India Encephalitis 2017: 1,228 fatalities

[Ronan Kelly]

From Week 18 IDSP report: http://idsp.nic.in/WriteReadData/l892s/182017.pdf

AH/DBG/2017/18/0629 Assam Dibrugarh Japanese
Encephalitis 06 cases 02 fatalities 06-05-17 06-05-17 Under
Surveillance
Cases reported from several villages namely
Zaloni Tea Estate, Nauholia, Digholia,
Sungipathar, Duliajan, Kathalguri, SC Naohalia,
Chenibill, Wilton, Gajalbasti, Kathalguri. PHC
Tengakhat, District RRT investigated the
outbreak. House to house survey done. All the 05
CSF and 05 serum samples collected and sent to
Microbiology Deptt., AMCH, Dibrugarh were
positive for JE IgM ELISA. Two death occurred
in 65yr and 50yr old male. All cases treated
symptomatically. Health education given.

AS/JRT/2017/18/0660 Assam Jorhat Japanese
Encephalitis 07 cases 01 fatality 24-04-17 Under
Surveillance
Cases reported from several villages from several BPHC
Dhekorgorah BPHC Ratanpur Lahon BPHC Chenijan TE
BPHC Borhulla. BPHC Nakachari BPHC, Borline Kathalguri.
District RRT investigated the outbreak. House to house survey
done. All the 07 Serum samples collected and sent to JMCH;
were positive for JE IgM ELISA. All cases treated
symptomatically. Health education given.

[Ronan Kelly]

Uttar Pradesh
Death of one in encephalitis
Publish Date: Thu, 15 Jun 2017 01:28 AM (IST) | Updated Date: Thu, 15 Jun 2017 01:28 AM (IST)
Death of one in encephalitisDeath of one in encephalitis
In Gorakhpur BRD Medical College, the cycle of death has started from Incephalitis. Last twenty four hours
Gorakhpur

In the BRD Medical College, the process of death has started from Incephalitis. A patient was admitted in the last twenty four hours while Kushinagar's four year old girl died. Treatment of 14 patients admitted to Nehru Hospital Since 1 January this year, 192 patients have been admitted in Medical College, out of which 62 have died.

- See more at: http://www.jagran.com/uttar-pradesh/....mvse4iAa.dpuf

[Ronan Kelly]

Acute Encephalitis Syndrome		12	Male			Alive	June 17, 2017 Time : 11:37 am	City : BIJNOR Distt. : BIJNOUR State : UTTAR PRADESH
Acute Encephalitis Syndrome		78	Male			Alive	June 17, 2017 Time : 11:23 am	City : BIJNOR Distt. : BIJNOUR State : UTTAR PRADESH

http://idsurv.org/display-data.php

Rajasthan
Suspected case of Japanese encephalitis in Pratapgarh

TNN | Jun 18, 2017, 10.15 AM IST


JAIPUR: Japanese encephalitis (JE) is alien to the state but a suspected case reported in Pratapgarh has given sleepless night to the health department officials.
A 10-year-old boy, resident of Daraganv of Dariyawad block of Pratapgarh district was brought to RNT Medical College with symptoms of JE. The doctors sent the samples to National Institute of Virology in Pune.
The boy tested positive for JE in a test of serum. But, he was tested negative for JE in cerebrospinal fluid (CSF) test.
...

http://timesofindia.indiatimes.com/city/jaipur/suspected-case-of-japanese-encephalitis-in-pratapgarh/articleshow/59197150.cms

[Ronan Kelly]

Uttar Pradesh
Death of one in encephalitis
Publish Date: Sun, 18 Jun 2017 02:31 AM (IST) | Updated Date: Sun, 18 Jun 2017 02:31 AM (IST)
Death of one in encephalitisDeath of one in encephalitis
In Gorakhpur, the recruitment of patients of Inseflitis and death of the patients is increasing. Past
Gorakhpur

Recurrence of Inseflitis patients in Purvanchal and the series of deaths are increasing. In the last twenty four hours, six new patients were admitted in the BRD Medical College, whereas Aditya of Deoria died.

Among the recruits, there are two patients of Kushinagar and each of the settlements, Maharajganj, Gorakhpur and Mau. 16 patients admitted to Nehru Hospital are undergoing treatment. Since last one January, 202 patients have been admitted to BRD Medical College, out of which 63 have died.

- See more at: http://www.jagran.com/uttar-pradesh/....KIZt1kuR.dpuf

[Ronan Kelly]

Acute Encephalitis Syndrome scare stalks Odisha
By Hemant Kumar Rout | Express News Service | Published: 19th June 2017 07:23 AM |
Last Updated: 19th June 2017 07:23 AM | A+A A- |

BHUBANESWAR: Acute Encephalitis Syndrome (AES) has come back to haunt the State health administration. It has affected 313 persons, mostly children, and claimed 10 lives in Odisha till end of May this year.

While three deaths have been reported from Khurda district and two from Balasore, one each has died in Kendrapara, Jajpur, Nayagarh, Puri and Sambalpur.
As per the statistics available with the directorate of National Vector Borne Disease Control Programme (NVBDCP), no death has been reported in Japanese Encephalitis (JE) though of 313 AES cases diagnosed so far, two have been found to be JE positive.
...
After spurt in AES and JE cases last year, 10 sentinel laboratories were set up in the State for immediate diagnosis of blood samples. These laboratories have been provided JE kits supplied by Pune-based National Institute of Virology.

The Health authorities have also planned to train all treating paediatric specialists to deal with encephalitis cases. They will be imparted training at AIIMS next month.
Last year, of 1,096 AES cases, 115 persons died of AES and 42 children died of JE. Most of the cases were reported from Malkangiri district. Along with Malkangiri, mass vaccination was carried out in Mayurbhanj, Keonjhar and Jajpur districts in campaign mode.
Meanwhile, the State Government has written to the Centre for vaccination in rest 13 districts which have reported AES cases in the past.

http://www.newindianexpress.com/states/odisha/2017/jun/19/acute-encephalitis-syndrome-scare-stalks-odisha-1618361.html

[Ronan Kelly]

Maharashtra
ONE JAPANESE ENCEPHALITIS CASE GETS STATE ON ITS TOES
By Vicky Pathare, Pune Mirror | Jun 22, 2017, 02.30 AM IST
One Japanese Encephalitis case gets state on its toes

On June 10, a couple from Kondhwa rushed their 10-month-old infant to a hospital after vomiting bouts, constant cough and noticeable abnormal behaviour. Suspecting that the kid might have contracted Japanese Encephalitis (JE) ? an infection that corrodes brain cells ? the doctors sent his blood samples to National Institute of Virology (NIV), which confirmed their suspicion. The diagnosis, a first in the city and second in the state, has got government officials on their toes.

The state epidemiology cell and Pune Municipal Corporation (PMC) epidemiology cell have been keeping a close watch on the situation to ensure that it does not go out of control.

Inamdar Multispecialty Hospital in Kondhwa communicated the diagnosis to the civic officials after the 10- month-old infant?s week-long struggle in the intensive care unit. After NIV?s confirmation, the doctors conveyed results t that showed severe inflammation of brain caused Japanese B Encephalitis Virus that is transmitted by the bite of infected Culvex Vishnui mosquito. The baby is currently stable and out of danger. He has been shifted to the general ward.
...

http://punemirror.indiatimes.com/pune/others/one-japanese-encephalitis-case-gets-state-on-its-toes/articleshow/59260060.cms

[Ronan Kelly]

AS/GLG/2017/20/0734 Assam Golaghat
Japanese Encephalitis 18 cases 00 01-05-17
Under Surveillance
Cases reported from All BPHC. District RRT investigated the
outbreak. House to house survey done. Out of 15 serum
samples and 1 CSF sample collected and sent to DPL, IDSP,
Golaghat and 3 serum samples and 1 CSF sample collected and
tested at JMCH, Jorhat, 2 serum samples were positive for JE
IgM by ELISA. All cases treated symptomatically. Source
reduction activities undertaken. Health education given.

AS/JRT/2017/20/0735 Assam Jorhat Japanese
Encephalitis 26 cases 02 fatalities 07-02-17 Under Surveillance
Cases reported from Village Chutiabari. SC Jalukonibari SD.
BPHC Baghchung. District RRT investigated the outbreak.
House to house survey done. Out of 08 CSF and 25 serum
samples tested at JMCH, Jorhat; 20 samples (CSF=5, Serum =
15) found positive for JE IgM by ELISA. All cases treated
symptomatically. Source reduction activities undertaken.
Health education given. Deceased were 60 year old Female and
19 years old male.

AS/JRT/2017/18/0660 Jorhat
Japanese Encephalitis 33 cases 03 fatalities 24-04-17
Under Surveillance
7 cases with one death were reported in week 18th. 26 more
cases and 2 deaths reported from Villages Chutiabari
Rongaihabigaon, Tehelsinghnagar, Puroniline, New Toklai
Panbari T.E, Dhekorgorah, No. 1 Bhurakola Gaon,
Baghargaon, Cheleng Chapori, Chenijan T.E, Dhekjakhowa
Gaon, Garajan Tiniali, Borline Kathalguri T.E. SC/PHC
Jalukonibari SD,BPHC Baghchung, Tamulbari SC,
Dhekorgorah MPHC, Puronimati SHC, Ratanpur Lahon
MPHC, Malapindha SC, Kakojan BPHC, Dhekiakhowa SC,
Borhulla CHC, Nakachari BPHC.08 CSF and 25serum samples
collected and sent to JMCH, Jorhat. 20 samples (CSF=5,
Serum = 15) found positive for JE IgM by ELISA. All cases
treated symptomatically. Source reduction activities
undertaken. Health education given

From week 20 IDSP report: http://idsp.nic.in/WriteReadData/l892s/202017.pdf

[Ronan Kelly]

Acute Encephalitis Syndrome		9 months	Female			Alive	June 24, 2017 Time : 11:48 am	City : BIJNOR Distt. : BIJNOUR State : UTTAR PRADESH
Acute Encephalitis Syndrome		60 months	Female			Alive	June 24, 2017 Time : 11:37 am	City : BIJNOR Distt. : BIJNOUR State : UTTAR PRADESH
Acute Encephalitis Syndrome		12 months	Male			Alive	June 24, 2017 Time : 11:31 am	City : BIJNOR Distt. : BIJNOUR State : UTTAR PRADESH

http://idsurv.org/display-data.php

[Ronan Kelly]

Three of the deaths of encephalitis
Publish Date: Sun, 25 Jun 2017 01:13 AM (IST) | Updated Date: Sun, 25 Jun 2017 01:13 AM (IST)

Three of the deaths of encephalitisThree of the deaths of encephalitis
Envelope in the Gorakhpur Puravucha is getting wrecked. In the last 24 hours, BRD Medical College
Gorakhpur

Infeiture of Insefitis is getting stronger in the eastern region. In the last 24 hours, a patient was admitted to the BRD Medical College, while three died during treatment. 19 patients admitted to Nehru Hospital are undergoing treatment.

Among the three innocent people who died were Manjit, 16, Manpreet of Gopalganj, Imashad, two and a half years of Gorakhpur and six years old Sikander of Balrampur.

Since January this year, 215 patients have been admitted to BRD Medical College, out of which 66 have died.

http://www.jagran.com/uttar-pradesh/gorakhpur-city-16256796.html

[Ronan Kelly]

Uttar Pradesh

Three of the deaths of encephalitis
Publish Date: Wed, 28 Jun 2017 01:40 AM (IST) | Updated Date: Wed, 28 Jun 2017 01:40 AM (IST)
Three of the deaths of encephalitisThree of the deaths of encephalitis
In Gorakhpur, the death toll from Incephalitis continues. In the last three days, BRD Medical Age
Gorakhpur

There is a continuation of deaths from Insepflitis in Purbachal. In the last three days, seven new patients were admitted in the BRD Medical College and three others died. 18 patients admitted to Nehru Hospital are undergoing treatment

The three people who died were Jyoti of 17 years of ghetto, four years of Gorakhpur and 4 years old Anok of Sant Kobirnagar. Since January this year, 222 patients have been admitted to BRD Medical College, out of which 69 have died.

http://www.jagran.com/uttar-pradesh/gorakhpur-city-16272257.html

[Ronan Kelly]

Scrab typhus encephalitis drug on ETC
Publish Date: Fri, 30 Jun 2017 01:07 AM (IST) | Updated Date: Fri, 30 Jun 2017 01:07 AM (IST)
Scrab typhus encephalitis drug on ETCScrab typhus encephalitis drug on ETC
Gorakhpur: Now at the health centers of the Gorakhpur and the Basti Mandal, which has attained Encephalitis Treatment Center
Gorakhpur: Now you will get the medicine of scrub typhus encephalitis on the health centers of the Gorakhpur and the Basti Mandals, which are in the category of Encephalitis Treatment Center. Instructions for providing dexycycline and azithromycin in these hospitals have been given to the CMO.

It is said that from July 3, a high level team of experts is going to visit these health centers. In patients of the team of Inphthitis, scrub typhus will also study the symptoms and treatment of bacteria.

------------

What is scrub typhus

So far, in addition to the Japanese encephalitis and waterborne diseases caused by mosquitoes, scrub typhus bacteria have been confirmed in patients in large numbers.

This bacteria is found in the cephaler (a special type of lice found in the woods in the woods). In view of this, it has now been decided to give antibiotic azithromycin or dxycycline to all patients of Inphalitis.

In the districts of Uttar Pradesh, for the identification of AES (acute encephalitis syndrome) disease, India is being researched by the Government of India, USAID, CDC Atlanta, Nimhans Bangalore and National Institute of Virology Pune. Scratch typhus that has been diagnosed with insufflation in the blood test of AES patients has been identified. After this, the officials were told that all the patients arriving in hospitals should be treated using antibiotic azithromycin or dxycycline on priority basis. The same medicine should be given to AES patients too. If there is any further diagnosis of the disease, then the disease should be treated.

http://www.jagran.com/uttar-pradesh/gorakhpur-city-16282922.html

Comment: Scrub Typhus was linked to AES cases in Assam 2013-15 and in Uttar Pradesh in 2016. - Ro
Scrub Typhus Leading to Acute Encephalitis Syndrome, Assam, India
Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, India - Role of scrub typhus.
The Gorakhpur mystery New research promises to find the causes behind India's annual encephalitis outbreaks.

[Ronan Kelly]

Death of one in encephalitis
Publish Date: Tue, 04 Jul 2017 01:04 AM (IST) | Updated Date: Tue, 04 Jul 2017 01:04 AM (IST)

In Gorakhpur, the process of recruitment of patients of Insefalitis has started and death has started. Past two
Gorakhpur

The recurrence of patients of Insefalitis in Purbachal has begun and a series of deaths has started. In the last two days, three new patients were admitted in the BRD Medical College, whereas the 12 year old Sudha died of Sant Kabirnagar. 13 patients admitted to Nehru Hospital are undergoing treatment.

There are only one patient for recruitment in Gorakhpur, Kushinagar and Santacirinagar. Since 1st January this year, 233 patients have been admitted to BRD Medical College, out of which 70 have died.

http://www.jagran.com/uttar-pradesh/gorakhpur-city-16304429.html

[Ronan Kelly]

Jharkhand
Suspected cases of Japanese Encephalitis surface in Jamshedpur
JAMSHEDPUR July 3, 2017 , by Desk 0 Comments 50
Jamshedpur, July 3: After eight confirm cases of dengue were reported, fresh suspected cases of Japanese Encephalitis (JE) have surfaced in the city.

District officer for Integrated Disease Surveillance Programme ( IDSP), Sahir Pall said they got two blood samples of suspected Japanese encephalitis (JE) cases, which were sent to the microbiology department of MGM Medical College in Dimna. ? We got the samples from a local hospital which has been sent to the lab for a test. The report is expected in the next 72-hours,? he said.
...

http://www.avenuemail.in/jamshedpur/suspected-cases-japanese-encephalitis-surface-jamshedpur/110280/

[Ronan Kelly]

Volume 23, Number 8?August 2017

Research Letter

Scrub Typhus as a Cause of Acute Encephalitis Syndrome, Gorakhpur, Uttar Pradesh, India

On This Page

• Research Letter
• Suggested Citation

Tables

• Table

Technical Appendices

• Technical Appendix

Downloads

• RIS[TXT - 2 KB]

Mahima Mittal, Jeromie Wesley Vivian Thanagraj, Winsley Rose, Valsan Philip Verghese, C.P. Girish Kumar, Mahim Mittal, R. Sabarinathan, Vijay Bondre, Nivedita Gupta, and Manoj V. Murhekar
Author affiliations: BRD Medical College, Gorakhpur, India (Mahmia Mittal, Mahim Mittal); National Institute of Epidemiology, Chennai, India (J.W.V. Thanagraj, C.P. Girish Kumar, R. Sabarinathan, M.V. Murhekar); Christian Medical College, Vellore, India (W. Rose, V.P. Verghese); National Institute of Virology, Gorakhpur (V. Bondre); Indian Council of Medical Research, Delhi, India (N. Gupta)
Suggested citation for this article
Abstract

Outbreaks of acute encephalitis syndrome (AES) have been occurring in Gorakhpur Division, Uttar Pradesh, India, for several years. In 2016, we conducted a case?control study. Our findings revealed a high proportion of AES cases with Orientia tsutsugamushi IgM and IgG, indicating that scrub typhus is a cause of AES.

Outbreaks of acute encephalitis syndrome (AES) with high case-fatality rates have been occurring in Gorakhpur Division of Uttar Pradesh, India, since 1978 (1). AES predominantly affects children <15 years of age (2), and its etiology has remained largely unknown (3,4). Studies focusing on AES in the region have documented that cases with unknown etiology accounted for 41.6% of cases in 2011?2012 (5) and 59% in 2013?2014 (6).
Investigations conducted during the 2015 outbreak revealed scrub typhus IgM in >60% of AES cases (7). The absence of information about IgM positivity from the general population, and the probability of high background antibody levels in areas to which scrub typhus is endemic, led us to conduct an unmatched case?control study in which we compared IgM and IgG seropositivity for Orientia tsutsugamushi, the causative agent of scrub typhus, in AES patients and healthy controls.
We conducted the study during August 17?October 16, 2016. Children <15 years of age with AES admitted to the BRD Medical College in Gorakhpur during the study period were recruited to the study if their parents consented to a blood draw and they had siblings <15 years of age. We defined a case of AES as an acute onset of fever and change in mental status or new onset seizures, excluding febrile seizures (8), with cerebrospinal fluid pleocytosis (cell counts >5/mm3). Controls were healthy children <15 years of age residing in the home (sibling controls) or village (community controls) of AES case-patients. We interviewed mothers and caretakers for information on case-patients and controls.
We collected 2-mL blood samples from case-patients and controls and tested the samples for O. tsutsugamushi IgM and IgG using commercial ELISAs (Scrub Typhus Detect; InBios International Inc., Seattle, WA, USA). We considered an optical density value >0.5 to be a positive result (9). We compared IgM and IgG positivity among AES case-patients and their controls by calculating crude and adjusted odds ratios (ORs) with 95% CIs.
We enrolled 46 case-patients and 151 controls (69 sibling and 82 community controls) in the study. The median age was 5 (interquartile range 3?9) years for patients and 7 (interquartile range 4?10) years for controls. The case-patients and controls did not differ by age group or sex (Table). The mothers of 54 (35.8%) of the control children reported a history of fever in the past 6 months.

Common symptoms among the 46 AES case-patients included seizures (69.6%), altered sensorium (52.2%), and vomiting (37%); physical examinations revealed hepatomegaly (43.4%), cervical or inguinal lymphadenopathy (39.1%), and periorbital edema (54.3%). Cerebrospinal fluid was clear in appearance in 43 of the patients we tested. Cell counts ranged from 5?100/mm3 in 41 (95.3%) and were >100/mm3 in 2 patients. Protein levels in fluid were <45 mg/dL in 8 patients, 46?100 mg/dL in 15, and >100 mg/dL in 20 patients. All AES case-patients were given intravenous azithromycin; 20 patients also received injected ceftriaxone. Eight patients died.
O. tsutsugamushi IgM was detected in 29 (63%) case-patients and IgG in 38 (82.6%). For controls, IgM was detected in 7 (4.6%) and IgG in 64 (42.4%) children. Of the 8 fatal cases, 6 patients had O. tsutsugamushi IgM and all had IgG. The distribution of optical density values for IgM and IgG among cases and controls are shown in the Appendix (Technical Appendix[PDF - 94 KB - 1 page]). Twenty-eight of the 29 IgM-positive cases and 6 of the 7 controls with IgM seroreactivity were also positive for IgG. Of the 7 controls with IgM seroreactivity, 3 had a history of febrile illness in the past 6 months.
The odds of IgM scrub typhus positivity were 35.1 (95% CI 13.4?92.3) times higher among AES case-patients than among controls; when adjusted for age, the odds were 29.9 (95% CI 9.6?92.9) times higher for case-patients. The odds of IgG positivity were 6.5 (2.8?14.8), times higher among AES case-patients than controls, and when adjusted for age, the odds were 3.8 (95% CI 1.4?10.9) times higher for case-patients. When analyzed separately, AES case-patients had higher odds for IgM positivity compared with sibling (OR 25.1, 95% 6.3?99.8) or community (OR 13.2, 95% 2.27?76.7) controls.
Our study had 1 main limitation: patients and controls were selected from the same village and shared the same environmental risk factors. Despite overmatching that underestimates the strength of association, the odds ratios for O. tsutsugamushi IgM and IgG positivity were significant. We concluded that the presence of higher levels of O. tsutsugamushi IgM and IgG among AES case-patients than among controls indicates a role for scrub typhus in the etiology of AES in Gorakhpur.

Dr. Mittal is the head of the Department of Pediatrics at BRD Medical College, Gorakhpur, India. Her research interests include central nervous system infections among children.


Acknowledgments

We thank the members of the expert group on Research-Cum-intervention project on AES/JE for their inputs on the study findings. We are grateful to Anita Mehta, S.K. Srivastava, and Bhoopendra Sharma for their cooperation. Thanks are also due to Mr. Karunakaran and Mr. Magesh for their technical support.
The study was funded from an extramural grant by the Indian Council of Medical Research, New Delhi.

References

• Mittal M, Kushwaha KP. AES: Clinical presentation and dilemmas in critical care management. J Commun Dis. 2014;46:50?6.
• Ranjan P, Gore M, Selvaraju S, Kushwaha KP, Srivastava DK, Murhekar M. Changes in acute encephalitis syndrome incidence after introduction of Japanese encephalitis vaccine in a region of India. J Infect. 2014;69:200?2. DOIPubMed
• Bhatt GC, Bondre VP, Sapkal GN, Sharma T, Kumar S, Gore MM, et al. Changing clinico-laboratory profile of encephalitis patients in the eastern Uttar Pradesh region of India. Trop Doct 2012;42:106e8. http://journals.sagepub.com/doi/pdf/...td.2011.110391
• Joshi R, Kalantri SP, Reingold A, Colford JM Jr. Changing landscape of acute encephalitis syndrome in India: a systematic review. Natl Med J India. 2012;25:212?20.PubMed
• Jain P, Jain A, Kumar A, Prakash S, Khan DN, Singh KP, et al. Epidemiology and etiology of acute encephalitis syndrome in North India. Jpn J Infect Dis. 2014;67:197?203. DOIPubMed
• Gupta S, Shahi RK, Nigam P. Clinico-etiological profile and predictors of outcome in acute encephalitis syndrome in adults. International Journal of Scientific Study. 2016;3:78?83 http://www.ijss-sn.com/uploads/2/0/1..._oa16_2016.pdf.
• Murhekar MV, Mittal M, Prakash JA, Pillai VM, Mittal M, Girish Kumar CP, et al. Acute encephalitis syndrome in Gorakhpur, Uttar Pradesh, India - Role of scrub typhus. J Infect. 2016;73:623?6. DOIPubMed
• World Health Organization. Acute Encephalitis Syndrome. Japanese encephalitis surveillance standards. January 2006. From WHO-recommended standards for surveillance of selected vaccine-preventable diseases. WHO/V&B/03.01 [cited 2016 Oct 14]. http://apps.who.int/iris/bitstream/1..._03.01_eng.pdf
• Blacksell SD, Tanganuchitcharnchai A, Nawtaisong P, Kantipong P, Laongnualpanich A, Day NP, et al. Diagnostic accuracy of the InBios scrub typhus detect enzyme-linked immunoassay for the detection of IgM antibodies in northern Thailand. Clin Vaccine Immunol. 2015;23:148?54. DOIPubMed

Table

• Table. Characteristics of patients with scrub typhus and controls in study of acute encephalitis syndrome, Gorakhpur, Uttar Pradesh, India, 2016

Technical Appendix

• Technical Appendix. Distribution of optical density (OD) values for Orientia tsutsugamushi IgM among patients with scrub typhus and controls in study of acute encephalitis syndrome, Gorakhpur, Uttar Pradesh, India 94 KB

Suggested citation for this article: Mittal M, Thangaraj JWV, Rose W, Verghese VP, Girish Kumar CP, Mittal M, et al. Scrub typhus as a cause of acute encephalitis syndrome, Gorakhpur, Uttar Pradesh, India. Emerg Infect Dis. 2017 Aug [date cited]. https://doi.org/10.3201/eid2308.170025
DOI: 10.3201/eid2308.170025

https://wwwnc.cdc.gov/eid/article/23/8/17-0025_article

[Ronan Kelly]

Assam
One dies of JE

From a Correspondent
MARGHERITA, July 5: Tension prevailed in Margherita region when a person died of Japanese Encephalitis on Wednesday at Assam Medical College and Hospital, Dibrugarh. Krishna Gope (60), resident of 1 no. Makum Pather, Margherita, was admitted to Assam Medical College and Hospital as he was suffering from severe fever.
...

http://webcomipl.com.md-in-18.webhostbox.net/state1/story.php?sec=2&subsec=2&id=313308&dtP=2017-07-06&ppr=1