Outbreak of meningitis/encephalitis in Sri Lanka hospital

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http://www.tamilnet.com/art.html?catid=13&artid=29807

Disease outbreak keeps UN staff away from Vavuniyaa hospital
[TamilNet, Sunday, 19 July 2009, 02:14 GMT]
Vavuniya-based United Nations staff providing relief services to the Internally Displaced People (IDPs) has been advised to keep away from the Vavuniya General Hospital due to an outbreak of meningitis and encephalitis, health officials in Vavuniyaa said. The UN warning to staff came amidst reports that hospital employees at Vavuniya had failed to inform authorities of the outbreak, the Sunday Times reported. Dr. Hemantha Herath, Health Coordinator of the IDP camps, told the newspaper, ?It is only now that we are getting a regular feedback from the hospital. They have not done in-depth investigations into these cases.?

Encephalitis is an acute inflammation of the brain. Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Also, encephalitis with meningitis is known as meningoencephalitis.

Over the past week 14 new encephalitis cases were detected in the hospital.

The World Health Organization in a report has pointed out that while the fatality rate of meningitis cases treated in all government hospitals in Sri Lanka from 2000 to 2005 has dropped to less than five percent, the fatality rate in the Vavuniya General Hospital was about 50 percent.

A team sent by the Health Ministry is studying the causes for the outbreak of these diseases.

Meanwhile, according to a latest UN report, diarrhoea and hepatitis A are still prevalent in some of the IDP camps.

Dr. Herath said the number of cases of diarrhoea and hepatitis A was not going down and they were closely monitoring the situation.

According to the report, health care, water distribution and supply of food items still need more attention. The report has warned of the effect the approaching rainy season might have on the camps, especially in low-lying areas. It has called for an improved drainage system and shelters before the rainy season begins.

The paper also reported that there is a shortage of complementary food items in the camps as NGOs which were supplying such items are pulling out.

The report said there is not enough suitable land to build more toilets. The camps currently have only about 9,215 toilets while 15,000 are needed.

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

This article is about a week earlier.

http://www.tamilnet.com/art.html?catid=13&artid=29776

Colombo doctors to investigate outbreak of meningitis, encephalitis in Vavuniyaa
[TamilNet, Sunday, 12 July 2009, 17:29 GMT]
Six medical officers from Colombo are scheduled to visit IDP camps which are described as internment camps by human rights agencies in Vavuniya tomorrow to investigate a suspected outbreak of meningitis and encephalitis, reported from the Vavuniyaa General Hospital. Meanwhile the Government Medical Officers Association (GMOA) has charged that a severe shortage of nurses and pharmacists in the Vavuniyaa camps is compounding health problems there.

Reports further say while 65 adults are suffering from either one of the ailments, 35 have died so far. Several displaced children at the Vavuniyaa General Hospital too are suspected to be suffering from the two illnesses.

More than 1200 IDPs are receiving treatment at the Vavuniyaa Hospital, for different ailments, currently.

The Health Ministry could not confirm the number of deaths, however a high ranking official in Colombo who did not want to be quoted admitted that the fatality rate in cases such as meningitis is high as it affects the brain. "Fatalities are high in such cases, but there is nothing to be alarmed about these figures as they are normal when compared with the population of IDPs we are dealing with," he said. The Ministry official also said the problem has been in existence in the camps over the past three to four months, according to Colombo media reports.

?This issue has been going on for some time now but the hospital does not have the expertise to diagnose the cause. The deaths occurred during the past three to four months,? he said.

?The medicines are quite expensive but nevertheless we have taken steps to send the needed supplies,? he said. According to this ministry official there are only 20 nurses serving all the camps and 80 doctors on duty at the medical centres.

?There were no nurses yesterday. We only saw one nurse and she too came from outside with a team of doctors. We need about 120 doctors and at least 300 nurses in the camps. At the Chettikulam hospital there are 130 children receiving treatment and there is only one doctor but no nurses. How can one doctor look after all the patients?? asked Dr. Upul Gunasekara, spokesperson of the GMOA. The Director of IDP Health Care heading the IDP Health Coordination Centre at Chettikulam, Dr. Hemantha Herath admitted that they were short of staff at the health centres. According to him the problem is mainly during the day, as nurses and doctors are brought from other hospitals for the night shifts.

The ministry is planning to send a batch of 300, recently qualified nurses to the camps in two weeks time. ?We are planning to give permanent appointments to these nurses in hospitals in Vavuniya, Mannar, Chettikulam and the IDP camps. Until then we will be sending small batches of nurses to serve in the area,? Dr. Ajith Mendis the Director General of Health told Colombo media.

The Ministry also dismissed allegations that there was insufficient number of pharmacists working in the camps.

However the GMOA alleges that the Ministry had no clear plan on how to handle the growing crisis at the camps.? The ministry has no plans to send nurses to these camps and the people are just criticizing the doctors who are working there. The doctors are frustrated with the situation,? Dr. Gunasekara said.

He also alleged there were severe lapses in the administration of health matters at the IDP camps. According to Dr. Gunasekara the doctors working at the IDP camps are not paid overtime, although doctors working in area hospitals are paid. Further, he claimed that there were no proper lodging facilities for the IDP camp doctors although the GMOA had raised the issue many times.

?These doctors have not visited their families in weeks as they live in the area and serve the people. But they do not even receive any overtime payment,? he said.

Meanwhile the Regional Director of Health Services (RDHS) of Vavuniyaa Dr. M. Mahendran said they were facing a problem of insufficient funds to make overtime payments to these doctors.? We have exceeded the provincial budget for health. I have been advised by the ministry to pay only four hours of the seven hours of overtime the doctors? work. I have to stick to these instructions,? he said.

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

The figures in this article include deaths due to all causes, but the bold text is telling.

http://www.dailymirror.lk/DM_BLOG/Sections/frmNewsDetailView.aspx?ARTID=55137

Health officials reject British media reports



By Sandun A Jayasekera

The World Health Organization (WHO), the Health Ministry and the medical fraternity yesterday rejected allegations by two leading British newspapers -- The London Times and The Daily Telegraph that some 200 refugees were dying daily due to poor sanitation and disease at welfare camps in the North.

They charged that a section of the international community with the connivance of certain local groups was attempting to tarnish Sri Lanka?s image with falsehoods about the situation in IDP camps at Vavuniya.

WHO country representative Dr. Firdozi Mehtha rejected the news reports that appeared in The London Times and The Daily Telegraph on July 10 and said the news items were totally incorrect and misleading.

?There is no such dreadful situation at the IDP camps in Vavuniya. The government is doing its utmost to provide maximum healthcare facilities. The WHO is satisfied with what the Sri Lankan government is doing though much more needs to be done. But this is understandable in such a situation,? Dr. Mehtha told a news conference at the Ministry auditorium.

Health Secretary Dr. Athula Kahndaliyanage said the Ministry was unaware as to when or how the British newspapers carried out a study to obtain this information.

?Our figures which anyone can verify say otherwise. There were only 163 deaths between June 15 and July 14. The maximum number of deaths reported from among an IDP population of 365,000 at 22 camps in Vavuniya was 11 on July 7. The deaths reported on other days during this period are less than 10 with the lowest being two reported last Tuesday,? Dr. Kahandaliyanage said.

He said the e mails going round locally and internationally quoting The London Times and The Daily Telegraph figures are prove there is a mudslinging campaign against Sri Lanka and added that the government was satisfied with the healthcare delivery system at the camps.

Sri Lanka Medical Association President Dr. Rizvi Sheriff said the National Steering Committee for IDPs regularly monitored health problems at IDPs camps and made recommendations to the Ministry on curative and preventive measures to be adopted.

?There is room for improvement. But the government is doing a commendable job to maintain satisfactory health and nutrition levels among the IDPs and especially among women and children. Medical assistance and nutrient supplements are regularly provided to children and mothers. The government is also constructing an additional 1,000 toilets,? Dr. Sheriff said.

Colombo Chief JMO Dr. Ananda Smarasekara said all deaths are reported to the nearest Police Post or Police Station indicating the name of the diseased, cause of death and the place.

?A doctor checks the body just after a death is reported and decides whether an autopsy is necessary,? Dr. Smarasekara said.

He said the main causes of deaths at the camps were heart diseases, diarrhoea, myocardial infraction, pneumonia, kidney diseases and diabetes, asthma and hypertension.

Dr. samarasekara said nearly all those who have fallen ill appear to have contracted their ailments during the war and while living in un cleared areas and were suffering from malnutrition at the time they crossed over to the liberated areas.

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

On second thought, this thread maybe should just be "Outbreaks of many diseases in camps in Sri Lanka", as there is a lot more here than meningitis and encephalitis.

http://www.monstersandcritics.com/n...loom_for_Sri_Lankas_displaced__News_Feature__

Health issues loom for Sri Lanka's displaced (News Feature)
South Asia Features
By Anthony David Jul 20, 2009, 4:32 GMT



Colombo - Scorching sun, swarming flies and dusty terrain greet visitors to camps in northern Sri Lanka where tens of thousands of civilians are housed after being displaced in the country's civil war.

Flies are rampant and hygiene is a life-threatening issue, a visitor to the camps told the German Press Agency dpa. 'The flies are so infinite we saw merchants sitting inside makeshift nets selling things.'

Toilet facilities are also inadequate. 'In one camp we saw some of the tents been removed and the area used as open defecating areas. On both sides of the road you could see human waste,' the report added.

A United Nations report on the conditions in the camps said there were currently only 9,215 toilets, less than the required 15,000.

More than two months have lapsed since the government declared victory over the Tamil rebels, but government authorities, UN agencies and aid groups are still struggling to provide facilities for the 280,000 refugees in the camps.

Most of the camps are located in Vavuniya, 254 kilometres north of Colombo, where jungles were cleared for tents and temporary shelters, with three to four families sharing each shelter.

UN agencies, as well as local and foreign non-governmental workers who were initially granted only restricted access, are now allowed into the camps, but the government still controls their movements.

While the latest UN statistics state some improvement over the past weeks, health concerns prevail, with cases of diarrhea, meningitis, encephalitis and chickenpox reported.

'The government may be trying to do its best, but the best seems to be not sufficient in these camps,' said an NGO worker, who asked not to be named.

Dr Hemantha Herath, health coordinator of the camps, confirmed that diarrhea and encephalitis are still prevalent.

Over the past week, 14 new encephalitis cases were detected in a hospital where the displaced are being treated, he said.

A medical officer working with the authorities providing relief services, who asked to remain anonymous, said there was a also a noticeable number of people suffering from some form of depression.

'Many have complained of lack of sleep, body pains and headaches. These are early signs of depression,' the doctor said.

Dr Vasana Kiridana, the consultant paediatrician of Vavuniya hospital where many of the displaced are being treated, said nearly 20 per cent of the refugees are children and many of them suffer from malnutrition, a result of living under difficult conditions.

'Acute malnutrition due to severe starvation has been identified as a major health concern. A significant proportion of these children are suffering from extreme malnutrition which requires in-hospital care with meticulous monitoring and feeding to save their fragile lives,' Dr Kiridana said.

However, government authorities in charge of the refugees' welfare are also concerned with security issues and funding challenges.

Most of the camp inmates have been living in areas controlled by the rebel Liberation Tigers of Tamil Eelam (LTTE) for over two decades. Some are relatives of killed rebels, while others may have been active rebels.

The security forces continue their screening process and already some 10,000 people said to be LTTE fighters have been segregated to undergo rehabilitation while others are to face court charges.

Sri Lanka's government spends 245,000 dollars a day to feed the displaced, not counting the costs of other facilities, amounting to a major drain on the island's finances.

Colombo has reiterated plans to resettle more than 80 per cent of the displaced before the end of the year in their original villages, but NGO workers say it will be a difficult task as some of the areas still need to be cleared of landmines.

Government and aid workers appear to be caught in a dilemma over whether to improve the shelter conditions or focus on the resettlement programmes.

Some of the refugees were driven from their homes almost two decades ago and have been living in camps with little hope for return since. However, with the end of the war, their chances for resettling in their home villages seems to have improved.




Read more: http://www.monstersandcritics.com/n...ankas_displaced__News_Feature__#ixzz0Lv5k6tJU

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

UH-OH!! If the military is locking down the hospital, we may have a problem. This one bears closer watching.

http://www.tamilnet.com/art.html?catid=13&artid=29825

Vavuniyaa hospital security tightened
[TamilNet, Tuesday, 21 July 2009, 17:15 GMT]
The deployment of Sri Lanka Army (SLA) soldiers at Vavuniyaa general hospital has been suddenly stepped up from Monday. SLA soldiers and police personnel are seen in every nook and corner of the hospital monitoring movement of each individual, civil sources say. All the entry and exit points of the hospital have been placed under the strict surveillance of the Sri Lankan forces.

Public Vehicle Park also has been placed under the strict supervision of the security forces.

Even the activities of normal clinics and out door patient department are being monitored by the security forces.

Civil sources say that patients and relatives of patients warded in the hospital fear to enter the hospital due to the sudden influx of more military personnel

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

And this disease is viral, as they are treating patients with antibiotics, and still over half are dying. Not good.

http://helpsrilankasdisplaced.com/Current-Needs.html

We write with some urgency as we have just confirmed that 65 adults at Vavuniya Hospital have contracted either meningitis or encephalitis, resulting in 35 deaths already. We cannot confirm the number of infected children, but there are several.



Currently, the outbreak is confined to Vavuniya Hospital, where over 3000 patients are currently being treated in overcrowded conditions. If any of those patients are discharged, they will go to Menik Farm (220,000 IDPs) and then we will have an even bigger human catastrophy on our hands.



We are liaising constantly with the doctors in charge of the hospitals and Menik Farm Zones. Due to an oversight, the Ministry of Health was unaware of the impending crisis until now. We trust they will send a team of specialists asap.



Regardless, Vavuniya Hospital is treating each infected patient with a cocktail of intravenous injections (administered twice) comprising of Meropenum, Vancomycin & Acyclover.


The desease is transmitted by viruses. Viral Flu, Chicken pox and other viruses are out of control at the camps.



We need to buy these drugs at Rs.2000 per shot, so Rs.4000 (less than $40) per infected patient. We would appreciate any donation you can give us toward this asap. Alternatively, you may purchase the drug and we will transport it personally, as always.



Please contact Thamara on 0779128020 or thamara@actlanka.org if you have any queries.



We will have a credit card gateway on our website in the next couple of days, making it easier for overseas members.



Meanwhile, all monies received are being directed toward medicines to Menik Farm, Cheddikulam, Puvarasikulam and Vavuniya Hospitals. In addition we are building a community centre and have facilitated 112 houses for IDPs.



Please treat this request as urgent. We hope the Ministry of Health will notify the media shortly.

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

This one suggest JE as a diagnosis, but JE is not contagious. The military presence is unusual for a JE outbreak, although I'm not sure whether the military presence is to quarantine the hospital, or protect the doctors from angry people.

http://www.island.lk/2009/07/22/news4.html



Thirteen patients suffering from Dengue and Japanese Encephalitis have been admitted to the Vavuniya Hospital.

According to Hospital sources this is the first time seven dengue patients have been admitted on a single day. Following this, steps have been taken to conduct blood checks on all patients seeking treatment with a history of fever.

The public complain that health authorities in Vavuniya failed to adopte proper measures to contain the spread of dengue.

 

[Rwilmer]

Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

Wouldn't treating with antibiotics mean this disease is bacterial? What do you think the disease is, alert?

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

I think Nipah is possible, given the symptoms. the location, and the CFR. The CFR is too high for JE, even in the poor conditions of the camp. The fact that the antibiotics don't work means that it isn't bacterial. I'm not sure what this is, but the high death rate and possible military quarantining of the hospital are alarming signs. If this is Nipah, this could be very ugly given the crowded and unhygenic conditions in the camps.

 

[Rwilmer]

Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

Srilanka is having a very bad year with dengue, I think dengue should remaina possibility here:

Dengue fever claims 190 lives in Sri Lanka


www.chinaview.cn 2009-07-21 19:52:55 Print

COLOMBO, July 21 (Xinhua) -- The number of dengue deaths has risen to 190 while more than 18,452 cases have been reported in Sri Lanka so far, government officials said on Tuesday.

The Department of Government Information said in a statement that the majority of these cases have been reported from areas like Gampaha, Kegalle, Kandy and Colombo.

As part of the efforts to control Dengue fever, two Dengue specialists from Cuba arrived in the capital Colombo on Tuesday to help health officials to handle the fast spreading Dengue epidemic in the island, the statement said.

Health officials said of the 18,452 cases the highest number of patients was reported from June, totaling 7,005.

This represents a sharp increase as 4,156 dengue cases and 85 deaths were reported for the whole year of 2008.

Government officials said dengue virus has hit countrywide this year affecting mostly the youth, many of them being students.

The rapidly rise in the level of the epidemic has forced the health authorities to carry out extensive public awareness campaign to eradicate the mosquito based epidemic.

Households have been warned to keep the environment free of mosquitoes. Those who allow the mosquitoes to breed by allowing stagnating water face prosecution with a special hotline being made available for public information.

The World Health Organization said some 2.5 billion people, two fifths of the world's population, are now at risk from dengue and estimated that there may be 50 million cases of dengue infection worldwide every year.

http://news.xinhuanet.com/english/2009-07/21/content_11746172.htm

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

Oh, there is dengue there, and hepatitis, and chickenpox, and just about everything you can imagine. But none of those illnesses would cause a viral meningitis or encephalitis.

And not to scare anyone, but in the past couple weeks there have been globablly about half a dozen outbreaks of meningitis/encephalitis of unknown etiology (Mukumbi, Seremban, Malacca, Neno/Tsangano, Vavuniya...). And some of them (although not this one) have occurred in places with good laboratory facilities to diagnose things.

 

[Rwilmer]

Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

Could H1N1 be a possibility? A mutated version of it?

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

Possible, but unlikely. Seremban and Malacca are in Malaysia, which has detected plenty of H1N1. They would have detected it if it were present in their meningoencephalitis cases.

 

[Rwilmer]

Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

In any of these menigittis cases, was menigittis confirmed? Could we have a mutated drug resistant menigittis outreak worldwide?

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

If by meningitis, you mean meningoccoal, NO. That is the problem. Some of the outbreaks have shown inflammation or infection in the brain, but no meningococci were found. No known pathogens have been isolated from any of these outbreaks AFAIK.

 

[Rwilmer]

Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

So you think we have this mystery virus circulating worldwide and it is going to kill us all?

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

That's a bit extreme. I don't know what's producing these outbreaks. Very few of them can be confirmed as spreading person-to-person. This could be a pathogen that is common in animals or is waterborne or mosquito or tick-borne. That would explain the sporadic nature of these outbreaks. They don't all seem to have the same CFR either. Malacca was one fatality in over 100 cases. Vavuniya seems to be over 50%. I'm not sure what's going on here, but it definitely bears closer watching (and maybe more intervention on the part of the WHO and other related authorities). I know the WHO has been working on the outbreaks in Neno/Tsangano, as well as the one in Mukumbi.

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

I'm wondering if I shouldn't make a separate thread for all these cases/clusters to bring all the information in one place.

 

[Rwilmer]

Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

Duplicate

 

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Re: Outbreak of meningitis/encephalitis in Sri Lanka hospital

Your post #19 is a duplicate of my post #3.