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Sunday, March 24, 2013

Rabies deaths in India - In temple city of madurai

A ProMED-mail post
Archive Number: 20130315.1588809
Date: Thu 14 Mar 2013
Source: The Times of India/Madurai, Times News Network (TNN) [edited]

The deaths of 2 women on 2 successive days at the Government Rajaji Hospital (GRH) due to rabies' infection has raised concerns over the increasing menace of stray dogs in the city [Madurai, Tamil Nadu state]. A 55 year old woman was admitted to the GRH on Tuesday [12 Mar 2013] due to rabies infection and died on the same day. Her relatives said that she was bitten by a stray dog 2 weeks ago. They also said that she did not get vaccinated for it. Similarly, a 45 year old woman died in the hospital due to rabies infection. She was hospitalised on Monday [11 Mar 2013] and died the same day. Hospital authorities said that 5 persons died due to rabies infection in the hospital during the last 3 months alone, compared with 12 deaths in the last one year. On average, there have been 10 deaths every year in the last 5 years due to rabies infection.

Following the frequent deaths due to rabies, residents and local representatives have urged the [Madurai] corporation to intensify the vaccination and sterilisation [of dogs]. M Chellam, ward 63 councillor, said that there are several complaints from the residents of her ward about stray dogs. The numbers of stray dogs are increasing in the area and the corporation should intensify efforts to capture them, she said. S Veerakumar, councillor of ward 60, said that the stray dog menace threatens the public in Avaniyapuram [municipality of Madurai district] area. "Corporation authorities take action only when we call them. Despite the dogs being captured they are again found in the same area as they are released in Vellaikal, a nearby place. When the dogs return, they are found more ferocious than earlier and threaten the public," he complained. A resident of Bethaniyapuram said, "The stray dog menace is very high in our area. Our repeated demands to capture the dogs are [not] heeded. We are afraid to cross the streets in the night as dogs seen in the area are ferocious. Last week [week of 11 Mar 2013], a dog bit 4 persons in the area which created panic here," he said. When contacted, Priya Raj, assistant city health officer said that they have been providing vaccination and sterilization of the stray dogs regularly.
Comments: Given the menace of stray dogs in most Indian cities, all International travelers should complete their course of Rabies vaccine before coming to India. I would also recommend that given the propensity of kids to play with stray dogs, parents in India consider routinely giving this vaccine to their children, since rabies is 100 % fatal.

Saturday, March 23, 2013

Pertussis (Whooping Cough) in USA - Waning Immunity

A ProMED-mail post
Archive Number: 20130316.1590032
Date: Mon 4 Mar 2013
Source: Davis County (UT) Clipper [edited]

Public health officials have launched a media campaign to "Stop Whooping Cough" that urges adults to get vaccinated against pertussis before being around an infant. The number of whooping cough cases in Utah jumped 142 percent between 2011 and 2012, health officials say. Concerns, especially for infants younger than one-year old who cannot be vaccinated, were the driving force. The state went from 618 reported cases in 2011 to 1497 in 2012.

"By adults getting vaccinated, they are protecting themselves 1st," said Davis County Health Department epidemiologist Brian Hatch. "The other goal, perhaps more important, is to protect those who can't be vaccinated. During the 1st year of life, infants can't be [fully] vaccinated."

Davis County saw a 456 percent rise in whooping cough, or 139 cases over the year's time, 7 of them resulting in hospitalization, Hatch said.

Utah is experiencing a dramatic increase in the number of pertussis cases. Utah's incidence rate is over 4 times the national average. More than half of infant pertussis cases must be hospitalized, according to a state Health Department press release. 83 percent of those infants were infected by a parent or other close family member. 90 percent of all pertussis deaths occur in infants.

The campaign is a collaboration by the Utah State Health Department and 9 of the 12 local health departments, including Davis. "We're actively putting resources into the campaign," Hatch said. "We're actively doing everything we can to help control pertussis."

Whooping cough usually results in minor C but prolonged C illness in healthy adults, but it can be fatal in infants who are too young to be immunized against it.

"So it's important that the adults and older children around an infant be adequately immunized by receiving a quick, easy, and relatively painless Tdap vaccine, according to the Health Department press release.

The campaign's website, StopWhoopingCough.org, helps visitors find a vaccination location near them. Those who get their Tdap vaccine from a participating health department clinic or at a Harmon's grocery store pharmacy will receive a free infant "onsie" while supplies last.

Minnesota, Oregon
Date: Mon 11 Mar 2013
Source: Daily Rx [edited]

Vaccines save lives by preventing a person from getting a disease or dramatically lowering their risks for the disease. But vaccines are not perfect. Their protection can wear off. A recent study found more evidence that the vaccine for whooping cough is wearing off sooner than researchers expected.

The researchers in this study found that the risk of catching pertussis among fully vaccinated children in 2 states increased considerably over a 6 year period. The study, led by Sara Y. Tartof, PhD, MPH, of the CDC, aimed to understand how the risk of catching pertussis changed as time passed after children were vaccinated against it. The disease can be fatal to babies, especially those under 2 months old who have not received their 1st vaccine for it.

The researchers tracked children in Minnesota and Oregon who were born between 1998 and 2003 and had received all 5 shots for the DTaP. These shots start with an initial one at 2 months old, with 4 booster shots following throughout early childhood.

The study included 224 378 children from Minnesota and 179 011 children from Oregon. Both Minnesota and Oregon had very high numbers of pertussis cases in 2010 and 2012. The researchers reviewed 458 of the children in the Minnesota group and 89 of the children in the Oregon group for the full time period studied. Over that time, the number of pertussis cases that occurred rose each year.

During the 1st year of follow-up of the study, a rate of 15.6 out of 100 000 children contracted pertussis in Minnesota. By the 6th year of the study, that rate had risen to 138.4 out of 100 000 children.

In Oregon, the rate of pertussis in the 1st year was 6.2 out of 100 000 children, which rose to 24.4 out of 100 000 children by the 6th year of the study.

In Minnesota, a child was twice as likely in the 2nd year of the study as in the 1st year to contract pertussis. By the 6th year, a child was 9 times more likely to catch whooping cough than they were in the 1st year of the study.

In Oregon, a child was 30 percent more likely to catch pertussis in the 2nd year of the study than in the 1st year. By the 6th year, children were 4 times more likely to catch pertussis than they were in the 1st year.

"This rise is likely attributable in part to waning immunity from DTaP vaccines," the researchers wrote. Past studies in the last year have shown that the vaccine's effectiveness decreases over time more quickly than was expected.

This discovery of the decreasing effectiveness of the vaccine over time led the CDC's immunization policy group to recommend that pregnant women be vaccinated with the Tdap (the adult version of the DTaP) each time they are pregnant, even if they had the shot within the past 5 years.

The CDC group, called the Advisory Committee for Immunization Practices, hopes the extra shot during pregnancy will offer a bit of extra protection to the baby during its 1st year of life. The vaccine is still effective in the couple of years after it is given, and babies who receive the vaccine on time will be protected by it from whooping cough. Babies are at the highest risk from dying from the disease.

The study was published 11 Mar 2013 in the journal Pediatrics. 

Friday, March 22, 2013

Dengue cases quadruple in Thailand !

13,200 dengue fever cases reported

As of March 11, 13,200 Thais have fallen victims of dengue fever so far this year, with 16 fatalities, according to the Public Health Ministry.

Officials said that the number of cases and the number of fatalities are both 4 times higher than the same period last year.
The ministry’s data shows that cases were reported in all provinces of Thailand. 
A war room is now in place to monitor the situation and devise measures to contain the disease. The ministry fears the situation would worsen during the rainy season.
It is important for travelers to remember to take universal precautions against mosquito bites, since there is a higher risk of resistant malaria & dengue when traveling in Thailand.

Measles Update - Cases from US, UK & Nigeria

A ProMED-mail post
Archive Number: 20130317.1591011

UK (Merseyside)
Date: Thu 14 Mar 2013
Source: The St Helens Reporter [edited]

St Helens is one of the worst areas to be affected by the measles outbreak, health chiefs say. There were 35 confirmed cases of the illness in the town last year [2012] compared with none in 2011, according to statistics from the Health Protection Agency (HPA). The surge is believed to be continuing this year [2013], with 2 cases seen already in 2013. However, St Helens isn't the worst affected area of Merseyside. Liverpool saw 313 cases last year and has already reported 11 in 2013.

Liz Gaulton, director of public health and local NHS, said: "In 2012, Merseyside was one of the worst hit areas for measles, and we have already had 2 cases confirmed this year [2013]. Measles is often associated with being a disease of the past. Many people are unaware that it is a dangerous infection that can have serious complications. In severe cases, measles can kill, as it spreads very easily and can affect anyone who is not protected.

Outbreaks elsewhere in the country have put medics on alert for people displaying symptoms of the condition, which in some cases can be fatal. Although often seen as a minor condition, there is no cure for measles once it has been contracted, and hundreds have already been hospitalised elsewhere in the country. It can be vaccinated against by children being up to date with their MMR immunisations, as the HPA says the disease is mainly spreading among unvaccinated schoolchildren.

Measles is a highly infectious viral illness, and it can prove deadly. Children, students, and pregnant women are most vulnerable, although it can affect anyone. It is passed from human to human and is usually spread when an infected person coughs or sneezes. The early signs include fever, a cough, sore eyes, and a red rash.

Nigeria (Kaduna)
Date: Thu 14 Mar 2013
Source: News 24 Nigeria [edited]

The Kaduna state government said on Thursday [14 Mar 2013] that it has recorded 500 cases of measles in 19 local government areas of the state from December last year [2012] to date. Dr Julius Gajere, the state's Rapid Response Team leader, told the News Agency of Nigeria (NAN) in Kaduna that no deaths had been recorded.

He said 83 per cent of the reported cases were in 6 local government areas. Gajere gave the names of the affected local governments as Igabi, Kaduna North, Kaduna South, Ikara, Makarfi, and Kubau. He also said that 96 per cent of the cases had manifested in children between 9 to 59 months old. "The main clinical features of the disease are fever, cough, conjunctivitis, runny nose, and maculopapular rashes. He advised the affected local councils to provide drugs, water, and clean environments to communities to prevent further spread of the disease. Gajere blamed the situation on low routine immunisation in the affected areas and urged the residents to embrace the immunisation programme.

Date: Thu 14 Mar 2013
Soure: Basking Ridge Patch [abbreviated & edited]

The New Jersey Department of Health has confirmed one case of measles in Somerset County and is investigating 2 other reported cases of measles in people determined to be at locations in the area from 6 to 12 Mar 2013.

In the 1st case, confirmed on 13 Mar 2013, a local health department was made aware of a medical center employee who developed fever and a rash on 8 Mar 2013. This person had contact with a known laboratory-confirmed case of measles in an unvaccinated person who had traveled internationally. A 2nd case was identified on 13 Mar 2013 in a person who also had contact with a laboratory-confirmed case. This 2nd individual has not yet been confirmed to have measles.

"If you're planning an international trip, the World Health Organization recommends that adults or adolescents unsure of their immune status get a dose of measles vaccine before traveling," 

Thursday, March 21, 2013

Rubella in Japan - increasing incidence

A ProMED-mail post
Archive Number: 20130319.1594293
Date: Wed 20 Mar 2013
From: M. Ujie [edited]

A Rubella pandemic has continued in Japan. Especially in Tokyo, the number of reported rubella cases in a week has exceeded 100 cases over several weeks. According to the National Institute of Infectious Diseases, as of week 10, 2013 (as of 13 Mar 2013), 1656 rubella patients have been reported. This number is still rapidly increasing and reaching to 2353 which is the number of rubella cases reported by prefecture and methods of diagnosis in week 52, 2012 (as of 8 Jan 2013).

In February 2013, a 25-year-old man who had generalized seizure with fever and rash was diagnosed with rubella encephalitis by the detection of rubella virus from throat swab and seroconversion of IgM antibodies at the National Center for Global Health and Medicine hospital in Tokyo. Rubella is known to potentially cause serious complications such as encephalitis. This is the second reported case of encephalitis due to rubella in Japan since last summer.

Moreover, in the 10th week of 2013, a second case of congenital rubella syndrome (CRS) was reported from Aichi prefecture which is located around the middle of Japan. In total 7 cases of CRS has been reported since the beginning of this epidemic of rubella last year [2012].

Generally, rubella is [more common] in the spring to summer. So the number of patients in the future likely will continue to increase. The Tokyo Prefectural Government on 14 Mar 2013 decided to pay a part of the cost of rubella vaccination in adults aged over 19 years old as emergent preventive measures against this epidemic. Urgent vaccinations against rubella needs to be promoted for all of people who have never had rubella before and have not been immunized against it. 

Wednesday, March 20, 2013

Mumps in US University

A ProMED-mail post
Archive Number: 20130319.1594231
Date: Tue 13 Mar 2013
Source: NBC12 [abridged, edited]

Mumps outbreak at University of Richmond


Close to 20 University of Richmond students may be suffering from mumps. The university is warning the campus about the outbreak, which heightened since early March [2013]. Virginia Health Department officials say they have lab-confirmed 5 to 10 cases of mumps. Another 10 patients showed symptoms which may be resulting from the virus. University officials say they wasted no time in warning everyone on and off campus. Emails were mass sent to students, parents, faculty and staff.

Most children in the U.S. are immunized for MMR -- measles, mumps and rubella. Generally, you can't get into schools, including the University of Richmond, without [evidence of] those shots. However, doctors say that doesn't mean a rare outbreak of the virus can't happen. Dr. Parham Jaberi of the Virginia Department of Health says "Mumps is a similar illness] to a cold [with symptoms of) fever, headache, muscle aches. People feel tired. They may have a loss of appetite," said Jaberi. Another common symptom of mumps is swollen cheeks. Patients may also develop other inflammation of other organs, including testicular inflammation in men. Mumps is contagious. It's transferred through droplets of body fluid, mainly saliva. The best way to avoid mumps is to cover your mouth and wash your hands.

Doctors say mumps is usually not serious and can be fended off in a few days. The Virginia Health Department is trying to figure out why this mumps outbreak is happening. Officials say international traveling may be to blame. They also say there are universities in nearby states reporting cases of mumps

Comments: This is the reason why US universities insist on many vaccines before international students come to US for higher education. It is important to remember that most Indians have not received the 2 doses of MMR vaccine that is now recommended (since 2011) by the Indian Academy of Pediatrics.

Tuesday, March 19, 2013

NOTICE - We are up & running again in Delhi after a break!

This is to inform you that the Delhi Clinic is now back after a small break.
Please contact us for further information / appointments from 20th March 2013 onward.
We thank you for your continued patronage.

Friday, March 15, 2013

Dengue in Portugal - CDC Travel Outbreak Notice

Updated: February 20, 2013

What Is the Current Situation?

As of February 3, 2013, 2,164 cases of dengue fever have been reported from the Portuguese island of Madeira since October 2012. There have been 78 cases of dengue reported in European travelers returning from Madeira.
At this time, CDC does not advise against travel to Madeira. However, travelers should protect themselves from mosquito bites.

What Is Dengue?

Dengue is an illness caused by a virus that is spread through mosquito bites. Symptoms include fever, headache, nausea, vomiting, rash, and pain in the eyes, joints, and muscles. Symptoms can take up to 2 weeks to develop after you are bitten by an infected mosquito but usually last one week. In severe cases, symptoms may include intense stomach pain, repeated vomiting, and bleeding from the nose or gums. See a doctor right away if you have these symptoms.
Travelers who go to tropical and subtropical regionsExternal Web Site Icon are at risk of getting dengue. These areas include parts of the Caribbean, Central and South America Adobe PDF fileWestern Pacific Islands, Australia (Queensland), Southeast Asia, and Africa Adobe PDF file. Dengue is more common in urban areas and is not usually seen at altitudes above 5,000 feet (1,500 meters). The mosquito that carries the dengue virus bites both day and night and is commonly found indoors as well as outdoors.

How Can Travelers Protect Themselves?

There is currently no vaccine or medicine to prevent dengue. Travelers can protect themselves from dengue by preventing mosquito bites.
  • Prevent mosquito bites
    • Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
    • Use an appropriate insect repellent as directed
    • Use products with the following active ingredients. Higher percentages of active ingredient provide longer protection.
      • DEET
      • Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
      • Oil of lemon eucalyptus (OLE) or PMD
      • IR3535 (Avon Skin So Soft Bug Guard Plus)
    • Always use insect repellent as directed.
      • If you are also using sunscreen, apply sunscreen first and insect repellent second.
      • Reapply as directed.
    • Follow package directions for using repellent on children
    • Use permethrin productsExternal Web Site Icon on clothing and gear. Do not use permethrin directly on skin.
    • Stay and sleep in screened or air-conditioned rooms
    • Use a bed net if the area where you are sleeping is exposed to the outdoors.
  • If you are bitten by mosquitoes:
    • Avoid scratching mosquito bites
    • Apply hydrocortisone cream or calamine lotion to reduce itching.
  • If you feel sick and think you may have dengue:
    • Talk to your doctor or nurse as soon as possible if you develop a fever during or in the 2 weeks after travel.
    • Get lots of rest and drink plenty of liquids.
    • Take medicine to control your fever and reduce your pain. Use acetaminophen (Tylenol). Do not take medicine that contains aspirin, ibuprofen (Advil®), or naproxen (Aleve).
    • Avoid spreading the disease by preventing more mosquito bites. 
    • See a doctor right away if you have intense stomach pain, repeated vomiting, or bleeding from the nose and gums.

Clinician Information:

Early and proper diagnosis of dengue is important, as many other diseases may mimic dengue. Health care providers should consider denguemalariachikungunya, and leptospirosis, depending on the itinerary and exposure, in the differential diagnosis of patients who have fever and a history of travel to tropical areas during the 2 weeks before symptom onset.
See the Clinical & Laboratory Guidance on the CDC dengue website for information about reporting dengue cases and guidance regarding dengue diagnostic testing. A serum sample should be obtained as early after the onset of fever as possible for dengue diagnostic testing. Molecular testing for DENV and immunodiagnostic testing for IgM anti-DENV should be ordered and can be obtained from commercial reference laboratories and a number of state or territorial health department laboratories. Consultation regarding management of suspect dengue cases or diagnostic testing can be obtained from:

CDC Dengue Branch
Division of Vector-Borne Diseases
National Center for Emerging and Zoonotic Infectious Diseases
1324 Calle CaƱada
San Juan, Puerto Rico 00920-3860
Telephone: 787-706-2399; fax: 787-706-2496

Thursday, March 14, 2013

Lassa Fever in Nigeria

A ProMED-mail post
Archive Number: 20130311.1581762
Date: Thu 28 Mar 2013
Source: Leadership, Nigeria [edited]

Lassa fever has claimed the lives of 8 people in Jega local government area of Kebbi State, while 3 others are still undergoing medical treatment at the Federal Medical Centre (FMC), Birnin Kebbi. A nurse at the FMC, Birnin Kebbi, who spoke on condition of anonymity, said they received the cases on Wed 27 Feb 2013 and that 3 people were confirmed dead on the spot, while 2 others died the following day.

The nurse further explained that on Friday [29 Feb 2013] 5 people were brought from the same local government, and one died in the night; another one passed away the following day, while the remaining 3 people are still undergoing medical treatment. "I was on duty on Wednesday [27 Feb 2013] when they brought them, and they were admitted in the A and E ward before they were taken to the main ward. You know, it is an airborne disease. The state government took care of their drugs free of charge," he said. One of the relatives of the deceased said that, initially, they assumed it was poison that had afflicted them, but on coming to the hospital, they discovered that it was Lassa fever. 

Wednesday, March 13, 2013

Cholera in Mozambique & Republic of Congo

A ProMED-mail post
Archive Number: 20130311.1581527

Cholera - Mozambique (Cabo Delgado, Niassa)Date: Wed, 6 Mar 2013 18:03:19 +0100
Source: AllAfrica, The Herald report [edited]
Health authorities say that a cholera outbreak in the northernmost province of Cabo Delgado has spread to Cuamba district in the neighboring province of Niassa. Up to Sun 2 Mar 2013, 33 cases of cholera had been diagnosed in Cuamba, although none of the patients had died, said the health authorities.
Cases continue to be diagnosed in the Cabo Delgado provincial capital Pemba, and the districts of Mecufi and Metuge, Radio Mozambique quoted the authorities as saying yesterday, 5 Mar 2013.
The radio reported that in the 1st 3 days of March 2013, there were 16 new cases, bringing the total number since the start of the year to 704 cases.

Cholera - Republic of Congo (Pointe-Noire) Date: Fri 1 Mar 2013 Source: Afriquejet, Pan African News Agency [PANA] report [edited]http://www.afriquejet.com/201303012890/Cholera-epidemic-Cholera-kills-8-in-Congo.html
A cholera epidemic which hit Congo's 2nd largest city, Pointe-Noire, has left 8 people dead from the 289 cases reported, Radio Congo Friday quoted the director of the health office in Pointe-Noire, Jean-Pierre Michel Ndzondault, as saying.
The Congolese government blames the spread of the disease on the recent torrential rain in the city coupled with poor sanitation of the area. Officials said if measures are not taken quickly, the epidemic could worsen during the forthcoming rainy season.

Comments: It is important that travelers from India to these countries take the available oral Cholera Vaccine (Shanchol), 2 doses at a gap of 15 days to protect them from cholera for a period of 2-3 years.

Hepatitis E in Sudan Refugee Camps

A ProMED-mail post
Archive Number: 20130308.1577420
Date: Mon 4 Mar 2013
Source: Radio Tamazuj [edited]

Over 88 cases of hepatitis E have been reported in Doro Camp of Upper Nile State, according to a medical source. The health worker reported that in a period of 27 days the camp has reported 88 cases of hepatitis E virus infection, explaining that 5-6 cases per day are reported to various units in the camp. "We have 88 cases with 3 death cases," he said. The officer added that the 3 deceased were all women, 2 of whom were pregnant. The medical officer said that patients suffering from the disease display signs like yellow urine and eyes, joint pains, and general body weakness.

There has been much confusion in the camp because many people want treatment but there is no medical treatment available for the disease; it is a preventable but not treatable disease. One camp resident told Radio Tamazuj: "We resort to traditional treatment because there is no treatment available to us." He described the traditional treatment as involving the use of fire to burn the affected part, which exposes the victim to more pain.

The medical aid organisation Medecins Sans Frontieres has embarked on an awareness campaign in Doro since last year [2012] when hepatitis E broke out in other nearby camps in Maban County inhabited by refugees from Blue Nile State. The affected camps are Jammam, Jandrassa, Yusif Batil, and Doro. The outbreak spread to the latter camp, the largest one, as a result of contact of the residents with affected people from the other camps.[A hepatitis E death toll of 88 cases was recorded on 1 Feb 2013 by Medecins Sans Frontieres and was reported subsequently to have risen to 11 cases (ProMED-mail postings Hepatitis E - South Sudan (02): refugee camps, 20130216.1545704) and may now have increased further. This report is posted because it contains additional information regarding the refugee camps affected and the responses to the outbreak.

Hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Other transmission routes include foodborne transmission from ingestion of products derived from infected animals and vertical transmission from a pregnant woman to her fetus. Currently, there is no vaccine available for control of hepatitis E virus infection. Hepatitis E virus infection is self-limiting in normal conditions, and fulminant hepatitis is rare, with only pregnant women being at increased risk. In environments such as the refugee camps in South Sudan, the outcomes are much more serious, especially for pregnant women.

Thursday, March 7, 2013

NOTICE : TravelSafe Clinic Delhi closed from 8th March to 19th March 2013

This is to inform you that the Delhi Branch of TravelSafe Clinic will remain closed from 8th March to 19th march 2013.
We will be available for Yellow Fever Vaccination and Travel Consultations from 20th March onward.
Any inconvenience caused is regretted.
The Chandigarh clinic can be contacted for appointments.