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DENGUE/DHF UPDATE (21): ASIA
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Pakistan (Sindh province). 6 Mar 2014. Dengue 127 cases; Municipality most affected: Karachi 120 cases.
http://www.nation.com.pk/sp-health/06-M ... ikes-again

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

Malaysia:
- National. 5 Mar 2014. Dengue 18 165 cases; Municipalities most affected: 64 per cent of cases are in Selangor, Kuala Lumpur and Putrajaya.
http://yourhealth.asiaone.com/content/m ... ngue-cases

[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]

- Terengganu state. 6 Mar 2014. Dengue 198 cases; Municipality most affected: Kuala Terengganu 150 cases, of which 13 were DHF/serious.
http://malaysiandigest.com/news/491901- ... ntrol.html

HEPATITIS C - INDIA (03): (NORTHEAST STATES) IV DRUG USERS
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Date: Tue 11 Mar 2014
Source: The Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 824861.cms


With little awareness about increasing hepatitis C cases in the northeast, activists and medical practitioners warned that unless effective programs were implemented, there would be a further escalation in the number of people acquiring this virus.

Often referred to as a viral time bomb [because it may be clinically silent until cirrhosis or liver cancer develop decades later. - Mod.LL], the disease is widespread among intravenous drug users (IDUs). Manipur's Surachanpur and Bishnupur districts have the highest number of people carrying the hepatitis C virus (HCV), with prevalence rates among the districts' IDUs being nearly 90 percent and 78 percent respectively.

In Nagaland's Wokha and Phek districts, the prevalence rate, as per an Integrated Bio Behavioural Assessment Round 2 Testing, conducted in 2009 by the Indian Council of Medical Research and others, was 20.8 percent and 8.7 percent respectively. Prior studies showed that in Manipur, the prevalence rate of HCV is 55 to 80 percent among IDUs, as opposed to 22 to 33 percent HIV prevalence among them.

"The main objective is to create awareness about viral hepatitis in the region. The epidemic is at our doorstep, with people getting infected, testing positive and some deaths being reported. However, NGOs and the government continue to ignore the spread of the disease," said Ketho, general secretary of Hepatitis Coalition of Nagaland (HEPCON).

With much of the focus being restricted to HIV-AIDS and cancer awareness, HCV often escapes attention. With no proper cure or vaccine, course-related HCV treatment is also considered too expensive. People with HCV are prone to develop chronicity that can lead to liver damages. Research show that close to 75 to 85 percent HCV patients develop chronicity, as opposed to hepatitis B patients (HBV) [which is about 5 percent. - Mod.LL]

"Intravenous drug users are the most vulnerable. HCV prevalence is much higher than that of HIV. This indicates that there is a bigger pool of HCV patients among IDUs," said Gajendra Kumar Medhi, doctor and scientist with the Indian Council of Medical Research.

Another factor responsible for the high prevalence of HCV amongst IDUs is needle-sharing. Even with efforts to promote safe injecting practices, the prevalence of needle-sharing is quite high. Users may lessen sharing of syringes, but indirect sharing is widely practiced. Nearly 50 to 70 percent IDUs admitted to sharing accessories like common containers for drug preparation, filter cotton and rinse water.

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[As yet, there is no available vaccine for the hepatitis C virus so prevention of transmission of the disease needs to be aimed at high risk groups such as intravenous drug users who share their "works". Needle exchange programs do work in decreasing transmission. Neither the statement that a needle exchange program (NEP) encourages increased drug use among program participants or the recruitment of 1st-time drug users, nor a parallel statement that the availability of the "morning after" pill encourages increased sexual contact are at all true.

The following reference is presented in support of NEPs:
Vlahov D, Junge B: The role of needle exchange programs in HIV prevention. Public Health Rep. Jun 1998; 113(Suppl 1): 75-80; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307729/. - Mod.LL

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

LEISHMANIASIS - PAKISTAN: (KHYBER-PAKHTUNKHWA)
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Date: Wed 5 Mar 2014
Source: The News International [edited]
http://www.thenews.com.pk/Todays-News-7 ... g-in-Kohat


The [Khyber-Pakhtunkhwa] provincial government has failed to control leishmaniasis disease found in over 1000 persons, including women and children, in the suburbs of Kohat city, sources said.

The sources said leishmaniasis had affected over 1000 people mostly women and children in Barh, Jabbi, and other areas for the last 3 months but the health authorities were keeping quiet over the issue.

Despite several attempts, District Health Officer [DHO] Habibur Rehman did not attend the call as he had been in Peshawar for the last one week. When contacted, Assistant Commissioner Farrukh Attique said that he had discussed the issue with the DHO and asked him to take prompt action and send medical teams to the affected areas for vaccination [see comment below].

Meanwhile, Additional Assistant Commissioner Fakhr Khan said that he had informed the Health Department about the epidemic long before, but had received no response so far.

--
Communicated by:
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[It is presumed that the report is about cutaneous leishmaniasis, CL. Leishmaniasis is highly endemic in Pakistan, but it is unclear what the denominator is.

Kohat is the administrative center of Khyber Pakhtunkhwa province of Pakistan, located in the northwest close to the border with Afghanistan.

The report mentions "teams for vaccination". This must be a mistake, as there is no vaccine for leishmaniasis.

A detailed discussion of leishmaniasis in the tribal areas of Pakistan is included in the 3 Feb 2014 ProMED-mail post from Leishmaniasis - Pakistan: (TA) 20140203.2252445. - Mod.EP

Maps of Pakistan can be seen at http://www.mapsofworld.com/pakistan/pak ... l-map.html and http://healthmap.org/promed/p/35382. - Sr.Tech.Ed.MJ]

DENGUE/DHF UPDATE (23): ASIA
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Pakistan (Sindh province). 14 Mar 2014. Dengue 135 cases; Municipality most affected: Karachi 127 cases.
http://www.geo.tv/article-141094-Anothe ... d-in-Sindh

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

Malaysia (Pahang). 12 Mar 2014. Dengue 249 cases; Districts most affected: Kuantan 141 cases, Temerloh 32 cases, Jerantut 23 cases, Maran 17 cases.
http://www.themalaymailonline.com/malay ... -in-pahang

[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]

HEPATITIS C - INDIA (04): (JAMMU AND KASHMIR), HEMOPHILIACS
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Date: Sun 23 Mar 2014
Source: Greater Kashmir [edited]
http://www.greaterkashmir.com/news/2014 ... ce--15.asp


Hemophilia patients in Kashmir have contracted hepatitis C, allegedly due to lack of proper blood screening measures in the Valley's government hospitals.

About 34 hemophilia patients have allegedly contracted the virus, which can cause liver damage, due to lack of proper blood screening measures at the Shri Maharaja Hari Singh Hospital (SMHS) and other hospitals in Kashmir. The patients, who required transfusion of fresh frozen plasma (FPP), have allegedly been given infected plasma.

A 22-year-old, who is undergoing follow-up treatment at the SMHS hospital here, has been told that the diagnosis and treatment of hepatitis C will cost at least 170 000 rupees [USD 2800]. "The doctors told me that treatment will spread over 6 months. But I can't afford the cost," he said. He said the cost would be incurred upon "screening of disease to assess the viral load and on medicines."

Another patient said that he had been suffering from hemophilia since childhood and got the shock of his life recently when he was diagnosed with hepatitis C. This person, who runs a shop at Handwara in north Kashmir, said he can't afford the treatment for hepatitis C disease.

One more hemophilic patient said he went for the transfusion of FFP as the SMHS hospital was facing shortage of injections. "Due to non-availability of the factor 8 injections at SMHS, I went for the fresh frozen plasma (FFP) transfusion. At the hospital, many of the patients were administered contaminated plasma, due to which they developed hepatitis C," he alleged, and added that at least 4 people have died in the past year [2013], allegedly after they contracted hepatitis C disease.

Medical Superintendent (MS) of the SMHS hospital Dr Nazir Chaudhary, however, said the hospital was earlier facing a shortage of funds to provide factor-8 and factor-9 injections to patients. "The problem has now been resolved. However, the government doesn't have the policy to provide free-of-cost treatment to patients," he said.

[Byline: Ishfaq Naseem]

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[This unfortunate event appears to be parallel to the famous Irish incident in which 704 Rh negative women who received an (in retrospect) HCV-contaminated (genotype 1b) anti-D immunoglobulin in an 18-month period between May 1977 to November 1978 were found to have evidence of active or previous infection with the [hepatitis C] virus when screened in the early 1990s. Like the above hemophiliac cohort, these were young individuals. Although chronic infection can occur in as many as 85 percent or more of those infected, this cohort appeared to have cleared the virus in 46 percent of the cases, and, 17 years after infection, of the 376 women studied, 49 percent had no evidence of fibrosis at all, and only 2 percent had cirrhosis, all of whom had a history of excessive alcohol intake.

Although it is possible that this particular virus was perhaps less likely to cause progressive liver disease, there are few parallel examples of this in the medical literature, where individuals are found to be infected by a lookback program rather than being discovered by having abnormal aminotransferase enzymes.

Reference: Fanning LJ: The Irish paradigm on the natural progression of hepatitis C virus infection: An investigation in a homogeneous patient population infected with HCV 1b. Int J Molec Med 22002;9:179-184.

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/305. - Mod.LL]

DENGUE/DHF UPDATE (25): ASIA
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Pakistan (Sindh province). 23 Mar 2014. Dengue 146 cases; deaths 1. Municipality most affected: Karachi 136 cases.
http://www.dailytimes.com.pk/national/2 ... in-karachi

[A 23 Mar 2014 report in The News indicates that the appearance of seasonal dengue cases is much earlier than usual this year (2014). Usually, the dengue outbreak begins after the summer monsoons in August (http://www.thenews.com.pk/Todays-News-4 ... -dangerous).

Maps of Pakistan can be accessed at http://www.ezilon.com/maps/images/asia/ ... kistan.gif and http://healthmap.org/promed/p/707. - Mod.TY]

Malaysia
- National. 21 Mar 2014. Dengue as of 15 Mar 2014, 21 967 cases; deaths 53. Dengue virus circulating: type 2.
http://www.bernama.com.my/bernama/v7/ge ... id=1023849

[Maps of Malaysia can be seen at http://www.ezilon.com/maps/images/asia/ ... al-map.gif and http://healthmap.org/promed/p/147. - Mod.TY]

- Penang. 20 Mar 2014. Dengue as of 15 Mar 2014, 490 cases; deaths 3.
http://www.freemalaysiatoday.com/catego ... in-penang/

HEPATITIS C - INDIA (05): (JAMMU AND KASHMIR), HEMOPHILIACS, COMMENTARY
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Date: Tue 25 Mar 2014
From: Gregor Caspari <g.caspari@ladr.de> [edited]


Coagulation factor VIII, which is at 100 percent in normal people, is below one percent in persons with severe hemophilia A. Normal treatment is transfusion of factor VIII concentrate, which is produced from pools of thousands of plasma donations, purified, and virus inactivated.

One liter of fresh frozen plasma raises factor VIII in the recipient by about 20 percentage points. Treatment is limited by the enormous volumes of plasma needed to prevent bleeding. This is why treatment should be, in these cases, by cryoprecipitate (single donor, much lower volume).

Donor plasma (for fresh frozen plasma or cryoprecipitate) may be tested for antibodies against hepatitis C virus (anti-HCV). However, plasma concentration of HCV is highest in fresh infections when anti-HCV is still negative. Fresh infections are, for different reasons, much more frequent in commercial blood donors as opposed to voluntary non-remunerated donors. To my knowledge, the Indian blood transfusion system relies heavily on commercial donors. As a result, infection can even be transmitted when testing was correct.

The risk stemming from fresh HCV infection of the donor can be further reduced when donations are, in addition to HCV antibody testing, screened for HCV genomes by RT PCR. This is so expensive that even in Germany, donations are tested in pools, and probably unaffordable for most of India. Even then, infection cannot be completely prevented because the volume transfused is much greater than the volume tested by PCR and may still contain a few viruses not detected by the test.

In resource-poor countries, antibody-testing is frequently done in pools of, for example, 5 donations, but then the sensitivity of the test is reduced, or antibody testing is not done at all.

It would be interesting to know what the actual problem in Kashmir was.

--
Dr. Gregor Caspari
Facharzt fur Transfusionsmedizin
Berlin, Germany
<g.caspari@ladr.de>

[ProMED thanks Dr. Caspari for his comments. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/142.]

RABIES - INDIA (02): (GUJARAT) WOLF, HUMANS BITTEN
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Date: Sun 30 Mar 2014
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 952714.cms


A wolf believed to be suffering from rabies injured 6 people in a village of Shahera taluka in Panchmahal district [Gujarat state]. The canine had strayed into the village and later died due to the disease. The wolf was spotted at Narsana village early on Saturday morning [29 Mar 2014] at around 7am by villagers. Forest officials said the animal looked visibly irritated and started attacking persons at the village.

A total of 6 people, who were in the farms or walking on pathways, were targeted by the wolf; 3 of the victims were injured seriously in the incident and had to be rushed to Godhra Civil Hospital for treatment, while 3 others were treated at Shahera community health centre.

--
Communicated by:
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[Rabies is widespread throughout India, but in the past 4 years there were only reports for Gujarat in 2012 -- the other years were blank in contrast to other Indian states. In that one year, 2012, Gujarat reported 5 outbreaks involving cattle, with a total of 34 cattle affected. Bat rabies is possible in cattle thanks to vampire bats in Latin America, but as they are not found elsewhere, we can assume that the bovine cases followed from canid bites, whether domestic or wild as in this report. In my experience, an absence of reports of an expected public health problem usually indicates a bureaucratic embarrassment. Domestic dog rabies is easily controlled via vaccination, and many countries have demonstrated success in controlling wildlife rabies through oral vaccination.

Gujarat is the westernmost Indian state bordering Pakistan; see: http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg and http://healthmap.org/promed/p/302. Panchmahal district is in the eastern portion of this state. - Mod.MHJ]

DENGUE/DHF UPDATE (28): ASIA
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Malaysia
Date: Thu 3 Apr 2014
Source: New Straits Times [edited]
http://www.nst.com.my/latest/dengue-cla ... h-1.547847


Dengue fever claimed another life in Kedah, bringing the total fatalities in the state to 2, from 293 cases reported for the 1st 3 months of this year [2014].

State Health Department director Dr Ismail Abu Taat said the latest death was also in Kuala Muda district, after the 1st fatality in January [2014], although the number of dengue cases in March [2014] had dropped to 33 cases. "We had managed to bring down the number of dengue cases from 106 cases in January [2014] and 154 cases in February [2014] to 33 cases in March [2014]."

He said from the total 293 cases in the 1st 3 months of this year [2014], Kuala Muda district recorded the highest number of dengue cases. "Kuala Muda district tops the list with 22 cases, followed by Kubang Pasu and Kota Star with 3 cases each. The remaining dengue case is reported in Baling district with 3 cases and Kulim district with 2 cases," he said.

In January this year [2014], a total of 106 cases of dengue were reported in the state [Kedah].

Kuala Muda district recorded a sharp increase with 61 cases, Kota Setar (13), Kulim (10), Kubang Pasu (7), Baling (7), Padang Terap (4), Langkawi (3) and Pendang (1).

Meanwhile in February [2014], a total of 154 cases were reported compared to 135 cases for the same period last year [2013].

Kuala Muda tops the list with 83 cases followed by Kulim (21), Kubang Pasu (14), Alor Star (14), Baling (10), Padang Terap (5), Langkawi (3), Pendang (3) and Sik (1).

A total of 817 dengue cases were reported with 4 deaths throughout 2012, and for last year [2013], the number slightly decreased to 813 cases with one casualty recorded in Padang Terap district.

On Monday [31 Mar 2014], Health minister Datuk Seri Dr S Subramaniam had said the country had recorded a drastic rise in dengue fever, as 24 917 cases were reported between 1 Jan until 29 Mar [2014], compared with just 6100 cases for the same period last year [2013].

Statistics by the Health Ministry revealed that the dengue cases have increased by 308 per cent, with 58 deaths reported compared with last year's [2013's] 14 fatalities.

[byline: Zahratulhayat Mat Arif]

--
communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[The newswire above reports that the outbreak of dengue continues to rise in Malaysia. The number of reported dengue cases in 2014 is about 4 times higher than in the same period of 2013.

A map of Malaysia can be seen at http://www.ezilon.com/maps/images/asia/ ... al-map.gif. For the interactive HealthMap/ProMED-mail map with direct links to other outbreaks in Malaysia and surrounding countries reported on ProMED-mail and PRO/MBDS, see http://healthmap.org/promed/p/13000. - Mod.QCN]

[A 6 Apr 2014 report in the New Straits Times quoted the minister of health saying that there have been 63 dengue deaths since January 2014. However, the number of new dengue cases is decreasing currently (http://www.nst.com.my/latest/dengue-cas ... m-1.553408). - Mod.TY]

DENGUE/DHF UPDATE (30): ASIA
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Malaysia
Date: Mon 7 Apr 2014
Source: The Malaysian Insider, Malaysian National News Agency (Bernama) report [edited]
http://www.themalaysianinsider.com/mala ... ar-bernama


Health Minister Datuk Seri Dr S Subramaniam says 63 deaths from dengue fever were recorded nationwide for the period [1 Jan to 4 Apr 2014]. He said 26 107 cases of dengue fever were reported nationwide during the period, and if no preventive measures were taken, it could be a major threat to the community and nation.

"In this regard, in conjunction with World Health Day this year [7 Apr 2014], I hope that Malaysians will be more aware of the threat of dengue, especially the _Aedes_ mosquito, the bearer of the dangerous disease [virus] which can kill," he said in a statement in Putrajaya, today [7 Apr 2014].

World Health Day is celebrated with the theme "Small Bite, Big Threat" in reference to the _Aedes_ mosquito.

The World Health Organisation has estimated that more than 2.5 billion, or 40 percent of the world's population, are at risk of being infected with dengue, and 50 million to 100 million dengue infections are expected each year. "This clearly shows that dengue fever has become a major burden to the world and is showing a very prolific rate of increase," it said.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[The newswire above reports that cases of dengue continue to rise in Malaysia. Up to 4 Apr 2014, 26 107 cases of dengue fever were reported in this country, and among those, 63 people died.

According to the WHO Western Pacific Regional Office (WPRO) dengue update, as of 25 Mar 2014, activity in the ongoing outbreak of dengue in Malaysia to date is 4 times higher in 2014 than during the same period in 2013 (see http://www.wpro.who.int/emerging_diseas ... pdates/en/). The above media report confirms this outbreak trend is continuing.

Maps of Malaysia can be seen at http://www.ezilon.com/maps/images/asia/ ... al-map.gif and http://healthmap.org/promed/p/147. - Mods.QCN/MPP]

[As of 5 Apr 2014, the state of Selangor reported 14 654 dengue cases with 24 deaths, the state of Malacca 855 cases with 3 deaths, and Negri Sembilan 1223 cases (http://www.nst.com.my/nation/general/25 ... r-1.557150). Mod.TY]

RABIES - INDIA (03): (HIMACHAL PRADESH), HUMAN, CANINE
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Date: 15 Apr 2014
From: Omesh Bharti <bhartiomesh@yahoo.com> [edited]


One person has died in the Chirgaun area of Shimla district of Himachal Pradesh state in India, and another 100 have been bitten by mad dogs, which were bitten by a rabid dog coming from outside the village. All are being given low cost intradermal anti-rabies vaccine.

--
Dr. Omesh Bharti
Simla. HP. India
<bhartiomesh@yahoo.com>

[Since 2008, the only OIE report of rabies in Himachal Pradesh was in 2010 and involved 4 dogs. This is a very mountainous Indian state and thus difficult to administer. Getting out to vaccinate the village dogs in Chirgaun would be a challenge, even in good weather. The Simla HP people are to be congratulated on vaccinating all the humans exposed in this incident. And our heartfelt thanks go to Dr. Bharti for his report.

I would like to take this opportunity to make a point. The core purpose of ProMED-mail is to increase awareness of unusual events, mainly from infectious diseases and toxic events in humans, animals, and food plants, that may have a terrorist origin. To do this, ProMED-mail reports normal events with some concentration on emerging diseases so that there is a running awareness of the normal. Our members are ProMED's eyes on the ground. You are the people who will see events before anyone else. For convenience, we moderators use the local press and TV reports, and those by the local and regional health services. But our members are a very important trip-wire for quick reporting. You are there for a purpose, not just to provide funding, for which we are grateful, though frankly it would be nice if more than 3 percent put their hands in their pockets. Our members are our eyes and ears.

To find Himachal Pradesh in India, go to:
http://en.wikipedia.org/wiki/Himachal_Pradesh
http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg.
For Shimla, go to:
http://www.fallingrain.com/world/IN/11/Shimla.html
http://www.mapsofindia.com/maps/himachalpradesh/.
Assuming it is the same village, Chirgaon is to the east of Shimla and isolated: http://indiamapia.com/Shimla/Chirgaon.html. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/304.]

LEISHMANIASIS - PAKISTAN (03): (PESHAWAR)
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Date: Wed 16 Apr 2014
Source: The News, Pakistan
http://www.thenews.com.pk/Todays-News-7 ... -in-Mardan


An outbreak of leishmaniasis in Mardan district could not be controlled for more than 2 years, and the disease continues to disfigure victims and residents, health officials said.

Officials confirm that the disease has afflicted people in Bezo Kharkai, Jalala, Lund Khwar, Mian Esa, Ikrampura, Muslimabad and other rural areas in Mardan district. Over 890 cases have been reported to basic health units and other health facilities since 2012, and hundreds have gone unreported, but the epidemic failed to attract the attention of the Health Department.

Even the injection that treats the disease is not available at the health facilities, and hardly any efforts are being made to ensure its availability, officials said.

According to doctors, leishmaniasis is caused by the bite of infected sandflies. Sores appear at the bite sites that take weeks, months and even over a year [to heal] in treatment. Even after proper treatment, leishmaniasis leaves a permanent and unpleasant scar.

Residents and officials said some villages, including Muslimabad, Hajiabad, Majani, and Ghundai, had badly been hit by the epidemic. "Every family has a leishmaniasis patient in these villages," said a technician at a BHU. "You will see many, many women whose faces have been disfigured by it if you visit the area," he said in a sympathetic tone.

Official figures suggested that 60 cases were reported in March-April [2014] from Mian Esa, 5 from Jalala, 125 from Lund Khwar, and 122 from Ikrampura area. A resident of Kalo village near Lund Khwar told The News that the leishmaniasis patients had been left in the lurch by the government. "Every family has a member with open sores, but there is no one to come to their help," he said. "The government should ensure spraying in affected areas and treat the patients," he demanded.

"The leishmaniasis cases have been reported to hospitals since 2012," said a doctor who did not want to be named. "It's not life-threatening," he said, playing down the epidemic. Officials said that a woman's liver had become enlarged due to leishmaniasis and that she was in critical condition. They traced the sandflies to the camp of Afghan refugees in Palai area of Malakand Agency.

Officials and locals said the government was doing little to control the epidemic, and, therefore, it was spreading. They said spraying had not been carried out for killing the infected sandflies. Dr Niaz, an official of the Health Department in Mardan, said they were carrying out spraying regularly in the affected areas but conceded that leishmaniasis cases continued to happen in these rural areas. Asked when they had last carried out spraying, he said it was in March this year [2014]. The technician said Lund Khwar was last fumigated in June 2013.

An official of the World Health Organisation said fumigation in streets was not effective against leishmaniasis. He said spraying had to be carried out inside homes to prevent the disease. Glocantine, an injection effective for leishmaniasis treatment, is not available at the health facilities in the area, according to locals and officials.

"Leishmaniasis patients are forced to get treatment privately, as Glocantine is not available at health facilities. An injection costs PKR 600 [USD 6.20], and a patient has to get a course of 14 injections," the technician said. Dr Niaz said the DHO office did not have the said injection. "An NGO is working on it, and it provides these injections to facilities," he said, while being unable to give the name of the NGO.

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

[A detailed discussion of leishmaniasis in the tribal areas of Pakistan is included in the 3 Feb 2014 ProMED-mail post "Leishmaniasis - Pakistan: (TA) 20140203.2252445."

In the camps hosting Afghan refugees, the prevalence of cutaneous leishmaniasis is approximately 2.5 percent, with up to 5 percent having scars after cutaneous leishmaniasis.

A recent, comprehensive global review of leishmaniasis, including the situation in Afghanistan, can be found in: 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.

The review states: "The notification of leishmaniasis is not mandatory in the country. There is no national leishmaniasis control program and no leishmaniasis vector control program, but bednet distribution takes place in refugee camps. There is no leishmaniasis reservoir program."

Without a clear control strategy including mapping of the problem, local outbreaks will continue to occur and cannot be contained by treatment of symptomatic cases alone. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/140.]

Indien - Nipah Virus
25.05.2018

Seit Mitte Mai sind im Distrikt Kozhikode (Bundesstaat Karela, S) 12 Menschen verstorben, es gibt weitere Verdachtsfälle. Es ist der erste Ausbruch in Südindien. Seit 1998 gab es mehrere Ausbrüche in Malaysia, Singapur und im indischen Bundesstaat Westbengalen. Die Krankheit zeigt eine grippeähnliche Symptomatik mit hohem Fieber und Muskelschmerzen und allgemeinem Krankheitsgefühl. Bei schwerem Verlauf kommt es zu Hirnhaut- und Hirnentzündung. Das Virus kommt in Speichel und Urin von infizierten Fledermäusen vor. Die Übertragung auf den Menschen erfolgt durch den Verzehr von rohem Fruchtsaft, eine Übertragung von Mensch zu Mensch ist ebenfalls möglich. Der Verzehr roher Fruchtsäfte und ungewaschener, speziell angebissener Baumfrüchte sollte vermieden werden. / Quelle: crm
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Japan - Masern
25.05.2018

In der Präfektur Okinawa sind seit Ende März 99 Fälle gemeldet worden. Als Indexfall wurde ein Tourist aus Taiwan identifiziert. Ein Jugendlicher hat die Infektion aus Okinawa in die Präfektur Aichi gebracht, dort sind inzwischen mindestens 23 Menschen erkrankt. Landesweit wurden bisher mehr als 170 Infektionen gemeldet. Impfschutz beachten. / Quelle: crm
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Malaysia - Tollwut
18.05.2018

Seit Juni 2017 sind 10 Menschen im Bundesstaat Sarawak verstorben. Bei 7 Betroffenen wurden Hundebisse bestätigt. Es sind die ersten bestätigten Fälle in Ostmalaysia (Insel Borneo). Bis Anfang Mai wurde die Infektion bei mindestens 66 Hunden und einer Katze registriert. Aufklärungskampagnen wurden gestartet, außerdem sollen Hunde und Katzen geimpft werden. Es wird vermutet, dass das Virus durch streunende Hunde aus Indonesien eingeschleppt wurde. Nach verdächtigen Tierkontakten sollte umgehend eine postexpositionelle Versorgung eingeleitet werden. / Quelle: crm
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Thailand - Dengue
25.05.2018

Seit Anfang des Jahres wurden ca. 11.700 Infektionen und 16 Todesfälle gemeldet. Besonders betroffen sind die Region um Bangkok und der Süden des Landes. Im letzten Jahr wurden mehr als 50.030 Erkrankungen und 59 Todesfälle gemeldet. Es waren die höchsten Fallzahlen seit 20 Jahren. Ein Infektionsrisiko besteht ganzjährig, die Hauptübertragungszeit sind die Monate Juli und August. Schutz vor den überwiegend tagaktiven Stechmücken beachten! / Quelle: crm

Gruß
Birgitt

Indien - Nipah Virus
29.05.2018

Seit Mitte Mai sind im Distrikt Kozhikode (Bundesstaat Karela, S) 14 Menschen verstorben, es gibt weitere Verdachtsfälle. Es ist der erste Ausbruch in Südindien. Seit 1998 gab es mehrere Ausbrüche in Malaysia, Singapur und im indischen Bundesstaat Westbengalen. Die Krankheit zeigt eine grippeähnliche Symptomatik mit hohem Fieber und Muskelschmerzen und allgemeinem Krankheitsgefühl. Bei schwerem Verlauf kommt es zu Hirnhaut- und Hirnentzündung. Das Virus kommt in Speichel und Urin von infizierten Fledermäusen vor. Die Übertragung auf den Menschen erfolgt durch den Verzehr von rohem Fruchtsaft, eine Übertragung von Mensch zu Mensch ist ebenfalls möglich. Der Verzehr roher Fruchtsäfte und ungewaschener, speziell angebissener Baumfrüchte sollte vermieden werden. / Quelle: crm
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Taiwan - Japanische Enzephalitis
29.05.2018

Bereits Ende Mai wurden 2 bestätigte Infektionen und ein Verdachtsfall im Süden des Landes gemeldet. Die Hauptübertragungszeit liegt zwischen den Monaten Juni und August. Mückenschutz beachten und ggf. Impfung erwägen. / Quelle: crm

Gruß
Birgitt

Indien - Nipah Virus
05.06.2018

Seit Mitte Mai sind im Distrikt Kozhikode (Bundesstaat Kerala, S) 16 Menschen verstorben, es gibt weitere Verdachtsfälle. Es ist der erste Ausbruch in Südindien. Seit 1998 gab es mehrere Ausbrüche in Malaysia, Singapur und im indischen Bundesstaat Westbengalen. Die Krankheit zeigt eine grippeähnliche Symptomatik mit hohem Fieber und Muskelschmerzen und allgemeinem Krankheitsgefühl. Bei schwerem Verlauf kommt es zu Hirnhaut- und Hirnentzündung. Das Virus kommt in Speichel und Urin von infizierten Fledermäusen vor. Die Übertragung auf den Menschen erfolgt durch den Verzehr von rohem Fruchtsaft, eine Übertragung von Mensch zu Mensch ist ebenfalls möglich. Der Verzehr roher Fruchtsäfte und ungewaschener, speziell angebissener Baumfrüchte sollte vermieden werden. / Quelle: crm

Gruß
Birgitt