Yemen - A Report that Hanta Virus is Infecting Hundreds, 104 undiagnosed fatalities

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

This now gets very interesting.

First, it is clear the illness under suspicion is HFRS, not HPS. HPS is a severe respiratory illness, and that just isn't the symptoms reported. Moreover, HPS has been found almost exclusively in the Americas, whereas HFRS is more qidespread in Asia.
Secondly. there are many hantaviruses that cause HFRS. The original one discovered in Korea is the Hantaan virus mentioned in the first post of this thread, and for which the genus Hantavirus is named. Whether it is the specific hantavirus involved in the outbreak is unclear. It's native region is China and Korea, quite far from the location of this outbreak. It would require serious explanation as to how it got to Yemen. There are several other hantaviruses that cause HFRS, including Pumala and Seoul viruses, although none have been reported from the Middle East, as far as I am aware. It is possible that this is a newly discovered member of this family, as the hantavirus family is already known to be spread worldwide.

Thirdly, there is a LOT of dengue in that area, which may have been masking this outbreak for much of the past two years, thus resulting in the delay in diagnosis. The earliest reports of a mystery hemorrhagic fever in Hodeidah date to August 2009. An article from November 2010 indicates that of 10 samples taken at random, six came back positive for dengue. It actually is a bit of a miracle that HFRS was diagnosed here as there were many other hemorrhagic fevers that might have been more likely geographically (CCHF, RVF, Alkhurma).

This should be sent to ProMED. It should be very interesting to see their commentary.

 

[sharon sanders]

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

To: ProMed <promed@promedmail.org>
Subject: Reports of Hanta Virus in Yemen
Date: Feb 27, 2011 11:40 PM

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

To: ProMed <promed@promedmail.org>
Subject: Reports of Hanta Virus in Yemen
Date: Feb 27, 2011 11:40 PM

Thank you, Sharon. as always.

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

And this is from today, and things get clear as mud. This one is still saying that dengue and chikungunya are being confirmed, and does not mention HFRS at all. Dengue and Chikungunya are endemic in Yemen.

It is worth pointing out that only one article mentions HFRS, but about 4-5 have mentioned either dengue (al-dhanak) or chikungunya (al-murkfess).

http://www.yobserver.com/front-page/10020855.html?utm_source=twitterfeed&utm_medium=twitter

Strange disease kills Hodeidah residents
Posted in: Front Page
Written By: Fares Anam
Article Date: Feb 28, 2011 - 12:35:10 PM

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President Ali Abdullah Saleh has instructed the government to form a special committee to tackle the spread of a mysterious disease in Hodeidah.

Hodeidah local council said that it has laid charges against the national Ministry of Health for not supporting the fight against a mysterious disease that has gripped the province and killed numerous citizens.

Local council sources said that the disease has spread in various districts. Medical sources in Hodeidah said that they had recorded 24 deaths as a result of the disease that has swept through the province over the past two weeks.

Najeeb Malha, chief at the Hodeidah doctor›s syndicate, criticized the Ministry of Health and medical authorities for its lack of assistance. He said that they were not moving fast enough in the face of a major catastrophe.

He appealed to President Ali Abdullah Saleh and the Minister of Health to immediately intervene to treat the injured and provide medical equipment to diagnose this mysterious disease. Malha explained that the disease killed a patient within two days. Its symptoms included bleeding, rapid kidney failure and a coma.
Abdul-Hakim al-Kuhlani, general manager for fighting diseases and surveillance at the Ministry of Health, told the Yemen Observer that samples of the disease›s bacteria had been sent for testing to the laboratories in Egypt.

“Tests showed that there are symptoms of Chicungungya disease, known publicly as al-Mukarfess, as well as dengue fever that is known as al-Dhanak fever,” he said. He said that this squashed claims that there was a mysterious diseases spreading in Hodeidah.

Symptoms of al-Mukarfess disease are pain in the muscles and joints and patients usually could not move much, said al-Kuhlani. “The symptoms of al-Danak are high fever, pain behind the ears, bleeding from the skin or through the nose or with the feaces.

But al-Mukarfess is less dangerous than al-Danak fever.” Al-Kuhlani said it has not been confirmed that the deaths were a result of these two serious diseases. He said that the Ministry of Health had performed many activities in fighting diseases in Hodeidah. “The ministry provided health centers in most of Hodeidah with many drugs and antibiotics to fight diseases because there is no specific drug to cure every disease in the world,” he said.

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

http://presidentsaleh.gov.ye/shownews.php?lng=en&_nsid=9136

Moreover, the meeting discussed a report on the health situation in Hodeidah province in light of the spread of some epidemic diseases that have affected a number of areas in the province and cause some deaths, and instructed the government to quickly send medical teams to the province to combat the reasons leading to the spread of those diseases and provide treatment for the disease-infected cases.

 

[sharon sanders]

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

I merged the 2 threads on this topic.

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths

One more point on terminology:

"Al-dhanak" is almost certainly the Arabic name for dengue fever, as all the articles seem to agree on that (although I don't speak Arabic). Today's article is the first that links "Al-murkfess" (or "Almrvks") to chikungunya; previous articles seem to use that as just the local name for the undiagnosed disease (and one ProMED post indicates that it is the Arabic word for "the crunching").

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths - Possibly Denque or Chikungunya

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths - Possibly Denque or Chikungunya

Chikungunya alone is unlikely to have caused 61 deaths, even over a year or more. Chikungunya in conjunction with dengue might have, however. We have several threads from other countires such as India and Sri Lanka where a "mystery disease" was in fact co-infection with dengue and chikungunya.

No mention of HFRS (or RVF, CCHF, etc.) here either.

This is the first mention of an increase in white blood cell count, too.

http://arabnews.com/saudiarabia/article293369.ece

Health Ministry warns of fatal illness spreading from Yemen

A map of the US Centers for Disease Control and Prevention (CDC) showing countries where people have been infected with the chikungya disease as of April 2010. The countries are: Benin, Burundi, Cambodia, Cameroon, Central African Republic, Comoros, Congo, DRC, East Timor, Equatorial Guinea, Guinea, India, Indonesia, Italy, Kenya, Laos, Madagascar, Malawi, Malaysia, Maldives, Mauritius, Mayotte, Myanmar, Nigeria, Pakistan, Philippines, Reunion, Senegal, Seychelles, Singapore, South Africa, Sudan, Taiwan, Tanzania, Thailand, Uganda, Vietnam, and Zimbabwe.

By MUHAMMAD HUMAIDAN & SAEED AL-BATATI | ARAB NEWS

Published: Mar 1, 2011 22:25 Updated: Mar 1, 2011 23:01

JEDDAH/SANAA: Many people who live on the Saudi-Yemen border fear that a fatal disease that has been responsible for dozens of deaths in Yemen’s western coastal area could cross into the Kingdom.

At least 65 deaths have been reported in Yemen’s western coastal province of Hodeidah.

The disease is thought to be chikungunya, though some medical officers dispute it. Symptoms of chikungunya include kidney failure, high temperature, diarrhea and vomiting.

Yemen’s President Ali Abdullah Saleh has formed a committee to monitor the spread of the disease and the country’s authorities are working hard to keep it in check.

Dr. Mohsen Al-Tobaiki, director of health in Jazan, said the Saudi authorities have been following developments across the border. Dr. Khaled Al-Mirghalani, spokesman for the Ministry of Health, and Dr. Ziyad Mishmish, undersecretary for preventive medicine, were unavailable for comment.

A number of medical and environmental experts in Jazan said there is a possibility of the disease entering the Kingdom through unregistered migrants who do not carry health certificates proving they have taken necessary vaccinations. They added that at the moment the border provinces in the south of the Kingdom are free from the disease.

According to Yemeni media, people in the Hodeidah area were shocked at the loss of life. Arafat Maki, a local journalist who contracted the illness, said the disease has caused panic in the area.

“Lots of people are thought to have died. The health facilities in Hodeidah and hospitals are working overtime to cope with the influx of patients,” he said. The disease is locally known as Al-Mukarfess.

Dr. Abdul Hakim Al-Khohlaini, manager of the epidemiological surveillance department at the Yemeni Ministry of Health, said that samples sent to Cairo for tests showed that the disease is chikungunya. He added that local doctors have also found other diseases in the area.

“Forty-five percent of the cases are chikungunya, 10 percent malaria and the rest dengue fever,” he said.

According to Al-Khohlaini, 61 people have died so far. “Some of the dead are very old and most of the cases haven't been verified by laboratories,” he said.

“Saudi health officials called us and inquired about the spread of a disease in the border provinces. We told them that it is chikungunya and assured them that the disease is under control and far away from the Saudi border,” he said.

However, another medical source gave a different assessment of the situation. Dr. Najeeb Molha, head of the Hodeidah doctors' syndicate who is also working with disease-fighting teams, said the disease is not chikungunya. “Chikungunya doesn't claim this high number of lives. Chikungunya sprung up in the area in the last three months of 2010 and does not exist anymore,” he said.

Molha said the symptoms of the disease are fever, diarrhea, renal failure and sudden increase in the number of white blood cells and granulocytes. “To my knowledge, 65 people have died because of the disease and 250 people are in hospitals. I think it is a kind of hemorrhagic fever. Our interference has helped in bringing down the number of victims and lessening the panic,” he said.

Molha said the Yemeni Ministry of Health is reluctant to reveal the results of tests, something that Al-Khohlaini has denied.

The director of Hodeidah's provincial health office refused to comment on the matter, saying he is waiting for the minister of health to complete his investigations.

Chikungunya, a mosquito-borne disease with symptoms similar to dengue fever, occurs mainly in Africa, Asia and the Indian subcontinent.

More than 100 people were reported to have died of the disease in India's southern Kerala state following an outbreak 2006 and 2007.

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths - Possibly Denque or Chikungunya

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths - Possibly Denque or Chikungunya

And here's the ProMED take on this complicated situation:

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,87349

Archive Number 20110302.0685
Published Date 02-MAR-2011
Subject PRO/AH/EDR> Undiagnosed disease - Yemen: (HU) RFI

UNDIAGNOSED DISEASE - YEMEN: (AL HUDAYDAH), 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: 1 Mar 2011
Source: Arab News [edited]
<http://arabnews.com/saudiarabia/article293369.ece>


At least 65 deaths have been reported in Yemen's western coastal
province of Hodeidah. The disease is thought to be chikungunya, though
some medical officers dispute it. Symptoms of chikungunya include
kidney failure, high temperature, diarrhea and vomiting [This is
inaccurate. The US CDC states that, "chikungunya virus infection can
cause a debilitating illness, most often characterized by fever,
headache, fatigue, nausea, vomiting, muscle pain, rash, and joint
pain. ... Additionally, some patients have reported incapacitating
joint pain, or arthritis which may last for weeks or months. ...
Fatalities related to chikungunya virus are rare."
(<http://www.cdc.gov/ncidod/dvbid/Chikungunya/CH_SymptomsTreatment.html>).
- Mod. TY].

Yemen's President Ali Abdullah Saleh has formed a committee to
monitor the spread of the disease, and the country's authorities are
working hard to keep it in check.

Dr. Mohsen Al-Tobaiki, director of health in Jazan, said the Saudi
authorities have been following developments across the border. Dr.
Khaled Al-Mirghalani, spokesman for the Ministry of Health, and Dr.
Ziyad Mishmish, undersecretary for preventive medicine, were
unavailable for comment.

A number of medical and environmental experts in Jazan said there is
a possibility of the disease entering the kingdom through unregistered
migrants who do not carry health certificates proving they have taken
necessary vaccinations [No vaccine is available for chikungunya virus.
- Mod.TY]. They added that, at the moment, the border provinces in the
south of the kingdom are free from the disease.

According to Yemeni media, people in the Hodeidah area were shocked
at the loss of life. Arafat Maki, a local journalist who contracted
the illness, said the disease has caused panic in the area.

"Lots of people are thought to have died. The health facilities in
Hodeidah and hospitals are working overtime to cope with the influx of
patients," he said. The disease is locally known as Al-Mukarfess.

Dr. Abdul Hakim Al-Khohlaini, manager of the epidemiological
surveillance department at the Yemeni Ministry of Health, said that
samples sent to Cairo for tests showed that the disease is
chikungunya. He added that local doctors have also found other
diseases in the area. "45 per cent of the cases are chikungunya, 10
percent malaria, and the rest dengue fever," he said.

According to Al-Khohlaini, 61 people have died so far. "Some of the
dead are very old, and most of the cases haven't been verified by
laboratories," he said. "Saudi health officials called us and inquired
about the spread of a disease in the border provinces. We told them
that it is chikungunya and assured them that the disease is under
control and far away from the Saudi border," he said.

However, another medical source gave a different assessment of the
situation. Dr. Najeeb Molha, head of the Hodeidah doctors' syndicate
who is also working with disease-fighting teams, said the disease is
not chikungunya. "Chikungunya doesn't claim this high a number of
lives. Chikungunya sprang up in the area in the last 3 months of 2010
and does not exist anymore," he said.

Molha said the symptoms of the disease are fever, diarrhea, renal
failure and sudden increase in the number of white blood cells and
granulocytes. "To my knowledge, 65 people have died because of the
disease, and 250 people are in hospitals. I think it is a kind of
hemorrhagic fever. Our interference has helped in bringing down the
number of victims and lessening the panic," he said.

The director of Hodeidah's provincial health office refused to
comment on the matter, saying he is waiting for the minister of health
to complete his investigations.

Chikungunya, a mosquito-borne disease with symptoms similar to dengue
fever, occurs mainly in Africa, Asia and the Indian subcontinent.

[Byline: Muhammad Humaidan, Saeed Al-Batati]

--
Communicated by:
John T. Cathey
Senior Editor
Annals of Saudi Medicine
Hematology/Oncology and Stem Cell Therapy
Scientific Publications Office
King Faisal Specialist Hospital and Research Centre (MBC 36)
PO BOX 3354
Riyadh 11211 Saudi Arabia
http://www.saudiannals.net
http://www.hemoncstem.net
<jtcathey@kfshrc.edu.sa>

[It is difficult to determine whether this outbreak is a totally new
one or a partial continuation of an outbreak reported in November 2010
(see ProMED-mail archive number 20101125.4246). The November 2010
outbreak reported low mortality and arthritis, much more compatible
with symptoms of chikungunya virus infections than the current report
above. The current outbreak may be one of mixed etiologies, but the
fatalities are extremely unlikely to have been caused by chikungunya
virus infection. One wonders whether the cases diagnosed by the
laboratory in Egypt were fatal ones or just febrile patients.
Curiously, no mention is made of arthralgia in the current report,
which is a key feature of chikungunya virus infections, leading one to
wonder whether the laboratory diagnoses of chikungunya virus infection
were made on serological grounds and reflect past rather than current
infections. Further information would be appreciated.

 

[Ronan Kelly]

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths - Possibly Denque or Chikungunya

Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, Some Deaths - Possibly Denque or Chikungunya

Unknown disease kills 104 people in Yemen

Health 3/6/2011 10:22:00 PM



SANAA, March 6 (KUNA) -- A mysterious disease has claimed the lives of 104 people in the Yemeni western province of Al-Hadida, a health official said here Sunday.
The disease kills people in just two days, and its symptoms include acute bleeding, rapid kidney failure and a significant rise of temperature, followed by a quick coma and sudden death, Director of the Yemeni doctors and pharmacists guild, Najib Malhi said in a statement.
Until this moment, doctors in the country cannot diagnose the illness, of symptoms that differ from the locally-common Dengue fever, caused by the Aedes aegypti mosquito.
The Yemeni cabinet, two weeks ago, announced Al-Hadida, "a province infected with a strange disease," tasking the health minister with the role of increasing locate to explore its cause and remedy.
Medical equipment and supplies in the province have also been doubled as a result, the Health Minister Abdulkarim Rasa was quoted as saying last week.
Anti-mosquito task forces have also been formed and are carrying out a wide-scale spray of insecticide across the country's provinces as a precautionary measure.

http://www.kuna.net.kw/NewsAgenciesPublicSite/ArticleDetails.aspx?id=2150165&Language=en

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, 104 undiagnosed fatalities

And this muddies the water even more...

http://www.yobserver.com/reports/10020886.html

Uncovering Yemen's contagious killer disease
Posted in: Reports
Written By: Mohammed Ali Kalfood For the Yemen Observer
Article Date: Mar 6, 2011 - 8:50:18 AM

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A contagious disease, popularly known as Mukarfas, has emerged and rapidly spread across various districts and villages of Hodeida governorate, local medical sources have confirmed.

It is believed that this contagious disease first appeared in Hodeida in October last year. It has left Hodeida’s citizens terrified and most doctors remain perplexed over the changing symptoms and nature of this disease.

Up to now, it has controversially been identified as ‘Dengue Fever’ which previously occurred and mostly spread in the northern parts of Hodeida governorate by the end of 2009, according to the Hodeida Health Bureau. The Yemen Observer contacted and met with some Hodeida health officials, academics and specialist doctors to conduct a comprehensive report on this deadly disease. Mukarfas dates back nearly six decades, said local sources. Mohammed Hossein, 45, from Al-Ma’arofiah in Al-Zaidyah district in Hodeida, said he had come heard about it since childhood.

“When I was a child, people used to say that Mukarfas was a disease that causes joint pain so severe to animals that these animals cannot move or even stand at all,” said Hossein. Dr. Haza’a Al-Qadasi, a university lecturer focusing on liver and diets, said that there was no disease called Mukarfas; rather it is an illness that occurs due to the infection of dengue fever with similar symptoms.

He said that the dengue fever virus was the result of a female mosquito transmitting it from the infected person to others. The host period lasts only five days. These infectious mosquitoes procreate amid sewage waste or garbage and mostly during winter. He also stressed that when the person is infected with the virus and if not treated immediately the disease will develop and cause hemorrhage and lead to death.

Local medical sources confirmed that this disease causes malignant symptoms that are mostly common with the symptoms of both dengue and German fevers. The symptoms start with increasingly abnormal high body temperature that often results in long-term loss of consciousness. In addition, the symptoms are acute and diachronic flu with coughing, headache, face distension, joint pain, body shaking, flow of blood from mouth and nose, skin rashes, diarrhea, vomiting, neck pain and back pain. Director of the Al-Olafi hospital in Hodeida, Dr. Yasser Jameel Shahir, also said that there was no disease called Mukarfas. This was just a popular word derived from the symptoms commonly related with dengue fever. Dr. Abdullah Al-Hariri, head of the nursing department at the Military Hospital in Hodeida, said that most of the recent medical checkups included Complete Blood Count tests to seek traces of the virus.

Dr. Najeeb Mulhi, head of the Hodeida Medical Doctor’s Association, said that this disease can take kill an infected person within two days as it causes acute hemorrhage and sudden renal failure. He said that the patient would experience increased body temperature, a high percentage of blood cells and irregular reduction of platelets, leading to sudden renal failure. Mulhi also expressed serious concern that up to now the disease in Hodeida has not clearly been identified and that its symptoms were in fact different from Mukarfas or dengue fever.

Dr. Ali Al-Ahdal, head of the Dialysis Center in Hodeida, said that the cases of renal failure that have been registered over the past two months totaled 45 and that five patients had died. The center had never seen such cases, he said. A medical report issued early last week by the appointed medical team of Hodeida Health Bureau revealed that at least 24 persons have died and more than 202 have been infected.

The medical report also stated that all cases showed viral and bacterial infections that were irresponsive to antibiotics. This resulted in neural and circulatory shock, a lack of urine, severe renal failure and high body temperature, in addition to diarrhea and vomiting. Medical teams in Hodeida expressed concern over the aggravating situation. Al-Thowra and Al-Olafi public hospitals is meanwhile experiencing a rapid increase of patients.

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, 104 undiagnosed fatalities

The actual symptoms of HFRS are below; HFRS may have been mentioned in one article due to renal failure, but the symptoms are a poor match.

HFRS apparently causes excessive urination (and many other hemorrhagic fevers cause bloody urination), but this illness in Hodeidah is reported as causing a lack of urination.

http://en.wikipedia.org/wiki/Hantavirus

Haemorrhagic fever with renal syndrome

Hantavirus has an incubation time of 2–4 weeks in humans before symptoms of infection occur. The symptoms of HFRS can be split into five phases:

Febrile phase: Symptoms include fever, chills, sweaty palms, diarrhea, malaise, headaches, nausea, abdominal and back pain, respiratory problems such as the ones common in the influenza virus, as well as gastro-intestinal problems. These symptoms normally occur for 3–7 days.
Hypotensive phase: This occurs when the blood platelet levels drop and symptoms can lead to tachycardia and hypoxemia. This phase can last for 2 days.
Oliguric phase: This phase lasts for 3–7 days and is characterised by the onset of renal failure and proteinuria occurs.
Diuretic phase: This is characterized by diuresis of 3–6L per day, which can last for a couple of days up to weeks.Convalescent phase: This is normally when recovery occurs and symptoms begin to improve.
Formerly called Korean hemorrhagic fever, HFRS is the term accepted by the World Health Organization.

 

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Re: Yemen - A Report that Hanta Virus is Infecting Hundreds, 104 undiagnosed fatalities

OK. So there's a lot of dengue and chikungunya there. But is there something else? And what is causing the renal failure?

http://www.invs.sante.fr/international/bhi/bhi_090311.pdf

French to English translation

In Yemen, an outbreak has been evolving for several months in Hodeidah governorate in the south-west (see Map 2). At this stage there are at least 1000 cases and nearly 75 deaths.

This epidemic was probably caused by different infectious phenomena.

Among 15 hospitalized cases, nearly 50% were positive for chikungunya virus.
Map 2. Location of the governorate of Hodeidah, Yemen.

The chikungunya virus has been identified as one of the causes of the epidemic that affects the region for several months. It can not explain the high lethality observed.

Although located in the zone of countries at risk defined by WHO, it is the first positive identification of chikungunya virus in the country. The installation of a transmission cycle supported in the country can not be excluded (presence of the vector Aedes aegypti and outbreaks of dengue).