KANPUR, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 400+ fatalities - Dengue, malaria, H1N1, others suspected

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Dengue, viral fever kill five persons

STAFF WRITER 23:9 HRS IST
Ghaziabad, Oct 4 (PTI) Dengue and viral fever killed five persons including two children in the district today, official sources said.

While two children aged nine and six years died of dengue at Dhaulana town, three persons died of viral fever at Patla village, they said.
http://ptinews.com/news/1007286_Dengue--viral-fever-kill-five-persons

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

13 more fall prey to mystery fever
Faiz Rahman Siddiqui, TNN, Oct 4, 2010, 09.56pm IST

KANPUR: Even as 13 persons, mostly minors, fell prey to mystery fever in Ramabainagar district (Kanpur Dehat) on Monday, district officials claimed they were trying to contain the spread of the disease which has claimed 180 lives so far.
"As many as 14 medical teams and para-medical teams are working in the field. The situation is being monitored in all the 82 affected villages,'' district magistrate Saroj Tewari told TOI.

Children are especially vulnerable to the killer virus, which was evident with seven deaths of minors in the district on Monday itself.

The DM has ordered health authorities to launch a massive cleanliness drive in all the villages. "Health teams have been asked to spray insecticide in the affected areas and distribute medicines to those down with fever,'' he added.

Billu, a resident of Akbarpur, said the deaths have created a scare among the residents of Ramabainagar district.

A public campaign has also been launched and villagers are being asked to report any symptoms of the disease as soon as possible. Health officials say the earlier it is detected, the easier it is to cure.

Chief Medical Officer, Lajjaram said, "We are taking effective steps to curb the disease.''

The health authorities, who till now had been terming these patients as suspected dengue, malaria, encephalitis, viral fever cases, said that the campaign to investigate, control and prevent spread of this fever were being continuing. Of the 1,172 persons who visited the district hospital on Monday, 207 were running fever. We have started the treatment of 21 patients here,'' Akbarpur district hospital authorities told TOI.

The continuous increase in the number of fever cases being reported everyday is causing concern for the health authorities, more so because the mystery fever seems to have spread to some more villages of the district.

In fact, the district health authorities are consulting specialists at the state capital to ascertain the disease.

Meanwhile, medical experts said that the stagnant water after rains in the region have only aggravated the problem, as mosquitoes would get more breeding grounds. Though fogging operations have been undertaken in the entire district particularly in Malasa, Amraudha and Akbarpur from where maximum number of patients have come, but this has not helped in stopping the fever from spreading.

Those who died on Monday include Ram Murti (45) of Akbarpur, Parth (1) of Shahzadpur, Chandni (2) of Angadpur, PK Naik (13) of Kishunpur Balai Dera, Amar Paswan (40) of Manethu, Rampat (8) of Mohammadpur, Rohit (15) of Kattapurwa Nagina, Vikas (14) of Khasbara, Shaeedan (60) of Afsariya, Janki (6) of Jainpur, Preeti (30) of Ratapur, Sudhir (22) of Kuwanrpur and Mauji Lal (55) of Kunwarpur.




Read more: 13 more fall prey to mystery fever - The Times of India http://timesofindia.indiatimes.com/...y-fever/articleshow/6685663.cms#ixzz11X3G4fLd

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Dengue on the rise, mystery fever causes panicLarger | Smaller Surbhi Khyati
Tags : Dengue, disease, fever
Posted: Tue Oct 05 2010, 23:26 hrs
Lucknow:

Dengue is on the rise in the state and the total number of cases of the disease has crossed 200. However, longer duration of fever and decreasing platelet count in the patients who have tested negative for the disease have puzzled the doctors. While hospitals are flooded with such patients, doctors suspect a change in the viral strain responsible for the longer duration of fever.

?Dengue cases are increasing but there are a number of cases where the patients test negative for dengue and yet their platelet count is decreasing,? said Chief Medical Officer Dr AK Shukla.


What is creating panic among the patients, said doctors, is the longer duration of fever. From the earlier trend of four to five days, this time the fever sustains for over 10 days.


?A change in the viral strain seems to have caused the new fever pattern. But there is no need to panic because mortality is still nil, at least in Lucknow,? said Shukla. ?Fall in platelets need not always indicate dengue. Dengue is generally accompanied by severe pain in the joints, which is not true in case of viral cases,? he said.


The hospitals of Lucknow, both private and government, are flooded with patients who have fever for over 10 days and their platelet count is decreasing. Balrampur Hospital, for instance, have at least 650 patients admitted while more were pouring in on Monday for admission, while the hospital has 605 beds.


Dr Shobhnath, Director, Balrampur Hospital, said: ?It is a common phenomenon that virus mutates after two to three strains. This time, the cases of viral fever have definitely increased while there are very few cases of diarrhoea, as compared to the last few years. However, the platelet count in these patients is decreasing only up to a level, after which it stabilises.? He said there is panic as people have become more conscious about platelet count.


According to the state Health department, a total of 218 people have tested positive for dengue while one has succumbed to the disease. The prevalence of the disease is reported in 30 districts of the state, with 119 cases reported from Lucknow, 11 cases from Baghpat, 9 from Ghaziabad, 8 from Kanpur, 7 each from Sultanpur and Badayun and 6 from Gautam Buddha Nagar, while the rest of the districts have reported 5 or fewer cases till date.


The number of the dengue cases this year is the highest in the last three years.
http://www.indianexpress.com/news/dengue-on-the-rise-mystery-fever-causes-panic/693005/0

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Confusion prevails over diagnostic tests for dengue
TNN, Oct 6, 2010, 12.26am IST

LUCKNOW: Even as around three dozen more suspected dengue cases, including around 12 in government hospitals, were reported in the city on Tuesday, confusion prevailed over the diagnostic test for confirmation of the disease.

While the Trauma Centre, medicine ward and the paediatrics emergency ward of Chhatrapati Shahuji Maharaj Medical University (CSMMU) was overburdened with the patients, several sharing beds and even lying on stretcher, government health officials remained in denial mode saying that only 10 cases and that too suspected ones have been reported in the last 24 hours.

On the other hand, the platelets crisis continued with people making beeline for the blood component for transfusion and very few coming for blood donation. Among new cases include three CSMMU students. Death of a suspected dengue patient, Sachin, 25, an employee of Nirman Nigam was also reported but authorities did not confirm it. Sachin was under-treatment in a private hospital.

Director general health, Dr P C Ram said that as per government of India guidelines, only those cases in which dengue has been confirmed by polymerase chain reaction (PCR) test can be considered as a dengue patient, but doctors (both government and private) said World Health Organisation (WHO) also approves Enzyme Linked ImmunoSorbent Assay (ELISA) test for rapid diagnosis of dengue.

The facility of PCR test is available only in CSMMU and SGPGIMS in the government sector and in a few private hospitals. In the government sector, PCR is available for Rs 230-Rs 300 and is free for below poverty line patients. The ELISA test is free in government hospitals since most of the victims are from poor category, labs at CSMMU and SGPGIMS are working overnight.

Government `officially' recognises only PCR test but doctors in government hospital said that they also take ELISA test into cognizance as PCR facility is limited in the city. Significantly, while suspected dengue cases are on the rise, the only testing facility for government hospitals is available in the health directorate. The blood samples of suspected cases from various government hospitals in the city are sent to health directorate for confirmation. As a result, there is a long queue of samples waiting for confirmation test. This is leading to delay in management of dengue patients.

"The need is to have more PCR labs in the state and equip hospitals in every district at least with Elisa facility and trained staff in dengue management," said a government doctor.

Dr A K Shukla, chief medical officer, Lucknow, blames private pathologies for causing panic. The platelets count can also decrease in other diseases other than dengue, he added.

Dr V S Nigam, officiating director, communicable diseases, said that PCR facility is very costly which poor cannot bear. Hence, he added, we also consider ELISA reports for treatment.

Dr P K Gupta, president pathologist association, said, "It's true that PCR is more accurate than ELISA but we also need to take into account the demographic and economic profile of our state before taking decisions."

Pathologist Dr Pragat Gupta said, "Rapid chromatography test can also deliver results in short time and at a very low cost in comparison to other tests."

"The rush for platelets is huge, over 200 units per day, as doctors are recommending transfusion even if the platelets count is one lakh or 50,000. Excess or unnecessary transfusion can cause complications," said Dr Tulika Chandra, in charge, Blood Bank, CSMMU. "The platelets transfusion is required only in case of internal bleeding or platelets count dips below 20,000," she said.

Platelet is a component of blood. It prevents bleeding and helps in formation of clot. Normal platelets count in human body is between 1.5 lakh and 4 lakh. In dengue patients, its drops to between 50,000 to one lakh. A unit of platelet is made from five units of blood and its shelf life is only five days. In CSMMU, it is available for Rs 50 per unit to in-house patients and Rs 400 per unit for outsiders.

box

PCR Test: Molecular test. It can detect dengue even in the early stages. Most accurate and sensitive. Investment cost to establish the lab and equipment between Rs 4 crore and Rs 5 crore. Cost of the test in private hospitals is Rs 5,000 and above. Result in a day.

ELISA Test: Less accurate than PCR but investment cost of facility around Rs 2 lakh and cost of testing in private Rs 2,000 and above. Can deliver results in few hours.

Rapid Chromatographic Test: Less accurate and reliable but handy. Can deliver results in few minutes. Cost in private centres between Rs 600 and Rs 1200.

Platelets Count Test: Cost between Rs 100 ans Rs 200. It's a blood test to find the concentration of platelets in the blood. It's not a confirmatory test but useful if patient has other symptoms of dengue. But there are several virus which can cause similar symptoms with reduction in platelets count in blood. Hence, it is used more to monitor the status of the patient once dengue is confirmed.




Read more: Confusion prevails over diagnostic tests for dengue - The Times of India http://timesofindia.indiatimes.com/...-dengue/articleshow/6694584.cms#ixzz11X9OETiB

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

http://timesofindia.indiatimes.com/city/kanpur/Many-deaths-from-high-fever/articleshow/6684914.cms


KANPUR: There seems to be no end to the deadly mosquito bite in the city. At a time when the health authorities are grappling to curb the diseases, many deaths have added to the panic. Deaths have been reported from various parts of the city. However, the health authorities are denying the reports.

Diseases like malaria and dengue have spread tentacles in various localities of Govind Nagar. Shiv Nagar, Nirala Nagar, Canal Colony and Kachchi Basti are worst affected. Several residents of these areas are suffering from fever and showing symptoms of malaria, dengue and chikungunia.

On October 2, Priya Devi (35) and Aakansha (4), resident of Govind Nagar died due to fever. According to the sources, two more deaths due to dengue were reported in Lala Lajpat Rai (LLR) Hospital. Nine-year-old Raju, a resident of Canal Colony succumbed to high fever on Sunday. Unhygienic conditions are prevailing in these areas.

However, the health authorities dismiss the death reports. They say that the cases cannot be confirmed dengue or chikungunia. Chief medical officer A Mishra said: "The cause of deaths could be ascertained only after laboratory examinations. There could be other causes of deaths."

When patients are showing symptoms of chikungunia, the medical college is ill-equipped to test the disease. The test conducted by private labs are expensive for the poor. Therefore, deaths due to chikungunia are going undetected [Deaths due to chikungunya are exceedingly rare - alert].

Expressing concern over the issue, Mishra said: "There are cases where it is difficult to ascertain the cause of fever. Therefore, the prime aim should be to detect the bacteria and the virus causing such fever. We have already sent a letter to the medical college, asking to collect the blood samples of the patients and to be sent to laboratory in Lucknow for test."

The fever has hit both the urban and rural areas. According to reports, in September alone, 463 patients were reported positive for malaria in the region, 432 from rural area and 31 from urban localities.



Read more: Many deaths from high fever - The Times of India http://timesofindia.indiatimes.com/...h-fever/articleshow/6684914.cms#ixzz11XNUpmiY

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

http://timesofindia.indiatimes.com/...irmed-dengue-positive/articleshow/6685273.cms


KANPUR: Of the 35 blood samples collected from September 25 to 30, 17 have been confirmed dengue positive by Ganesh Shankar Vidyarthi Memorial (GSVM) on Monday. The health department is ill-equipped to combat the disease.

Admitting that the urban malaria department has no sufficient `anti-larvae' to kill mosquitoes, urban malaria officer AK Singh said every month, the city requires 30 litres of anti-larvae for 14 sectors, registering maximum number of malarial patients. These include Babupurwa, Maccharia, Bekanganj and Chamanganj."

"The demand of the chemical exceeds actual supply in the city. Each month we are provided only 20 litres of chemicals which is not sufficient for the waterlogged areas of Kanpur," added the officer.

It needs to be mentioned that many have fallen prey to the deadly disease. However, the deaths are going unreported. Dengue is a viral disease spread by mosquitoes. The symptoms include headache, fever, exhaustion, severe joint and muscle pain and rash.

Experts say that dengue fever affects children and adults. It begins with fever, headache and pain in muscles and bones. The illness last for 10 days after which recovery starts. The other serious manifestation can be dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS).

Chief medical officer Ashok Mishra said: "There is a need to make people aware about the prevention of the disease. One should kill mosquitoes by spraying DDT or flit, prevent stagnation of water in nearby areas and coolers as well, cover doors and windows with meshes and screens, use mosquito nets during night and apply mosquito repellent cream on exposed part of the body."

Read more: 35 blood samples confirmed dengue positive - The Times of India http://timesofindia.indiatimes.com/...ositive/articleshow/6685273.cms#ixzz11XOgvmOf

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Yikes.

There do seem to be two "mystery" outbreaks in Uttar Pradesh in this thread. One has symptoms like dengue or chikungunya and may in fact be a compound outbreak of the two diseases. But there seems to be something else going on in Ramabai Nagar, where 216 people have died. In that outbreak, very little in symptomatic description has been given, but the one post in this thread that did give a description described it as similar to viral encephalitis, and causing death within 12-14 hours, which might be AES. I have reproduced that post below as #30.

http://timesofindia.indiatimes.com/city/kanpur/Accused-of-rape-arrested/articleshow/6701927.cms


Mystery fever: With 18 deaths on Wednesday, the death toll in mystery fever in Ramabai Nagar rose to 216.


Read more: Accused of rape arrested - The Times of India http://timesofindia.indiatimes.com/...rrested/articleshow/6701927.cms#ixzz11bwS90x9

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

http://timesofindia.indiatimes.com/speednewsshow/6698860.cms

The death toll in the `mystery' fever raging the Ramabainagar district for the past one month rose to 198 on Wednesday, with 17 more deaths reported and the disease has now started spreading its tentacles to several other parts of the district.

 

[Vibrant62]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Hi Alert - Yikes indeed.

The causative aetiology is still very confusing. It appears we have a number of options up for consideration here that could be responsible for the high death rates.
a) Dengue, possibly a new viral variant?
b) Chikungunya, again possibly a new viral variant?
c) H1N1 flu
d) any combination of the above?

Hard data on coinfections or genetic typing of isolated virus would be very helpful - from reports, I believe that the Pune laboratory is looking at this, so let us hope there is some hard data soon.

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

I see no sign the NIV in Pune has been contacted. I think the samples have only gone as far as Lucknow. It is well past time someone alert ProMED and the WHO.

H1N1 is exceedingly unlikely due to both the high death toll and lack of respiratory symptoms. There is likely some dengue and chikungunya, as well as some malaria, but it seems the mystery fever is the viral encephalitis mentioned in a previous post (which I am having trouble finding).

Update: I posted that article below - apparently we had it in a different thread.

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Here it is - it is post #5 in the thread below (but the original article has been removed):

http://www.flutrackers.com/forum/showthread.php?p=372842

According to the doctor at Rasoolabad primary health centre, all the victims first developed high fever before having convulsions and dying.

A paediatrician, who accompanied the health team to the villages, said that the outbreak seemed to be a virulent form of encephalitis.

"The children succumbed within 12-14 hours of the onset of high fever," he said.

"We have told the block health officials in Derapur to clear the stagnant water immediately and send blood samples collected from affected persons to the district hospital at Akbarpur," chief medical officer Lajjaram said.


Nearly 400 villagers of Gilauliya in Derapur block are down with fever since the past one week. Shiva, Jaipal, Mahipal, Jyoti, Phool Kumari, Kapil, Vishal, Muskan, Rohit, Jaikaran, Neha, Ravi, Nidhi, Romi, Reeta, Shiv Devi, Rukmani, Rampyari, Sharbati, Prema, Priyanka and Sindoori were among those having fever.

Raghuram of Derapur said his three-year-old son, Bablu, was fine when he had dinner and went to bed last night. "He suddenly fell ill this morning. We took him to the health centre where he became unconscious."

"There is no health facility here and the doctors are just distributing paracetamol tablets," Balram, another villager added.

Read more: Six more succumb to mystery fever - The Times of India http://timesofindia.indiatimes.com/c...#ixzz10foYxBCE

 

[Vibrant62]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Thanks alert

Whilst a viral encephalitis fits the symptoms, flu infection can attack the brain and H1N1 appears to have a higher propensity for this than normal, and is prevalent in India at the moment, so until it is tested for and comes back negative I wouldn't rule it in or out of the mix - but overall I agree with you. It sounds like one for Promed/WHO

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Also bear in mind confirmed cases of measles in the area, one confirmed death in Delhi from meningeal encephalitis, and 8 confirmed flu B deaths.
One would think that if these cases were some combination of AES/JE, there would be some expertise in identifying it given Uttar Pradesh's history with encephalitis outbreaks.
I suspect that there is a bunch of different things going on here - malaria, dengue, meningitis, H1N1, other flu strains, measles, and probably some cholera and gastroenteritis after the flooding.
Does anyone know offhand if JE/AES was active in the region west of Lucknow - Kanpur, Ghaziabad, Ramabai Nagar etc in previous years? Most of the reports this year are coming from East of Lucknow in the Ghorakpur region.

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

There seems to be a massive "AES" outbreak in Uttar Pradesh the past few years. This summer, 200+ died at Gorakhpur. Keep in mind that "AES" really isn't a diagnosis, it is just a name for non-JE encephalitis.

http://intvlive.com/Intv-News/08-27-2010/2010-08-27_Gorakhpur.html

Last year, almost 600 died:

http://www.flutrackers.com/forum/showthread.php?t=104020

And in Kanpur itself in 2008, 200+ died of a mystery fever that sounds an awful lot like this outbreak - 15-20 deaths per day over about a month, with the outbreak only stopping when temperatures dropped.

http://www.hindustantimes.com/Mystery-virus-kills-160/Article1-333470.aspx

Here is the 2007 outbreak (over 250 dead, henipavirus suspect):

http://www.promedmail.org/pls/apex/...,F2400_P1001_USE_ARCHIVE:1202,20071022.3440,Y

And here is a ProMED post from 2005, also western UP:

http://www.promedmail.org/pls/apex/...,F2400_P1001_USE_ARCHIVE:1202,20051113.3322,Y

And a VERY similar to the present outbreak, western UP, 2004:

http://www.promedmail.org/pls/apex/...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,27233

There is a very good chance there is a previously undiscovered encephalitis virus lurking there.

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Here's a report from 2008;

Illness pradesh Teena Thacker


Posted: Fri Sep 12 2008, 23:48 hrs

The ?mysterious? disease that caused a spate of deaths in Kanpur and Rampur districts made national headlines this month, but the fact that this state endured such an outbreak should not come as a surprise. Given the incidence of diseases such as polio, malaria, Japanese encephalitis, diarrhoea, hepatitis E and measles, Uttar Pradesh is arguably the sickest state in the country. It doesn?t fare much better when it comes to other health indicators such as maternal and infant mortality rates either.


According to the recent National Family Health Survey (NFHS) III, the situation in UP is such that only 23 per cent of children between 12 and 23 months have received all the recommended vaccines.


?Forty-seven per cent of children are underweight, 46 per cent are stunted, 14 per cent are too thin for their height,? says the report. Even more alarming is that the number of infant deaths per 1,000 live births in the last few years stand at 73.

Experts in the Union Health Ministry say that while there has been considerable improvement in other states like Bihar ? which also faced similar problems until recently ? UP?s predicament stems from the low literacy rate and the prevalence of unsanitary living conditions.


?People in UP stay in close-knit, crowded areas, which results in unhygienic conditions and consequently means more diseases,? said a senior official in the ministry. Illiteracy serves to exacerbate the situation.


According to the NFHS, 54 per cent of women get no education and this may have something to do with the high fertility rate.


?Many couples have at least three children and it?s not unusual for the number to go up to six or seven. This trend is not so common in other states now,? added an official.


In 2007, over 500 children died from an unknown strain of the encephalitis virus; 305 children were afflicted with polio; and 2,556 with tuberculosis ? the maximum in any state.


The situation has not shown much improvement this year. At least 50 people have already died due to an unknown strain of the encephalitis virus.


And even as health authorities were congratulating themselves over the falling incidence of polio a few months ago, the virulent poliovirus has again taken UP in its grip. Other than its spread in western UP districts like Moradabad and Badaun, this time the virus has spread in ?low-risk? districts too, such as Hardoi, which last saw a polio case in 2006. And Mirzapur, which had also been free of the disease for a while, reported cases with poliovirus P3 (as opposed to the more common P1). And while the fear of polio grips western UP, the eastern part of the state is reeling under water-borne diseases, with several deaths reported as well.


Uttar Pradesh also saw a spurt of measles this year and as many as 36 people, most of them children, ended up succumbing to the usually non-fatal disease.


But it is Kanpur where the urgency of addressing the health crisis is most evident due to the spread of a ?mysterious fever? that has spread across as many as 150 villages, specifically in four blocks ? Amraudha, Malasa, Dherapur and Sarvankheda ? that are home to three lakh people. Seruva ka Purva village under the Sarvankheda Block has already witnessed over 100 cases and the deaths of two children over the past few days.


While investigations revealed that some died due to hepatitis E, health authorities are still concerned, since the latest report by the National Institute of Communicable Diseases (NICD) has confirmed that the deaths could be due to malaria. Authorities are now concerned that a mutant strain of p.vivax malaria ? which was prevalent in Kanpur but not fatal ? could be causing the deaths.

The experts suspect that this new strain could lead to larger problems. ?The p.vivax strain of malaria usually does not cause mortality. But if it?s doing so like it did in Venezuela, it is a cause of concern. We are also investigating whether some other new strain has been circulating in the area,? said Dr Shiv Lal, director, NICD.


In the meantime, a new case ? West Nile virus ? has been diagnosed for the first time in the state.


However, even as the health situation in Uttar Pradesh has reached crisis proportions, authorities appear to be more concerned with making excuses and claiming ignorance than tackling the problem. For polio, they blame victims? resistance to polio drops; they throw their hands up in the air for encephalitis, saying it is an unknown strain; while faulty water pipelines are the prime accused for diarrhoea deaths.


But despite evidence to the contrary, health authorities believe that the situation is under control. ?There has been improvement as far as the spread of diseases in the state are concerned,? said Dr I S Srivastava, DG, Health Services, UP. ?We are vigilant about health conditions and whenever needed, teams are being sent for investigations,? added Dr Srivastava.


Water and Vector borne diseases:


Malaria 23278 cases.


Filaria 3440 cases.


Kala Azar 33 cases.


Dengue 1 case (one death).


JE 894 cases (163 deaths).


Diarrhea 7828 cases (94 deaths).


Gastroenteritis 543 cases (15 deaths).


Hepatitis 51 cases (3 deaths).


Cholera No case so far.


Measels 1825 cases (45 deaths).
http://www.indianexpress.com/news/illness-pradesh/360240/0

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Back to 2002 , same region.


Malaria claims 3 lives in Kanpur
TNN, Nov 1, 2002, 12.21am IST

KANPUR: Malaria claimed three lives here on Thursday. Dozens of children are undergoing treatment in various hospitals and nursing homes.
However, doctors of the GSVM Medical College, ruling out the possibility of dengu outbreak in the city, said that patients suffering from viral fever had turned serious due to delay in treatment.
Incharge of the Intensive Care Unit (ICU) Arti Lalchandani said that several patients, suffering from malaria and meningitis, were undergoing treatment in the LLR Hospital. She also confirmed the death of three patients in the past 24 hours.
Blaming poor sanitation for the spread of the disease, she said that "some doctors avoid giving antibiotics to patients in initial stage. This often leads to complications."
Meanwhile, president of the Kanpur Nursing Home Association Nayeem Hamid said that dozens of cases of malaria and viral fever had been reported in his hospital. He added that body ache, fever with shivering and vomiting were main symptoms of malaria.


Read more: Malaria claims 3 lives in Kanpur - The Times of India http://timesofindia.indiatimes.com/articleshow/26902368.cms#ixzz11cGT0yj3

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

2 women succumb to dengue in Ghaziabad
PTI | 03:10 PM,Oct 05,2010
Ghaziabad, Oct 5 (PTI) Over a dozen people, including two women have succumbed to dengue and viral fever in the district, sources here said today. While around nine people reportedly died of viral fever, two women succumbed to dengue in the district, they said. With the continuing rise in number of cases of the vector-borne disease, government and private hospitals in the entire district are already filled to capacity, forcing doctors to transfer patients to hospitals in neighbouring Delhi and Meerut. Although the chief medical officer of the district AK Dhawan admitted that there were a lot of dengue cases in the district, he was unable to give an exact estimate of the total number of cases. All medical facilities are being provided to patients on regular basis at primary health centers and the patients are consistently monitored to check the spread of the disease, said Dhawan.
http://ibnlive.in.com/generalnewsfeed/news/2-women-succumb-to-dengue-in-ghaziabad/379581.html

 

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Officials take stock of mystery fever cases in Ramabai Nagar
TNN, Oct 7, 2010, 10.55pm IST

KANPUR: A state-level team comprising the joint director, health, visited Ramabai Nagar district and held a review meeting with the district health and administrative officials to tackle issues related to the spread of `mystery' fever. The fever have claimed more than 200 lives in the past one month.

After a review meeting with the district officials, joint director, health, SC Saxena visited the district hospital in Akbarpur. They went through the detailed lists of dengue and malaria patients undergoing treatment there.

They stressed upon the need for cross-checking the blood platelets of the patients suspected to be suffering from dengue or malaria. They also questioned the three recent deaths due to malaria at the district hospital.

Saxena said a district-level committee of district medical and health officer, government hospital superintendent and heads of the public health centres and community health centres would investigate the cases to check whether they were tested positive for dengue, falciparem or malaria in the Elisa test.

"In every one lakh fever cases, around 100 would be dengue or malaria. Though, the spot test shows positive for different diseases, only an Elisa test can confirm what disease is causing the fever," he pointed out.

He said every malaria patient must be given the radical treatment. "The standard drug protocol has to be followed by all to prevent the spread of vector-borne diseases," Saxena said. The team also instructed health officials to conduct fogging drive with active participation of the public.

Meanwhile, district magistrate Saroj Tewari said all village heads would be made partners in the area-wise survey to deal with fever-related issues on a regular basis. He would address them at a meeting shortly.



Read more: Officials take stock of mystery fever cases in Ramabai Nagar - The Times of India http://timesofindia.indiatimes.com/...i-Nagar/articleshow/6708908.cms#ixzz11hyiI0nz

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

"In every one lakh fever cases, around 100 would be dengue or malaria. Though, the spot test shows positive for different diseases, only an Elisa test can confirm what disease is causing the fever," he pointed out.

http://timesofindia.indiatimes.com/...i-Nagar/articleshow/6708908.cms#ixzz11hyiI0nz

Excellent find, RoRo. I believe a "lakh" is 100,000, so they are saying their labs are only good enough to detect 100 in 100,000, which is 1 in 1000 malaria or dengue cases.

 

[alert]

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

Re: Kanpur, Uttar Pradesh: mystery fever outbreak- 250 fatalities in September - Dengue, malaria, others suspected

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85202

Archive Number 20101007.3640
Published Date 07-OCT-2010
Subject PRO/EDR> Undiagnosed fatal illness - India: (UP) RFI


UNDIAGNOSED FATAL ILLNESS - INDIA: (UTTAR PRADESH) 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: Mon 4 Oct 2010
Source: The Times of India (TOI), Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/city/kanpur/13-more-fall-prey-to-mystery-fever/articleshow/6685663.cms#ixzz11X3G4fLd>


Even as 13 persons, mostly minors, fell prey to mystery fever in
Ramabainagar district ([formerly] Kanpur Dehat) on Monday [4 Oct
2010], district officials claimed they were trying to contain the
spread of the disease which has claimed 180 lives so far. "As many as
14 medical teams and paramedical teams are working in the field. The
situation is being monitored in all the 82 affected villages,''
district magistrate Saroj Tewari told TOI. Children are especially
vulnerable to the killer virus, which was evident with 7 deaths of
minors in the district on Monday itself.

The DM [district magistrate] has ordered health authorities to launch
a massive cleanliness drive in all the villages. "Health teams have
been asked to spray insecticide in the affected areas and distribute
medicines to those down with fever,'' he added.

A resident of Akbarpur, said the deaths have created a scare among
the residents of Ramabainagar district. A public campaign has also
been launched and villagers are being asked to report any symptoms of
the disease as soon as possible. Health officials say the earlier it
is detected, the easier it is to cure. Chief medical officer,
Lajjaram said, "We are taking effective steps to curb the disease.''

The health authorities, who till now had been terming these patients
as suspected dengue, malaria, encephalitis, viral fever cases, said
that the campaign to investigate, control, and prevent spread of this
fever were being continuing. Of the 1172 persons who visited the
district hospital on Monday [4 Oct 2010], 207 were running fever. We
have started the treatment of 21 patients here,'' Akbarpur district
hospital authorities told TOI.

The continuous increase in the number of fever cases being reported
everyday is causing concern for the health authorities, more so
because the mystery fever seems to have spread to some more villages
of the district. In fact, the district health authorities are
consulting specialists at the state capital to ascertain the disease.

Meanwhile, medical experts said that the stagnant water after rains
in the region have only aggravated the problem, as mosquitoes would
get more breeding grounds. Though fogging operations have been
undertaken in the entire district particularly in Malasa, Amraudha,
and Akbarpur from where maximum number of patients have come, this
has not helped in stopping the fever from spreading.

[Byline: Faiz Rahman Siddiqui]

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[The region where the cases are occurring is in mid-Uttar Pradesh,
and not in the eastern region of the state where the cases of
Japanese encephalitis and undiagnosed encephalitis cases have been
occurring recently. The distance between these 2 areas does not
exclude the possibility of JE virus infections in the outbreak above.
However, this report does not provide enough information to even
speculate on what the etiological agent involved in this outbreak
might be. The health authorities are apparently categorizing these
patients as suspected dengue, malaria, encephalitis, and viral fever
cases -- all caused by very different etiological agents. Viral fever
and encephalitis are general diagnoses and could be caused by several
different viruses, if indeed viruses are involved. The emphasis on
mosquito control implies vector transmission. The authorities are not
quoted as indicating which of these etiological agents have been
tested for nor on what basis mosquito transmission is suspected.

It is difficult to understand how health officials can state that "we
are taking effective steps to curb the disease,'' if they do not know
which etiological agent(s) is (are) causing the cases. It would be of
interest to know if Nipah virus infections have been tested for.
Nipah virus is endemic in _Pteropus_ fruit bats in the Indian
subcontinent and Southeast Asia, and transmission does not involve
arthropod vectors. The 7 Oct 2010 edition of the Press Trust of India
(<http://ptinews.com/news/965007_11-die-due-to-viral--malaria-and-dengue-fever-in-Kanpur>)
quoted local health authorities as saying that they do not have
adequate facilities to detect dengue cases and have to send the
samples to Lucknow, 150 km (93 mi) from Kampur. The test report takes
at least 3-4 days to come. ProMED-mail hopes that the test result for
dengue and other potential etiological agents will become available
soon and permit local health authorities to focus on appropriate
preventive measures. ProMED will be very interested in receiving
further information as it becomes available.