Sindhuli, Nepal: Undiagnosed Disease - 6 Dead/150 sick (High Fever, Vomiting Blood, etc)

[Shiloh]

Source: http://www.myrepublica.com/portal/index.php?action=news_details&news_id=8421

Sindhuli deaths "not due to diarrhea"


REPUBLICA
KATHMANDU, Aug 9: The Epidemiology and Disease Control Division has asserted the five deaths caused in Kalpabrikshya and Kyaneshwar Village Development Committees (VDC) in Sindhuli districts are not due to diarrhea as was reported by certain sections of the media.

?The deaths in the last couple of days are due to a yet to be confirmed disease that causes very high fever, severe headache, difficulty in breathing, and bleeding from mouth and nose and discharge of blood in cough, and not due to diarrhea,? acting director of the Epidemiology and Disease Control Division Dr Bishwa Raj Khanal said quoting his district officers.

Dr Khanal said that a team from district headquarter reached the area Saturday itself and confirmed that the deaths were not due to diarrhea. ?We have sent a team (by road) from Kathmandu this morning for laboratory tests to diagnose the disease which looks like Japanese encephalitis, dengue malaria or leptospyrosis,? Dr Khanal said.

Another team also flew to the area late in the afternoon to control the situation while the health ministry has also requested the World Health Organization (WHO) to send its surveillance medical officer based in Janakpur to Sindhuli.



Published on 2009-08-09 17:52:07

 

[Dark Horse]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

This is very scary news. It looks from this news article like H1N1, especially the part about the headaches. It is disturbing to see quarantines in China for an alleged plague, similar mysterious fever in Tajikistan (spelling?). These outbreaks must be very carefully monitored. You can just imagine how many flawed new flu diagnostic kits they have available in Nepal and Tajikistan and expert medical people to do any testing.

 

[Jeremy]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

The reports coming out of Nepal for the past 3 months have been very disoncerting. There has been a supposed Diahhrea outbreak for a couple of months that has been killing a lot of people. However, there have also been sporatic reports of odd deaths (including pregnant women) that have had me on edge a bit more than usual.

Like I said in the thread about August, we have to be seriously looking into these diahhrea & meningitis outbreaks more than usual. In 1918 the flu looked like many different diseases and then it came in strong with a hemorhaggic component.

Keep your eyes open and alert.

 

[Rwilmer]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Yes the hemoraging component seems to be in Liberia also. We seems to so far have 3 outreaks here with hemoraging.

 

[Jeremy]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

http://www.nepalnews.com/main/index...five-lives-in-sindhupalchok-in-two-days-.html

Five persons have died in Marin area of Sindhuli district in the last two days due to a disease that was not immediately identified, health officials in Sindhuli say.

The number reached five after a thirteen-year-old girl Sun Maya Ghalan of Kalpabrikshya VDC-9, Sindhuli died Sunday due to the disease.

Similar disease had claimed two lives each in Kalpabrikshya VDC and Kyaneshwar VDC Saturday.

Those killed due to the disease on Saturday are Raju Lama and four-year-old Reeta Nepali of Kalpabrikshya VDC, and Bhakta Bahadhur Bishwakarma, 55, and Kali Maya Bishwakarma, 42, of Kyaneshwar VDC.

Although, initial reports said they had died due to diarrhea, a team of health workers who reached the area has confirmed diarrhea was not the cause of the deaths, according to district health officer Binaya Manandhar.

Manandhar informed, the patients showed symptoms like high fever, bleeding from nose and mouth and difficulty in breathing.

More than 150 people have been affected by the disease in the area. A health team has been deployed in the area. nepalnews.com

 

[Jeremy]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Hmmm,

Seems to be affecting all ages.

4 year old
13 year old
42 year old
55 year old

And it looks like 150 people are currenlty affected by this disease.

 

[Jeremy]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

http://www.kantipuronline.com/kolnews.php?&nid=208712

Kantipur Report
SINDHULI, Aug 9 - [FONT=Georgia, Times New Roman, Times, serif]Two more persons died from high fever and several others have fallen ill in Sindhuli district. With this, the death toll from the unidentified disease has climbed to five.
In the latest incident, Sunamaya Than, 13, of Gyaneshwor VDC-9, died this morning, while Kalimaya BK, 42, died last evening. They succumbed to their illness on the way to hospital after they had a high fever and started to vomit blood.
Earlier, three persons, including minors, have died in two Vices of Marinchhetra following the spread of diarrhoea and high fever.
According to Binaya Mahanandar, a senior public health officer at the District Health Office, a team of health workers from Kapilakot health post have reached the affected region and intensified the treatment.
The health workers informed that the disease has taken its toll on huge number of people.
[/FONT]

 

[Rwilmer]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

HHMM, seems to have flu-like symptoms with hemorhaging. Could this be a mutated swine flu?

 

[Jeremy]

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

Re: Sindhuli, Nepal: deaths "not due to diarrhea"

HHMM, seems to have flu-like symptoms with hemorhaging. Could this be a mutated swine flu?

Anything is possible. The next couple of days will tell the tale.

A WHO team is on the way, and if the deaths start to spike in Sindhuli in the next couple of days or this week we will know that something is up.

 

[Shadmin]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Makes me wonder if it could possibly be more cases of pneumonic plague due to the proximity to China and the respiratory component? I am not saying it is impossible to be influenza but it strikes me as something different like an Arenavirus or a Nairovirus like the virus that causes Crimean Congo Hemorrhagic Fever? It could even be a new virus which we have never seen before? Until we get some test results which will hopefully solve the mystery we don't know I guess? Scary disease with the hemorrhagic and respiratory components? Respiratory symptomology is always worrisome with any new/unknown disease due to the potential for human to human transmission as well as potential lethality. I wonder if the victims are literally "crashing" and bleeding out? This could suggest a lethal viral hemorrhagic fever on the same level as some of the known VHF viruses such as Ebola, Lassa, CCHF etc.? It should be interesting once more information concerning the disease becomes known?

 

[Jeremy]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

http://www.myrepublica.com/portal/index.php?action=news_details&news_id=8469

Govt yet to identify Sindhuli disease

KATHMANDU, Aug 10: The government has yet to confirm the cause of five deaths in Kalpabriksha and Kyaneshwar VDCs in Sindhuli district more than a week after the first death.

The Epidemiology and Disease Control Division, which on Sunday said that the deaths were not due to diarrhea, on Monday said the disease was not malaria either.

?It can either be dengue fever or leptospirosis. Today, we have sent another team to the area with dengue kit and the report is expected soon,? Dr Pranaya Kumar Upadhyaya at the Epidemiology and Disease Control Division said.

Upadhyaya said there are currently 38 patients of the unidentified disease. Two are being treated in critical condition.

The disease is characterized by very high fever, severe headache, difficulty in breathing, bleeding from mouth and nose and discharge of blood in cough.

A team each from Kathmandu and Janakpur were sent to the area on Sunday while a team from district headquarters had reached the area on Saturday.

 

[HenryN]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

http://www.myrepublica.com/portal/index.php?action=news_details&news_id=8469

Govt yet to identify Sindhuli disease

KATHMANDU, Aug 10: The government has yet to confirm the cause of five deaths in Kalpabriksha and Kyaneshwar VDCs in Sindhuli district more than a week after the first death.

The Epidemiology and Disease Control Division, which on Sunday said that the deaths were not due to diarrhea, on Monday said the disease was not malaria either.

?It can either be dengue fever or leptospirosis. Today, we have sent another team to the area with dengue kit and the report is expected soon,? Dr Pranaya Kumar Upadhyaya at the Epidemiology and Disease Control Division said.

Upadhyaya said there are currently 38 patients of the unidentified disease. Two are being treated in critical condition.

The disease is characterized by very high fever, severe headache, difficulty in breathing, bleeding from mouth and nose and discharge of blood in cough.

A team each from Kathmandu and Janakpur were sent to the area on Sunday while a team from district headquarters had reached the area on Saturday.

I would think influenza A would be at the top of the list, but it doesn't seem to have been ruled in or out.

 

[Jeremy]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

They have ruled out Malaria.

Now they are working through Dengue and Leptospirosis.

Both are possibilities, however so if influenza (based on the symptoms).

Today's report says 38 are infected, while yesterdays reports said the numbers were above 150 or classified as "huge".

Conflicting reports are nothing new....we will have to see what tomorrow brings.

 

[Jeremy]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

I would think influenza A would be at the top of the list, but it doesn't seem to have been ruled in or out.

I think they are not including it right now because they "supposedly" only have 20 cases of H1N1 in Nepal.

If the dengue tests come back negative as well as the lepo test then influenza moves up the list.

Regardless, whatever it is, Nepal felt it necessary to request a WHO team investigate.

 

[alert]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

I am indecisive as to whether this is H1N1 or some other disease. To say that laboratory facilities in that area are poor is an massive understatement. Unless this is dengue (and DHF), I really don't expect to get a concrete diagnosis for this one.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78738

Archive Number 20090810.2842
Published Date 10-AUG-2009
Subject PRO/EDR> Undiagnosed disease - Nepal: (SI) RFI


UNDIAGNOSED DISEASE - NEPAL: (SINDHULI) REQUEST FOR INFORMATION
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 9 Aug 2009
Source: Nepal Republica, social affairs [edited]
<http://www.myrepublica.com/portal/index.php?action=news_details&news_id=8421>


Deaths in Sindhuli not due to diarrhea
--------------------------------------
The Epidemiology and Disease Control Division has on Sunday [9 Aug 2009]
asserted that 5 deaths in Kalpabriksha and Kyaneshwar [Sindhuli district]
VDCs [village development committees] were not caused by diarrhea [that is,
associated with an outbreak of cholera] as was reported by certain sections
of the media.

"These deaths in the last couple of days are due to an as yet to be
identified disease that causes very high fever, severe headache, difficulty
in breathing, and bleeding from the mouth and nose and discharge of blood
in cough, and not due to diarrhea," acting director of the Epidemiology and
Disease Control Division Dr Bishwa Raj Khanal said quoting his district
officers.

Dr Khanal said a team from the district headquarters reached the area on
Saturday [8 Aug 2009] and confirmed that the deaths were not caused by
diarrhea. "We have sent a team (by road) from Kathmandu this morning [to
carry out] laboratory tests to diagnose the disease which looks like
Japanese encephalitis, dengue, malaria, or leptospirosis," Dr Khanal said.

Another team also flew to the area late in the afternoon to control the
situation while the health ministry has also requested the World Health
Organization (WHO) to send its surveillance medical officer based in
Janakpur to Sindhuli.

--
communicated by:
ProMED-mail rapporteur Brent Barrett

[According to the same report, the Epidemiology and Disease Control
Division has stated that a contemporaneous outbreak of cholera in Nepal is
gradually coming under control. The official death toll in this outbreak is
put at 256 with 144 in Jajarkot, 43 in Rukum, 14 in Dailekh, 13 in Achham,
9 each in Baitadi and Surkhet, 4 in Rolpa, 3 each in Dolpa, Salyan,
Dadeldhura, Bajura, and Bajhang, 2 each in Doti and Pyuthan, and one in
Kanchanpur.

The 5 deaths in Sindhuli district are attributed to an outbreak of a
different disease. The symptoms of the disease are not well enough
described to suggest an etiology with confidence, but a hemorrhagic fever
is a possibility. Further information is requested.

The HealthMap/ProMED-mail interactive map of Nepal is available at
<http://healthmap.org/r/00Fm>. Sindhuli District lies in the south of the
central region of Nepal. A map of the Sindhuli district can be accessed at
<http://ncthakur.itgo.com/districtmaps/sindhuli_district.htm>. - Mod.CP]

[see also:
Pneumonia deaths - Nepal: (GO), RFI 20090517.1846
Undiagnosed illness - Nepal: (RO) RFI 20090512.1779
Undiagnosed deaths - Nepal: (DP) RFI 20090318.1093]

.................cp/mj/sh

 

[Jeremy]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Very interesting. Promed is now picking up on a type of Influenza being the possible culprit.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78764

UNDIAGNOSED DISEASE - NEPAL (02): (SINDHULI)
********************************************
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 11 Aug 2009
From: David Thomson <david.thomson@global.net.pg> [edited]


A comment
---------
The undiagnosed disease reported in the ProMED-mail post entitled
"Undiagnosed disease - Nepal: (SI) RFI 20090810.2842", sounds remarkably
like the undiagnosed condition reported via ProMED-mail and recorded in
several remote villages in Nepal back in about March or early April 2009
(can't quite recall the dates or references of the initial and at least one
follow-up post).

From memory it reportedly killed at least 16 (most from one village) and
had spread to at least 2 other nearby villages. I seem to recall that it
occurred there about 3 weeks before poultry started dying from H5N1 in
Tibet and wild birds started dying in Quinghai lakes and then in Mongolia.
At that time I don't think clinical reports included severe headaches, but
did include fever, SARI [symptoms associated with respiratory illness], and
haemorrhagic expectoration.

Could possibly have been a very aggressive influenza originally, but with
the strong headache added, now sounds a bit more like a haemorrhagic fever
of some type (as pointed out by the Moderator). A spot to watch, I believe.

--
David Thomson
Sub-regional Animal Health Specialist
Secretariat of the Pacific Community
<david.thomson@global.net.pg>

[David Thomson's comments are welcomed and ProMED-mail awaits with interest
the outcome of the investigation now under way in Sindhuli District. The
ProMED-mail posts cited by David Thomson are those listed below, I believe.
There is certainly some similarity in the descriptions of the disease, but
the outbreaks occurred in different districts of Nepal. - Mod.CP]

[see also:
Avian influenza (49): Mongolia (AR) wild birds, H5 20090811.2866
Undiagnosed disease - Nepal: (SI) RFI 20090810.2842
Avian influenza (39): Mongolia (AR) wild birds 20090528.1985
Avian influenza (38): Mongolia (AR) wild birds 20090527.1971
Avian influenza (36): China (QH), wild birds 20090518.1869
Pneumonia deaths - Nepal: (GO), RFI 20090517.1846
Undiagnosed illness - Nepal: (RO) RFI 20090512.1779
Avian influenza (35): China (Tibet) 20090419.1484
Undiagnosed deaths - Nepal: (DP) RFI 20090318.1093]

.................cp/mj/sh

 

[alert]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

What is odd is that this illness has been reported in different districts all over Nepal (Dolpa, Rolpa, Sindhuli, etc.), some of which were BEFORE the H1N1 outbreak in Mexico. I'm really not sure what to make of this, and with the absolute lack of medical and laboratory facilities in Nepal, I'm not sure we'll ever know.

There have been far more reports of undiagnosed illness and undiagnosed fatalities out of Nepal in the past few months than the ProMed links indicate. A few of them have mentioned vomitting up blood. But the one referred to in the above post is likely the one out of Gorkha, which was respiratory and NOT hemorrhagic. I believe that one was the one that had 16 deaths in 3 villages and caused China to close the border. I suspect that one was caused by H3N2 seasonal influenza virus as China picked up one case across the border in which they confirmed that agent. I wonder if someone should point that out to ProMed.

What is fairly odd out of all the hemorrhagic-type reports out of Nepal is the relatively low CFR. Hemorrhagic symptoms are usually a sign of severe illness, even if the illness is not a VHF. Several of the reports out of Nepal have mentioned hundreds of people vomitting blood, but no deaths. That's odd, especially for a location with no medical facilities. Even the current report with 5 deaths in 150 cases (and at least 100 likely recovered before the report mentioning 38 ill) is a low fatality rate for a VHF.

Also, note that no report on this incident came out of Nepal's papers in the past 24 hours. If this was a big concern today, it should have been reported. This is just odd.

 

[Jeremy]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

What is fairly odd out of all the hemorrhagic-type reports out of Nepal is the relatively low CFR. Hemorrhagic symptoms are usually a sign of severe illness, even if the illness is not a VHF. Several of the reports out of Nepal have mentioned hundreds of people vomitting blood, but no deaths. That's odd, especially for a location with no medical facilities. Even the current report with 5 deaths in 150 cases (and at least 100 likely recovered before the report mentioning 38 ill) is a low fatality rate for a VHF.

Also, note that no report on this incident came out of Nepal's papers today. If this was a big concern today, it should have been reported. This is just odd.

There are a couple of ways to look at this.

First, there are the location of where the reports are coming from.

Most of the reports from Kathmandu and are second hand. The only report that definetly comes from Sindhuli is the one that mentions "huge" numbers. Now, I have no idea what the population of Sindhuli is so I cannot attest to what constitutes "huge" for that population.

So I have to take the Kathmandu reports of number of cases with a grain of salt. As well, I don't think we can assume as that just because one report says that there are 150 and the another report the next day says 38 means that 100 people have recovered.

Personally, I feel like the there is still too little information....

However, all that being said, there is a WHO team on the ground so if the situation is much worse than these initial reports it normally takes a couple of days for that information to filter out. If the story goes dead by the end of the week than it might very well have been a self limiting outbreak of VHF.

 

[Desolation_anonymous]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Makes me wonder if it could possibly be more cases of pneumonic plague due to the proximity to China and the respiratory component? I am not saying it is impossible to be influenza but it strikes me as something different like an Arenavirus or a Nairovirus like the virus that causes Crimean Congo Hemorrhagic Fever? It could even be a new virus which we have never seen before? Until we get some test results which will hopefully solve the mystery we don't know I guess? Scary disease with the hemorrhagic and respiratory components? Respiratory symptomology is always worrisome with any new/unknown disease due to the potential for human to human transmission as well as potential lethality. I wonder if the victims are literally "crashing" and bleeding out? This could suggest a lethal viral hemorrhagic fever on the same level as some of the known VHF viruses such as Ebola, Lassa, CCHF etc.? It should be interesting once more information concerning the disease becomes known?

I'm not a doctor or virologist but this sounds scary and I second that it sounds like it has components of a VHF, but more information needs to be discerned as well as lab tests (not likely to region). Unfortunately these can be caused by Filoviruses, Adenoviruses, bunyviruses.

http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lassaf.htm
I know vomiting blood happens often.

However, due to the region I wonder if Hantaviruses, perhaps an unknown one, are being looked at? Varying ones can cause high fever, vomiting, etc... and the ones in the US an cause scary respiratory symptoms.

 

[alert]

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Re: Sindhuli, Nepal: Undiagnosed Disease - 5 Dead/150 sick (High Fever, Vomiting Blood, etc)

Personally, I feel like the there is still too little information....

However, all that being said, there is a WHO team on the ground so if the situation is much worse than these initial reports it normally takes a couple of days for that information to filter out. If the story goes dead by the end of the week than it might very well have been a self limiting outbreak of VHF.

The epidemiology of this is not consistent with VHF. It seems that almost everyone got sick at once. A VHF outbreak typically takes place over several months. Also, VHF typically causes diarrrhea, often bloody. Diarrhea has specifically been excluded as a symptom here. This outbreak as reported really isn't consistent with either VHF or influenza (H1N1 or H5N1). Hantavirus is possible, but I don't think we would ever find out. Dengue and DHF are also possible, too. But I do think this story will go dead shortly (if it hasn't already).