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  • NEPAL-unidentified disease (ProMed)

    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

  • #2
    Re: NEPAL-unidentified disease (ProMed)

    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
    mmmmmm.....

    Comment


    • #3
      Re: NEPAL-unidentified disease (ProMed)

      I would like to suggest that given even the remote possibility of H5N1 that we are not alone in wondering if this may be H5N1. The locale is rife with migrating birds known to be infected with the disease. The people of the region are no doubt ignorant of the threat of picking up and eating a sick bird. (Why waste good protein?) And while I do not usually don tin-foil hats, I too am mulling over the possibility of influenza. The demographics are suggestive, the etiology is suspect, the geography is suspicious. I am far from convinced but the possibility is obvious. A little scepticism is always wise but I am still going to keep my eye on this situation.

      Knee-jerk.....I just wish that every time someone wonders aloud whether a new outbreak somewhere may be flu virus, that we could be assured of honesty from the PTB. It is little wonder that bloggers are deeply suspicious of opposing knee-jerk positions that it is unlikely to be H5N1. Too many times in the past have we been told it was not bf when later it turned out it was. A little more forthrightness on the part of officials would go a long way in snuffing out the words of those who are scare-mongers. I for one would welcome a little more wisdom and honesty, and a lot less debasement from those who are in charge of the worlds health. When the messages lean more towards economic stability and less towards public health who can blame us for our raised eyebrows?
      Please do not ask me for medical advice, I am not a medical doctor.

      Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
      Thank you,
      Shannon Bennett

      Comment


      • #4
        Re: NEPAL-unidentified disease (ProMed)

        for the record...I agree with you both.

        Comment


        • #5
          Re: NEPAL-unidentified disease (ProMed)

          Exactly Shannon.

          Comment


          • #6
            Re: NEPAL-unidentified disease (ProMed)

            Nepal Health Officials Rule Out Outbreak
            August 22nd, 2006 @ 9:37am
            Phoenix, Arizona News - KTAR.com. The page brings you up to date news from state of Arizona. KTAR.com is the home of News/Talk 92.3 KTAR. - Home - 92.3 KTAR


            KATMANDU, Nepal (AP) - Nepalese health officials ruled out Tuesday a mysterious disease outbreak in a mountain village, saying seven people who died there in less than two weeks had died of a variety of causes.

            On Saturday the Kathmandu Post reported 14 unexplained deaths in Betini, Nuwakot district, sparking concerns that a deadly disease had struck the village, possibly bird flu. The report said the disease first struck dogs and chicken in June.

            Two teams of health workers were sent from a district hospital to investigate the deaths in Betini, about 30 miles northwest of the capital Katmandu, but found no mysterious outbreak, Bikash Lamichane, a doctor at a local hospital said on the telephone Tuesday.

            The health workers discovered that only seven had died, five of chronic diseases including asthma and kidney problems, and two of diarrhea, Lamichane said.

            There are not many hospitals or doctors in the villages in Nepal and patients in the mountainous region have to walk for hours if not days to reach the nearest road to get to a hospital.

            (Copyright 2006 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

            Comment


            • #7
              Re: NEPAL-unidentified disease (ProMed)

              I would feel far more reassured if the officials hadn't been locals. I remain sceptical of both the reports that the diseases were mostly chronic and that it was H5N1. A contingency of the WHO would have been more believable. Toss this one in the review it later bin.
              Please do not ask me for medical advice, I am not a medical doctor.

              Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
              Thank you,
              Shannon Bennett

              Comment


              • #8
                Re: NEPAL-unidentified disease (ProMed)

                I guess their dogs and chickens died of asthma too. Or maybe they didn't die too. No bleeding from noses, no fever. Guys, it was all a bad dream...

                Comment


                • #9
                  Re: NEPAL-unidentified disease (ProMed)

                  Originally posted by vaffie
                  I guess their dogs and chickens died of asthma too. Or maybe they didn't die too. No bleeding from noses, no fever. Guys, it was all a bad dream...
                  Great statement Vaffie!

                  How can anyone hope for containment when most nations are in denial and those that admit they have a problem do not follow recommended procedures?

                  Indonesia is giving antiviral meds to everyone and most others deny human cases.
                  Granted, Nepal may not be H5N1, but the cover story doesn't add up at all.

                  Sometimes it feels as though the authorities in charge are as unpredictable as the virus.
                  "There's a chance peace will come in your life - please buy one" - Melanie Safka
                  "The greatest way to live with honor in this world is to be what we pretend to be" - Socrates

                  Comment


                  • #10
                    Re: NEPAL-unidentified disease (ProMed)

                    A rumour about humans with bleeding nose can equally apply to dogs and chickens.

                    Comment


                    • #11
                      Re: NEPAL-unidentified disease (ProMed)

                      Does anyone know what all their pigs died of back in June? Below is a link to an article where 30 pigs died but the vet never actually went out to look at the pigs. They just looked at pictures of them.
                      http://www.e-pao.net/GP.asp?src=4..120606.jun06

                      Comment


                      • #12
                        Re: NEPAL-unidentified disease (ProMed)

                        Originally posted by ruthbeme
                        Does anyone know what all their pigs died of back in June? Below is a link to an article where 30 pigs died but the vet never actually went out to look at the pigs. They just looked at pictures of them.
                        http://www.e-pao.net/GP.asp?src=4..120606.jun06
                        Hi Ruthbeme,
                        The article you mention is actually from far eastern India, almost 700 miles away, near the border of Myanmar. There have been vast numbers of reports such as that one, with symptoms of nosebleeds, etc., across India for the last eight months but primarily in the Madhya and Andra Pradesh areas, and they were all either blamed on swine flu or not investigated.

                        Comment


                        • #13
                          Re: NEPAL-unidentified disease (ProMed)

                          Thank so much Vaffie. I was unaware of the distance between these areas. I have also read other similar articles where they discuss dogs and pigs, can dogs catch swine flu?

                          Comment


                          • #14
                            Re: NEPAL-unidentified disease (ProMed)

                            Some historical perspective and commentary on Nepal - I pulled these from Dr. Niman's site.

                            Mysterious Disease Kills 22 in Western Nepal
                            June 16, 2005


                            H3N2 California Origins in Nepal
                            June 29, 2005


                            H5N1 Bird Flu Migrates Toward Nepal India Bangladesh Bhutan
                            August 10, 2005


                            Influenza Deaths in Nepal Raise Concerns
                            September 14, 2005


                            Look familar? Who knows?...There is a lot of disease in this world. I just wish that some journalists would follow up on their reports of outbreaks and mysterious deaths. Not sexy enough I guess. This is not specific commentary on Nepal - it is universal! Please note, I said "some" not all journalists. As far as I can tell there are no follow up reports on the above stories - at least not on the internet.
                            "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

                            Comment


                            • #15
                              Re: NEPAL-unidentified disease (ProMed)

                              Thanks Niko for the info. Great digging!

                              Comment

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