UNDIAGNOSED DEATHS - NEPAL (NUWAKOT): 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>
[1]
Date: 19 Aug 2006
From: ProMED-mail <promed@promedmail.org>
Source: Xinhua [edited]
<http://english.people.com.cn/200608/19/eng20060819_294852.html>
Unidentified disease kills 14 in central Nepal
-----------------------------------------------
An unprecedented epidemic of an unidentified disease has killed at
least 14 people, including 7 children, in central Nepal in the past 2
weeks, The Kathmandu Post reported on Saturday [19 Aug 2006].
According to the newspaper, the disease, which was 1st detected in
dogs and chickens during the last week of June 2006, had started
spreading to humans in Netini, a far eastern village of Nuwakot
district, some 50 km northwest of Kathmandu.
Major symptoms of the disease are high fever with bleeding from the
nose and mouth at the time of death.
--
ProMED-mail
<promed@promedmail.org>
******
[2]
Date: 19 Aug 2006
From: Joe Dudley <jdudley@eaicorp.com>
Source: eKantipur Online [edited]
<http://www.kantipuronline.com/kolnews.php?&nid=83207>
An unprecedented epidemic of an unidentified disease has killed at
least 14 people, including 7 children, in Netini VDC, a far eastern
village of the district, in the past 2 weeks.
The disease, which was 1st detected in dogs and chickens in the last
week of June 2006, has started spreading to humans.
Major symptoms of the disease are high fever with bleeding from the
nose and mouth at the time of death.
--
Joe Dudley
Chief Scientist, Biosecurity & Biosurveillance
EAI Corporation
SAIC
<jdudley@eai.com>
[Given the paucity of symptoms provided in the 2 very similar
newswires above, it would be very hazardous to venture a differential
diagnosis at this time. That being said, it is important to mention
that we were 1st alerted to this outbreak by a subscriber (who,
though known to us, did not wish that identifying information be
given), who mentioned that chat rooms/blogs were speculating that
this might be due to H5N1, given the history of poultry and dogs
(although dogs have not been routinely identified as being affected
by H5N1). It seems that in today's environment, any mention of an
animal death preceding undiagnosed human deaths results in a "knee
jerk" response on the part of bloggers to attribute deaths to H5N1
immediately, even if the symptoms are not clearly those associated
with human H5N1 deaths as seen in the majority of cases confirmed and
officially reported.
This moderator did use the Global infectious disease epidemiology
network (GIDEON <http://www.gideononline.net>) and ran the above
given information complex (fatal outcome, hemorrhagic illness, fever,
contact with birds (no choice of poultry was given) and dogs in
Nepal, and came up with: "No known infectious diseases fit this complex."
Eliminating exposure to birds, the most likely infectious disease
mentioned was leptospirosis, known to be endemic in Nepal. Another
febrile hemorrhagic disease reported in the literature to occur in
Nepal is old world hantavirus (from Mod.MPP discussion in ProMED-mail
posting Undiagnosed deaths - Nepal (Udyapur): RFI 20050824.2493:
"There is an article in the Japanese literature (abstract in English)
<http://www.jarmam.gr.jp/jarmam/8-2/e/2.html> which identified an
overall seropositivity rate of 8.7 percent of 322 specimens from
patients attending outpatient clinics at the Tribhuvan University
Teaching Hospital in Kathmandu. Of note, a higher positivity rate of
12 percent was seen in those living outside of the Kathmandu valley
(5.1 percent), suggesting hantavirus infection was more prevalent in
rural areas.").
As one can see from the see also list below, ProMED-mail reports of
undiagnosed illnesses and deaths in Nepal have not been rare.
Unfortunately, what has been rare is for ProMED-mail to receive
information from knowledgeable sources in Nepal on results of
epidemiologic and laboratory investigations into these reported
outbreaks and clusters. We are still awaiting information on an
outbreak reported last month (July 2006), for which this moderator
postulated that the most likely diagnosis might be typhoid fever.
Once again, we are requesting that knowledgeable sources (either
Nepal-based or organizations that have knowledgeable sources based in
Nepal) shed light into what may be the etiology of the above
mentioned fatal febrile illness with hemorrhagic phenomena occurring
in the Nuwakot district of Nepal. - Mod.MPP]
[see also:
Undiagnosed deaths - Nepal (Sankhuwasabha)(03): RFI 20060806.2194
Undiagnosed deaths - Nepal (Sankhuwasabha)(02): RFI 20060730.2108
Undiagnosed deaths - Nepal (Sankhuwasabha): RFI 20060728.2088
2005
----
Undiagnosed deaths - Nepal (Udyapur): RFI 20050824.2493
Undiagnosed deaths - Nepal: RFI 20050617.1709
2003
----
Unexplained deaths - Nepal (Bajura): RFI 20030212.0377
1999
----
Unidentified disease - Nepal 19990308.0345
1996
----
Fever, fatal - Nepal (5) 19960422.0760
Fever, fatal - Nepal (3): Current status 19960418.0749
Mystery fever in Nepal. 19960416.0728
Fever, fatal - Nepal (2): ?possible diagnoses 19960411.0687
Fever, fatal - Nepal (press report) 19960409.0673]
....................mpp/msp/mpp
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: 19 Aug 2006
From: ProMED-mail <promed@promedmail.org>
Source: Xinhua [edited]
<http://english.people.com.cn/200608/19/eng20060819_294852.html>
Unidentified disease kills 14 in central Nepal
-----------------------------------------------
An unprecedented epidemic of an unidentified disease has killed at
least 14 people, including 7 children, in central Nepal in the past 2
weeks, The Kathmandu Post reported on Saturday [19 Aug 2006].
According to the newspaper, the disease, which was 1st detected in
dogs and chickens during the last week of June 2006, had started
spreading to humans in Netini, a far eastern village of Nuwakot
district, some 50 km northwest of Kathmandu.
Major symptoms of the disease are high fever with bleeding from the
nose and mouth at the time of death.
--
ProMED-mail
<promed@promedmail.org>
******
[2]
Date: 19 Aug 2006
From: Joe Dudley <jdudley@eaicorp.com>
Source: eKantipur Online [edited]
<http://www.kantipuronline.com/kolnews.php?&nid=83207>
An unprecedented epidemic of an unidentified disease has killed at
least 14 people, including 7 children, in Netini VDC, a far eastern
village of the district, in the past 2 weeks.
The disease, which was 1st detected in dogs and chickens in the last
week of June 2006, has started spreading to humans.
Major symptoms of the disease are high fever with bleeding from the
nose and mouth at the time of death.
--
Joe Dudley
Chief Scientist, Biosecurity & Biosurveillance
EAI Corporation
SAIC
<jdudley@eai.com>
[Given the paucity of symptoms provided in the 2 very similar
newswires above, it would be very hazardous to venture a differential
diagnosis at this time. That being said, it is important to mention
that we were 1st alerted to this outbreak by a subscriber (who,
though known to us, did not wish that identifying information be
given), who mentioned that chat rooms/blogs were speculating that
this might be due to H5N1, given the history of poultry and dogs
(although dogs have not been routinely identified as being affected
by H5N1). It seems that in today's environment, any mention of an
animal death preceding undiagnosed human deaths results in a "knee
jerk" response on the part of bloggers to attribute deaths to H5N1
immediately, even if the symptoms are not clearly those associated
with human H5N1 deaths as seen in the majority of cases confirmed and
officially reported.
This moderator did use the Global infectious disease epidemiology
network (GIDEON <http://www.gideononline.net>) and ran the above
given information complex (fatal outcome, hemorrhagic illness, fever,
contact with birds (no choice of poultry was given) and dogs in
Nepal, and came up with: "No known infectious diseases fit this complex."
Eliminating exposure to birds, the most likely infectious disease
mentioned was leptospirosis, known to be endemic in Nepal. Another
febrile hemorrhagic disease reported in the literature to occur in
Nepal is old world hantavirus (from Mod.MPP discussion in ProMED-mail
posting Undiagnosed deaths - Nepal (Udyapur): RFI 20050824.2493:
"There is an article in the Japanese literature (abstract in English)
<http://www.jarmam.gr.jp/jarmam/8-2/e/2.html> which identified an
overall seropositivity rate of 8.7 percent of 322 specimens from
patients attending outpatient clinics at the Tribhuvan University
Teaching Hospital in Kathmandu. Of note, a higher positivity rate of
12 percent was seen in those living outside of the Kathmandu valley
(5.1 percent), suggesting hantavirus infection was more prevalent in
rural areas.").
As one can see from the see also list below, ProMED-mail reports of
undiagnosed illnesses and deaths in Nepal have not been rare.
Unfortunately, what has been rare is for ProMED-mail to receive
information from knowledgeable sources in Nepal on results of
epidemiologic and laboratory investigations into these reported
outbreaks and clusters. We are still awaiting information on an
outbreak reported last month (July 2006), for which this moderator
postulated that the most likely diagnosis might be typhoid fever.
Once again, we are requesting that knowledgeable sources (either
Nepal-based or organizations that have knowledgeable sources based in
Nepal) shed light into what may be the etiology of the above
mentioned fatal febrile illness with hemorrhagic phenomena occurring
in the Nuwakot district of Nepal. - Mod.MPP]
[see also:
Undiagnosed deaths - Nepal (Sankhuwasabha)(03): RFI 20060806.2194
Undiagnosed deaths - Nepal (Sankhuwasabha)(02): RFI 20060730.2108
Undiagnosed deaths - Nepal (Sankhuwasabha): RFI 20060728.2088
2005
----
Undiagnosed deaths - Nepal (Udyapur): RFI 20050824.2493
Undiagnosed deaths - Nepal: RFI 20050617.1709
2003
----
Unexplained deaths - Nepal (Bajura): RFI 20030212.0377
1999
----
Unidentified disease - Nepal 19990308.0345
1996
----
Fever, fatal - Nepal (5) 19960422.0760
Fever, fatal - Nepal (3): Current status 19960418.0749
Mystery fever in Nepal. 19960416.0728
Fever, fatal - Nepal (2): ?possible diagnoses 19960411.0687
Fever, fatal - Nepal (press report) 19960409.0673]
....................mpp/msp/mpp
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