UNDIAGNOSED PULMONARY DISEASE - INDIA (03): HANTAVIRUS NOT
**********************************************************
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Date Tue 19 Aug 2008
Source: Sahara Samay [edited]
<http://www.saharasamay.com/samayhtml/ar ... sid=104138>


Reports from Pune research institute have put an end to speculations that a
deadly Hantavirus was spreading in India. The reports from the Pune
laboratory have showed negative results. The death of one girl from high
fever and severe lung infection and the hospitalization of another person
had sent the health department in Uttarakhand into a tizzy.

Authorities at Mahant Indresh Hospital had claimed that 2 girls -- one from
Dehradun and another from Tehri -- were admitted some days ago with very
high fever and severe infection in their lungs, both symptoms of hantavirus
pulmonary syndrome (HPS). The patients were later shifted to Himalayan
Institute Hospital at Jollygrant for better treatment after they started
complaining of stomach problems and difficulty in breathing. One of the
girls later died.

Symptoms seen in both the girls strongly indicated that they were infected
by a hantavirus, [that causes] a deadly disease that spreads through rats
and lizards. It could lead to bubonic plague. [see comments in ProMED-mail
archive 20080807.2434. Lizards are not hosts of any known hantavirus, nor
does HPS become bubonic plague, although rats are hosts of this bacterial
disease. - Mod.TY]

Taking note of the death, the health department sent a team of doctors to
the hospital and the Himalayan Institute Hospital on Sunday [17 Aug 2008]
to investigate and take blood samples from the surviving patient. The blood
samples were sent to National Institute of Virology, Pune and the National
Institute for Communicable Diseases in New Delhi for confirmation.

The report has now come and has ruled out presence of the deadly virus.

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

[Although hantavirus infection has been ruled out in the surviving case,
there is no indication of what the etiological agent of these 2 cases might
be. ProMED-mail would appreciate receiving further information as it
becomes available.

A map of India showing the locations of Uttarakhan can be found at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>. -
Mod.TY]

UNDIAGNOSED FATAL ILLNESS - INDIA (06): (UTTAR PRADESH)
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Further clarification - 2 outbreaks
[2] A state-wide alert in Uttar Pradesh
[3] Rodentborne disease
[4] The AES outbreak in eastern Uttar Pradesh

******
[1] Further clarification - 2 outbreaks
Date: Fri 29 Aug 2008
From: Arvind Nath
<arvindnath@rediffmail.com>


Part (1) of archive no. 20080828.2697 (28 Aug 2008), entitled "Undiagnosed
fatal illness - India (04): (UP)" is not related to the earlier archive on
"Undiagnosed fatal illness - India (03): (UP) RFI 20080826.2666". This is
because the affected locations in the former are "13 districts of eastern
Uttar Pradesh" while the location of the latter is Kanpur Dehat District
which does not belong to eastern Uttar Pradesh.

However, Part (2) of the former conveying Dr Jacob John's comments is most
probably related to the latter.

--
Dr Arvind Nath,
Scientist 'C'
Div. of Epidemiology & Communicable Diseases
Indian Council of Medical Research
New Delhi, INDIA

[Agreed -- see: Undiagnosed fatal illness - India (05): (UP), clarifying
20080829.2709. ProMED-mail thanks Dr Nath for this additional
clarification. To avoid further confusion ProMED-mail will refer to the
outbreak of 'acute encephalitis syndrome (AES) as the eastern outbreak, and
the outbreak of febrile possibly waterborne disease as the south eastern
outbreak.

An interactive map of the states of India that shows the districts in Uttar
Pradesh can be accessed at
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>. - Mod.CP]

******
[2] A state-wide alert in Uttar Pradesh
Date: Fri 29 Aug 2008
Source: Thaindian News, IANS report [edited]
<http://www.thaindian.com/newsportal/unc ... 90149.html>


Health alert in Uttar Pradesh
-----------------------------
With thousands of people affected by diarrhoea, malaria, gastroenteritis,
and even a mysterious disease that has claimed at least 135 lives, Uttar
Pradesh has sounded a statewide health alert. "Since January [2008], the
state has been grappling with diseases like diarrhoea, gastroenteritis,
measles, malaria and such. Taking this into account, we have sounded the
alert across Uttar Pradesh," I S Srivastava, director general (medical and
health), told Indo-Asian News Service (IANS).

Doctors in the state will now make door-to-door visits in the affected
villages. Fogging and spraying of insecticides will be undertaken on a
war-footing, he added.

The Kanpur division is grappling with a mysterious disease that has claimed
about 135 lives in 4 weeks, officials said Friday [29 Aug 2008]. This
disease has symptoms similar to that of malaria and is accompanied by high
fever.

Since January 2008, diarrhoea has affected more than 7000 people, of whom
94 have died. Likewise, out of the 570 people infected by gastroenteritis,
15 have died, say officials.

In east Uttar Pradesh, acute encephalitis syndrome (AES) has infected more
than 900 people, of whom 160 have died. Cases of jaundice and kala azar
have also been reported, according to health records. The worst affected
districts include Kanpur Dehat (Akbarpur), Muzaffarnagar, Maharajganj,
Siddharthnagar, Mau, Azamgarh, Balrampur and Gorakhpur.

"Directions have been issued to the chief medical officers to disinfect all
sources of drinking water, especially wells and hand pumps," said Srivastava.

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

[This state-wide alert includes the outbreak of AES in eastern Uttar
Pradesh, the outbreak of febrile possibly waterborne disease in the Kanpur
Dehat district in south eastern Uttar Pradesh, and some other outbreaks not
previously reported. - Mod.CP]

******
[3] Rodentborne disease
Date: Fri 29 Aug 2008
From: Dr Jan Clement
<jan.clement.dr@telenet.be>


Rodentborne disease: leptospirosis and hantavirus infection
------------------------------------------------------------
We fully agree with Dr T Jacob John, when he says that immediate
serological testing for leptospirosis is warranted. With the scarce
clinical and epidemiological information we have already, the presumptive
diagnosis of a Japanese encephalitis (JE) outbreak seems rather improbable.
Sudden epidemics of a "viral disease" in warm and moist regions with poor
sanitation should always evoke the possible diagnosis of leptospirosis,
particularly if they occur after floods.

The wild rat is here the prime suspect, being the main (but not the only)
reservoir for leptospirosis. However, the wild rat is also the worldwide
reservoir of at least one known serotype of hantavirus, being Seoul virus
(SEOV). Double infections by both leptospirosis and SEOV have already been
described. In previous ProMED-mail posts, we have already pointed out to
the distinct possibility of a novel hantavirus in India, discovered but not
isolated yet in patients presenting with symptoms suggestive for
leptospirosis. It should be remembered that in similar episodes in Orissa
and Mumba, the serodiagnosis of leptospirosis was worked out indeed, but
not a potential concomitant infection by a hantavirus. It is striking that
in most reports of leptospirosis outbreaks in South East Asia (and even in
South America), the number of seroconfirmed cases surpasses rarely 50 per
cent.

Moreover, the main clinical characteristics of what we know from the
current outbreak in Uttar Pradesh are fever and CNS involvement. Both can
occur also in leptospirosis, as well as in hantavirus infections. Aseptic
meningitis is, together with renal involvement, the most common
complication of leptospirosis, but encephalitis may also occur. The same,
perhaps to a minor degree is true for hantavirus and dengue (Clement J,
Colson P, Van Ranst M. Dengue versus hantavirus CNS infections. Lancet
2000; 355: 2163-4). Leptospirosis and hantavirus infections, although
resulting from totally different pathogens, have not only most clinical
symptoms, but also most laboratory anomalies in common. Both are announced
by thrombocytopenia, the severity of which is an indicator of the clinical
complications to come (Clement J, Maes P, Van Ranst M. Acute kidney injury
in emerging, non-tropical infections. Acta Clin Belg 2007; 62: 387-95).
Thrombocytopenia is not a consistent sign for JE. Early, marked, but
transient proteinuria is the most consistent sign however in both early
leptospirosis and hantavirus infections.

Even in the New World hantavirus infections, which are (wrongly) supposed
to target only the lungs, early proteinuria is found in > 90 per cent of
cases. With the restriction in mind for a minimal degree of proteinuria in
high fever cases (probably even more in infants), a detection of + to +++
degree of proteinuria is without doubt the quickest, simplest, and by far
the cheapest bedside test for a first tentative diagnosis of leptospirosis
and/or hantavirus infections. When urine dipsticks are not available or too
expensive, even the good old urine boiling test might be considered. The
fact that only (?) infants seem affected is the only serious argument
against the tentative diagnosis of both these rodent-borne infections, and
would point rather to a dengue hypothesis.

For reasons still ill understood, hantavirus cases under the age of 15 are
definitely rare in most series. But then, IF there is really a novel
hantavirus roaming around in India, it could as well be a form having the
brain in youngsters as main target organ. Let us not forget that nobody
expected to see emerging in the USA in 1993 a "new disease," affecting
mainly the lungs in healthy young adults, and later called "hantavirus
pulmonary syndrome." Health authorities in Pune tried virus culture to
track the elusive cause of the current outbreak, and expected "results
within 2 or 3 days of collection of the samples."

However, during JE outbreaks, virus isolation is rarely successful, because
the viraemic phase is probably over when CNS symptoms start to appear. The
same goes for hantavirus infections, at least for the milder (Puumala
virus-induced) forms in Europe and Russia. Moreover, hantavirus isolation
is always a tricky affair, needing several time-consuming passages on VERO
E 6 cells in labs with a BSL of at least 3. Finally, since hantaviruses do
not induce a CPE in culture, they can only be detected by selective
techniques such as IFA with specific antisera, or PCR with specific
primers. For a putative novel hantavirus, both are lacking.

--
Jan Clement MD and Piet Maes PhD
Hantavirus Reference Centre
Laboratory of Clinical and Epidemiological Virology and Rega Institute for
Medical Research
University of Leuven
U.Z. Gasthuisberg, Herestraat, 49
B-300 Leuven
Belgium
<jan.clement@uzleuven.be>

[Drs Clement and Maes have made a constructive contribution to assessment
of the etiology of the outbreak of febrile, possibly waterborne, disease in
south eastern Uttar Pradesh. Their assessment of the role of hantaviruses
in such situations is persuasive and worthy of further intensive
investigation. - Mod.CP]

******
[4] The AES outbreak in eastern Uttar Pradesh
Date: Thu 28 Aug 2008
Source: Thaindian News, ANI report [edited]
<http://www.thaindian.com/newsportal/hea ... 89818.html>


Doctors team visit encephalitis-hit Gorakhpur
---------------------------------------------
A team of doctors deputed by the Union Government, including 2 from the
United States, visited Gorakhpur district of Uttar Pradesh today to examine
patients suffering from encephalitis. The team, along with the 2 doctors of
the US Centers for Disease Control and Prevention, Atlanta (CDC), visited
Gorakhpur to examine patients and study the virus that causes the disease.

The fatal vectorborne disease spreads through viral infection and has
already claimed 171 lives during this season. "From 1 Jan 2008, records
shows that 851 people were admitted out of which 171 people have died,"
said Lalit Mohan, a doctor at the local BRD hospital to reporters. Most of
the patients fall in the age group of 6 months to 12 years. The death toll
due to disease is rising and experts have expressed serious concern.

The disease causes inflammation of the brain. The initial symptoms of the
disease are recurring fever and vomiting. Experts feel that parents as well
as the local doctors have failed to understand the seriousness of this mild
fever, which can prove to be fatal.

The disease is endemic to the region and experts say that immediate
measures are required to contain the virus from spreading.

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

[This report refers to the outbreak of undiagnosed fatal disease in eastern
Uttar Pradesh. The etiology of the disease remains unclear.

A map of the Indian state of Uttar Pradesh showing Gorakhpur in the far
east of the state and Kanpur in the central/south-eastern region of the
state is available at
<http://mapsofindia.com/maps/uttarprades ... strict.htm>. - Mod.CP

The AES outbreak report does not indicate why this is not thought to be
Japanese encephalitis (JE). Is this a region where JE vaccine has been
routinely included in the children's vaccine series for years, and where
that coverage has been good, suggesting that most children should be
protected? ProMED-mail would appreciate information on that aspect. - Mod.JW]

UNDIAGNOSED FATAL ILLNESS - INDIA (07): (UTTAR PRADESH)
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<http://www.isid.org>

Date: Mon 1 Sep 2008
From: T Jacob John <vlr_tjjohn@sancharnet.in>


I am responding to the following query in "Undiagnosed fatal illness -
India (06): (UP) 20080830.2718": "The AES [acute encephalitis syndrome]
outbreak report does not indicate why this is not thought to be Japanese
encephalitis (JE). Is this a region where JE vaccine has been routinely
included in the children's vaccine series for years, and where that
coverage has been good, suggesting that most children should be protected?
ProMED-mail would appreciate information on that aspect."

In the last quarter of 2005, over 1500 children died in Eastern Uttar
Pradesh districts due to an outbreak of JE. A quick decision was made by
the Government of India to seek licensure of the live SA-14-14-2 (Chinese
origin) vaccine. In May and June 2006, 6.8 million children, one to 15
years were vaccinated in a highly successful campaign, covering more than
98 per cent of targeted children.

Vaccination was conducted only in the JE endemic districts in the eastern
region of Uttar Pradesh. Thereafter single dose JE vaccine has been
introduced in the National Immunisation Program in these districts and thus
JE vaccination has become "routine" in those districts.

This method of one campaign followed by routine vaccination has been
conducted in all JE endemic districts year by year, from 2006. This year
[2008] the campaigns will be in the southern most state of Kerala (limited
districts). This JE vaccination program is technically and financially
supported by PATH (Program for Appropriate Technology in Health
). You will be able to get full details from PATH (Dr Kathy
Neuzil is the nodal expert).

The Immunisation Program in Uttar Pradesh is weak and apparently the use of
JE vaccine in the routine system has not been very successful (from
conversations, no definitive data). However, local pediatricians have felt
substantial decline of JE from the 2006 JE season. It is for this reason
that the current "acute encephalitis syndrome" is not thought to be JE by
the government medical officers. In one of the reports a couple of weeks
ago there was mention that among over 100 children tested, only 5 had
evidence of JE virus infection. Testing for JE virus infection [by the]
health system in Uttar Pradesh leaves much to be desired from quality and
equity angles. Their annual non-polio "acute flaccid paralysis" rate is
above 7 per 100 000 children under tha age of 15, whereas the norm is 1/100
000 elsewhere. The Polio Eradication Initiative pegged up the norm for
Indian subcontinent to 2/100 000 -- but 7-10 per year remains unexplained.
So, Uttar Pradesh has low literacy, high density of population, high birth
rate, high infant mortality rate, poor vaccination coverage, high burden of
all sorts of infectious diseases, and weak health care and public health
systems. You may recall that Uttar Pradesh (along with neighboring Bihar)
is still endemic with wild types 1 and 3 polioviruses. "The wages of
neglect are death."

--
Dr T Jacob John
Christian Medical College
Vellore
India
<vlr_tjjohn@sancharnet.in>

[ProMED-mail thanks Professor T Jacob John for his comprehensive and
informed response.

A map of India showing the states of Bihar, Kerala, and Uttar Pradesh can
be accessed at
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>. - Mod.CP]

Indien - Chikungunya (CHIC), Dengue (DF), Japanische Enzephalitis (JE)
01.09.2008

Diese, von Mücken übertragenen Viruskrankheiten sind in Indien verbreitet. Vor allem während der Monsunregen muss mit einem erhöhten Infektionsrisiko gerechnet werden, auch in den Städten. In diesem Jahr war bisher die Südwestküste mit Teilen von Kerala und Karnataka betroffen. Derzeit wird eine Krankheitswelle von CHIC aus Bangalore gemeldet. Aus Delhi und Haryana (an Delhi angrenzend) werden seit Mitte August vermehrt Dengue-Erkrankungen gemeldet. Die Fallzahlen liegen höher als im Vergleichszeitraum 2007. Schutz vor tag- und nachtaktiven Stechmücken beachten. Im Mai begann die Übertragungssaison für die Japanische Enzephaltiis. Sie endet im Oktober und hat ihren Gipfel erfahrungsgemäß im August-September. Betroffen sind insbesondere die Bundesstaaten Uttar Pradesh und Bihar. Risiko-Reisende sollten geimpft sein. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (34)
**********************************************
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ProMED-mail is a program of the
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******
Cholera - Iran (Tehran, Qom)
Date: Wed 27 Aug 2008
Source: The National (UAE) [edited]
<http://www.thenational.ae/article/20080 ... 31481/1011>


Health officials have imposed emergency measures in Iran to contain
an outbreak of cholera, with bans in some cities on the sale of raw
salad greens and street food vendors as well as penalties for
businesses that do not heed the warnings.

Officials fear the disease, spread through contaminated water or
food, has been brought in from neighboring Pakistan and Afghanistan.

Hasan Emami Razavi, the deputy health minister, said on Tuesday [26
Aug 2008], 96 people, including 18 Pakistani and Afghan nationals,
have contracted the disease in the past month, and 4 people,
including an elderly man in Tehran, have died.

Fars News Agency, yesterday [26 Aug 2008], reported a 9-year-old
Afghan girl also died, possibly of cholera. The report has not been
confirmed by the health ministry.

In Qom [Qom province] and Karaj [Tehran province], the 2 cities worst
hit by the disease, health officials have banned the sale and supply
of salad and other greens as well as prepared dishes containing these
raw ingredients. Businesses ignoring the warnings face being shut
down. Qom, 183 km (114 mi) south of Tehran, is Iran's 2nd largest holy city.

Millions of Iranians and Shiites from other countries, including
Afghanistan and Pakistan, flock to the city every year to pay their
respects to the shrine of Lady Fatemeh Masoumeh, the daughter of the
7th Shiite Imam. The 1st cases of cholera were reported in Qom in August 2008.

Karaj, 35 km (22 mi) west of the capital, is Iran's 5th largest city
with a population of 1.3 million. After Tehran, it has the largest
number of Afghan immigrants and refugees.

Yesterday [26 Aug 2008], the health ministry said there was no threat
to Tehran from the cholera outbreak.

In 1998, an outbreak of cholera in Iraq that spread to Iran infected
10 000 and killed 100 people. Last September [2007], Iran's Haj and
Pilgrimage Organization suspended sending pilgrims to Iraq after 57
people who had visited the country or been in contact with others
returning from there were diagnosed with cholera.

[Byline: Maryam Sinaiee]

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

[The HealthMap/ProMED-mail interactive map of Iran showing the
affected areas in the north can be found at
<http://healthmap.org/promed?v=32.7,54.2,5>. - Mod.LL]

UNDIAGNOSED FATAL ILLNESS - INDIA ( 08 ): (UTTAR PRADESH)
*******************************************************
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: Fri 5 Sep 2008
From: Dr. John R. Wecker
<jwecker@path.org>

In response to the very informative summary of JE vaccination
activities in Uttar Pradesh (UP) [India], as provided by Dr. T. Jacob
John on 1 Sep 2008 [Archive 20080901.2738], PATH would like to add
the following details: Building off high coverage reported in 7
districts of UP in 2006 (99.9 percent of the target population of 6.8
million children aged 1 - 15 years), JE vaccination campaigns
continued in high-risk districts through 2007 and 2008. In 2007, the
target population was 9.8 million in 11 endemic districts, with
reported coverage of 9.5 million (96.7 percent). In 2008, the target
population was 10.8 million in 9 endemic districts, and reported
coverage was 10.7 million (98.8 percent). In total, since GOI
(Government of India) implemented JE vaccination campaigns in 2006,
27 million children in 27 districts of UP have been vaccinated; 43
million in high-risk districts throughout all of India. The GOI has
developed and funded the JE control strategy, with technical support
provided by PATH, UNICEF, and WHO.

Earlier this year [2008], UNICEF began conducting JE vaccination
coverage evaluation surveys in UP, with data forthcoming. Recognizing
that routine surveillance is critical to measuring the impact of
vaccination on disease burden, GOI (Immunization Division and the
National Vector-borne Disease Control Program) are focusing efforts
on strengthening acute encephalitis syndrome (AES) surveillance
throughout the country and improving laboratory capacity for
confirmation of AES causes.

Routine immunization is also a crucial follow-up activity to JE
vaccination campaigns to ensure that the annual birth cohort is
protected. Logistical challenges between district, state, and
national levels regarding communications and supply have delayed the
introduction of comprehensive, routine JE immunization in many areas
covered in India's vaccination campaigns. However, health officials
are working at all levels to improve routine JE immunization
programs, ensure stable supply, standardize reporting, implement
strong communications, and resolve other logistical challenges. GOI
is preparing guidelines for introduction of routine JE immunization.
State-level workshops conducted with support from PATH are
identifying specific barriers and setting plans for rapidly addressing them.

--
Dr. John R. Wecker
Director, PATH JE project, USA
<jwecker@path.org>

[ProMED thanks Dr. Wecker for providing the details of the JE virus
vaccination campaign in UP. The numbers of individuals vaccinated is
impressive. It would be interesting to know the estimated population
of susceptible individuals in the areas of high risk that are
included in the campaign. The development of laboratory diagnostic
capability will be of particular value in determining the etiological
agents responsible for the acute encephalitis syndrome that
physicians are reporting in the areas.

A map of India showing the states of Bihar, Kerala, and Uttar Pradesh
can be accessed at:
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>. - Mod.TY]

MILZBRAND, HUMAN, BOVINE - KIRGISISTAN (CHUYSKAYA)
***********************************************
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: 1 Sep 2008
Source: Kazakhstan segodnya [trans. Mod.NP, edited]
<http://www.gazeta.kz/art.asp?aid=116794>


Five persons have been hospitalized with anthrax in Kyrgyzstan. The
Kyrgyz Republican Centre of Quarantine & Especially Dangerous
Infections has reported that all 5 persons are inhabitants of the
Zhayilsky district in the Chuyskaya oblast.

They were infected during the necessary [?] slaughter and butchering
of sick animals. It has been established that the cutaneous form of
anthrax affected these 5 individuals.

These are not the 1st cases of anthrax, and the situation with this
disease remains complicated due to the 1260 ground foci of past
infections and the large number of unascertained or lost places of
mortality and burial sites of sick animals. Also, there is a low
level of disease prophylaxis among domestic animals. In all, 27 cases
of anthrax have been registered this year [2008] in Kyrgyzstan.

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

[To find Kyrgyzstan, go to:
<http://www.fallingrain.com/world/KG/>,
Chuy Oblast:
<http://www.fallingrain.com/world/KG/2/>
<http://encarta.msn.com/encnet/features/ ... ckCheck=on>,
where the Kazakh ecology pokes down into northern Kyrgyzstan. - Mod MHJ]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (35)
**********************************************
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:
Asia
[1] Cholera - India (West Bengal)
[2] Cholera - Pakistan (Federally Administered Tribal Areas)

******

[1] Cholera - India (West Bengal)
Date: Sun 7 Sep 2008
Source: The Times of India [edited]
<http://timesofindia.indiatimes.com/Kolk ... 454131.cms>


Around 70 people at Sidhar village under Suti-I block in Murshidabad
are suffering from cholera for the last week or so. The disease has
already claimed 2 lives. Sources said all the tube wells in the
village are lying defunct for the last few months. Some of the wells
are also in a poor condition. So, the villagers were collecting
drinking water from river Banshlai.

The disease possibly broke out as villagers drank the water without
boiling it. 2 children, aged 2 and 4, have died of the disease. 11
victims have been admitted to Raghunathganj and Aahiran hospitals in
a critical condition.

Chief medical officer of health (CMOH), Murshidabad, Srikanta Roy
said: "A medical team is working in the village to stop the disease
from spreading to newer areas. We have also spoken to the local
administration to set up tube wells and repair the old ones."

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

[Murshidabad is located in eastern India in West Bengal and can be
found on a map at
<http://en.wikipedia.org/wiki/Murshidabad_District>. - Mod.LL]

******
[2] Cholera - Pakistan (Federally Administered Tribal Areas)
Date: Fri 5 Sep 2008
Source: Reuters India [edited]
<http://in.reuters.com/article/domesticN ... 05?sp=true>


Cholera has broken out among some of up to 300 000 people in
northwestern Pakistan who have fled fighting between government
forces and militants, the International Committee of the Red Cross
(ICRC) said on Friday [5 Sep 2008]. The situation in the Bajaur
region, a haven for Al-Qaeda and Taliban fighters along the Afghan
border, remains "very volatile" despite a government-declared
ceasefire for Ramadan, a senior ICRC official said.

The neutral humanitarian agency's top priority is providing clean
water and sanitation to tens of thousands who fled Bajaur for nearby
Lower Dir district since the conflict intensified 4 weeks ago.

"Cholera has started in certain areas... It is a major concern,"
Pascal Cuttat, head of ICRC's delegation in Pakistan, told a news
briefing. "The most immediate need remains access to clean water and
sanitation. No food, health care, or shelter is going to be of any
good if people get water-borne diseases," he said.

The ICRC had no figures for the number of cases of cholera, which
Cuttat said had been confirmed in local laboratories by Pakistani
doctors. The World Health Organisation (WHO) said it had no immediate
information on any cholera outbreaks in Pakistan.

About 80 percent of an estimated 50 000 displaced in hot and
overcrowded makeshift camps or schools in Lower Dir, are women and
children, according to Cuttat. Most men stayed in the villages to
guard their property and harvest crops. Another 20 000 people have
fled more recent fighting which erupted in Swat Valley in North West
Frontier Province, he said.

[Byline: Stephanie Nebehay]

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

[Bajaur is an Agency (district) of the Federally Administered Tribal
Areas (FATA) of Pakistan (<http://en.wikipedia.org/wiki/Bajaur>).
FATA can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... kistan.pdf>. - Mod.LL]

Iran - Cholera
08.09.2008

Aus dem Iran wird ein Cholera-Ausbruch mit bisher 96 Erkrankungen und 4 Todesfällen gemeldet. In einigen Regionen wurde den Restaurants der Verkauf von Salat und rohem Gemüse untersagt. Hygiene beachten. / Quelle: crm
________________________

Pakistan - Darminfektionen
08.09.2008

Risiko für Durchfallerkrankungen landesweit. Aus einem Flüchtlingslager im Nordwesten des Landes wurde Anfang September ein Cholera-Ausbruch gemeldet. Mit örtlichen Ausbrüchen muss landesweit gerechnet werden. Typhus kommt vereinzelt vor. Polio zirkuliert noch immer als Wildvirus Typ 1 und Typ 3; für 2006 wurden 40 und für 2007 noch 32 Erkrankungen nachgewiesen. In diesem Jahr waren es bisher 41. Hygiene und Impfschutz beachten. / Quelle: crm

MILZBRAND, HUMAN, BOVINE - KAZAKHSTAN: (ZHAMBYL)
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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: 12 Sep 2008
Source: Russian News & Information Agency [edited]
<http://en.rian.ru/world/20080912/116732104.html>


Five people hospitalized with anthrax in southern Kazakhstan have had
their diagnosis confirmed, the Kazakh emergencies ministry said
Friday [12 Sep 2008]. The patients, from a village in the Zhambyl
Region, were hospitalized a week ago.

"Laboratory tests have confirmed the diagnosis," the emergencies
ministry press service said, adding that the patients were in
satisfactory condition and that people they had come into contact
with were being closely watched.

Measures are being taken to prevent an epidemic in the region.

Outbreaks of anthrax are relatively common in the Central Asian
state. Owners of sick cattle have been known to sell meat from
infected animals after culling them, bypassing veterinary checks.

At least 2 people died of anthrax in Kazakhstan last summer [2007].

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

["Owners of sick cattle have been known to sell meat from infected
animals." Unfortunately, this happens constantly in Central Asia and
Russia. This disease is most common in the swath of the southern
border oblasts of Kazakhstan and is primarily of strains
geographically associated with the historic Old Silk Road. - Mod.MHJ]

MILZBRAND, HUMAN - KYRGYZSTAN (08 ): (BATKEN)
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Date: Mon 15 Sep 2008
Source: Central Asian News [in Russian, trans. & summ. Corr.ATS, edited]
<http://www.ca-news.org/news/37415?from=ya>


Emergency situation is announced in the South of Kyrgyzstan because
of anthrax outbreak
----------------------------------------------------------------------
An emergency situation has been established because of an anthrax
outbreak in the [Kadamdzhay] region of Batken oblast. Two [foci] of
infection have been registered in the villages of Uchkorgon and
Markaz. The local authority reported that 11 people are in the
hospital with suspicion of anthrax and for 5 of them the diagnosis
has been confirmed. One patient is in critical condition. The deputy
head of the district administration, Turgunbay Aytmatova, added that
the patients have all necessary supplies for adequate treatment.

--
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[About 30 cases of anthrax have been registered in Osh, Chuy, and
Jalal-Abad oblasts [provinces] of Kyrgyzstan this year (2008). Batken
oblast updated the list of affected territories. The causes of the
spread of infection were mentioned in ProMED-mail reports previously.
The origin of the problem is the lack of appropriate veterinary
control over farm animals. It is interesting that outbreaks of
foot-and-mouth disease were recorded in the same regions during
2006-2007. The recent outbreak of foot-and-mouth disease in cattle
has been handled successfully in Kyrgyzstan, however it seems that
the veterinary service is employing a narrowly defined, rather than a
system wide approach in this republic. - Mod.NP

The BBC has picked up this story and reported it at
<http://www.redorbit.com/news/health/155 ... _district/>

"The Batken oblast/province is to the west of Osh and is surrounded
by Tajikistan. It is essentially mountain ranges with a few strung
out valleys narrowly winding into the mountains. Isolated. The
Kadamdzhay raion/district/county is in the top right quadrant of
Batken and has a significant amount of sand hills in its centre. The
northern border is in the Fergana valley so unless Uchkorgon & Markaz
are tucked away in the hills they are more likely to be sharing the
Fergana ecosystem and the ongoing disease hazards of that region, as
do the Kyrgyz oblasts of Osh and Jalalabad."
For Kyrgyzstan, go to:
<http://www.lib.utexas.edu/maps/commonwe ... pol_05.jpg>
Batken can be located on the map at:
<http://www.fallingrain.com/world/KG/0/Batken.html>. - Mod.MHJ]

JAPANESE ENCEPHALITIS - INDIA (02): (UTTAR PRADESH)
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Wed 17 Sep 2008
Source: ABC news, Associated Press (AP) report [edited]
<http://abcnews.go.com/International/wir ... id=5820792>


Bad vaccines risk encephalitis epidemic in India
------------------------------------------------
India's government sent thousands of ineffective vaccines to a
northern Indian state, halting a planned immunization drive against a
deadly outbreak of Japanese encephalitis that has killed more than
200 children since June [2008], officials said Wednesday [17 Sep 2008].

The mistake -- compounding delays in starting the immunizations --
raises chances that hundreds more children could die of the disease
this year [2008], health officials warned.

North India's impoverished Uttar Pradesh state suffers from recurring
annual outbreaks of the mosquito-borne disease, which causes high
fevers and vomiting -- and sometimes comas and death. It is
particularly deadly among children.

Japanese encephalitis can be prevented by a vaccine, but stocks sent
by the federal government to the state showed in testing that they
were "unfit for human use," state Health Minister Anant Kumar Mishra
told The Associated Press in Lucknow, the state capital.

"Over 1000 people have been affected with encephalitis, and we are
not sure when the fresh stock of vaccines will arrive," Mishra said.
"In the absence of vaccine we cannot start the vaccination drive."

In 2005, more than 1500 children were killed by the disease, but the
numbers dropped sharply after the government started an annual
vaccination drive in 2006.

Last year [2007], about 400 children were killed by Japanese
encephalitis [virus] in Uttar Pradesh. Officials had hoped to keep
the death toll relatively low this year [2008].

Uttar Pradesh's director general of health, Ishwar Sharan Srivastava,
said the state had asked for the vaccines earlier -- in time for the
monsoon season's start in June -- but only received them last week
[week of 8 Sep 2008]. He said they needed up to 1 million vaccine [doses].

And Mishra said that of the 460 000 vaccine [doses] received, many
had indicators that they had lost their potency. Officials from the
federal Health Ministry said it was not immediately clear what happened.

"It is hard to tell as how these vaccines got spoiled. The exact
reason could be ascertained only after tests," said Dr Jagdish
Chandra, a Health Ministry expert sent to investigate.

At least 234 children, all under 15 years, have died of the disease
since June this year [2008], and the death toll is likely to rise
without vaccinations, Mishra said.

Encephalitis usually spreads in eastern parts of Uttar Pradesh during
and after the June-to-September monsoon season, when pools of
stagnant water provide breeding grounds for mosquitoes.

The mosquitoes transmit the virus from pigs and birds to humans.
Since most infected people never develop symptoms, many adults are
immune from earlier exposure -- leaving young children most vulnerable.

[Byline: Biswajeet Banerjee]

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

[The newswire refers to the existing Japanese encephalitis (JEV)
vaccine distributed in Uttar Pradesh as "unfit for human
consumption". A further scientific definition of "unfit for human
consumption" is not specifically provided so it is unclear if the
problem relates to a break in the cold chain or if the problem
relates to the initial production process. In the former case, the
cold chain refers to the temperature requirements to maintain potency
of manufactured vaccine from the production site up through the
actual delivery site when vaccine is administered. Many of the
vaccines in use today are heat labile, so that if stored or
transported at high temperatures, the vaccine will lose its potency.
To monitor this, vaccine vials now have temperature markers, which
will change color when the vaccine has been exposed to temperatures
above safe levels that would threaten the vaccine potency. The
newswire above suggests that this is the case: "many had indicators
that they had lost their potency."

According to the WHO (World Health Organization) website, "Licensed
JE vaccines include inactivated mouse brain-derived vaccines, a Vero
cell-derived inactivated vaccine, and a live attenuated SA14-14-2
vaccine produced in primary hamster kidney cells. Currently, there is
no JE vaccine which is WHO-prequalified. Recognizing the burden of
disease, more countries are introducing JE vaccination into their
routine paediatric schedules. The inactivated mouse brain-derived
vaccine is gradually being replaced by the live attenuated SA14-14-2
vaccine. In addition, several candidate vaccines are in late stage
development, and are expected to be licensed in the near future. With
improved vaccines becoming available, the global demand for JE
vaccines is projected to more than double by 2012." (For detailed
information on the types of vaccine currently in use and under study, see
<http://www.path.org/vaccineresources/fi ... 5Mar08.pdf>).


In the past, India was using a locally prepared JEV that was an
inactivated mouse brain-derived vaccine. In the recent past, in
collaboration with PATH (formerly known as Program for Appropriate
Technology in Health), India has been using the live attenuated
SA14-14-2 vaccine to expand vaccination activities against JE in the
country (see <http://www.path.org/projects/japanese_e ... roject.php>).

If the vaccines that were used in Uttar Pradesh (UP) were substandard
in terms of potency, that would help to explain why this year (2008)
has seen a major increase in the JE activity in UP in spite of
increased vaccination activities.

More information on official investigations on the potency of
distributed JEV in Uttar Pradesh from knowledgeable sources would be
greatly appreciated.

For a map of India with states, see
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.

For the interactive HealthMap/ProMED map of India with links to other
recent ProMED-mail postings on events in India and surrounding areas, see
<http://healthmap.org/promed?v=22.9,79.6,5>. - Mod.MPP]

MILZBRAND, HUMAN - KYRGYZSTAN (09): (BATKEN, JALAL-ABAD)
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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: Tue 16 Sep 2008
Source: RIA (Russian News & Information Agency) Novosti [edited]
<http://en.rian.ru/world/20080916/116836545.html>


Two outbreaks of anthrax have been reported in southern Kyrgyzstan, a
source in the republic's emergencies ministry said on Tuesday [16 Sep 2008].

The potentially fatal disease has been confirmed in 14 people,
including several children, in the republic's Batken Region. [An
increase of 3 more cases. - Mod.MHJ] All of them became infected
after culling sick cattle.

Six people have also been hospitalized after showing symptoms of the
disease in the southwestern Jalal-Abad Region. The health of another
71 people is being monitored.

--
Communicated by:
ProMED-mail
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[As before, this reflects the ongoing inadequate control situation in
the Fergana valley. - Mod MHJ]

Indien - Poliomyelitis
22.09.2008

Trotz flächendeckender Impfkampagnen gehört Indien noch immer zu den vier Ländern mit endemischer Polio und steht mit den Fallzahlen weltweit nach Nigeria an zweiter Stelle. Bis 16. September diesen Jahres wurden bereits 420 Erkrankungen registriert. Hygiene und Impfschutz beachten.

Kasachstan - Milzbrand
22.09.2008

Am 12. September wurde bei 5 hospitalisierten Patienten im Süden Kasachstans die Diagnose Milzbrand bestätigt. In Zentralasien wird häufig das Fleisch verendeter Tiere ohne veterinärmedizinische Kontrolle auf den Markt gebracht. Nahrungsmittelhygiene beachten.
_______________________

Kirgisistan - Milzbrand
22.09.2008

Mitte September werden zwei Ausbrüche von Milzbrand bestätigt. Hierbei sind 14 Personen in der Region Batken erkrankt, 6 in Jalal-Abad. In Zentralasien wird häufig das Fleisch verendeter Tiere ohne veterinärmedizinische Kontrolle auf den Markt gebracht. Nahrungsmittelhygiene beachten.