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CHIKUNGUNYA (45): INDIA (ODISHA), SUSPECTED
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A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org

Date: Sun 10 Nov 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 524515.cms


Several persons of Mallikeswara village in Ganjam district are suffering from a mysterious disease. At least 15 new cases were reported on Friday [8 Nov 2013]. The symptoms of the disease match those of chikungunya, but this can only be confirmed after laboratory testing, doctors said on Saturday [9 Nov 2013].

A team of doctors led by district malaria officer U S Mishra along with paramedics went to the affected village in Khallikote block on Friday [8 Nov 2013]. They treated patients and collected blood samples. "We conducted a door-to-door survey and collected 38 blood samples from the village. All of them tested negative for malaria," said Mishra. "The samples will be tested at the laboratory of MKCG Medical College and Hospital here for chikungunya [virus or antibody?]," he added.

The disease broke out a week back. Villagers panicked when 2 persons died recently. The health department, however, allayed the fears. "The deaths of the 2 were not related to the disease. The deceased were old men," said the malaria officer. He said the situation in the village is under control, and no new cases were reported on Saturday [9 Nov 2013].

The main reason for the spread of chikungunya, malaria, and dengue is stagnant water, said a doctor of the social medicine department of MKCG.

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[Chikungunya virus is endemic in India, and cases appear sporadically in diverse locations, such as Odisha state. This is the 2nd reported chikungunya virus outbreak in the Ganjam district of Odisha state this year (2013), the earlier one having occurred in early January 2013. That outbreak may have been a continuation of the 2012 outbreak in the same locality. If the chikungunya virus vector mosquitoes, _Aedes aegypti_, are present, as is likely, the occurrence of additional cases can be expected unless the vector control efforts are effective. There is no commercially available chikungunya virus vaccine.

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

DENGUE/DHF UPDATE (92): ASIA
*************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Pakistan
- Malakand, Khyber Pakhtunkhwa province
- Shangla, Khyber Pakhtunkhwa province
- Swat Valley, Khyber Pakhtunkhwa province
- Punjab province
- Sindh province
India
- Delhi
- Nashik, Maharashtra state
- Chandigarh, Punjab state
Nepal (Ratnanagar, Chitwan district)

*****

Pakistan
- Malakand, Khyber Pakhtunkhwa province. 7 Nov 2013. Dengue (conf.) 462 cases; deaths 1.
http://www.thenews.com.pk/Todays-News-2 ... n-Malakand

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

- Shangla, Khyber Pakhtunkhwa province. 7 Nov 2013. Dengue 1241 cases.
http://www.thenews.com.pk/Todays-News-2 ... in-Shangla

- Swat Valley, Khyber Pakhtunkhwa province. 7 Nov 2013. Dengue (susp.) 5139 cases in the last 85 days.
http://paktribune.com/news/Five-more-co ... 64344.html

- Punjab province. 10 Nov 2013. Dengue 1445 cases, at least 80 new cases in the last 24 hours; deaths 3. Municipalities most affected: Lahore, Rawalpindi.
http://www.brecorder.com/general-news/172/1252498/

- Sindh province. 5 Nov 2013. Dengue 3955 cases; deaths 22. Municipalities most affected: Karachi 3414 cases, Hyderabad 505 cases. Increasing.
http://www.geo.tv/article-125278-Karach ... reaches-22

India
- Delhi. 8 Nov 2013. Dengue 4727 cases; deaths 6. Increasing.
http://health.india.com/news/delhi-deng ... ches-4727/

[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]

- Nashik, Maharashtra state. 8 Nov 2013. Dengue 8 deaths since June 2013.
http://timesofindia.indiatimes.com/city ... 399655.cms

- Chandigarh, Punjab state. 6 Nov 2013. Dengue 66 cases.
http://www.indianexpress.com/news/only- ... r/1191381/

Nepal (Ratnanagar, Chitwan district). 4 Nov 2013. Dengue in the last 16 days, 71 cases; since mid-June 2013, 150 cases.
http://thehimalayantimes.com/fullNews.p ... sID=395953

[Maps of Nepal can be accessed at http://ncthakur.itgo.com/map04.htm and http://healthmap.org/r/977V. - Mod.TY]

DENGUE/DHF UPDATE (94): ASIA
************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Pakistan
- Swat Valley, Khyber Pakhtunkhwa province
- Punjab province
- Sindh province
India
- Vadodara, Gujarat state
- Kanpur, Uttar Pradesh state

******

Pakistan
- Swat Valley, Khyber Pakhtunkhwa province. 12 Nov 2013. Dengue 5159 cases hospitalized; deaths (susp.) 37.
http://www.thenews.com.pk/Todays-News-7 ... ngue-virus

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

- Punjab province. 18 Nov 2013. Dengue 1912 cases; last 24 hours 89 cases, 70 in Lahore. Increasing.
http://pakobserver.net/detailnews.asp?id=224057
[Another report of 14 Nov 2013 indicated 16 deaths in the province, 10 in Lahore and over 900 cases in Lahore.]
http://paktribune.com/news/Dengue-claim ... 64533.html

- Sindh province. 13 Nov 2013. Dengue 4358 cases. Municipality most affected: Karachi 3786 cases.
http://www.thenews.com.pk/Todays-News-4 ... for-dengue

India
- Vadodara, Gujarat state. 14 Nov 2013. Dengue 223 cases. Increasing.
http://timesofindia.indiatimes.com/city ... 777846.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]

- Kanpur, Uttar Pradesh state. 14 Nov 2013. Dengue 605 cases. Dengue virus circulating type 3.
http://timesofindia.indiatimes.com/city ... 718558.cms

CHIKUNGUNYA (48): INDIA (GUJARAT)
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Tue 19 Nov 2013
Source: The Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 038235.cms


According to the latest data released by the health department of the AMC [Ahmedabad Municipal Corporation], Ahmedabad city has recorded an increase of more than 350 in the cases of chikungunya [virus infection] from Sep 2013 to 16 Nov 2013 compared with Sep-Nov 2012.

Compared with 24 cases from Sep-Nov 2012, 369 cases of chikungunya [virus infection] were reported from Sep to 16 Nov 2013.

--
communicated by:
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[The number of reported infections from chikungunya virus in Ahmedabad has increased from 39 as of July 2013 to the 350 cases reported above. Chikungunya virus is endemic in India and causes sporadic outbreaks in various parts of the country. Not surprisingly, Ahmedabad is having a mixed outbreak of chikungunya and dengue virus infections since both viruses are transmitted by the same vector mosquito. If the chikungunya virus vector mosquitoes, _Aedes aegypti_, are relatively abundant as is likely, the occurrence of additional cases can be expected unless the vector control efforts are effective. Although the fatality rate is low to nil, morbidity can be high with persistent arthralgia that can last weeks to months. There is no commercially available chikungunya virus vaccine.

A HealthMap/ProMED-mail map showing the location of Gujarat state can be accessed at http://healthmap.org/r/27Ix. - Mod.TY]

SCRUB TYPHUS - INDIA (06): (TAMIL NADU)
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Date: Wed 20 Nov 2013
Source: The New Indian Express [edited]
http://newindianexpress.com/cities/chen ... 900008.ece


The rains might have brought some respite to the city of Chennai [Tamil Nadu] but the slush that is left behind may harbor mites.

Doctors in Chennai are warning of an infection that spreads from to the bite of mites. These mites cause a disease called scrub typhus that is prevalent during peak monsoon season. The disease, which leaves symptoms similar to other monsoon-related diseases, could prove fatal if not diagnosed and treated on time. Medical experts have been expressing concern over scrub typhus as they have been witnessing a rise in the number of cases at government hospitals.

At the Rajiv Gandhi Government General Hospital (RGGGH) alone, there had been 2 or 3 cases every week in the last few months. The disease has symptoms which people often associate with dengue and other viral diseases -- high fever, headaches, rashes, lymph-node enlargement, and body ache.

"People often test for other diseases, but don't think of scrub typhus. Not many know that it is a completely treatable disease. But if left untreated, it could prove fatal," a doctor at the RGGGH said.

These mites, usually found in forest areas in the hills. When they bite, they will leave an eschar or scab on the surface of the skin. This eschar is particularly important for diagnosis, doctors said.

[byline: U Tejonmayam]

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communicated by:
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[The following is excerpted from: Demma LJ, McQuiston JH, Nicholson WL, et al. Scrub typhus, Republic of Palau. Emerg Infect Dis. 2006; 12 (2): 290-5; available at http://wwwnc.cdc.gov/eid/content/12/2/pdfs/v12-n2.pdf and was part of a moderation by my colleague ML:

"Scrub typhus is a zoonotic illness caused by _Orientia tsutsugamushi_. The pathogen is transmitted through the bite of larval mites (chiggers) of the _Trombiculidae_ family, which serve as both the vector and the reservoir (1,2). Rodents of the family _Muridae_ (rats and mice) are common hosts for trombiculid mites and may support _O. tsutsugamushi_. Geographically specific foci of scrub typhus are thus determined by the distribution of vector mites and their rodent hosts and by interactions of mites and rodents with humans (3). Scrub typhus has been reported from many regions of Asia and the Pacific islands, and known disease-endemic regions extend from Japan and eastern Russia southward to Australia and westward to Pakistan and Afghanistan (4,5).

"Scrub typhus is typically a nonspecific febrile illness; its severity may be influenced by the strain of _O. tsutsugamushi_, a person's immune status, and other factors. Diagnosis may be complicated in areas where the disease has not been documented recently or in regions lacking the capacity for laboratory confirmation. Illness develops after an incubation period of 6 to 21 days and usually begins with an eschar at the site of a chigger bite. Fever, headache, [lymphadenopathy], and myalgias are common, and a maculopapular rash may also be present. Nausea, vomiting, diarrhea, or lower respiratory symptoms can also occur. Manifestations such as pneumonitis, meningoencephalitis, jaundice, renal failure, and myocarditis can develop during the prolonged clinical course of untreated illness (6). Establishing the diagnosis and initiating prompt antimicrobial drug therapy are important, because death rates for untreated scrub typhus patients are 1-30 per cent (5). Scrub typhus is effectively treated with doxycycline, and treatment should begin immediately upon suspicion of illness without awaiting laboratory confirmation."

References
----------
1. Traub R, Wisseman CL, Jones MR, O'Keefe JJ. The acquisition of _Rickettsia tsutsugamushi_ by chiggers (trombiculid mites) during the feeding process. Ann NY Acad Sci. 1975; 266: 91-114.
2. Traub R, Wisseman CL. The ecology of chigger-borne rickettsiosis (scrub typhus). J Med Entomol. 1974; 11(3): 237-303.
3. Lerdthunsee K, Khuntirat B, Leepitakrat W, Tanskul P, et al. Scrub typhus: vector competence of _Leptotrombidium chiangraiensis_ chiggers and transmission efficacy and isolation of _Orientia tsutsugamushi_. Ann N Y Acad Sci. 2003; 990: 25-35; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12860596.
4. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003; 16(5): 429-36; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14501995.
5. Silpapojakul K. Scrub typhus in the Western Pacific region. Ann Acad Med Singapore. 1997; 26(6): 794-800; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9522982.
6. Corwin AL, Soeprapto W, Widodo PS, Rahardjo E, et al. Short report: surveillance of rickettsial infections in Indonesian military personnel during peace keeping operations in Cambodia. Am J Trop Med Hyg 1997; 57(5): 569-70; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9392597.

Rodents may serve as reservoirs, although transovarial transmission in mites is the dominant mechanism for maintenance of _O. tsutsugamushi_ (http://www.cdc.gov/ncidod/EID/vol9no12/03-0212.htm). Humans become infected when they accidentally encroach in an area where the chigger-rodent cycle is occurring, most often areas of low-lying scrub brush or transitional vegetation.

Patients with severe scrub typhus can develop multiorgan failure and disseminated intravascular coagulopathy with hemorrhage.

Maps of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/2bxj. - Sr.Tech.Ed.MJ]

DENGUE/DHF UPDATE (96): ASIA
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Cases in various countries:
Pakistan
- Punjab province
- Rawalpindi, Punjab province
- Sindh province
India
- Delhi
- Ludhiana, Punjab state

******

Pakistan
- Punjab province. 24 Nov 2013. Dengue 2164 cases; 46 cases in past 24 hrs. Municipality most affected: Lahore over 1300 cases. Increasing.
http://www.dailytimes.com.pk/default.as ... 013_pg13_1

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

- Rawalpindi, Punjab province. 21 Nov 2013. Dengue deaths 18. Increasing.
http://pakobserver.net/detailnews.asp?id=224321

- Sindh province. 22 Nov 2013. Dengue 4800 cases; deaths 29. Municipalities most affected Karachi 4171 cases, Hyderabad 569 cases.
http://www.geo.tv/article-127439-29th-d ... s-in-Sindh

India
- Delhi. 19 Nov 2013. Dengue as of 16 Nov 2013, 5115 cases; deaths 6.
http://www.indianexpress.com/news/dengu ... s/1196639/

[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]

- Ludhiana, Punjab state. 22 Nov. 2013. Dengue (conf.) 1549 cases in Ludhiana hospitals.
http://www.hindustantimes.com/punjab/lu ... 54528.aspx

CHIKUNGUNYA (50): INDIA (MAHARASHTRA)
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Mon 25 Nov 2013
Source: The Indian Express [edited]
http://www.indianexpress.com/news/dengu ... e/1199266/


While the winter chill has brought down the number of [dengue] cases last week, warmer days as predicted by the [Pune] Met department has again spiked up the cases with ten new infections being reported on Sunday [24 Nov 2013].

Dr S T Pardeshi, acting medical chief of Pune Municipal Corporation (PMC) attributed this rise to variations in weather. On several days the morning chill is soon offset by warm weather during the day, he said. According to IMD, the trend of rising temperature is likely to continue for the next 24 hours. The minimum temperature is likely to be go up to 15 degree Celsius [59 F], a release said.

"We are picking up new cases daily as the health department has been collating data from private hospitals. Earlier, we would get cases only from state run Sassoon general hospital or PMC run hospitals," Pardeshi admitted.

According to Dr Rajesh Gadia, consulting physician at KEM hospital, it is a known fact that cases of [chikungunya and dengue virus] infections rise post monsoon. The sudden rain few weeks ago also led to accumulation of stagnant water with the existing garbage, he said. Pardeshi said that their ongoing survey has detected a large number of [_Aedes_ vector mosquito] breeding spots at households. Doctors admit though that the cases have been mild with few being hospitalized. As against the large number of dengue cases, there have been 38 cases of chikungunya from January till date, Pardeshi said.

--
Communicated by:
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[Chikungunya virus is endemic in India and causes sporadic outbreaks in various parts of the country. Not surprisingly, Pune is having a mixed outbreak of chikungunya and dengue virus infections since both viruses are transmitted by the same vector mosquito. If the chikungunya virus vector mosquitoes, _Aedes aegypti_, are relatively abundant as is likely, the occurrence of additional cases can be expected unless the vector control efforts are effective or temperatures decline further. Although the fatality rate for chikungunya virus infections is low to nil, morbidity can be high with persistent arthralgia that can last weeks to months. There is no commercially available chikungunya virus vaccine.


A HealthMap/ProMED-mail map showing the location of Pune in Maharashtra state can be accessed at http://healthmap.org/r/2gZV. - Mod.TY]

DENGUE/DHF UPDATE (98): ASIA
****************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Pakistan
- Punjab province
- Lahore, Punjab province
- Ludhiana and vicinity, Punjab province
- Sindh province, cases
- Sindh province, deaths
India
- Delhi
- Karnataka state
- Dakshina Kannada district, Karnataka state
- Pune, Maharashtra state
Nepal (Chitwan district)

******

Pakistan
- Punjab province. 30 Nov 2013. Dengue 2385 cases, 25 new cases in the last 24 hours.
http://www.thefrontierpost.com/article/ ... in-Punjab/

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

- Lahore, Punjab province. 26 Nov 2013. Dengue 1400 cases. Increasing.
http://www.dailytimes.com.pk/default.as ... 013_pg7_11

- Ludhiana and vicinity, Punjab province. 29 Nov 2013. Dengue 1468 cases; deaths: 6.
http://www.hindustantimes.com/punjab/lu ... 57231.aspx

- Sindh province, cases. 30 Nov 2013. Dengue 5058 cases. Municipalities most affected Karachi 4414 cases, Hyderabad 577 cases.
http://www.thenews.com.pk/article-12847 ... s-reported

- Sindh province, deaths. 25 Nov 2013. Dengue deaths 30 in province; most deaths (25) are in Karachi.
http://www.thenews.com.pk/article-12782 ... -in-Thatta

India
- Delhi. 25 Nov 2013. Dengue 5212 cases in the capital, with an additional 67 cases reported from the National Capital Region, which includes parts of Haryana and Uttar Pradesh states adjoining Delhi; deaths 6.
http://www.ianslive.in/index.php?param= ... 5/NATION/1

[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]

- Karnataka state. 26 Nov 2013. Dengue 6023 cases; deaths 12.
http://newindianexpress.com/states/karn ... 911860.ece

- Dakshina Kannada district, Karnataka state. 1 Dec 2013. Dengue (susp.) 612 cases, (conf.) 119 cases. Increasing.
http://timesofindia.indiatimes.com/city ... 685044.cms

- Pune, Maharashtra state. 25 Nov 2013. Dengue 741 cases. Increasing.
http://www.indianexpress.com/news/dengu ... e/1199266/

Nepal
Chitwan district) 27 Nov 2013. Dengue 215 cases. Increasing.
http://www.myrepublica.com/portal/index ... s_id=65202

[Maps of Nepal can be accessed at http://ncthakur.itgo.com/map04.htm and http://healthmap.org/r/977V. - Mod.TY]

RABIES - INDIA (08): (MAHARASHTRA) CANINE, HUMAN
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Fri 6 Dec 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 926341.cms


The rabid dog that bit an 11-year-old girl on [19 Nov 2013] had bitten 4 more people in the same area [Pune, Maharashtra state] on that day. The girl succumbed to the infection at 9:30 pm on Wednesday, 4 Dec 2013, while the 4 others are recovering. As many as 100 dog bite cases have been reported from the area in the past few days.

"All the 5 people, including the deceased victim, were reported to my clinic between 9:30 pm and 11:30 pm on 19 Nov 2013. The 11-year old suffered an injury on her forehead and it was a deep wound. So, I advised her parents to rush her to Sassoon hospital," said physician Vilas M Dhere, who runs a clinic in Rammya Nagari in Bibvewadi [Pune]. Among the dog bite patients who reported to Dhere that day included a 30-year-old man who suffered an injury in his right armpit; a 22-year-old man whose got a deep wound on his right earlobe; a 50-year-old man who was bitten near the eyes and a 28-year-old man who got wounds on his head. "All 4 patients are recovering," Dhere said.

Dhere's clinic has been offering anti-rabies vaccines at subsidized rates through a project run by the Sevadham Trust and Grahak Panchayat since 2005. There are 4 more such clinics located in Yerawada, Perugate, Kunjirwadi and Narayangaon [areas in and around Pune] that do similar work. "As anti-rabies vaccines are provided for a very nominal charge, I get dog bite cases from Bibvewadi, Dhankawadi, Kondhwa, Katraj and even Peth areas. I have overseen such cases since January this year [2013]. The deceased girl was a grade III dog bite patient. However, I only possess the vaccine for grade I and II cases," Dhere said.

On why such a large number of cases are reported from the Bibvewadi-Dhankawadi-Katraj-Kondhwa belt, Dhere said, "Most housing colonies in these areas have issues regarding sanitation. Packs of dog are seen roaming freely near overflowing garbage bins." Local corporator Yogesh Tilekar said, "The Pune Municipal Corporation's squad that catches stray dogs take the round of the area during day between 11:00 am and 5:00 pm. But the canines create problems usually after 6:00 pm. I have requested the municipal commissioner to direct the squad to catch the strays in the evening."

Doctors working at the anti-rabies project at Perugate clinic also get a steady flow of cases every day. "Around 70 cases are usually reported to our clinic throughout the year," said family physician Manoj More. S T Pardeshi, PMC medical officer of health, said, "We have intensified the work of catching stray dogs from the outskirts where most dog bite cases are reported. We hope to check the menace soon."

Experts have highlighted the need for health education programmes for the medical community and the public. They said the importance of proper wound care and post-exposure vaccination must be reinforced to prevent rabies infection.

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

[It is likely that the victim in this incident succumbed to rabies virus infection as a consequence of the site of the bite, thereby enabling rabies virus to enter the central nervous system before inactivation of the virus by administration of anti-rabies vaccine.

Regarding the management of animal bite wounds, the National Centre for Disease Control of India recommends the following:
- Since the rabies virus enters the human body through a bite or scratch, it is imperative to remove as much saliva, and thereby the virus, from the wound as is possible by an efficient wound cleaning that should not involve additional trauma.
- Since the rabies virus can persist and even multiply at the site of the bite for a long time, wound cleaning must be performed even if the patient reports late.
- This can be done by prompt and gentle thorough washing with soap or detergent and flushing the wound with running water for 10 minutes.
- If soap and detergent are not immediately available, wash with running water for at least 10 minutes.
- Avoid direct touching of wounds with bare hands.
- The application of irritants (like chilies, oil, turmeric, lime, salt, etc.) is unnecessary and damaging. In case irritants have been applied on the wound, enough gentle washing with soap or detergent to remove the extraneous material, especially oil, should be done followed by flushing with a copious amount of water for 10 minutes immediately.
- Application of antiseptics: After thorough washing and drying of the wound, any one of the following available chemical agents should be applied: povidone-iodine (Betadine), alcohol, chloroxylenol (Dettol), chlorhexidine-gluconate and cetrimide solution (Savlon -- in appropriate recommended dilution), etc. - Mod.CP

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

DENGUE/DHF UPDATE (100): ASIA
**********************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Pakistan
- Punjab province
- Sindh province
India (Delhi)

*****
Pakistan
- Punjab province. 6 Dec 2013. Dengue 2514 cases; deaths on 6 Dec 2013, 2. Increasing.
http://www.pakistantoday.com.pk/2013/12 ... e-two-die/

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

- Sindh province. 6 Dec 2013. Dengue 5242 cases; deaths 31. Municipality most affected: Karachi 4587 cases, deaths 25.
http://www.dailytimes.com.pk/default.as ... 013_pg12_3

India
Delhi. 2 Dec 2013. Dengue 5387 cases; deaths 6. Most cases have been reported from the north zone (2152), followed by south (1613), and east (1483) zones.
http://www.canindia.com/2013/12/5387-de ... A8I7S.dpuf

[Maps of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/8UMD. - Mod.TY]

HEPATITIS A - UZBEKISTAN (02): REGIONAL INCIDENCE
*************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Sun 15 Dec 2013
From Steve Berger <steve@gideononline.com> [edited]


The following comment is in response to the ProMED-mail post entitled: Hepatitis A - Uzbekistan: (FA) 20131214.2116240.

Reported rates of hepatitis A for Uzbekistan and bordering countries are strikingly similar and somewhat higher than those for the Russian Federation [1,2]. See graph [3]: http://cdn.gideononline.com/wp/wp-conte ... AUzbek.png.

References:
1. Berger SA. Infectious Diseases of Uzbekistan, 2013. 354 pages, 74 graphs, 69 references http://www.gideononline.com/ebooks/dise ... al-status/.
2. Berger SA. Hepatitis A: Global Status, 2013. 169 pages, 182 graphs, 1274 references http://www.gideononline.com/ebooks/dise ... al-status/.
3. Gideon Graph Tool, see tutorial at http://www.GIDEONonline.com/wp/wp-conte ... Graphs.pps.

--
Steve Berger
Geographic Medicine,
Tel Aviv Medical Center
Israel
<steve@gideononline.com>

[ProMED-mail thanks Steve Berger for making this information available.

The progressive decline in the incidence of hepatitis A in these countries is striking and follows closely the pattern observed in the Russian Federation during the period 1999 to 2009. These figures probably reflect a general improvement in living standards and education during this period as well as the increasing availability of effective hepatitis A virus vaccines. - Mod.CP

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

DENGUE/DHF UPDATE (102): ASIA
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International Society for Infectious Diseases
http://www.isid.org

Cases in various countries:
Pakistan:
- National
- Punjab province
- Sindh province
India:
- National
- Maharashtra state

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Pakistan:
- National. 9 Dec 2013. Dengue over 4000 cases since September 2013.
http://www.globalpost.com/dispatch/news ... r-pakistan

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

- Punjab province. 12 Dec 2013. Dengue 2589 cases; Deaths 26
http://www.thefrontierpost.com/article/ ... jab-61267/

- Sindh province. 13 Dec 2013. Dengue 5430 cases; Deaths 33; Municipality most affected: Karachi over 4700 cases, 13 cases in last 24 hours.
http://www.thefrontierpost.com/article/ ... n-Karachi/

India:
- National. 10 Dec 2013. Dengue to November 2013, 67 365 cases; Deaths 152
http://news.outlookindia.com/items.aspx?artid=820363

[Maps of India can be seen at
http://www.mapsofindia.com/maps/india/i ... al-map.htm and
http://healthmap.org/r/8UMD. - Mod.TY]

- Maharashtra state. 9 Dec 2013. Dengue 4026 cases; Municipality most affected: Mumbai 863 cases.; Deaths 11.
http://timesofindia.indiatimes.com/city ... 099131.cms

LEPROSY - INDIA (05): (ANDHRA PRADESH) INCREASED INCIDENCE
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Date: Sat 21 Dec 2013
Source: The Times of India Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 694843.cms


Leprosy is increasing alarmingly in Andhra Pradesh with the government doing little to check the bacterial infection from spreading, experts said as a staggering 8285 cases were reported in the state during 2012-13. As many as 239 new cases were detected in Hyderabad in the same period.

Health department officials said Andhra Pradesh now figures among the top 12 states with the highest caseloads of leprosy in the country. The proportion of new paediatric cases in the state was also among the highest in the country, experts said. Data from the National Leprosy Eradication Programme shows that out of the total new cases, a substantial 911 cases (11.34 per cent) are of children, officials said.

Experts said the numbers have gone up particularly in the last 2 years. During 2011-12, 7820 cases were detected, they pointed out and attributed the situation to the state government's apathy towards the health issue, so much so that it is now regaining ground.

"We could not identify these cases well in time," said Dr Michael Sukumar, a WHO consultant who is working with the state leprosy cell [in Hyderabad], underscoring a situation when agencies are sometimes helpless when local governments fail to read health warnings.

Experts said people wrongly assume that the ancient disease is non-existent now. Also, people affected by leprosy still live in leprosy colonies, because they have no other option as the disease has a deep-rooted stigma attached to it since ancient times. There are 3 such colonies in Hyderabad at Maula Ali, Vanasthalipuram, and Borabanda.

There are several pockets in the state where the disease has regained ground. Numbers of children with leprosy have been found to be high in East and West Godavari, Krishna, Guntur, Nellore, Chittoor, Kadapa, Kurnool, and Medak. West Godavari reported the highest number of children with leprosy followed by Nellore. Cases with severe deformities were found in West Godavari, Krishna, Guntur, Prakasam, Nellore, Kadapa, Anantapur, Kurnool, Mahbubnagar, Nizamabad, and Khamman.

Vineeta Shankar, director, Sasakawa India Leprosy Foundation, said lepers face enormous stigma and discrimination at all levels. "Even in public hospitals, they are treated badly. Opening a bank account is almost impossible," said Shankar. "Family members who do not suffer from the disease also face the stigma. It is not always easy to get admission in government schools, as teachers are scared. Other children do not talk to them," she said.

"Getting disability pension, which they are entitled to, is a problem because of bureaucratic problems. The crucial support system is lacking at all levels and the situation in AP is pathetic," said MA Shakeel, an advocate, who filed a PIL [public-interest litigation] on the condition of leprosy patients in the state a few years ago.

However, Shankar emphasized that 90-95 per cent of human beings are genetically immune to leprosy and, hence, it is not such a big public threat. Early deformity can be corrected by physiotherapy and corrective surgeries. However, if the disease has progressed, it can only be managed.

[byline: Bushra Baseerat]

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[For a discussion of leprosy in India, see moderator ML's comments in ProMED-mail posts Leprosy - India (03): (GJ) increased incidence, comment 20131006.1986913 and Leprosy - India (02): (GJ) increased incidence 20131005.1984154.

Andhra Pradesh is one of the 28 states of India, situated on India's south eastern coast; it is India's 4th largest state by area and 5th largest by population (http://en.wikipedia.org/wiki/Andhra_Pradesh). Its capital and largest city is Hyderabad. Maps of India, showing the location of the state of Andhra Pradesh, can be found at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/2JmE. A map of Andhra Pradesh can be seen at http://www.mapsofindia.com/maps/andhrap ... strict.htm. - Mod.ML]

DENGUE/DHF UPDATE (104): ASIA
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*****

India (Delhi). 16 Dec 2013. Dengue 5546 cases; deaths 6.
http://www.mizonews.net/nation/dengue-c ... 5500-mark/

[Maps of India can be seen at http://www.mapsofindia.com/maps/india/i ... al-map.htm and http://healthmap.org/r/2joK. - Mod.TY]

Pakistan (Sindh province). 20 Dec 2013. Dengue 5603 cases. Municipality most affected: Karachi 4913 cases.
http://www.thenews.com.pk/Todays-News-4 ... for-dengue

[Maps of Pakistan can be accessed at http://www.ezilon.com/maps/images/asia/ ... kistan.gif and http://healthmap.org/r/2NT8. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (70): ASIA
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Cholera - India (Karnataka)
Date: Wed 18 Dec 2013
Source: The Hindu [edited]
http://www.thehindu.com/todays-paper/tp ... 472462.ece


Deputy Commissioner and District Magistrate N. Jayaram on Tue 17 Dec 2013 declared Sultanpur village -- under the Noginahal Primary Health Centre (PHC) of Hukkeri taluk [a taluk is an administrative region. - Mod.LL] -- as cholera-affected. He directed officials of the Health Department to take up measures to prevent the spread of the disease to adjoining areas.

Mr. Jayaram said that 36 cases were reported from the village. All patients were being treated at the PHC and other private health centres. He told the Health Department officials to set up teams of doctors to provide treatment. He urged the residents of Sultanpur and adjoining areas to maintain cleanliness and to drink boiled water.

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[An interactive ProMED HealthMap of the state can be found at: http://healthmap.org/r/1-eG.]