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Northern India and Nepal Watch

Sharpe

Senior Moderator
The situation in northern India and Nepal deserves attention. Over the last month, there has been a rising number of reports from the entire region of outbreaks of disease in which people are developing high fever, vomiting, diarrhea, respiratory distress, and at times, major mucosal bleeding, convulsions, encephalitis, and death. In several of the cases, doctors have been becoming sick, and in others, like Lucknow, the hospitals have become filled to capacity. The outbreaks have variously been blamed on Japanese Encephalitis and Dengue, but the symptoms and pattern of spread do not fit either--in fact the diagnoses almost sound like they are more based on the fact that it's September than what's wrong with the patients. Below are two reports from Lucknow on the situation at King George's Hospital today. Locations to watch closely in the coming days based on the number of reports in the past month include:
Lucknow, India
Surat, India
Kanpur, India
Bajura, Nepal
Nepalgung, Nepal
Nuwakot, Nepal

Dengue alert: Children falling prey in Old City
Maulshree Seth

Lucknow, September 1: About three days back, a 24-year-old resident of Vikas Nagar suffering from dengue was admitted to the King George’s Medical University (KGMU). Officials at the hospital’s paediatric department said they have been receiving at least two-three dengue cases every week at their OPD since July-end. Most of the cases are from Vikas Nagar, Thakurganj and other parts of the Old City.

Fearing a possible outbreak, the doctors are keeping a close watch. The chief medical officer, Dr K K Singh, said he has asked all the hospitals to send a daily report on the dengue cases from today. ‘’As per our information, only one case of dengue has been reported so far. If any hospital informs us about such cases in future, we are ready to take immediate action,’’ said Singh.

‘’This is the usual timing for outbreak of dengue. We are keeping a regular track of the cases coming in our OPD, as well as those admitted in the hospital. After discussion with experts, we found that the strain of virus found in and around Lucknow is more severe,’’ said Dr Rashmi Kumar, professor, paediatric department, KGMU.

‘’For instance, dengue cases in Delhi show routine symptoms like fever. The patients there have not been known to suffer convulsions or sudden contraction of muscles, like we have noticed here. Moreover, some dengue patients here have also shown symptoms of encephalitis, but we will be able to make definite conclusions only after the results of the PCR (polumerase chain reaction) tests come in.”

However, the reports of samples which were sent for PCR tests to the Sanjay Gandhi Post-Graduate Institute (SGPGI) have been pending for about a month now.


No bed at KGMU medicine dept yet again
Express News Service

Lucknow, September 1: On the one hand, the department of Medicines, King George’s Medical University, has been asked by the district health authorities to keep a record of the dengue patients, on the other hand, the department has again stopped admitting new patients. It is the second time in two weeks that the department has written to the incharge of the Trauma Centre of KGMU ‘‘not to send any new patients to them following the on-going contruction work at the department’’.

It is to be noted that the construction work has been going on for the past two months, following which, the entry of patients had been stopped from time to time. Today, attendants of patients, from not only Lucknow but adjoining districts of Hardoi and Sitapur also, could be seen pleading with the doctors to admit them, but were being asked to come on Monday, following a crisis at the Medicine department.

[FONT=Arial, Helvetica, sans-serif]Talking to Express Newsline, Santram from Hardoi informed, ‘‘My father has been suffering from continuous fever for the past one week. I took him to the district hospital, but they asked me to go to the KGMU. However, here I’m being told to come later. We have no place to put up in the city, thus I’m requesting them (doctors) to admit my father.’’ And Hazari Prasad, the father of Santram, was not the lone case to the point. [/FONT] [FONT=Arial, Helvetica, sans-serif]The sources at Trauma Centre informed that around 60 per cent of the patients who come to Trauma belong to Medicine, thus the crisis at the department was certainly causing inconvenience to the patients and their attendants, especially those coming from other districts. However, the officials of the department claimed they would soon solve the crisis and begin admitting new patients. [/FONT]
 
Re: Northern India and Nepal Watch

These stories of people vomiting blood are becoming concerningly common. This is not dengue. Mormugao handles 8% of all of India's port traffic. For more, read: http://www.mormugaoport.gov.in/newindex1.htm

http://oheraldo.in/node/18787
Dengue claims one more life in Vasco

HERALD CORRESPONDENT
MORMUGAO, SEPT 8 - Dengue is believed to have claimed its third victim in the port town, when a man from the Harbour area passed away in the GMC hospital on Thursday.
According to reports, Santosh Chowdhary, a native of UP, had been suffering from high fever since the past few days. A local doctor gave him medication and advised him to do a blood test.
Santosh, however, did not get his blood tested and it was only when he began complaining of fever and vomitted blood that he was rushed to the GMC hospital, where he breathed his last. Family members stated that Santosh had died due to dengue.
This is the third dengue related death of in Mormugao taluka, following the deaths of a young boy from Ashai Dongry and a police constable attached to Mormugao police.
 
Re: Northern India and Nepal Watch

First diagnosed with pneumonia then encephalitis...what does this have to do with Japanese Encephalitis or malaria? I'm sorry, it's not. It is PAINful to watch these outbreaks unfold. I hope someone is listening. This situation is very concerning. Below is also quoted from a month ago--you can see how it has escalated rapidly.

http://www.hindustantimes.com/news/5922_1791560,0015002500010000.htm
Suspected viral encephalitis, malaria raging in region

MALARIA and viral encephalitis epidemic has hit the rural Allahabad and adjoining districts with double intensity.

Shockingly, as many as 11 children died due to suspected viral encephalitis and other mosquito borne diseases at the Sarojini Naidu Children's Hospital here between September 1 and 8.

The worst affected area is Pratapgarh, where viral encephalitis has taken the form of epidemic. But the malaria department is yet to wake up from the apparent complacency.

According to the hospital records, 11 children including, Rahul of Kamla Nagar, Sushma of Civil Lines, Santoshi, Sujal, Anjana, Gyan, Lakshmi, Arjun and Manish died in the past one week due to diarrhoea, malaria, viral encephalitis and other mosquito borne diseases.

The SN Children's Hospital is also daily receiving a large number of 'brain fever' patients from Pratapgarh. The beds have become full and even two children share the same bed. Most of the parents are not even informed about the illness of their child, who could only tell that their kid was suffering from high fever, headache, disorientation, coma and seizures.

In the past two days, as many as three children suffering from suspected viral encephalitis and malaria from Pratapgarh district were admitted to Emergency Ward of the hospital. These are Mohini Devi (6) of Sonasaraiyan, Nitya Tripathi of Gaura and Manisha (2) of Lalganj in Pratapgarh. Barring Manisha, the other two children are still critical.

The other high fever patients who were admitted to the hospital in the past one week, include Sushil (6) of Kaudihar, Abhishek (five months) of Ballia, Radhika (eight months) of Hanumanganj and Kalicharan (5) of Mahewa Ghat (Kaushambi).

Father of three-month-old boy from Chitrakoot, said his son was diagnosed as suffering from pneumonia and later with brain fever. He was admitted to the hospital about five days back and is still not responding to the medicines, he said.

Meanwhile, the hospital is also turning away many patients owing to paucity of beds. A senior staff nurse said the number of suspected viral encephalitis and malaria patients have suddenly increased in the past 15 days. "Many staff are doing extra duty to manage these patients, as some of them are very serious.

However, the hospital is providing them all the medicines and other facilities," she said.

Additional Director (Allahabad Division) Dr GC Srivastava said it was a serious matter if a large number of suspected viral encephalitis cases were reporting from Pratapgarh. "The Pratapgarh health department will be asked to send the details of all the malaria and encephalitis patients. The matter will also be inquired at every level to identify the loopholes in malaria control programme," he added.

UNDIAGNOSED DEATHS - INDIA (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: 9 Aug 2006 18:28:36 -0000 From: Manmath Mishra <mishramanmath@rediffmail.com> Today I was watching TV when I came to know that some mysterious disease has taken place in the Koraon block of Allahabad district, UP, India, and so far it has caused a few deaths, and one patient has been admitted to T.B.Sapru Hospital, Allahabad, UP, in critical condition. The disease is as yet undiagnosed. -- Dr.M.N. Mishra <mishramanmath@rediffmail.com> [India must be the world champion for undiagnosed diseases -- since 1999 ProMED has posted 67 reports of undiagnosed outbreaks in humans and animals there (human outbreaks listed below -- note reports from Uttar Pradesh state in 2002, 2004 & 2005). In a few cases these have eventually been diagnosed as Japanese encephalitis, Kyasanur Forest disease or Chandipura fever, but in most cases no final diagnosis came to the ears of ProMED. We encourage our readers to follow Dr Mishra's example and send us news of outbreaks -- and especially of the final diagnosis, when known. - Mod.JW]
 
Re: Northern India and Nepal Watch

Watch for illness reports in health care workers in the hospitals. That might be a signal for something other than a mosquito borne disease.
C R
 
Re: Northern India and Nepal Watch

Very good point, CR. That is why this report from the neighboring area 2.5 weeks ago is so concerning.


August 19 WITH THE death of a woman due to encephalitis and several children hospitalised with other complaints, the city seems to be in the grip of epidemics. A resident doctor at Ganesh Shanker Vidyarthi Memorial Medical College was also reported to be suffering from palsiparum malaria here today. He was admitted to the ICU of the medicine ward of the medical college following deterioration in his condition. The situation was so bad at Hallet hospital that several patients could not be shifted to ICU wards for want of beds. According to reports, Sarita (50) was admitted to the ICU of the medicine ward under Dr Arti Lalchandani, following complaints of high fever and several fit attacks. Her tests had indicated that she was suffering from encephalitis. However, she succumbed to the disease today. Similarly, a resident doctor of the medical College hostel complained of vomiting and was rushed to the ICU of the medicine Ward. The doctor treating him confirmed that he was suffering from palsiparum malaria. According to the doctors, his condition was still critical. Reports said several other junior doctors were also suffering from viral fever. Meanwhile, another encephalitis patient was admitted to bed no 2 of the ICU of the medicine ward today. In the pediatric department of the GSVM Medical College, there was a continuous flow of children complaining of various diseases. According to reports, Avinash (6), son of Gyani had been admitted under HoD Dr VN Tripathi. Similarly, Pranshu (1), son of AN Shukla of Babupurva, Farhan (7), a resident of Nawabganj, Devnarain (5), Rajan (9), Lalit Kumar (3), Arjun (8 month), Shruti (three-and-a-half-years) had been admitted to hospital as they were suffering from epidemic diseases, confirmed the doctors attending them.
 
Re: Northern India and Nepal Watch

Christian Rivers said:
My thoughts exactly, CR. While everyone's focus is on Indonesia (and rightly so), the most deadly strains are evolving in India. Qinghai was it's first offspring. This second, encephalitis-causing strain in Uttar Pradesh, when it gets a good hold of human transmission, as it appears to be doing with those doctors, is going to be the worst of all. Note to everyone: I am only speculating.
 
Re: Northern India and Nepal Watch

I found this article interesting:

HC [High Court]Takes Serious Note of Japanese Encephalitis

06 September, 2006

The Allahabad High Court today took serious note of the Japanese Encephalitis (JE) affecting thousands of children in Eastern Uttar Pradesh.

The court has directed the Principal Secretary of Medical and Health, and the Director General of Medical and Health of the UP government to appear before the court on September 12 with a detailed report in relation to the steps taken in the matter.

The order was passed by Justice Sunil Ambawani hearing a contempt petition filed by Rajesh Kumar Srivastava of Varanasi.

The court observed the reports submitted by expert doctors, who doubted the disease to be either JE or Cox Rackie Encephalitis, a viral infection, which incubates in pigs and is carried by mosquito in paddy fields to rural areas.

The experts have also recommended to set up the labs either at SGPGI, Lucknow or BRD Medical College in Gorakhpur for identifying the virus. But these recommendations were not taken into consideration, the court said.

The Right to Health is a basic human right guranteed under Article 21 of the Constitution of India and the government, which ignores this right and allows its children to die, does not have a right to continue even for a day, the court added.

Passing the order, the court said the medical institutes have not yet completed studies to recommend standardised treatment for either of these infections.

The state government has not yet provided them with sufficient funds and there are no equipped laboratories to isolate the strains and to identify them.

(UNI)


Copyright ? 2006 Indlaw Communications Pvt. Limited. (ICPL).
All rights reserved.
ICPL shall not be liable for the adequacy of the information, any mistakes, in accuracies or improper display of content and for any actions taken in reliance there on.
http://www.indlawnews.com/A15B3DBF5A4FE1528BA1E68DC21F4D6A

uttarpradesh-location-map.gif
http://www.mapsofindia.com/maps/uttarpradesh/uttarpradeshlocation.htm
 
Re: Northern India and Nepal Watch

You know, Niko, every day I say to myself, "Sharpee, don't worry, countries just don't let their kids die from unidentified epidemic diseases indefinitely, without at least sending someone, anyone a sample. Sooner or later, someone decides to do something, anything. And every day, I look at the news again, and it's bigger, and more hospitals are filled up two to a bed, with dying kids and sick doctors, and I try to comfort myself again." I'm beginning to come to the grim reality however that the only time this disease will be identified is when it has reached thousands of kids in other countries who do test it. The whole of India has one lab, and by the sounds of it, it's overwhelmed, underfunded, overworked, and has terrible samples to work with.
 
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Re: Northern India and Nepal Watch

Sharpe said:
You know, Niko, every day I say to myself, "Sharpe, don't worry, countries just don't let their kids die from unidentified epidemic diseases indefinitely, without at least sending someone, anyone a sample.....
Well, we can all hope and dream :rolleyes: I'm with ya! Just came across an editorial piece in a pedriatric publication from 2003 about a "mystery disease". Same old, same old...here are some snippets:

Media reports on mystery disease in 2003

Recently a number of outbreaks of what is often called ‘mystery disease’ or disease caused by a ‘mystery virus’ has been reported in India, in newspapers and newsmagazines. The most recent outbreak was in May to July 2003, occurring in various districts of Andhra Pradesh (AP)(1,2). In one magazine it was reported that 79 (53%) among 148 ill children died due to the ‘mysterious disease’(1). Apparently a similar outbreak with high fatality occurred in the neighboring region of Maharashtra also. The number of children who died in these outbreaks was 116 in AP and 54 in Maharashtra(2). Although suspected to be viral encephalitis, on investigation only 3 children were found to have recent infection with Japanese encephalitis (JE) virus in AP, and the Maharashtra outbreak was "proved JE negative", thus excluding JE as the outbreak disease in either State(1,2). Therefore, the disease was undiagnosed, hence called ‘mysterious’ by the media.
....
Children affected with the ‘mystery disease’ died within one day, which does not happen in JE. It was reported that the "health officials feel the epidemic is similar to the ‘mutant measles viral’ outbreak that plagued Warangal last May-June"(3).
...
The clinical picture of illness.

The reports on the clinical picture of the disease in the media are as follows. "Almost all children who died were in the 2-12 age group and death came within 36 hours of their hospitalization"(1). "Diarrhea followed by high fever, convulsions and then irreversible coma are some of the common symptoms of this killer disease"(2). "Most alarmingly, children…..have been succumbing within 10 to 12 hours". "The mortality rate has been almost 60%"(2).
......
It is generally accepted that at the time of onset of the illness no particular infection is involved in the pathogenesis. Evidently, there is no ‘encephalitis’ and it is not a CNS infection, although many clinicians have conflated encephalitis with the acute encephalopathy and this confusion persists even today, as illustrated in Saharanpur (2002), AP and Maharashtra (2003). However, an infectious disease in the preceding two weeks appears to be a common feature if history is taken carefully. In most instances it is an upper respiratory disease. Two specific infectious diseases are associated with the development of Reye’s syndrome - chickenpox and influenza due to type B virus. In the vast majority of the Indian cases the history of preceding illness was not sought or reported.
When diagnosis and treatment is solely reliant upon clinical observation and common practices coupled with lack of funds and labs, this is what you get I suppose. :(

Added link: http://www.indianpediatrics.net/sep2003/sep-863-869.htm
 
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Re: Epidemic Hazard - North America -Early flu season

Re: Epidemic Hazard - North America -Early flu season

http://visz.rsoe.hu/alertmap/woalert_read.php?id=7585&cat=dis&lang=eng

Epidemic - Asia
Event summary

GLIDE Number EP-20060914-7585-NPL
Event type Epidemic Date / time [UTC] 14/09/2006 - 11:55:04 (Military Time, UTC)
Country Nepal Area -
County / State Dadeldhura district City Jogbudha
Cause of event Unknow Log date 14/09/2006 - 11:55:04 (Military Time, UTC)
Damage level Large Time left -
Latitude: N 29? 15.000 Longitude: E 80? 25.000
Number of deaths: Not or Not data Number of injured persons: Not or Not data
Evacuated: - Infected 1000
-

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

DESCRIPTION
More than 1000 people are suffering from various diseases including malaria, typhoid and viral influenza at remote Jogbudha village of Dadeldhura district in far-west Nepal, local media reported on Thursday. "Above 1000 people are suffering from these diseases at a dozen areas including Sadani, Bhaurkunda, Karali, Tatapani, Lamigada and Jamerani of the village, some 700 km west of Kathmandu," Nepal Samarchar Patra, a Nepali language daily reported. "The condition of most of the patients is upsetting," the daily quoted a health worker Hikmat Bahadur Dhami, as saying. "We also don't have adequate medicines for treatment," he added. "As many as eight people of single family are suffering from the diseases," Dhami said, adding the number of patients has increased due to lack of timely medical intervention. Mandhir Singh Bhandari, former village chief of Jogbudha said that nobody remained there to help the patients in some cases when the entire family members turned sick. People also failed to go to neighboring Indian cities including Tanakpur, Poligunj and Pilbhit for treatment due to rising water level in the Mahakali river that separate the two countries. District Health Office of Dadeldhura said that it had already sent additional medical team to the village with medicines.
 
Re: Epidemic Hazard - North America -Early flu season

Re: Epidemic Hazard - North America -Early flu season

This is all very concerning.
 
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