Bangladesh - 36 dead from Nipah Virus

[Ronan Kelly]

5 died, 6 fall sick of unknown disease in Bangladesh
15:40, February 02, 2011
Five people, including three minors, died and six others fell seriously sick after being attacked by an unknown disease at different villages in Bangladesh's Hatibandha sub-district of Lalmonirhat district, 343 km northwest of capital Dhaka, on Tuesday and Wednesday.

The six patients were admitted to the sub-district health complex.

Doctor Bimol Roy of the sub-district health complex was quoted by private news agency UNB as saying that the patients were attacked by fever at first then the body become cold with vomiting.

...

Source: Xinhua

http://english.people.com.cn/90001/90777/90851/7279137.html

[Ronan Kelly]

Re: 5 died, 6 fall sick of unknown disease in Bangladesh

'Viral fever' claims 3 more at Htibandha
Wed, Feb 2nd, 2011 5:23 pm BdST Dial 2000 from your GP mobile for latest news



Dhaka, Feb 2 (bdnews24.com) ? Three more people have died at Hatibandha in Lalmonirhat where four, including three children, had died the previous day after contracting a fever from an unknown disease.

Upazila Executive Officer (UNO) Asharfuzzaman told bdnews24.com that one Azizul Islam, 30, died at Rangpur Medical College Hospital in the morning. The two others were Abdul Karim, 22, and Anwara Begum, 45.

...

An investigation has been launched to identify the unknown disease. IEDCR says the fever could be a result of a viral infection.

IEDCR director Mahmudur Rahman told bdnews24.com: "I think the disease causes high fever and is followed by brain infection."

On Tuesday, four people died from the disease between 12pm to 8:30pm. At least 30 people are believed to have been affected by the disease in the last two days.

The major symptom of the disease is the rise of temperature at intervals and then finally dropping sharply, resulting in the patient's death.

...

bdnews24.com/nih/mi/ost/pks/tk/1718h

[Ronan Kelly]

Re: 7 died, 30 fall sick of unknown disease in Bangladesh

Unknown disease kills 4, attacks 19 in 24 hours
Our Correspondent, LalmonirhatAn unknown disease killed four people and attacked 19 others in Hatibandha upazila of Lalmonirhat district in 24 hours till yesterday evening.

The deceased are Sabina, 3, daughter of Mokbul Hossain of Saniazan Char village, Sajjad Hossain, 3, son of Belal Hossain of Tongvanga village, Rajjak Miah, 32, son of Abbas Ali of Genduguri village under Hatibandha upazila, and Aronno Ghos, 8, son of Ashok Ghos of 'bus stand' area of Hatibandha town.

With high fever, they were taken to Hatibandha upazila health complex where Sabina died on Monday night.

Sajjad died after he was transferred to Rangpur Medical College Hospital yesterday morning while Rajjak Miah died on the way to Dhaka Medical College Hospital at noon.

The four victims first got fever and their temperature went up rapidly. At one stage, their bodies became cold and they died, family and health complex sources said.

?I am feeling fever and it is getting serious. My body is also becoming cold,? Aronno Ghos said sometime before he died last night.

With similar symptoms, his sister Anonna Ghos, 4, and 17 others are undergoing treatment at Hatibandha upazila health complex.

...

http://www.thedailystar.net/newDesign/news-details.php?nid=172487

[Ronan Kelly]

Re: 7 died, 30 fall sick of unknown disease in Bangladesh

The fact that they are from different villages tends to rule out a point poisoning source. But so many serious cases at once is strange. It is imperative to find out if the victims share some link. There is at least one fatal case 8yo Aronno whose 4 yo sister is ill. The numbers of sick people seem to have grown rapidly from 6 to 19 to 30 in the past 48 hours.

[Vibrant62]

Re: 7 died, 30 fall sick of unknown disease in Bangladesh

RoRo - Thanks for picking this up. There is little information here to get much of a perspective.

On an assumption that this is an infectious pathogen, there is nothing here that indicates what the incubation period might be i.e how rapidly disease onset is after exposure, nor is there any indication of transmissibility, how long a period there is between fever onset and death, nor any indication (as yet) of any recoveries.

RoRo - Is this part of a recently flooded area that you know of, or is this an area that is particularly prone to viral or bacterial diseases of any kind that might meet this aetiology?

As far as I can see it is
1. High fever that persists for (? days, ?hours)
2. A decline in body temperature (over how long a period? and how long after fever onset?) to death. It would seem from these reports that this transistion period is short for those that have died i.e the order of hours at worst or days at best.

H5N1 always springs to mind as one to rule out as rapidly as possible and Bangladesh has had its problems - I dont know if there are any reports of diseased animals in the area yet this year?

Not much to go on, but the growth rate is almost exponential.

[Ronan Kelly]

Re: 7 died, 30 fall sick of unknown disease in Bangladesh

I don't know the answer to most of those questions. Bangladesh has been suffering from many cold related deaths - around a hundred up to Jan 17, but the furore around this recent cluster seems to indicate that it's something unusual.

Bangladesh: Situation Report no. 203 - Cold Wave
Source: Network for Information, Response and Preparedness Activities on Disaster

Date: 17 Jan 2011

Full_Report (pdf* format - 133.3 Kbytes) http://www.reliefweb.int/rw/RWFiles2011.nsf/FilesByRWDocUnidFilename/MCOI-8D7CU6-full_report.pdf/$File/full_report.pdf

Event details:

Although the intensity of cold wave is reduced than last few days, it is reported that a total of 11 people has died in different districts of Bangladesh for cold related diseases such as pneumonia, cold diarrhea and fever and so on. More people are getting affected of various diseases for severe cold every day. Misery added to the poor for the need of warm cloth.

At least six people have died of cold-related diseases in Kurigram in the last 24 hours, local public representatives have said. The sun has not seen in last one week in the Chilmari Upazilla of Kurigram district.

Many were seen gathering around fire to warm up themselves. Approximately 72 thousand people of Aila affected peoples' sufferings knows no bound as they have no shelter and living on "Beri Badh" in wrecked houses.

People from the affected area said, everyday thousands of people admitted into hospital due to different diseases resulting from heavy cold. Due to dense fog the seed bed of rice has damaged in Adamdighi of Bagura District has reported.

http://www.google.com/url?sa=t&source=news&cd=1&ved=0CCIQqQIwAA&url=http%3A%2F%2Fwww.reliefweb.int%2Frw%2Frwb.nsf%2Fdb900sid%2FMCOI-8D7CU6%3FOpenDocument&ei=0HBJTYTDF8OqlAePl9X6Dw&usg=AFQjCNFVaIxTj9hfliw9sDvJWBV1PlfzNQ

[Shiloh]

Re: 7 died, 30 fall sick of unknown disease in Bangladesh

Source: http://www.thedailystar.net/newDesig....php?nid=28266

Wednesday, February 2, 2011
Unknown disease claims 8 more
Star Online Report

Eight more people of Hatibandha and Pirgachha upazilas of Lalmonirhat and Rangpur died of an unknown disease on Wednesday raising the death toll 12.

Seven of the deceased are from Hatibandha while the other Pirgachha, our correspondents reported.

Zakir Hossain, a doctor at Rangpur Medical College, said the victims died of excessive fever and convulsion, our Lalmonirhat correspondent reports...

...He suspects the disease might be Japanese Encephalitis or Nipah...

[alert]

Re: 7 died, 30 fall sick of unknown disease in Bangladesh

Source: http://www.thedailystar.net/newDesig....php?nid=28266

Wednesday, February 2, 2011
Unknown disease claims 8 more
Star Online Report

Eight more people of Hatibandha and Pirgachha upazilas of Lalmonirhat and Rangpur died of an unknown disease on Wednesday raising the death toll 12.

Seven of the deceased are from Hatibandha while the other Pirgachha, our correspondents reported.

Zakir Hossain, a doctor at Rangpur Medical College, said the victims died of excessive fever and convulsion, our Lalmonirhat correspondent reports...

...He suspects the disease might be Japanese Encephalitis or Nipah...

Just on location alone, even before seeing the symptoms, Nipah or JE was my guess. With convulsions as a symptom, encephalitis is highly probable. Given the relatively high apparent fatality rate, Nipah is suspect.

Previous large Nipah outbreaks with large geographical scattering such as is apparent here have been blamed on people consuming fruit that had been nibbled on by infected bats.

[alert]

Re: 12 died, others fall sick of unknown encephalitis in Bangladesh - Nipah suspected

http://www.thedailystar.net/newDesign/news-details.php?nid=172670

'Unknown' Disease
8 more die in Lalmonirhat
Staff Correspondent Eight people, mostly children, of Hatibandha and Pirgachha upazilas of Lalmonirhat and Rangpur districts died of an ?unknown disease? yesterday raising the death toll to 12 while 24 more patients are admitted to different hospitals.

Of the diseased, seven -- Gourob Roy, 2, Nishad, 3, Yasmin Akhter, 4, Anonya Ghosh, 4, Kajol Islam, 8, Sadequl, 22, and Azizul Islam, 32, -- are of Hatibandha and Tamanna, 4, is of Pirgachha.

On Tuesday, five people -- Sabina, Sajjad, Razzak Miah and Aranya Ghosh -- died of this disease in Lalmonirhat and Rangpur.

All the victims were admitted to hospitals with high fever and headache and succumbed to the disease within 30 hours of catching the fever.

An eight-member team of doctors and technicians left for Hatibandha from Dhaka yesterday morning to identify the disease. Subodh Kumar Kundo, principal scientific officer (Zoonosis) of Institute of Epidemiology, Disease Control and Research (IEDCR), is leading the team.

They will collect blood samples of the patients and examine the specimens at the IEDCR laboratory, said Mahmudur Rahman, director of the institute.

Based on the symptoms, he suspects the disease might be Japanese Encephalitis, a type of brain inflammation caused by virus, or Nipah.

A four-member medical team led by Rangpur Divisional Health Director Shahdat Hossain visited Hatibandha health complex and different villages of the upazila yesterday.

Shahdat Hossain said they had already sent blood samples of the patients to IEDCR for diagnosis.

Viral encephalitis is not a new disease in the country. Every year during the winter a number of people get infected with the mosquito borne disease. The patient gets high fever ranging from 103 to 104 degrees Fahrenheit and it has no treatment except symptom management, IEDCR sources said.

[alert]

Re: 12 died, others fall sick of unknown disease in Bangladesh

One other, less likely possibility that is likely under consideration:

http://www.icddrb.org/publication.cfm?classificationID=56&pubID=9402

Apparently, 19 people died in about a week in 2007 in Bangladesh, and the symptomatic description was similar to this one (vomitting and altered mental status), but the cause was the consumption of a toxic plant.

[alert]

Re: 12 died, others fall sick of unknown encephalitis in Bangladesh - Nipah suspected

http://www.bdnews24.com/details.php?id=186320&cid=2

SPECIAL
'Mystery' fever alarms experts
Thu, Feb 3rd, 2011 12:05 am BdST Dial 2000 from your GP mobile for latest news



Nurul Islam Hasib

Dhaka, Feb 2 (bdnews24.com)?The death of seven people from 'mystery' fever in a northern border district has the experts scrambling to find out whether it was caused by a fresh outbreak of highly fatal 'nipah virus'.

The virus is highly infectious as it has killed 113 people out of 152 who had the fever since its first outbreak in 2001 when it was unknown to all.

The disease has become a cause of anxiety among Bangladesh's health authorities as it unfailingly strikes every year and there is little the doctors can do except circulating awareness message 'not to drink raw palm juice'. The juice, scientists say, is thought to be responsible for causing the infection.

"The government has taken the fatalities in Hatiabandha upazila of Lalmonirhat district seriously," said Prof Mahmurdur Rahman, director of the Institute of Epidemiology Disease Control and Research (IEDCR).

He told bdnews24.com that a 10-member team, comprising IEDCR and ICDDR,B scientists, left Dhaka for Hatiabandha on Wednesday to investigate into the mystery fever that left a few people critically ill in the last 36 hours.

Doctors at the Rangpur Medical College Hospital where some victims were transferred have not been able to pin-point the origin of the disease or how it spreads. It reportedly begins with high fever followed by seizure and death.

"We suspect it is encephalitis, a serious brain infection, usually triggered by a virus either nipah or Japanese Encephalitis," Prof Rahman said, adding that only lab test can confirm the virus.

They (the team) will collect blood samples for lab test in the IEDCR, the lone nipah virus identification laboratory in the South-East Asia

A ICDDR,B scientist requesting anonymity, however, said they were suspecting nipah to be the cause of the latest outbreak as the symptoms of the patients who died were similar to those infected with nipah virus. Last month, they also got a nipah case from that region.

According to experts nipah virus spread during December to April when fruit bats perch on the jars used for collecting palm juice. They usually leave saliva and droppings into it while sipping the juice.

When people drink raw juice, the virus gets into them and passes from person to person.

It is so infectious that in 2004 four members of a family in Faridpur died after one of them got infected. A rickshaw-puller who carried a patient to the hospital also got infected and died.

"Pteropus bats carry the virus in Bangladesh," said Dr Salahuddin Khan, an ICDDR,B scientist, adding that their research showed using bamboo or stick shade or covering the pitcher with polythene can prevent the juice contamination.

"But people should avoid drinking raw juice," Prof Rahman said, adding they have been circulating such messages and carrying out their surveillance at six health facilities including medical colleges.

Besides, IEDCR also collects information from local health authorities elsewhere.

He suggested 'one health' approach that means concerted effort of physicians, animal scientists and anthropologists to contain the spread of the virus.

Prof Rahman said once people believed that it was 'evil spirit' that kill people, but now they have started to understand the fact. "When people can understand the fact, they can prevent it."

Nipah was first detected in Malaysia in 1998, but at present Bangladesh, a hotspot for emerging diseases, is the only country in the world that reports nipah. No one can say why.

Meherpur, Naogoan, Rajbari, Faridpur, Tangail, Thakurgoan, Kushtia, Manikganj, and Rangpur are the districts where the disease was detected.

"We should heighten our surveillance but we cannot do due to budget constraints," Prof Rahman said

[Shiloh]

Re: 12 died, others fall sick of unknown disease in Bangladesh

Source: http://www.bdnews24.com/details.php?id=186320&cid=2

'Mystery' fever alarms experts
Thu, Feb 3rd, 2011 12:05 am BdST

Dial 2000 from your GP mobile for latest news
Nurul Islam Hasib

Dhaka, Feb 2 (bdnews24.com)?The death of seven people from 'mystery' fever in a northern border district has the experts scrambling to find out whether it was caused by a fresh outbreak of highly fatal 'nipah virus'.

The virus is highly infectious as it has killed 113 people out of 152 who had the fever since its first outbreak in 2001 when it was unknown to all.

The disease has become a cause of anxiety among Bangladesh's health authorities as it unfailingly strikes every year and there is little the doctors can do except circulating awareness message 'not to drink raw palm juice'. The juice, scientists say, is thought to be responsible for causing the infection...

[alert]

Re: 12 died, others fall sick of unknown disease in Bangladesh

http://www.bdnews24.com/details.php?id=186336&cid=2

2 more die of unknown disease
Thu, Feb 3rd, 2011 10:57 am BdST Dial 2000 from your GP mobile for latest news



Lalmonirhat, Feb 3 (bdnews24.com) ? Two more people have died of fever caused by an unknown virus at Hatibandha Upazila in Lalmonirhat, raising the death toll to 13 in last few days.

Health officials said at least 30 people are believed to have been affected by the disease so far.
Hatibandha Upazila Executive Officer Ashrafuzzaman on Thursday said there were nine deaths recorded on Wednesday, while four died on Tuesday.

The deceased are Zafar Ali and Ananya Ghose, 4.

Meanwhile, a team of experts from the Institute of Epidemiology Diseases Control and Research (IEDCR) reached Lalmonirhat to investigate the outbreak of the mysterious disease.

The 10-member team led by scientific officer Subodh Kumar Kundu includes five physicians.

They will work in two groups and visit Rangpur hospital and the affected areas in Hatibandha.

On Wednesday, a three-member physicians' team from Rangpur led by divisional health director Dr Shahadat Hossain visited Hatibandha.

Shahadat later told reporters that it could be a viral fever spread by bats, according to initial probe. "We've asked people not to eat local fruits including date juice, sugarcane and papaya."

IEDCR director Mahmudur Rahman on Wednesday told bdnews24.com: "I think the disease causes high fever and is followed by brain infection."

The major symptom of the disease is high temperature at intervals and sudden sharp fall, resulting in the patient's death.

[Ronan Kelly]

Re: 12 died, others fall sick of unknown disease in Bangladesh

?Encephalitis? behind death of 17
Disease Control and Research to confirm Friday after examination of the specimens

Experts on Thursday clinically identified the unknown disease as ?Encephalitis? that claimed five more lives in Lalmonirhat and Rangpur Wednesday night and Thursday.


The final diagnosis will come after examining the specimens at the Disease Control and Research (IEDCR) laboratory on Friday, they said.


The death toll from the disease now stands at 17.


The dead were identified as Sudipta, 10, Zafar Ali, 40, of South Goddimari village, Abdul Karim, 23, of West Bejpur, Khairul Islam, 50, of Tongbhanga and Aranyo Gosh, 8, of local bus terminal area in Hatibandha upazila of Lalmonirhat.


Of them, Sudipta died at the Dhaka Shishu Hospital around 11:00am Thursday, Aranyo Ghosh at Rangpur Medical College Hospital (RMCH) at about 1:30am Thursday, Zafar died at Hatibandha Upazila Health Complex at about 11:30pm on Wednesday, and Khairul Islam around 12:30am on way to RMCH.


Another deceased, Abdul Karim, died at his West Bejpur residence at about 4:15am Thursday after he was released from RMCH.

http://www.thedailystar.net/newDesign/latest_news.php?nid=28287

[alert]

Re: 17 died, others fall sick of unknown encephalitis in Bangladesh - virus under investigation

It seemed clear from the symptomatic description that encephalitis was likely the cause of death, but it is important to know the agent in order to stop the outbreak. Nipah has been speculated as a likely possibility, but Nipah has a fairly long incubation period (about 7-21 days according to various sources), and an outbreak this large would have likely developed over several months, not in three days. Previous large Nipah outbreaks have taken place over many months with cases in distinct generations (http://en.wikipedia.org/wiki/Henipavirus#Nipah_virus). Nipah virus would liekly also affect all ages equally, not predominantly children. In addition, they might have detected it by now.

Other encephalitis viruses are likely also being tested for. A very good candidate from an epidemiological point of view is Chandipura virus. This virus also produces encephalitis with a high CFR (http://en.wikipedia.org/wiki/Chandipura_virus), and has the advantage of producing illness mostly in kids and clusters over a very short period of time. We have several threads of such outbreaks here on FT (http://www.flutrackers.com/forum/sho...=126141&page=3 is a good example of a very similar one, with ten deaths in three days) of such outbreaks in nieghboring India, but that virus has never been detected in Bangladesh, according to the wikipedia article.

And of course, there is the ongoing "AES" outbreak in nearby Uttar Pradesh, India (about 200 miles west), which is likely caused by several viruses, some of which have not been precisely identified.