Uganda - Double whammy as Yellow Fever outbreak joins Marburg Fever

UGANDA (eTN) - Uganda’s tourism industry is in jitters since the announcement that Marburg Fever has been identified as the cause of death of at least four people in the Kabale District in Southwestern Uganda. The situation was made worse when it became known that at least one case of Yellow Fever has also been identified in Northern Uganda, besides an outbreak of deadly hepatitis in the Northeast of the country. The Marburg outbreak follows hot on the heels of an Ebola outbreak in Uganda’s Kibale district which scared potential visitors and led to the denial of a visa for Uganda’s Muslim faithful who wanted to go for the Haj pilgrimage only to be told they were banned over Ebola fears.

Current visitors to Uganda, though most unlikely to come anywhere near the area where the Yellow Fever outbreaks were recorded, will now be well advised to get their own Yellow Fever inoculations as the certificate could be demanded from them when getting home or traveling elsewhere after a visit to Uganda.

Said a regular commentator from Kampala yesterday evening when the added bad news was announced: “This was to be a year of celebration. Lonely Planet made us their top destination for 2012. We celebrated 50 years of independence. Business generally was on the upswing. But it ended up as far from normal. We are reassuring our tourists that they need not worry as those places in the North are far from tourist routes, but the Kabale thing is, of course, at the crossroads to Kisoro and Mgahinga and to Bwindi, and that is not so good. Still let me say that our visitors are safe and need not worry.”

As reassuring as that may sound, ahead of the busy high season, this is not something Uganda needed to go through. The international media are now also highlighting the fighting right across the borders in Congo, where militias and the regime army are battling for supremacy to control the area rich in minerals and oil and the spillover of tens of thousands of refugees once again, besides warming up the old stories on disease outbreaks in the past. It never rains but pours it seems, but the time is now to stand up and tell the world about the bright sides of our country and why we are after all called “The Pearl of Africa.”

Source

Nigeria: 100 Million At Risk of Yellow Fever Outbreak

Over 100 million Nigerians are at the risk of yellow fever infection due to government's failure to conduct vaccination, the National Primary Health Care Development Agency (NPHCDA) has warned.

Health experts at a stakeholders meeting for yellow fever preventive campaign in Abuja said the disease outbreak is imminent as no mass vaccination has been conducted in the nation since the last outbreak 30 years ago.

Speaking at the event, chairman Expert Review Committee on polio eradication and routine immunization, Professor Oyewole Tomori said Nigeria is already endangered with a recent outbreak in nearby Cameroun.

Some 377 local government areas in 25 states have been marked as high risk areas, an assessment survey of the country.

Tomori said, "We are sitting on a tinderbox due to our population, if we have not done a mass vaccination campaign; it means we have a large number of people who are vulnerable."

He pointed out that a recent outbreak of yellow fever in six districts of Cameroun bordering Cross River State has placed Nigeria at risk because it is the only country among 13 other countries in West Africa yet to conduct mass vaccination.

Source

Acute Waterborne Encephalitis - a new type of unknown brain fever now killing children in Eastern UP

A ProMED-mail post
http://www.promedmail.org

Date: Mon 22 Oct 2012

Source: The Times of India [edited]

http://articles.timesofindia.indiatimes.com/2012-10-22/india/34652749_1_handpump-india-mark-ii-encephalitis

When a man had a little money saved, over 10 years ago, he installed a handpump outside his small house in Badhariya village. The 1st he heard of the handpump being too shallow was when his 9-year-old daughter died of encephalitis this year [2012] and the grieving father was told it was because of the water she had drunk from the handpump.

With water-borne acute encephalitis syndrome (AES) now making up close to 95 per cent of the encephalitis cases across eastern Uttar Pradesh, there is a renewed focus on the water the area's children are drinking. "The big problem in this area is that since it is low-lying and surrounded by rivers, the water table is very high, which makes contamination easier," says Gorakhpur's district magistrate Ravi Kumar NG.

Milind Gore, who heads the National Institute of Virology's Gorakhpur research unit, says water samples taken by them near handpumps in affected areas have shown the presence of enteroviruses, which can cause AES.

An important part of the administration's work to prevent encephalitis is discouraging people from using these handpumps and installing India Mark II pumps. "We have been sanctioned Rs 160 crore [USD 34 309 018] for improving drinking water, through which 4600 handpumps are being installed in Gorakhpur district alone," says Kumar.

But while the shallow handpump is now accepted as the villain in the piece, residents say they had to take no permissions while installing handpumps, many of them up to 25 years ago. "We got the contractor to put in a handpump, and when he hit water, he stopped. How would village people know how deep to put it in?" says a man, whose brother lost his infant daughter to AES 12 days ago.

"No one has ever told us there is any problem with our handpump," says a woman of Bargadahi village in Gorakhpur. Her 6-year-old daughter was hospitalized with AES a month ago but has largely recovered. The entire family still drinks water from the same handpump outside their house.

In other villages, some of the deeper handpumps installed by the government are located inside the compounds of the better off, often upper caste, residents of the village, a problem the district administration too acknowledges. Against this backdrop, the Centre's continued insistence on improved handpumps in an area in which groundwater poses problems seems fraught with danger.

Commentary: It is still saddening to see that we do not even know what diseases are children are dying off! While authorities in Saudi Arabia are able to identify 1 person with a new type of viral infection, in India thousands of children die every year due to viral brain fever without any known causes!! I hope that our large medical institutions like ICMR, and big hospitals like AIIMS, SGPGI (Lucknow) should look in to this shameful finding and try to find the cause of these serious illnesses so that we can try to save these unfortunate children.

Dengue outbreak hits Tricity

The annual dengue epidemic is peaking and sufferers are pouring in to the tricity’s hospitals. Figures available from the UT Nodal Officer for Dengue indicate 118 cases from Chandigarh  alone 118. When patients from outside the city are added in, the figure rises to 187. The majority of the cases are from Mauli Jagran, Hallo Majra, Maloya Colony and other slum areas of the city.

The Nodal Officer said all three city hospitals are fully equipped with medicines and doctors to tackle the patients. Moreover, these medicines are administered free of cost. He claimed that Health Department volunteers are going door to door to tell people what they must do to prevent mosquitoes from breeding. Dengue is spread by mosquitoes.

Neighboring Mohali is likewise beset by dengue. Dr Rajiv Challa, Senior Medical Officer of the Phase Six Civil Hospital said that he has 100 confirmed cases and about another 100 cases of suspected dengue. Bhalla mentioned elaborate arrangements to tackle the disease and he too warned people to take steps to prevent mosquito breeding. However, data from the National Vector Borne Disease Control Programme reveals that in 2011 33 people died of dengue. The number of dengue deaths in the state has been steadily on the rise since 2007. In Panchkula, out 33 suspected cases, 7 are confirmed as dengue.

Doctors strictly warn against self medication. If you have fever consult a doctor, and complete the treatment he prescribes. In some people, dengue is moderate and goes away on its own after a few days of fever depending on their immunity. To protect yourself from dengue, wear full sleeved shirts or kurtas, and use repellent creams and mosquito coils.

Dengue is spread by the bite of an infected aedes Egypti mosquito. The symptoms include high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash and mild bleeding.

Source

HEALTH HAZARDS - SAUDI ARABIA: UPDATED HAJJ PILGRIMS TRAVEL ADVICE

A ProMED-mail post
http://www.promedmail.org

Date: 11 Oct 2012

Source: Eurosurveillance 2012; 17(41), 11 Oct [edited]

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20295

The Hajj: updated health hazards and current recommendations for 2012

This year [2012] the Hajj will take place during [24-29 Oct 2012]. Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo, cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. Current guidelines foresee mandatory vaccination with quadrivalent meningococcal vaccine for all pilgrims and yellow fever and poliomyelitis vaccine for pilgrims from high-risk countries. Influenza vaccine is strongly recommended.

The annual Hajj is one of the greatest assemblies of humankind on earth. Each year, 3 million Muslims attend the Hajj in Mecca, Saudi Arabia. Of these, 1.8 million non-Saudi Arabians usually come from overseas countries, and 89 per cent (1.6 millions) of them arrive by air [1]. Pilgrims come from more than 180 countries worldwide, and about 45 000 pilgrims each year arrive to Saudi Arabia from the European Union [2].



Preventive measures during the Hajj:

Saudi Arabia provides free health care to all pilgrims during the Hajj. For the 2012 Hajj, which will take place on [24-29 Oct 2012], the country has prepared 25 hospitals, 4427 beds including 500 critical care beds and 550 emergency care beds. In addition, there are 141 health care centres in the vicinity of the Hajj area with 20 000 specialised health care workers. The planning for the Hajj relies on the coordinated efforts of 24 supervisory committees [2]. The Hajj preventive medicine committee oversees all public health and preventative matters during the Hajj. A large number of public health officers regulate ports of entry for all pilgrims to ensure compliance with the requirements of the Saudi Arabian Ministry of Health. Public health teams are located in various areas of the Hajj, including 21 mobile teams. At each of the 18 hubs at King Abdulaziz International Airport Hajj terminal in Jeddah, 2 clinical examination rooms and a large holding area are dedicated to assess arriving pilgrims, check their immunisation status, and administer the recommended prophylactic medicines [2]. The public health teams and teams at the ports of entry report back to the command centre on 9 communicable diseases using electronic and manual surveillance systems. These diseases are influenza, influenza-like illness, meningococcal disease, food poisoning, viral haemorrhagic fevers, yellow fever, cholera, poliomyelitis, and plague [2].



Pre- and post-Hajj travel advice:

The Hajj is a unique event with possible impact on international public health. Health care practitioners around the world must be attentive to the potential risks of disease transmission during the Hajj. They must recommend appropriate strategies for the prevention and control of communicable diseases before, during, and after the completion of the Hajj. The current international collaboration in planning vaccination campaigns, developing visa quotas, arranging rapid repatriation, and managing health hazards at the Hajj are crucial steps in this process. The Saudi Arabian Ministry of Health publishes the Hajj requirements for each Hajj season. This year's [2012] Hajj recommendations have recently been published [3].



Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo (DRC), cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. We present here the changes and additions made in the recommendations for these diseases. For completeness, we also summarise the existing recommendations [3,4].



Meningococcal disease

The risk of the occurrence of meningococcal outbreaks is a real concern during the Hajj seasons. This risk is related to the high carriage rates, with one study from Mecca reporting carriage rate as high as 80 per cent [5]. Due to the previous occurrence of meningococcal outbreaks, the bivalent A and C meningococcal vaccine became a requirement for the attendance of the Hajj in 1986. Two large outbreaks caused by meningococcal serogroup W135 in 2000 and 2001 [6-8] resulted in an extension of the previous requirement to include serogroups Y and W135, and the quadrivalent (A, C, Y, W135) meningococcal polysaccharide vaccine was included as a requirement for a Hajj visa in May 2001 [9]. In addition, visitors arriving from countries in the African meningitis belt receive chemoprophylaxis with ciprofloxacin tablets (500 mg) at the port of entry to lower the rate of meningococcal carriage. It is estimated that about 400 000 to 460 000 pilgrims receive the recommended doses at the port of entry in Saudi Arabia. Compliance with meningococcal vaccination among arriving international pilgrims exceeded 97 per cent in 2011 [1].



Yellow fever

In accordance with the International Health Regulations 2005, all travellers arriving from countries identified by the World Health Organization (WHO) as areas at risk of yellow fever must present a valid yellow fever vaccination certificate showing that the person was vaccinated at least 10 days previously and not more than 10 years before arrival at the border. In the absence of such a certificate, the individual will be placed under strict surveillance for 6 days from the date of vaccination or the last date of potential exposure to infection, whichever is earlier. Health offices at entry points will be responsible for notifying the appropriate director general of health affairs in the region or governorate about the temporary place of residence of the visitor. Aircraft, ships, and other means of transportation arriving from countries affected by yellow fever are requested to submit a certificate indicating that it applied disinfection in accordance with methods recommended by WHO.



Risks of respiratory tract infections

Acute upper respiratory tract infections (URTIs) are the most common disease during Hajj. There are many factors promoting the spread of respiratory pathogens, including close contact among pilgrims, shared sleeping tents, and dense air pollution [2]. The pathogens causing URTIs among pilgrims are respiratory syncytial virus (RSV), parainfluenza virus, influenza virus and adenovirus [10]. The rates of different types of respiratory virus infections are as follows: influenza (9.8 per cent), parainfluenza (7.4 per cent), adenovirus (5.4 per cent) and RSV (1.4 per cent) [11]. Because of overcrowding and the fact that many Muslims come from countries where tuberculosis (TB) is endemic, pulmonary tuberculosis was a leading cause of hospitalisation in patients with community-acquired pneumonia [12]. The estimated risk of tuberculosis acquisition during the Hajj is thought to be around 10 per cent, based on the use of pre-visit and post-visit QuantiFERON TB assay test [13]. In another community-based survey of the epidemiology of tuberculosis in Saudi Arabia, positive tests using purified tuberculin antigens were more frequent in Saudi Arabians living in the Holy cities hosting pilgrims compared to other cities in Saudi Arabia [14]. The development of strategies to reduce the transmission of TB during the Hajj is a challenge for which no evidence-based approved measures are available to date. The Saudi Arabian Ministry of Health continues to recommend wearing face masks in crowded places and changing them frequently to minimise transmission of respiratory infections. Controlling tuberculosis transmission in mass gatherings is an area that needs urgent research studies. [14].



Novel coronavirus infection

Of particular interest is the recent report of 2 cases of acute respiratory failure associated with a novel coronavirus. Both patients were previously healthy adults. The cases occurred a few months before the 2012 Muslim Hajj season. The 1st case of infection with the novel coronavirus was identified in a Saudi Arabian national, who died in June 2012 [15,16]. The 2nd case was a patient from Qatar who was transferred to a hospital in London, United Kingdom in early September 2012 [17]. Available data to date do not support human-to-human transmission of this novel coronavirus, and zoonotic transmission is highly suspected. In the 2nd case of this novel coronavirus infection, none of the 64 close contacts developed severe disease, 13 of them (20 percent) reported mild respiratory symptoms, and the novel coronavirus was not detected in 10 symptomatic contacts who were tested [17].



WHO does not recommend any travel restrictions to or from Saudi Arabia. The current case definitions from WHO [18] and from the Saudi Arabian Ministry of Health can be found on the WHO website (http://www.who.int/csr/disease/coronavirus_infections/case_definition/en/index.html) and in Table 1, respectively. The practice of good hand hygiene and cough etiquette was associated with less respiratory illness among United States travellers to the 2009 Hajj [19]. It is recommended that pilgrims continue to practice proper hand hygiene, protective behaviours and cough etiquette to further decrease the occurrence of respiratory diseases. [see Table 1. Severe respiratory disease associated with novel coronavirus: case definition by the Saudi Arabian Ministry of Health at above given URL link.]



Foodborne diseases and cholera

Diarrhoeal illnesses during mass gathering including Hajj are a potential health hazard. Many factors may contribute to this problem including: inadequate standards of food hygiene, shortage of water, the presence asymptomatic carriers of pathogenic bacteria, and the preparation of large numbers of meals poorly stored by pilgrims. There are only few studies describing the incidence and aetiology of traveller's diarrhoea during the Hajj. In one study, diarrhoea was the 3rd most common cause (6.7 per cent) of hospitalisation [20]. Another study describes an outbreak of diarrhoeal illness in a small number of soldiers during the Hajj season [21]. As a precautionary measure, the Saudi Arabian Ministry of Health strongly enforces that pilgrims are not allowed to bring fresh food into Saudi Arabia. Only properly canned or sealed food or food stored in containers with easy access for inspection is allowed in small quantities, sufficient for one person for the duration of their trip.



Cholera is another risk during the Hajj, especially in light of the continued occurrence of outbreaks in different countries. As of 20 Sep 2012, a total of 19 283 cases, including 276 (1.4 per cent) deaths have been reported in the ongoing cholera outbreak in Sierra Leone since the beginning of the year [2012] [22]. The highest numbers of cases occurred in the western area of the country, where the capital city of Freetown is located. In addition, the WHO reported a sharp increase in the number of cholera cases in July [2012] in the DRC and many other countries [23]. The Ministry of Health of Saudi Arabia has updated its public health staff at all ports of entry for pilgrims, to be observant of all pilgrims coming from areas where cholera has been reported by WHO, and to maintain a high level of vigilance for any signs and symptoms of diarrhoea, and to continue surveillance at their camps and initiate quarantine and contact tracing once a case is suspected. Emphasis is being placed on early detection of cases and timely provision of treatment at all Hajj premises, once pilgrims have passed the ports of entry while incubating the disease.



Poliomyelitis

Poliomyelitis is still predominant in certain countries around the world. The attendance of visitors from these countries to the Hajj may pose a health risk for other visitors. All travellers arriving from polio-endemic countries and re-established transmission countries, namely Afghanistan, Angola, Chad, the DRC, Nigeria and Pakistan, regardless of age and vaccination status, should receive one dose of oral poliovirus vaccine (OPV). Proof of OPV vaccination at least 6 weeks prior departure is required to apply for entry visa for Saudi Arabia. These travellers will also receive one dose of OPV at border points on arrival in Saudi Arabia. The same requirements are valid for travellers from recently endemic countries at high risk of reimportation of poliovirus, i.e. India (Table 2).



Polio cases secondary to wild poliovirus importation or to circulating vaccine-derived poliovirus in the past 12 months have been reported in the following countries: China, Central African Republic, Cote d'Ivoire, Kenya, Mali, Niger, Somalia and Yemen [4]. All visitors aged under 15 years travelling to Saudi Arabia from these countries should be vaccinated against poliomyelitis with the OPV or inactivated poliovirus vaccine (IPV). Proof of OPV or IPV vaccination 6 weeks prior to application is required for entry visa. Irrespective of previous immunisation history, all visitors under 15 years arriving in Saudi Arabia will also receive one dose of OPV at border points (Table 2).



Table 2. Saudi Arabian health requirements and recommendations for entry visas for the Hajj seasons in 2012



Ebola outbreaks

Two large outbreaks of Ebola have been reported by the Ministries of Health of Uganda and the DRC. In Uganda, a total of 24 probable and confirmed cases were reported during the outbreak. Eleven of these 24 cases have been laboratory-confirmed by the Uganda Virus Research Institute in Entebbe. A total of 17 deaths were reported in this outbreak. The last confirmed case was admitted on [3 Aug 2012] and discharged from hospital on [24 Aug 2012] [24,25]. This is twice the maximum incubation period (21 days) for Ebola proposed by the WHO during Ebola outbreak response operations. In the DRC, 46 cases (14 laboratory-confirmed, 32 probable) of Ebola haemorrhagic fever were reported until [15 Sep 2012]. Of these, 19 have been fatal (6 confirmed, 13 probable). The cases occurred in 2 health zones of Isiro and Viadana in Haut-Uele district in Province Orientale. In addition, 26 suspected cases have been reported and are being investigated.



The 2 Ebola outbreaks are not epidemiologically linked and have been caused by 2 different Ebola subtypes: Ebola subtype Sudan in Uganda, and Ebola subtype Bundibugyo in DRC. To avoid global spread of the disease, the Saudi Arabian Ministry of Health decided to exclude pilgrims from these 2 countries for this Hajj season. This restriction is based on the careful review and deliberation of the national committee on communicable disease prevention who felt that it cannot be excluded that new cases may emerge, and on the fact that the risk of disease transmission is thought to be high with potential catastrophic consequences if occurring during the Hajj, as the disease has a high mortality rate, and no therapeutic interventions are available.

Malaria cases hit four-year high in Goa

October 14, 2012

PANJIM: Goa has witnessed a sudden rise of malaria cases this year, breaking a four-year declining trend, even as Directorate of Health Services stated that there was no reason to panic.

When asked to explain the reason for the sudden spurt in malaria cases, Dr Sachin Govekar cited “intermittent rainfall” and the number of migrants coming in from “states where malaria is high.”

“If we have a large number of migrants coming in from states such as Orissa, Bengal, and other states where incidence of malaria is high, then our number (of cases) goes up as well,” Govekar said.

With three months to go, before the end of the year, the state has registered a total of 1145 cases compared to last year’s total of 935 cases.

September registered the second highest number of cases (210) this year, with the highest number of 309 cases registered in July at the peak of the monsoon followed by August which recorded 145 cases of malaria, according to statistics made available by Directorate of Health Services.

Out of the 210 cases of malaria, 198 were diagnosed as Plasmodium vivex and 12 as Plasmodium falciparum.

The State Health Department had in the past made giant strides in controlling vector borne diseases since 2007 having successfully halved the number of cases each year from 6000-odd cases in the entire state to just 935 last year. That trend has now been broken.

Commenting on the trend, Dr Govekar said “We have done tremendous work in the past, and while it is true that there has been an increase this year, there is no reason to panic. The situation is under control. It is not as bad as it was before,” Govekar said.

To the health department’s credit there have been no deaths due to malaria this year, while there were two deaths recorded last year.

On the front of the other vector borne diseases, from August 18, 2012 to October 12, 2012 one case of Dengue has been detected in UHC Margao jurisdiction. So also from August 18, 2012 to October 12, 2012 a total of 118 samples were tested and two were confirmed positive for Chikungunya, one each under jurisdiction of PHC Curchorem and Curtorim.

So also from August 18, 2012 to October 12, 2012, six cases were confirmed positive for Japanese Encephalitis, one each under the jurisdiction of PHC Candolim, Bicholim, Betki, Sanguem, Loutolim and Quepem, and two from PHC Corlim.

Source

From a travel perspective this means there is a larger reservoir of malaria cases from which infection can be transmitted. Individual measures against mosquito bites are imperative and travellers need to discuss the advisability of taking antimalarial medication with a  travel health professional. 

TravelSafe Clinic is India's first & only ISO 9001:2008 certified travel health clinic. We provide traveler health advice, vaccinations including yellow fever vaccination and special consultations for travel to high risk regions. Latest advice on epidemics, disease outbreaks is provided. Contact us for more information.

HAND, FOOT AND MOUTH DISEASE - INDIA: (WEST BENGAL)

A ProMED-mail post
http://www.promedmail.org Date: Wed 3 Oct 2012

Source: The Times of India, Kolkata [edited]
http://timesofindia.indiatimes.com/city/kolkata/Infectious-disease-sweeps-Kolkata-schools/articleshow/16647312.cms

Just when the city was starting to breathe easy after a tough battle with dengue fever over the last couple of months, doctors say thousands of children are battling with another disease that has symptoms similar to dengue fever. That kids are more vulnerable to hand, foot and mouth disease [HFMD] has left parents and doctors across the city worried. Paediatrician Shantanu Ray say he has never come across so many hand, foot and mouth cases in Kolkata before. "Most have been extremely severe. The rashes are taking at least a week to go. It's leading to a complete loss of appetite, weakness and fever. Lack of awareness has made things worse. Parents of affected children are often sending their children to school mistaking it to be ordinary body rashes. It has hastened the spread of the disease," he added. The initial symptoms of the disease -- fever, headache, loss of appetite and rashes -- have left both doctors and patients confused and scared. Even though hand, foot and mouth disease usually strikes only children and is rarely fatal, it has been severe, prompting doctors to treat it as seriously as dengue fever. Caused by a highly contagious virus, it has been affecting children aged between 2-8 years. Hand, foot and mouth disease rarely affects those above 10 years of age, but it spreads from person to person through nose and throat discharges, saliva, fluid from blisters, or the stools of an infected person. A child is most contagious in the 1st week when he/she contracts the disease. Soon after the dengue epidemic started in late July 2012, hand, foot and mouth disease had set in also. By late August 2012, thousands had been affected in Kolkata. The numbers have started going down, but the virus is still active, say doctors. "Since it coincided with dengue, it led to a panic. The symptoms are scarily similar to those of dengue. Apart from the rashes, which are restricted to the mouth, hands and feet, other indicators are no different from those of dengue. High fever, headache, loss of appetite are the common indicators," said Arindam Kar, director, Medical Institute of Critical Care. But it could be even more painful than dengue, pointed out some experts. The blisters triggered by the virus could appear on the tongue, lips and other parts of the mouth, making it painful to chew and swallow food. Several playschools had to shut down following the outbreak. Many asked parents to stop sending their children to school if they had rashes. "Almost 20 percent of our students had the disease. It was spreading fast, so we had shut down for a week," said the teacher in charge of a playschool in Alipore. "Fortunately, our students have not yet been affected. But there is reason to be careful," said Malini Bhagat, principal, Mahadevi Birla Girls' Higher Secondary School.
Hand, foot and mouth disease is a relatively common viral infection that usually begins in the throat. Caused by intestinal viruses of the family _Picornaviridae_, it takes 3 to 7 days for the symptoms to develop. It is less common in adults, but those with immune deficiencies are very susceptible. There is no specific treatment for the infection other than relief of symptoms. Treatment with antibiotics does not work and is usually not recommended. "But it might be necessary in some cases. Also, the blisters need to be treated with ointments to make them disappear fast," said Ray.

Commentary: A similar smaller scale epidemic has been reported from Delhi too (personal communication), and even in Chandigarh we have seen a few cases of HFMD. Early exit from school, and not joining back till the rashes subside is probably the best approach in this situation.

INFLUENZA (96): NEPAL (KATMANDU), H1N1

A ProMED-mail post
http://www.promedmail.orgDate: Wed 3 Oct 2012 

Source: http://www.globaltimes.cn/content/736422.shtml

Swine flu virus, called pandemic influenza A(H1N1)pdm9, has been detected in the Nepali capital and 3 other districts outside the capital, doctors at the Sukraraj Tropical & Infectious Disease Hospital in Kathmandu said Wednesday [3 Oct 2012]. Doctors confirmed the outbreak of swine flu virus [infection] after the virus was detected in blood samples collected in the capital and the country's mid-western districts of Chitwan, Sindhuli and Khotang. Prior to this outbreak, H1N1 virus was seen in Nepal in 2009. Doctor Gita Shakya, director of the National Public Health Laboratory of Kathmandu, said that people don't have to be worried about the disease as it can be cured if found in the preliminary stage. Dr. Shakya said the reason behind the resurgence of the virus in Nepal is that several districts of the country have recently been suffering from [an unidentified] viral fever. Doctors said so far over a dozen people died due to viral fever outbreaks in Nepal. "Of the total 24 deaths from viral fever, some of them might have died due to late diagnosis of the swine flu virus," Dr. Shakya said. According to Dr. Shakya, they have detected the swine flu virus [on the basis of] laboratory tests employing polymerase chain reaction (PCR) technology rather than tests based on rapid kits. Dr. Sher Bahadur Pun at the Infectious Disease Hospital said some patients have also been diagnosed with both types of influenza A and B influenza virus. The virus usually strikes children and young people who have low immune capability against minor diseases. In 2009, over 40 people were killed during the outbreak of the virus in Nepal.

Comments: H1N1 is now endemic to many parts of India, however outbreaks of swine flu in neighboring countries remain a cause of concern, and would suggest that we need to remain prepared & continue active surveillance for preventing future epidemics in India.

Current status of Dengue in India

Here is a list of latest Dengue cases in India (Source)

- India, Punjab state. 27 Sep 2012. Dengue 99 cases, (suspected) 9 more cases; Deaths at least one; Increasing.http://www.hindustantimes.com/Punjab/Ludhiana/Suspected-dengue-patient-dies-9-more-suspected-cases-reported/SP-Article1-936426.aspx

- India, Maharashtra state. 28 Sep 2012. Dengue 451 cases; Deaths one. http://articles.timesofindia.indiatimes.com/2012-09-28/mumbai/34147281_1_dengue-cases-dengue-toll-platelet-count

- India Odisha state. 24 Sep 2012. Dengue 575 cases; Deaths 5; Increasing. http://timesofindia.indiatimes.com/city/bhubaneswar/Two-more-die-of-dengue-in-state/articleshow/16522104.cms

- India, Delhi. 30 Sep 2012. Dengue 65 cases (locally acquired); Deaths 2. http://www.indianexpress.com/news/38yearold-from-loni-is-second-to-die-of-dengue-this-season/1009837/

Commentary: I am practising in Punjab, and seeing the impact of Dengue cases in the tricity of Chandigarh, Panchkula & Mohali, I believe that a vaccine for Dengue, though still far away. is going to be a very important addition to our fight against this deadly disease. In the meantime, steps to curb the mosquito population needs to be taken in earnest, by the public at large, and health authorities to decrease the incidence of this & other mosquito borne diseases.

HEPATITIS C - INDIA: (PUNJAB), HIGH INCIDENCE

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 1 Oct 2012
Source: Hindustan Times [edited]
http://www.hindustantimes.com/Punjab/Bathinda/3-100-hepatitis-C-cases-only-87-stated/SP-Article1-938460.aspx
3100 hepatitis C cases, only 87 stated
A deadly virus has gripped people battling a more serious disease of poverty. Down with hepatitis C, more than 1600 poor people in Baghapurana, 600 in Langeana village, 900 in Badhni Kalan town and many more in the surrounding areas in this district are in a lonely struggle. Instead of installing hepatitis test facilities at the civil hospitals of Baghapurana, Badhni Kalan and Nihal Singh Wala, the Health Department has tried to cover up the epidemic. Its survey teams recorded only 87 cases of the disease. "The survey was an eyewash and done in haste for the sake of filing a report," said Charanjit Sharma, a teacher at Langeana, a [badly] affected village that no team ever visited. The ruling Shiromani Akali Dal (SAD) party had made an election promise of solving Moga's 10-year-old hepatitis-C problem, recalls social worker Gurtej Singh Brar of Langeana. "Where's the solution?" said Charan Singh of Baghapurana, former subedar [junior commissioned officer] in the army. A total of 4 residents of Langeana found out they had hepatitis when they went to donate blood at a camp in their village. That was 3 years ago. "In the past 10 years, the Health Department has never organised any camp for the hepatitis-C examination," said one of them. 5 people from 2 poor families of Sukhanand village visit a baba (witch doctor) every Sunday to get rid of the curse. "We have no money for treatment," said one of the people seeking relief. "We are a family of 6; how can my 2 sons and I get any medicine for hepatitis-C from any private hospital." Additional deputy commissioner Joram Beda accepted the seriousness of the situation. "The health department does hold examination camps from time to time," he said. "Many private doctors, however, do not report all the hepatitis cases to us. I will seek a detailed report and do an investigation."

Cholera - India (Jammu and Kashmir State)

Date: Mon 24 Sep 2012
Source: Greater Kashmir News
http://www.greaterkashmir.com/news/2012/Sep/25/238-diagnosed-with-cholera-in-north-kashmir-73.asp
In a matter of grave concern for health officials in the Kashmir Valley, at least 238 patients were diagnosed with cholera in north Kashmir's Baramulla district with Public Health Authorities saying that all the water samples collected from the areas are "grossly contaminated" and tested positive for fecal matter.
"We have treated over 500 patients for different water-borne diseases in Baramulla and 238 patients were declared as cholera cases after clinical suspicion by the doctors in various district hospitals. They mostly live in Tangmarg, Kunzer, and Pattan areas," sources told Greater Kashmir. The clinical suspicion emerged from the microbiological analysis by the public health officials in the district.