Dear Friends,
Attached is a map I made of the districts in Uttar Pradesh experiencing encephalitis outbreaks. Red indicates the first areas affected, while pink represents most recent districts. You can judge for yourself what you think of the below testing. Does it represent rising titers of antibodies, old antibodies, or viral antigens? It makes all the difference in the world whether it is actually H5N1 or JE.


19 more die of encephalitis, toll up to 134

Sunday, 21 August , 2005, 21:27

Gorakhpur/Fatehpur: With the disease spreading its tentacles, 19 people died of suspected Japanese Encephalitis (JE) in two districts of Uttar Pradesh, raising the toll to 134 on Sunday as 13 blood samples tested at the National Institute of Infectious Diseases (NIID) were confirmed to be JE-positive.

Of the victims, 14 succumbed at a hospital in Gorakhpur, while five died in the villages of Fatehpur district in Uttar Pradesh.

More than 180 children were being treated in BRD Medical College hospital and in all 464 people had been admitted to the hospital since July 31, its Principal Saudan Singh said in Gorakhpur.



He said blood samples of 43 patients had been sent to NIID in New Delhi, which confirmed 31 as "positive Japanese Encephalitis cases".

More doctors and paramedical staff had been requisitioned to cope with the inflow of brain fever patients, Singh added.

Five persons - three girls and two women - died and more than 10 were reported suffering from suspected brain fever in Hathgaon area of Fatehpur district in central UP.

The victims died in the past 24 hours and the symptoms of the disease were spreading rapidly leading to panic in villages across the district, officials said.

State Chief Secretary Neera Yadav, meanwhile, said a full-fledged pathological laboratory for JE testing would start functioning here at the District Hospital here by September 15.

Attached Images

 

Great Job! Here's the link to the article.

According to ProMed (I forget which day) this district has a multi-year history of encephalitis outbreaks, although this year (after bizarre weather patterns) has been worse than most. Like many encephalitis viruses, this one is carried by mosquitos.

endemic to India & other parts of Asia. What's being described - save for the dates, fits the standard profile. AND most have tested positive. I didn't realize it also affected some birds & swine.

One thing to remember with human H5N1 as with any flu strain or any illness - there is a RANGE of severity & complications & encephalitis so far in humans with H5N1 has occured in the context of outbreaks where MOST cases show the 'normal' range, (albeit pretty severe), of flu symptoms. Before we begin seeing a large number of encephalitis, meningitis & other nervous system manifestations, I'd first expect to hear of an exponential number of severe respiratory cases. I can't find such in this outbreak.

As to what the positive results actually represent, I don't know - it's not stated. I see no reported outbreaks of poultry disease either.

But one of these days...

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Vaffie,

Thank you for the map. As Dr. Niman has commented in a recent post here, there is a possibility bird flu has existed in India for years, and not been reported. This sudden spread of encephalitis with high fatality needs to be thoroughly investigated NOW! It could possibly be bird flu. Some adults are dying from it---which is very strange. Most adults in India are immune to Japanese encephalitis from previous exposures.

India is overcome right now with "viral fever" countrywide.
See www.agonist.org, click "Bulletin boards", then "Disease Outbreaks" for more info.

is that India, which I consider to be in the direct line of fire - still has no meansa to test for H5N1. Any specimens would have to be sent out of country.

I know Canada has a mobile lab set up to deal with outbreak emergencies in countries without their own facilities. It was recently sent to Angola, to help with Marburg.

I'd dearly love to know that a number of such labs, rapidly deployable, were available with the capacity to test for H5N1 for WHEN we suspect outbreaks in nations with no current capacity to test. The big problem with that of course is that they'd still have to be requested by the host nation.

India this summer has seen a lot of meningitis/encephalitis. Medical care in the cities, if you've got $$$ is perfectly adequate. But that's not where H5N1 human cases will break. That will happen in underserved or unserved rural areas. It's frustrating in that India has a high level of 'background' endemic illnesses & outbreaks of unknown viral fevers occur constantly - always have.

In these times though, it adds to everybody's already increasing case of nerves.

__________________
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The picture has been updated again, with blue representing the most recent districts in India and Nepal.

Encephalitis toll reaches 41 in western Nepal
www.chinaview.cn 2005-08-22 14:08:08

KATHMANDU, Aug. 22 (Xinhuanet) -- With the new deaths in the past two days, the outbreak of Japanese encephalitis in western Nepal has claimed 41 lives this summer, the district public health office said Monday.

"At least 13 persons died on Saturday and Sunday, mounting the death toll to 18 in Kailali district, some 700 km west of Kathmandu," the district public health office said in a press statement.

Four persons died on Saturday while six others succumbed to thedisease on Sunday at Seti Zonal Hospital, the statement noted, adding, "Similarly, three persons died at Tikapur Hospital of the district on Saturday, increasing the death toll in the hospital toeight so far."

At present, 91 such patients are undergoing treatment at the two hospitals, the statement revealed.

In Dang district, some 500 km west of Kathmandu, two persons died due to the disease on Sunday, adding the death toll to five in the past week. More than 15 patients are undergoing treatment at Ghorahi Hospital of the district, according to the statement.

Meanwhile, a 3-year-old girl of Patabhar village in Bardiya district, some 600 km west of Kathmandu, died due to Japanese encephalitis on Saturday. The death toll has reached to three in the district.

In Banke district, a neighboring district of Bardiya, a total of 14 persons fell prey to the disease this summer while 25 persons are undergoing treatment at Bheri Zonal Hospital and Nepalgunj Medical College Hospital.

Similarly, a 7-year-old girl died due to the disease on Sunday in Bhairahawa city of Rupandehi district, some 300 km west of Kathmandu, the statement added. Enditem

Japanese encephalitis kills 158 people in India's UP state
www.chinaview.cn 2005-08-22 19:48:26

　NEW DELHI, Aug. 22 (Xinhuanet) -- Over 158 persons including a large number of children have died because of Japanese encephalitis over the last three weeks in northern Indian state ofUttar Pradesh, Indo-Asian News Service (IANS) reported Monday fromstate capital Lucknow.

According to the report, the disease has now spread to several far areas and has taken even state capital Lucknow in its grip.

Thirteen people died in 24 hours at the special encephalitis unit created at the Medical College in Gorakhpur, the nodal treatment center for the worst affected areas of eastern Uttar Pradesh, IANS said.

State Health Director General O.P. Singh said the virus had spread to as far as Chitrakoot district in the southeastern cornerof the state where six children have died.

Fatehpur district in central Uttar Pradesh also reported some deaths.

"While the victims were mostly children, eight adults have also succumbed to the virus, ever since it broke out on July 29," Singhsaid.

About 500 patients have been brought to Gorakhpur medical college so far.

Hospital authorities, however, fear that the number of patientswould rise in the coming days. "With the heavy onset of rains, leading to increased filth and squalor, the virus was bound to proliferate. So we are in for tougher days ahead when more casualties are bound to occur," they said.

This type of brain fever, which has been confirmed as Japanese encephalitis by the National Institute of Infectious Diseases (NIID), has been a perennial problem in large parts of eastern Uttar Pradesh where the virus has been striking consecutively for the past 27 years, taking a toll of about 1,500 lives. Enditem

Attached Images

 

This situation is VERY ALARMING. Lab testing of the encephalitis cases' cerebrospinal fluid must be done now.

I just saw at the Agonist thread they are have a "dry spell" in this area. So no mosquitoes---no Japanese encephalitis.

http://www.financialexpress.com/fe_...ntent_id=100049



Dry spell in August belies farmers’ hope

Ashok B Sharma

New Delhi, Aug 22 The south-west monsoon has entered a weak phase with two successive weeks of subdued rainfall.

Area coverage under all kharif (summer) crops, with the exception of cotton, sugarcane, jute, sesamum and castor, is lagging behind due to erratic rainfall.

This year sowing was delayed due to dry spell in June, the first month of the monsoon season. Monsoon revived on June 27 and there was good rainfall in July. The two months, July and August, are crucial for agriculture. Good rains in July saw a spurt in farming activity, but the return of dry spell in the first two weeks of August again belied the hopes of farmers.

Immediate revival of the monsoon is no where in sight as the official weather forecasting agency, India Meteorological Department (IMD), has indicated that “weak monsoon conditions are likely to prevail in the second half of the ensuing week.”

In the week ending August 10, the average cumulative rainfall over the country was deficient by 25%. In the subsequent week ending August 17, the rainfall deficiency increased to 46%.

After August 3, the rain gods have changed their course. Till August 3, almost the entire country, with the exception of Bihar, Jharkhand and northeastern states, received good rainfall. After August 3, the rain gods are now busy watering Bihar, hilly parts of West Bengal and northeastern states, at the expense of other regions of the country. However, Jharkhand still remains unfortunate with scanty rainfall in past two weeks.

In the week ending August 10, as many as 20 out of 36 meteorological sub-divisions received scanty to deficient rains. The lucky 16 meteorological sub-divisions which received goods rains were : Punjab, Haryana & Delhi, eastern Gujarat, Konkan & Goa, Madhya Maharashtra, Vidarbha, Chhattisgarh, Telangana, north interior Karnataka, coastal Karnataka, south interior Karnataka, Bihar, sub-Himalayan West Bengal & Sikkim and the entire north-eastern region.

In the the week ending August 17, when the rainfall deficiency became more acute, as many as 28 out of 36 meteorological sub-divisions received scanty to deficient rains. They lucky eight which received good rains were: Bihar, Assam & Meghalaya, sub-Himalayan West Bengal & Sikkim, north interior Karnataka, Telangana, south interior Karnataka, Ralayaseema and Andaman & Nicobar Islands.

http://timesofindia.indiatimes.com/...how/1207674.cms

Japanese encephalitis claims 17 more lives

TIMES NEWS NETWORK[ TUESDAY, AUGUST 23, 2005 01:58:05 AM ]


LUCKNOW: Deaths caused by suspected Japanese encephalitis (JE) continue unabated with 17 more patients succumbing to the killer virus in Gorakhpur till Monday evening, taking the toll to 153. As many as 66 fresh cases were admitted to the Baba Raghav Das Medical College (BRDMC), Gorakhpur during the last 24 hours.

Significantly, though JE has been a menace in the region for the past 25 years, for the first time in the history of BRDMC and Gorkahpur, arrangements have been made for on-the-spot JE confirmatory test through Elisa kits supplied by the National Institute of Virology, Pune.

The total number of patients under treatment at BRDMC were said to be over 200. As per official reports, total 530 suspected JE cases have been reported so far in eastern UP since its outbreak on July 29. Health directorate sources in the state capital said that suspected JE cases have also been reported from Balrampur, Gonda and Azamgargh districts. With no mechanism in the region to control mosquitoes, the carrier of the virus causing JE, authorities fear that the toll may rise further in coming days and situation will come under control only after the monsoon is over.

"The disease will die a natural death by the month of November when the season changes as there are no other method which we can use to eliminate the killer virus," admitted BRDMC principal Dr Saudan Singh. He said that the best they can do is to offer all possible treatment to the patients. He said that patients are being given antibiotics to prevent further infections, which in many cases cause death.

http://www.promedmail.org/pls/prome...L_ID:1000,30147


***JAPANESE ENCEPHALITIS - NEPAL: SUSPECTED, REQUEST FOR INFORMATION

Date: Sun, 21 Aug 2005 05:46:59 -0400 (EDT)
From: ProMED <promed@promedmail.org>
Source:Radio Australia - News, 21 Aug 2005 [edited]
<http://www.abc.net.au/ra/news/stories/s1442632.htm>


An outbreak of encephalitis in southwest Nepal has claimed at least 20 lives in the past week with more than 60 new cases reported at the weekend. The government has now rushed medicines and special teams to southwest Nepal to deal with the outbreak.

The virus is normally carried by mosquitoes, which flourish as annual monsoon rains sweep the area in August-September.

An outbreak of the disease across the border in northern India [Uttar Pradesh] has killed at least 99 children, with another 140 undergoing
treatment.

--
ProMED-mail
<promed@promedmail.org>

[More information on this outbreak including laboratory results/confirmation would be appreciated. - Mod.MPP]***

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http://www.kantipuronline.com/kolnews.php?&nid=49476

You are reading: Kantipur Online >> Others
------------------------------------------------------------

Encephalitis toll in Terai districts reaches 41


KOL Report

KATHMANDU, Aug 22 - The outbreak of Japanese encephalitis in the Terai districts of western Nepal has claimed several lives in the past two days, pushing the death toll to 41 this summer, even as many have been admitted to hospitals for treatment, according to reports.
A report from Kailali said 13 persons died on Saturday and Sunday alone mounting the death toll to 18 in the district. Four persons died on Saturday while six others succumbed to the disease on Sunday at Seti Zonal Hospital. Similarly, three persons died at Tikapur Hospital Saturday increasing the death toll there to eight so far.

At present, 91 such patients are undergoing treatment at the two hospitals.

In Dang, two persons died due to the disease on Sunday, adding the death toll to five in the past one week. Fifteen patients are undergoing treatment at Ghorahi Hospital in Dang.

A report from Bardiya said three-year-old Tejrani Tharu of Patabhar VDC-4 in Bardiya district died due to Japanese encephalitis, Saturday. The death toll has now climbed to three in the district.

In Bhairahawa Gudiya Sahani, 7, of Bayarghari-7, died due to the disease on Sunday.

In Banke, a total of 14 persons fell prey to the disease this summer while 25 persons are undergoing treatment at Bheri Zonal Hospital (BZH) and Nepalgunj Medical College hospital.

According to hospital sources, of the 14, twelve persons died at BZH, while two others succumbed to the disease at the medical college hospital.

156 dead as encephalitis spreads in northern India
23/08/2005 - 08:42:05

http://breakingnews.iol.ie/news/sto...514&p=y53463zzx

An outbreak of Japanese encephalitis has spread to new areas of northern India, officials said today, as 20 additional deaths pushed the toll from the mosquito-borne disease to 156 fatalities in two weeks.

Nearly 500 infected people, mostly children, remain in hospitals across Uttar Pradesh state, with 68 new patients admitted in the past day to the main hospital in the Gorakhpur district, the hardest hit area, said SP Tripathi, a doctor at the hospital.

Seventeen of the new deaths, including three adults, occurred in Gorakhpur, 165 miles east of Lucknow, the capital of Uttar Pradesh state, Tripathi said.

In Lucknow’s King George’s Medical College hospital, 24 new encephalitis patients were admitted, said a doctor. Fifty-two children were already being treated there for the disease.

OP Singh, the state’s top health official, said the disease was initially confined to Gorakhpur and other eastern parts of Uttar Pradesh, but cases were being reported from other areas of the state.

Several districts in the impoverished state are prone to the disease, which causes high fever, vomiting and, ultimately, can leave patients comatose.

The disease is preventable by vaccination, but health authorities in the state say there isn’t enough money to immunise the children.

The state has sought help of Unicef and the World Health Organisation to tackle the situation.
According to official estimates, about 3,500 people have died of encephalitis in the state over the past 25 years.

No cerebrospinal fluid (CSF) testing has been reported from India for Japanese encephalitis. Blood tests are not reliable, as antibodies found may be from an old prior infection. I want to see that an influenza A test has been done! Please post any lab confirmation of Japanese encephalitis by CSF testing if you see it.

http://news.bbc.co.uk/2/hi/south_asia/4179760.stm


India encephalitis toll hits 175

Children are worst affected by the outbreak
The number of deaths from an outbreak of Japanese encephalitis in India's Uttar Pradesh state has risen to at least 175.
Officials fear the death toll may be much higher as fatalities in rural areas often go unreported.

They say there is an acute shortage of vaccine in the northern state.

In the past few weeks more than 500 people, mostly children, have been treated for the disease, which occurs regularly during India's monsoon.

Encephalitis, a mosquito-borne disease, has killed 3,500 people in Uttar Pradesh in the past 25 years.

Hospital overcrowding

The BBC's Ram Dutt Tripathi in Lucknow says the official figures may be under-estimates as Gorakhpur district, 250km (165 miles) east of state capital Lucknow, has itself reported 167 deaths.

Most of the victims are very poor people from rural areas, says Dr TN Dhole, professor of microbiology in Lucknow's Sanjay Gandhi Post Graduate Medical Institute.

Senior officials have travelled to the area to supervise relief operations.

Doctors said children between the age of six months to 15 years were worst-affected.

Dr KP Kushwaha, a paediatrician from Gorakhpur, said up to 50 new sufferers were arriving every day.

He said there were no beds available in the hospital and even the corridors were full.

Japanese encephalitis, which causes high fever, vomiting and can leave patients comatose, usually hits the state at the end of August but this time it struck in July.

The disease has recurred annually in eastern regions of the state since about 1980.

Uttar Pradesh needs 50m vaccines every year, according to state health officials.

But the Kasauli-based Central Institute is only able to supply 200,000, they say.

JAPANESE ENCEPHALITIS - INDIA (UTTAR PRADESH)(02): SUSPECTED, 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>

Sponsored in part by Elsevier, publisher of
Travel Medicine and Infectious Disease
<http://www.travelmedicine.elsevier.com>

Date: Sat, 20 Aug 2005 08:00:19 -0400 (EDT)
From: ProMED <promed@promedmail.org>
Source: Reuters AlertNet, 20 Aug 2005 [edited]
<http://www.alertnet.org/thenews/newsdesk/DEL270755.htm>


India's encephalitis death toll rises to 110
------------------------------------------
The death toll in an encephalitis outbreak in India's northern state of
Uttar Pradesh rose to 110 on Saturday with 20 more deaths reported in the
past 36 hours, a health official said.

Most of the dead were children and more than 170 people were in hospital,
many of them in critical condition.

"Encephalitis is a perennial problem during the rainy season, but the
situation appears to be quite alarming this time," said K.P. Kushwaha, a
health official in Gorakhpur town, worst hit by the outbreak.

Encephalitis, an acute form of brain fever, is caused by a virus spread by
mosquitoes and proliferates in water-logged parts of India during the
monsoon season. Last year, about 50 people died of the disease in Uttar
Pradesh. India has suffered serious flooding during this year's monsoon
season, which runs from June to September.

In Mumbai (also known as Bombay) and adjacent areas, 210 people have died
of diseases such as leptospirosis, gastroenteritis and malaria after the
worst floods in history hit the region 3 weeks ago.

--
ProMED-mail
<promed@promedmail.org>

[The authorities have not yet identified the etiology of the current
outbreak of encephalitis in Uttar Pradesh State. The term 'Japanese
encephalitis' is used tentatively, only until the true cause is identified.
Obviously, the extraordinarily high death tolls indicate that encephalitis
this monsoon season seems to be unusually severe. The fact that there have
been 64 new deaths in the 3 days since the previous report dated 17 Aug
2005 (see also: 20050818.2421) is alarming indeed. Again, ProMED-mail would
greatly appreciate any further information concerning the so-called
perennial problem referred to in the Reuters report. - Mod.RY]

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Japanese encephalitis has not been lab confirmed by cerebrospinal (CSF) fluid tests.

http://www.newkerala.com/news.php?a...llnews&id=17063

Posted on 25 Aug 2005 # IANS


Encephalitis toll crosses 200 in Uttar Pradesh:
Lucknow: Uttar Pradesh may not get immediate respite from Japanese encephalitis, which has taken a toll of more than 200 lives since it broke out July 29.

Three patients, including an adult, succumbed to the disease at the King George's Medical University (KGMU) here Thursday, while 17 deaths were reported from Gorakhpur and about half a dozen in the districts of eastern Uttar Pradesh.

Things have virtually been left to god's mercy, with the state administration expressing helplessness in arresting the spread of the brain fever.

"The virus grows largely between August and October, but vaccination, which is the only effective preventive method, cannot be undertaken after the outbreak of the disease," Uttar Pradesh's director general of health O.P. Singh told IANS here.

"Vaccines will not be of any use now. But I must say that we have now learnt a lesson and we would be better equipped to deal with the disease next year."

But Singh's word cannot be taken at face value as Japanese encephalitis has been striking the state for 27 consecutive years, claiming more than 1,500 lives.

Unofficial reports say the actual toll could be much higher than 200, as there is no system of recording the deaths in villages and smaller towns where the disease is believed to have taken a heavy toll.

"At this stage, anti-mosquito treatment through fogging is the only way to curb the rapid spread of the virus," Singh said. But he was not sure if fogging machines were available in the dozen odd affected districts.

Social activists in Gorakhpur - the epicentre of the disease - had demanded the removal of pigs from residential areas.

"Yes, we had decided to launch a drive against the proliferation of pigs in residential areas; but then local legislators have come in the way to pressurise the administration to defer its plan," a district official told IANS on condition of anonymity.

"Who doesn't know that the presence of pigs is a major source of mosquito breeding?"

Even Governor T.V. Rajeshwar, who visited Gorakhpur last week to take stock of the situation, had urged the administration to take measures against pigs.

The disease had taken a toll of 228 people in 2004, but health officials say it could be much higher this time.

"Unlike 2004 and many preceding years, when the disease remained confined only to eastern Uttar Pradesh, the virus has spread across to Lucknow in central Uttar Pradesh," said an official.



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