Mystery virus kills 137 in UP since January, experts clueless - Encephalitis

[Treyfish]

Kounteya Sinha , TNN 21 August 2009, 02:48am IST


<!-- google_ad_section_start -->NEW DELHI: It's a virus that has already claimed over 100 lives but Indian and American scientists seem to have no clue about what it is. While the <TABLE style="MARGIN-TOP: 10px; MARGIN-BOTTOM: 4px; MARGIN-RIGHT: 8px" cellSpacing=0 cellPadding=0 align=left><TBODY><TR><TD id=bellyad></TD></TR></TBODY></TABLE><TABLE style="MARGIN: 0px 10px 0px 0px; CLEAR: both" class=cnt width=200 align=left><TBODY></TBODY></TABLE>entire country is busy dealing with H1N1 [COLOR=blue !important][COLOR=blue !important]influenza[/COLOR][/COLOR], a mystery virus is causing havoc in Uttar Pradesh.

Since January, the state has recorded 665 cases of Acute Encephalitis Syndrome (AES) -- a severe neurological condition associated with significant morbidity and mortality. Around 137 people have already succumbed to the viral infection.

Lab investigations have revealed that only 34 of the cases and four of the deaths were caused by Japanese Encephalitis -- a known scourge in the state. However, scientists have no clue what caused the rest of the 133 encephalitis deaths and 631 cases.

According to officials, this mystery virus has been causing brain fever and killing people in UP since last year but no breakthrough has been made regarding the virus's identity and nature.

Experts from Centre for Disease Control and Prevention (CDC) Atlanta had picked up 150 samples from UP to help identify the virus. But they too have failed to make any headway.

Speaking to TOI, director of National Institute of Virology (Gorakhpur) Dr Milind Gore said, "We are working on identifying the virus and its origin. At present we don't know what's causing these cases of AES and deaths. We suspect it could be a type of enterovirus."

Dr Gore added, "It is clear that JE alone isn't causing AES. We recently checked 450 stool swabs and found that 68% of them were positive for enteroviruses. However, we don't know exactly which one from this family of viruses is the dominant one behind the deaths. Even CDC experts haven't figured it out."

Officials said the search for the "real culprit" behind the AES cases had taken a beating in the last few months with scientists in NIV Pune drowned with H1N1 samples.

"H1N1 has proved to be a setback for the work on encephalitis in UP. Improved methods of diagnosis and new primers were to be tested against the unknown virus. But everybody at NIV Pune is busy with H1N1," an official said.

AES is characterised by imflamation of the brain, seizures and convulsions among children.

International NGO PATH's senior programme officer for JE Dr Pritu Dhalaria told TOI, "Usually, around four to five enteroviruses work in tandem, in clusters in particular areas. It is therefore difficult to identify exactly which virus is the deadly one. By this time last year, UP had recorded 435 AES cases of which only 15 were caused by JE. This year, the cases have increased, and we don't know which virus is behind it."

Non-polio enteroviruses are very common across the globe. They are second only to the common cold viruses, the rhinoviruses, as the most common viral infectious agents in humans.

Although infection often has no symptoms and goes unnoticed, these viruses are also associated with occasional outbreaks in which a larger-than-usual number of patients develop clinical disease, sometimes with fatal consequences.

Transmission of enterovirus infections is increased by poor hygiene and overcrowded living conditions. Measures that can be taken to avoid getting infected with enteroviruses include frequent hand washing.

Enteroviruses can be found in the respiratory secretions and stool of an infected person. Other persons may become infected by direct contact with secretions from an infected person or by contact with contaminated surfaces or objects.

According to some experts, UP has seen a nearly 40% increase in AES cases this year, majority of them not belonging to the enterovirus category. :tiphat:http://timesofindia.indiatimes.com/news/india/Mystery-virus-kills-137-in-UP-experts-clueless/articleshow/4916125.cms

 

[alert]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Send that one to ProMed. They posted an RFI about what they thought was confusing JE case counts here:

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,78860

That clarifies it - 30 cases have been confirmed as JE, but the 600+ cases is not lab confirmed anything - it is just the number of people with encephalitis symptoms.

 

[alert]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Better yet, send this to ProMed too, to answer the RFI. Yes, I know the counts in this article are complete nonsense as they contradict themselves.

http://sify.com/news/fullstory.php?...ims_five_more_lives_in_Uttar_Pradesh_toll_166

Encephalitis claims five more lives in Uttar Pradesh, toll 166

2009-08-20 19:50:00


With the death of five more children Thursday in eastern Uttar Pradesh, the deadly encephalitis has now taken 166 lives of minors in this part of the state in 2009, officials said.

According to health officials, a total of 1,117 cases have been reported in seven districts of eastern Uttar Pradesh till now and of them 677 are children below the age of 15. All the fatalities have also been of minors.


'Last year, out of the 1,000-odd patients admitted here, 734 were children below 15 years of which 151 died till Aug 31, 2008. This year, 677 cases out of over 1,000 patients were children and the casualty is 166,' Rakesh Saxena, the principal of Baba Raghav Das Medical College (BRDMC) in Gorakhpur, told IANS.


As per the records of the 56-bed encephalitis ward of BRDMC, the only hospital in the region specialised in the treatment of the disease, presently there are nearly 150 children under treatment.


'At least 90 percent of the patients are children as they are most susceptible and prone to the disease,' Saxena added.


The virus, which has become an annual feature here, has the state health department in a tizzy.


'Till 2005 the region was suffering due to Japanese Encephalitis (JE), a mosquito borne disease, which was eradicated to some extent. But now it is Enteroviral Encephalitis (VE), which is water borne,' Additional Director (Health) L.P. Rawat said.


'Majority of those admitted (to hospital) have been treated. We are alert but cannot help it until there is awareness in the people to protect themselves from the viruses,' he added.


However, the doctors at the BRDMC differ in their views.


'Although we have more patients of VE but JE is still killing children. At least 30 percent patients have JE. In fact nothing constructive has been done so far to save the children,' K.P. Kushawaha, head of the paediatrics department of BRD Medical College, said.


But experts believe that the blame game between the state and the central government is leading to more deaths in the region.


'The disease hit the region in 1978 and has since then has killed over 30,000 children. The political parties are more interested in confusing the residents rather than spreading awareness and eradicating the disease that could soon become an epidemic,' said T.N. Dhole, an expert on the subject at the Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) here.


'With only 30-odd deaths swine flu has been declared an epidemic. It is just because it is spreading across the world and could easily spread from one country to another. But the government is not paying any heed to this (JE and VE) that has taken more lives in a small portion of Uttar Pradesh than the entire toll of swine flu,' he said.


Although there have been some actions by political parties on the disease, they have led to no or negligible results.


'Congress general secretary Rahul Gandhi had visited the BRDMC hospital in 2005, after which the union health ministry imported Chinese vaccine which was administered to over 56 lakh (5.6 million) children. But the death rate didn't fall in the subsequent years,' R.N. Singh, a practising paediatrician in Gorakhpur, said.


Gandhi again visited Gorakhpur in 2008, this time with a team of doctors including two from US Centre for Disease Control and Prevention, Atlanta. The team studied the virus and its spread. The results of the study are still awaited. Gorakhpur is nearly 300 km from here.


The state government on its part has been continuously blaming the central government.


'We have sent many reports to the centre to help us in eradicating the disease. But they have failed to respond. But to the best of out capacity, we have provided every facility at the BRD Medical College to treat the patients,' state Health Minister Anant Kumar Mishra said.


'We had demanded the upgradation of the BRD Medical College and equip it with modern system to study encephalitis. But the state and the central governments opened one such centre in the SGPGIMS, Lucknow. Eastern Uttar Pradesh also needs various mobile teams of expert doctors to reach the patients immediately because according to my estimate only one out of a 100 children reaches the BRD Medical College,' Singh said.

SEARCH

 

[hermann]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

:tiphat:

This problem with an unknown strain of encephalitis in UP is not new. In 2007 over 500 children died from an unknown strain of encephalitis.

http://www.indianexpress.com/news/illness-pradesh/360240/0

Until date they have no name for this virus. The CDC failed to make any headway and after two (may be three) years the National Institute of Virology (Gorakhpur) suspect it could be a type of enterovirus. Unbelievable!
There was (is?) a epidemic problem with a new encephalitis strain in Vietnam. The Central Epidemiology Institute called this virus acmong (nightmare). ?Acmong virus has caused encephalitis epidemics in the northern province of Bac Giang for two consecutive years, 2007 and 2008.? Is there may be a connection?

I am not a scientist, I am just an observer. I am not sure, but sometimes I think in southeast Asia there is a new widespread virus. A virus which has symptoms similar to encephalitis, flu and cholera. In 2008 there were many short news about mysterious diseases in southeast Asia. David Buhril discribed precisely a strange disease in Tipaimukh, this disease attacks the villagers since 2007.

David Buhril 2008
http://www.kanglaonline.com/index.php?template=kshow&kid=1192

David Buhril 2009:
http://www.indigenousportal.com/Health/Death-Stalks-Forgotten-Hills.html

 

[sharon sanders]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Welcome Hermann!

 

[Shiloh]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Some other posts on the subject are here:\
http://www.flutrackers.com/forum/showthread.php?t=104020

 

[mixin]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

I didn't realize the cause of encephalitis was such a mystery until I read this recent study: Etiology of Encephalitis in Australia, 1990–2007.

http://www.flutrackers.com/forum/showthread.php?p=283996#post283996

 

[alert]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

I think that is exactly the problem. No one really bothers to check out the actual etiology responsible for most encephaltis cases. It was usually blamed on JE or West Nile or something simliar (depending on the geographical area), and no one paid any attention. Since it was viral, no one really cared what virus it was; they couldn't treat it anyway. I think there are likely several unrecognized causes of encephalitis, enterovirus being one of them. I also think that testing for these agents might be hampered by the fact that the infection is occurring in the brain, so blood samples might not show any agent at all.

As far as "acmong virus", my understanding on that one is that they actually isolated a previously unrecognized pathogen from children (and maybe even mosquitos too) in Bac Giang. I don't think they released a formal report classifying what family the virus belonged to, but I don't think it was an enterovirus as it was definitely mosquito borne, not waterborne.

It isn't just Asia, as well. The above post mentions the situation in Australia, as well as the US and Europe. Malaysia has reported a few sporadic undiagnosed viral encephalitis fatalities this year that casued a VERY long thread here that ultimately exceeded 100 posts and got titled "Assorted Illnesses" when it became clear that it wasn't all the same pathogen. Moreover, there has been an outbreak going on all summer on the border of Malawi and Mozambique that the US CDC has been investigating for nearly two months (last count 142 cases, 20 fatalities) that is likely viral encephalitis, but neither the CDC or the South African reference labs can find any known pathogen.

I don't think it's a single widespread virus - there seems to be a wide difference in CFR and in epidemiology. The "acmong virus" only affected kids. Many of these pathogens seem to be waterborne, while others seem to be vector-borne. I think it's several (many?) viruses that no one ever bothered to check for before. And I think it has been going on for years, if not decades.

 

[Niko]

Re: India: Deadly brain fever takes toll in Uttar Pradesh

Re: India: Deadly brain fever takes toll in Uttar Pradesh

Unfortunately, undiagnosed/confirmed cases of encephalitis (particularly in Uttar Pradesh) have been an annual occurrence.

Historical perspective:

In 2005, Uttar Pradesh had 5699 cases with 1315 deaths due to J.E.

See page 3 of http://www.whoindia.org/LinkFiles/C...se_Encephalitis_in_South_East_Asia_Region.pdf

(Note: only a tiny fraction of cases is laboratory confirmed)

from pdf above...[FONT=&quot]

[/FONT]View attachment JE.doc


[FONT=&quot]

<!--[endif]-->[/FONT]

 

[alert]

Re: Encephalitis kills 172 in UP since January, experts clueless

Re: Encephalitis kills 172 in UP since January, experts clueless

http://www.ptinews.com/news/240446_Nine-children-die-of-Japanese-Encephalitis

Nine children die of Japanese Encephalitis

--------------------------------------------------------------------------------
Advertisement
Share Print E-mail Comment[ - ] Text [ + ]STAFF WRITER 9:41 HRS IST
Gorakhpur (UP) Aug 21 (PTI) Nine more children have died due to Japanese encephalitis here, taking the toll in the viral infection in the district since January to 172.

Additional Director, Health, Dr L P Rawat saidtoday that while five children died on Wednesday four died yesterday.

Twelve more persons suffering from the brain fever have been admitted to the BRD Medical College here where 114 people are already undergoing treatment, he added.

The deadly Japanese Encephalitis fever is caused by a virus found in pigs and wild and transferred to humans by mosquito bite. It affects the brain and causes high fever and respiratory distress.

Japanese Encephalitis claims many lives in Uttar Pradesh each year.

 

[alert]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

The red and blue statements are definitely contradictory.

http://timesofindia.indiatimes.com/...-decode-mystery-virus/articleshow/4920904.cms

NIV team in Gorakhpur to decode mystery virus
Swati Shinde & Umesh Isalkar, TNN 22 August 2009, 04:05am IST
Print Email Discuss Bookmark/Share Save Comment Text Size: |

PUNE: A four-member team of the National Institute of Virology (NIV), Pune, is in Gorakhpur, hoping to crack the code of the mystery virus that has
killed over 100 people in Uttar Pradesh. The team has been assigned the job of ascertaining the nature and characteristics of the virus, how it is spreading and eventually to find a way to control it so as to provide guidelines to the state government that will implement them as preventive measures.

Speaking to TOI on Friday, AC Mishra, director, NIV, Pune said, "Our team has been working in Gorakhpur for a long time, particularly to study this virus. They are doing a surveillance of the environment and the breed of mosquitoes and trying to understand which family the virus hails from."

Since January, UP has recorded 665 cases of Acute Encephalitis Syndrome (AES) a severe neurological condition associated with significant morbidity and mortality. Around 137 people have already succumbed to the viral infection.

When contacted, Milind Gore, who is leading the NIV team in Gorakhpur, told TOI, "Since the virus is not entirely known and we are still unable to distinctly classify it, we are finding out the percentage of its presence in the environment and its transmission into the body. We have noticed that most times it is found in children. We know that it is an enterovirus."

This mystery virus has been causing brain fever and killing people in UP since last year but no breakthrough has been made regarding the virus's identity and nature.

Gore said, "Right now we are trying to figure out how many people have been infected by the virus, what is the mode of spreading and in what other diseases is the virus or its characteristics found."

Initially, a four-member team went to Gorakhpur and started work on the study. However, a full-fledged centre will soon be established and more people will be recruited for this study. The NIV team is closely working with experts from the Centre for Disease Control and Prevention (CDC) Atlanta.

"We are sharing the results of our finding with the American team and vice-versa. We are working together and the aim of both these teams is to know more about the virus," Gore added.

Once the case of the mystery virus is solved, the team will be recommending guidelines to the Uttar Pradesh government as well as the preventive measures that can be implemented to curb the spreading of virus.

 

[Emily]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Just don't worry that the latest mystery illness has anything to do with the new JE vaccine tested in India.

http://www.scidev.net/en/south-asia...-encephalitis-vaccine-presents-no-danger.html
Japanese encephalitis vaccine presents no danger

Philip Bedford

Senior vice-president
Clinical Operations and Regulatory Affairs
Acambis Research Limited

20 September 2006
The article also states: "The risk associated with the emergence of a pathogenic virus during mass vaccination following recombination between ChimeriVax-JE and another flavivirus, however small, cannot be ignored."

We agree. However, all scientific data to date indicate that if possible, the theoretical risk of recombination in a manner that creates a viable virus capable of replication and survival is extremely low.

Again, we do not mean to minimise this issue ? indeed, we have conducted considerable experimentation to investigate this possibility, and have found such a recombination event to be below levels of detection under the most favourable experimental conditions to detect such an event.

Moreover, the risk of this theoretical event, when viewed in the light of the individual and public health benefits of vaccination with ChimeriVax-JE, should be no reason for concern.

The article states: "The trial was originally due to take place last year in Thailand. A senior official of the Thai Ministry of Health told SciDev.Net that the World Health Organization (WHO) did not support the trial and that it was eventually abandoned for no clear reason. The vaccine manufacturer Acambis declined to reply when asked why it moved the trial to India."

 

[alert]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Something to keep an eye on, but the timing is bad. UP has been reporting lots of encephalitis that wasn't JE since at least 2005, and that vaccine article is from September 2006.

 

[Emily]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Something to keep an eye on, but the timing is bad. UP has been reporting lots of encephalitis that wasn't JE since at least 2005, and that vaccine article is from September 2006.

Not that I think it's related, but looks like testing may have been done in India prior to that 2006 article.

http://www.bharatbiotech.com/2005_nov10_2.htm

There must be a typo there.

"The pricing of this live, attenuated injectable vaccine would be competitive compared to other unsafe vaccines available in India and other south east Asian nations, he averred."

 

[Shiloh]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Source: http://news.bbc.co.uk/2/hi/south_asia/8217453.stm


Encephalitis kills 200 in India
By Ram Dutt Tripathi
BBC Hindi, Lucknow


At least 200 children have died in an outbreak of Japanese encephalitis in northern India, health officials say.

So far, 900 affected children have been admitted to hospitals in Uttar Pradesh state. Some patients have come from neighbouring Bihar state and Nepal.

There is no specific cure for the mosquito-borne disease which has killed thousands in India since 1978.

Health experts complain that red tape has prevented development of an effective vaccination programme.

The disease occurs regularly during India's monsoon.

Doctors say children between the age of six months to 15 years are worst affected and most of the victims are poor people from rural areas.

Breeding ground

"The attack of the encephalitis virus is extremely ferocious this year," says Dr Rashmi Kumar, an expert on Japanese encephalitis at Lucknow Medical College hospital.

"Children are developing a serious condition within a day or two of getting infected," she says.

Health officials in the state capital, Lucknow, say cases of acute encephalitis are being reported mostly from 14 districts of eastern Uttar Pradesh in the foothills of the Himalayas.

The low-lying areas are prone to annual floods, and severe water-logging and a lack of sanitation provide a breeding ground for mosquitoes.

Doctors say Gorakhpur town is the epicentre of the disease.

Last year, the government said it would spend 60 million rupees ($1.24m) to upgrade facilities at Gorakhpur Medical College hospital.

But, doctors say, the hospital does not have adequate numbers of medical staff to deal with the large numbers of patients.

Doctors say the children who survive will have to face lifelong problems as the disease has a crippling effect.

'Preventable'

While there is no specific cure for the disease after it has been contracted, three vaccines are in use worldwide that have reportedly been successful in preventing the disease.

But India has so far failed to develop an effective vaccination programme.

After the disease killed 1,500 children in 2005, a public outcry forced the government to import vaccines from China and a mass vaccination project was started.

However, doctors say the vaccine coverage has not been satisfactory this year, with many parents of affected children saying no vaccination was done in their areas.

Japanese encephalitis, which causes high fever, vomiting and can leave patients comatose, usually hits Uttar Pradesh state in July-August.

The disease has recurred annually in eastern regions of the state since 1978.

 

[alert]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Note the bold text. That seems to go against the entire point of this thread, as well as our seeming consensus here on FT.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78914

JAPANESE ENCEPHALITIS - INDIA (04): (UTTAR PRADESH)
***************************************************
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 24 Aug 2009
Source: BBC News [edited]
<http://news.bbc.co.uk/2/hi/south_asia/8217453.stm>


At least 200 children have died in an outbreak of Japanese
encephalitis in northern India, health officials say. So far, 900
affected children have been admitted to hospitals in Uttar Pradesh
state. Some patients have come from neighbouring Bihar state and
Nepal.

There is no specific cure for the mosquito-borne disease, which has
killed thousands in India since 1978. Health experts complain that
red tape has prevented development of an effective vaccination
programme. The disease occurs regularly during India's monsoon.

Doctors say children between the ages of 6 months to 15 years are
worst affected and most of the victims are poor people from rural
areas. "The attack of the encephalitis virus is extremely ferocious
this year [2009]," says Dr Rashmi Kumar, an expert on Japanese
encephalitis at Lucknow Medical College hospital. "Children are
developing a serious condition within a day or 2 of getting
infected," she says.

Health officials in the state capital, Lucknow, say cases of acute
encephalitis are being reported mostly from 14 districts of eastern
Uttar Pradesh in the foothills of the Himalayas. The low-lying areas
are prone to annual floods, and severe water-logging and a lack of
sanitation provide a breeding ground for mosquitoes.

Doctors say Gorakhpur town is the epicentre of the disease. Last year
[2008], the government said it would spend 60 million rupees (USD
1.24m) to upgrade facilities at Gorakhpur Medical College hospital.
But, doctors say, the hospital does not have adequate numbers of
medical staff to deal with the large numbers of patients. Doctors say
the children who survive will have to face lifelong problems as the
disease has a crippling effect.

While there is no specific cure for the disease after it has been
contracted, 3 vaccines are in use worldwide that have reportedly been
successful in preventing the disease. But India has so far failed to
develop an effective vaccination programme. After the disease killed
1500 children in 2005, a public outcry forced the government to
import vaccines from China and a mass vaccination project was
started. However, doctors say the vaccine coverage has not been
satisfactory this year [2009], with many parents of affected children
saying no vaccination was done in their areas.

Japanese encephalitis, which causes high fever, vomiting, and can
leave patients comatose, usually hits Uttar Pradesh state in
July-August. The disease has recurred annually in eastern regions of
the state since 1978.

[Byline: Ram Dutt Tripathi]

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

[The Japanese encephalitis (JE) outbreak continues to spread and
intensify in Uttar Pradesh and neighboring areas. One wonders if most
of the previously reported cases of unspecified "encephalitis" in
this area (see previous ProMED-mail 2009 posts, below) are mostly
cases of JE virus infection.

A map showing the location of Indian states including Uttar Pradesh
in northeastern India can be accessed at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/india_pol01.jpg>.
A HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/00Hk>. - Mod.TY]

[see also:
Japanese encephalitis - India (03): (UP) RFI 20090819.2937
Japanese encephalitis - India (02): (UP, NL, AS) 20090818.2929
Japanese encephalitis - India (UP): susp, RFI 20090513.1789
2008
----
Japanese encephalitis - India (08): (UP) 20081115.3609
Japanese encephalitis - India (07): (UP) 20081110.3542
Japanese encephalitis - India (06): (WB, UP) 20081017.3295
Japanese encephalitis - India (05): (UP) RFI 20081014.3260
Japanese encephalitis - India (04): (UP, AS) 20080923.3011
Japanese encephalitis - India (03): (UP), RFI 20080923.2998
Japanese encephalitis - India (02): (UP) 20080918.2924
Japanese encephalitis - India: (UP) 20080731.2345]
...................................ty/mj/lm

 

[Emily]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

From the links below, it at least looks like there was a successful mass vaccination program in UP recently for JE with a proven effective MLV Chinese JE vaccine.

http://www.iapcoi.com/je.htm
"In 2005 India witnessed a massive outbreak of JE which resulted in 2000 deaths and even greater disability. In response to this outbreak the Government of India with support of Program for Appropriate Technology in Health (PATH) initiated a pilot project in 2006 of immunizing children in hyperendemic districts against JE. 7 districts in UP, 2 in Assam and one each in West Bengal and Karnataka were targeted. SA-14-14-2 live JE vaccine manufactured by Chengdu institute of Biological Products, Chengdu, China was used.

It was given in a campaign mode to children aged 1-15 years as a single subcutaneous dose using autodisable (AD) syringe. Eleven million children were targeted as beneficiaries and 9 million children actually received the vaccine, i.e. nearly 86% of the target was achieved. UP recorded 96% coverage against all expectations. ....This project reached 20 million children in 2007 and aims to reach 20 million more in 2008. "


http://www.sciencedirect.com/scienc...serid=10&md5=94f78661eda3cc1e64cc9e249884d95a
Single dose of SA 14-14-2 vaccine provides long-term protection against Japanese encephalitis: A case?control study in Nepalese children 5 years after immunization
"Five years after administration of a single dose, SA 14-14-2 provided a protective efficacy of 96.2% (CI 73.1?99.9%)."

http://www.path.org/vaccineresources/details.php?i=800
2009: Effectiveness of One Dose of SA 14-14-2 Vaccine Against Japanese Encephalitis

"Correspondence, published in the New England Journal of Medicine, about a small case control study in Uttar Pradesh, India, on the efficacy of a single dose of the SA 14-14-2 JE vaccine within six months of its administration. Effectiveness was found to be similar to previous studies in Nepal."


Studied for effectiveness against many regional strains of JE.
http://cat.inist.fr/?aModele=afficheN&cpsidt=15084021

Long track record reported of safety and effectiveness.
http://www3.niaid.nih.gov/news/events/meetings/Viral+Infections/PDF/Yongxin.pdf

And the 150 CDC samples were negative for JE.

Experts from Centre for Disease Control and Prevention (CDC) Atlanta had picked up 150 samples from UP to help identify the virus. But they too have failed to make any headway.

Looks like more research is very much needed.

 

[Emily]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

http://www.indianexpress.com/news/what-about-encephalitis-up-doctor-writes-in-blood-to-rahul/502895/1
Aug 17, 2009 at 0403 hrs
What about encephalitis: UP doctor writes in blood to Rahul

Over 200 cases and 40 deaths have taken place in eastern UP in the past one month due to encephalitis, the disease which has a mortality rate between 30 to 40 per cent. In the same period, only 20 cases of mild flu have been reported. According to Dr K P Kushwaha of the BRD Medical College, eight to 10 patients are being admitted daily at BDR Medical College. However, while all government attention is focused on swine flu, few seem to be bothered about encephalitis. For swine flu, all hospitals have been put on alert, whereas there is no such alert for encephalitis. Tests for detection of swine flu, each of which is three times costlier, are being done daily, while encephalitis-detection tests are being conducted at a maximum of thrice a week.
?The reason is simple: swine flu is an imported disease where the victims are either people who have returned from abroad or belong to the middle class.
Encephalitis is affecting children of poor people in eastern UP. We have to find ways to draw attention towards encephalitis deaths and cases,? said Dr R N Singh, who heads Encephalitis Eradication Movement, a private initiative.
Singh was here on Sunday to launch a campaign by writing a letter in blood to AICC general secretary Rahul Gandhi. Volunteers followed him by writing similar letters in blood to PM Manmohan Singh and Union Health Minister Ghulam Nabi Azad. The idea was to draw attention of the government towards encephalitis deaths....



More on situation here:
http://www.indianexpress.com/news/je-vaccine-supply-to-up-loses-potency/361451/1
JE vaccine supply to UP loses potency
Monday , Sep 15, 2008 at 0155 hrs
http://www.indianexpress.com/news/one-dose-or-two-for-je-vaccine-experts-to-decide-soon/469027/2
One dose or two for JE vaccine? Experts to decide soon
Monday , Jun 01, 2009 at 0204 hrs

 

[alert]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

ProMed just uncorked these two postings, minutes apart. They seem to represent the two different sides of this debate.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78943

JAPANESE ENCEPHALITIS - INDIA (05): (UTTAR PRADESH)
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 25 Aug 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-08/25/content_11940936.htm>


The Press Trust of India on Tuesday [25 Aug 2009] reported that 3
more Indian children have died of Japanese encephalitis in the
northern Indian state of Uttar Pradesh, taking the toll due to the
viral infection in the state since January [2009], to 180. The
children belonging to Kushinagar, Siddharthanagar, and Mahrajganj
districts of Uttar Pradesh died in the last 2 days at the BRD Medical
College in Gorakhpur, where a total of 20 people suffering from the
viral fever were being treated, said the report.

The deadly Japanese encephalitis fever is caused by a virus found in
pigs and transferred to humans by mosquito bites. The disease affects
the brain and causes high fever and respiratory distress.

[Editor: Li Xianzhi]

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

A map showing the location of Indian states including Uttar Pradesh
in northeastern India can be accessed at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/india_pol01.jpg>.
A HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/00Hk>. - Mod.TY]

[see also:
Japanese encephalitis - India (04): (UP) 20090824.2985
Japanese encephalitis - India (03): (UP) RFI 20090819.2937
Japanese encephalitis - India (02): (UP, NL, AS) 20090818.2929
Japanese encephalitis - India (UP): susp, RFI 20090513.1789
2008
----
Japanese encephalitis - India (08): (UP) 20081115.3609
Japanese encephalitis - India (07): (UP) 20081110.3542
Japanese encephalitis - India (06): (WB, UP) 20081017.3295
Japanese encephalitis - India (05): (UP) RFI 20081014.3260
Japanese encephalitis - India (04): (UP, AS) 20080923.3011
Japanese encephalitis - India (03): (UP), RFI 20080923.2998
Japanese encephalitis - India (02): (UP) 20080918.2924
Japanese encephalitis - India: (UP) 20080731.2345]
...................................ty/mj/lm


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

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78942

ENCEPHALITIS - 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>

[1]
Date: Sat 22 Aug 2009
Source: The Times of India (TOI), Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/news/city/pune/NIV-team-in-Gorakhpur-to-decode-mystery-virus/articleshow/4920904.cms>


A 4-member team of the National Institute of Virology (NIV), Pune, is
in Gorakhpur, hoping to crack the code of the mystery virus that has
killed over 100 people in Uttar Pradesh. The team has been assigned
the job of ascertaining the nature and characteristics of the virus,
how it is spreading, and eventually to find a way to control it so as
to provide guidelines to the state government that will implement
them as preventive measures.

Speaking to TOI on Friday [21 Aug 2009], AC Mishra, director, NIV,
Pune said, "Our team has been working in Gorakhpur for a long time,
particularly to study this virus. They are doing a surveillance of
the environment and the breed of mosquitoes and trying to understand
which family the virus hails from."

Since January [2009], UP has recorded 665 cases of acute encephalitis
syndrome (AES) a severe neurological condition associated with
significant morbidity and mortality. Around 137 people have already
succumbed to the viral infection.

When contacted, Milind Gore, who is leading the NIV team in
Gorakhpur, told TOI, "Since the virus is not entirely known and we
are still unable to distinctly classify it, we are finding out the
percentage of its presence in the environment and its transmission
into the body. We have noticed that most times it is found in
children. We know that it is an enterovirus."

This mystery virus has been causing brain fever and killing people in
UP since last year [2008] but no breakthrough has been made regarding
the virus's identity and nature. Gore said, "Right now we are trying
to figure out how many people have been infected by the virus, what
is the mode of spreading and in what other diseases is the virus or
its characteristics found."

Initially, a 4-member team went to Gorakhpur and started work on the
study. However, a full-fledged centre will soon be established and
more people will be recruited for this study. The NIV team is closely
working with experts from the Centre for Disease Control and
Prevention (CDC) Atlanta. "We are sharing the results of our finding
with the American team and vice-versa. We are working together and
the aim of both these teams is to know more about the virus," Gore
added.

Once the case of the mystery virus is solved, the team will be
recommending guidelines to the Uttar Pradesh government as well as
the preventive measures that can be implemented to curb the spreading
of virus.

[Byline: Swati Shinde, Umesh Isalkar]

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

******
[2]
Date: Fri 21 Aug 2009
Source: The Times of India (TOI), Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/news/india/Mystery-virus-kills-137-in-UP-experts-clueless/articleshow/4916125.cms>


It's a virus that has already claimed over 100 lives but Indian and
American scientists seem to have no clue about what it is. Since
January [2009], the state has recorded 665 cases of acute
encephalitis syndrome (AES) -- a severe neurological condition
associated with significant morbidity and mortality. Around 137
people have already succumbed to the viral infection.

Lab investigations have revealed that only 34 of the cases and 4 of
the deaths were caused by Japanese encephalitis [virus infection] --
a known scourge in the state. However, scientists have no clue what
caused the rest of the 133 encephalitis deaths and 631 cases.
According to officials, this mystery virus has been causing brain
fever and killing people in UP since last year [2008] but no
breakthrough has been made regarding the virus's identity and nature.

Experts from Centre for Disease Control and Prevention (CDC) Atlanta
had picked up 150 samples from UP to help identify the virus. But
they too have failed to make any headway. Speaking to TOI, director
of National Institute of Virology (Gorakhpur) Dr Milind Gore said,
"We are working on identifying the virus and its origin. At present
we don't know what's causing these cases of AES and deaths. We
suspect it could be a type of enterovirus."

Dr Gore added, "It is clear that JE [virus] alone isn't causing AES.
We recently checked 450 stool swabs and found that 68 percent of them
were positive for enteroviruses. However, we don't know exactly which
one from this family of viruses is the dominant one behind the
deaths. Even CDC experts haven't figured it out." Officials said the
search for the "real culprit" behind the AES cases had taken a
beating in the last few months with scientists in NIV Pune drowned
with H1N1 samples.

"H1N1 has proved to be a setback for the work on encephalitis in UP.
Improved methods of diagnosis and new primers were to be tested
against the unknown virus. But everybody at NIV Pune is busy with
H1N1," an official said.

AES is characterised by inflammation of the brain, seizures, and
convulsions among children.

International NGO PATH's senior programme officer for JE Dr Pritu
Dhalaria told TOI, "Usually, around 4-5 enteroviruses work in tandem,
in clusters in particular areas. It is therefore difficult to
identify exactly which virus is the deadly one. By this time last
year [2008], UP had recorded 435 AES cases of which only 15 were
caused by JE [virus]. This year [2009], the cases have increased, and
we don't know which virus is behind it."

Non-polio enteroviruses are very common across the globe. They are
2nd only to the common cold viruses, the rhinoviruses, as the most
common viral infectious agents in humans. Although infection often
has no symptoms and goes unnoticed, these viruses are also associated
with occasional outbreaks in which a larger-than-usual number of
patients develop clinical disease, sometimes with fatal consequences.
Transmission of enterovirus infections is increased by poor hygiene
and overcrowded living conditions. Measures that can be taken to
avoid getting infected with enteroviruses include frequent hand
washing.

Enteroviruses can be found in the respiratory secretions and stool of
an infected person. Other persons may become infected by direct
contact with secretions from an infected person or by contact with
contaminated surfaces or objects.

According to some experts, UP has seen a nearly 40 percent increase
in AES cases this year [2009], majority of them not belonging to the
enterovirus category.

[Byline: Kounteya Sinha]

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

[Clearly, some of these cases of encephalitis were cause by JE virus
infections. The 1st report above states that the non-JE cases were
caused by an enterovirus. The 2nd report is confusing, stating that
unidentified enteroviruses are involved but ending by saying the
majority were not. The basis on which these statements were made
would be of interest.

ProMED-mail requests further information about the etiology of these
encephalitis cases as it becomes available.

Encephalitis of enterovirus etiology has occurred previously in this
area, as reported in the following reference:
Sapkal GN, Bondre VP, Fulmali PV, Patil P, Gopalkrishna V, Dadhania
V, et al. 2009: Enteroviruses in patients with acute encephalitis,
Uttar Pradesh, India. Emerg Infect Dis. 15: 295-8 (full article
available at <http://www.cdc.gov/eid/content/15/2/pdfs/08-0865.pdf>)

Abstract
--------
An outbreak of viral encephalitis occurred in northern India in 2006.
Attempts to identify an etiologic agent in cerebrospinal fluid by
using reverse transcription-PCR showed positivity to enterovirus (EV)
in 66 of 306 patients. Sequencing and phylogenetic analyses of PCR
products from 59 of 66 specimens showed similarity with EV-89 and
EV-76 sequences.

A map showing the location of Indian states including Uttar Pradesh
in northeastern India can be accessed at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/india_pol01.jpg>.
A HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/00Hk>. - Mod.TY]

[see also:
Japanese encephalitis - India (03): (UP) RFI 20090819.2937
Japanese encephalitis - India (02): (UP, NL, AS) 20090818.2929
Japanese encephalitis - India (UP): susp, RFI 20090513.1789]
...................................ty/mj/lm

 

[Emily]

Re: Mystery virus kills 137 in UP since January, experts clueless

Re: Mystery virus kills 137 in UP since January, experts clueless

Archive Number 20090827.3015
Published Date 27-AUG-2009
Subject PRO/EDR> Japanese encephalitis - India (06): (UP)

JAPANESE ENCEPHALITIS - INDIA (06): (UTTAR PRADESH)
***************************************************
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: Wed 26 Aug 2009
From: Deborah Phillips <dphillips@path.org> [edited]


To offer some clarity regarding the recent reports of encephalitis
outbreaks in Uttar Pradesh (UP), Assam, and Nagaland, we would like to
share information we have gathered through our collaboration with the
Government of India.

Since January 2009, UP has recorded 665 acute encephalitis syndrome (AES)
cases. Samples were collected and tested for all cases, and 34 cases and 4
deaths were laboratory-confirmed as Japanese encephalitis (JE) All 4 deaths
occurred in unvaccinated children, 2 children among the surviving cases had
received JE vaccine. The National Institute of Virology continues to
investigate the cause(s) of other AES cases.

From 2006-2008, JE vaccination campaigns for children 1-15 years of age
were held in 27 districts in UP. This year [2009], campaigns in UP were
held in May in 7 additional districts: Allahabad, Pratapgarh, Fatehpur,
Kanpur (urban), Ghazipur, Jaunpur, and Shahjahanpur. The reported coverage
for the 2009 campaigns was 84.6 per cent.

In Assam, according to the Government of India, 109 AES cases were reported
from July-August 2009. Of these, 33 were JE cases, of which 10 adults and 5
children (all unvaccinated) died. Non-JE AES samples are being tested at
the Regional Medical Research Center to determine other etiologies, and
results are expected soon.

A total of 6 districts of upper Assam were covered in JE vaccination
campaigns held in 2006-2008, targeting children 1-15 years of age
(Dibrugarh, Jorhat, Tinsukia, Sivsagar, Golaghat, and Dhemaji). This year
[2009], campaigns were held in May in Lakhimpur (upper Assam), Sonitpur
(middle Assam), and Kamrup (lower Assam), with an overall reported coverage
of 74 per cent.

Nagaland was not included in the national government's initial plan to
target high-risk districts throughout the country. However, given the
recent outbreak situation, the Government of India is considering whether
to include additional states, such as Nagaland, Manipur, and Uttaranchal
for next year's [2010] JE vaccination campaigns.

--
Deborah Phillips
Communications Officer
PATH
USA
<dphillips@path.org>

[ProMED-mail thanks Deborah Phillips for this report, confirming Japanese
encephalitis (JE) virus as the etiologic agent responsible for some of the
AES cases, and providing information about the status of the Indian
government's JE vaccination campaign in this area. ProMED awaits with
interest information on the etiological agent responsible for the remaining
AES cases.

A map showing the location of Indian states including Uttar Pradesh in
north eastern India can be accessed at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/india_pol01.jpg>. A
HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/00Hk>. - Mod.TY]

[see also:
Japanese encephalitis - India (05): (UP) 20090826.3001
Japanese encephalitis - India (04): (UP) 20090824.2985
Japanese encephalitis - India (03): (UP) RFI 20090819.2937
Japanese encephalitis - India (02): (UP, NL, AS) 20090818.2929
Japanese encephalitis - India (UP): susp, RFI 20090513.1789
2008
---
Japanese encephalitis - India (08): (UP) 20081115.3609
Japanese encephalitis - India (07): (UP) 20081110.3542
Japanese encephalitis - India (06): (WB, UP) 20081017.3295
Japanese encephalitis - India (05): (UP) RFI 20081014.3260
Japanese encephalitis - India (04): (UP, AS) 20080923.3011
Japanese encephalitis - India (03): (UP), RFI 20080923.2998
Japanese encephalitis - India (02): (UP) 20080918.2924
Japanese encephalitis - India: (UP) 20080731.2345]

.................jw/ty/mj/sh