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JAPANESE ENCEPHALITIS AND OTHER - INDIA (15): (BIHAR)
******************************************************
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: Sun 11 Sep 2011
Source: Hindustan Times [edited]
<http://www.hindustantimes.com/Japanese- ... 44485.aspx>


Japanese encephalitis (JE) [virus] has struck Gaya and its surrounding
areas, claiming the lives of 16 children over the last 3 weeks. The
children were admitted to Gaya's Anugrah Narayan Magadh Medical
College and Hospital (ANMMCH), where dozens of others are under
treatment.

"On Friday night [9 Sep 2011], 8 of the children succumbed to the
disease, 3 of them within an hour," said Dr Sitaram Prasad,
superintendent, ANMMCH. "Till today [11 Sep 2011], the hospital has
admitted 56 children. Children in the 11-12-year age group are the
worst hit, Prasad said. The symptoms of the disease include
inflammation of the brain, high fever, headaches, rheumatic pains, a
stiff neck, convulsions, and nausea.

Doctors say the disease is not limited to Gaya district. A few of the
patients have come from Bihar's Aurangabad and Jharkhand's Chatra as
well.

The ANMMCH and the Patna Medical College Hospital (PMCH) are running
short of diagnostic kits. The ANMMCH authorities have already
requested the National Institute of Virology (NIV), Pune, to send kits
at the earliest. "I have also contacted the in-charge of JE at the
Union health ministry to arrange for the direct supply of kits to the
medical college hospitals," said head of department of microbiology,
PMCH, Dr Shankar Prakash.

Principal secretary (health) Amarjeet Sinha who visited ANMMCH to
assess the situation, has promised all help. Gaya civil surgeon Dr
Dileep Kumar said a team comprising four specialists from PMCH, 4
doctors from the Gaya district hospital and five from ANMMCH has been
constituted to tackle the situation. "Fogging and other preventive
measures to control mosquito breeding have been intensified," Kumar
said.

[Byline: Shantanu Chakraborty]

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

[All cases have been attributed to JE virus infections, with no
mention of "acute encephalitis syndrome" of unknown etiology, which
has been mentioned in previous reports this year from northeastern
India. Neither is there mention of JE vaccination status in the
affected population in the report above.

Gaya is the 2nd largest city in Bihar state and the capital of the
district. A HealthMap Interactive map showing the location of Gaya can
be accessed at <http://healthmap.org/r/1emt>. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (16): (BIHAR)
*****************************************************
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 13 Sep 2011
Source: IBN Live [edited]
<http://ibnlive.in.com/generalnewsfeed/n ... 21743.html>


Encephalitis claims 24 lives in Bihar
-------------------------------------
With the death of 3 more children in a hospital here today, Japanese
encephalitis has claimed 24 lives in Bihar during the past 3 weeks,
official sources said. The 3 children died in the Anugrah Narayan
Sinha Medical College-cum-Hospital, its Superintendent Sitaram Prasad
said. A total of 84 patients, including 25 children, are currently
undergoing treatment in the hospital, Prasad said, adding that their
blood tests had confirmed the disease. He said that most of the
patients had come from Gaya, Aurangabad and Nawada districts of Bihar
and Chatra district of Jharkhand.

--
Communicated by:
Ronan Kelly for FluTrackers
<ronankelly@comcast.net>

[The death toll from JE virus infections in Gaya has gone from 16 on
11 Sep 2011 (see ProMed-mail archive no. 20110912.2774) to 25 just 2
days later. All are attributed to JE virus, with no mention of the
acute encephalitis syndrome of undetermined etiology previously
mentioned in recent reports from northeastern India. There is still no
mention of the JE vaccination status of this population.

Gaya is the 2nd largest city in Bihar state and the capital of the
district. A HealthMap Interactive map showing the location of Gaya can
be accessed at <http://healthmap.org/r/1emt>. - Mod.TY]

DENGUE/DHF UPDATE 2011 (37)
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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>

*****

- Pakistan (Punjab province). 9 Sep 2011. An ongoing dengue fever
outbreak in Pakistan's eastern province of Punjab has killed at least
11 people so far and affected thousands of people, officials said on
Friday [9 Sep 2011]. According to statistics released by the Health
Department, the number of dengue patients reported so far is 2100,
including 2042 in the provincial capital of Lahore. 11 people have
died from dengue in Lahore.
<http://channel6newsonline.com/2011/09/s ... -province/>

[A HealthMap/ProMED-mail interactive map of Punjab province can be
accessed at <http://healthmap.org/r/0cco>. - Mod.TY]

- Pakistan (Lahore, Punjab province). 9 Sep 2011. The recent wave of
dengue fever that hit Pakistan's eastern province of Punjab,
especially its provincial capital Lahore, killed at least 10 people
and affected 2256 others.
<http://news.xinhuanet.com/english2010/h ... 128849.htm>

[The case counts may not be current. The report above indicates that
11 people have died of dengue virus infections in Lahore alone. -
Mod.TY]

- Pakistan (Islamabad and national). 10 Sep 2011. According to
National Institute of Health, so far total suspected cases of dengue
fever have been 2708 while confirmed cases are 2413 across the
country. In Islamabad so far 28 confirmed cases have been reported
while 2170 in Punjab, 26 in Rawalpindi, 176 in Sindh, 8 in KP
[Khyber-Pakhtunkhwa, formerly North-West Frontier], and 5 are reported
in AJK [Azad Jammu and Kashmir]. So far 4 deaths have been reported
due to fever; one patient died in Islamabad, one in Lahore, one in
Karachi, one in Noshehra, and no death has been reported from
Balochistan.
<http://nation.com.pk/pakistan-news-news ... -Islamabad>

- Pakistan (Islamabad and Rawalpindi). 12 Sep 2011. Within the past
one month, over 3000 positive cases of dengue fever have been reported
in the Punjab province only while the number has been showing sharp
increase within the last one week. The number of dengue fever suspects
and confirmed cases in twin cities of Rawalpindi and Islamabad are
also on the rise and health experts fear that the region might face a
massive outbreak within days to come if the issue is not taken
seriously by the concerned authorities and individuals as well.
<http://www.thenews.com.pk/TodaysPrintDe ... =9/12/2011>

[A HealthMap/ProMED-mail interactive map showing the locations of the
twin cities of Rawalpindi and Islamabad can be accessed at
<http://healthmap.org/r/1eCx>. - Mod.TY]

- Pakistan (Rawalpindi). 6 Sep 2011. A total of 125 dengue fever cases
were reported and are being treated in 3 teaching hospitals in
Rawalpindi city.
<http://ftpapp.app.com.pk/en_/index.php? ... 5&Itemid=2>

- Pakistan (Sindh province). 10 Sep 2011. 29 dengue cases have been
reported in Sindh over the last 9 days. In the last 24 hours, 8 cases
have been reported. According to the Dengue Surveillance Cell, 7
patients are from Karachi while one is from Sukkur. From last year
[2010] till date 190 dengue cases have been reported in the province.
<http://www.thenews.com.pk/NewsDetail.as ... d-in-Sindh>

[A HealthMap/ProMED-mail interactive map of Sindh province can be
accessed at <http://healthmap.org/r/02SY>. - Mod.TY]

- India (national, forwarded by Ronan Kelly for FluTrackers.com
<ronankelly@comcast.net>). The IDSP [Integrated Disease Surveillance
Project] has released updated official figures for dengue, state by
state in India to August 2011:
State / Cases / Fatalities
Andhra Pradesh / 110 / 3
Assam / 1 / 0
Goa / 7 / 0
Gujarat / 288 / 0
Haryana / 14 / 1
Jharkhand / 4 / 0
Karnataka / 206 / 3
Kerala / 733 / 4
Madhya Pradesh / 3 / 0
Maharashtra / 223 / 2
Orissa / 876 / 23
Punjab / 274 / 0
Rajasthan / 52 / 0
Tamil Nadu / 868 / 2
Uttar Pradesh / 1 / 0
Uttarakhand / 2 / 0
West Bengal / 94 / 0
Chandigarh / 1 / 0
Delhi / 66 / 1
Puducherry / 30 / 0
Total / 3853 / 39

The following case numbers were recorded in August 2011
State / Cases / Fatalities
Andhra Pradesh / 49 / 3
Goa / 1 / 0
Gujarat / 85 / 0
Haryana / 10 / 1
Jharkhand / 4 / 0
Karnataka / 30 / 1
Kerala / 142 / 0
Maharashtra / 23 / 0
Orissa / 874 / 22
Punjab / 181 / 0
Rajasthan / 26 / 0
Tamil Nadu / 135 / 0
West Bengal / 20 / 0
Delhi / 51 / 0
<http://nvbdcp.gov.in/den-cd.html>

[A map showing Delhi and the states in India can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.
- Mod.TY]

- India (Orissa state). 6 Sep 2011. The death toll rose to 26 from 25
with one death reported today [6 Sep 2011]. A total of 1253 samples
have been found positive out of total 3357 samples tested.
<http://orissadiary.com/CurrentNews.asp?id=28968>

- India (Delhi). 6 Sep 2011. Dengue cases in the city reached the 92
mark after 3 new patients tested positive for dengue fever.

JAPANESE ENCEPHALITIS AND OTHER - INDIA (17): (BIHAR)
*****************************************************
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:
[1] Bihar
[2] NVBDC statistics as of 13 Sep 2011

******
[1] Bihar
Date: Wed 14 Sep 2011
Source: Yahoo News, Indo Asian News Service (IANS) report [edited]
<http://in.news.yahoo.com/bihar-suspecte ... 38810.html>


With 6 more children dying, encephalitis is now suspected to have
claimed 25 young lives in Bihar, an official said Wednesday [14 Sep
2011]. The 6 children died in the last 2 days at Anugrah Narain
Medical College and Hospital (ANMCH) in Gaya, about 100 km [62 mi]
from [Patna], said the district health official. 19 children had died
earlier. The children reported high fever, followed by bouts of
unconsciousness and convulsions.

To date, more than 75 children with suspected encephalitis admitted,
to the hospital, said its superintendent, Sitaram Prasad. "Most of the
children were from rural areas of Gaya and neighbouring districts.
More than 2 dozen children are still battling for life," he said.

Measures were being taken to check the spread of the disease, said
Health Minister Ashwini Kumar Choubey.

Suspected encephalitis hit Gaya in 2009, 2007, and 2005 and killed
dozens of children, said a district administration official.

Fear of suspected encephalitis is haunting the Patna Medical College
and Hospital (PMCH) with 45 samples of brain fever cases having tested
positive in the last 1.5 months. 3 people reportedly died due to the
disease.

The state health department is running short of Japanese encephalitis
[JE] kits to test [for] the infection. "In view of seriousness of the
issue, ANMCH and PMCH have sent an SOS to the National Institute of
Virology, Pune, to send the kits soon," an official of the health
department told IANS.

2 months ago, 51 children died in Muzaffarpur district but the state
government is yet to confirm these as encephalitis deaths. Last month
[August 2011], union Health and Family Welfare Minister Ghulam Nabi
Azad informed the Rajya Sabha [Council of States] that clinical and
epidemiological data suggested that it was an outbreak of acute
encephalitis syndrome, resulting in 150 cases and 55 deaths, mostly
among children. In a written reply, the minister said these cases were
reported from early June to mid-July [2011] from Muzaffarpur and its
bordering areas.

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

******
[2] NVBDC statistics as of 13 Sep 2011
Date: 14 Sep 2011
Source: NVBDCP (National Vector Borne Disease Control Program) India
<http://nvbdcp.gov.in/je-cd.html>

The following cumulative case numbers of AES/JE (to Sep 13) were
released today by the NVBDCP;


State: Cases / Fatalities
Andhra Pradesh: 59 / 1
Assam: 1308 / 246
Bihar: 288 / 54
Goa: 53 / 0
Karnataka: 94 / 0
Kerala: 79 / 3
Maharashtra: 4 / 3
Manipur: 2 / 0
Nagaland: 44 / 6
Tamil Nadu: 404 / 13
Uttar Pradesh: 1782 / 248
West Bengal: 341 / 10

Total: 4458 / 584

(The numbers for Bihar do not include a current outbreak in Gaya which
has caused an additional 25 fatalities.)

--
Communicated by:
Ronan Kelly for FluTrackers.com
<ronankelly@comcast.net>

[The one additional death cited in the report in [1] above has
occurred in the past 24 hours (see ProMED-mail archive no
20110913.2793). Presumably this case is also due to JE virus
infection, as yesterday's (13 Sep 2011) report indicated that the 24
deaths were due to infection by that virus.

There are no indications given about the measures to be taken to halt
the spread of the disease. Is a JE virus vaccination campaign planned?
Again, the etiology of the acute encephalitis syndrome cases in the
Muzaffarpur district mentioned above is not specified.

Gaya is the 2nd largest city in Bihar state and the capital of the
district. A HealthMap Interactive map showing the location of Gaya can
be accessed at <http://healthmap.org/r/1emt>.

With respect to the information in report [2] above, JE cases are
widely scattered across the Indian states. It would be of interest to
know if vaccination campaigns were carried out in the states most
affected. - Mod.TY]

SCRUB TYPHUS - INDIA (02): (NAGALAND)
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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: Fri 16 Sep 2011
Source: The Morung Express [edited]
<http://www.morungexpress.com/frontpage/70829.html>


The Department of Health and Family Welfare has informed that it had
received a telephone message on 12 Sep 2011 of an outbreak of fever of
unknown cause leading to 3 deaths at Poilwa village, Peren District
[India]. Immediately the State Rapid Response Team (RRT) of Integrated
Disease Surveillance Project (IDSP), Nagaland, comprising of Dr. John
Kemp (State Surveillance Officer), Dr. Sao Tunyi (epidemiologist), Dr.
Kevisevolie Sekhose (epidemiologist), and Venezo Vasa (entomologist)
conducted an outbreak investigation at Poilwa village.

The team collected 3 samples from suspected cases. All 3 were tested
positive for scrub typhus. To date, there are 9 cases with 3 deaths.
This was stated in an official press note issued by Dr. Imtimeren
Jamir, the Principal Director, Directorate of Health and Family
Welfare, Kohima.

Scrub typhus is rickettsial disease caused _Orientia tsutsugamushi_
and transmitted by the bite of mite called _Leptotrombidium deliense_.
In Nagaland, it was formerly detected by IDSP with Central
Surveillance Team in Longsa village Mokokchung in 2006, and in Porba
village of Phek District in 2007.

Signs and symptoms [of scrub typhus]:
- After the bite of infected mite larvae called chiggers, a papule
develops at the biting site which ulcerates and eventually heals with
the development of a black eschar.
- Patients develop sudden fever with headache, weakness, myalgias,
generalized enlargement of lymph nodes, photophobia, and dry cough.
- A week later, a rash appears on the trunk, then on the extremities,
and turns pale within a few days.
- Symptoms generally disappear after 2 weeks even without treatment.
However, in severe cases with pneumonia and myocarditis, mortality may
reach 30 percent.

The most commonly used test for diagnosis is Weil-Felix test, which is
available at State IDSP laboratory, Kohima. More specific serological
tests like detection of IgM [immunoglobulin M antibody] can also be
done for diagnosis. IFA [indirect immunofluorescence antibody assay]
is the gold standard.

Scrub typhus responds well to the antibiotic doxycycline or
chloramphenicol. In resistant cases, rifampicin can be used. In
children and pregnant women, azithromycin is the drug of choice.
Sulfonamide group of drugs are contraindicated.

As scrub typhus is found in distinct areas (typhus islands), control
measures can be carried out by treating the ground and vegetation with
residual insecticides, reducing rodent populations, and destroying
limited amounts of local vegetation. Protective clothing, applying of
mite repellent to exposed skin, and chemoprophylaxis can be considered
for persons in infested terrains. No effective vaccine has been
developed to date.

The State RRT team carried out the outbreak investigation along with
doing and entomological survey. The patients were treated with
appropriate medicines and awareness and preventive measures were
communicated with the villagers. The concerned local health
authorities and programs are informed for further necessary action.
The mop-up operation is being carried out by the National Vector Borne
Disease Control Program.

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

[For a discussion of scrub typhus, see ProMED-mail post Scrub typhus -
India: (HP) 20110319.0872.

Nagaland is a state in the far northeastern part of India. It borders
the state of Assam to the west, Arunachal Pradesh and part of Assam to
the north, Burma to the east and Manipur to the south. Peren is one of
its eleven districts (for a map of the districts of Nagaland, see
<http://en.wikipedia.org/wiki/File:Nagalandmap.png>). Most of the
inhabitants belong to the Zeliang and Kuki tribes
(<http://en.wikipedia.org/wiki/Peren_District>). Poilwa is a Zeliang
tribe village
(<http://www.incredibleindia.org/newsite/ ... pageid=381>). A
HealthMap/ProMED-mail interactive map of India that shows the state of
Nagaland can be found at <http://healthmap.org/r/010T>. - Mod.ML]

SCRUB TYPHUS - INDIA (03): (HIMACHAL PRADESH)
*********************************************
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ProMED-mail is a program of the
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Date: Sun 18 Sep 2011
From: Omesh Bharti <bhartiomesh@yahoo.com> [edited]


In Himachal, more than 13 patients have died of scrub typhus.

An awareness campaign is on, and doctors are on high alert. This time,
more people died due to a prolonged spell of the rainy season.

--
Dr. Omesh Kumar Bharti M.B.B.S.,D.H.M.,M.A.E. (Epidemiology)
Emergency Medical Response and Transport
Directorate of Health, Kasumpati, SHIMLA
Himachal Pradesh, India
<bhartiomesh@yahoo.com>

[ProMED-mail thanks Dr Bharti for his report on scrub typhus in
Himachal Pradesh.

ProMED-mail posted a report of a large outbreak of scrub typhus in
Himachal Pradesh in March 2011; there were more than 200 cases,
although none were fatal at the time (see Scrub typhus - India: (HP)
20110319.0872).

Himachal Pradesh is a state in northwestern India that is bordered by
the Indian states of Jammu and Kashmir on the north, Punjab on the
west and southwest, Haryana and Uttar Pradesh on the south,
Uttarakhand on the southeast, and by the Tibet Autonomous Region on
the east (<http://en.wikipedia.org/wiki/Himachal_Pradesh>).

Himachal Pradesh is a mountainous state with an elevation ranging from
about 350 meters (1148 ft) to 7000 meters (22 966 ft) above sea level
and has one of the highest per capita incomes of any state in India.

Himachal Pradesh can be located on a map of India at
<http://en.wikipedia.org/wiki/File:India ... or_map.svg>.
A HealthMap/ProMED-mail interactive map of India that shows the state
of Himachal Pradesh can be found at <http://healthmap.org/r/1cZv>. -
Mod.ML]

DENGUE/DHF UPDATE 2011 (38)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


- Pakistan (Karachi, Sindh province). 16 Sep 2011. In Karachi, 18 new
dengue fever cases were reported on Friday 16 Sep 2011] raising the
number of confirmed dengue patients in the province to 235 during the
ongoing year [2011]. In the province, 3 [dengue] patients have died.
<http://www.brecorder.com/pakistan/gener ... achi-.html>

[A HealthMap/ProMED-mail interactive map showing the location of
Karachi in Sindh orovince can be accessed at
<http://healthmap.org/r/1fy9>. - Mod. TY]

- Pakistan (Rawalpindi, Punjab province) 16 Sep 2011. So far, this
year, 36 dengue fever cases,admitted in Holy Family Hospital, Benazir
Bhutto Hospital and District Headquarter Hospital of Rawalpindi, have
been declared positive by National Institute of Health (NIH).According
to District Health Department’s figure, this year total 412
suspected dengue fever cases have been admitted in hospitals of
Rawalpindi and the patients are being provided medical treatment in
three teaching hospitals of the city.
<http://app.com.pk/en_/index.php?option= ... 5&Itemid=2>

[A HealthMap/ProMED-mail interactive map showing the location of
Rawalpindi in northern Punjab province, can be accessed at
<http://healthmap.org/r/0cco>. - Mod. TY]

- Pakistan (Punjab province). 14 Sep 2011. So far more than 5000 cases
of dengue are reported in Punjab, out of which over 4400 are from
Lahore alone. Official figures report 11 people have died in the
province. However, unconfirmed reports state that the death toll has
reached 18.
<http://tribune.com.pk/story/252117/deng ... e-to-rise/>

- Pakistan (central Punjab province). 14 Sep. 2011. Around 4400 cases
of the mosquito-borne disease have been reported in the central Punjab
province over the past 2 months, forcing the provincial government on
Tuesday [13 Sep 2011] to close down schools for 10 days. Most of the
cases have been reported in Lahore, the provincial capital, where
about 2950 people tested positive. So far, 8 people have died of
dengue.
<http://www.reuters.com/article/2011/09/ ... 2720110914>

- Pakistan (Lahore, Punjab province). 14 Sep 2011. The total number of
dengue fever patients has risen to 3765 after 353 fresh cases were
reported during the last 24 hours in the provincial capital. 8 deaths
have so far been reported since the outbreak of the disease [began].
<http://ftpapp.app.com.pk/en_/index.php? ... &Itemid=38>

[It is not clear why there is a discrepancy in the number of dengue
cases in Lahore between the 3 reports above. Perhaps the number of
cases coming in to hospitals and health centers has been so great over
the past few days that the statistics have not kept up with the
outbreak. Also, it is not clear which figures are official ones and
which unofficial. - Mod. TY]

- Pakistan (Khyber Pakhtunkhwa). 13 Sep 2011. Dengue fever claimed
one more life in Khyber Pakhtunkhwa (KPK), raising the death toll in
the province to 3. According to the health department, over 100
patients suspected of having Dengue are admitted in hospitals across
KPK while there have been 29 confirmed cases.
<http://www.geo.tv/9-13-2011/86179.htm>

[A healthMap/ProMED-mail interactive map showing the location of
Khyber-Pakhtunkhwa (formerly North-West Frontier) can be accessed at
<http://healthmap.org/r/1b77>.

- India (Noida, Uttar Pradesh) state. 15 Sep 2011. Dengue has reared
its ugly head even in Noida with the district hospital confirming 6
cases from the 36 samples sent by private hospitals for testing.
Private hospitals in the city, however, said that the number of dengue
cases is lesser as compared to the past years
<http://articles.timesofindia.indiatimes ... aria-cases>

A HealthMap/ProMED-mail interactive map showing the location of Noida,
Uttar Pradesh state, can be accessed at <http://healthmap.org/r/1fya>.
- Mod. TY]

- India (Gurgaon, Harayana state). 13 Sep 2011. Only 14 people have
been detected with dengue this year [2011], a dreaded mosquito-borne
disease which infected 800 people and claimed 14 lives last year
[2010].
<http://www.hindustantimes.com/Dengue-ca ... 44899.aspx>

[A HealthMap/ProMED-mail interactive map showing the location of
Gurgaon, Harayana state, can be accessed at
<http://healthmap.org/r/1fyb>. - Mod. TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (18): (UTTAR PRADESH)
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Sun 18 Sep 2011
Source: IBN Live, Press Trust of India (PTI) report [edited]
<http://ibnlive.in.com/generalnewsfeed/n ... 27755.html>


In the last 24 hours 11 persons have died of Japanese encephalitis
[JE; virus] and its water borne form at BRD Medical College Hospital
[in Gorakhpur] taking the total number of causalities due to the
diseases to 300 this year [2011]. 42 people have been admitted to the
hospital with symptoms of JE, which occurs at the onset of monsoon due
to mosquito bite, and water borne viral encephalitis which is due to
consumption of contaminated water, officials said. The dead included
children in the age group of 3-14 years. As many as 264 patients
belonging to Gorakhpur, Basti, and Devipatan divisions are undergoing
treatment at the hospital, they said. Officials claimed that JE cases
have come down to as low as 9 per cent of total encephalitis deaths.

--
Communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[In this report, unlike the most recent ones, both JE virus and an
unidentified water-borne pathogen are indicated as responsible for
these encephalitis cases. These cases of undiagnosed etiology are
often referred to as acute encephalitis. It is unfortunate that the
etiology of these cases, presumably one or more enteroviruses, has not
been determined after several years of occurrences.

A HealthMap/ProMED-mail interactive map showing the location of
Gorakhpur and the other localities in eastern Uttar Pradesh state can
be accessed at <http://healthmap.org/r/02lp>. - Mod.TY]

******
[2]
Date: Sun 18 Sep 2011
Source: Newsonair, Prasar Bharati (Broadcasting Corporation of India)
[edited]
<http://www.newsonair.com/showNews.asp> [the story can be found in the
archives]


In Uttar Pradesh, 18 children have succumbed to Japanese encephalitis
[virus infections] in different districts of eastern Uttar Pradesh.
Quoting Official sources AIR correspondent reports that of these, 11
children died at Baba Raghav Das Medical College Hospital in
Gorakhpur, 3 in Bahraich, and 4 patients succumbed to the deadly
disease in Allahabad district. With these, the death toll due to
different kinds of encephalitis has mounted to 307 in various eastern
districts this year [2011]. Our correspondent reports that more than
270 patients are being treated for encephalitis in the government
hospitals of the region.

--
Communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[Again, several different types of encephalitis etiologies are
mentioned, but only JE virus is identified. - Mod.TY]

******
[3]
Date: Mon 19 Sep 2011
Source: Express India, The Indian Express [summ., edited]
<http://www.expressindia.com/latest-news ... rs/848583/>


Even as the health directorate struggles to control the rising number
of cases of acute encephalitis syndrome (AES) in Uttar Pradesh (UP),
the state government is planning to procure 4 special ventilators for
the neo-natal unit of Baba Raghav Das (BRD) Medical College,
Gorakhpur, under National Rural Health Mission. The ventilators will
be specifically used to cater to AES-affected children with body
weight below 5 kg [11 lb].

Cases of AES have been increasing in the state. According to the
latest figures from the Health Directorate, as many as 1864 cases have
been reported from Uttar Pradesh so far, with 262 deaths. With 221
cases reported from Bihar and 6 others from Nepal, the total number of
AES cases this year [2011] has reached 2091, while deaths have crossed
300.

Of the total cases in UP, 126 cases and 12 deaths are due to Japanese
encephalitis [virus infections]. However, said Dr KP Kushwaha, head of
the pediatric department of BRD Medical College, the number of JE
cases this year are low compared to last year [2010], when around 12
per cent of the total AES cases were of JE. "This year till now, the
JE cases are merely 6 to 7 per cent of the total AES cases," he said.

[Byline: Surbhi Khyati]

--
Communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[There is still no indication of what the etiology of the non-JE virus
infections might be. - Mod.TY]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (19): (UTTAR PRADESH), REQUEST
FOR INFORMATION
**************************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 19 Sep 2011
Source: The Times of India [edited]
<http://timesofindia.indiatimes.com/indi ... 040937.cms>


In a potential epidemic, at least 61 people have died and 662
hospitalized due to encephalitis in the last 10 days in the district,
around 125 kms [78 mi] north-east of Lucknow.

The chief medical superintendent in-charge of the district hospital,
Dr RS Baranwal said encephalitis in the area was caused by
[transmitted by] mosquitoes that breed in stagnant water.

Encephalitis is most often caused by a viral infection and exposure to
viruses can occur through mosquito, tick, and other insect bites,
contaminated food or drink, breathing in respiratory droplets from an
infected person and skin contact. The disease caused by the herpes
simplex virus is the major cause of fatal cases in all ages, including
newborns, especially during or after monsoons in India. Last year
[2010], a large number of deaths due to encephalitis were reported in
Bihar and UP [Uttar Pradesh). "Therefore, it is important to maintain
cleanliness with an aim to prevent the disease from spreading," Dr
Baranwal said.

On Monday [13 Sep 2011], 3 more children died due to the disease
[encephalitis], taking the death toll to 61 in the district. 10 new
patients have also been admitted to the district hospital. The number
of patients suffering from acute fever has crossed 662. Of them the
condition of 6 children is stated to be critical. The blood and serum
samples of 13 patients have been sent to Lucknow medical college for
examination.

The paediatrician of the district hospital Dr.K.K.Verma said that it
was for the 1st time in 2 years that the patients in such a huge
number had been coming to the hospital. He said that last Tuesday 350
patients had visited the Out Patient Department (OPD), which was a
record in itself. Earlier, the maximum number of patients to OPD were
150 to 175.

Dr RS Baranwal said that considering the increasing number of patients
in the hospital a letter had been written to the government for more
medicine and resources. A new lot of medicine would arrive in a day or
2, he added.

Due to the increasing number of encephalitis patients in the hospital,
new patients are now lying outdoors on the ground and hoping to get
medical treatment.

[Byline: Bipin Chand Agarwal]

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

[This report mentions various etiologies of encephalitis in that
region of India without indicating which of these might be responsible
for the numerous cases in the hospital. Previous recent reports of
encephalitis in this region indicated that Japanese encephalitis virus
was responsible for at least some of them, while other were due to an
unspecified acute encephalitis syndrome, some associated with water
that suggest enteroviruses might be involved. ProMED will be
interested in learning of the results of the tests being conducted on
the serum samples submitted to the Lucknow laboratory.

A map showing the location of the Bahralch district in Uttar Pradesh
state can be accessed at <http://en.wikipedia.org/wiki/Bahraich> and a
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/1f*E>. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (31): ASIA
******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Asia
[1] Diarrhea, fatal - Pakistan (Federally Administered Tribal Areas)
[2] Cholera - Pakistan (Sindh)
[3], [4] Possible cholera - Uzbekistan

******
[1] Diarrhea, fatal - Pakistan (Federally Administered Tribal Areas)
Date: Mon 19 Sep 2011
Source: Pakistan Observer [edited]
<http://pakobserver.net/detailnews.asp?id=115047>


At least 7 people including women and children died and dozens others
were hospitalized after diarrhea broke out in Tirah Valley of Khyber
Agency. According to local sources, due to contaminated water and
unhygienic conditions, epidemics like diarrhea broke out in far flung
and militancy-hit Tirah Valley.

Due to the outbreak of the epidemic and absence of appropriate medical
treatment, 7 people including women and children have died during the
past 2 days. Meanwhile, dozens of other diarrhea patients were shifted
to different hospitals. Most of the hospitals in the troubled area
were closed due to militants' activities and security forces' action,
and there was no staff in the hospitals and Basic Health Units (BHU).

Local sources said that several affected people were in critical
condition as there was no facility of medical treatment in the area.
The dwellers of Tirah Valley have demanded the provincial and federal
government to send doctors' teams and medicines to the affected areas
to stop the further spread of the epidemic.

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

[It is likely that the outbreak is indeed cholera. - Mod.LL]

******
[2] Cholera - Pakistan (Sindh)
Date: Mon 19 Sep 2011
Source: Pakistan Today [edited]
<http://www.pakistantoday.com.pk/2011/09 ... med-cases/>


Out of the 283 suspected cholera cases in rain-hit areas of Sindh, 24
have been confirmed positive, and 3 people have died due to the
disease so far, the WHO said in its report issued on Sunday evening,
18 Sep 2011.

"Between a month's period (16 Aug to 15 Sep 2011), the DEWS detected
225 alerts, out of which 42 were confirmed outbreaks, and the Rapid
Response Team responded to all reported outbreaks within 48 hours, and
among these, 35 were attributed to acute watery diarrhea," the DEWS
said in the report. "In the last few days, the WHO distributed health
kits, essential medicines and medical supplies to cover the needs of a
population of about a quarter million," the report quoted WHO
representative Dr Guido Sabatinelli as saying.

[Byline: Amar Guriro]

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

[Acute watery diarrhea is often used as a euphemism for cholera. -
Mod.LL]

******
[3] Possible cholera - Uzbekistan (Tashkent)
Date: Fri 16 Sep 2011
Source: Uznews [edited]
<http://www.uznews.net/news_single.php?l ... &nid=17912>


Through its media service, Jahon, the Uzbek foreign ministry appears
to be denying claims that Uzbekistan is experiencing an outbreak of
cholera. The ministry of health in Uzbekistan and the state
epidemiological surveillance unit are also refuting reports of a
cholera outbreak.

"If we announce a cholera diagnosis, then we immediately have to
organise quarantine, and nobody wants that," said one doctor in the
Tinchlik village hospital in Yangiyul district, Tashkent. Quarantine,
he says, means that villages and towns where cholera has been
identified have to be "shut down," and clean drinking water has to be
supplied, which is an extremely costly operation for the district
authorities, especially in villages like Tinchlik."

"We haven't had clean water for 20 years. The old water pipes have
crumbled, but nobody has ever replaced them," said Akramkhodzh
Mukhiddinov, member of the Human Rights Alliance of Uzbekistan (PAU)
and also a resident of Tinchlik.

Mukhiddinov claims that many people who have their own transport bring
drinking water from Yangiyul or Tashkent, but most people take water
from waterways running through the area.

"People take water from the irrigation channels, then boil it and
drink it. There is no alternative when there is no clean mains water,"
says Mukhiddinov. He claims that people most at risk of contracting
cholera are those who take water from the Boz-Su river. "A 45-year-old
man, who drank water from this river, died recently in our village,"
Mukhiddinov says.

Meanwhile, Uzbekistan's health ministry and foreign affairs ministry
are categorically denying reports of a cholera outbreak.

"When you present them with concrete facts about people dying from an
illness, the symptoms of which are extremely similar to those of
cholera, ministry of health civil servants don't respond, claiming
that they have heard of no such instances," one Tashkent journalist
remarked.

Uzbekistan's state epidemiological service also denies the outbreak of
cholera.

"We are currently running a campaign to vaccinate children against
measles and German measles, but have heard nothing about cholera. If
there were cases, we would have made statements about this," said one
employee of the state epidemiological surveillance service in
Chilanzar district, Tashkent.

"The symptoms of cholera, vomiting and diarrhea, are similar to those
of other intestinal illnesses, and it is possible that people are
mistaken about what is actually wrong," an employee of the
epidemiological surveillance unit speculated. When asked about
cholera, the source asked us not to use his name.

Despite official denials, many doctors are saying confidentially that
there are cases of cholera now in Uzbekistan. They do not hide the
fact that people have died from an intestinal illness, the name of
which doctors will not spell out to their relatives.

"I am convinced my husband died of cholera after he swam in the Boz-Su
river," said a 30-year-old Tashkent resident.

The outbreak of cholera would appear to be confirmed, at least, by
events in Yangiyul district and in Yangiyul hospital, where, in
mid-August 2011, dozens of people arrived each day with symptoms of
this disease, not only vomiting and diarrhea but also severe
dehydration. Previously, the Almazarsk district of Tashkent had
experienced cholera-like illness, also linked to water from the Boz-Su
river.

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

******
[4] Possible cholera - Uzbekistan (Tashkent)
Date: Fri 9 Sep 2011
Source: Ferghana.ru [abstracted by submitter, edited]
<http://www.fergananews.com/>


An epidemic of an unknown disease with symptoms of cholera has been
raging for over 20 days in the town of Yangiyol in Uzbekistan's
Tashkent Region [near the capital Tashkent].

A Ferghana correspondent on 8 Sep 2011 visited Yangiyol to check the
validity of the rumours about a possible epidemic of cholera in the
town. Announcements are posted on the doors of practically all cafes
and shops calling on the locals to thoroughly wash their hands before
eating meals, fruits and vegetables, and to drink only boiled water.

Doctors at the Yangiyol hospital did not comment on what type of
enteric disease has affected so many people or mention the name of the
disease. However, one of the medical staff on condition of anonymity
said that starting from 15 Aug 2011, several dozen people have been
taken to the hospital every day with symptoms of the disease.

"Their ages range from small children to mature men and women. All
were in a grave condition, could not walk or even stand, and had
constant diarrhea and vomiting. The whole hospital stank of rotten
fish. The nurses constantly washed them," he said.

According to the source, the doctors were banned from diagnosing [the
disease] as cholera. "A woman from Xalqobod [a settlement in the town]
with the same symptoms by herself went to a clinic of infectious
diseases in Tashkent city, where she was immediately diagnosed with
cholera," he said.

He said that towards the end of August 2011, more and more sick people
were admitted every day. "It reached a peak on 31 Aug 2011: 70 people
with similar symptoms were taken to the hospital. Only the existing
staff worked at the hospital those days. No one was sent in to help,
only those who were on leave or sick leave were called in to work,"
the hospital staff member complained.

The majority of the patients are residents of Xalqobod. "The Bozsuv
canal flows there, and many [of the patients] had swum in it. Some had
washed dishes and some their hands," the source explained.

--
Communicated by
Michelle Sellors
Specialist Nurse Travel Health
MASTA Ltd
<michelle.sellors@masta.org>

[The outbreak and its epidemiology certainly sound like _V. cholerae_
infection. Perhaps calling it acute watery diarrhea would be better. -
Mod.LL]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (20): (BIHAR)
*****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 19 Sep 2011
Source: Zeenews [edited]
<http://zeenews.india.com/news/bihar/jap ... 32500.html>


On Monday [19 Sep 2011], 3 girls suffering from Japanese encephalitis
[virus infections; JE] died in a government hospital here, taking the
statewide toll to 31 in Bihar, officials said. The girls died in
Anugrah Narayan Medical College and Hospital. With this, the total
number of people died due to the fever rose to 31, ANMCH
Superintendent Sitaram Singh said. 2 of the girls were from Gaya
district, while the other was from Nawada district, he said.

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

[The number of deaths due to JE virus infections in Bihar state have
increased from 25 on 14 Sep 2011 to 31 just 4 days later.
Interestingly, official government National Vector Borne Disease
Control statistics for JE virus plus the undiagnosed fatal cases of
acute encephalitis syndrome in Bihar state as of 13 Sep 2011 are given
as 54, but do not indicate how many of these are due to JE virus
infections [see ProMED-mail archive number 20110914.2803].

Gaya is the 2nd largest city in Bihar state and the capital of the
district. A HealthMap Interactive map showing the location of Gaya can
be accessed at <http://healthmap.org/r/1emt>. - Mod.TY]

JAUNDICE - INDIA: (JAMMU AND KASHMIR) CONTAMINATED WATER, REQUEST FOR
INFORMATION
*********************************************************************************
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: Thu 22 Sep 2011
Source: Kashmir Dispatch [edited]
<http://www.kashmirdispatch.com/headline ... ashmir.htm>


A local news agency reported on Thu 22 Sep 2011 that 3 people
including 2 infants have died while 13 people have been hospitalized
in south Kashmir's Shopian district due to an outbreak of jaundice. It
said that 2 pregnant women hailing from Karwadah in the district were
suffering from jaundice and were shifted to the SMHS hospital [in
Srinagar] today [22 Sep 2011]. Both women delivered, but the infants
did not survive and passed away minutes after being born.

Doctors at the hospital told the news agency that the infants died due
to jaundice. The news agency said that [one of the women] also passed
away after delivering her baby.

The agency quoted its correspondent in Shopian saying that many
patients were shifted to local hospitals in the districts, while 13
people were shifted to SK Institute of Medical Sciences in Soura,
Srinagar. The condition of 2 of the patients, it said, was critical.
Meanwhile, the department of Health has established a camp in the
area, the agency said.

In total 22 patients have been identified in the area and [on the
basis of their] the condition some have been referred to Srinagar
hospital, chief medical officer Dr Nazir Ahmad said. He admitted that
the risk of pregnant woman catching the disease was higher. Regarding
the death of the mother, he said, "Even though we don't have exact
details about her, she was said to be suffering from hepatitis during
her pregnancy."

People in the area have expressed anger against the Public Health
Engineering Department [PHE] for failing to provide a clean water
supply. The water tank constructed by the PHE has not been cleaned
[for a long time] and is not well kept, they alleged. Experts say that
the outbreak is primarily due to [consumption of] contaminated water.

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

[Jaundice is caused by a build-up of bilirubin in the blood and
tissues of the body. Bilirubin is a waste product that is produced
when red blood cells break down. Jaundice can occur as a result of any
condition, problem, or underlying factor that disrupts the movement of
bilirubin from the blood to the liver and then out of the body.
Intra-hepatic jaundice occurs when damage to the liver disrupts the
liver's ability to process bilirubin. Causes of intra-hepatic jaundice
include: the viral hepatitis group of infections (hepatitis A,
hepatitis B, hepatitis C, and hepatitis E viruses), leptospirosis (a
bacterial infection that is spread by animals, particularly rodents
and is common in tropical areas), glandular fever (caused by the
Epstein-Barr virus), and over-exposure to substances such as alcohol,
paracetamol, phenolic compounds, etc, autoimmune disease, and certain
genetic conditions.

Perhaps hepatitis E virus infection is the most likely cause of the
outbreak in Shopian which is associated with an inadequately
maintained water supply. Such outbreaks have not been uncommon in
India in the past. Further information is awaited concerning the
investigation into the causation of this outbreak.

Shopian District is one of the districts of Jammu and Kashmir state,
India. Its headquarters are located at Shopian city. A map showing the
location of Shopian district can be accessed at
<http://jammukashmirrealities.blogspot.c ... ct_20.html>.
The HealthMap/ProMED-mail interactive map of India can be seen at
<http://healthmap.org/r/1hcH>. - Mod.CP]

LEPTOSPIROSIS, FATAL - INDIA (02): (KERALA)
*******************************************
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: Fri 23 Sep 2011
Source: News Tonight [edited]
<http://newstonight.net/content/kerala-a ... y-outbreak>


The Kerala administration has decided to launch 'fever clinics' in
medical institutions, as well as district hospitals, and, if
achievable, in private hospitals, with the aim to fight the spread of
rat fever (leptospirosis) in the Malabar area.

This declaration has been made by Mr Adoor Prakash, minister for
health. After a conference with senior medical functionaries, the
minister stated that medical camps, wherever needed, would be held for
cure as also to create attentiveness regarding the illness amongst the
community. The Indian Medical Association will offer up all necessary
backing for arranging the camps. While explicating the actions being
pioneered to deal with the situation, Mr Adoor stated that that a
drive to clean up the premises and public places would be introduced
with the assistance of charitable groups in addition to educational
institutions. In this connection, a 7 day-long program will take place
from 25 Sep to 2 Oct 2011.

The Accredited Social Health Activists (ASHA) workers will also be
deployed in the field to assist the attempts to put control over the
outbreak. A Central group would visit Kerala to review the whole
situation. The Minister added that around 256 suspected cases of rat
fever were found in Kozhikode region, out of which 33 cases were
confirmed. In the same way, 43 fatalities thus far were suspected to
have been caused by the illness, out of which 2 had been confirmed.

[Byline: Pratibha Minhas]

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

[Bacteria of the genus _Leptospira_ cause leptospirosis. More than 200
pathogenic leptospiral serovars, distinguished on the basis of
bacterial surface antigens, have been identified. Different
leptospiral serovars are prevalent in particular geographical regions.
The disease is transmitted to humans from wildlife species, such as
rats, sometimes domestic animals, such as dogs, and livestock, such as
cattle and pigs. When these animals are infected, they may have no or
minimal symptoms of the disease, but develop a renal carrier state
associated with long term urinary shedding. The infection is
transmitted to humans by contact with water, soil, or food
contaminated with the urine of these chronically infected animals.

Outbreaks of leptospirosis are usually associated with exposure to
contaminated floodwater. _Leptospira_ survive for weeks to months in
warm, fresh water or soil flooded with fresh water. The bacteria can
enter the body through skin or mucous membranes, especially if the
skin is broken from a cut or scratch. Drinking contaminated water or
food can also cause infection. Person to person transmission is rare.

The symptoms in humans appear after a 3-14 day incubation period.
Because of the relatively nonspecific nature of the clinical
presentation of leptospirosis, its diagnosis cannot be made
confidently without laboratory confirmation. For further discussion of
leptospirosis, see ProMED-mail post Leptospirosis - India: (KA,KL)
20110709.2079.

Leptospirosis occurs worldwide and frequently follows flooding after
heavy rain. The rainy summer monsoon season begins in Kerala in June
and lasts until the end of September, with flooding every year
(<http://www.mapsofindia.com/surat/flood.html>).

In a flood-affected area, leptospirosis chemoprophylaxis is
doxycycline 200 mg, once a week for those exposed to contaminated
floodwater or soil. Each 200 mg dose provides a benefit for up to 7
days, so the dose may be repeated if high-risk conditions persist
longer than this.

People exposed in flooded fields should be cautioned against direct
contact with contaminated water or mud and should be advised to use
rubber shoes or boots and gloves. Broken skin should be protected with
a waterproof dressing. All food and drinking water should be protected
against contamination. All drinking water should be boiled unless it
is known to be absolutely safe. Fresh vegetables and fruit should be
washed in clean water and then cooked or peeled. Because rodents are
the major reservoir of _Leptospira interrogans_, rodent control
measures should be undertaken.

A map of the states of India can be found at
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>. For
the interactive HealthMap/ProMED map of India, see
<http://healthmap.org/r/1h98>. - Mod.ML]

JAPANESE ENCEPHALITIS AND OTHER - INDIA (21): (DELHI)
*****************************************************
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: Sat 24 Sep 2011
Source: Indian Express [summ., edited]
<http://www.indianexpress.com/news/first ... y/851006/0>


Confirming 4 cases of Japanese encephalitis (JE) [virus infection] in
the city, officials on Friday [23 Sep 2011] said preliminary inquiries
had established that the patients did not travel to endemic areas in
the recent past and appeared to have contracted the virus in Delhi
itself.

The state government had directed MCD [Municipal Corporation of Delhi]
and NDMC [New Delhi Municipal Council] to conduct inquiries about 4
persons who had tested positive for JE [virus antibodies] in
serological tests conducted by the National Centre for Disease Control
(NCDC). Of the 4, 3 are children from Bawana and Jahangirpuri in North
West Delhi while the 4th is an HIV positive woman from Gole Market in
New Delhi.

Dr RP Vashisht, state programme officer of the Integrated Disease
Surveillance Project (IDSP), said: "None of the 4 patients is in a
serious condition. All of them are responding to treatment."

Dr VK Monga, chairperson of the MCD public health committee, said:
"After the JE virus enters the body, it only takes between 5-15 days
for the symptoms to manifest. This is known as the incubation period
of the virus. No patient appears to have travelled to any endemic area
in the last month." He said though 2 patients had travelled to UP
[Uttar Pradesh] in February and July [2011], the virus was contracted
in the last 15 days.

The vector-borne disease is carried by a female mosquito of the _Culex
tritaeniorhynchus_ species. "The virus is found in pigs and cattle. A
mosquito which bites any infected cattle becomes a vector and can
spread it to human beings. [Cattle are not involved in the
transmission cycle of JE virus; wild birds are the reservoir. Pigs are
amplifying hosts. - Mod.TY]. It has a very high mortality rate of
20-40 per cent. This is the 1st time that cases have been confirmed in
Delhi, so we are worried," Dr Monga said.

Both MCD and NDMC said they have taken immediate measures to control
the spread of the virus. "We have carried out intensive fogging and
anti-larval treatment activities within a 2 km [1.2 mi] diameter of
the area of residence of the patients in North West Delhi on Friday
[23 Sep 2011]," Dr Monga said. NDMC health officer Dr PK Sharma said
similar measures had been taken in the Gole Market area.

[Byline: Pritha Chatterjee]

--
Communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[There have been scattered cases across India this JE virus
transmission season in 2011, particularly in Uttar Pradesh and Bihar
states. If vector mosquitoes are abundant in Delhi, health authorities
there have a legitimate cause for concern.

This report does not indicate what type of serological tests were
done. Presumably they were single, not paired acute/convalescent
samples, since these were fatal cases and so it would not be possible
to demonstrate a significant diagnostic rise in antibody titer.
Interpretation of serological tests with flaviviruses such as JE virus
must be done with caution, due to confusing or misleading
cross-reactions with viruses within the flaviviruses.

A HealthMap/ProMED-mail interactive map showing the location of Delhi
can be accessed at <http://healthmap.org/r/1hcw>. - Mod.TY]

LEPTOSPIROSIS, FATAL - INDIA (03): (GUJARAT)
********************************************
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: Fri 23 Sep 2011
Source: Day Breaking News [edited]
<http://www.daybreakingnews.com/post/In- ... onths.aspx>


In the past 2 months, nearly 130 [people] were killed by the dangerous
disease leptospirosis in south Gujarat. They are admitted to the civil
hospital at Surat, and most of them were in special wards in very
serious condition. They are affected by this disease because most of
them are farmers, and they have to work in sugarcane and paddy
fields.

Doctors say this is a bacterial infection that is spread through dirty
water, and it can be spread even by rat urine. [The bacteria] enter
into the body through wounds or cuts. The symptoms for this virus are
similar to those of dengue and flu. Physician at the Civil Hospital Dr
Kamalesh said these bacteria will mainly affect the lungs, kidney and
liver; the main symptoms for this disease are jaundice, fever and
redness in eyes.

From 415 villages, around 750 cases have been affected, and the
government has sent a special team to the villages to bring medicines
for this disease.

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

[The numbers of deaths and cases of leptospirosis in Gujarat have
increased since the last ProMED-mail post (Leptospirosis, fatal -
India: (GJ) 20110829.2647). For a discussion of leptospirosis, please
see ProMED-mail post Leptospirosis - India: (KA,KL) 20110709.2079.

Gujarat has an agricultural economy; the total crop area amounts to
more than one-half of the total land area
(<http://en.wikipedia.org/wiki/Gujarat#Agriculture>).

Leptospirosis is also known as canecutter's disease or sugar cane
fever, because of the spread of the disease by canefield rats, which
would likely be facilitated in flooded cane fields during the monsoon
season. The rainy summer monsoon season begins in Gujarat in late June
and lasts until the end of September, with flooding every year
(<http://www.mapsofindia.com/surat/flood.html>).

A map of Gujarat can be found at
<http://upload.wikimedia.org/wikipedia/c ... _South.png>,
and a map of the states of India can be found at
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>. For
the interactive HealthMap/ProMED map of India, see
<http://healthmap.org/r/008o>. - Mod.ML]