Gujarat: CCHF claims 4 lives including 2 doctors, nurse

[Ronan Kelly]

Mystery fever claims a life
TNN, Jan 18, 2011, 04.13am IST
GANDHINAGAR: State health authorities have called a team from National Institute of Virology (NIV) to investigate into the mystery fever that has claimed one life and left two people critical in different city hospitals.

Doctors have not been able to pin-point the origin or the spread of the fever which is reported to begin with fever, stomach pain and vomiting and rapidly deteriorate later.

The first case of the mystery fever was reported with the death of one Amina Momin, a 30-year old woman from Sanand, who was admitted to Shalby Hospital on December 29 with high fever, abdominal pain and severe vomiting.


....


While the death of a young woman to fever caused concern, what set the alarm bells ringing was two people who had come in touch with Momin too falling ill with similar symptoms. A young nurse at Shalby Hospital, who attended to Momin in the Intensive Care Unit (ICU) is currently critical with the same symptoms. Momin's husband too is admitted at Sterling Hospital.

...
Read more: Mystery fever claims a life - The Times of India http://timesofindia.indiatimes.com/c...#ixzz1BOAmbp8J

[Ronan Kelly]

Re: Gujarat: Mystery fever claims a life, attending nurse critical, negative for dengue

Sent to Promed

[Ronan Kelly]

Re: Gujarat: Mystery fever claims a life, attending nurse critical, negative for dengue

Mystery fever claims one life, 2 critical


Woman, 30, admitted with high fever, abdominal pain, vomitting dies of internal haemmorhage at Shalby
By Ahmedabad Mirror Bureau
Posted On Tuesday, January 18, 2011

...

A hospital source confirmed the two persons who were in close contact with Amina suffering from the same symptoms. Test reports have been negative for bacterial infection, dengue or other known infections. ?It is important to know what we are dealing with and also its spread, whether it is through air, mosquito or other means. Taking note that fever is rapidly deteriorating the patient?s health, the NIV team will collect samples and conduct other inquiries,? the source said.

...

http://www.ahmedabadmirror.com/printarticle.aspx?page=comments&action=translate&sectid=3&contentid=20110118201101180256067829b113945&subsite=

[alert]

Re: Gujarat: Nosocomial CCHF outbreak

Three deaths so far (and the hsuband is not mentioned), CCHF confirmed. I believe the correct spelling of that virus is "Crimean Congo Hemorrhagic Fever", not the spelling below.

I've never seen a CCHF outbreak report from India. Perhaps the index case travelled, or perhaps this is the first report of that illness in India.

Obviously, this should go to ProMED too.

http://www.thaindian.com/newsportal/health1/mystery-virus-which-killed-three-identified_100489848.html

Gandhinagar, Jan 18 (IANS) The mystery virus that created a panic of sorts among the medical fraternity in Ahmedabad following the death of a patient, her consulting doctor and nurse, has been identified, state Health Minister Jay Narayan Vyas said here Tuesday.According to the minister, a sample sent to the National Institute of Virology, Pune, has identified the virus as Crimian Congo Haemorregic Fever (CCHF).
A woman, Shamima, from Kolat village of Sanand Taluka near Ahmedabad was admitted to a private hospital in Ahmedabad in the first week of January after she was reported suffering from a mysterious fever.

The patient subsequently died. There was consternation in medical circles when her consulting doctor Gagan, who had examined her, also passed away as did the nurse Asha John, who had attended to her.

Vyas said that the state government was not taking chances and a team of experts headed by Kamlesh Upadhyaya has been constituted to take charge of the matter. “Survey teams have fanned out in a five km area of the village to which the patient belonged to carry out a door to door check,” he added.

Meanwhile, a team from Delhi is expected here in the next two days to conduct a study. Municipal health authorities said that random sampling was being done in the city hospitals to check if there was any spread of the virus.

[alert]

Re: Gujarat: CCHF claims at least three lives

The wikipedia article on CCHF below contains a rough reference to 2 previous CCHF cases in India, but it is not clear where and when, and I am not fully certain it is not an updated reference to the current outbreak.

Update: A bit of further sleuthing (such as Googling "CCHF India") indicates that CCHF has been found in India before.

http://en.wikipedia.org/wiki/CCHF

[Giuseppe]

Re: Gujarat: Mystery fever claims a life, attending nurse critical, negative for dengue

India, Mystery killer virus identified in Ahmedabad (Lead)


[Source: Thaindian, View Original Article. 1/18/11.]

Gandhinagar, Jan 18 (IANS) The mystery virus that created a panic of sorts among the medical fraternity in Ahmedabad following the death of a patient, her consulting doctor and nurse, has been identified, state Health Minister Jay Narayan Vyas said here Tuesday. According to the minister, a sample sent to the National Institute of Virology, Pune, [...] [the virus is CCHF]

(...)

-
-----

[Ronan Kelly]

Re: Gujarat: Mystery fever claims a life, attending nurse critical, negative for dengue

Great find, alert. I've sent that article to promed also. Thank you!

[alert]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse - two additional cases suspected

http://www.sify.com/news/mystery-killer-virus-identified-in-ahmedabad-news-health-lbsxugghgbg.html

IANS
Mystery killer virus identified in Ahmedabad

2011-01-18 23:20:00

Influenza AntigenAds by GoogleSwine H1N1, H5N1, H3N2 Protein Recombinant Hemagglutinin Antigen SinoBiological.com/Influenza


Gandhinagar, Jan 18 (IANS) The mystery virus that created a panic of sorts among the medical fraternity in Ahmedabad following the death of a patient, her consulting doctor and nurse, has been identified, state Health Minister Jay Narayan Vyas said here Tuesday.

According to the minister, a sample sent to the National Institute of Virology, Pune, has identified the virus as Crimian Congo Haemorregic Fever (CCHF).


Thirty-year-old Amina Momin, from Kolat village of Sanand Taluka near Ahmedabad, was admitted to a private hospital in Ahmedabad in the first week of January after she was reported suffering from a mysterious fever.


The patient subsequently died. There was consternation in medical circles when her consulting doctor Gagan Sharma, who had examined her, also passed away Jan 13. Her nurse Asha John died Tuesday.


Amina's husband Hussain Rehman and brother Hussain Rasool are also suspected to have contracted the same virus.


Vyas said that the state government was not taking chances and a team of experts headed by Kamlesh Upadhyaya has been constituted to take charge of the matter. 'Survey teams have fanned out in a five-kilometre area of the village to which the patient belonged to carry out a door-to-door check,' he added.


Meanwhile, a team from Delhi is expected here in the next two days to conduct a study. Municipal health authorities said that random sampling was being done in the city hospitals to check if there was any spread of the virus.

[Ronan Kelly]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse

Deadly virus makes first appearance in India, kills three in Gujarat
Syed Khalique Ahmed , Tanvir A Siddiqui , Anuradha Mascarenhas


The Pune-based National Institute of Virology (NIV) has confirmed India?s first cases of the deadly Crimean Congo Haemorrhagic Fever (CCHF) from Sanand, near Ahmedabad.

The virus has so far killed three people, including a woman who first picked it up, and the doctor and a nurse who treated her at a private hospital in Ahmedabad. As of Tuesday evening, two more patients had been hospitalised.

The NIV is testing some 50 samples from the area, and the Gujarat government, warned of a possible outbreak, has begun a screening exercise in the area, covering about 16,000 villagers.

...

http://www.indianexpress.com/news/Deadly-virus-makes-first-appearance-in-India--kills-three-in-Gujarat/739292

[alert]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse

http://www.promedmail.org/pls/apex/f?p=2400:1001:1507921603780210::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86707

Archive Number 20110118.0211
Published Date 18-JAN-2011
Subject PRO/AH/EDR> Undiagnosed hemorrhagic fever, fatal - India: (GJ) RFI


UNDIAGNOSED HEMORRHAGIC FEVER, FATAL - INDIA: (GUJARAT) 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: Tue 18 Jan 2011
Source: The Times of India (TOI), Times News Network (TNN), Ahmedabad [edited]
<http://timesofindia.indiatimes.com/city/ahmedabad/Mystery-fever-claims-a-life/articleshow/7308549.cms>


Mystery fever claims a life
---------------------------
[Gujarat] State health authorities have called a team from the
National Institute of Virology (NIV) to investigate the mystery fever
that has claimed one life and left 2 people critical in different
city hospitals. Doctors have not been able to pin-point the origin or
the spread of the fever which is reported to begin with fever,
stomach pain and vomiting, and rapidly deteriorate later.

The 1st case of the mystery fever was reported with the death of a
30-year-old woman from Sanand, who was admitted to Shalby Hospital
[in Ahmedabad] on 29 Dec 2010 with high fever, abdominal pain, and
severe vomiting. Despite all the medication administered, her
condition continued to worsen, her blood count crashed with platelets
dipping to alarming levels. She eventually suffered internal
hemorrhaging and succumbed to systemic organ failure. The woman did
not test positive for dengue fever, the severe form of which [dengue
haemorrhagic fever] has similar symptoms.

While the death of a young woman to fever caused concern, what set
the alarm bells ringing was 2 people who had come in [contact] with
the deceased also falling ill with similar symptoms. A young nurse at
Shalby Hospital, who attended to the 1st patient in the Intensive
Care Unit (ICU) is currently critical with the same symptoms. The
deceased woman's husband has also been admitted to Sterling Hospital.

"The nurse is critical and may have to be put on a ventilator,"
doctors said. They said that 2 people who were in close contact with
the deceased woman getting the fever shows that it is contagious.
Since test reports have not been positive for bacterial infection,
dengue, or other known infections [?], it is important to know
exactly what we are dealing with and also its spread, whether it is
through air, by mosquito, or other means.

Taking note that fever rapidly deteriorates the health of the
patient, NIV teams will collect samples and conduct other inquiries
to ascertain the kind of fever, its spread, and precautions needed to
prevent its spread and protocol needed for better management.

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

[The signs and symptoms of the deceased patient's illness are
compatible with those of a haemorrhgic fever. The results of
diagnostic tests are not disclosed, other than that dengue fever has
been excluded. Of other haemorrhagic fevers, Crimean-Congo
haemorrhagic fever (CCHF) is a possibility (although there have been
no previous reports in ProMED-mail of CCHF in India). When patients
with CCHF are admitted to hospital, there is a risk of nosocomial
spread of infection (as has occurred in this case) and in the past,
serious outbreaks have occurred in this way. According to the WHO
fact sheet
(<http://www.who.int/mediacentre/factsheets/fs208/en/index.html>)
patients with fatal disease do not usually develop a measurable
antibody response and in these individuals, as well as in patients in
the 1st few days of illness, diagnosis is achieved by virus detection
in blood or tissue samples. This may explain the difficulty in making
a positive diagnosis in this case. However, although CCHF is a
contagious disease, it is primarily a zoonosis transmitted by
_Hyalomma_ species ticks . Humans who become infected with CCHF
usually acquire the virus from direct contact with blood or other
infected tissues from livestock during this time, or rarely they may
become infected from a tick bite. The majority of cases have occurred
in those involved with the livestock industry, such as agricultural
workers, slaughterhouse workers, and veterinarians. The circumstances
and occupation of the diseased woman would be a relevant factor in
the diagnosis.

The outcome of the investigation being undertaken by the Indian
National Institute of Virology is awaited with interest.

[alert]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse

http://www.ahmedabadmirror.com/article/3/20110119201101190304073932a18dcef/Mystery-disease-toll-now-3;-NIV-says-it&#37;E2%80%99s-Congo-fever.html

Mystery disease toll now 3; NIV says it’s Congo fever
Asha John, the nurse who tended the first victim of the infectious disease at Shalby Hospital died on Tuesday



Ahmedabad Mirror Bureau

Posted On Wednesday, January 19, 2011 at 03:04:07 AM






The mystery disease that has claimed two more lives and sparked fears of a health crisis in Ahmedabad may be Crimean-Congo haemorrhagic fever (CCHF), which is caused by a tick-borne virus. The National Institute of Virology (NIV), Pune, on Tuesday said with a degree of sureness that the disease was CCHF, also known as Congo fever.

John was a nurse at Shalby Hospital

“It is definitely a viral fever. We have identified the disease, which is called Crimean-Congo haemorrhagic fever. It is a highly infectious disease. We are trying to trace the virus,” the director of NIV, Dr A C Mishra, told Mirror, adding that NIV had alerted the Gujarat government about the threat of the disease on January 16.

This initial assessment came even as the number of deaths because of the disease rose to three on Tuesday. Asha John, a nurse who contracted the disease while tending its first victim, Amina Momin (30), at Shalby Hospital, died in the morning. Like Momin, a native of Kolat village near Sanand, John also suffered from high fever, abdominal pain and bouts of vomiting.

The third victim is a doctor, Gagan Sharma. He passed away during treatment at Sterling Hospital in the morning of January 13, but his death came to light only on Tuesday. The reports of two more deaths alarmed health authorities, city and state, and escalated fears about the spread of what is now being suspected as Congo fever.

---------

http://www.ahmedabadmirror.com/article/3/2011011920110119025623386d2a04ec/NIV-collects-samples;-govt-forms-team-of-experts.html?pageno=1

NIV collects samples; govt forms team of experts


Dilip Patel and Mehul Jani

Posted On Wednesday, January 19, 2011 at 02:56:23 AM







A team from NIV team arrived here today (Tuesday), collected samples and sent them for testing to Pune. Treatment protocol will be decided after results arrive

– J N Vyas, state health minister

A team of experts from the National Institute of Virology (NIV), Pune, arrived in Ahmedabad on Tuesday and collected blood samples of two men believed to be suffering from Crimean-Congo haemorrhagic fever (CCHF), a highly infectious disease.

Both the men — Rehman Hussain Momin and Hussain Rasool — hail from Kolat village near Sanand and are related to Amina Momin, who died of suspected CCHF in the first week of January.

“The team arrived here today (Tuesday), collected samples and sent them for testing to Pune. We may get the results tomorrow (Wednesday) or on Thursday. The treatment protocol will be decided after the results arrive,” State Health Minister J N Vyas told Mirror.

The NIV team, he said, also visited Kolat village to find the source of the infection. “Government officers, too, visited Kolat and adjoining areas to check if more people are suffering from any viral disease,” Vyas said, adding that experts from National Institute of Communicable Diseases (NICD) would arrive in the state on Wednesday to assist the government.

He confirmed that three people had died of a mystery disease, which is now believed to Congo fever. “The first victim’s husband (Rehman) is already under medical observation, and her brother (Rasool) has also been hospitalised,” he said.

The AMC and state government have started taking measures to prevent the spread of the disease. The civic authority has asked all hospitals to collect blood samples of patients who are suffering from high fever and bouts of vomiting, among other symptoms identified with viral diseases.

It has asked hospitals to send medical reports of all patients who are suffering from fever and had tested negative for dengue. The state government has formed a team of doctors and medical experts to gather information of suspected cases and prepare an action plan to tackle a possible viral outbreak.

The team is headed by deputy commissioner (epidemic) S J Gandhi and comprises Dr Kamlesh Upadhyay, B D Mankad, Nilesh Modi and Atul Patel.

[alert]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse

http://www.ahmedabadmirror.com/article/3/2011011920110119025625495ca399f07/Kolat-remains-calm.html?pageno=1

You are here - HomeNewsCity Story
City

Kolat remains calm
People in the village, from where the suspected CCHF virus has originated, have no clue that a native has died because of the infectious disease



Ruturaj Jadav

Posted On Wednesday, January 19, 2011 at 02:56:25 AM







A native of Kolat near Sanand, Amina Momin, died of suspected CCHF in the first week of January


Calm prevails at Kolat thanks to the villagers? ignorance of the deadly nature of Crimean-Congo haemorrhagic fever that has claimed a life. The husband and brother of the woman who fell to Crimean-Congo haemorrhagic fever (CCHF) have been quarantined and fellow villagers have little clue to what is happening around them except that some officials have visited Kolat, near Sanand on the outskirts of the city.

Sarpanch Manubha Vaghela, who is travelling, told Mirror on telephone, ?I?ve heard about the incident but as I am not in the village, I don?t know about the situation there.? However, panchayat member Devraj Rabari said, ?I am aware of the death of a woman but life is normal in the village. People are calm and going about their routine as usual. A team had come to our village for inspection and met several families.?

Another local, Praveen Parekh, said that there was no panic in the village and the condition was normal. ?Officials are in the village and they held a meeting at the panchayat office. The officials divided themselves in several teams and helped by local health workers conducted a door-to-door survey. They also took samples of blood from people.? Thirty-year-old Amina Momin had died of CCHF in the first week of January at a private hospital in Ahmedabad. Her husband Rehman Hussain, 32, and brother Hussain Rasool, 28, have been quarantined in different hospitals in Ahmedabad.

The virus that caused her death was identified only on Tuesday. State Health Additional Director Paresh Dave said that the government had sought assistance from National Institute of Virology to unravel the mystery. ?We have sent 32 teams along with a team from NIV. The teams will survey five villages surrounding Kolat.?

[alert]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse

http://www.promedmail.org/pls/apex/f?p=2400:1001:390878888968478::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86712

Archive Number 20110118.0216
Published Date 18-JAN-2011
Subject PRO/AH/EDR> Undiagnosed hemorrhagic fever, fatal - India (02): (GJ) CCHF conf.


UNDIAGNOSED HEMORRHAGIC FEVER, FATAL - INDIA (02): (GUJARAT)
CRIMEAN-CONGO HEMORRHAGIC FEVER CONFIRMED
************************************************** *************************
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 18 Jan 2010
Source: Thaindian News, Indo Asian News Service (IANS) report [edited]
<http://www.thaindian.com/newsportal/health1/mystery-virus-which-killed-three-identified_100489848.html>


Mystery virus which killed 3 identified
---------------------------------------
The mystery virus that created a panic of sorts among the medical
fraternity in Ahmedabad [Gujarat] following the death of a patient,
her consulting doctor, and nurse, has been identified, state Health
Minister Jay Narayan Vyas [in Gandhinagar] Tuesday [18 Jan 2011].
According to the Minister, a sample sent to the National Institute of
Virology, Pune [Maharashtra], has been identified as Crimean-Congo
hemorrhagic fever (CCHF) [virus].

A woman from Kolat village of Sanand Taluka near Ahmedabad was
admitted to a private hospital in Ahmedabad in the 1st week of
January [2011] after she was reported suffering from a mysterious
fever. The patient subsequently died. There was consternation in
medical circles when her consulting doctor, who had examined her,
also passed away as did the nurse, who had attended to her.

Vyas said that the state government was not taking chances and a team
of experts headed by Kamlesh Upadhyaya has been constituted to take
charge of the matter. "Survey teams have fanned out in a 5 km [3 mi]
area of the village to which the patient belonged to carry out a door
to door check," he added.

Meanwhile, a team from Delhi is expected here in the next 2 days to
conduct a study. Municipal health authorities said that random
sampling was being done in the city hospitals to check if there was
any spread of the virus.

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

[The previous post in this thread predicted that the undiagnosed
fever might be caused by Crimean-Congo haemorrhagic fever virus. The
confirmation above becomes the 1st report in ProMED-mail of the
occurrence of Crimean-Congo haemorrhagic fever (CCHF) in India. It
is likely that CCHF virus is present ticks in the vicinity of Kolat
village and their eradication should be undertaken.

This report records a 3rd death. The deceased are the patient, the
attending physician, and the ICU nurse. The condition of the victim's
husband who is being treated in hospital is not revealed. - Mod.CP]

[alert]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse

http://www.dnaindia.com/mumbai/report_national-institute-of-virology-identifies-deadly-ahmedabad-bug_1496512

National Institute of Virology identifies deadly Ahmedabad bug
Published: Wednesday, Jan 19, 2011, 13:43 IST
By Nozia Sayyed | Place: Pune | Agency: DNA

A hitherto unknown virus with a high mortality rate that killed three people in the last 15 days in Ahmedabad (Gujarat) has been successfully identified by the city-based National Institute of Virology (NIV).

The virus, Crimean Congo Haemorrhagic Fever (CCHF), has a high mortality rate of 90%.

NIV director, Dr AC Mishra, told DNA, ?The virus that killed three people in the last 15 days has a mortality of 90%, which is tremendously high. A patient with this infection can go into coma in a span of three days after getting infected,?? he added.

Mishra said a team was sent to Ahmedabad to collect samples last week after Shelby Hospital there contacted the NIV in connection with three patients with similar clinical conditions who were not responding to treatment. Two of these patients succumbed to their illness.

?Since two of the patients died, a sample was collected from the third (female) patient on Saturday and was examined in Pune on Sunday. Detailed reports of this virus being CCHF and its mortality rate were submitted to the Union and Gujarat governments on Monday. We were informed that the patient from whom the sample was collected succumbed on Tuesday,? he said.

So far, six patients with similar symptoms have been admitted to the same hospital, he said. Fifty more samples from the patients have been collected for screening for CCHF at NIV. The younger brother of the (third) patient is currently critical and has been admitted with similar conditions.

Mishra said CCHF is caused when tick-borne virus changes its clinical nature after being transferred from animals (cattle or rats) to humans.

Compared to swine flu or Influenza-A H1N1, Mishra said that while H1N1 spreads quickly, but has a mortality of just 0.1%, CCHF has a mortality rate of 90% and the severity is high. Treatment is easy in H1N1, whereas due to the confused clinical picture, the treatment becomes very difficult in CCHF.

[alert]

Re: Gujarat: CCHF claims 3 lives including attending doctor and nurse

http://www.thehindu.com/news/article1102910.ece

ICMR asks people not to panic over Congo virus
Aarti Dhar
Share ? Comment ? print ? T+ Confirming the first case in Ahmedabad of human infection caused by Crimean?Congo Hemorrhagic Fever (CCHF) virus, the Indian Council of Medical Research (ICMR) on Wednesday asked people not to panic as any possible outbreak of the disease could be controlled by proper hygiene and infection control measures in hospitals where the patients are admitted.

A six-member team of specialists from the National Institute for Communicable Diseases (NICD) will visit Ahmedabad on Thursday.

Tests conducted at the National Institute of Virology (under ICMR, Pune) have confirmed the presence of the CCHF virus in blood as well as urine samples of a patient.

While reports from Gujarat claimed three persons from Sanad had died and a few others were being treated for the deadly disease, the Centre did not give out any figure of the dead or those affected.

?After proper control measure, the outbreaks can be successfully handled locally. In this instance, awareness among the doctors and also prompt diagnosis at NIV is an evidence of the competence of our system and there should be no reason for any panic reaction,? the ICMR statement said.

However, as of now there is no medicine or vaccine that can prevent or cure the disease. The CCHF virus is known to be transmitted among animals through ticks. It does not affect animals, but kills 20 to 40 per cent of humans who contract it.

The ICMR added that typically, one to three days after the incubation period following a tick bite (5-6 days after exposure to infected blood or tissues), flu-like symptoms appear, which may resolve after a week. In up to 75 per cent of cases, however, signs of hemorrhage appear within 3-5 days of the onset of illness. Patients usually begin to recover after 9-10 days, but it can lead to death in some cases.

The CCHF virus has earlier been reported from Africa, the Balkans, the Middle East and Pakistan. There is serological evidence of CCHF infection being present in India in animals.

Reports from Ahmedabad suggest that a woman died of the disease on January 3, followed by the doctor and the nurse who had attended on her. The doctors took the nurse's sample which tested positive for the Congo virus. Fifty others are being tested for the disease.

The Gujarat government has already warned of a possible outbreak and started screening process in 16,000 villages.

The virus is said to be highly infectious and causes multi-organ failures after affecting the brain, resulting in convulsions.