La Reunion: Outbreak History

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http://www.todayonline.com/articles/96232.asp

Doctors on the Indian Ocean island of Reunion are battling an epidemic of a crippling mosquito-borne disease that has no known cure, French Health Minister Xavier Bertrand said.

About 7,200 cases of "chikungunya" had been recorded, including 1,600 cases last week alone, the minister told the French upper house.

"It is a major public-health issue," he told senators.

Chikungunya is Swahili for "that which bends up" and refers to the stooped posture of those afflicted by the non-fatal disease for which there is no known vaccine or cure.

Authorities on the volcanic island east of Madagascar, a French overseas department with a population of 760,000, have earmarked 600,000 euros (720,000 dollars) to fight the outbreak, including special mosquito-eradication brigades.

 

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Re: Outbreak History

Re: Outbreak History

THIS IS FROM OCTOBER 26 2005.
http://www.channelnewsasia.com/stories/afp_world/view/175423/1/.html

SAINT DENIS DE LA REUNION, Reunion Island - Preliminary tests on a man hospitalised on the French island of Reunion in the Indian Ocean indicate he may have contracted bird flu, the authorities said Wednesday.

Conclusive test results on the 43-year-old patient -- who recently returned from a trip to Thailand -- will be known "before the end of the week," the government administrator's office on the island said in a statement.

The man was admitted to hospital on Saturday "for weakness and strong headaches," the statement said.

When he started coughing on Monday, "two samples taken to look for the flu virus H5N1 were taken from his nose and his throat. The first was inconclusive, the second was positive," the statement said.

"There is therefore a suspicion of flu of avian origin, even though the symptoms are not very indicative," the office said, adding that test samples had been sent to mainland France for more thorough analysis.

The man, a French citizen, is in quarantine and receiving anti-viral treatment in the island's Bellepierre hospital in the main city of Saint Denis, a doctor at the hospital told AFP.

His condition was not worrying, suggesting that he may have a "benign form" of the virus," the doctor said, speaking on condition of anonymity.

The man was believed to have been in contact with birds during a visit to a bird park in Thailand during his vacation, the doctor said.

Nineteen other people who went on the same trip to Thailand have been questioned about their health, authorities added. Two of them have "flu-type symptoms" and are undergoing tests, the results of which are not yet available.

Thailand is one of a number of Asian countries where outbreaks of a virulent strain of H5N1 virus have proved lethal to humans. The virus has killed more than 60 people in Asia since late 2003.

The government administrator's office in Reunion stressed that the H5N1 virus, believed to be spread by migrating birds, "is not transmissible between humans" and that therefore no special measures were being taken for the man's family or the island's population of 780,000.

However it asked people planning a trip to countries affected by bird flu, "in particular Thailand, Cambodia, Vietnam and Indonesia, to avoid all contact with birds."

Reunion Island is located east of Madagascar, off the African coast.

The French health ministry's Health Monitoring Institute (InVS) in Paris said that so far a dozen people who had returned to mainland France from countries hit by the spread of bird flu had been tested but none had been infected.

The head of the institute, Jean-Claude Desenclos, told a parliamentary committee on bird flu that the tests were carried out because the individuals were deemed at risk of contamination after detailing the nature of their trips.

They were differentiated from the 200 other people who complained of flu-type symptoms on arrival in French airports from contaminated countries but who were not thought to have been exposed to the virus. - AFP/ir

 

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http://www.clicanoo.com/article.php3?id_article=121155

MACHINE TRANSLATED

HEALTH
Chikungunya : A petition denounces the figures of the DRASS
About thirty doctors have just signed a petition questioning the figures of Drass. According to these experts, the number of victims of the chikungunya is largely higher than the 7 600 cases officially listed with the Meeting. They ask more transparency in ḻinformation.

[ January 19, 2006 ]


In Saint-Louis and the River, one laughs gently with each new communication of Drass (regional Direction of the medical and social businesses). 5000, 5 500, 6 000 and aujourd?hui 7 600 cases... The number of people touched by the virus increases ?raisonnablement?, when the commune undergoes an explosion of the cases of chikungunya. You have known as odd ? Even the mayor of the city, Cyrille Hamilcaro, admits that the patients are ?certainement more numerous than those announced by Drass since everyone will not be announced at its médecin?. And precisely, the experts start to have enough d?entendre of it the only voice of the medical authorities. They have just passed to l?action in a letter signed by 32 doctors of the commune. That is to say great majority of the general practitioners of Saint-Louis and the River.

NOT TO BE ACCESSORY

?Le figure of 7 600 cases declared for all the department is a lie which we hope for by omission. With a margin of a few hundreds, it corresponds to the number of patients on the sector of Saint-Louis to him seul?, denounce the doctors who continue on the ton of anger : ?Nous now let us take as an affront this figure official, which respect the medical persons in charge have aujourd?hui for us, professional, overflowed of work ?? In pharmacies as in the medical cabinets, the number of visits related to the chikungunya can climb jusqu?? 80 people per week. And c?est like that since the month d?octobre, l?époque where ḻepidemy started to take again service after a lull in July and August. In short, as many reasons which make say than the reality of Drass does not correspond to that of the general practitioners. D?autant that ?tout gives rise to think that this figure of 7 600 will n?augmentera that very slowly for the autorités?, the experts add who specify : ?La out-of-stock condition of reagents for the blood tests, combined with the instruction given to the doctors not to prescribe taking away more will contribute to keep a comfortable blur on the figures officiels?. In a mail of December 26, Drass requires to limit to the maximum the blood tests allowing d?identifier the chikungunya. The direction of the medical businesses wishes to confine them with the people touched in a geographical area up to that point preserved virus or that where ḻidentification of the chikungunya n?est not formal. In short, the accessory doctors do not want ?être d?aucun interest politico-économique?. They are said on the contrary ?soucieux to denounce the painful effects, invalidating and much more consequent of this simple disease than those d?une grippe?. And ultimately, they express the wish to find ?des healthy bases of dialogue with figures and qualifiers more in connection with the réalité.?

J - PH L.


"INVESTIGATORS SHOULD BE SENT to US" Meets with Serge Petiteau, ḻinitiator of this petition and doctor with the Saint-Louis River.

Which reasons pushed you to launch this petition ? There is a gap between the reality of Drass and our daily newspaper. Last week, j?ai have 90 new cases of chikungunya. Each day, I can detect the virus at 5 to 15 people. In this moment, one would say that that is calmed. But after the peaks of the end of l?année, there should not any more be large world to prick with the Saint-Louis River.

Do you feel a wind of panic among your patients ? Not, overall, j?ai business with people who appear serene. In any case in my cabinet. J?essaie to render comprehensible to them that the perhaps fast cure just like it can take months. Some require s?il exists vaccines. It is still too early for that. The scientific knowledge of the virus is with its stammerings. Perhaps that if the authorities recognized this established fact, the actions of prevention would be easier to carry out.

What do you wish aujourd?hui on behalf of the authorities ? Drass should send investigators to us to note the exact number of new cases. The figures are aujourd?hui established starting from the information sheets supplemented by the doctors. However, everyone n?envoie inevitably not given to Drass. But one needs especially a greater transparency in ḻinformation, in particular concerning the cases of transmission of the virus d?une pregnant woman to her child. It s?agit not d?être alarmist but to inform well.

 

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MACHINE TRANSLATION:

http://www.clicanoo.com/article.php3?id_article=121122
HEALTH
Chikungunya : Fear, revolt and business
More than 7600 official cases, of tens of thousands for the PS-Greens, the PCR and numbers general practitioners.Thirty-two d?entre them, originating in the South, signed a petition to show share of their consternation Drass to guarantee a calculation which appears to them more than untrue. According to their experiment of the ground, this number would correspond at most to the number of patients saint-louisiens ! The prefect goes up to the crenel, the members of Parliament réunionnais - communist especially - denounce, but nothing n?y made. Aedes albopictus reign as a Master and all the country tightens the buttocks !

[ January 19, 2006 ]


In the sad history of ḻepidemy of chikungunya, the things go from evil in worse. The exotic influenza whose l?Institut of medical day before affirmed on April 29, 2005, ̴ḻimportation of case of chikungunya in the territories of l?océan Indien and in metropolis does not constitute a worrying phenomenon in terms of health publique? became with the wire of the months, for the Meeting, a d?inquiétude cause, of polemic and finally a problem of public health, currently unverifiable. And due, l?histoire badly started. Medical authorities réunionnaises, contrary to those of Mayotte, which had the same elements ḏinformation - the interregional cell ḏepidemiology (Wax) is common to the Meeting and Mayotte - chose a passive vigilance when Dass mahoraise passed to l?action as of the end March. Ḻepidemy flamed into Large-Comore and l?on knew what it s?agissait. March 24, indeed, the Comorian mission of Center for desease control and prevention (CDC) d?Atlanta had clearly identified the virus which touched the Comoros since January. Mahorais chose the prevention, 80 agents on the ground, general mobilization, jusqu?aux mosques which are flytoxées ! Mahorais even borrowed 30 liters d?insecticide from our Drass...

ACCOUNTS D?APOTHICAIRES

With the Meeting, the same time, nothing. If not a chronic infestation d?aedes albopictus. And when well even Drass, State and department would have liked to act differently, they do not l?auraient been able, for lack of means, human and technical. Drass did not count whereas 40 agents in long final on the retirement and the Department, undoubtedly the only one of all the Metropolitan France and overseas, was completely stripped. The harmful effects caused by the mosquitos n?intéressaient more the general advisers since 1986. It is true that the sudden starts of the departmental political life occupied them more than comfort of their fellow-citizens and a fortiori of the ?zoreils? of passage. Morality, one s?est cut off behind l?avis from l?Institut of medical day before which estimated, April 29, qu?il n?y did not have a problem. Drass feared more the dengue, which had pointed its nose l?année preceding, that the chikungunya. In its misfortune, the Meeting had chance. Because if an epidemic of dengue had struck, one would be with the calculation of deaths, as in the Antilles. The fact is that when ḻepidemy began with the Meeting, it was followed with precision by Drass, but the capacity of reaction on the ground of this service was rather symbolic system. L?hiver n?a not stopped the propagation of the evil, and in spite of all the beautiful speeches, from the communication of the ones and motions of the others and the accounts d?apothicaires of Drass, the disease passed on an épidémo-endemic mode. For the doctors with the fact of these realities, the situation is summarized with this observation : ?Le chikungunya, it will be necessary to learn how to live with now... ? Like prèvu, with the return of the hot and wet season - rather foreseeable l?admettre is needed well - ḻepidemy set out again of more beautiful.

THE SUBJECT EAST TABOO

Meanwhile, at the beginning of October, this funny of Comorian influenza had changed statute. Officially benign for 6 months, it became officially ?incapacitante?, and in l?esprit of people, rather dangerous. Because finally, a bébête which in certain cases dispatches you in the coma with pipes everywhere, even if there is the chance not to burst some, this n?est not frankly benign. The serious cases of chikungunya called into question the official vulgate on the disease. The thing more serious than was envisaged : méningoencéphalites on adults, women pregnant and new-born, that cools ! Since, people are afraid. Not a family which does not count patients, devastated communes, like the River-Saint-Louis, of the overflowed and stripped doctors... Time n?est more with do-it-yourself. Associations are assembled which will require accounts, in good time, if necessary. Because the worst remainder to come. The subject is taboo, but it is necessary well to say the things, after the serious cases, aujourd?hui proven, one awaits the official first dead of the chikungunya. The virus has already ?aidé? to pass from the sick, old or weakened people... In the hospitals, one supervises, one listens, everyone is wary, especially in the South the direction of l?hôpital n?accepte to over there communicate that for varnishings...

Philippe The Claire

Special Internet site chikungunya www.chikungunya.net, c?est the name of new Internet site created by Jean-Hugues Mausole, to inform on the virus, ?alerter l?opinion public metropolitan, ? and ?susciter a reaction of the local authorities and nationales.? This Réunionnais, consulting in data processing, Parisian since nearly thirty years, proposes on its site of the bonds towards articles of press, sources scientific and useful addresses. It projects to put on line a forum of discussions. C?est while visiting, each morning, Clicanoo, qu?il were informed of the phenomenon chikungunya. Two members of its family caught the virus. What started its initiative. Jean-Hugues Mausole regrets qu?en metropolis ?on remains indifferent vis-a-vis to Dom-Tom? and that the national press if wrote little on the chikungunya.

Reagents : ?retour with the normale? It n?était more possible to d?établir of diagnosis of the virus of the chikungunya : the reagents useful for the realization of serologies were in out-of-stock condition, during a few days. These reagents do not n?existent in the trade. They are manufactured by the national center of reference of the arboviroses in Lyon. ?Tout is solved since about fifteen jours?, explain Isabelle Shuffenecker, assistant director. The diagnosis is again operational, in two metropolitan laboratories, for the cases addressed by the general practitioners. With the Meeting also, only for the patients of the hospital complex of Saint-Pierre. The CHD of Saint-Denis east developing the diagnosis. Nothing will change on the clinical level, the diagnosis will be just more fast.

?Contre the chikungunya?, anger hardly assembles One month after its creation, ḻassociation ?L?île of the Meeting against the chikungunya? count close d?une hundred d?adhérents. Its objectives ? To inform, sensitize the population and to defend the interests of the victims. Its president, Josette Brushes, of Saint-Louis is very anxious : ?En February, people will resume work. One will see the damage of the chikungunya on the socio-economic level. Small companies, which will be obliged to close, will require comptes.? And to point out anger among its members : ?certains speaks about legal procedure, to require accounts of the representatives of l?État, to seize the administrative court. Our right of citizen, even if if personally I am not procédurière.? L?association comes d?envoyer a mail to the regional council, claiming ?de to him to make decrease l?octroi sea of the anti-mosquito products cause a drop in to them prix.? The mayors of l?île were also contacted. L?association organizes, soon, a meeting with Sainte-Marie and always projects d?organiser permanences in Saint-Louis and elsewhere, ?partout where there will be volontaires.?

Josette Brushes, Tel.. : 06 92 35 51 88. Courriel : laurelyse@hotmail. COM.

Démoustication : l?exemple of Saint-Andrew the figures s?emballent. Saint-Andrew, one ensures a day before chikungunya, since the beginning of November. ?Depuis at the end of December, one records an explosion, a score of cases declared per day, note Patrick Amourdom, person in charge for the service technique-environment. The city, Drass and Cirest take care of démoustiquer at the private individuals. They do not n?exigent medical ḏattestation. In a radius of 200 meters, one treats the larval sites (credit one week) and the parks (credit 10 days). ?Notre goal is of démoustiquer in the three jours? : an objective which would be achieved, according to the person in charge, at least ? .70.%. About thirty d?agents communal work on the ground. And the city is under discussion with under prefecture for a reinforcement of forty agents, in helped contracts. Cirest deployed six people for the demoustication and ten for sensitizing. Side of Drass, three to six agents are active on Saint-Andrew. Like a taste of too little : ?Un cost, a reorganization, the commune is forced to replace a role which n?est not the sien.? The DRASS refused to communicate. We will know some more, aujourd?hui, at the time d?une conference press. However, it would seem qu?un new d?intervention plan envisages, overall, a presence reinforced with l?armée and the reception new French canon insecticidal, coming from the United States. The gross armada ?

C.D.





PS-VERTS : TEN MONTHS OF REFLEXION Michel Vergoz gave yesterday a confrénce of press in the name of the regional advisers PS and Greens. At the end of 10 months of reflexion it estimates that the Area really owes s?impliquer in the war against the mosquito. Supported by his colleagues of Saint-Joseph and Saint-Benoît cheese, l?ex-mayor of Holy Rose, pharmacist of his state, sees ?plus of 100 patients by jour?, in calls with l?union crowned against the mosquito qu?il qualifies d?ennemi. ?Il is necessary to be offensive, the situation becomes a serious (...). serious medical crisis with the human and economic consequences... ? To face, according to l?apothicaire Vergoz, which causes d?expérience, it is necessary to put a term at the lawsuits d?intention, to listen to the general practitioners and éradiquer the mosquito while using of the good old women methods of disease prevention... 10 months to call with l?union crowned c?est of it well. To encourage the regional council to move c?est... to better note than Michel Vergoz denounces in the passing those which, in the slides - Area undoubtedly - are delighted by misfortunes of the mayor of Saint-Louis and hope for political repercussions of l?affaire chikungunya. Such a cynicism is indeed condemnable. How the mosquito pricks those which make such thoughts !

Ph.L.​

 

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Grande Comore and Mayotte are other islands in the Indian Ocean near Reunion:

http://www.clicanoo.com/article.php3?id_article=121122

Quote:
Dans la triste histoire de l??pid?mie de chikungunya, les choses vont de mal en pis. La grippe exotique dont l?Institut de veille sanitaire affirmait le 29 avril 2005, ?l?importation de cas de chikungunya dans les territoires de l?oc?an Indien et en m?tropole ne constitue pas un ph?nom?ne inqui?tant en termes de sant? publique? est devenue au fil des mois, pour La R?union, une cause d?inqui?tude, de pol?mique et finalement un probl?me de sant? publique, actuellement incontr?lable. Et pour cause, l?histoire a mal commenc?. Les autorit?s sanitaires r?unionnaises, contrairement ? celles de Mayotte, qui disposaient des m?mes ?l?ments d?information - la cellule interr?gionale d??pid?miologie (Cire) est commune ? La R?union et ? Mayotte - ont opt? pour une vigilance passive quand la Dass mahoraise passait ? l?action d?s la fin mars. L??pid?mie flambait en Grande-Comore et l?on savait de quoi il s?agissait. Le 24 mars, en effet, la mission comorienne du Center for desease control and prevention (CDC) d?Atlanta avait clairement identifi? le virus qui touchait les Comores depuis le mois de janvier. Les Mahorais ont opt? pour la pr?vention, 80 agents sur le terrain, mobilisation g?n?rale, jusqu?aux mosqu?es qui sont flytox?es ! Les Mahorais ont m?me emprunt? 30 litres d?insecticide ? notre Drass. A La R?union, ? la m?me ?poque, rien ..
A brief translation:

In the brief history of the sad disease called chikungunya, things have gone from bad to worse. About the exotic virus, the City Sanitation Institute affirmed that: The arrival of Chikungunya in the territories of the Indian ocean does not constitute a worrying phenomenon in terms of public health" but this month, in Reunion, it is becoming an uncontrollable problem of public health. Because of this, a sad story commenced. The Reunion sanitation authorities, unlike the authorities on the island of Mayotte (who had the same information from Cire) opted for a passive response and the Dass unfortunately did not take any action at the end of March. The epidemic blazed on the island of Grande Comore. On 24 March the mission from CDC Atlanta to Grande Comore clearly identified the virus that had touched Comore since the month of January. The people of Mayotte opted for prevention: 80 health agents, public education...and they even borrowed 30 liters of insectiside from our Drass! In Reunion, meanwhile, they did nothing.
================

So, this virus is new as of January in Reunion. However, it is not only found on Reunion but on Mayotte and Grand Comore as well. It seems that Grand Comore had samples of the virus analyzed by CDC in Atlanta in March. They may be assuming this virus is chikungunya due to it's official naming by the CDC, and may be using differential diagnosis rather than blood tests in order to determine the cause of disease on Reunion.

However, in October of 2005 the disease seems to have changed significantly on Reunion. Even with the increase in the virulence of the disease, it seems that no more action has been taken on the part of the authorities to lessen the epidemic which now has new life endangering and disabling features.

Grand Comore and Mayotte seem to have taken an active role in fighting the virus, while Reunion has been passive at best and has engaged in a cover-up at worst. The island is a tourist destination and indications are that they do not want word of this epidemic to spread:

http://www.clicanoo.com/article.php3?id_article=121155

Quote:
"MALGR? les interventions r?p?t?es de l?Ordre des M?decins aupr?s des autorit?s pour que la menace de chikungunya soit consid?r?e dans sa pleine mesure, pour qu?une lutte active soit mise en place au plus t?t, le laxisme, la minoration du danger, la priorit? offerte aux int?r?ts ?conomiques, ont conduit ? la situation que vit aujourd?hui La R?union. Celle d?une alerte ?pid?mique qui compte plusieurs milliers de victimes."
Unfortunately the repeated urgings of the (organization of physicians) to put a (fight) response in place as soon as possible should be considered, but the lax response, the trivialization of the danger, and the priority given to economic interests, have led to the situation we have today on Reunion - that of an epidemic with thousands of victims.
==============

Whether chicungunya or AI, it is the responses of the local authorities that need to be changed but I would assume that the response of the PTB would be identical, in either case, so that economic interests are served.

 

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Being one living of l?le of the Meeting, I d?tre scandalized in front of loisivet? of the services known as "qualified" as regards prophylxie is allowed. Only for my family, on 26 people, 9 developed the disease with same the sympt?mes(fever sup with 40?C, pains with the articulations, cephalgias, eruptions cutaneous, vomiting, diarrhoeas, asthenia, mouth ulcers). Here as with the ministry that does not seem to throw into a panic large world. I even allows itself to question produces them used by these services for d?sinsectiser: because they passed at home as in my acoutr?s neighbors dune held of cosmonaut in order to vaporize the famous one produces succeptible to destroy the mosquitos and the larvae. But jai panicked when I saw them vaporizing with energy on the cage of rabbit of my daughter. To my great amazement, the rabbit goes as a charme(astonishing when one knows at which point a rabbit is fragile)... The doctors, although exceeded are frileux when with the regulation dantalgic effective. People suffer atrociously, the medical cabinets are saturated, the urgencies of the hospitals are overflowed... One lies us on the exact number of patients: the authorities say 7600 cases on l?le, whereas the doctors record 450 new cases per day. Which makes fun tone? Perhaps some d?c?s official should be awaited to act effectively, because semi-officially......

 

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Installation dune cell of permanent crisis, military and civil special brigades, reinforcement of the plan of communication: the prefect Laurent Cayrel announced yesterday the large axes of his new plan of fight against the chikungunya which, almost a year after the beginning of lepidemy, strikes down each days of the hundreds of new victims. Medical Lurgence is from now on undeniable, lamplor of the figures is confirmed. The misinformation did not n?tait where it was claimed. Quimporte, the prefect does not return in sterile debates, but points out its concern: the "general mobilization." "All the goodwills are the welcomes."
Yesterday of the Senate, G?lita Hoarau required of the government which durable strategy "intends to implement to place the Meeting under the most favorable conditions to face this type of medical crisis?" , while recalling that "in the Fifties, the Meeting knew to triumph over paludism. It must be able aujourdhui to triumph over Chikungunya ". The s?natrice puts forward "exceptional measures privileging the biological fight if lon wants to draw aside dautres medical and environmental risks" .


"Laugmentation of the cases of contamination (of 200 with more than 1.000 cases per week) is posterior with the measurements installation by the authorities", underlined yesterday G?lita Hoarau with the platform of the Senate (photo Imaz Press R?union)

 

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Re: Outbreak History

Re: Outbreak History

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CELL OF CRISIS TO THE PREFECTURE

L?tat awakes, a little late
Published in the edition of Friday January 20, 2006 (Pages 4 and 5)

Close dun year after the beginning of lepidemy, the fight against the chikungunya will see "a reinforcement very Net of the means human, financial and organisational", specified yesterday the prefect with a many and impatient press to know new official measurements. Multiplying investigations and recognitions of new cases, without being able to give figures on lamplor human of the phenomenon, the Prefecture seems to take, aujourdhui finally, medical conscience of lurgence. It reinforces the prevention and communication, and always calls some with the Community fight.


PUBLIC HEALTH - SICKNESS INSURANCE


C ELA makes me think of this child who, not very conscious of the danger, in spite of the warning of his/her parents, continuous to balance itself on its chair, looking at you right in the eyes, with arrogance. Then it ends up falling. It had been prevented, but its experiment should be made. In the case of the chikungunya, which touches for the first time a country known as developed, cest unfortunately with the detriment of R?unionnais, their health, economic situation of our very whole island that the Prefecture makes lexp?rience of management dune medical situation durgence.

The solicited regional Council

The Prefecture sets up a cell of permanent crisis which will gather persons in charge for the sub-prefectures, DRASS, DASS, WAX, SDIS, police force and gendarmerie. This cell will collect information relating to the declared cases and will coordinate the means set up on the ground. Although this type of device is already activated, from new partners will allow his reinforcement for a closer cooperation. For proof, the meetings of work will not be weekly any more, but twice-weekly, with a point presses every Thursday. To also note that the prefect, on the directive of the ministry of lOutre-sea, will propose with the regional Council to sunir with the fight.

Civil and military arsenal

Second slope of the prefectoral strategy: the mobilization of eleven special brigades of fight against the chikungunya. Four military brigades made up each of 20 soldiers, dun agent of the DRASS, are already operational, on the ground. They profit each one dun 4X4 equipped dun insecticidal pulverizer long range, of individual pulverizers managed by people, still in formation.
Seven civil brigades will be mobilized on the communes of Saint-Denis, Saint-Louis, Saint-Beno?t, Saint-Andrew, Saint-Pierre and Saint-Paul. The helped contracts of the town halls will support the device darrondissement, supported by the sub-prefects. These brigades will be operational only on February 1, in 10 days (either several thousands of case later). They will be framed by the sappers firemen and the municipal agents, equipped with the material of desinsectisation. The prefect notes that the priority will be given to the commune of Saint-Louis, very severely touched, as underlined it lately, in an opened letter, 32 doctors of the commune, submerged of work.

Communication of mass

The plan of communication, up to that point pillar of the " great daction plan " that the Prefecture announced on January 4, also will be reinforced to allow, in accordance with the recommendations lOMS, to carry out a true Community fight. All the daily newspapers, without exception this time, the magazines, the free newspapers, the communal ones will carry the messages of prevention. The radio countryside will continue and samplifier, supplemented as of February by tele messages. On this point, Laurent Cayrel recalls that the ministries for Health and lOutre-sea support linitiative. Postings, flyers, SMS, Toll-free number: all the vectors of communication will be undertaken to try to touch lensemble population and thus to allow its mobilization.
The prefect insisted on the two essential engines of the fight, his two pillars: lelimination of the larval lodgings and individual protection with " a special mention for the old people, the pregnant women, the sick people ." On the whole cest a deuros million mobilized since the beginning of the fight. And " if necessary, if that sav?re necessary, the ministry of lOutre-sea and that of health will be able to decide additional means ." Us here are reassured!

Est?fani

The official figures are not reliable any more

" Completely, the figures are underestimated "

Answering the question of the estimates of case of chikungunya, the prefect supports that " lon cannot use methods of systematic multiplication, that would like to say that all l?le is infected in the manner ." Since the beginning of lepidemy, the system of active location of the cases declared set up by the medical services was " extremely reliable jusqu? this increase honest in lepidemy in mid-December ", explains Doctor Philippe Renaud of the WAX (interregional Cell depidemiology).
In the lately declared zones, it is still used and would be, according to him, still convincing. On the other hand, in the active zones of lepidemy, it would not be " also any more effective ." The figures lattestent: since December 25, 2.857 descriptions were recorded on all l?le including 418 in Saint-Louis, whereas the medical profession gives a broad fork from 700 to 1.000 new treated cases each week, according to sectors'. One is far from the account.
Medical LInstitut of day before thus thinks of lelaboration dune new method of counting to obtain " a fork destimations, an appreciation, more precise ." Without this new method, no margin derror can be confirmed " Completely, the figures are underestimated ", continues Doctor Renaud who Never speaks dune frequency about transmission of lepidemy of 1.200 cases "it na be also activates since the beginning. The transmission is very significant especially in lEst and the South, but all the communes are touched. Vis-a-vis this blaze, one needs a readjustment of our methods for a reliable estimate ."


The hospital ones overflowed

" a concern, a concern "

Some establishments of health of l?le set up systems of vigilance to make it possible lARH (regional Agency of lhospitalisation) to lay out d?l?ments in real times and thus to reorganize the assumption of responsibility of the patients, their reorientation. In lEst, the wards seem submerged and have evil, in spite of their implication, to manage lamplor of the phenomenon. Philippe Roger, deputy manager of the DRASS, stresses that cest " a concern, a concern. "It is thus necessary to activate the services of care in residence, the domestic assistances, the networks of social to support the old people, the isolated people, those suffering already from various worsening pathologies. On this point, the prefect launches " a direct call with the doctors for quils mobilize himself on this subject, quils advises and sensitizes the patients on the individual protection measures ."

Year folds ke its

" No direct death "
Jusqu? aujourdhui, no death due to the chikungunya nest recorded, at least, no element makes it possible to corroborate that old people would have succumbed to the effects of the disease. Doctor Christian Lassalle admits that in nourrisson infected by the mosquito, the articular pains can involve a loss dapp?tit, risks of dehydrations, " indirect effects of the disease particularly serious, as for the old people, chronic pathologies ." Lon records " not direct death. "

 

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http://216.239.37.104/translate_c?hl=en&u=http://www.clicanoo.com/article.php3%3Fid_article%3D120243&prev=/search%3Fq%3Dforum%2B%2522la%2Breunion%2522%2Bchikungunya%26start%3D20%26hl%3Den%26lr%3D%26sa%3DN

Chikungunya: The continuous black series
"large the national press" seizes chikungunya! While waiting for that something occurs in metropolis, according to precepts' of the philosophy of the guava of France, what is nine on the territory? 6 273 official cases, 30 000 semi-official. Lepidemy flames. One seeks miracle cures. The commandos "spray insecticide" do not provide and the friends of lenvironnement denounce lusage dinsecticides nonselective...

With Chik City, that pricks with complete freedom

The Creoles of snows propose their assistance

The "chantalgoya" more extremely than ?milie!

Obviously, the plan "Vigimoustik" made long fire... Weather obliges, there are mosquitos more and more, and fatally more and more of "chikunguny?s" people. Certain general practitioners record more dune about fifteen case per day... Then the 250 weekly cases appear well timor?s taking into consideration l?tat of health of certain districts, of Saint-Louis in particular. Notwithstanding, cest with the patients to announce themselves to Drass, who nen can more, its manpower not allowing him to treat all the announced hearths. Dailleurs a polemic is in the train of sinstaller because Drass naccepte of "flytoxer" the hearths qu? the sick condition quune or several people reside at it. It thus refuses to dintervenir in a preventive way, which makes mad managed which calls upon the commandos "spray insecticide" in lespoir not to find itself "chikunguny?s". In good logic they regret, to be protected, it is necessary to be sick...

TWO OTHER CASES OF Materno-Foetal TRANSMISSION

Side assessment, beyond the 6000 and some cases licensed, it is appropriate dajouter "a new" case serious of meningoencephalitis for chik diagnosed definitively on a Sir, 75 years old, by lh?pital of Bellepierre. Last August, the poor Mister sest typed a strong chikungunya, with 15 days in reanimation, intubation and tutti quanti, because of serious neurological complications. The serologies dispatched in Lyon were lengthily awaited - fault of laboratory r?unionnais - but the c?phalo-rachidian liquid and blood tests showed the danticorps presence and of the virus. The Mister sen is well drawn, but it kept some matter d?locution after-effects, just like first R?unionnaise reached denc?phalite with chik, on Saint-Pierre, who suffers from minor functional after-effects; idem for two of the babies of Saint-Pierre whose IRM would present some anomalies. For the table of hunting of chik, it is necessary to add two other cases of materno-foetal transmission on Saint-Denis. Dr. Christian Lassalle explains: "us were indeed announced mid-December two new-born babies who presented a chik without gravity at the CHD (Dr. Alessandri) (...). Like the precedents of Saint-Pierre, they would be transmissions at the end of the pregnancy or at the time of laccouchement. What does not mean only all the mothers who have the chik at this time, transmit it, because we have also observations of chik in the mom at the end of the pregnancy without consequence for the baby (...) We build with lInstitut national of medical day before, all the establishments of health and CNR, a protocol dinvestigation reinforced, with a scientific committee, to be with light on all these new questions." It is true that many people cogite on the subject. There is little, the Meeting received the visit dune embassy of general lInspection of the social affairs (IGAS), doubled dune mission of lInstitut national of medical day before (INVS).

THE DEFICIENCY OF DEPARTMENTAL PLAN D?LIMINATION

The ones analyzed the phenomenon of pseudo-influenza aviaire which had stirred up jusquau Minister for Health, the others gambergeaient on the "chikungunyesques" evolutions inter alia viral jokes. During this time, the general council is to the absent subscriberes, who noncontent to davoir completely failed in his mission of fight against the mosquitos vectors of harmful effects, affirms by the voice of his president of the moment: "Our community thus does not have to date and does not wish to create some, of service entitled to take actions of protection, treatment, work and controls necessary to this mission..." (note: of demoustication). Mrs. Dindar, who does not doubt nothing, claims an exemption from the law n?2004-809 of August 13, 2004, which envisages the transfer to the departments of competences of anti-vectorial fight. She cynically supports qu? the Meeting "the Prefect of Area wishes to preserve lenti?re competence as regards fight against the mosquitos vectors of human diseases, including the actions of prospection, treatments, work and controls and thus to preserve the service of disease prevention at the level of Drass..." Mrs. Dindar makes fun doubly of the good people, because another aspect of lincurie departmental, person in charge for the proliferation of laedes albopictus, lies in the deficiency of the departmental plan delimination (October 2002) which, as Gerard Lacroix underlines it, independent ecologist, does not envisage anything sagissant lelimination or the consignment artificial containers, plastic packing or quills retaining leau. However this waste strews the least recess with l?le and constitutes thousands even larval million lodgings. Their elimination concerns since 1999 competence the Department. scorned only here during glosses, aedes albopictus became malicious...

Philippe The Claire

 

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MACHINE TRANSLATED

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Chikungunya : Except control
10 383 listed cases. Yesterday, during the meeting ?chikungunya? weekly magazine, the prefect recognized that ḻepidemy was in rise, in particular in l?Est and South. A plan of fight ?renforcé-renforcé? is launched... but the means of Drass remain at the very least insufficient.

[ January 20, 2006 ]


Change of speech, yesterday, at the time of the press conference organized by the prefect on the chikungunya. Whereas the official figures made state of 7 600 cases Wednesday, they flamed to 10 383 in two days with a flat of size released by Dr. Philippe Renault of the Wax (interregional cell ḏepidemiology) : ?Ces figures is underestimated, well sûr?. L?explication with this recent obviousness n?a not trailed. The system of active location of the new cases is exceeded by ḻamplor of the task. And it does not go any more but out of the many hearths.... One estimates at 1 200 per week the new victims of l?ennemi réunionnais, always indexed mainly in l?Est and the South. The Wax thus reflects with l?Institut of medical day before on the installation d?une new method ḏestimation to put a term at this blur, which one learned qu?il yesterday went back to three weeks. Solemn D?où l?appel of the prefect to the doctors (and in particular with those which disputed the official figures openly) : l?efficience of the device raises of the precision of information qu?ils want to transmit well. But not question in so far as Drass sends investigators to note the exact number of new cases. That would make as much d?agents in less on the ground. Agents which precisely s?en do not leave any more. Thus, the tracking and the possible demoustication of the ten houses surrounding that of the patient indexed n?est more with l?ordre of the day that in the new sites, to choke the chikungunya before qu?il the street in Saint-Louis or in the other already infested hearths does not devastate, the demoustication can be made only in a more massive way, in general district by district. The human and financial means should however be reinforced. A cell of permanent crisis is installation at the prefecture. A twice-weekly meeting will be organized, in particular joining together the vice-chancellorship (returned of the classes obliges, 150 agents of national ḻEducation were formed) and, innovation, the general council. Eleven special brigades also will be created. The four first, made up of twenty soldiers and d?un agent of Drass like d?un vehicle 4x4 and the equipment of pulverization, should be operational as of Monday. Lastly, the plan of communication will be packed, a specialist as regards crisis in health being waited soon. To date, the financial mobilization of l?État s?élève to a d?euro million.

Anne Dalaine

COMMENT S.O.S cyclone ! Officially, round of applause chikungunyés breadth passed in one week of 7 600 official cases to 10 383 officially underestimated cases.... Large the mamaouchi of the doctors that l?on n?avait much not heard these last months, would have spoken about 40 000 cases, perhaps more... Funny ḏarithmetic nevertheless which sees mosquitos deducted starting from random variables, which one ends up admitting qu?elles are purely virtual, for lack of system of serious census. All that because the chikungunya n?est not a notifiable disease. C?était envisaged. Not more than the méningoencéphalites, the comatose ones, the transmissions mother-child and tutti quanti. C?est thus on this moving basis that the ?Vigimoustik-reinforced-renforcé? plan; is implemented, supposément proportioned with ḻardor of l?offensive of l?aedes albopictus. This dirty irritant animal puts in rout ḻorganisation of the health of more developed of Dom ! Our Mahorais friends could laugh at it, them which with their thin means cut the wings to the n?attaque chik before even qu?il l?île to the perfumes. In any case, 10 000, 20 000, 30 000 cases or more, c?est of similar with same, because the Meeting n?a ever be in a position to control a arbovirose like the dengue or the CHIK. With 40 agents, Drass was unable to react. C?était a brain without members. Budgetary economies, departures with the retirement... One did not n?allait nevertheless s?emmerder with mosquitos which flutter to 10 000 km of Paris. And the general council, for which the responsibility c?était first to control the mosquitos vectors of harmful effects, once disencumbered of disease prevention, in 1986, it even forgot jusqu?au name of the mosquito. This n?est not Mâme Dindar which will say the opposite. It affirmed there is little that the department did not wish to obtain d?un service demoustication, when well even the law l?y obliged. Do beautiful feel responsibility, not ? Whereas does remain it to hope ? To pass through the punctures, to give in l?autodéfense ? The old Creoles who know that l?on does not play with impunity with nature hope for a good cyclone... The version weather of Kärcher de Sarko.

Philippe The Claire

 

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For any media or interested parties who might be searching for some more complete data on this oubreak on La Reunion, here are charts and statistics, updated as of January 12th:

http://www.orsrun.net/PointChik20060112.pdf

Two things stand out to me:

1. The cases are most definitely clustered by neighborhood. This seems unusual in a mosquito vectored disease and much more like a H2H problem.

2. The vast majority of cases are NOT confirmed as chikungunya (I assume these cases are simply assumed to be chikungunya and that they are not using lab tests on this vast number of cases, but only differential diagnosis). This is no small point, and one that should not be overlooked, in the midst of such an epidemic.

 

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CHIKUNGUNYA - MAURITIUS AND REUNION ISLAND (02): REUNION
************************************************** ******
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: Sat, 21 Jan 2006
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: Clicanoo, le journal de l'ile de la Reunion, 21 Jan 2006 [trans.
and edited by Mod.RY]
<http://www.clicanoo.com/article.php3?id_article=121171>
<http://www.chikungunya.net/Discussions/forum.htm>


During the weekly chikungunya meeting yesterday, the Prefect admitted that the epidemic was getting worse, especially in the east and the south [of the island]. An action plan has been launched, but the means provided by Drass (Direction regionale des affaires sanitaires et sociales) are
insufficient. There was a change of tone during yesterday's press
conference about chikungunya, organized by the Prefect. Where there were 7600 officially reported cases on Wednesday, they had ballooned to 10383 in 2 days, and Dr Philippe Renault from Cire (Cellule interregionale
d'epidemiologie) remarked that these numbers were undoubtedly an
under-estimation.

The explanation for this came swiftly. The actual reporting of new cases is overtaken by the magnitude of the task, and only works outside of the
numerous infected clusters. It is estimated that there are 1200 new victims per week, again mostly in the East and the South. Cire, together with Institute for Health Control (l'Institut de Veille Sanitaire) has been
thinking about putting in place a new method of reporting in order to put
an end to this situation. Therefore the Prefect made it clear to the
doctors (and those who openly take issue with the official numbers) that an efficient plan of action depends on their accurate reporting.

But at this moment there is no sign that Drass will send investigators to
help collect the exact numbers of new cases, which means fewer people on the spot, while the ones who are there cannot handle the situation any more. Thus, the detection and possible fumigation against mosquitoes of the 10 houses surrounding a residence of a reported victim is only possible in new sites, in order to snuff out chikungunya before it ravages the whole street.

In Saint-Louis or in other infested clusters, fumigation should be carried
out on a massive scale, from neighborhood to neighborhood. In any case,
human and financial resources need to be strengthened. A permanent crisis center has been set up at the prefecture. There will be bi-weekly meetings with the education officers and a general council. We will also create 11 special brigades; the first 4 (made up of 20 military people and an agent of Drass, with a 4x4 vehicle and spraying material) will be operational as of Monday. Finally, a specialist in health crisis management will soon be added to the communication plan. The state has mobilized one million Euros to date [USD 1.15 million].

[byline: Anne Dalaine]

--
ProMED-mail
<promed@promedmail.org>

[The chikungunya outbreak on Reunion Island seems more serious than it
first appeared to be. The doctors on a chikungunya forum (in French) are
questioning the actual numbers and the magnitude of the epidemic. According to the local newspaper, 2783 new cases were reported in just 2 days, which would mean the epidemic is spreading at a speed of 58 new cases per hour or one new case per minute. ProMED-mail would like to get further information from readers who are familiar with the situation. -Mod.RY]

 

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THE CHIKUNGUNYA, LIKE THE HEAT WAVE, IS NOT MORTALS

"the truth alone is a revolutionist"
Published in the edition of Monday January 23, 2006 (page 3)


CCould OMMENT a rise in the temperature lead to the lasting death of 15.000 people in France l?été 2002 ? The heat wave n?est not a virus, not a bacterium, not a bacillus, and yet in 15 days, thousands of French succumbed to this strong heat. Old people, with reduced mobility, suffering of worsening pathologies, isolated, n?ont have the reflex of s?hydrater. L?on however does not say qu?elles died of dehydration but well of the heat wave. L?État which recognized its interference, activates since, each summer, the principle of precaution, opens new beds in the hospitals and reinforces the care in residence. A catastrophe is very often needed, to react.
With the Meeting, much of victims of the chikungunya find themselves in situations of extreme distress. They lose the control of their members, cannot more s?alimenter, s?hydrater. The treatments are prescribed with strong amounts to relieve the intense pains, weakening the organizations, generating new pathologies. A 88 year old woman living the district of Bellepierre in Saint-Denis is confined to bed since February 2005. She was already hospitalized once, before joining her residence. A young man of the Port reached by the virus, made cardiac complications because of the treatment. Without l?intervention of his father, hospital, it would have succumbed. Mrs Dovaria, the secretary of ḻassociation of Colette Brosse, and well d?autres about which one does not speak, had certainly still a few years of life in front of them.
According to authorities', it n?y has "not direct death" due to the chikungunya. But qu?est this qu?un direct death ? They are l?âge, the diabetes, l?hypertension which was right of these people but not the virus. The lack of research on the disease, its knowledge with conditional make it possible to d?entretenir the blur. Let us cease ḻhypocrisy there. If to be realistic c?est to be alarmist, then sound the bugle of the truth, because as Lénine said it, "the truth alone is a revolutionist."

Estéfany

 

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Re: Outbreak History

Re: Outbreak History

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?Le chikungunya killed our mère?
If testimonys multiply at families whose member, often old and weakened, is recently deceased after having contracted the disease, rare which is those still accept d?en to speak. Two families of l?Est opened their door to us. Two families endeuillées by the loss d?une mother : Marthe, 85 years old, in full form before d?être struck by the disease, and Lisette, 43 years, which had already suffered in the past pulmonary d?une embolism, died last Tuesday. She suffered hard from the chikungunya since the beginning from l?année. The question of the responsibility for the virus, when well even it is indirect, arises from now on. Just like that of l?offre of care.

[ January 23, 2006 ]

The pain is still sharp. For the families N and Nivarosa, the scar will undoubtedly remain forever open. And, aujourd?hui, in Saint-Benoît, at N, one is not obstructed to say high what many thinks low. Still under the shock of the sudden death of their mother, 85 years old, Marthe, her daughters stigmatize the disease directly. Remarks which would have been confirmed by the family practitioner, according to Jacqueline. ?Après the death, j?ai requested from the doctor of what mom died, then qu?elle went perfectly well three days before. Its answer was clear, according to it, my mother n?aurait not resisted the strong fever caused by the chikungunya?.

RED PLATES

And to continue : ?Elle then to alert the sub-prefecture to prevent them d?un death due to the virus? acknowledged us to have;. The chikungunya, indirect factor of mortality at weakened people, with l?instar of the heat wave or influenza with l?origine - let us point out it - each year of death at the old people ? The question is put. A question about all the lips, whereas multiply testimonys within the population of close relations died after having contracted the disease, mainly of the old or already weakened people. In N, the girl of the victim is affirmative : ?C?est the chikungunya which killed our mère?. Before pointing out the facts. Thursday January 5, the family takes along the old injury to consult a general practitioner after an abrupt rise of fever. The latter diagnoses an influenza and However prescribes drugs in consequence (Dafalgan...)., its health continues to be degraded. The following day, of the red plates appear on its body, the doctor comes in his residence and speaks this time about the chikungunya. The drugs remain the same ones. Its close relations insist to make hospitalize the old injury, but the expert reassures them in their advising d?attendre deadline a five days, time with the drugs to d?agir. L?entourage then tries its chance directly near l?hôpital near. ?On m?a answered qu?il n?y did not have a place available and to keep mom in residence. Of course, we did not want to disencumber us, but we are not trained for cela?, tell aujourd?hui his/her daughter. During the day of Friday, l?état of the old injury worsens, it cannot move practically more, nor to speak... It will décédera the following day, at 6. 00 of the morning. ?Pourtant, mom was quelqu?un in good health for her age. A few days before, its tension was normal, just like its rate of diabète?, its close relations confirm. ?Nous we did not wait to see it also dying brusquement?, they continue.

SERIOUS DOUBTS

Persuaded that without ḻepidemy, it would be still aujourd?hui at their sides. An opinion without turning and less moderate than that of Nivarosa, with Arm-Panon, under the blow of the disappearance of their mother, Lisette, 43 years old. Died most probably of the continuations d?une long disease from which it had suffered before : a pulmonary embolism. A thesis that her husband, Yvrin and his four children (25, 20, 18 and 3 years and half) do not contradict, without s?empêcher d?émettre some doubts. The mother indeed suffered since about fifteen days the chikungunya - contracted by all the members of the family - at the point to have to keep the bed with pains described like very important. In addition drugs taken with life by the late one - Préviscan and Tardyferon - the attending practitionar (injoignable this weekend) returns by twice visits to suffering and prescribes the drugs d?usage to him. If the fever and the pains s?estompent first once, the mother very seriously makes to a relapse at the point d?inquiéter her entourage. January 15 at the end of the morning, it decides to go to the cabinet medicine of guard of the Saint-Benoît cheese private clinic. According to his close relations, the doctor of permanence confirms the disease, but refuses d?hospitaliser Lisette calling upon a lack of beds... It will succumb two days later to its residence, at the end d?une crisis flash which will leave disarmed its close relations. The arrived helps half an hour later will not manage to reanimate the suffering one. A fate to which the family cannot be solved yet : ?Comment can one let a seriously sick person s?en turn over to it without more precautions ??, question l?un his/her children, Jerome. Their eyes, s?il is obviously impossible d?affirmer that the disease worsened l?état health of their mother jusqu?? to cause her death, the question remains nevertheless posed, the latter going perfectly well, according to its entourage, before contracting in its turn the disease. Only an autopsy
advised by the attending practitionar of Nivarosa - could affirm or cancel this assumption. It with what refuses for l?instant the family.

P. Madubost

We voluntarily used the only initial one of the patronym of the first family of our witnesses.

Free Dom challenges the Area Yesterday, at the beginning of evening, ḻAssociation Free Dom, under the feather of its spokesman, Yasmina Panshbaya, challenged the Area, l?incitant with s?associer with measurements of anti-CHIK fight launched by the prefecture. Free Dom wishes in particular that ?le regional council suspends temporarily, d?urgence, the taxation d?octroi of sea of the medical and plant health products intended d?une share to look after the patients and, d?autre share, to fight for ḻeradication of the mosquito carrying the virus... ? Taking into account the position of Camille Sudre in the regional majority, this official statement takes a very particular direction.

 

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HEALTH
Six dead, suspended blood taking away
Drass confirms l?existence of deaths induced by the chikungunya. It supervises the certificates of death transmitted by the communes and in addition of the two cases indicated by the JIR, four other of comparable nature underline some. French L?Établissement of blood suspended all prèlèvement blood on all l?île.

[ January 24, 2006 ]


The Newspaper of l?Île returned account yesterday of the pain of two families endeuillées by Chikungunya, in l?Est, with Saint-Benoît and Arm-Panon. Two families struck by the loss d?une mother : Marthe, 85 years old, in full form before d?être touched by the disease and Lisette, 43 years, which had already suffered in the past pulmonary d?une embolism, died last Tuesday. She suffered hard from Chikungunya since the beginning from l?année. Consulted on these types of death, Drass produces four other similar cases dating from January. This information proceeds of the monitoring of the certificates of death recorded and transmitted by the municipalities. These certificates indicate the causes of the death by descending order d?importance and probability. The four cases of which we treat present systematically, but according to various appreciations', according to experts', an added again CHIK. Three of the four trespassed are women. The first, 94 years old, succumbed to a heart failure. The chikungunya is indicated as causes secondary death. The second victim, old 90 years, passed consecutively to a cerebral vascular accident. The CHIK was there still with the number of the causes of the demise. The third unhappy one suffered from the chikungunya when it made a cardiorespiratory stop caused by another infection.

?PRÉVENIR D?UN DEATH DUE TO the VIRUS?

The fourth victim is a man, 47 years old, alcoholic chronicle, touched by the chikungunya, he succumbed to a pneumonia with septic shock. Drass, explains the doctor Lassalle inspector, supervises this ḏinformation source attentively, and will inform the cases announced by the JIR when they are transmitted to him. L?impact of being done ḻepidemy more extremely these last weeks, this vigilance will be increased. But specifies Dr. Lassalle, these deaths are not regarded as ?anormaux?, within sight of the circumstances. None of the four cases presents the CHIK as causes first of death. According to Dr.'s Lassalle, if d?aventure the thing were presented, of the investigations would be immediately launched to check the thing scientifically. L?un of the deaths presented yesterday by the JIR could be extraordinary. The parents of the victim explained indeed : ?Après the death, j?ai requested from the doctor of what mom died, then qu?elle went perfectly well three days before. Its answer was clear, according to it, my mother n?aurait not resisted the strong fever caused by the chikungunya (...) it then acknowledged us to have to alert the sub-prefecture to prevent them d?un death due to the virus.?

D?AUTRES THINK OF WEST NILE

Beyond, Dr. Lassalle s?inquiète of l?effet-mask of the chikungunya whose symptoms can veil d?autres pathologies. And when the CHIK n?est not diagnosed, l?hôpital returns sometimes on their premises of the patients carrying heavy pathologies... And if Drass fears cases of underhand dengue, d?autres thinks of West nile, a virus which can be conveyed by l?aedes aegypti. Just like one suspects atypical cases with hepatic prevalence and of the cases of myocarditis... Lastly, the suspension of the blood-péi taking away by l?Établissement French of blood shows that l?on does not want to take any risk of contamination and that l?on n?élude no assumption. The things are serious, the Meeting is in first line in ḻexperimentation d?une arbovirose malconnue, the services administraifs suffer, like postal l?agence of Saint-Leu, closed yesterday due to CHIK, or the wards, which pay themselves their tribe with ḻepidemy. Is it necessary to consider the implementation d?un plane type ORSEC, a CHIKSEC with metropolitan reinforcements and active national solidarity ?

Philippe The Claire

 

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Re: Outbreak History

Re: Outbreak History

MACHINE TRANSLATED
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Hello,

I leave lhopital to France to linstant. I have just spent 8 days to the Meeting and I returned Wednesday 19/01 and before yesterday evening jai have a rise of brutal fever 40? + impossiblity to go knee, ankle shoulder and courbatur?e handle. Docs of lhopital nont decel? this disease but influenza whereas jai, all symptoms of Chikungunya. Short any Ca for saying that this fever is monstreuse and that the aches hurt. And quen metropolis they are not at all informed on Chikungunya.

 

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Searched Alta vista for Chikungunya - as Google only returned 2 news items.
This is a page that came up.
It's from 1986 - however note the bold type - in light of current events in Indonesia - could there be a current connection? Do we know for a fact, that Mosquito's are NOT a vector for H5N1?

http://www.cdc.gov/mmwr/preview/mmwrhtml/00000794.htm



September 12, 1986 / 35(36);573-4

Chikungunya Fever among U.S. Peace Corps Volunteers -- Republic of the Philippines

Three cases of chikungunya fever were diagnosed recently among U.S. Peace Corps volunteers stationed in the Republic of the Philippines. These are the first cases reported from the Philippines since 1968. The cases were diagnosed as part of a collaborative long-term infectious disease study by the U.S. Naval Medical Research Unit No. 2 and the U.S. Peace Corps in the Philippines.

The first patient, a 27-year-old male, was stationed in Mindanao, one of the southernmost islands of the Philippine archipelago. His illness occurred in June 1985 but was not diagnosed until October 1985. The second case occurred mid-November 1985 in a 31-year-old female stationed on Cebu, one of the islands that forms the central portion of the archipelago. The third case occurred in January 1986 in a 23-year-old female stationed on the island of Masbate, also in the central part of the country but north of Cebu.

All three cases were diagnosed using an IgM antibody-capture enzyme-linked immunosorbent assay (ELISA). Chikungunya virus was isolated from a blood sample obtained from one of the patients 3 days after onset of fever. The clinical presentations were typical of chikungunya fever and included acute onset of high fever, severe joint pain, and skin rash. The illnesses persisted 3-7 days, and all patients recovered uneventfully.

Chikungunya virus may have been introduced into the southern Philippines from Indonesia. The first case detected in the Philippines occurred in an area of Mindanao, Davao del Sur, which is approximately 200 km north of central Indonesia; the area is reportedly frequently visited by Indonesian traders and fishermen.

The full extent of epidemic activity in the Philippines is not known. One of the Peace Corps volunteer patients reported many cases of a chikungunya-like illness (locally termed "Chinese fever" or "Asian flu") in the Filipino population of the village where she lived. The potential for widespread activity is present because of the large population of susceptibles and the abundance of the vector, Aedes aegypti, particularly in large urban areas like Manila. Reported by CG Hayes, PhD, T O'Rourke, MD, U.S. Naval Medical Research Unit No. 2; A Sarr, US Peace Corps, Philippines; Div of Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note
Editorial Note: The word "chikungunya" is Swahili for "that which bends up," in reference to the stooped posture of patients afflicted with the severe joint pain associated with this disease. The disease was first recognized in epidemic form in East Africa in 1952-1953 (1). The etiologic agent, chikungunya virus, is arthropod-borne and has been placed in the family Togaviridae, genus Alphavirus (2). Human infections are acquired by the bite of infected A. aegypti mosquitoes, and epidemics are sustained by human-mosquito-human transmission. The epidemic cycle is thus similar to those of dengue and urban yellow fever.

Since 1954, the virus has been implicated as the cause of epidemics in Asian countries including the Philippines, Thailand, Cambodia, Vietnam, India, Burma, and Sri Lanka. Epidemics of chikungunya were documented in the Philippines in 1954, 1956, and 1968 (3-4). Serosurveys suggest that virus activity occurred in the central and southern part of the archipelago (5). Chikungunya virus has been isolated from humans and mosquitoes in eastern, southern, western, and central Africa and in southeastern Asia, where it has been responsible for illnesses in hundreds to thousands of individuals.

...................(NOT hudreds of thousands of individuals! but in all those countries - hundreds TO thousands of cases.....yet now, there are over 40,000 cases on one island?)..............

the notice continues...

Chikungunya fever is characterized by sudden onset, chills and fever, headache, nausea, vomiting, arthralgia, and rash. In contrast to dengue, chikungunya is characterized by a briefer febrile episode, by persistent arthralgia in some cases, and by the absence of fatalities. However, similarities between clinical appearances of the two diseases probably account for misclassification and some underreporting of chikungunya fever in areas with endemic dengue; therefore, laboratory confirmation of reported cases is important. The IgM-capture ELISA used for diagnosis of these patients is especially useful in this regard (6).


References

Robinson MC. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-1953. I. Clinical features. Trans Royal Society Trop Med Hyg 1955;49:28-32.

Calisher CH, Shope RE, Brandt W, et al. Proposed antigenic classification of registered arboviruses. I. Togaviridae, Alphavirus. Intervirology 1980;14:229-32.

Campos LE, San Juan A, Cenabre LC, Almagro EF. Isolation of chikungunya virus in the Philippines. Acta Med Philippina 1969;5:152-5.

Macasaet FF. Further observation on chikungunya fever. J Philippines Med Assoc 1970;46:235-42.

Tesh RB, Gadjusek DC, Garruto RM, et al. The distribution and prevalence of group A arbovirus neutralizing antibodies among human populations in Southeast Asia and the Pacific Islands. Am J Trop Med Hyg 1975;24:664-75.

Calisher CH, El-Kafrawi AO, Al-Deen Mahmud MI, et al. Complex-specific immunoglobulin M antibody patterns in humans infected with alphaviruses. J Clin Microbiol 1986;23:155-9.

 

[DB]

This page is in French, but scroll down a bit to see the graphic. Data is as of January 23rd:

http://www.orsrun.net/PointChik20060123.pdf

From the Document "EPIDEMIE DE CHIKUNGUNYA A LA REUNION
Situation au
23 janvier 2006"

Formes graves et atypiques
Au 23 janvier, 4 certificats de d?c?s survenus depuis le d?but du mois de janvier 2006 mentionnent le chikungunya parmi les maladies ayant provoqu? ou contribu? au d?c?s. Il s?agit de 3 femmes respectivement ?g?es de 82, 91 et 94 ans et d?un homme de 48 ans atteint de pathologie chronique.

Les certificats ne comportent pas d?information sur la confirmation biologique de l?infection.

22 formes graves ou atypiques d?infections par le virus chikungunya ont ?t? rapport?es par le dispositif de surveillance au 23 janvier 2005, 13 chez le nouveau-n? (dont 3 post-natals) et 9 chez l?adulte. Pour la totalit? des adultes et 6 nouveau-n?s, il s?agit d?atteintes neurologiques (my?lo-m?ningoenc?phalite, syndrome de Guillain-Barr?). L??volution clinique et de l?imagerie sont plut?t favorables mais le recul est insuffisant pour ?valuer avec pr?cision les s?quelles ?ventuelles.

=============

Aytipical and Grave Forms of the Disease
As of January 23, four death certificates issued since the beginning of January mention chikungunya among the diseases that caused or contributed to the deaths. It seems that these cases were three women, ages 82, 91, and 94 and a man age 48 who had a chronic pre-existing illness. The death certificates do not include information about the biological testing done to reach confirmation.

22 atypical or very grave presentations, not usual in chikungunya, have been reported acording to the surveillence ending Jan. 23rd: 13 new-borns (three of them neo-nates) and 9 adultes. All of the adults and 6 of the new borns show neurological involvement (meylo- meningitis- encephalitis, Guillain-Barr? syndrome). Their outcomes at this time look favorable, but the sufficient time has not yet passed to see what the outcome will be eventually.

 

[DB]

http://www.todayonline.com/articles/97607.asp

An epidemic of a crippling and incurable mosquito-borne disease has continued to spread throughout the Indian Ocean island of Reunion, with thousands of new cases reported.

Only in the last week more than 5,600 new cases were reported, taking the total number of people infected by "chikungunya" to 22,167 on the French-ruled island since the beginning of the epidemic last March, said Gilles Brucker, director of a government health monitoring institute on Thursday.

"We should expect that the number of cases will pass 30,000," Brucker said.

Chikungunya is Swahili for "that which bends up" and refers to the stooped posture of those afflicted by the non-fatal disease for which there is no known vaccine or cure.

The disease is "very painful, very crippling for certain persons" and could be "potentially serious for weak and vulnerable patients," Brucker said.

In several death certificates issued since the beginning of the month, the disease was "mentioned as a possible cause of the death," he added.

Local authorities have decided to postpone for one week students' return to high schools and colleges, initially planned for next Monday after the main summer holiday, in order to decontaminate schools.

Mayors throughout the island should decide later on Thursday if the return of primary shool students should also be adjourned.

Authorities on the volcanic island east of Madagascar, a French overseas department with a population of 760,000 and a popular holiday destination, have earmarked 600,000 euros (720,000 dollars) to fight the outbreak, including special mosquito-eradication brigades.

Top health ministry official Didier Houssain, accompanying Brucker, called for measures to be stepped up against mosquitos, particularly by eliminating some 250 unauthorised garbage dumps on the island and installing modern incinerators.

The number of "commandos" tasked to intervene in the field will be increased from 11 to 20, and a special free telephone number for tourists introduced. ? AFP

 

[DB]

The Swiss one is one of the posts on this forum: http://www.chikungunya.net/Discussions/forum.htm

Le Chikungunya ou le mini palu 23 janvier 2006
Bonjour,

Je sors de l’hopital en France à l’instant. je viens de passer 8 jours à La Réunion et je rentrée Mercredi 19/01 et avant hier soir j’ai eu une montée de fièvre brutale 40° + impossiblité de marcher genou, cheville épaule et poignée courbaturée. Les docs de lhopital n’ont pas decelé cette maladie mais la grippe alors que j’ai, tout les symptomes du Chikungunya. Bref tout ca pour dire que cette fièvre est monstreuse et que les courbatures font mal. Et qu’en métropole ils ne sont pas du tout informés sur le Chikungunya.

http://www.afrik.com/forum.php3?id_article=9190

Translation:

"At the moment, I am in the hospital in France. I just came back from spending 8 days in La Reunion and I returned Wed., 1/19. Before yesterday evening I had a brutal fever of 101 degrees plus [conversion please!] and it was impossible to walk on my joints, my shoulder and sharp "corbaturee." The doctors in the hospital have not revealed this illness as anything but the flu but I have all the symptoms of Chikungunya. In short, in any case I have to say that that that fever is monsterous and that the "corbatures" are painful. And here in this city they are not informed about Chikungunya."