Suspected Hantavirus case in Mumbai - Aug 2015 - Promed update

Published Date: 2015-08-24 16:58:18
Subject: PRO/AH/EDR> Hantavirus update - Asia (03): India (MH) 
Archive Number: 20150824.3598785

HANTAVIRUS UPDATE - ASIA (03): INDIA (MAHARASHTRA)
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Date: Thu 20 Aug 2015
Source: Hindustan Times [edited]
http://www.hindustantimes.com/mumbai/contrary-to-bmc-s-claims-lab-reports-hantavirus-cases/article1-1382265.aspx


While the municipal health department has denied the incidence of [infections with a] hantavirus, a rare but deadly virus [clinically] similar to the leptospirosis pathogen, in Mumbai, a private diagnostic laboratory in the city that tested blood samples for the presence of the virus found 14 positive cases in the past 1.5 years.

On 4 Aug [2015], the Hindustan Times reported that the blood sample from a Kurla resident who was admitted to private hospital in Ghatkopar in July 2015 indicated that he had [a] hantavirus [infection] [see ProMED-mail archive no. 20150805.3560460]. The patient is now cured.

Following the report, the Brihanmumbai Municipal Corporation (BMC) collected blood samples from the patient and sent them for confirmatory tests to the National Institute of Virology (NIV) in Pune, but the reports were negative. Metropolis, a chain of pathology lab across the country, tested as many as 114 suspected samples of hantavirus, of which 14 were positive.

"Ours is a laboratory with pan-India presence, and it is not just Mumbai that we receive samples from but from all over the country. And we have positive cases of hantavirus [infection] from all over. In Mumbai alone, from 2014 to now we have had enough positive cases that show that the virus is very much present," said Dr Nilesh Shah, group president, scientific services and operations, west India, Metropolis.

The BMC said it is unaware of the new cases and it would have to investigate further and contact the lab for details. "We do not have any knowledge about the 14 cases. We will have to get in touch with the lab for further details," said Dr Mini Khetarpal, chief of epidemiology, BMC.

However, the civic body maintained that a hantavirus was not present in the city. "We cannot say for sure that there is hantavirus in light of the new cases that have been brought up. However, in our meeting with Bombay Veterinary College we were assured that no tests revealed the presence of virus in the city," he added. [But] "It would be unwise to say that are no hantavirus cases in the city. It is a matter of referring the cases for diagnosis for the said virus and reporting," said Dr Om Srivastava, infectious diseases expert at Jaslok Hospital. "In theory, it can be said that the antibodies will be present in the body. However, in this particular case it is unlikely that it will test positive, as there has been a significant delay in collecting the blood sample," he added. [This is incorrect. It is only the virus that disappears from the bpdy with time -- the antibodies remain and increase. - Mod.JW]

[Byline: Shobhan Singh]

--
Communicated by:
ProMED-mail from HealthMap Alerts


[It is difficult to draw conclusions from the information provided in the report above regarding whether the patient reported on 4 Aug 2015 had a hantavirus infection or not. Initially, the diagnosis was made on clinical grounds (respiratory disease), but the results from the NIV, the national reference laboratory, were negative. It is equally difficult to conclude whether there are human hantavirus infections in Mumbai. The private laboratory reported that 14 blood samples tested positive, presumably for hantavirus antibodies. The type of test used is not specified nor is the particular hantavirus [tested for]. 

Cases of hantavirus infections in humans in India are reported occasionally. The most recent cases of reported suspected hantavirus infections in India were in January 2014 in Kerala and October 2011in Andhra Pradesh, where there were 3 cases of a suspected hantavirus infection in Nellore. The specific hantavirus involved in these cases was not stated either. In Asia, the 5 recognized hantaviruses with their main rodent reservoir species are: Hantaan virus (_Apodemus agrarius_), Amur virus (_A. peninsulae_), Thailand virus (_Bandicota indica_), Seoul virus (widely distributed worldwide in _Rattus norvegicus_), and Muju virus (_Myodes regulus_).

In a 4 Feb 2010 ProMED-mail post (archive no. 20100205.0385), it was reported that Dr J. Clement and colleagues from the National Reference Laboratory for Hantavirus Infections, University Hospital Gasthuisberg, Leuven, Belgium found evidence in India of the murine Seoul virus (SEOV) infection and also of the arvicoline Puumala virus (PUUV) infection, the latter in 2 fatal cases (from the Cochin and Chennai regions, respectively) with acute respiratory syndrome, symptoms similar to those in the more recently described Nellore cases in 2011 (see ProMED-mail archive no. 20111026.3187) as well as in the case described in 2011.

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

Where can I get Yellow Fever Vaccination in Hyderabad/ Secundrabad?

I have gotten many queries regarding Yellow Fever Vaccination Center in Hyderabad/ Andhra Pradesh/ Telangana. I am posting the details here

GUIDELINES FOR TRAVELLERS
before taking appointment

 For all vaccinations Original passport is required.

       1.    Bring original passport & printout of your appointment.

       2.    Have breakfast / lunch before coming for vaccination.  Don’t take

           vaccine on an empty stomach.

       3.    Do not take any antibiotics 24 hours prior to vaccination.

       4.    Wear loose and short sleeves while coming for vaccination.

       5.    People with history of allergy to egg should inform the Medical

            Officer before taking vaccine.

       6.    People suffering with fever should not take any vaccine.

       7.    Minimum gap of one month should be maintained between 1^st &

            2^nd doses of MMR / Hepatitis B vaccine.

       8.    Do not take more than 2 vaccines on a singles day.

       9.    Person who have to take multiple vaccines.  Once you have

           completed vaccination on any appointed day, take the next vaccination   

           appointment after a gap of one month.

         10.   Students who want to go for TB (Montoux) test and also take       

         any other Vaccine:

            (a)   First go for Mantoux test, collect report after 48 hours and

                   then take Vaccine.  Take any vaccine appointment accordingly.

             (b)   There is no need of taking online appointment of Mantoux test.

            (c)  Timing for Mantoux Test 8.30 A.M to 12.30 P.M.  Test will be

                  done at Central Reception Section.

          11.  Persons who have taken any vaccine in the recent past should inform

            the same before taking vaccine here.

       12.  Do not take any vaccine just before your date of departure.  Give a gap

             of at least one week between vaccination and departure day.

       13.  All vaccines (except Yellow fever given on Tuesday and Fridays.)

              have to be purchased outside and you have to come along with

              invoice bill.

       14.  Appointment for Yellow Fever  & Oral Polio Vaccine will be given

              on Tuesday and Fridays only. 

       15.    Service charges: Rs. 50/- per vaccine.

       16.  Charges for Yellow Fever vaccine: Rs. 250/-(Rs. 200/- for vaccine +

              Rs. 50/- for service charges).

       17.  These charges should be paid at the cash counter and receipt to

             be obtained.

       18.  Come at least 10minutes before the time of appointment.

       19.  As per the instructions of Govt. of India, persons visiting the

              following countries have to take oral polio vaccine at least 6 weeks
        prior to their arrivals at any Indian port of entry  NIGERIA,  KENYA,

              ETHIOPIA, SOMALIA, ISRAEL, PAKISTAN, AFGHANISTAN.

       20.  Pregnant women should inform the doctor before taking vaccination.

WISH YOU HAPPY JOURNEY!

Source

Comment: In my opinion the main problems are two fold. It is inconvenient since the center is open only twice a week. No one answers the phone usually, so you are never really sure if you would actually be able to get the injection if you are coming from a far off place.
The use of multi-dose vial, and the use of a generic non standard Yellow Fever vaccines are other issues that you need to be aware of.
The good news is that they have an online registration system for travelers, You can try it here
Unfortunately, I am not aware of any private centers doing the Yellow Fever vaccination in an appropriate way in Hyderabad.
Any feedback from people taking the vaccination at this (or any other center) would be appreciated.
DISCLAIMER : All the information is taken from the govt websites, and I am not liable for any changes/ errors. Please confirm with the local authorities for any changes in the schedule / pricing. 

Where can I get Yellow Fever Vaccination in Chennai/ Tamil Nadu?

I have gotten a lot of queries regarding Yellow Fever Vaccination Center in South india. I am posting the details here for Chennai Center for Yellow Fever Vaccination

• CONTACT ADDRESS:
  
  International vaccination centre
  
  King Institute of Preventive
  
  Medicine & Research, Guindy ,Chennai –600032
• Phone              :    044-22501520
• Ext                  :    127, 128
• Email ID          :    kipmguindy@yahoo.com

• ACTIVITIES OF INTERNATIONAL VACCINATION CENTRE
  I. YELLOW FEVER VACCINE:
         Vaccination against yellow fever for International Travellers is being done on Fridays from 10.00 am to 3.00 pm and the certificate issued immediately. (If Friday is a holiday it’s done on the previous working day)
• FEE                             :    Rs. 200 / 500 dose
• Mandatory requirement         :     Passport
      Immunity begins from 10 days after Vaccination and lasts for 10 years.
  
       The vaccine is a freeze–dried virus containing chick embryo tissues infected with attenuated yellow fever virus strain 17D. The vaccine meets WHO requirements .It is obtained from CRI Kasauli, which procures it from Federal state unitary Enterprise on manufacture of Bacterial and viral preparations (Russian Academy of Medical Sciences)
• Utilization of vaccine per week              : 100 – 120 doses
• Annual performance                               : 2010 – 2011 - 4700
• Allergic manifestations to the vaccine     : NIL reported till date
  Travellers have been injected and issued the certificate of Vaccination on the same day.

Source

There is another center in Port Health organization, here are its details

XI. Vaccination against Yellow Fever

Instructions for Yellow Fever Vaccination

Yellow fever vaccination is given on demand at a nominal charge of Rs.300/- on Wednesdays and Fridays between 10AM to 1.00PM

Port health Organisation is the only centre in Kerala authorized by Ministry of Health & Family Welfare to provide Yellow Fever Vaccination for passengers travelling to Yellow Fever affected countries in Africa and South America.

Port Health Organisation, Cochin is located in Willingdon Island. The Office is located in the north end of the island opposite Customs House and next to Mercantile Marine Department (MMD).

Passengers for Yellow Fever Vaccination are to report to vaccination centre before 10 O’ clock along with Passport/ photocopy of the Passport. After reaching the centre please register your name in the registration slip and fill up the Consent Form for vaccination. The vaccination will start after 11 AM.

The validity of the Yellow Fever Vaccination starts from the 10th day of the vaccination to 10 years and a re-vaccination is required on completion of 10 years.

Passengers going to Kenya, Nigeria, Ethiopia, Syria, Somalia, Afghanistan and Pakistan should take Polio Vaccination alongwith Yellow Fever Vaccination. Passengers should inform the Registration Clerk about the countries they intend to visit. PHO, Cochin has made arrangement for Oral Polio Vaccination to be given along with Yellow Fever Vaccination. The passengers are required to take the Oral Polio Vaccination 4 weeks prior to visiting the Polio affected countries. The Oral Polio Vaccine is valid for 1 Year.

The passengers who have taken the Yellow Fever Vaccination are also requested to inform the Port Health Organisation about serious/ life threatening side effects, if any, they had within 1 month of the vaccination in writing to Port Health Officer at the following E-mail ID – phocochin@yahoo.co.in  or by phone 0484 2666060.   The side effects includes continues fever/ pain or lump at the site of injection, allergy, breathlessness, asthma, itching at the site of injection or severe anaphylactic reaction following the vaccination.

Duplicate Yellow Fever Vaccination card is issued to persons who have lost the Yellow Fever card on production of

1. FIR in original   2. Passport   3. Photocopy of the Original Yellow Fever Card issued ( if any )  4. Request letter addressed to Port Health Officer. 

Address

Port Health Organisation,
Willingdon Island,
Cochin-682009.

Source

Comment: In my opinion the main problems are two fold. It is inconvenient since the center is open only once a week. No one answers the phone usually, so you are never really sure if you would actually be able to get the injection if you are coming from a far off place.
The use of multi-dose vial, and the use of a generic non standard Yellow Fever vaccine are other issues that you need to be aware of.
Unfortunately, I am not aware of any private centers doing the same in Chennai.
Any feedback from people taking the vaccination at this (or any other center) would be appreciated
DISCLAIMER : All the information is taken from the govt websites, and I am not liable for any changes/ errors. Please confirm with the local authorities for any changes in the schedule / pricing. 

What happens if I travel before the mandatory 10 days period after taking Yellow Fever vaccination

Dear Dr Gaurav,

My name is **** and I am from Bangalore. I travel to Uganda in a few days. I just realised that I need to get yellow fever vaccination. I called the public health office in Bangalore and I may or may not be able to get the vaccination done on Wednesday. I arrive in Uganda on Friday afternoon. I was wondering if having the two days in between is sufficient for the vaccination to take effect. Online it says that it takes about ten days for it to take effect.

I know that as a doctor you would obviously not advise me to take the risk of travelling without getting the proper vaccination, but, I was wondering if I was willing to take the risk, does the government have a policy against me immigrating if I haven't given it the recommended period of ten days? I return from Uganda in two weeks from now.

Thanks so much! I shall be very grateful if you could reply to me at your earliest convenience.

Ans. Hi,

Thanks for contacting me,

You are correct in understanding that the Yellow Fever Vaccine takes 10 days for effect as per the government notification.

The government / immigration policy can put you in quarantine, or even deport you in case you have not waited for the mandatory 10 days period. You may be treated as someone NOT possessing the Yellow fever Vaccination certificate.

While this is usually not the case in real life, it is certainly a possibility, and hence I would recommend that you consider postponing the trip by a few days if possible,

Warm regards

Dr Gaurav Gupta