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HEPATITIS A - INDIA: (DELHI) MEDICAL COLLEGE
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Date: Sat 1 Feb 2014
Source: Daily Mail [edited]
http://www.dailymail.co.uk/indiahome/in ... break.html


This time, it is at the Girls' Hostel of the Maulana Azad Medical College (MAMC) in the Capital [Delhi] where 53 medical students have reportedly contracted hepatitis A after consuming contaminated water, and possibly food. While doctors from the Community Medicine Department and the National Institute of Communicable Diseases (NICD) have gone into action to tackle the situation, students alleged the college authorities had turned a blind eye to repeated complaints about "miserable" water quality.

With hepatitis A looming large, students have been asked to report any form of illness that may indicate contracting the virus. At least 53 students from the girls' hostel of the Maulana Azad Medical College have taken ill after reportedly consuming contaminated water and food. Notices have been put up across the hostel urging the students to inform community medicine department if anyone is suffering from hepatitis A or any water-borne disease, or even if there are symptoms of any such disease.

The GB Pant Hospital, which is associated with MAMC, has hurriedly constituted a committee to deal with the problem, and water facilities at the hostel have been inspected. But it is a belated action, students said. "We complained several times to the college authorities, but everyone turned a blind eye. The drinking water facilities were already miserable, and adding to the problem were the workers in hostel mess who had been rearing rabbits. The rodents often nibbled on the food that was supplied to us," a student alleged.

"Two months ago [November 2013], some students fell ill but the authorities didn't pay any attention. Gradually, the numbers started increasing. Today [31 Jan 2014], at least 53 students are suffering from hepatitis A," she said. Pointing at apathy on part of the college authorities, another student alleged that there was no provision to check quality of food and water. "The water in the hostel was really bad. We are compelled to stay here and consume the dirty food and water," she said on condition of anonymity.

A visibly shaken up college administration is now trying to get things in order.

"In November 2013, we came across some cases of Hepatitis A. Earlier this week [week of 27 Jan 2014], we had a few more cases. We immediately started chlorination of water. We have cleaned the water coolers and water filters. We have called in NICD experts in the college," said Dr Deepak K. Tempe, Dean of MAMC.

"Some cases of food poisoning are also suspected because of the rabbits in the mess. We have already removed the rabbits from the mess," he claimed. "The department of community medicine has also been chipped in. We have constituted a committee of doctors that is looking into the matter seriously," Tempe added.

The college authorities are mulling over the need to vaccinate all the students, but NICD has not recommended mass vaccination so far.

Meanwhile, officials of Delhi Jal Board have blamed the hostel authorities. "There can be a possibility that they are not cleaning their water tanks or pipes," a Delhi Jal Board official said.

[Byline: Neetu Chandra]

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[Hepatitis A is a liver infection caused by the hepatitis A virus. The virus is spread by faecal-oral transmission. Hepatitis A is closely associated with inadequate sanitation and poor personal hygiene. Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms. Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Waterborne outbreaks, though infrequent, are usually associated with sewage contaminated or inadequately treated water.

Casual contact among people does not spread the virus. In developing countries [where sanitary conditions are poor], most children experience infection in early childhood. As a consequence of poor sanitary conditions and hygienic practices, most children (up to 90%) have been infected with the hepatitis A virus before the age of 10. Those infected in childhood do not experience any noticeable symptoms. Consequently epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low and outbreaks are rare.

In developing countries, countries with transitional economies and regions where sanitary conditions are variable, children often escape infection in early childhood. Ironically, these improved economic and sanitary conditions may lead to a higher susceptibility in older age groups and, [because infections that occur in adolescents and adults are more often symptomatic,] higher disease rates and large outbreaks can occur.

According to Wikipedia, the Maulana Azad Medical College (MAMC) is a government medical college in Delhi affiliated with the University of Delhi. It is named after an Indian freedom fighter and the 1st education minister of independent India. It is located at Bahadur Shah Zafar Marg, New Delhi. MAMC is one of India's premier medical colleges and consistently ranked amongst the top 5 medical colleges in the country. - Mod.CP


A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2joK.]

HEPATITIS A - INDIA (02): (DELHI) MEDICAL COLLEGE, COMMENT
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Date: Sun 2 Feb 2014
From: Professor T Jacob John <tjacobjohn@yahoo.co.in> [edited]


Hepatitis A outbreak in an Indian medical college -- comment
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An outbreak of hepatitis A in a medical college is not only distressing news but also disappointing [see ProMED-mail Hepatitis A - India: (Delhi) medical college 20140202.2248684]. India has transitioned from hyper-endemic state with no outbreaks to outbreaks in many places, since about the beginning of this century. One of the earliest and best reported outbreaks was in another medical college, Kottaym, Kerala in 2003, as reported by Arankalle VA et al [Arankalle VA, Sarada Devi KL, Lole KS, et al: Molecular characterization of hepatitis A virus from a large outbreak from Kerala, India. Indian J Med Res 2006; 123(6): 760-9; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16885597]

Hepatitis A is prevented by immunisation. The vaccine is completely safe. The inactivated virus vaccine is more expensive than the live virus vaccine made in China and licensed in India. Virtually every one gets hepatitis A infection, with increasing frequency of disease, and even outbreaks, in India, on account of the age shift of 1st infection from pre-school age to adolescents and adults.

In both outbreaks in the 2 medical colleges no one seems to have considered immunisation to control the outbreak. There is no excuse for not vaccinating medical and nursing students at the time of entry, either after antibody screening (to save on vaccines in those already immune) or without it (for simplifying the process).

--
T Jacob John
Kamalakshipuram
Vellore, TN 632002
India
<tjacobjohn@yahoo.co.in>

[ProMED-mail thanks Professor T Jacob John for provision of this information and recommendations for future practice in Indian medical schools. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2joK.]

DENGUE/DHF UPDATE (11): ASIA
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Malaysia (Pehang state). 27 Jan 2014. Dengue 82 cases; District most affected: Kuantan 51 cases.
http://www.themalaymailonline.com/malay ... n-the-rise

[Maps of Malaysia can be seen at
http://www.ezilon.com/maps/images/asia/ ... al-map.gif and
http://healthmap.org/r/1yAq. - Mod.TY]

LEISHMANIASIS - PAKISTAN: (FEDERALLY ADMINISTERED TRIBAL AREAS)
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Date: Mon 3 Feb 2014
Source: The News, Pakistan [edited]
http://www.thenews.com.pk/Todays-News-7 ... sis-in-Lan


Officials at the Agency Headquarters Hospital in Landikotal said on Sunday [2 Feb 2014] that they had diagnosed over 254 patients with leishmaniasis.

However, they claimed to have initiated an awareness campaign against the disease in the entire Khyber Agency. Agency Surgeon Dr Abdur Rehman told The News that health officials had detected 254 patients in Landikotal tehsil [a tehsil is an administrative division] in January 2014, which comprised mostly women and children.

The health official said that the disease is caused by the bite of sand flies, which have invaded most parts of Fata [Federally Administered Tribal Areas]. "Though we have registered and diagnosed hundreds of leishmaniasis cases in Landikotal in the past few months, the disease is rampant in most parts of Fata, as tribesmen are not fully aware about the gravity of this disease and the free treatment provided by the Directorate of Health Fata," Dr Rehman said.

He said it was unfortunate that most of such cases were laying hidden inside houses in most tribal areas due to lack of awareness among the masses. He said the disease could easily be communicated to members of a family when a sand fly bites one person in a house. Dr Rehman Afridi said the case reporting has registered a sharp rise in recent days as an effective anti-leishmaniasis campaign has been launched in all the 3 tehsils of Khyber Agency.

Regarding the root of the sand fly, he said it had come from bordering areas of Afghanistan. He said a study conducted by the department showed that most affected patients belong to border areas. Some patients at the AHQ hospital in Landikotal, however, complained that they were facing difficulties in getting free and timely treatment. They said they had repeatedly approached the medical superintendent of the hospital but to no avail.

Most of the patients belong to poor families who are unable to afford the costly treatment on their own. Local elders also demanded that the health authorities ensure timely distribution of mosquito nets. They alleged that nets were given to undeserving and comparatively well-off people instead of underprivileged people. They said that, hopefully, timely and judicious distribution would help stop leishmaniasis.

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[Landikotal is located close to the border between Pakistan and Afghanistan on the Peshawar-Kabul highway.

Leishmaniasis, mainly cutaneous leishmaniasis [CL], is rampant in Afghanistan and Pakistan. Control measures completely ceased under the Taliban regime, and control measures are still grossly inadequate in both Afghanistan and Pakistan.

In Pakistan, CL is a major and fast increasing public health problem, both among the local Pakistani population and the Afghan refugees in camps. Its extensive spreading has been associated with mass migration, from endemic to non-endemic areas and vice versa, and with Afghan refugees from areas where CL is highly endemic. Outbreaks are frequent -- for example, in early 2011 in Mianwali, Punjab province, which is a bordering district with Kyber Pakhtunkhwa province, and probably cases have come from Afghan refugees residing in the area.

In Afghanistan, CL is well known under the name "saldana" ("that which lasts one year"). Leishmaniasis in Afghanistan was almost eradicated in the 1960s and 70s, when an extensive DDT spraying campaign greatly reduced the sandfly population. However, CL by _L. tropica_ has now returned as a major public health problem.

CL is underreported. Surveys consistently show higher case numbers than the officially reported ones. Reporting systems are weak, and many patients resort to the informal private sector because of the lack of drugs in government clinics.

The above citations are both from: Alvar J, et al. Leishmaniasis worldwide and global estimates of its incidence. PloS One Published: 31 May 2012, DOI: 10.1371/journal.pone.0035671. http://www.plosone.org/article/info%3Ad ... 35671.s086. - Mod.EP

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (06): ASIA
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Cholera - Iran
Date: Tue 28 Jan 2014
Source: Trend News Agency [edited]
http://en.trend.az/news/society/2235134.html


Some 256 cases of cholera infection were revealed in Iran in the current year (the year in Iran changes on 21 March), deputy head of the Iranian Health Ministry's Communicable Diseases Centre, Mahmoud Nabavi said, IRNA [Islamic Republic News Agency] reported on 28 Jan 2014. He said all the necessary measures have been taken in this regard and the general condition of patients is satisfactory.

He said that 83 per cent of people infected with cholera are citizens of the neighboring countries and illegal migrants. "Over 74 per cent of people infected with this disease live in villages. Some 91 per cent of the infected are men," he said.

The cases of cholera infection have been identified in Iran for about 45 years, according to Iranian media outlets.

As of September 2013, the number of people infected with cholera was 170.

[byline: Temkin Jafarov]

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[Maps of Iran can be seen at http://www.ezilon.com/maps/images/asia/ ... f-Iran.gif and http://healthmap.org/r/1Cfu. - Sr.Tech.Ed.MJ]

KYASANUR FOREST DISEASE - INDIA: (KARNATAKA)
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Date: Sat 8 Feb 2014
From: Dr Gudadappa Kasabi <drgudadappa@gmail.com> [edited]


Kyasanur Forest disease cases started reporting this year [2014] among residents of Shimoga district of Karnataka [state], India. Out of 20 suspected cases, 12 samples were tested and 6 were confirmed positive by RT-PCR. The remaining 8 samples need to be tested.

--
Dr Gudadappa Kasabi
Health and Family Welfare Department
Karnataka
India
<drgudadappa@gmail.com>

[The disease was 1st detected in Shimoga district, Karnataka state, in 1957 and has since appeared sporadically in the thickly wooded areas of Dakshina Kannada, Udupi, Chikmagalur, Shimoga, and Chamarajanagar (all in Karnataka state). The disease occurs in humans and monkeys, and the virus is transmitted by ticks with _Haemaphysalis spinigera_ as the major vector. Most human cases occur during the dry season. Additional information is available from the CDC fact sheet (see: http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... estDis.pdf).

ProMED-mail thanks Dr Gudadappa Kasabi for submitting this 1st hand report from Karnataka state.

A HealthMap/ProMED-mail interactive map showing the location of the Shimoga district, Karnataka state, can be accessed at http://healthmap.org/r/1L-v. - Mod.TY]

CHICKENPOX - THAILAND: CHILDREN
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Date: Mon 3 Feb 2014
Source: The Global Dispatch, Outbreak News [edited]
http://www.theglobaldispatch.com/thaila ... ary-41035/


The Thailand Ministry of Public Health (MOPH) is reporting an outbreak of chickenpox, which infected some 2565 patients during the 1st 19 days of January 2014, according to a National News Bureau of Thailand report today [3 Feb 2014].

The Permanent Secretary for Public Health Dr Narong Sahamethapat stated that the cool weather during January-March of every year was conducive to the spread of varicella-zoster virus, the chickenpox virus. He thus encouraged all to be on guard against the highly communicable disease, as anyone with low immunity could be infected, especially children under the age of one. Thailand reported 48 000 chickenpox cases during 2013, with most cases seen in children aged between 5 and 9.

Chickenpox is a common, usually benign childhood disease caused by varicella-zoster virus (VZV), a member of the family _Herpesviridae_. This virus causes 2 distinct diseases; varicella (chickenpox) is the primary infection, and later when VZV reactivates, herpes zoster (or shingles).

Chickenpox is highly contagious and is spread by coughing and sneezing, by direct contact, and by aerosolization of the virus from skin lesions. You can also get it by contact with the vesicle secretions from shingles. The disease is characterized by fever and a red, itchy skin rash that usually starts on the abdomen, back, or face and then spreads to nearly all parts of the body. The rash begins as small red bumps that appear as pimples or insect bites. They then develop into thin-walled blisters that are filled with clear fluid which collapse on puncture. The blisters then break, crust over, and leave dry brown scabs.

The chickenpox lesions may be present in several stages of maturity and are more abundant on covered rather than exposed skin. Lesions may also be found in the mouth, upper respiratory tract, and on the genitals. Chickenpox is contagious from 1-2 days before the rash forms and continues until all the lesions are crusted over (usually about 5 days). This disease is more serious in adults than in children. Complications of chickenpox are rare but include pneumonia, encephalitis and secondary bacterial infections. Infection with this virus usually gives lifelong immunity, although 2nd attacks have been documented in immuno-compromised people. The viral infection remains latent, and disease may recur years later as shingles. According to the Centers for Disease Control and Prevention (CDC), chickenpox vaccine is the best protection against chickenpox. The vaccine is made from weakened (attenuated) varicella virus that produces an immune response in your body that protects you against chickenpox. The chickenpox vaccine was licensed for use in the United States in 1995.

[Byline: Robert Herriman]

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[The large number of cases of chickenpox is unusual and not explained.

Chickenpox is a very contagious disease caused by varicella-zoster virus (VZV). It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters. Before the availability of a vaccine, about 4 million people would get chickenpox each year in the United States. Also, about 10 600 people were hospitalized, and 100 to 150 died each year as a result of chickenpox.

Chickenpox vaccine is very safe and effective at preventing the disease. Most people who get the vaccine will not get chickenpox. If a vaccinated person does get chickenpox, it is usually mild, with fewer blisters and mild or no fever. The chickenpox vaccine prevents almost all cases of severe disease. Varicella virus is a DNA virus, and infection can be treated also with the antiviral drugs (acyclovir, valacyclovir, and famciclovir).

Primary infection with VZV causes varicella. Reactivation of latent infection causes herpes zoster (shingles). Shingles, also known as zoster or herpes zoster, is a painful skin rash caused by the varicella-zoster virus, the same virus that causes chickenpox. Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However, the risk of getting the disease increases as a person gets older. About half of all cases occur among men and women who are 60 years old or older. People who have medical conditions that keep their immune systems from working properly, such as certain cancers, including leukemia and lymphoma, and human immunodeficiency virus (HIV), and people who receive immunosuppressive drugs, such as steroids and drugs given after organ transplantation, are also at greater risk of getting shingles. People who develop shingles typically have only one episode. In rare cases, however, a person can have a 2nd or even a 3rd episode. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1l5W.]

DENGUE/DHF UPDATE (13): ASIA
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Malaysia (Petaling Jaya, Selangor state). 7 Feb 2014. Dengue as of 1 Feb 2014, 835 cases.
http://www.thestar.com.my/News/Nation/2 ... ts-a-snag/

[Maps of Malaysia can be seen at http://www.ezilon.com/maps/images/asia/ ... al-map.gif and
http://healthmap.org/r/a8G2. - Mod.TY]

DENGUE/DHF UPDATE (15): ASIA
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Malaysia
- National. 13 Feb 2014. Dengue 11 870 cases; deaths 22.
http://malaysiandigest.com/news/487662- ... jan-1.html

[An additional report indicated that the most common dengue virus circulating is type 2.
http://www.thestar.com.my/News/Nation/2 ... ts-says-d/

[Maps of Malaysia can be seen at http://www.ezilon.com/maps/images/asia/ ... al-map.gif and http://healthmap.org/r/alyH. - Mod.TY]

- Kedah state. 12 Feb 2014. Dengue 106 cases; deaths 1. Municipality most affected: Kuala Muda 61 cases.
http://www.nst.com.my/latest/106-dengue ... r-1.481744

Pakistan (Sindh province). 11 Feb 2014. Dengue 99 cases. Municipality most affected: Karachi (95 cases).
http://www.thenews.com.pk/article-13745 ... in-Karachi

[A new report indicated 97 cases in Karachi with 1 death.
http://www.pakistantoday.com.pk/2014/02 ... to-strike/

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

RABIES - INDIA: (TAMIL NADU) CANINE, HUMAN
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Date: Sat 22 Feb 2014
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 808579.cms


A 24-year-old post-graduate student of social work at Madras Christian College [MCC], Tambaram [Tamil Nadu state], died of rabies early on Friday [21 Feb 2014]. He was bitten by a rabid pup on the college campus in November 2013. He was a dog lover.

In November 2013, he and his classmates were walking to their department when they came across the pup. He and a classmate played with the pup, which bit them both. He and his friend went to general physicians to get treated. "The girl's physician recommended that she take the anti-rabies vaccine, but the man's doctor seems to have said a tetanus toxoid shot would suffice," said Durai Jasper, public relations officer of CMC Vellore, who confirmed that he died at the hospital at 1:00 a.m. on Friday [21 Feb 2014].

A post by MCC's department of social welfare on a social networking site on 13 Feb [2014] said the man complained of shoulder pain after 2 days, and his parents took him to a doctor close to their home. The doctor informed them that the man was displaying symptoms of advanced stage of rabies and told them to take him to a government hospital.

[Byline: M Ramya]

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[Unfortunately, human rabies cases of canine origin are not rare in India, and a case occurred last year (2013) in Tamil Nadu state. It is not clear why the female classmate was given post-exposure treatment for rabies, but the young man was not. This case underscores the need to have the source of the virus, in this situation the puppy, tested for rabies. Had that been done, the young man undoubtedly would have been treated for rabies exposure.

A HealthMap/ProMED-mail map showing the location of Tamil Nadu state can be accessed at http://healthmap.org/r/2kP3. - Mod.TY]

DENGUE/DHF UPDATE (17): ASIA
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Thailand
Date: Sun 23 Feb 2014
Source: National news Bureau of Thailand (NNT) [edited]
http://thainews.prd.go.th/centerweb/new ... 2230010004


The Trang Public Health Office is urging people to eliminate mosquito breeding sites to prevent dengue outbreaks. Dr. Witoon Leungdilok, Trang Public Health physician, said that dengue fever patients have already been diagnosed frequently between 1 Jan and 17 Feb, this year [2014].

There have been 1433 patients with dengue fever, one of whom died. However, it's expected that the incidence of dengue this year [2014] will not be as severe as in 2013, when 152 768 dengue patients were identified, the highest number in 20 years. Of the sufferers, 132 died. Even so, this year [2014] may see up to 80 000-100 000 patients.

The Ministry of Public Health has instructed the Public Health Office nationwide to encourage people to eliminate mosquito breeding sites around households, especially in the areas where dengue patients were found last year [2013]. Mosquito breeding sites should be eliminated every week.

From analysis of data on the dengue situation in 2013, the highest number of dengue patients occurs in the adolescent group aged 15-24, followed by children aged 10-14, children aged 5-9 years, and adults aged 25-34. This year [2014], teenagers are still the most vulnerable group due a lifestyle that brings risks of being bitten by mosquitoes while enjoying activities outside the classroom, or being outdoors at night for a long time.

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[According to the above newswire, 1433 dengue fever cases were reported from 1 Jan to 17 Feb 2014 with one death.
Last year [2013], Thailand experienced one of its worst outbreaks in the last 20 years, with over 135 000 reported cases, including some deaths http://www.phac-aspc.gc.ca/tmp-pmv/noti ... .php?id=44.
There is no vaccine to protect against dengue. Developing a vaccine against dengue/severe dengue has been challenging, although there has been recent progress in vaccine development. WHO provides technical advice and guidance to countries and private partners to support vaccine research and evaluation. Several candidate vaccines are in various phases of trials.

Outbreaks of dengue fever have become increasingly frequent over the past 25 years. Background information on dengue in the region is available from the general ProMED-mail list. The postings below can be found at http://www.promedmail.org.

A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/atiW. - Mod.TTM]

[Official statistics on reported cases of dengue fever, DHS (dengue hemorrhagic syndrome) and DSS (dengue shock syndrome) can be found at the Thailand Ministry of Public Health surveillance data website at http://www.boe.moph.go.th/boedb/surdata/. - Mod.MPP]

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Malaysia:
- National. 18 Feb 2014. Dengue 13 915 cases; Deaths 6.
http://www.thestandard.com.hk/breaking_ ... d=4&d_str=

[Maps of Malaysia can be seen at http://www.ezilon.com/maps/images/asia/ ... al-map.gif and http://healthmap.org/r/alyH. - Mod.TY]

- Selangor state. 18 Feb 2014. Dengue, districts most affected: Subang Jaya in January 2014 alone 971 cases, (conf.) 871 cases; Petaling 3796 cases with one death.
http://www.thestar.com.my/News/Communit ... ed-to-108/

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Pakistan (Sindh province). 22 Feb 2014. Dengue 115 cases; Municipality most affected: Karachi 109 cases.
http://www.thenews.com.pk/article-13876 ... in-Karachi

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

DENGUE/DHF UPDATE (19): ASIA
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Malaysia (national). 3 Mar 2014. Dengue as of 28 Feb 2014, 18 047 cases; deaths 36.
http://english.astroawani.com/news/show ... niam-31114

[Maps of Malaysia can be seen at http://www.ezilon.com/maps/images/asia/ ... al-map.gif and
http://healthmap.org/r/1yAq. - Mod.TY]

India (Pune, Maharashtra state). 26 Feb 2014. Dengue 47 cases.
http://timesofindia.indiatimes.com/city ... 039377.cms

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

Pakistan (Sindh province). 22 Feb 2015. Dengue 115 cases. Municipality most affected: Karachi 109 cases.
http://www.thenews.com.pk/article-13876 ... in-Karachi

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

MALARIA, PLASMODIUM KNOWLESI, HUMAN - MALAYSIA
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Date: Sun 2 Mar 2014
Source: The Global Dispatch [edited]
http://www.theglobaldispatch.com/cases- ... sia-27363/


Health officials in Malaysia are showing concern over the increases in cases of the "monkey malaria" _Plasmodium knowlesi_ in humans in recent years, according to a Sun Daily report today [2 Mar 2014].

University of Malaya Department of Parasitology consultant Datin Dr Indra Vythilingam said the number of cases had increased significantly since 2004. "We have seen a lot of people with monkey malaria," she told the Sun today [2 Mar 2014].

_Plasmodium knowlesi_, often considered the 5th human malaria species (along with _P. falciparum_, _P. vivax_, _P. malariae_ and _P. ovale_) because it has been seen in humans, is still mostly known as a malaria of macaques in southeast Asia, where 78 percent of the monkeys tested were positive.

In 2011, in a paper published in the journal PloS Pathogens, researchers from Malaysia and London warned that this species of malaria, most frequently seen in macaques, could eventually target humans. Researchers at the time were concerned about this huge reservoir of _P. knowlesi_ in the monkeys and the increasing human populations and deforestation. The Sun Daily reports that in 1992, the parasite only accounted for one percent of reported malarial infections in Malaysia, but cases had increased to 35 percent in 2011.

Malaysian health authorities are taking measures to get the monkey malaria under control. These measures include setting up a surveillance system, an integrated vector management system, early detection and prompt treatment, preparedness and outbreak response, capacity-building, and operational research.

_Plasmodium knowlesi_ is mostly found in Southeast Asian countries, particularly in Borneo, Malaysia, Myanmar, the Philippines, Singapore, and Thailand.

_Plasmodium knowlesi_ is absent in Africa. This may be because there are no long-tailed and pig-tailed macaques (the reservoir hosts of _P. knowlesi_) in Africa, and many West Africans lack the Duffy antigen, a protein on the surface of the red blood cell that the parasite uses to invade. Mosquitoes belonging to the _Anopheles leucosphyrus_ group are known to transmit _P. knowlesi_ from monkeys to humans.

[Byline: Robert Herriman]

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

[It is not entirely clear whether this article refers to a percentage increase in the number of _P. knowlesi_ cases or to an increase in absolute numbers. Before 2008, _P. knowlesi_ was diagnosed as _P. malariae_ based on microscopy of blood films. A percentage increase -- as alluded to -- since 1992 is simply a function of the increasing use of molecular diagnostics and may not reflect a real increase.

Infection with _P. knowlesi_ is transmitted from Macaque monkeys, and so far, human-to-human transmission via mosquito is not believed to take place. The Macaque monkeys are not found outside Southeast Asia, and thus _P. knowlesi_ is not found outside the habitat of Macaque monkeys. - Mod.EP

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

KYASANUR FOREST DISEASE - INDIA (02): (KERALA)
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Date: Sat 1 Mar 2014
Source: Daijiworld [edited]
http://www.daijiworld.com/news/news_dis ... _id=220679


With more than a dozen people in the Malnad region [in Shimoga district] infected by Kyasanur Forest disease (KFD), which is generally known as monkey fever, Karnataka's Health Minister UT Khadar has urged the people of the Malnad region and those residing adjacent to forest areas to take all precautionary steps to prevent spreading of money fever.

Khadar, who spoke to reporters after holding a meeting with officials of the Health Department in Bangalore on Saturday [1 Mar 2014], said 24 cases of money fever have been reported from Thirthahalli and other parts of Shimoga and Chikmagalur districts. Out of 90 cases reported, blood tests have confirmed 24 cases of money fever. The disease has not claimed any lives so far, the minister said.

The officials of the department have been instructed to ensure availability of medicines at the primary health centres to check the spread of money fever and other communicable diseases during the summer.

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[The disease was 1st detected in Shimoga district, Karnataka state in 1957 and has since appeared sporadically in the thickly wooded areas of Dakshina Kannada, Udupi, Chikmagalur, Shimoga, and Chamarajanagar (all in Karnataka state), where it is endemic. The increased rate of illegal felling of trees and deforestation has been blamed as one of the reasons for the outbreaks of Kyasanur Forest disease (KFD). The disease occurs in humans and monkeys.

Although the virus has been isolated from 16 species of ticks, _Haemaphysalis spinigera_ is the major vector. Most human cases occur during the dry season. The only way to prevent occurrence of additional cases is to avoid tick bites. KFD virus is a member of the _Flaviviridae_ family. Additional information is available from the CDC fact sheet (see: http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... estDis.pdf).

A HealthMap/ProMED-mail interactive map showing the location of the KFD endemic areas of Shimoga and Chikmagalur districts, central Karnataka state, can be accessed at http://healthmap.org/r/1L-v. - Mod.TY]
______

KYASANUR FOREST DISEASE - INDIA (03): (KERALA)
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Date: Sat 22 Feb 2014
Source: The New Indian Express [edited]
http://www.newindianexpress.com/cities/ ... y292qh5OSo


Monkey fever, a viral disease characterised by headache and haemorrhage, is sweeping through parts of Shimoga, Chikmagalur and Dakshina Kannada districts.

Also called the Kyasanur forest disease (KFD), it spreads through the bite of a forest tick, which carries the disease-causing virus from monkeys and other hosts to humans. The Health Department has already recorded 74 cases of monkey fever and has stepped up efforts to identify the affected and take preventive measures in Thirthahalli and Hosanagar taluks of Shimoga and other affected districts.

The department has deputed a mobile unit with a doctor and 2 nurses to create awareness among people about the disease. According to officials, they have covered 98 per cent of the houses in the targeted area in Shimoga and given 4500 bottles of medicated oil to families who visit forests.

Deputy Commissioner Vipul Bansal said the 1st case was reported from Kannangi in Thirthahalli. "As per protocol, people living in targeted areas close to the forest are vaccinated for 5 years in a particular season. After the incident, all have been vaccinated," said Bansal. He said that after a case of monkey fever was reported 4 months back, blood samples were taken from patients and sent for testing. After confirmation, a house-to-house survey was taken up. People have also been urged to notify authorities if they spot a dead monkey. "Dead monkeys have to be buried 5 km away from the village, and all people in the area have to be vaccinated," he said.

District Health Officer Rajesh Suragihalli said the disease does not have any specific treatment. As in other types of fever, treatment aims at bringing down body temperature, said Suragihalli. If the immune system is strong, the disease does not cause any damage, but if it resurfaces within a few weeks, it is dangerous, he said.

The DHO said healthcare workers have been directed to conduct house-to-house surveys and educate families on the disease.

[Byline: Mohammed Yacoob]

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Communicated by:
ProMED-mail from HealthMap Alerts
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[There have been previous reports of Kyasanur forest disease (KFD) cases in this area this year (2014). KFD virus is endemic in this area. As noted in the ProMED post of 1 Mar 2014 (archive no. 20140304.2313813), the disease was 1st detected in Shimoga district, Karnataka state in 1957 and has since appeared sporadically in the thickly wooded areas of Dakshina Kannada, Udupi, Chikmagalur, Shimoga, and Chamarajanagar (all in Karnataka state), where it is endemic. The increased rate of illegal felling of trees and deforestation has been blamed as one of the reasons for the outbreaks of KFD. The disease occurs in humans and monkeys.

Although the virus has been isolated from 16 species of ticks, _Haemaphysalis spinigera_ is the major vector. Most human cases occur during the dry season. The only way to prevent occurrence of additional cases is to avoid tick bites. KFD virus is a member of the _Flaviviridae_ family. Additional information is available from the CDC fact sheet (see: http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... estDis.pdf).

A HealthMap/ProMED interactive map showing the location of the KFD endemic areas of Shimoga, Chikmagalur, and Dakshina Kannada districts, central Karnataka state, can be accessed at http://healthmap.org/r/1L-v. - Mod.TY]

ACUTE ENCEPHALITIS SYNDROME - INDIA: (UTTAR PRADESH) RICKETTSIA PROWAZEKII/HEAD LICE SUSPECTED, REQUEST FOR INFORMATION
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Date: Wed 5 Mar 2014
Source: The Indian Express [edited]
http://indianexpress.com/article/india/ ... nel-finds/


The mystery deaths of hundreds of children in eastern Uttar Pradesh [UP, India] last year [2013] was likely caused by a bacterial infection that is transmitted through head lice, an expert group has concluded.

The group of 20-odd experts from India and abroad, which was set up on [19 Nov 2013], submitted its report to the state government last week [week of 24 Feb 2014]. The findings of the report, which are yet to be officially released, are likely to change the focus of identification, prevention and treatment of acute encephalitis syndrome (AES) both in UP and the rest of the country.

The microorganism suspected to cause the disease is _Rickettsia prowazekii_, which is transmitted through the faeces of lice. The expert panel has recommended "delousing" as the most important preventive mechanism, and treatment with permethrin lotion. Skin biopsy and immunofluorescent assay tests have been recommended in addition to existing tests to identify _R. prowazekii_. Doxycycline has been recommended in addition to the existing treatment protocol even before diagnosis is confirmed.

The group has also recommended that patients should not be made to share cots in hospitals, because "lice leave the dying patient and invade other patients." The large number of patients and a shortage of beds has seen 2 or 3 children being put on the same bed at BRD Medical College, Gorakhpur, for years. [Baba Raghav Das (BRD) Medical College is a Medical College in Gorakhpur, Uttar Pradesh, India.]

The group, headed by Andhra Pradesh encephalitis expert P Nagabhushana Rao, was asked to recommend "clinical care management protocols and surveillance guidelines for AES and JE (Japanese encephalitis) in Uttar Pradesh." The group was constituted after measures such as "vaccination against JE, environmental management, larval control, pig control as well as provision of India Mark II hand pumps and deep wells to counter enteroviral infections" failed to significantly reduce AES cases and mortality. [India Mark II is a human-powered hand pump designed to lift water from a depth of 50 meters (164 feet) or less (http://en.wikipedia.org/wiki/India_Mark_II)].

Members of the group included experts from the National Institute of Virology, National Vector Borne Disease Control Program, BRD Medical College, Gorakhpur, and experts from non-government organisation PATH [a nonprofit organization that bridges public health agencies and private industry; http://www.path.org/about/index.php.] It also had experts from the Centers for Disease Control and Prevention, US, including Ken Earhart, director, Disease Detection Regional Center of CDC-India, as honorary members.

The experts analysed 276 AES cases that came to BRD Medical College, Gorakhpur, in 2013. Epidemiological analysis and clinical data analysis suggested "rickettsial infection (epidemic typhus) caused by _Rickettsia prowazekii_ is the most likely cause of AES." Pritu Dhalaria, convener of the group, said, "Treatment is very simple and death can be prevented if the patient is given a single dose of doxycycline at an early stage. Mass delousing programmes must be carried out in all high-risk districts."

[Byline: Maulshree Seth]

--
Communicated by:
Ronan Kelly
Senior Moderator, FluTrackers
<ronankelly@comcast.net>

[Rickettsial infections, including scrub typhus, endemic (or murine, flea-borne) typhus and Indian tick typhus caused by _Rickettsia conorii_, are known to be prevalent in various parts of India (https://indianpediatrics.net/feb2010/157.pdf). ProMED-mail has extensively posted reports of outbreaks of acute encephalitis syndrome (AES) of unknown etiology in India (see prior ProMED-mail post Japanese encephalitis & other - India (22): (BR) 20131231.2145305 and others below). In past reports, the disease has been associated with Japanese encephalitis virus infections and with consumption of contaminated water, suggesting enterovirus infections. The above news reports says that a team of experts have attributed the cause of acute encephalitis syndrome (AES) in hundreds of children in eastern Uttar Pradesh, India in 2013 to _Rickettsia prowazekii_ infection, which they say was transmitted person-to-person by human head lice.

Lice found on each area of the body are different from each other. The three types of lice that live on humans are: _Pediculus humanus capitis_ (head louse), _Pediculus humanus corporis_ (body louse), and _Phthirus pubis_ ("crab" or pubic louse). Lice infestations are spread most commonly by close person-to-person contact or through shared clothing or personal items (such as hats or hairbrushes). A louse cannot jump or fly and dogs, cats, and other pets do not play a role in the transmission of human lice (http://www.cdc.gov/parasites/lice/). Body lice live and lay eggs (nits) in the seams of clothing; they are usually not seen on the body, except when they feed; whereas head lice attach their eggs to the base of the hair shaft, and the lice and their eggs are usually found in hair. Head lice are common in preschool and elementary school-age children.

Head lice have not been previously known to transmit disease (http://www.cdc.gov/parasites/lice/head/ ... /faqs.html), although secondary staphylococcal or streptococcal infection also may occur, usually limited to the scalp. Only the body louse was known to spread disease; body lice are vectors for: _R. prowazekii_, the cause of epidemic typhus; _Bartonella quintana_, the cause of trench fever; and _Borrelia recurrentis_, the cause of relapsing fever.

The news report does above not say how head lice were implicated in the outbreak of AES in India. However, specific PCR amplification and determination of the nucleotide base sequences of the amplification products has been used to detect bacterial DNA in lice; using this approach, the presence of _R. prowazekii_ was confirmed in body lice collected from refugees in Burundi, among whom typhus was epidemic (http://www.ncbi.nlm.nih.gov/pubmed/9986 ... t=Abstract). ProMED-mail would be interested in exactly how infection with _R. prowazekii_ and head lice were implicated in the AES outbreak in India from knowledgeable sources.

Rickettsiae are obligate intracellular coccobacillary bacteria that have typical Gram negative cell walls, but do not stain well with Gram stain. They, however, appear red with Giemsa or Gimenez stains. Rickettsial diseases are usually transmitted to humans by arthropods. _R. prowazekii_ live in the alimentary tract of the body louse, which bites a human for a blood meal and causes an itchy reaction on the host's skin. The louse defecates as it eats; when the host scratches the site, and the rickettsia-laden louse feces is inoculated into the bite wound.

Rickettsiae invade endothelial cells that line the inner walls of blood vessels. The consequent vascular injury causes increases vascular permeability with consequent tissue edema, loss of blood volume, hypoalbuminemia, decreased osmotic pressure, hypotension, tissue hypoperfusion, and end-organ ischemia. This process leads to interstitial pneumonitis, noncardiogenic pulmonary edema, cerebral edema, and meningoencephalitis. Epidemic typhus is usually diagnosed by serology, such as, indirect fluorescence antibody test, complement fixation, and enzyme immunoassay (EIA). However, _R. prowazekii_ may cross-react with _Rickettsia typhi_ (the cause of murine typhus) (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC95923/). _R. prowazekii_ can also be identified in tissue samples, including skin biopsies, by immunohistochemical staining and polymerase chain reaction (PCR) assays. Early treatment with antibiotics, such as doxycycline, is effective. The case-fatality rate is up to 40% in the absence of antibiotic treatment.

A new human-independent natural cycle of epidemic typhus has been described in flying squirrels and their ectoparasites. Flying squirrels are the only known vertebrate reservoir of _R. prowazekii_, other than humans, and contact with these animals has been linked to most sporadic epidemic typhus cases in the United States (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033063/). - Mod.ML]

Cases of AES in northeastern India (especially eastern Uttar Pradesh and Behar states) have seasonal occurrence, peaking in the warmest months and declining as ambient temperatures cool. No explanation is offered by the investigators of how body louse transmission of _R. prowazekii_ would be seasonal and why disease is limited to children. The epidemiological analysis that the report mentions provides no details. WHO indicates that a macular rash is a key sign of epidemic typhus, yet the reports of AES do not mention this in the cases they report. Clearly, laboratory diagnosis to determine the etiological agent(s) involved in these cases is needed. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1-k3.]