KANPUR, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 400+ fatalities - Dengue, malaria, H1N1, others suspected

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 356 fatalities - Dengue, malaria, H1N1, others suspected

Summary of age-related data for fatalities in Uttar Pradesh.

In Kanpur information is available for 65 of 356 fatalities;

<10: 24 (37%)
10s: 13 (20%)
20s: 4 (6.1%)
30s: 6 (9.2%)
40s: 8 (12%)
50s: 5 (7.7%)
60s: 5 (7.7%)

In Lucknow information from 16 of 56 fatalities;

<10: 2 (13%)
10s: 0 (0%)
20s: 9 (56%)
30s: 1 (6.2%)
40s: 2 (13%)
50s: 1 (6.2%)
60s: 1 (6.2%)

With such small sample sizes, and taking into account reporting bias, any conclusions are tenuous at best, but both outbreaks seem to be affecting younger populations - especially children in the Kanpur case.

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 356 fatalities - Dengue, malaria, H1N1, others suspected

Hindi to English translation
Fever took the lives of three innocent Oct 26, 07:40 pm
Ramabai Nagar, our representatives: the district despite the outbreak of the disease and illness on Tuesday, doctors from the hospitals affected villages were missing from the health teams. To be in the grip of deadly fever after the death of three innocent yet the death toll has gone up 360.
District in the last three months despite the strange fever deaths continuing control of the Department of Health has not been negligent. Tuesday Ghorikrn native son of Sarvesh Lalla (1), the Sanu Chipattie Muasanagr Hyatt's daughter Zara (1) and the daughter of Manoj Durghapur semaphore Crest (8) was killed. While doctors from government hospitals and village health teams were missing, the patient was forced to wander. Alam, the disease in affected villages - except two places are not going anywhere health teams. Distress by making rural Zolahchhapoan treatment are putting lives at risk. DM Saroj Kumar Tiwari said that surprise inspections of hospitals, physicians and personnel by making irresponsible action will be. Department of Health in the CMO office for the deployment efforts are being made.

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6850633.htm

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 360 fatalities - Dengue, malaria, H1N1, others suspected

Central team begins review of dengue outbreak

Express News Service
Posted: Oct 26, 2010 at 0546 hrs IST

Lucknow A Central government team, led by director of National Vector Borne Disease Control Programme (NVBDCP) Dr AC Dhariwal, arrived in Lucknow on Monday to review the spread of dengue in the state. The team plans to stay in the state for two days.


.....


?Our team has been visiting other districts as well,? said Dhariwal, adding that a team had visited Kanpur Dehat (Ramabai Nagar) last week. According to official data, only two cases [of dengue] have been reported so far in Ramabai Nagar. However, Dhariwal said the number was more.

http://www.expressindia.com/latest-news/central-team-begins-review-of-dengue-outbreak/702594/

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 360 fatalities - Dengue, malaria, H1N1, others suspected

Hindi to English translation
Seven and eight than apply: the brunt of the disease: fever and the three-handedly broke Oct 27, 11:24 pm

Ramabai Nagar, office news: the disease is not the name of mindless havoc. Fever on Wednesday three more people died. District 363 The death toll from the disease so far has.
District in the last three months of strange fever deaths havoc despite the continuing negligence in the health department could not control. Nagina Tehsil area resident on Wednesday Bhoaganipur Sivaprasad's son Santosh Yadav (28), son of Kalan's Murllypur Patraoal (25) and the Rjrza Jlalpur (60) was killed. Here, despite the outbreak of disease and illness affecting doctors from government hospitals to rural health teams were missing, the patient was forced to wander. Villagers alleged that doctors at health centers not receive the treatment they Zolahchhapoan have had to make. DM Saroj Kumar Tiwari said that surprise inspections of hospitals by making administrative officers will be tight rein on Lahparwahoan. He said the district's new CMO, Dr. Ramesh Chandra Srivastava has to be deployed on Wednesday. CMO said that the village health team by sending a fact with respect to deaths and disease will be tested and anti-larval spraying of DDT in the affected villages will be made.

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6855343.html

[alert]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 363 fatalities - Dengue, malaria, H1N1, others suspected

The link below, while referring to the outbreak in Lucknow, not Kanpur, indicates that despite repeated denials, a majority of that outbreak was indeed due to dengue, possibly a new strain. The similarity in the two outbreaks suggests that may be the case in Kanpur as well.

http://timesofindia.indiatimes.com/city/lucknow/Viral-deaths-in-Khadra-due-to-dengue-Report/articleshow/6824850.cms

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 363 fatalities - Dengue, malaria, H1N1, others suspected

Hindi to English translation
Of fever and respiratory Thmee one, dozens sick Oct 28, 08:27 pm
Ramabai Nagar, our representative: outbreak of fever in the district on Thursday, killing a young man. The death toll has yet to be 364. Dozens of villages are vulnerable to disease and health teams not reaching the villagers resentful. Reached the district hospital suffering from malaria were found in three patients.

Outbreak of fever in the district so far has released a series of deaths. Thursday compassion hamlet village resident Ombabu (24) died of the fever. After the outbreak of the disease around the affected villages were missing from the health teams conducted the cleaning operation does not show anywhere. District Hospital Emergency Room OPD closing out of the crowd was the fever victims. A dozen critical patients admitted treatment was started, the three new malaria patients given RT mark. Charge of infectious disease in the affected villages, said Dr. Arvind Sschane The health teams will be verified

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6857054.html

[alert]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 364 fatalities - Dengue, malaria, H1N1, others suspected

http://www.promedmail.org/pls/apex/f..._ID:1000,85551

Archive Number 20101028.3916
Published Date 28-OCT-2010
Subject PRO/EDR> Undiagnosed fatal illness - India (05): (UP) RFI


UNDIAGNOSED FATAL ILLNESS - INDIA (05): (UTTAR PRADESH) REQUEST FOR INFORMATION
************************************************** *************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


[1]
Date: Wed 27 Oct 2010
Source: Yahoo India [in Hindi, machine trans., summ. & edited]



On Wednesday [27 Oct 2010] 3 more people died in the Ramabai Nagar
district. The death toll from the disease so far has reached 363 in
the last 3 months of this strange fever outbreak that the health
department could not control.

DM Saroj Kumar Tiwari the district chief medical officer said that
the village health team will be sending the facts with respect to
deaths and disease and anti-larval spraying of DDT in the affected
villages will be made.

--
Communicated by:
Ronan Kelly


[The implementation of DDT spraying to control mosquito larvae
mentioned in this report suggests that the etiological agent is
mosquito borne, but without indicating what that agent might be.

A map showing the location of Ramabai Nagar (also known as Kanpur
Dehat) district in Uttar Pradesh can be accessed at
.
A map of the districts of Uttar Pradesh, showing the location of the
affected Kanpur Dehat and Lucknow districts can be accessed at
.
A HealthMap/ProMED-mail interactive map of India is available at
. - Mod.TY]

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 364 fatalities - Dengue, malaria, H1N1, others suspected

Hindi to English translation
District Hospital suffering fever reached 155 Oct 29, 09:48 pm
Ramabai Nagar, our representatives: an outbreak of fever in the district has not subsided name. District hospital on Friday suffering fever reached 155, of these eight critical patients admitted to treatment has been started.

CHC and PHC not being used to enroll patients in treatment in the name of where the death Zolahchhap patients are divided. District Hospital is growing congestion in the fever victims. Suffer fever reached 155 on Friday, two of which were confirmed to be suffering from malaria. Aghasi While the range of Bhoaganipur Mahjben, Dastampur the Ajr, Balhdrapur the Kalloo, Sarkauda the Shiva, Akbarpur the peace, Aragaan Aramjanqui of discretion and Adoadiamu serious condition due to fever has started recruiting treatment. Dr. DC Mishra said CMS Sarkauda Zolahchhap the Shiva is critical to the treatment. He said the large number of patients reaching the only serious patients admitted to treatment have been made.

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6860848.htm

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 364 fatalities - Dengue, malaria, H1N1, others suspected

More and more likely that this is a mixture of mostly dengue and malaria.

Hindi to English translation
No fever havoc handed, four were John Oct 29, 07:09 pm
Ramabai Nagar, our representative: strange fever in the district is not the name of mindless havoc. On Friday, the four more people died of the fever. To be in the grip of fever death toll has gone up 368. While District 520 malaria patients a month in hospital and of these 56 patients were found to suffer from Failsiferma.
Thamt fever in the district do not see. Only four deaths in two days after Friday's sudden fever Akbarpur Siadulare (60), the Kamaladevi Rur (55), the semaphore Harishchandra (50) and Raju son of Kasoler delightful (2) has died. Fever victims Kanpur city's medical colleges and private hospitals and district hospital tests confirmed dengue so far 520 from September 20 meeting and 56 malaria patients were confirmed to be suffering from the Failsiferma. The mosquito-borne disease outbreaks after the Department of Health has refused to accept. New Delhi and Lucknow come from teams of experts with respect to the disease could not have anything yet clear. Department of Health failed to gain complete control over the disease is proven. DM Saroj Kumar Tiwari said cleaning campaigns in villages to prevent disease and anti-larval spraying with DDT is being made. Personnel to ensure presence of doctors and hospitals for the random inspection instructions are given.

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6859411.htm

[Ronan Kelly]

Re: Kanpur, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 368 fatalities - Dengue, malaria, H1N1, others suspected

Hindi to English translation
Four of fever and the own broken Oct 30, 08:31 pm Here

Ramabai Nagar, our representative: strange fever in the district is not the name of mindless havoc. Four people on Saturday came in the grip of the fever died. So far the death toll from the disease has become 372. While District 110 fever victims were treated at the hospital came.

Outbreak of fever despite the continuing deaths of health workers do not have discretionary control. Block level health centers to recruit patients not being treated Zolahchhapoan rural distress are forced to make. Alam on Saturday that the disease in the affected villages not reached health teams. Akbarpur block Budyzaya village ruby red fever sufferers Mishra (50) and Anwa village Servedra (28), Alroapur the Mualchandra (50), his granddaughter dew (9) daughter who died Brjendra Katiyar. While the district came to the hospital half a dozen serious fever in 110 patients began treatment were admitted to the victims. Dr. DC Mishra told CMS to test suffering from malaria fever, three of the victims were found, which is given RT.
http://in.jagran.yahoo.com/news/loca...1_6863423.html

[Ronan Kelly]

Re: KANPUR, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 372 fatalities - Dengue, malaria, H1N1, others suspected

From Kanpur city as opposed to Kanpur Dehat/ Ramabai Nagar - more confirmation of dengue in the region.

Hindi to English translation
Two dozen dengue and chikungunya Zajamu Oct 31, 11:03 pm

Kanpur, City Correspondent: dirt of the city in a neighborhood of chikungunya and dengue to cry havoc. The area of Zajamu Rasulabad Inn of the Ram Rai. Here more than two dozen people are vulnerable to these diseases. Pile of dirt, filling the sewer here identifies became contaminated water supply is also a big problem. Spraying of mosquito larvae and the absence of anti Afagiang empire. In the absence of several months cleaning Councillor has expressed resentment against the people.

Place - place Bjbjate garbage pile and drains even infectious diseases like dengue spreads is ever and sometimes diarrhea. Consequent Faisal (4), Afiafa (3), Huriya (2), Moin (5), Deepak (15), Shankar (50), Zaheer (40), Amjad (32), Arshad (16), Zubair (22 ) Two dozen people, including chikungunya and dengue is vulnerable to. People do not say that Ssafaikarmee months. Tanriyoan half a dozen dirty and chemical-rich water at the plot fills in the blank. Councillor Haji Faiayaj often been complained of, but did not get rid of the problem.

A dozen new dengue patients

Medical College Mikroboyolawji Department weekly report 12 new patients of dengue confirmed. The week 98 samples had come. At the same time here has been 120 confirmed dengue patients. According to the urban malaria officer Dr AK Singh, Kanpur, five new patients, four Ramabai Nagar, Unnao and two is a Farrukhabad.

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6867368.html

[Ronan Kelly]

Re: KANPUR, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 372 fatalities - Dengue, malaria, H1N1, others suspected

Hatmapur is (I think) in Kanpur Nagar.

Hindi to English translation
Nov 01, 01:38 am Here
Hatmapur, Representative: Last come the BSF on Peakware leave young vulnerable to dengue Asne died Sunday afternoon.

Are told that the village of Patara area resident Jagdishpur Jaipal Singh Chandel, son of Ram Mohan (30) in the young to the post of BSF were deployed in Siliguri. After coming on vacation with family living in the village, Ram Mohan high fever Thursday morning came, a prominent doctor whose treatment he located the city was built. According to the investigation conducted by family doctors in Rammohan was confirmed to be dengue. Ram Mohan died after being freaked afternoon

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6867940.htm

[Vibrant62]

Re: KANPUR, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 372 fatalities - Dengue, malaria, H1N1, others suspected

Let us assume for a minute that the vast majority of these deaths are indeed from dengue fever.

The WHO factsheet on dengue fever says

http://www.who.int/mediacentre/factsheets/fs117/en/

CharacteristicsDengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death.

The clinical features of dengue fever vary according to the age of the patient. Infants and young children may have a fever with rash. Older children and adults may have either a mild fever or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash.

Dengue haemorrhagic fever (DHF) is a potentially deadly complication that is characterized by high fever, often with enlargement of the liver, and in severe cases circulatory failure. The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41&#176;C, possibly with convulsions and other complications.

In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock and die within 12 to 24 hours, or quickly recover following appropriate medical treatment (see below).

Treatment
There is no specific treatment for dengue fever.

For DHF, medical care by physicians and nurses experienced with the effects and progression of the complicating haemorrhagic fever can frequently save lives - decreasing mortality rates from more than 20&#37; to less than 1% . Maintenance of the patient's circulating fluid volume is the central feature of DHF care.




The news reports of these deaths have included quite a few reports of sudden illness and death within a short space of time - and given that DHF is supposed to be 'rare', the numbers of infected would have to be vast... Additionally, with the right treatment, even DHF should have a low mortality rate of close to 1%.. So what is going on here?

It is also far from clear how often actual dengue testing is carried out as opposed to an observational diagnosis.

So even if this IS dengue that is primarily responsible for causing deaths here, it is possibly not behaving 'normally' for dengue. So we have to consider the possibilities of a new form of dengue, or a unique severity caused by co-infections, or?

I will still be glad when the Delhi tests and analysis are back, just to be sure of what the precise problem is here, especially as it appears to be slowly spreading.

[alert]

Re: KANPUR, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 372 fatalities - Dengue, malaria, H1N1, others suspected

The more recent daily update found by RoRo indicated 110 cases and 4 deaths that day. So the CFR is about 4&#37;. The symptoms reported do sound far more like DHF than classical dengue. And 20% as a fatality rate for DHF wouldn't surprise me here as the articles indicate that very little to no medical care is available, and many of the victims are badly malnutritioned and on the verge of starvation.

There is also the strong possiblility that most of these cases are co-ifnected with malaria - an earlier report (#45) in this thread indicates that at least 17 fatal cases also tested positive for malaria. In Lucknow, there are reports of dysentery as well because the stagnant water that is breeding the mosquitoes has contaminated the drinking water.

Also, the total population of Ramabai Nagar is large (over one million people), so there may be far more illnesses than just the severe reported ones, which would also balance the numbers. The number of reported ill may just include the DHF cases. We are seeing statements like "Every house has someone with fever".

The outbreak also appears to be slowing down as weather turns colder, as we are getting reports of 1-4 deaths a day in Kanpur, and 1-3 in Lucknow for most of the past week, compared with a peak day of 24 deaths in Kanpur and nine in Lucknow.

[Vibrant62]

Re: KANPUR, Uttar Pradesh: Post-Monsoon disease outbreaks 2010 - 372 fatalities - Dengue, malaria, H1N1, others suspected

All valid points that are not unreasonable: however, the reported cases of 24 hours or less from fever onset to death does not fit the normal dengue profile, and it is this that bothers me the most. The rest is still educated guesswork at the moment in terms of relative numbers, and impossible to call for sure in any direction.