H5N1

An online course in rabies

Via Michael Walsh's excellent blog Infection Landscapes, another well-organized mini-course: Rabies. Excerpt:

This time at Infection Landscapes we cover the "madness" disease. Rabies is a zoonotic disease that causes encephalitis and, if no vaccine is administered, almost always results in death. While human rabies infection is not common in the developed world, it is a significant cause of death in the developing world where the vast majority of infections are acquired from dogs. The name "rabies" comes from the Latin word for madness. This is an ancient disease having been documented for almost four thousand years. It has always been associated with rage and violence in the afflicted.

India: Expert team in Patna to study litchi-encephalitis connection

Via the Deccan Herald: Expert team in Patna to study litchi-encephalitis connection. Excerpt:

A team of experts from the National Centre for Disease Control (NCDC), New Delhi, has flown down to Bihar amidst reports that three children, suspected to have been afflicted with acute encephalitis syndrome (AES), have died in the last few days. 

The experts will study litchi orchards in Muzaffarpur district and find out whether there is any link with AES because it is suspected that the dreadful disease–encephalitis–breaks out during the fruition season of litchi, and the virus thrives in the litchi plants. 

 In the last few years, encephalitis has taken a heavy toll in Bihar with 45 children in 2011 and 173 in 2012 respectively, dying due to this mysterious disease. The scientific probe by the NCDC has been necessitated because the months of May and June are the season for litchis and children have complained of symptoms of the disease after visiting litchi orchards.

India: Encephalitis claims 3 kids in Bihar

Here we go again. Via The Times of India: Encephalitis claims 3 kids in Bihar. Excerpt:

A six-month-old baby succumbed to a deadly mosquito-borne disease in Bihar Thursday, taking the toll from the disease to three in 2013, and 16 children have been admitted to hospitals in Muzaffarpur, officials said. 

Six-month-old Himanshu Kumar died of suspected Acute Encephalitis Syndrome (AES), at Sakra Referral Hospital, Muzaffarpur Civil Surgeon Gayan Bhusan said. 

The AES is a severe case of encephalitis characterised by inflammation of the brain. The mosquitoes transmit the infection causing high fever among the children. 

All the three deaths have taken place in Muzaffarpur. 

Earlier this week, a four-year-old boy died of suspected AES at the Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, about 70 km from here. 

Bhusan said the situation is under control and there was no need to panic. 

Last week, a one-year-old girl died of suspected AES at the hospital in Muzaffarpur. It was the first death suspected to be caused by AES reported in Bihar. 

Bhusan said that so far 16 children with symptoms of AES were admitted to various hospitals in the district in the last 10 days. 

"Every year, encephalitis hit Muzaffarpur, Gaya and other neighbouring districts in May or June. But this year it seems to have hit a little early," a health department official here said. 

Last year, the AES killed nearly 240 children in Muzaffarpur and Gaya districts.

India: Japanese encephalitis vaccination drive begins in Gorakhpur

Via Zeenews.com, a PTI report: Japanese Encephalitis vaccination drive begins in Gorakhpur. And not a minute too soon. Excerpt:

Gorakhpur: In order to protect children from the dreaded Japanese Encephalitis (JE), a massive vaccination drive has begun here, a senior health official said on Friday. 

The vaccination drive has been included in the routine vaccination programme for children up to two years, said M P Singh, Chief Medical Officer Gorakhpur. 

The free drive began on April 15. 

"The families living near the piggeries are given priority as the vector-borne disease spreads through mosquitoes that carry JE viruses," he said. 

Pig is the primary host to JE virus. 

The disease takes toll of an average 500 lives every year in terai region of Uttar Pradesh. 

According to health officials, the disease has claimed over 15,000 lives, mostly children since 1978 when the disease surfaced for the first time in the area.

India: Encephalitis claims 38 before peak season

Meanwhile, via The Times of India, a recurring nightmare: Encephalitis claims 38 before peak season. Excerpt:

LUCKNOW: Encephalitis normally makes its presence felt during monsoons. However, this time, acute encephalitis has claimed 38 lives and affected 118 persons even before the onset of the disease season. This despite chief secretary Jawed Usmani issuing repeated directives to the state health department and officials posted in the districts to initiate preventive measures. 

Encephalitis is the inflammation of the brain caused by microbial agents such as bacteria and viruses. The cause of infection in eastern districts of UP, parts of Bihar and Nepal is virus in 98% of the patients. Encephalitis has killed children for long, but the documentation work began in the mid 1970s. Earlier, the Arbo-B virus was the cause of encephalitis and the disease was called Japanese encephalitis. 

After extensive vaccination campaigns, the incidence of Japanese encephalitis subsided. Still children continue to die. Researches have shown that the cause of encephalitis in about 45% of the cases is not known. 

Statistics gathered from the health department show that of the total cases, 103 patients belonged to UP of whom 34 died. Bihar accounted for the remaining 14 cases and four deaths. A patient from Nepal is also undergoing treatment at the Baba Raghav Das Medical College of Gorakhpur. Kushinagar turned out to be the worst affected district so far, but Gorakhpur has seen the maximum deaths. 

In Kushinagar, as many as 30 cases and 10 deaths have been reported while in Gorakhpur, 12 of the 23 patients suffering with acute encephalitis have died. What has pressed the panic button for the health department officials is that the case fatality rate for the first quarter of 2013 is significantly higher than that in 2012. 

Case fatality rate refers to the number of patients who die against those admitted. In the first quarter of 2012, as many as 26.88% of the children suffering from AES died, a growth of 33% in 2013. Doctors at the communicable diseases unit of state health directorate believe that by the end of the year, the case fatality rate will subside. 

The only silver lining is that the number of cases of Japanese encephalitis. Experts at the Gorakhpur unit of National Institute of Virology give credit to the special vaccination drive against JE for the low number of cases. Still as these children struggle for life, staff employed in the hospital attended them calmly. 

"The season is yet to begin. Come in August or September to know what the encephalitis epidemic looks like," a medical officer told TOI.

Sri Lanka: Japanese encephalitis under control

Via the Sunday Observer: Japanese Encephalitis under control - Unit chief.

Japanese Encephalitis (JE) cases which soared alarmingly in December and January, have declined with a few positive cases being reported from Ratnapura and Kurunegala in February, Epidemiology Head, Dr. Paba Palihawadana told the Sunday Observer, yesterday. She said all children under ten years have been immunized against the disease in Ratnapura where the highest number of cases had been reported. 

JE is a viral infection affecting both humans and animals. Pigs, especially piglets are vulnerable to the disease caused by the mosquito. All pigs in the affected districts are thus being immunized against the disease, she said.

"We have asked pig owners to keep their piglets inside the pens and install screens to prevent mosquitoes entering the pens", she said.

Dr. Paba said most of the deaths reported were elderly persons over 65 years who also suffered from various chronic ailments which compounded their conditions when infected. 'Surveillance will continue in high risk areas.'

Sri Lanka: Japanese encephalitis patients reported from Ratnapura

Via Daily News: Japanese encephalitis patients reported from Ratnapura.

Eight Japanese encephalitis patients were reported from Ratnapura. Patients who were suspected of having the illness were diagnosed with viral encephalitis which is a common illness. The number of patients suspected with Japanese encephalitis was 52, a Health Ministry spokesperson said. 

According to him, seven out of eight Japanese encephalitis patients were above 48 and there was a two-month-old infant. 

The Health Ministry has vaccinated children below 10 against Japanese encephalitis in Ratnapura. Every year viral encephalitis hit this area and around 40 patients are reported. 

Meanwhile, the Medical Research Institute (MRI) is carrying out diagnosis testing for Japanese encephalitis without interruption. 

Pigs spread the Japanese encephalitis virus. Therefore, arrangements are made to vaccinate all pigs in farms against the disease. 

The virus is transmitted through the Culex mosquito. 

The ministry has taken steps to destroy mosquito breeding places by fogging and spraying chemicals.

This is a setback; less than a week ago, Daily News ran a story on how Japanese encephalitis had been curbed in Ratnapura.

India: Preparing for the next round of encephalitis

Via The Times of India: 'Inter-departmental coordination must to tackle encephalitis'. Excerpt:

LUCKNOW: Chief secretary Jawed Usmani asserted on the need for inter-departmental coordination to effectively implement preventive measures for checking the annual death of Japanese encephalitis and acute encephalitis syndrome. 

In a review meeting held on Monday he stated that departmental milestones should be fixed, so that achieving the assigned target is easy. 

He also delegated the responsibility of implementing anti-JE/AES plans to divisional commissioners and district magistrates in their respective areas of influence. The strategy to check encephalitis in the endemic region largely depends on access to safe drinking water and so proposal for installing 4,189 hand pumps worth Rs 24337.13 lakh has been sent to the Centre. 

The strategy has elements of strengthening the BRD Medical College, providing healthy food to children through anganwadi centres, impart training to anganwadi workers among others. 

In a prior meeting, the chief secretary fixed March 2013 as the deadline for completion of all construction work related to the 100-bedded ventilator ward at Baba Raghav Das Medical College, Gorakhpur. He has also told the officials to ensure that the unit gets fully functional by the end of June 2013. 

In 2012, the UP government had claimed that it has taken various steps to control the spread of encephalitis in the eastern districts of the state, but the year-end report shows little improvement on ground from the previous years. 

Figures from the health directorate show that as many as 3,484 persons were affected by acute encephalitis syndrome and 557 died of it in 2012. In 2011, the corresponding figures were 3,490 and 583. However, a considerable fall was noticed in the number of JE patients.

Sri Lanka: Japanese encephalitis curbed in Ratnapura

Via the Daily News: Japanese Encephalitis curbed in Ratnapura.

The spread of Japanese encephalitis in the Ratnapura district dropped significantly with only five patients reported during last week. However, three other cases have been detected in Kegalle, Sabaragamuwa Provincial Council Additional Secretary Sunil Leelananda said. 

Ratnapura district Health Service Director Dr Athula Dangalla said around 60,000 children below 10 years had already been immunised for Japanese encephalitis in the district. 

This was revealed at a press conference presided over by Sabaragamuwa Chief Minister and Health Minister Maheepala Herath and attended by district health officials at the Chief Minister’s office on Tuesday. 

Around 11 persons died and 48 Japanese encephalitis cases detected by February 11 from December last year to January this year, Leelananda said. 

The immunisation of children below 10 years was carried out covering almost all the regions that were disease prone. Destroying mosquito breeding areas and immunising pigs reared by people in the district were also carried out on the Chief Minister’s directive.

Sri Lanka: Japanese encephalitis vaccination for Ratnapura children

Via the Daily News: Japanese Encephalitis vaccination for Ratnapura children.

A programme to vaccinate children below 10 years in the Ratnapura district against Japanese Encephalitis and several other measures have been taken by the Ratnapura District Health Office to counter the spread of the disease, Health Director Dr Athula Dangalle said. 

This follows the death of nine due to Japanese Encephalitis during the last two months, he said. 

Addressing a meeting held under the patronage of Sabaragamuwa Chief Minister Maheepala Herath at the Chief Ministry on February 6, Dr Dangalla said 46 persons had contracted the virus from 16 MoH divisions in the district except Imbulpe and Ayagama and nine of them had succumbed to the disease. 

He said arrangements had been made to launch the vaccination programme from February 7 on the direction of the Chief Minister from several MoH divisions including Elapathe. 

Arrangements have also been made to obtain 196,000 doses of the vaccine to facilitate this programme. 

Pigs have been identified as the main source of this virus which is then transmitted to persons by mosquitoes who serve as the carrier. 

There are nearly 2,300 pigs reared in piggeries in the district and steps would be taken to immunise the pigs to control the spread of the disease. 

Dr Dangalla said 20,000 vials of the vaccine would be obtained on an urgent basis from the Epidemiology Unity as a short term measure.