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Forum: Disease Outbreaks That Could Be H 5 N 1

09 October 2006

Are we there yet – at 10:59

Since we know that avian influenza has been misdiagnosed as Dengue Fever, I thought it might be helpful to have a thread where we can assemble a “watch list” of sorts to keep our eyes on.

This could be something, it could be nothing (well not nothing, it could simply be dengue fever).

I’ll start with:

Colombia finds 1,842 dengue cases, 11 killed

http://tinyurl.com/e58hj

The day after tomorrow – at 11:20

Extremely drug-resistant tuberculosis strain emerges in South Africa From Wikinews, the free news source you can write! Jump to: navigation, search September 10, 2006

Photomicrograph of a staining of Mycobacterium tuberculosis, the bacterium that causes tuberculosis. Photo credit: Dr. George P. Kubica, CDC X-ray of a patient diagnosed with far-advanced lung tuberculosis.New research findings from South Africa on an extremely drug-resistant (XDR) strain of the bacterium that causes tuberculosis (TB) alarm experts. XDR-TB is defined as resistance to three or more second line antibiotics for TB. The condition remains treatable with other types of medications, but those are less effective, costlier and toxic. If the afflicted persons can’t be diagnosed timely and given proper treatment, they can die within a month. Of 53 patients who had this form of the lung infection in the study, 52 died, reports ABC News.

Dr. Tony Moll discovered the Extremely Drug Resistant Tuberculosis (XDR-TB) in the South African region KwaZulu-Natal. In an interview, he said the new variant was “very highly troubling and alarming because of the very high fatality rate.” Some patients might have contracted the bug in the hospital, Dr. Moll thinks, and at least two were hospital health workers. In one year’s time, an infected person may infect 10 to 15 close contacts. However, the percentage of XDR-TB in the entire group of people with tuberculosis still seems to be low; 6,000 of the total 330,000 people infected at any particular moment in South Africa.

The typical symptoms of TB (like prolonged coughing, fever, night sweats, weight loss and chest pain), and signs on X-ray are identical for XDR-TB. To ascertain the presence of this resistant form, a laboratory test on the patient’s sputum is necessary, but these tests are often too expensive in the poor countries where TB is present. Also, these countries frequently have high HIV-rates too; 44 patient’s in the study by Dr. Moll were seropositive. These patients are particularly vulnerable. Dr. Karin Weyer, director of the South African Medical Research Council’s Unit for TB Research, cautioned that “In a country with such high prevalence of HIV, the emergence of XDR-TB is a nightmare.” Because TB is often a hallmark of AIDS, many people afraid of the social stigma don’t seek medical attention.

These distressing findings urged a two-day meeting in Johannesburg to discuss the situation. Experts like Dr. Moll believe the new strain is also present in other provinces than Kwazulu-Natal. Conference organizers report cases in Mozambique and Botswana too. The World Health Organization has called for renewed efforts to combat the disease. Meanwhile, officials of the Health Ministry are suspected to be enforcing a media ban on the topics of AIDS and possibly TB.

During the 1990s, multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampin, emerged as a threat to TB control, both in the United States and worldwide.

http://tinyurl.com/fl45z

cottontop – at 15:51

Are we there yet - at 10:59

“since we know that avian influenza has been misdognosed as Degune Fever….”

That is a powerful statement, and we need proof from them, somehow, that it has been. IF, people, and that is a big if, avian flu has been misdignosed as Degune Fever, than we need to start putting our plans into action, now.

Before I fall for this assumption, I want to see the mortality numbers of the Dengue Fever patients.

DennisCat 16:17

Colombia has seen 1,842 cases of classic dengue fever so far this year, 11 people were were killed by hemorrhagic dengue fever, according to official statistics published on Sunday. The worst-hit department was Sucre, where 1,242 cases have been found and four people have died. ..more than 100 of them have become hemorrhagic dengue.

http://tinyurl.com/zf59g

DennisCat 16:18

Fiji

More cases of influenza are being reported in the north as the incidents of typhoid have fallen. Northern Health Services Doctor Ami Chandra said the recent rain was to blame for many people developing headache, fever and running nose. He said cases of diarrhoea had also dropped from 50 per day to at least 10 compared to the past few weeks. Dr Chandra said 190 confirmed cases of typhoid had been treated so far and the numbers were declining every month. He said at least 20 cases were treated each month since the beginning of the year but the number had dropped to approximately 15. Dr Chandra said people living in villages and settlements were receptive to the campaign program. He said patients suffering with influenza were also expected to reduce in a few days. He said the epidemic started in Viti Levu a few weeks ago and the movement of people had spread the virus.

http://tinyurl.com/of36f

DennisCat 16:20

Pakistan

At least 20 more patients including 8 women suffering from viral hemorrhagic fever (VHF) have been admitted into the different hospitals here, taking the total number of patients to over 35. Health Department sources told that the two patients were already admitted in the Liaquat National Hospital, while 16 more patients were admitted during the last two days,

http://tinyurl.com/l2pc3

A former Lurker – at 16:23

cottontop – at 15:51 I believe you are misinterpreting the statement “Since we know that avian influenza has been misdiagnosed as Dengue Fever” …. It does not mean that it Has in these cases but that it HAS been misdiagnosed in the PAST. First of all the 1918 flu was originally diagnosed as Dengue Fever in many cases. Secondly there was at least one case of H5N1 this summer that was also misdiagnosed as Dengue Fever. Therefore we should be alert to the fact some may be mixed in and missed. Esspecially since the tests for H5N1 are not always (usually?) accurate. I’m sure someone will provide a link to the case this summer.

beehiver – at 16:28

If memory serves me correctly, it was in Indonesia. I don’t have time to search the Indonesia threads right now, sorry.

Oremus – at 16:55

We know it has been misdiagnosed as SARS. China’s first belatedly reported case (that we know of, of course).

anon_22 – at 17:46

It’s on this thread. Report from Indonesia about how it is difficult to differentiate between H5N1 and seasonal flu and dengue fever. Go to that thread for details.

cottontop – at 18:31

A former lurker - at 16:23

Perhaps saying “…misdiagnosed, “in the past”, would have clarified the statement. People like me are totaly new to this.

10 October 2006

Cygnet – at 00:08

Anon-22 — what do you make of this links on the difficulty of diagnosisng chik/dengue?

http://tinyurl.com/z6w9u

Talks about only 50% of the cases testing positive — I have no idea what a normal rate would be. Sounds like they’re treating some cases as presumed dengue without a positive diagnosis. Probably, it IS dengue, buuuut …

Also, I’ve seen some news articles — which I now cannot find — noting that the platelet counts are not as low as expected in all cases. Maybe somebody else can dig them up. Given that H5N1 is associated with a higher platelet count than dengue … anyway, little clues that may mean absolutely nothing.

Dennis in Colorado – at 15:09

Panama
http://www.minsa.gob.pa/ via ProMed

10 Oct 2006: communication No. 8 — Ministry of Health/Social Security

In order to keep the community informed on the advances made in the investigations into the causes of the renal insufficiency and neurologic deficits syndrome, the Ministry of Health and the Social Security Agency, with the intention to preserve public health, announce:

Tests conducted to date:
- more than 30 products, including foods and medications, have been analyzed in the search into the possible causes of this syndrome and results thus far have been negative.
- as of today, the US CDC [Centers for Disease Control and Prevention], have conducted testing for the following [infectious agents] and they have all been negative: enterovirus, flavivirus, rickettsia, leptospirosis.
- the University of Panama has conducted the following tests, all with negative results: lead, arsenic, cadmium, selenium
- results from some tests conducted in the United States and in Panama are awaited.
- the field epidemiology group is investigating and making daily detailed surveys. - a team of epidemiologists is working 24 hours a day conducting field visits and case detection.
- today there was a meeting of the clinical commission consisting of the following specialists: Jorge Motta, Gissel Rodriguez, Aaron Benzadon, Julio Toro, Rosendo Diaz, Eduardo Reyes, Nestor Sossa, Jaime Arias, Jose Moreno, Dona de Lee, Luis Bravo, Walter Valverde, Jose Manzanares, Ricardo Medina, Diego Rey, Xavier Saenz Llorens y Enrique Mendoza. The specialists mentioned have been involved in the analysis of cases and clinical correlations.
- the total number of patients remains 31. Of these, 28 are from the Social Security Health System (CSS), 3 are from the Santo Tomas hospital, 4 are ambulatory, 4 are in the intensive care units and 2 are in [the convalescent unit].
- unfortunately today one of the patients admitted to the intensive care unit of the Social Security Hospital Complex died, raising the total number of deaths [attributed to this syndrome] to 21.
- there are 7 suspected cases under investigation, 6 from the Social Security Health System and one in the Santo Tomas Hospital.

We reiterate:
- abstain from taking the medication Lisinopril Normon as a preventive measure and provisionally until health authorities determine otherwise.
- those patients who have these medications can exchange them at the designated Health Centers and PolyClinics.
- people with the following symptoms: vomiting, fever, diarrhea, decrease in urinary output, or generalized weakness should go to the nearest health center, polyclinic, or hospital.
- do not self medicate and use only those medicines prescribed by the [health care system.]
- remember the hotline numbers: 800–5500, 512–9607, 512–9609, 229–5703.

The Commissioners:
Rosario Turner, Ruben D Lopez
CSS, CSS
Nestor Sossa, Cirilo Lawson
CSS, MINSA
Vicente Bayard
MINSA

We reiterate to the population that the investigations to determine the causes of this syndrome are continuing and are being carried out with the support of the Gorgas Institute Health Studies, The Center for Disease Control and Prevention of Atlanta, USA, and the specialized institute of Analysis of the University of Panama.

Newyorkprepper – at 15:39

Dumb question…how do your pronounce “dengue”?

Milo – at 15:47

Newyorkprepper – at 15:39

“deng - gee.” I think “deng - gay” is an alternate pronunciation.

the NG in “deng” has the “ng” sound as in “song,” the G in “gee” or “gay” is hard as in “garden,” not soft as in “giant.” Stress on the first syllable.

Newyorkprepper – at 15:56

Thanks…I always wondered that! :-)

Green Mom – at 16:45

My sister in the Peace Corps always pronounced it deng-gay but I don’t know if that was a Dominican/Peruvian spanish pronounciation or her Southern Appalachian pronouncation.

NoFluingAroundat 19:36

H5N1 has also been misdiagnosed as “Typhus”

NoFluingAroundat 19:44

pronounced “deng-e”

11 October 2006

Commonground – at 07:36

http://tinyurl.com/jsmsu
Excerpt:

The Cinere region, Depok was stated berstatus the extraordinary incident (KLB) the Cikungunya illness because of the number of Chikungunya sign sufferers in the Limo RW Subdistrict 03 and 04, the Depok City continued to improve. Till Wednesday early afternoon already 93 people suffered the Chikungunya sign. The head and the Eradication of the Illness of the Depok City of the Health Service of the Prevention Sub- Service, Ani Rubiani in Depok, on Wednesday, suggested that although this case was classed as KLB, the community might not be concerned because of Chikungunya did not endanger. “Chikungunya not until deadly, only was sick several days,” he said. He proposed that the number of sufferers was still continuing to improve to the vector (the disseminator of the virus) succeeded in being overcome. The number 93 sufferers were spread in two RW. the Sufferer was often met in RT 02/04 totalling 50 people, RT 01 numbering 21 people, RT 03 numbering 20 people and in RW 03 numbering two people.

Commonground – at 07:37

http://tinyurl.com/elqu4
Padang — MOLE: thick Smog that covered the Dharmasraya Regency, West Sumatra (West Sumatra), for the last four days, caused the increase in the case of the Acute Respiratory Tract Infection (ISPA) in the new regency results pemekaran 2003. The section head the Health of Dharmasraya Yunier Healthy said the rise happened 20 percent, approximately 500 ISPA cases, from the previous month. According to Yunier, some last time happened the rise in the sufferer’s ISPA visit to several community health centres in Dharmasraya against the month beforehand. Yunier said the Standard Index of the air Pollutant (ISPU) in Dharmasraya when pointing out the level of the PM 10 (the solid particle/dust) 100 ppm. “For his certain data will be announced two days more (on Thursday, 12/10).” At this time, the team of the health of the province of the service has descended tested the quality of air here, he said. However according to Yunier, till at this time did not yet have the appeal used the mask. In the meantime, the distance of the look in Dharmasraya only reached 300 through to 400 metre.

Commonground – at 07:38

http://tinyurl.com/eqkxj
Occupants of the Luxurious House could be Also attacked by Chikungunya The report on the Reporter Kompas R Adhi Kusumaputra Depok, Kompas — occupants of the luxurious house that generally clean also could be attacked by the illness chikungu him that at this time became an epidemic in the Cinere District, the Limo Subdistrict, the Depok City. “Did don’t regard light.” Because mosquitoes did not gaze at the status, rich or poor. At this time indeed that often was indeed affected by the middle circle low. But was not closed the possibility of mosquitoes aedes aegypti as the main vector chikungu him also bit anyone, who by chance stopped over in the middle housing complex upper, so as this illness spread other occupants, explained the Head of the Limo Community Health Centre, Dr Lexiani, on Wednesday (11/10). Until struck 12.00, the number of sufferers chikungu him improved to 93 people. Many citizens that beforehand did not report to the community health centre, berbomdong-bondong reported this to the command post in Street Persatuan, Cinere. Moreover several newcomers were feverish on Tuesday night.

Commonground – at 07:39

ANTHRAX, HUMAN, BOVINE - INDONESIA (SULAWESI)
Date: Tue 10 Oct 2006
http://tinyurl.com/p2vhk
An anthrax epidemic has been declared in Gowa, South Sulawesi, with cows in 3 villages infected with the deadly illness and fears that infected meat has been sold to the public, an official says. No people in the region have been reported sick with the disease.

Bategulung village secretary Abdul Hamid said 3 cows in the village had been confirmed infected with anthrax during the past week. Two possibly infected cows had been slaughtered before the disease was detected and their meat sold to the public, he said. Abdul Hamid said the administration had issued a circular informing people not to sell or slaughter cattle until the beasts had been inspected and cleared by the local health office.

Green Mom – at 14:23

How contagous is Anthrax? I had a notion it was fairly hard to contract in a nateral setting. Could it be mistaken for flu-well you must think so or you wouldn’t post it here. Sorry, up too late last night discussing conspiracy theorys with Wolverine…..

Commonground – at 14:36

I don’t necessarily think it has to do with flu, but I’m just watching the cow die off. For now, keeping my eyes on the situation. Anthrax has happened before in Indo. It’s not new.

Commonground – at 15:00

Excerpt: http://tinyurl.com/gwv79
Anthrax was found Again in Gowa
Sungguminasa, the Stand — the anthrax Illness again attacked the cattle livestock in the Gowa Regency. A cow belonging to Lawanri Dg the Roll, the citizen of the Bategulung Village, the Bategulung Village, of the Bontonompo Subdistrict, suddenly died suddenly, last Sunday (8/10). Results of the temporary inspection the team from the Big Veteriner Hall (BBV) Maros that descended to the location of the same day concluded the cattle positive was attacked by the anthrax illness. To mid last September, positive cattle anthrax was also found in the Village bought up Untia, the Village Maccini the Wedge, the Bajeng Subdistrict. As many as 11 cattle died suddenly in this village for the last two months. The section head Livestock Breeding (Disnak) the Gowa Regency, Hatta Kanna, that it was confirmed per the telephone, on Tuesday (10/10), justified the discovery of positive cattle this anthrax. Upon arrival at the location immediately was done by medical treatment and giving antibiotik to 96 cattle livestock in this village. It was not old that afterwards the team from BBV arrived and immediately took the sample of blood and the location land of the death of these cattle. “Results of his inspection named cattle that died suddenly that was positive anthrax,” said Hatta. The cattle were at once buried appropriately the control procedure of anthrax. Apart from taking the sample of cattle blood that died suddenly that, the BBV team also took the sample of blood of nine cattle near the location. Results of his inspection were not yet available. Was not vaccinated by the Owner of cattle, Dg the Roll said, there were no signs of his cattle was unhealthy before dying suddenly. That morning, these cattle were supervised to around his house and gave him ate. The cattle only ate the stick of corn that almost dried up. Around one hour after eating the stick of the corn, the cattle arrived- arrived died. From his nose went out mucus was yellowish. On his ears went out blood. Signs were similar to the anthrax illness. According to him, from his five property cattle, only that one that died. Separately was received by information had two cattle that experienced the similar sign in the village that was known the Chairman’s native village DPRD Gowa, Mallingkai Maknun. However, cattle that began to be sick that could not die because of his owner direct menjualn him. From the story in this village, said Hatta, in the last two years the cattle livestock had in this area experienced the death that was expected by the anthrax illness. At that time, disnak immediately did the isolation and gave the vaccination comprehensively to all the cattle livestock in the place. Evidently, cattle that died suddenly and was stated positive this anthrax was not vaccinated at that time.

Pixie – at 17:37

Comment: Not H5N1, but gives an insight to the level of surveillance, manpower, and disease control in Indonesia:

Gowa begins anthrax vaccinations Andi Hajramurni, The Jakarta Post, Makassar (in English) October 12, 2006 http://tinyurl.com/pnfez

The Gowa regency administration has begun vaccinating cattle for anthrax in two infected areas in the region and is requiring all farmers to have beasts tested and certified free of the disease before they are killed in designated slaughterhouses….<snip>

Anthrax is an acute infectious disease that typically affects cattle, but can be transmitted to humans through the handling or consumption of infected meat that is undercooked. When anthrax spores are inhaled, the disease is usually fatal.Arfah said the office had begun vaccinating cattle in Maccinibaji and Pabbentengan but was not immunizing beasts across the entire region — the standard procedure — because it did not have enough staff to do the job….<snip>

“In the meantime, we have prioritized the vaccination to cattle in areas where there have been positive cases of anthrax since we have limited manpower. We only have six officials … so in a day they can only vaccinate around 200 cattle,” Arfah said… <snip>

The Gowa health office has yet to test blood samples taken from residents in the affected areas. No people have been reported sick with the disease.

The office will work to completely vaccinate cattle in the regency in stages, Arfah said. There are between 60,000 and 80,000 cattle across the regency. <snip>

Influentia2 – at 18:09

PIXIE, I hope I haven’t wasted space here I didn’t see this anywhere else but I don’t have the time to check several threads. I think this is a follow up to that outbreak that started in Garut and went Tasikmalaya and Bandung. If so, case closed?

http://tinyurl.com/gmsr2

Bandung, (HOMEWORK). -The Number Of sufferers muntaber in Kab. Bandung that came to the regional Hospital (RSD) Soreang continued to improve. Since Tuesday night (10/10) till Wednesday (11/10), was gotten by 28 patients muntaber just that came from several subdistricts in Kab. Bandung. Therefore, the number of sufferers muntaber since the last two days improved to 115 people. However, as many as 32 patients were stated recovered and was permitted to come home although must undergo treated the road. The patient who was treated in the IGD RSD Soreang corridor also was still being seen, although being not chock full like the previous day. Several patients also still were treated in the room corridor like that was seen in roses space and the Poinciana Tree with used veldbed. The patient muntaber just that came yesterday, most came from Kec. Soreang, Cangkuang, Katapang, Pasirjambu, and Cipongkor. The spreading muntaber this was still equitable and was not focussed in one place, as far as the Kab side of the Health Service. Bandung did not yet state the status of the extraordinary incident (KLB). Regarding the cause muntaber this, the RSD Soreang side went through his laboratory did the temporary research into 28 samples of the waste (faeces) the sufferer. Results, totalling 22 positive samples contained the amoeba and the bacteria. Yesterday, the Section Head the Prov Health. West Java, Dr. Yudhi Prayudha, carried out the visit to RSD Soreang at the same time giving help of the infusion liquid ringer the lactate totalling 100 gourds. The side of Dinkes West Java also stated his readiness to help RSD Soreang in handled muntaber in Kab. Bandung. According to Yudhi, was estimated muntaber in Kab. Bandung came from amoeba dysentery. The cause that most general that is the existence of the parasite infection entamoeba histolytica that caused amoeba dysentery. These germs could be spread and spread to the other person through food and water that have been contaminated by the waste but also the fly. Prevention efforts spread him muntaber in Kab.Bandung was done together in various community health centres in two today.However, compared with the other community health centre, four community health centres in the Kec territory.Soreang namely the Soreang Community Health Centre, Sukajadi, Kopo, and Gajahmekar, received the priority to do kaporitisasi and the distribution of the solution oralit free.His article, from 115 sufferers muntaber in Kab.Bandung, almost half of it came from Kec.Soreang, despite spread equitable in 10 villages.The head of the Soreang Community Health Centre, Dr. Ina Rinawaty, that was accompanied by the Chairman of the Prevention Program and the Control of the Illness (P2P) the Soreang Community Health Centre, Rachmat Shah, admitted that the quality of water that was consumed by the community tended to descend at this time.On the consideration, his side afterwards did kaporitisasi or giving of the solution calcium hypochlorite (chlorine) to each one of the citizen’s wells that was used for the everyday requirement.“Pemberian chlorine was meant to kill several protracted germs in water sumur,” said Dr. Ina in counselling gaps to the community in the Village Ciwaru the Village/Kec.Soreang Kab.Bandung yesterday morning.In the Ciwaru Village, as many as 8 people could be run off with to RSD Soreang because muntaber in the last two days.After being done by the research evidently 8 people mengonsumsi water from the same well, that was sucked by making use of the water pump to his house was their respective.

”Sebelum him we did not place suspicious because water that came from the well far was not different, both from the colour and the feeling. It is hoped giving of this chlorine could avoid us from the plague muntaber,” Engkan Rokayah words (60), the citizen Ciwaru. West Javanese Governor, Danny Setiawan said, the extraordinary incident (KLB) could not be maintained in West Java because still was partial in three regencies. “Bila in one area was found by the case with the number that many, the district head berkewenangan to say KLB,” he said. According to Danny, when muntaber has attacked 50% the West Javanese territory, just could be stated KLB. touched on the use of the KLB fund for the illness muntaber, according to Danny, this fund was not yet distributed. “Sampai at this time still made use of the regional capacity was increased by available facilities in the service. Dinkes also did not yet put forward the problem of the lack for the control penyakit,” he revealed. (A-124/A-158)

Pixie – at 19:38

Influentia2: That sounds about right - amoebic dysentery. The part about it being spread by flies is interesting, though. It sounds like the outbreak in Bandung is waning as they say their wards are no longer “chock full” of patients at RSD Soreang (I like their fluent use of English!). Hopefully the mutabar situation is temporary and is, in fact, due to the usual water problems, which in this case seem to be seasonal.

LauraBat 19:41

Is it me, or are these sudden cases of super-virulent TB a bit suspect? Since when do TB patients die within weeks? Or is becuase most cases are curretnly in Africa and likely many patients had supressed immune systems?

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