Mystery illness kills at least 20 in Nepal in the last 10 days

[Snowy Owl]

Mystery illness kills at least 20 in Nepal
http://today.reuters.com/News/CrisesArticle.aspx?storyId=B145880

All thanks to Reuters for their Public Health Information Services

KATHMANDU, Oct 31 (Reuters) - A mysterious disease has killed at least 20 people in two villages of west Nepal over the past 10 days, and hundreds more are sick, a health official said on Tuesday.

"People suddenly catch high fever, start shivering, faint and then die," said Ram Bahadur Chand, a senior official the district public health office in Nepalgunj, 321 km (201 miles) west of the capital, Kathmandu.

Local media reports put the death toll at 36 from four remote villages near Nepalgunj.

"We have 20 confirmed deaths so far and more than 300 people are suffering from the unknown disease," Chand told Reuters.

He said 200 blood samples had been collected and medical workers had reached the affected villages.

Each year Nepal's rickety health infrastructure run by a mere 1300 doctors in 87 hospitals around the country deals with hundreds of thousands of cases of pneumonia, cholera, fever, diarrhoea and tuberculosis.

Many of the poor Himalayan nation's 26 million people are either unable to afford the cost of medical treatment or do not have access to basic health care.​

 

[Jeremy]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

"People suddenly catch high fever, start shivering, faint and then die," said Ram Bahadur Chand, a senior official the district public health office in Nepalgunj, 321 km (201 miles) west of the capital, Kathmandu.

​

I would really like to know how soon after the fever does death ensue.

If it is 6-12 hours then I would put this in the "very bad news" category.

 

[Snowy Owl]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Jeremy,

I will have some contact with the Nepal MSF Team there, we do have a small team.

The situation is bad, even International News Desk are nervous, they await lab confirmation.

As you know I seldomly post in Breaking News, and on top of this I have to make it a sticky, we do have to get as much informations as possible from Nepal. Not Stick this one, would be IMHO pure negligence.

Snowy

 

[Jeremy]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Snowy,

The vague description that we are getting from Nepal is enough to make one stand at attention.

As always thank you.

-Jeremy

 

[sharon sanders]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Nepal thread:

http://www.flutrackers.com/forum/showthread.php?t=11661&highlight

 

[LMonty]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Thanks fro bringing that thread up, Sharon. Is this a continuation of the same illness thats been reported for awhile? Or is it a new outbreak? (I understanfdthat noone has answers yet, just the questions I'm asking myself!)

IIRC there were also animal deaths in the area? Does anyone recall that?


Snowy, I hope that team takes good care of themselves, and has tamiflu just in case. I'd be very, very concerned about healthcare worker infections if they occur. Do you by any chance know what other differential diagnoses are beign considered? I dont knwo the current weather, things like vectors, could dengue be at fault, etc....

 

[Snowy Owl]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Hi LMonty,

Malaria is out now and so is Dengue, what is not yet ruled out is Japanese Encephalitis.

SO

 

[LMonty]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Thanks, Michel, I knew you'd be on top of it!

 

[Jeremy]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Here is the WHO information on Japanese Encephalitis in the India and Nepal regions.

http://www.searo.who.int/en/section1226/section2073.asp

If you do a search on the website for "Japanese Encephalitis" you will find all the information they have.

In 2005, a total of 2824 suspect JE cases were reported, of which 316 died (CFR 11.2%).

​

While the CFR for the "mystery disease" in Nepal does come close previous JE outbreaks the symptoms seem to be different.

I also believe that if it was a JE outbreak they would have called it a JE outbreak.

 

[Snowy Owl]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Chandipura Virus is strongly suspected

http://www.ias.ac.in/meetings/myrmeet/15mym_talks/dchattopadhyay/img1.html

All thanks to all and to the FluTrackers Team Development Lab

SO, we must now await lab results.

Definition of Chandipura virus

Chandipura virus: A virus that causes fever, symptoms similar to those of flu, and acute encephalitis (inflammation of the brain). Chandipura virus was first isolated in 1965 in a village in Maharashtra State, India. Since then, the virus has been reported in adjoining states in central India. The likely vector (carrier) of the virus is the female phlebotomine sandfly. The virus has been detected in sandflies in Senegal and Nigeria as well as in India. In 2003 Chandipura virus was responsible for an outbreak in southern India in which 329 children developed acute encephalitis and 183 died. The disease progressed rapidly from an influenza-like illness to coma and death. Chandipura virus is a member of the Vesiculovirus genus of the family Rhabdoviridae. This virus should be considered as an important emerging pathogen.

http://www.medterms.com/script/main/...ticlekey=39105


There was an outbreak in Andhra Pradesh in 2003 that is documented in the Lancet.

The Lancet 2004; 364:869-874
DOI:10.1016/S0140-6736(04)16982-1
A large outbreak of acute encephalitis with high fatality rate in children in Andhra Pradesh, India, in 2003, associated with Chandipura virus
http://www.flutrackers.com/forum/showthread.php?t=12308

Thank you all

 

[MHSC]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Any idea how quickly those lab results will be available?

 

[MHSC]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

[FONT=Verdana,Arial]36 die of unknown illness in Banke
[/FONT]

BY JANAK NEPAL

BANKE, Oct 31 - Thirty-six people have died of an "unknown" disease that has spread in six villages in the district in the last two weeks, according to latest updates.

More than 50 people have been affected by the ailment.


In Phattepur VDC alone, 23 people have died due to the disease. According to Nedeer Khan, a local, 11 people from Prirahawa village of ward number 4 and 5 of the VDC; seven from Nagakaipur village; three from Phattepur village and two from Hardaiwa village have died.


Likewise, 10 people died of the disease in Gangapur and three in Narainapur village-one died during treatment in Nepalgunj Hospital on Sunday, while two had died in the Gangapur earlier.


Viral fever, body ache, shivering and sudden unconsciousness are some of the symptoms of the "mysterious ailment", locals said.


Almost every household in these villages has at least one member suffering from the ailment, locals claimed. Many victims have not received any medical care so far due to the poor financial condition of these impoverished families.


Several patients have been going to local drugstores asking for help. "About 30-35 patients come to us daily. As we do not have any means to diagnose the ailment, we have been giving antibiotics to the patients assuming it is common cold," said a local pharmacist, requesting anonymity.


Meanwhile, health agencies are yet to send medical teams to the villages in the region. Doctors and medicines had still not reached the region even until Tuesday afternoon.
The district health office had received information that the disease had spread in the region on Friday. Although the medical team was scheduled to arrive at the area today, latest reports state that the doctors are yet to leave Nepalgunj.


Although the "mystery" disease that has affected over 150 people in six villages of four VDCs is suspected of being Malaria, blood tests conducted by a team of Malaria inspectors and lab assistants yesterday failed to identify aliment.


"In the absence of electricity, our equipments failed to identify the disease", the team was quoted saying.


However, malaria medicine has already been administered to patients whose condition has become critical, Gangapur Health post in charge Narayan Sharma said.


Meanwhile, the seven party leaders of Banke have accused their respective parties of neglecting the possibly epidemic nature of the situation. An emergency meet of the leaders is going on in Banke.


"We are shocked at the disregard shown by the health agencies," secretary of CPN-UML Banke Devraj Bhar said, adding, "A team of specialists should be immediately dispatched to the region."
.



Posted on: 2006-10-30 22:06:29 (Server Time)




http://www.kantipuronline.com/kolnews.php?nid=90030

 

[Snowy Owl]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

MHSC

What I could gather as informations is that some samples are on their way to the Katmandu Infectious Diseases Center, some are on their way to New Delhi from where samples will be send to Pune(India) and if all permissions granthed some to Pasteur Institute in Paris.

Seems that no one expect results before few days at least.

SO

 

[Jeremy]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

<TABLE cellSpacing=0 cellPadding=0 width=470><TBODY><TR><TD class=black-head-news vAlign=top align=left colSpan=2 height=25>http://www.theindiancatholic.com/newsread.asp?nid=4234
Mystery disease kills 36 in Nepal
</TD></TR><TR><TD class=text colSpan=2 height=25><TABLE cellSpacing=0 cellPadding=0 width=466 border=0><TBODY><TR><TD class=text width=335>
KATHMANDU -- The spread of an unidentified disease in Banke district, about 400-km west of Kathmandu, has claimed more than 30 lives in the past two weeks, Nepalese newspapers reported on Tuesday. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>

The disease made more than 500 people sick in four villages of the district and more than 36 people were in critical condition, the Himalayan Times reported.

The highest death toll, 23, occurred in Fattehpur village.

Thirty-six people had died due to the epidemic in just over one week, said Ram Bahadur Chand, chief of the epidemic control programme in the Banke District Public Health Office.

The major symptoms of the disease were high fever, body ache and loss of consciousness, the daily Kantipur reported.

Most of those who have died are children and the elderly, the Himalayan Times report said.

Medicines were said to be in short supply. Those who could afford treatment were visiting the Bheri zonal hospital in Nepalgunj town and hospitals in neighbouring India.

According to the report, even though the district health office dispatched a team to investigate and identify the disease, blood tests could not be conducted due to the absence of electricity.

Villagers accused the government of being indifferent to their plight and not doing enough to control the disease.

 

[Jeremy]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

A couple of points about this latest report.

1) There are now reports of 500 people infected.
2) 36 people have died.
3) At least 36 more people are in critical condition.
4) Most of those who have died are children and the elderly

If those other 36 people in critical condition don't make it then our CFR goes to 14%.

The last point is what really interests me the most.

They say that "most" of those that have died have been children and the elderly. This is the first peice of news that would tend to reduce the possibility of it being H5N1, as the average age of death from H5N1 is 27.

More information on this outbreak is still needed to be sure and hopefully we can get some test results soon.

 

[Shannon Bennett]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Jeremy, I agree with you. H5N1 has a predilection for children and those who are only a little older. The older you get the less likely you are to succumb. So, if this is killing the very old and the very young, I don't think it is H5N1.

 

[Jeremy]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Jeremy, I agree with you. H5N1 has a predilection for children and those who are only a little older. The older you get the less likely you are to succumb. So, if this is killing the very old and the very young, I don't think it is H5N1.

They say "Most of those who have died are children and the elderly".

The only pause I have is with the phrase "most".

I am probably overanalyzing at this point but this phrase doesn't rule out that some of the dead are people in the middle aged group.

Furthermore we don't know if those that are in critical condition are also children and elderly.

That being said, the more the reports do come out with the deaths being with children and elderly the less likely H5N1 is going to be the culprit.

 

[hawkeye]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

Killer disease in Banke was malaria, not dengue [ 2006-11-6 ]
From Indira Aryal
BANKE (Piparhawa), Nov. 5: Laboratory test in the epidemic areas of Banke district identified Falciparum malaria instead of dengue, which was suspected earlier.

A total of 32 people have died and several hundred suffered from fever, headache, cough and severs in the 10 VDCs of the district. Around 1,200 people were affected by malaria in four VDCs and 521 people were tested positive for falciparum malaria and the rest by vivax malaria. Twelve serious cases have been referred to Bheri Zonal Hospital.

When no medical facility was available locally many suffering took medicines prescribed by fake doctors coming from across the border. Hirduram Dhobi, 30, of Piparhawa said he took medicines prescribed by doctors coming from bordering of India. The fever was controlled for a few days and then starts again. He has been suffering from fever and headache for the last 10 days. Dhobi has been taken to Bheri Zonal Hospital. It took a lot of time for the team coming from Kathmandu to convince him to go to the hospital.

Piparhawa is the worst affected VDC with small children to old people suffering from the disease. Eleven people died in the VDC alone and all of the 25 huts in the village have at least one or two suffering form the disease.

A medical team by Dr. Mahesh Maskey, advisor at the Minister for Health and Population Amik Serchan, local team from Banke district, a team for laboratory test from Hetuda have been mobilised in the area to assess the situation and provide services. The team found that was falciparum malaria.

Those affected were brought to the health camp organised by Epidemiology and Disease Control Unit (EDCU) under the MoHP, Nepalgunj Nursing Hospital and World Health Organisation (WHO). Six teams from different organisations have been mobilising in the area.

Dr. Suman Thapa, who was involving in the treatment and test, said that there was no death from malaria after the mobilisation of the team. There was one death and it was from diarrhoea.

The team carried out regular lab test and checked up everyone in the VDCs. Although more cases were found, but there is no death. Doctors said that the outbreak was caused due to the recent flood.

Thapa said the doses of the medicines prescribed and distributed by the quacks were incomplete. They were also not authorised to prescribe the drugs and they charged heavily. Still, people prefer them than to go to the health post or the hospital. They were even unwilling to come to the camp. "The doctors visited their homes and convinced them before they were willing to come to the camp or to go to the zonal hospital,"said Dr. Thapa.

Around 10 VDCs in remote parts of the district, including Gangapur, Fattepur-Piparhawa, Narainapur and Holia VDCs have been affected by Falciparum for the last week weeks causing 32 deaths.

Dr. Maskey said that the major cause of death was malaria, but there are also deaths from other diseases. If it were only malaria the toll would not have been so high.

Dr. Soe Aung, epidemiologist of WHO Nepal, said that there are only a few new cases of malaria and there would be no new epidemic in the area. He said it would take at least two weeks to control the disease. He said no case of dengue was found and there was no risk of dengue in the area.

Health worker at the Banke Health Post Narayan Sharma said there was a similar epidemic in the area about two decades ago, but the death was not so high. He said controlling the spread in such a small area was a challenge.

Sharma said that first people suffer from fever, stomachache, diarrhea, and headache and then the patient fainted. He said that there is no doctor in the whole nine VDCs of the area. He said more than 300 people became sick in Sonbarsa VDC alone.

There has been spraying programme in the affected VDCs to control malaria. There are 292 houses in the Sonbarsa VDC and there is plan to complete spraying in all the houses within two days and then start in another VDC.

The epidemic had started from October 18 but the information about the outbreak had reached the district headquarters only after 10 days. Health worker at the Fattepur Health Post Durga Sharma said people were not aware about the epidemic and the locals do not take any initiative to control the disease. The death toll would not have been so high if the epidemic was reported earlier.

 

[hawkeye]

Re: Mystery illness kills at least 20 in Nepal in the last 10 days

11 malaria patients under observation
Sunday, November 05,2006

BANKE: The Banke District Public Health Office (DPHO) is keeping 11 malaria-stricken patients of Banke district under observation from Saturday.
Banke DPHO chief Jay Bahadur Karki said: ?The patients are undergoing treatment under the direct supervision of doctors. Steps are underway to shift these patients to Nepalgunj.?
A medical team deployed here had referred the patients to Nepalgunj on Wednesday. However, the patients? relatives could not take them to Nepalgunj due to poverty. ?The patients are undergoing free treatment here. The DPHO is bearing all the expenses of their treatment,? Karki said. Karki said the team is still active in malaria-affected areas to locate malaria patients and treat them.