeon is also being asked to take action against unregistered RMPs," said deputy commissioner Indu Malhotra.
[byline: BB Goyal]
--
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<promed@promedmail.org>
[The extent of hepatitis C virus infection in Kalala village is exceptional. According to WHO (http://www.who.int/mediacentre/factshee ... index.html), hepatitis C is found worldwide, with some countries having chronic infection rates as high as 5 per cent and above. The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipment. Hepatitis C is not a waterborne infection as believed by the Kalala villagers. Hepatitis C virus is most commonly transmitted through exposure to infectious blood. This can occur through receipt of contaminated blood transfusions, blood products and organ transplants; injections given with contaminated syringes and needlestick injuries in health care settings; injection drug use; or by being born to a hepatitis C infected mother. Hepatitis C may be transmitted through sex with an infected person or sharing personal items contaminated with infectious blood, but these are less common. Hepatitis C is not spread through breast milk, food, or water, or by casual contact with an infected person.
About 75-85 per cent of newly infected persons develop chronic infection and 60-70 per cent of chronically infected people develop chronic liver disease; 5-20 per cent develop cirrhosis and 1-5 per cent die from cirrhosis or liver cancer. In 25 per cent of liver cancer patients, the underlying cause is hepatitis C.
Combination antiviral therapy with interferon and ribavirin has been the mainstay of hepatitis C treatment. Unfortunately, interferon is not widely available globally, it is not always well tolerated, some virus genotypes respond better to interferon than others, and many people who take interferon do not finish their treatment. This means that while hepatitis C is generally considered to be a curable disease, for many people this is not a reality.
Scientific advances have led to the development of new antiviral drugs for hepatitis C, which may be more effective and better tolerated than existing therapies (involving combined use of interferon and ribavirin). However, these drugs are too expensive for widespread use.
Kalala village is in Barnala district in India's Punjab state. A map of the states of India can be accessed at: http://www.theindiatravelguide.com/test/main1.htm. - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2ey1.]
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Denguefieber in Indien und Pakistan
DENGUE/DHF UPDATE (62): ASIA
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- Pakistan (Sindh province). 28 Jul 2013. Dengue 524 cases: Municipality most affected: 511 cases with 6 deaths; Increasing.
http://www.thenews.com.pk/Todays-News-4 ... s-reported
[Maps of Pakistan can be accessed at
http://www.ezilon.com/maps/images/asia/ ... kistan.gif
and http://healthmap.org/r/2NT8. - Mod.TY]
- India:
- Karnataka state. 23 Jul 2013. Dengue as of 1 Jul 2013, 2849 cases; Deaths 9.
http://newindianexpress.com/states/karn ... 697368.ece
[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]
- Dakshina Kannada district, Karnataka state. Dengue 213 cases; Deaths 2.
http://www.sahilonline.org/mobile/?cid= ... 2&viewed=0
- Odisha state. 22 Jul 2013. Dengue 66 cases: Municipality most affected: Cuttack 46 cases.
http://www.thestatesman.net/news/6603-D ... ttack.html.
*****************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
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*****
- Pakistan (Sindh province). 28 Jul 2013. Dengue 524 cases: Municipality most affected: 511 cases with 6 deaths; Increasing.
http://www.thenews.com.pk/Todays-News-4 ... s-reported
[Maps of Pakistan can be accessed at
http://www.ezilon.com/maps/images/asia/ ... kistan.gif
and http://healthmap.org/r/2NT8. - Mod.TY]
- India:
- Karnataka state. 23 Jul 2013. Dengue as of 1 Jul 2013, 2849 cases; Deaths 9.
http://newindianexpress.com/states/karn ... 697368.ece
[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]
- Dakshina Kannada district, Karnataka state. Dengue 213 cases; Deaths 2.
http://www.sahilonline.org/mobile/?cid= ... 2&viewed=0
- Odisha state. 22 Jul 2013. Dengue 66 cases: Municipality most affected: Cuttack 46 cases.
http://www.thestatesman.net/news/6603-D ... ttack.html.
-
Birgitt
- Moderator
- Beiträge: 35259
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Hepatitis E in Indien
HEPATITIS E - INDIA: (BIHAR), PATNA
***********************************
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 29 Jul 2013
Source: The Times of India, Patna [abbreviated & edited]
http://timesofindia.indiatimes.com/city ... 439359.cms
As the world marked World Hepatitis Day on Sunday [28 Jul 2013], experts in Patna say that out of 5 [causes] of hepatitis -- also known as inflammation of the liver -- hepatitis E has assumed epidemic portions in certain parts of the city.
Hepatitis E spreads through contaminated food and water. "In Patna, it has assumed epidemic [proportions] in areas where there is garbage all around and pure water is unavailable," said noted physician Dr Gopal Prasad Sinha.
Hepatitis A, like hepatitis E, is spread through contaminated food and water and poor sanitation. However, unlike hepatitis E, a vaccine is available for hepatitis A. "It is seasonal, and its cases usually rise in rainy season," said Dr Gaurav Kumar, gastroenterologist with AIIMS-Patna [All India Institute of Medical Sciences-Patna]. Hepatitis B and C are leading causes of liver cancer and are spread through sexual contact or transfusion of infected blood.
--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[Hepatitis E is a liver disease caused by the hepatitis E virus: a non-enveloped, positive-sense, single-stranded ribonucleic acid (RNA) virus. Hepatitis E virus is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death.
Hepatitis E is found worldwide, and different genotypes of hepatitis E virus determine differences in epidemiology. Genotype 1 is usually seen in developing countries and causes community-level outbreaks, while genotype 3 is usually seen in the developed countries and does not cause outbreaks. Globally, 57 000 deaths and 3.4 million cases of acute hepatitis E are attributable to infection with hepatitis E virus genotypes 1 and 2.
Further information is awaited concerning the extent and severity of the outbreak of hepatitis E in Patna. Patna is the capital of the Indian state of Bihar, and its most populous city, and also the 2nd most populous city of Eastern India. It is the administrative, industrial, and educational centre of the state. The modern city of Patna is on the southern bank of the Ganges. The city also straddles the rivers Sone, Gandak and Punpun. In June 2009, the World Bank ranked Patna in 2nd place in India, after Delhi, in terms of the ease of starting a business. Patna has been ranked as the 21st fastest growing city in the world and 5th fastest growing city in India by City Mayors Foundation.
A map of the states of India, showing the location of Bihar state and the city of Patna, can be accessed at: http://www.theindiatravelguide.com/test/main1.htm. - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1*O9.]
***********************************
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 29 Jul 2013
Source: The Times of India, Patna [abbreviated & edited]
http://timesofindia.indiatimes.com/city ... 439359.cms
As the world marked World Hepatitis Day on Sunday [28 Jul 2013], experts in Patna say that out of 5 [causes] of hepatitis -- also known as inflammation of the liver -- hepatitis E has assumed epidemic portions in certain parts of the city.
Hepatitis E spreads through contaminated food and water. "In Patna, it has assumed epidemic [proportions] in areas where there is garbage all around and pure water is unavailable," said noted physician Dr Gopal Prasad Sinha.
Hepatitis A, like hepatitis E, is spread through contaminated food and water and poor sanitation. However, unlike hepatitis E, a vaccine is available for hepatitis A. "It is seasonal, and its cases usually rise in rainy season," said Dr Gaurav Kumar, gastroenterologist with AIIMS-Patna [All India Institute of Medical Sciences-Patna]. Hepatitis B and C are leading causes of liver cancer and are spread through sexual contact or transfusion of infected blood.
--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[Hepatitis E is a liver disease caused by the hepatitis E virus: a non-enveloped, positive-sense, single-stranded ribonucleic acid (RNA) virus. Hepatitis E virus is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death.
Hepatitis E is found worldwide, and different genotypes of hepatitis E virus determine differences in epidemiology. Genotype 1 is usually seen in developing countries and causes community-level outbreaks, while genotype 3 is usually seen in the developed countries and does not cause outbreaks. Globally, 57 000 deaths and 3.4 million cases of acute hepatitis E are attributable to infection with hepatitis E virus genotypes 1 and 2.
Further information is awaited concerning the extent and severity of the outbreak of hepatitis E in Patna. Patna is the capital of the Indian state of Bihar, and its most populous city, and also the 2nd most populous city of Eastern India. It is the administrative, industrial, and educational centre of the state. The modern city of Patna is on the southern bank of the Ganges. The city also straddles the rivers Sone, Gandak and Punpun. In June 2009, the World Bank ranked Patna in 2nd place in India, after Delhi, in terms of the ease of starting a business. Patna has been ranked as the 21st fastest growing city in the world and 5th fastest growing city in India by City Mayors Foundation.
A map of the states of India, showing the location of Bihar state and the city of Patna, can be accessed at: http://www.theindiatravelguide.com/test/main1.htm. - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1*O9.]
-
Birgitt
- Moderator
- Beiträge: 35259
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Japanische Enzephalities in Indien
JAPANESE ENCEPHALITIS AND OTHER - INDIA (12): (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: Wed 31 Jul 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 494687.cms
One more death due to encephalitis on Monday night [29 Jul 2013] raised the death toll to 88 this year [2013, in Gorakhpur, eastern Uttar Pradesh state]. A one and a half year old girl, a resident of Padrauna, Kushinagar, died due to encephalitis on Monday night.
Moreover, 8 patients of the deadly disease were admitted to the hospital within the last 24 hours. At present, 37 encephalitis patients are getting treatment at the hospital.
--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[Eastern Uttar Pradesh state has been a hot spot for encephalitis, often termed acute encephalitis syndrome, with many of the cases hospitalized in Gorakhpur. As is usually the case for reports of encephalitis cases in India, the etiologies of these cases is not given. Sometimes all these cases are attributed to Japanese encephalitis virus (JEV) infections, sometimes just a lesser proportion of them, and sometimes none of them. Without knowing the specific etiology or etiologies of these encephalitis cases, targeted control measures will not be possible. Fortunately, the effective JEV vaccine provides an opportunity for prevention of some of these cases if applied before the main transmission season arrives. However, the transmission season is well under way in Uttar Pradesh. No mention is made in the report above as to whether such vaccination campaign is planned or if any of the cases were vaccinated.
Maps of India showing Uttar Pradesh state can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/1-k3. - Mod.TY]
*************************************************************
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 31 Jul 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 494687.cms
One more death due to encephalitis on Monday night [29 Jul 2013] raised the death toll to 88 this year [2013, in Gorakhpur, eastern Uttar Pradesh state]. A one and a half year old girl, a resident of Padrauna, Kushinagar, died due to encephalitis on Monday night.
Moreover, 8 patients of the deadly disease were admitted to the hospital within the last 24 hours. At present, 37 encephalitis patients are getting treatment at the hospital.
--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[Eastern Uttar Pradesh state has been a hot spot for encephalitis, often termed acute encephalitis syndrome, with many of the cases hospitalized in Gorakhpur. As is usually the case for reports of encephalitis cases in India, the etiologies of these cases is not given. Sometimes all these cases are attributed to Japanese encephalitis virus (JEV) infections, sometimes just a lesser proportion of them, and sometimes none of them. Without knowing the specific etiology or etiologies of these encephalitis cases, targeted control measures will not be possible. Fortunately, the effective JEV vaccine provides an opportunity for prevention of some of these cases if applied before the main transmission season arrives. However, the transmission season is well under way in Uttar Pradesh. No mention is made in the report above as to whether such vaccination campaign is planned or if any of the cases were vaccinated.
Maps of India showing Uttar Pradesh state can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/1-k3. - Mod.TY]
