I thought that Nepal should have its separate thread. The death count on the “mystery illness” stands at 36 right now and they don’t think it is dengue or malaria. (they see a lot of that but this seems different). “ People suddenly catch high fever, start shivering, faint and then die. “ It (shivering) is about like the symptoms in birds. “The number of those affected and dead could be even higher, according to locals. “ “Dr Shuvesh Raj Kayastha, chief at Mahakali Zonal Hospital at Kanchanpur, Mahendranagar, said that the disease could be caused by viral infection. He further feared that it could be an illness similar to SARS (severe acute respiratory syndrome).”
Here are the English news sources I have located on Nepal to help things along.
http://www.thehimalayantimes.com/
http://www.nepalnews.com.np/independent.htm
http://www.nepalnews.com.np/ktmpost.htm
http://www.peoplesreview.com.np/
http://www.nepalnews.com.np/trn.htm
http://www.nepalnews.com.np/spotlight.htm
http://www.nepalnews.com.np/sundaypost.htm
http://www.nepalnews.com.np/telegraph.htm
What ever it is, it doesn’t sound good.
and for for reference to start:
Mystery disease kills 36 in Nepal
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.
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.
symptoms : “ Fever, headache, running nose, pain on hands and legs, difficulty in respiration are the symptoms of the disease.
“According to locals, those who died showed strange symptoms of headache and breathing difficulty. They died shortly after..”
“Several dozen people in Belapur VDC have been infected with the disease over the last 2 weeks, reports said. The disease has ‘’‘symptoms like severe headache, fever, and cough’‘’. Eight deaths have so far been confirmed in the VDC.”
Map of Nepal Administrative Divisions:
It is very important to note that this may not be — and is probably not — H5N1. There’s no mention of a respiratory component that I’ve seen. (Which doesn’t mean that there’s not, but is worth noting.)
This is an extremely poor, extremely remote area with people who (from what I’ve been able to infer) may be dealing with chronic malnutrition. It could very easily be something mundane and ordinary … anything from measles to seasonal flu.
One GOOD thing, if this does turn out to be panflu, is that it IS very remote. Hopefully, they’d be able to contain it. If they can’t contain it then we may have a solid “heads up” between the time that we have a diagnosis (“Hey! These people are testing positive for influenza A!) and the time it really gets smoking. It might delay the start of the pandemic by several days to weeks — I’d much rather H5N1 go pandemic in the back beyond of Nepal than, say, Jakarta.
Since they note that there are medical personell in the area, we’ll likely hear one way or another about flu.
Ah. Looks like there are respiratory symptoms.
Hmmmm. Okay, I’m watching this one closely now.
And people are leaving the area to go to hospitals … if they’re going to hospitals, they should be able to get tests done to at least establish if they test positive for Influenza A.
Any news on health care workers getting sick?
Quick question for those who are better at crunching numbers than I — what’s the average time from date of onset to date of death for H5N1? (If this is panflu — and I’m hoping it’s not — but if it is, I’m thinking it’s too soon to establish a CFR yet because the disease will not have run its course for the majority of patients. CFR may go up.)
Yes, there has been no testing for H5N1 that I know about. Notice that they are having problem with testing since they don’t even have electricity.
Cygnet – at 21:42 -date of onset to date of death for H5N1
I seem to recall it is about 7 to 10 days from exposure to hospital symptoms and it can take a month or so before death.
notice the last Egyptian case. “the woman became ill on Sep 30 and was hospitalized Oct 4. She had suffered from pneumonia and been treated with oseltamivir.” and then died on Oct 30. She was tested as “negative during all but the last of the hopital treatment. That should give you an idea. But we don’t know her original exposure date.
http://tinyurl.com/uruvq (for the Egypt info)
Rapid antigen testing for influenza A does not require electricity.
(Sorry, didn’t mean to sound so abrupt.Touchy mouse here.)
I’m suspecting the “no electrity” comment may have had more to do with testing for malaria.
My guess if if the little mountain clinic cannot afford electricity, they may not be able to afford antigen testings or a frig to keep supplies in.
I posted this on the India thread before I realized DennisC had started a Nepal thread. I think it is a worthwile article to post here too.
Medical teams leave for Banke Himalayan News Service Banke, October 31:
Teams of medical professionals today left for remote villages of Banke district affected by an undiagnosed disease, District Public Health Office (DPHO) Banke said. An 11-member team led by Dr Kumar Sanshah left for the affected VDCs including Fattehpur, Gangapur and Narainapur, chief of Epidemic Disease Control Program of DPHO, Ram Bahadur Chand said. An eight-member team led by Dr Jeewan Pradhan left for Holiya VDC. The teams have taken equipment necessary for blood tests and administering medicines adequate for around 500 patients. The disease has not been diagnosed yet but medical professionals have taken medicines for malaria because PF positive was found in the blood samples of two patients from the village, the DPHO said. “A medical team has started testing the blood samples of the patients but the results have not reached the DPHO yet due to lack of means of communication,” Chand said. Local residents said the patients were being distributed medicines for malaria even though the disease wasn’t diagnosed. The DPHO is also making preparations to spray insecticides to prevent spread of the disease. Chand added that DPHO Banke has asked for a specialists’ team from the Health Ministry for control of the disease. “We have asked for a specialists’ team; we are really concerned for the treatment of the patients,” Chand said. Advisor of Health Ministry, Dr Mahesh Maskey and Senior Public Health Officer Giriraj Subedi reached Nepalgunj to coordinate for control of the epidemic.
Also want to repost this article. Please take note of the ages. In looking at the CDC website concerning malaria it appears that pregnant women and young children are the ones at greatest risk of severe cases of malaria. The ages of those reported in this article do not match that criteria, though it does say “Most of those dead are children and the aged.” Malnutrition could also be a contributing factor.
Banke mystery disease toll rises to 36
Tuesday, October 31,2006
BANKE: An unknown disease spreading in four village development committees across Banke’s Rapti has taken 36 lives so far. The number of patients who are suffering from the disease has risen to 500.
The toll has risen to 23 in Fattehpur VDC, 10 in Gangapur VDC, two in Narainapur and one in Chauferi village. Most of those dead are children and the aged. Over 36 people are in a critical condition. Medicines are in short supply. Those who can afford treatment are visiting Bheri zonal hospital and hospitals in India.
Three sons of Sarif Khan at Piprahawa in Fattehpur VDC died three days ago. One Bhaigeni Ahir’s 13-year-old son Ram Oasis Ahir and 16-year-old daughter Kushmi Ahir died yesterday. Baismali Budhamagar, 52, died in Fattehpur VDC yesterday. Her neighbour, 44-year-old Krishna Bahadur Gharti, had died five days ago.
Seven persons at Fattehpur - 6 Jhagariya and three in Fattehpur ward number 1 died within a week. According to assistant health worker in the Gangapur health post, Narayan Sharma, 10 persons have died in Gangapur VDC. Head of the epidemic control programme in the District Public Health Office (DPHO) Banke, Ram Bahadur Chand, confirmed that 36 people have died due to the epidemic in the last one week across the Rapti.
Even though the DPHO dispatched a team, blood tests could not be done due to the absence of electricity and, as a result, the disease could not be identified. Blood samples have been taken from some people and medicines given to them, AHW Sharma said.
“I informed the DPHO about the situation on Friday, but the team arrived here today. The disease is still unknown,” Sharma told this daily.
Nasaruddin Seikh of Fattehpur 5 Piprahawa, said: “All in my family are sick. People are dying. People can save their lives if doctors and medicines start coming.” Locals have accused the government of being indifferent to their plight.
I googled the temp there, it’s sunny and 66F with the five day forecast dropping into the fifties. This is too cool for mosquitoes unless they act differently in that part of the world. With 500 sufferring and many critically ill I wonder what medications the doctors gave them? They didn’t have electricity to run blood tests with. We should scan for a Tamiflu blanket over the next few days.
Dennis C: Glad you started the thread.
DennisC: Yes, thank you for starting this thread, but I wish you didn’t have to. How sad this all is. :(
Cerebral malaria identified as killer disease in Banke
Kathmandu, 31 Oct: Cerebral malaria resulted in the deaths of 36 persons in Banke. This was confirmed after medical tests, Kantipur FM reported quoting government health officials. The disease has infected nearly 500 persons. Three health camps are being established to treat the sick Wednesday at the villages.
People’s News/BR
What is cerebral malaria?
Cerebral malaria (CM) collectively involves the clinical manifestations of Plasmodium falciparum malaria that induce changes in mental status and coma. It is an acute, widespread disease of the brain which is accompanied by fever. The mortality ratio is between 25–50%. If a person is not treated, CM is fatal in 24–72 hours. The histopathological hallmark of this encephalopathy is the sequestration of cerebral capillaries and venules with parasitized red blood cells (PRBCs) and non-PRBCs (NPRBCs). Ring-like lesions in the brain are major characteristics. Disease risk factors include being a child under 10 years of age and living in malaria-endemic area.
What are the symptoms?
Clinical manifestations of cerebral malaria are numerous, but there are three primary symptoms generally common to both adults and children: (1) impaired consciousness with non-specific fever; (2) generalized convulsions and neurological sequelae; and (3) coma that persists for 24–72 hours, initially rousable and then unrousable.
The cause of cerebral malaria is not well understood. Currently, there are two major hypotheses explaining its etiology. They are the mechanical and the humoral hypotheses.
What are possible treatment options?
As cerebral malaria is the fatal within days of malaria infection if left untreated, immediate treatment is crucial. Because natural immunity to malaria is not fully understood (Immunity) and thus cannot yet be artificially imitated by drugs, control and prevention strategies are significant. Two of these are antimalarial chemotherapy and adjunctive measures. Public health interventions are also critical (Public Health).
P. falciparum parasites in brain capillary (J.S. Tatz)
I have found the encarta map which shows Banke in the south of Nepal, close to the border with India. This makes it more of a tropical area - compared with the mountainous regions we usually associate with Nepal.
Here is the link to the map - you can zoom in and out and find all sorts of places - have fun!
DennisC @ 21:25 on 31 October … I think Belapur is in India - not far from Mumbai - I cannot find a similar/same name in Nepal.
Great, that’s all we need is it to spread to the much more populous country of India. But I also wonder if malaria is a disease that’s common there, or maybe they’re having a warmer than normal fall, wetter than normal, etc? Malaria is nasty no matter what but this form seems especially bad.
I finally heard back from my friend hiking in Nepal - he said there are rumors about this disease already floating around the country - he’s no where near but word travels fast enough even in remote areas. It definitely has people spooked because victims seem to die so quickly. A member of his group had to go to a local “clinic” for antibiotics for an infected foot and reported back it was a pretty scary place. And this is a group of guys used to roughing it.
Also - don’t bet on it being so “remote” 1000′s of Westerners go backpacking in Nepal every year. My friend and his mates will be back in England in two weeks. And if it’s something airborne, like mosquitos, well, we all know what can happen with that.
Betty at 3:07, thanks for the info about cerebral malaria. However, the clinical picture did not include respiratory difficulties as posted for instance by DennisC at 21:23 yesterday. Thus, one is prompted to wonder if there is another pathogen in circulation.
LauraB – at 06:06
Great, that’s all we need is it to spread to the much more populous country of India.
Mystery disease kills 36 in Nepal
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.
Sorry the line I tried to highlight in blue did not post. (curious)
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.
The CDC site on malaria notes that symptoms of severe malaria caused by P. falciparum include “pulmonary edema (fluid buildup in the lungs) or acute respiratory distress syndrome (ARDS), which may occur even after the parasite counts have decreased in response to treatment.”
In regards to whether malaria is endemic to Nepal, they have the following description of risk for travelers: “Nepal: Rural areas in the Terai and Hill Districts, except no risk at altitudes higher than 1,200 meters (3,937 feet). No risk in Kathmandu or on typical Himalayan treks.”
To my mind, it is within the realm of possibility that they could be experiencing a severe and sudden explosion of P. falciparum malaria, with the result that a percentage of those infected have developed cerebral effects. However, other explanations are also within the realm of possibility.
AnnieB:
I hope that the problem in the Banke district of Nepal is malaria, but on the India thread when we first noticed patients with suspected dengue entering the teaching hospital in Nepalgunj, Nepal (the main city in the Banke district), followed by several members of the same Nepalgunj University Hospital teaching staff falling ill with suspected dengue, we looked up the weather forcasts for that area. (BTW, the suspected dengue patients in the Nepalgunj Hospital, Banke region, all tested negative for dengue, including the staff).
The mosquito’s apparently do not breed or survive well when the weather begins to drop below 19 degrees C at night (at least that’s what we’ve heard over and over from New Delhi about their hopes that their dengue plague is now ending with the cooler weather).
Unfortunately, the weather in Banke district is not completely tropical at this time and some of the mosquito problem should have been taken care of by the cool nightime temperatures. The forecast for this upcoming week in Nepalgunj is very much like last week’s, with daytime/nightime temperatures © forecast from Wednesday as:
28/13 - 28/14 - 26/13 - 27/12 - 27/12
Did some checking on the Banke district, is primarily under 500 meters elevation. That makes it well within the guidelines for mosquito to live in Nepal. Additionally, the area has suffered much flooding to the extent that Red Cross and others mobilized to set up mobile clinics, refugee camps etc. . .and an advisory was put out that some communicable diseases including malaria could increase.
DennisC has just posted an update about the suspected dengue patients in Nepalgunj (on the Not BF But Close thread). The tested 15 patients in the Nepalgunj medical college using the more sensitive Eliza test, and 6 patients tested positive for dengue (which still makes me wonder what the other 10 have).
Two additional cases are also noted as having gone to Lukhnow for treatment, one of which I believe was the professor whose family moved him in rather a panic after the medical college failed to reach a diagnosis. The two Lukhow cases are noted as being treated for dengue.
Kathmandu (Nepali: ????????, Nepal Bhasa:???) is the capital city of Nepal and it is also the largest city in Nepal. It stands at an elevation of approximately 4,265 ft (1,300 m). It is an urban and suburban area of about 1.5 million inhabitants in the tri-city area in the Kathmandu Valley in central Nepal, along the Bagmati River. The two other cities are Patan and Bhaktapur http://en.wikipedia.org/wiki/Kathmandu
the backyard of the world, lets hope so if… Last time I saw a dockumentary about himalaya it was like scoutscamp of trekkers and climbers there, not to mention the paraschut folks, the hangliders, the scientists and astronomers etc.. Lets hope its the wrong season if it is HPH5N1.. And overpopulated India is next door. They also have some hard conflict beween government and Maoist guerilia..
some NGOs is probably there with healthcare..
Well, I still have some questions.
On the plus side the area has had flooding which increases the likelihood of malaria.
On the negative side, the weather has been to cool for optimal mosquito activity. The locals including the health care workers didn’t see it as malaria. Malaria is endemic to the area so not only should they recognize the symptoms but it is common practice in areas with endemic malaria to treat for malaria based on symptoms and not wait for results from the lab. Also, one article dated 10/31 states the health team/officials (which had some bigwigs in it if the titles in the article are true) arrived on 10/31. Another article dated 10/31 quotes the health officials as stating that the outbreak is Cerebral Malaria. IMHO it is pretty fast work to arrive in a remote location, set up shop, test all or most of the subjects spread out in several villages, compare notes from all the villages, and make the public statement arrive back in time to make news that same day. Just MHO based on my personal experience in some very remote locations that didn’t involve setting up medical equipment. Again, JMHO.
Please, add your comments, especially on anything I overlooked or misinterpreted ie: dates of the news articles etc.
Wow, all you sleuths are wonderful, we have a pretty good team here looking up information!
Homesteader – at 13:51 Your questions about the outdoor temperatures, dates of team members going onsite and then the date of the cerebral malaria diagnosis were ones I also had. In some of the articles, it stated that these individuals were not testing positive for malaria. If they were negative, I would assume they would be negative for cerebral malaria as well.
The villagers are stating that the politicians are not doing anything and the people of Nepal are starting to get nervous about the “mystery illness”. Could this extremely quick diagnosis be one to just satisfy the people until they can do more testing? I do not want to sound like a conspiracy theorist, but this fast diagnosis of less than a day does not make sense to me. A diagnosis of malaria (a disease they have to deal with on a regular basis) may make the people less angry with the governmental officials involved.
Follow-up on previous post; My background checking found that Mosquitos/malaria are not present above 1200 meters in Nepal. Banke district is primarily 500 meters. Link is for nifty map site for Nepal which is where I got the elevation info.
I also agree that there are some questions that need answering.
It’s possible that there might indeed be a small malaria outbreak there, due to the flooding, sufficient to give a few positive test results, that authorities are falsely proclaiming to be the cause of all of the illness. A masking effect, in other words, whether deliberate or not. I guess we will always wonder about coinfection in these situations.
A quote from one of the articles, compliments of Okie.
Medical teams leave for Banke Himalayan News Service Banke, October 31:
Teams of medical professionals today left for remote villages of Banke district affected by an undiagnosed disease, District Public Health Office (DPHO) Banke said. An 11-member team led by Dr Kumar Sanshah left for the affected VDCs including Fattehpur, Gangapur and Narainapur, chief of Epidemic Disease Control Program of DPHO, Ram Bahadur Chand said. An eight-member team led by Dr Jeewan Pradhan left for Holiya VDC. end quote.
So the Chief of Epidemic Disease Control Program of DPHO either volunteered or was ordered to go. The article states they left today (10/31) to get to a remote area, yet they also declared the cause of the outbreak the same day? Sounds like WHOeey to me.
Pseudorandom – at 14:32
I agree. I would feel so much better if they said something like- we checked for H5N1 and it was negative in all cases. But I worry too much…. I’ve got to stop that.
One more post and then I’m going to leave this alone.
Question for an experienced Tropical Disease Doc: Does this outbreak profile match a typical malaria outbreak profile?
From what I can gather sypmtoms typically appear 7–20 days after infection,(which only occurs when a mosquito bites an infected human, then goes and bites another infected human. This could explain family members being infected, but articles quote villagers as saying every family in some villages had an infected member) with shorter time before onset in younger children. Additionally, people native to areas where malaria is endemic often have developed a degree of immunity. This outbreak’s timeline appears to my untrained eye to be quite compressed for a typical malaria outbreak. That is why I’m hoping minds greater than mine will comment.
Recent Timetable for Nepal
Map of Nepal Administrative Divisions: http://tinyurl.com/yynvae
I thought it would be helpful to have a summary of the action in Nepal recently. I have no idea what may be happening there, and even ProMed has discussed dengue, Japanese Encephalitis, Malaria, and Influenza as being possible. One news report speculated that some reported symptoms resembled SARS.
Thanks, Pixie. Such summaries are of great benefit for those of us with little time (and short attention spans:)
This is in India, posted by witness on India III thread. Symptoms are identical to all the Nepal posts.
Mystery disease strikes village, three dead Our Correspondent
Fatehabad, October 28 Death of three persons in a span of one week due to some mysterious disease at Dayyar village in this district has caused scare among villagers.
The disease has affected almost all families in the village, which has some 800 houses. Those who died of this disease complained of high fever, severe headache and vomiting. Villagers allege it is an attack of dengue. However, the health authorities have denied it and said supply of contaminated drinking water was responsible for the disease.
According to reports, Pala Ram (40) of the village died on October 21 after a brief illness. Ishwar Godara (42) died the next day. On October 24, Dara Singh (22) also died. All the three died after a brief illness and complained of high fever, severe headache and vomited blood before breathing their last. Several other villagers are suffering from fever in this village.
Link: http://www.tribuneindia.com/2006/20061029/haryana.htm#1
Sorry, hit the submit button too early.
Wikipedia link for Fatehabad (reporter from Fatehabad)
http://en.wikipedia.org/wiki/User:Ganeshbot/sandbox/Fatehabad
Couldn’t locate Dayyar. Fatehabad is due west of Banke District, Nepal.
Never a good sign when no one can even figure out or agree what is the cause.
Death toll up to 39 now. Article linked below has additional case info (age) concerning the deceased.
excerpt from above:
Meanwhile, a report from Bara said blood tests of 25 persons in Bara’s Kabahi Goth showed one person was infected with malaria.
So what is wrong with the other 24?
NEPALGUNJ, Banke, Nepal
BY JANAK NEPAL / http://tinyurl.com/ygr68m
36 die of unknown illness in Banke
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 [sic] 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.”
I’m beginning to smell a rat. I have gone back and forth in my mind as to whether to post this, but my suspicion has won out. On the link below you will see mention of the mystery disease we are talking about. Yesterday there were four different links to news sources all touting the “36 deaths” due to a mysterious disease. This evening it looks significantly different. Someone has changed it to make it appear a bit less ominous. This, along with the quick diagnosis, within the same day of announcement of the investigative team leaving Kathmandu, makes me wonder if panic control via information manipulation has begun.
Pixie – at 20:45
very good - thanks.
Okieman - Thanks for your post. I must say,I agree.I posted this next article on the India site,but after seeing Pixie’s post at 22:08 mention shivering, I decided to post it here also.
Mystery disease kills nine mules—Gaighat,Oct.9 An unknown disease has cropped up among mules,leaving nine of them dead on Saturday in Udaypur. The nine dead mules were among 40 others that were carrying goods from Gaighat to Diktel of Khotang.The mules sweated profusely and shivered before dying. Eight other mules died after evincing similar symptoms before the Tihar festival.Though tissue samples of the mules that died a few months ago were sent o Kathmandu to ascertain the cause of their death, the disease is yet to be identified.www.thehimalayantimes.com
Okieman. I agree with you. I am a veterinarian and not an expert in semi-tropical diseases…but a lot of the human disease that has been mentioned on Indonesia, Nepal and India etc. threads are remarkably similar in clinical signs and often seem unrelated to the etiology mentioned. The case of a number of persons dying from water contamination is quite wrong unless the water was contaminated with industrial poisons.
I don’t think all the intuition here is wrong…you just haven’t been able to put your collective finger on it…yet.
Stick with it…this can’t go one forever.
An animal example of the same thing would be the sudden silence about the millions of pigs that have been dying in China…did they stop dying? Who knows? When they came up with a list of rule outs for the disease, it looked like they just started writing down diseases in the index of a veterinary textbook.
A lot of people are being told to keep quiet…and the teller must have a great deal of percieved power.
While I have to say that this all may be very innocent and it just be what it appears to be, simple diseases in far off lands, My gut tells me to be wary of the reports because all to often a “Government offical” can walk into a Doctors office, in the countries in quesion, and say “This is the disease Doctor and that is how it WILL be reported” I suspect that the US CDC, may currently be guilty of the same thing
Given that this is an area where malaria is endemic, I’d be surprised if they DIDN’T have some positive tests.
Question for the doctors here:
1. How easy is malaria to diagnose? (i.e., is it like dengue where you can have it and test negative?) 2. Will asymptomatic carriers test positive? (i.e., they’ve got the bug but the symptoms are from something else) 3. How likely is an large outbreak like this in an area where people are likely already heavily exposed?
Anon 451. I would agree but they keep mentioning the same clinical signs. I am amazed as a veterinarian at how many viral disease result in temp, pneuonia and bleeding from nose and mouth…and at the same times have sudden deaths that usually don’t occur with pneumonia.
What we are probably getting is a number of clusters that don’t break open to a full pandemic because the virus has not acquired the potential yet…
…in this case, they could be diagnosed with only suspected disease as they die quite quickly and no one would be the wiser because it is only expanding so far.
Just from my experience with disease, it doesn’t make any sense the way they describe things.
Again, it seems like “they” (WHO) would just test for H5N1 and then report the results. But I guess that would be too simple. Surely they know that the world is concerned and at risk.
The malarial parasite is visible within red blood cells - a Wright-Geimsa stain and a microscope is all the equipment necessary, both of which are rudimentary and portable. That said, it would be pretty hard to see it without electricity for your scope. The testing for malaria vs. detection of a viral illess would be vastly different. With viruses you’re looking for antibodies present in serum. Malarial parasites can be seen with the eye. Not easy to mistake the two IMO.
Comment: It does say here that only the younger stages are present (thus visible)in the circulating blood cells. That would make it harder to detect in the really sick folks, but more likely to find it in people whose disease is not as advanced. It may be too late for those who’ve died, but early enough to see it in the people around them.
http://en.wikipedia.org/wiki/Plasmodium_falciparum
Among medical professionals, the preferred method to diagnose malaria and determine which species of Plasmodium is causing the infection is by examination of a blood film microscopically in a laboratory. Each species has distinctive physical characteristics that are apparent under a microscope. In P. falciparum, only early trophozoites and gametocytes are seen in the peripheral blood. It is unusual to see mature trophozoites or schizonts in peripheral blood smears as these are usually sequestered in the tissues.
http://www.rbm.who.int/wmr2005/profiles/tajikistan.pdf
From April 05 about malaria in Tajikistan, but it verifies that people can be asymptomatic carriers, or reservoirs for infection. All you need are the mosquitos…
Okay, I’ll go back to my room now.
Interesting link to history and prevalence of malaria in Nepal
Nepalese Pandemic Plan http://tinyurl.com/yckmdc
In February 2006 the Government of Nepal endorsed a joint Health and Agriculture National Avian Influenza and Influenza Pandemic Preparedness and Response Plan (NAIIPPRP). The plan created a joint health and agriculture Technical Subcommitte on Avian Influenza (TSCAI) under the National Disaster Relief Central Coordination Committee.
As the NAIIPRP is strategic in nature, a detailed Operational Plan for the period 2006–2010 was developed and endorsed by the TSCAI in August 2006. This USD18.2 million plan has a human health and an animal health component, as actual implementation will fall mainly under the two responsible line ministries: Ministry of Health and Population and Ministry of Agriculture and Cooperatives. Conversations for funding of the Plan are ongoing with the World Bank and a final appraisal mission is planned for October. This mission will lead to negotiations between GoN and WB. It is expected that the WB will provide full funding of the plan including resources for a compensation fund for indemnification to farmers if culling were necessary to control avian flu. The UN team, (WHO, FAO, UNICEF, UNDP and OCHA) and the WB played a pivotal role in ensuring the technical soundness of the different components of the Plan.
The Plan, that is expected to initiate in December 2006, beyond preparing the country for the advent of avian influenza or an influenza pandemic, will therefore have a significant effect on improving the performance of disease surveillance and control and improvement of both human health and animal health irrespective of the evolution of the avian influenza situation.
In August, the MOHP, Department of Health Services, with support from WHO, trained 50 Regional staff, belonging to the Rapid Response Teams of the Public Health Network on Human Avian Influenza Outbreak Investigation. Trainers were WHO experts from Thailand and Delhi. WHO has also provided the MOHP with sufficient sets of Personal Protective Equipment and antivirals to respond to 30 outbreaks in each development region. Antivirals and PPE for the hospital management of suspected cases and if necessary for containment activities, have also been procured for the MOHP. read more…
old news from CDC - but may be useful now? http://tinyurl.com/vc5wx
In July 2004, an outbreak of influenza A (H3N2) was detected at 3 Bhutanese refugee camps in southeastern Nepal. Hemagglutination inhibition showed that ¡Ö40% of the viruses from this outbreak were antigenically distinct from the A/Wyoming/3/03 vaccine strain. Four amino acid differences were observed in most of the 26 isolates compared with the A/Wyoming/3/2003 vaccine strain. All 4 substitutions are located within or adjacent to known antibody-binding sites. Several isolates showed a lysine-to-asparagine substitution at position 145 (K145N) in the hemagglutinin molecule, which may be noteworthy since position 145 is located within a glycosylation site and adjacent to an antibody-binding site. H3N2 viruses continue to drift from the vaccine strain and may remain as the dominant strains during the 2005¨C2006 influenza season. Thus, the 2005¨C2006 Northern Hemisphere vaccine strain was changed to A/California/7/2004, a virus with all 4 amino acid substitutions observed in these Nepalese isolates.
In December 2005, nearly 3000 cases of Japanese encephalitis were reported of which more than 300 people died. The most affected areas were in the western, mid-western and far-western regions of Nepal. For further details of areas affected please see the World Health Organisation Regional Office for South East Asia website at: Japanese Encephalitis.
From Nepal British Embassy website http://tinyurl.com/yy7z9c
Old news - The New Straits Times, March 31, 1999
Singapore - Another eleven abattoir workers in Singapore have been tested positive for a newly-detected virus, one of the two which has killed 71 people in Malaysia. A government statement said the Hendra-like virus was detected in blood samples of the victims sent to the Atlanta-based Centres for Disease Control and Prevention (CDC) for testing. The abattoir workers were earlier suspected of being infected with Japanese encephalitis (JE). One of them have since died while six of the 11 remain in hospital, one of them in serious condition. http://tinyurl.com/ydfg4v ____________________________________________________
I posted this because I wonder if there is a ‘trend’ in these old news stories - Japanese Encephalitis confused with ‘hendra-like virus’ and mystery illness similar to that in Nepal?? The animals killed in the abbattoir possibly a mammalian vector for it??
Hendra virus (formerly called equine morbillivirus) is a member of the family Paramyxoviridae. The virus was first isolated in 1994 from specimens obtained during an outbreak of respiratory and neurologic disease in horses and humans in Hendra, a suburb of Brisbane, Australia. Nipah virus, also a member of the family Paramyxoviridae, is related but not identical to Hendra virus. Nipah virus was initially isolated in 1999 upon examining samples from an outbreak of encephalitis and respiratory illness among adult men in Malaysia and Singapore.
The natural reservoir for Hendra virus is thought to be flying foxes (bats of the genus Pteropus) found in Australia. The natural reservoir for Nipah virus is still under investigation, but preliminary data suggest that bats of the genus Pteropus are also the reservoirs for Nipah virus in Malaysia. Where are the diseases found?
Hendra virus caused disease in horses in Australia, and the human infections there were due to direct exposure to tissues and secretions from infected horses. Nipah virus caused a relatively mild disease in pigs in Malaysia and Singapore. Nipah virus was transmitted to humans, cats, and dogs through close contact with infected pigs.
How are Hendra and Nipah viruses transmitted to humans?
Pig farm in Malaysia, 1999. In Australia, humans became ill after exposure to body fluids and excretions of horses infected with Hendra virus. In Malaysia and Singapore, humans were infected with Nipah virus through close contact with infected pigs.
Only three human cases of Hendra virus disease have been recognized. Two of the three individuals known to be infected had a respiratory illness with severe flu-like signs and symptoms. Infection with Nipah virus was associated with an encephalitis (inflammation of the brain) characterized by fever and drowsiness and more serious central nervous system disease, such as coma, seizures, and inability to maintain breathing.
Illness with Nipah virus begins with 3–14 days of fever and headache. This is followed by drowsiness and disorientation characterized by mental confusion. These signs and symptoms can progress to coma within 24–48 hours. Some patients have had a respiratory illness during the early part of their infections.
Still looking for a Tropical Disease Doc with experience in Malaria Outbreaks to comment.
gharris. Wow!! That was quite a piece of detective work. Thanks for the nice summary on emerging diseases and other information.
gharris: One of the news stories from Nepal did speculate that it might be Nipah virus. I’ll see if I can find out which one and who said it.
Comment: Ok, WHO is headed to the Nepalgunj area. From DennisC’s post at 22:22: http://tinyurl.com/y4gdrj
According to him, three teams from Kathmandu - one each from National Public Health Laboratory, EDCD, Teku Tropical Disease Control, and an expert from World Health Organization (WHO) have already gone to the site. Similarly, a team from Hetauda Vector Born Disease Research and Training Center, a team of Malaria experts, besides four teams from the district are in the affected area.
<snip>
Meanwhile, a report from Banke said medicines and test kits required for the treatment of malaria has reached the district headquarters Tuesday. According to District Public Health Office, Banke, the medical team sent from Kathmandu is yet to arrive.
I remember the emergence of the Hendra virus in Australia in 1994 very well. The farm owner, workers and the attending veterinarian died and it took a while to isolate this completely new virus.
In a sense every veterinarian remembers it because it was the point at which an age of innocence ended. Up until that point, zoonotic diseases seemed quite remote and in most cases zoonotic diseases (diseases humans can get from animals) were treatable and relatively mild.
The Australian case proved that all previous assumptions were suspect.
I believe the mortality rate for both these viruses is extremely high if not 100% and Nipah virus should be in any list of rule outs and it has been mentioned as a future pandemic risk along with H5N1.
This is from a recently published research article on a Nipah/Hendra outbreak, suggesting H2H is possible, and creating concern whether these viruses are also mutating.
Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in 2001. Indian J Med Res. 2006 Apr;123(4):553–60. Harit AK, et al.
[from abstract]…”An outbreak of acute encephalitis occurred in Siliguri (West Bengal) town of India between January 31 and February 23, 2001…A total of 66 probable cases and 45 deaths were reported. Epidemiological linkages between cases point towards person-to-person transmission and incubation period of around 10 days. There was neither any concurrent illness in animals nor was there any exposure of cases to animals. Centres for Disease Control and Prevention, Atlanta, USA concluded on the basis of tests carried out on serum specimen from four cases and two contacts that the causative pathogen appears to be Nipah/ Hendra or closely related virus.”
A couple other articles suggested that Nipah and Hendra may be emerging human pathogens. Here is one.
Hendra and Nipah viruses: pathogenesis and therapeutics. Curr Mol Med. 2005 Dec;5(8):805–16. Eaton BT, et al.
[Abstract] “Within the past decade a number of new zoonotic paramyxoviruses emerged from flying foxes to cause serious disease outbreaks in man and livestock. Hendra virus was the cause of fatal infections of horses and man in Australia in 1994, 1999 and 2004. Nipah virus caused encephalitis in humans both in Malaysia in 1998/99, following silent spread of the virus in the pig population, and in Bangladesh from 2001 to 2004 probably as a result of direct bat to human transmission and spread within the human population. Hendra and Nipah viruses are highly pathogenic in humans with case fatality rates of 40% to 70%. Their genetic constitution, virulence and wide host range make them unique paramyxoviruses and they have been given Biosecurity Level 4 status in a new genus Henipavirus within the family Paramyxoviridae. Recent studies on the virulence, host range and cell tropisms of henipaviruses provide insights into the unique biological properties of these emerging human pathogens and suggest approaches for vaccine development and therapeutic countermeasures.”
Sorry, here is url for the second Nipah/Hendra article posted by me above (morning brain!).
Do the Hendra and Nipah viruses have the ability to spread h2h? If not, how would hundreds of people potentially be infected with this virus (if that is what we are debating)? Do the viruses need a mammalian vector to spread? The geography of these clusters of “mystery illness” seems to be fairly large to be able to spread to at least one person in each household in so many villages over a relatively short period of time if it is not h2h related. Any thoughts?
Sniffles,
What you point out is why I’m looking for comments from a specialist in Tropical Diseases with Malaria experience. The question being is the Banke outbreak appear to be typical for Cerebral Malaria or not? Remembering that the weather there has not been maximally conducive to mosquito activity.
This one seems like food poisoning
More than 250 people became sick after dining together in southeast Nepal, local Kantipur F.M. Radio reported on Thursday. The victims from Rampurbirta village of Siraha district had dinner together after a ceremony memorizing a dead villager. Ratan Kumar Das, director at the Public Health Office of Siraha, said the food poisoning was probably caused by the pickle they ate’. A medical team led by Das to treat the villagers has returned to district headquarters as the crisis started to calm down.
Beehiver. Thanks In five or six posts, you and gharris have given the reader a third year veterinary school summary of two emerging zoonotic diseases.
The level of scientific discourse on flu wiki is a wonderful thing. /:0)
DennisC – at 10:11 Did all 250 ill people eat pickles? I guess I do not always take articles at full value anymore and totally believe everything stated. I remember the Karo cluster starting out as food poisoning from a family gathering….
Tom at 10:15, The level of scientific discourse on flu wiki is a wonderful thing.
Tom I am walking around here this morning feeling the exact same thing, it is such an incredible pleasure to be working with this group, with all the input of some great people…thank you all so much for quickly helping to shine light on the current issues. Not just this thread but so many others too. In the course of only some hours we’ve been able to pull valuable info together, this is making me high today, LOL, this pleasure of working together…and fueling a small hope that maybe some serious problems can be headed off in the future thanks to all this education. Sorry for the off-topic but you all are the greatest…
Oh my gosh, between Nipah, Hendra, malaria, Morgellons, H5N1, Hanta, Ebola, SARS, etc., etc., etc. it is a wonder any of us are alive.
“Do the Hendra and Nipah viruses have the ability to spread h2h? If not, how would hundreds of people potentially be infected with this virus (if that is what we are debating)? Do the viruses need a mammalian vector to spread?”
This is from 1996 and it was a small study, but it appears that Hendra spreads easily cat to cat…
“To assess the susceptibility of cats to equine morbillivirus (EMV)” {Hendra) “by direct administration of the virus by subcutaneous, intra-nasal or oral routes, and following exposure to infected cats….
…RESULTS: All cats administered the virus by subcutaneous, intra-nasal or oral routes became infected and developed the disease within 4 to 8 days. One of two cats in contact with affected cats also developed the disease, but two cats kept near to affected cats did not become infected…”
“CONCLUSION: This is the first demonstration that animals can be infected with EMV by non-parenteral means, that the virus can transmit naturally between animals and confirms other reports of the similarity of EMV disease in horses and cats.”
Nipah, Hendra, and bats, yet again…
Beyond Singapore, Malaysia and Australia, do we know what is, presently, the geographical spread of these horrors? Are they expanding their territories?
Thanks for all the effort here.
12 malaria patients await rescue
Himalayan News Service Banke, November 2:
Lack of transport facility has threatened the lives of cerebral malaria patients in remote villages of Banke. Teams of medical experts reached the villages yesterday and have started conducting tests and treatment. However, 12 patients whom they had referred for special treatment in Nepalgunj have not been able to go there due to lack of transport facility.
<snip>
Director General of the Department of Health, Dr Mahendrakeshari Chhetri, expressed hope that they would be able to control the disease soon. “We have dispatched enough equipment and medicines for the villages,” he said, adding that the remoteness of the villages and the Rapti river has affected the treatment process. Malaria was detected in 82 of the 255 blood samples. Of them 39 were found to have P Falsiperam and 43 were infected with P Vivex malaria. An experts’ team headed by Dr Suman Thapa has set up health camps in Fattehpur, Nairanapur and Holiya VDCs.
Mystery illness ‘could be Herpes Encephalitis
“…could not confirm the diagnosis until they received received the results of blood tests sent to laboratories in Germany and the UK, expected today….
He also said that ministry officials suspected that the boy died of Herpes Encephalitis, a viral infection characterised by high fever, seizures and depressed level of consciousness….
Herpes Encephalitis was one of the alternate diagnoses they had considered for Mama Komariah (67), who recently died in Indonesia. She was tested multiple times for H5N1 without clear results and after her spinal fluid was sampled they stated she was H5N1 positive.
This is an editorial from the Kathmandu Post. I posted it in its entirety because cutting parts of it out to post would make it too difficult to read. After I read it, I had more questions than answers:
Dengue threat
By Dr Som P Pudasaini
The dengue virus, which recently threatened India’s West Bengal and Uttar Pradesh states sharing border with Nepal, should have caught Nepal’s attention. Although media had warned of possible dengue onslaughts on the districts bordering Indian states, the government ruled out any threat of dengue virus to Nepal. Unfortunately, the sheer lackadaisical approach has now given the government a wake-up call. In Banke district alone, nine cases of dengue have been confirmed so far. The death toll in Bardiya and other districts has crossed 36 in less than one month. And the number of patients admitted to various hospitals is increasing. The doctors who examined the patients at Nepalgunj Teaching Hospital have also admitted that dengue has now entered Nepal. Some government doctors seem to have been baffled when patients complain of body ache, shivering and sudden unconsciousness.
What is ridiculous is the way the doctors attended a Maoist-organized meeting in Nepalgunj amid the dengue onslaught. Bheri Zonal Hospital in Nepalgunj had virtually no doctors throughout Wednesday. The 12-patients who died of the “unknown” disease at Bheri Zonal Hospital last week certainly shows how the government doctors perform their duty. The doctors of Bheri Zonal Hospital have claimed the disease as “unknown”, while Nepalgunj Teaching Hospital has confirmed it a dengue virus. Is it because the government hospitals have no laboratory to examine the diseases? How could the doctors of Nepalgunj Teaching Hospital confirm it so soon? The diseases cited by the chief of the Epidemiology and Disease Control Division (EDCD) now raise some doubt. The EDCD chief-examined diseases may not be typhoid, Japanese Encephalitis, Falci Farum malaria and anemia, as he claims. Such medical examination may mislead health personnel.
The unknown disease has threatened the VDCs on the bank of the Rapti River. Many patients of Phattepur, Gangapur, Nagaikapur and Hardawai VDCs of Banke and Bardiya districts have been admitted to Indian hospitals across the border. Now the disease has spread to other adjoining VDCs surging in the form of new epidemic. The Ministry of Health has not confirmed yet whether the unknown disease is really dengue, though the government sent-medical teams had collected the blood samples four days ago. The delay in disclosing the details of the disease has claimed more lives and has not helped the patients. Besides, the government also failed to dispatch the medicines and medical teams on time to the unknown disease-hit VDCs. Above all, the Maoists cannot invite doctors forcefully for their meetings. They should realize that patients need doctors more than the “intolerant” Maoists for their gatherings.
Sounds like some people are telling the doctors what they are to find and what they are not to find. Hide lie and deceive as long as possible.
Hmmmmm
Disease diagnosed as Cerebral Malaria, 31 died, 700 affected
NEPALGUNJ, Nov. 2: The unidentified epidemic that spread in five VDCs of Banke district across the Rapti River has been identified as cerebral malaria infected from a plus modem falsifoam, a virus.
The team of doctors including Epidemiologists deployed by the Health Ministry identified the disease after examining blood test from the locals.
Around 31 died and other above 700 locals have been affected from the epidemic, according to District Public Health Office, Banke.
The team of doctors that came from Kathmandu and medical persons of local Bheri zonal hospital and Nepalgunj medical college have been serving those affected from pandemic in the area.
Local political parties, Nepal Tarun Dal and local clubs are also serving in the disease-ridden area.
Meanwhile in Kathmandu, the Nepali Congress (Democratic) has drawn attention of the government and concerned sides to adopt all necessary measures to take the unknown epidemic disease that broke out in five VDCs of Banke district across the Rapti River under control and to provide treatment to all those affected.
The demise of around 36 locals from the mystery disease has grieved the party, reads the press release issued by the NC (D).
The press release also stated that the severe affect of the disease seen in a large number of people, lack of their necessary treatment, unidentified state of disease and its outbreak as a epidemic has saddened enough the party.
Earlier, Nepalgunj, a team of Epidemeology and Disease Control Division, Kathmandu including specialists has reached in five VDCs of Banke district across the Rapti river to carry out research and study regarding an unknown disease that broke out in the VDCs and to provide health check ups and treatment to the locals.
A 11-member medical team including World Health Organization (WHO) Epidemiologist Dr. Suman Thapa, medical persons from Health Service Department and chief advisor of Deputy Prime Minister and Minister for Health Dr Mahesh Makey would carry out blood tests of those affected from the unidentified disease.
In addition to the team, doctors of local Bheri Zonal Hospital Dr. Usha Shah, Dr. Binod khanal, Dr. Sarbesh Sharma including medical persons of district public health office have also been serving in the disease-ridden area.
The mystery disease which so far claimed 24 lives is expected to be identified till tomorrow. The disease reportedly affected around 4000 locals of five VDCs, phattepur, Matehiya, Gangapur, Holiya and Narainapur of the district.
The arrangement of transport vehicles have been made to take the disease affected locals who were refereed to the hospitals, according to district public Health Office.
Various political parties and local social organizations have also been assisting in the disease-ridden area.
Meanwhile in Dhading, local people of Pathak village of Naubise VDC-7 have been terrified after incident of sting by an unknown poisonous insect has been increasing.
One woman has, already, been killed while three others have been seriously injured following the insect’s bite.
The wife of Kedar Bhatta died while the wife of Madhu Pathak, the wife of Kancha Damai and Subadra Pathak have been injured.
Two others�Krishna Kumar Upreti and the wife of Nawaraj Regmi are currently undergoing treatment at Teku Hospital in Kathmandu.
The insect has been attacking only the women who go to the forest to collect fodder and firewood.
The sting of the insect leads to pain as that of a hornet sting, swelling of the area, vomiting and unconsciousness. Amount of poison has been found in the blood test of the victims, it is stated.
Likewise in Inaruwa, father and son in Bharaul VDC of Sunsari district died in the same day.
The deceased has been identified as Krishna Bahadur Thapa (father), 65, and Hari Bahadur Thapa (son), 30, locals of Kalabanja, said former VDC vice-chairman Nilam Khanal.
Hari who was undergoing treatment in Bharatpur hospital returned home to meet his father suffering from cancer. Son Thapa has also been suffering from Brain Tumor The last ritual of both father and son was performed in the bank of the Sapta Koshi river in Chatara.
“The press release also stated that the severe affect of the disease seen in a large number of people, lack of their necessary treatment, unidentified state of disease and its outbreak as a epidemic has saddened enough the party”
:-(
“Above all, the Maoists cannot invite doctors forcefully for their meetings.” Ungood.
(And it’s awful that the women are getting killed by insect stings.)
From ProMedmail:
Nov. 2, 2006 / http://tinyurl.com/yhu6wq
UNDIAGNOSED DEATHS - NEPAL (BANKE) (02): MALARIA SUSPECTED
The mystery disease that has spread in some villages of Banke district in mid-western Nepal for the past 2 weeks was diagnosed as cerebral malaria, The Himalayan Times reported on Thursday [2 Nov 2006].
Talking to the daily, advisor to the Health Ministry Mahesh Maskey said a medical team reached the affected villages with essential equipment and medicines on Wednesday [1 Nov 2006] to examine the patients.
“The disease was diagnosed as cerebral malaria (a severe type of malaria), after examining blood samples of some patients,” Maskey said. Fifteen of the patients were found infected with malaria.
<snip>
What were the other patients diagnosed with? And how many other patients were there? Previous reports dated 10/31 stated the medical team(s?)reached the villages on 10/31 and made the diagnosis that day in time to be reported in the article.
IMHO: They need to get their stories straight.
The article posted by Oremus at 2:52 stated -
The unidentified epidemic that spread in five VDCs of Banke district across the Rapti River has been identified as cerebral malaria infected from a plus modem falsifoam, a virus.
Plasmodium falciparum is not a virus…
In the article posted by Oremus – at 02:52, it stated:
“The mystery disease which so far claimed 24 lives is expected to be identified till tomorrow. The disease reportedly affected around 4000 locals of five VDCs, phattepur, Matehiya, Gangapur, Holiya and Narainapur of the district.”
I would take that to mean they are guessing it is cerebral malaria. They do not have the test results back to make a diagnosis, but it did not stop them from telling the world it was malaria.
Sniffles – at 09:23
You got it.
busy mosquitoes. they go from 300 to 400 to 500 to 4000 patients affected within a week’s time. one village after another being afflicted.
November 3 news article. Quote is at the very bottom. This was at an address to the Nepal House of Representatives. You would think this guy would know what is going on. He continues to call it an unknown disease. I think the jury is still out concerning what this disease really is.
<snip>
Deputy Prime Minister and Health Minister Amik Sherchan informed the House of the deaths in several villages in Banke district following the spread of an unknown disease. He, however, said the government has no information about the spread of dengue.
12 malaria patients await rescue
Himalayan News Service Banke, November 2:
Lack of transport facility has threatened the lives of cerebral malaria patients in remote villages of Banke. Teams of medical experts reached the villages yesterday and have started conducting tests and treatment. However, 12 patients whom they had referred for special treatment in Nepalgunj have not been able to go there due to lack of transport facility. Head of the District Public Health Office, Banke, Jay Bahadur Karki, said medical teams had referred the malaria patients to Nepalgunj yesterday. The teams, however, could not be sure which villages those 12 patients were from. Advisor to the Health Ministry, Dr Mahesh Maskey, said they were working to bring the serious patients to Nepalgunj on a helicopter. “We are trying to ferry the patients to Nepalgunj but there is no helicopter in Nepalgunj at the moment,” Dr Maskey said. “I have talked to the Prime Minister on this regard but nothing has happened as yet,” he said. Meanwhile, Dr Usha Shah, chief of the Bheri zonal hospital told a press conference here that they would provide free treatment to malaria patients. Director General of the Department of Health, Dr Mahendrakeshari Chhetri, expressed hope that they would be able to control the disease soon. “We have dispatched enough equipment and medicines for the villages,” he said, adding that the remoteness of the villages and the Rapti river has affected the treatment process. Malaria was detected in 82 of the 255 blood samples. Of them 39 were found to have P Falsiperam and 43 were infected with P Vivex malaria. An experts’ team headed by Dr Suman Thapa has set up health camps in Fattehpur, Nairanapur and Holiya VDCs.
TreasureIslandGal – at 10:21 busy mosquitoes. they go from 300 to 400 to 500 to 4000 patients affected within a week’s time. one village after another being afflicted.
That is very true, isn’t it? And the mosquitos are doing all this breeding and multiplying in fairly cool weather.
I decided to compose that summary, above, of everyone’s recent findings on Nepal after spending several hours sitting outside at a soccer match that evening. I was freezing by the end of it, the temperature was around 56 degrees F, and it certainly didn’t feel like mosquito weather to me.
Sounds to me like they have more mosquitoes than flies. Something may have extended their season and their hunting grounds—like the culling of millions of wild birds?
Comment: Debate over the “mystery virus” in Banke district, Nepal, has reached the Nepalese House of Representatives where it is here characterized as being dengue or malaria.
Sherchan tells MPs about situation of dengue
2006–11–3 / http://tinyurl.com/y5aqt9
KATHMANDU, Nov. 2: Deputy Prime Minister and Minister for Health and Population Amik Serchan has informed the House of Representatives (HOR) about the situation dengue and other epidemics in west Nepal.
Thirty-one people have died of dengue in three VDCs of Banke Holia, Fattepur and Gangapur the deaths of two are yet to be verified, Deputy Prime Minister Sherchan told the House.
A team of six doctors has reached the VDCs and blood tests of 521 persons showed malaria in 37 and malaria parasite in five. A WHO team has also reached the place and army and police teams are also going to the place.
“A doctor had presented a report 11 years ago saying there was dengue in the area, but the earlier governments failed to take any action,”Sherchan said. “However, no death by dengue was reported in the area and this time it has come in from India due to open border.?
Members during the Special Hour had questioned the government on what it was doing to the health problems in the western part of Nepal. They also raised questions and put forth their views regarding Nepal’s loss in the UN Security Council election, road accidents because of unmanaged transportation system, closure of Tatopani border, agitation of temporary teachers, problems of the Melamchi Water Project and other issues.
<snip>
Why are they sending army and police with the WHO??? Kind of sounds like the movie “Outbreak”, doesn’t it?
“A WHO team has also reached the place and army and police teams are also going to the place.”
That is one heck of a lot of fire power for a dengue/malaria outbreak.
Yeah, I thought that seemed VERY strange as well. Aren’t these simple, remote villagers? And heck, apparently they are all very sick or else caring for a very sick person. Doesn’t sound like a very “dangerous” group that would require military intervention.
Maybe the police and military will be used more to maintain a quarantine and keep others OUT until they get a good handle on this.
Jumping from 300 to 4000 people in a week doesn’t sound like dengue or malaria in my book.
Very important developments in Banke district, Nepal, from above, at 14:25:
Could you provide a link for the 4000 number? The most I’ve seen so far is 700.
Never mind, it was in article I posted. Embarrassing.
that was me
“Could you provide a link for the 4000 number? The most I’ve seen so far is 700.”
-See Oremus – at 02:52. The story is posted and about 3/4 of the way down there is this paragraph:
“The mystery disease which so far claimed 24 lives is expected to be identified till tomorrow. The disease reportedly affected around 4000 locals of five VDCs, phattepur, Matehiya, Gangapur, Holiya and Narainapur of the district.
hahaha! :D
that was a nice way of lightening up this thread!
nothing like a brain fart for a good chuckle!
Try reconciling the Pixie – at 14:25 post with my Okieman – at 11:08 post.
Things don’t add up.
Sending the army and police does not sound good.
Watch what they do, not what they say.
That 4000 number might have been a typo in the Nepali news report. It might have been meant to read “400,” since they talk about a total of 700 overal, and then break it down by district.
Hopefully it is a typo.
a 400 typo doesn’t bring in the army. a 4000 reality would.
TreasureIslandGal – at 15:35 a 400 typo doesn’t bring in the army. a 4000 reality would.
That was my thought also. They deal with infectious disease all the time in this part of the world. I am sure they do not regularly send in WHO, police, and the military for a few hundred cases of malaria in a relatively remote area of their country. This does not pass the smell test for me.
Got them pegged now. Go to this link. It describes “The Rising Nepal” (the newspaper linked in Pixie’s 14:25 post) as being a government owned paper.
It says it has affected 4000.And a WHO epidemiologist is taking orders for sandwiches.
Hi Treyfish! Yeah, it says 4000. And it’s from the gov. newspaper. Best that somebody proofread that before publication or that extra zero could cause them no little trouble.
I was just trying to be optimistic….
I can’t find this article. Can someone copy/paste it or something?
under the radar – at 16:03 I think this is the one we are talking about (the 4000)
it is above at: Oremus – at 02:52 (Nov 3)
The 4000 number was stated in an article in the Rising Nepal site:
From Oremus at 2:52 http://tinyurl.com/yf4twv :
The mystery disease which so far claimed 24 lives is expected to be identified till tomorrow. The disease reportedly affected around 4000 locals of five VDCs, phattepur, Matehiya, Gangapur, Holiya and Narainapur of the district.
Thank you, I see it now :)
i find the part about
“The insect has been attacking only the women who go to the forest to collect fodder and firewood. The sting of the insect leads to pain as that of a hornet sting, swelling of the area, vomiting and unconsciousness. Amount of poison has been found in the blood test of the victims, it is stated.”
Is there any chance that a Type A virus could be spread by an insect?? Anyone here know? I know that one report from Indo was saying that flys could transfer the virus (mechanical vector) but what about mosquitoes? (????)
Pixie,if i run my 3 computers,tied together with wires and duct tape,3 mice and and keys,3monitors, wired to sat and phoneline……with 5 widows open to news pages on each one…. i might be able to keep up with ya!HOW DO YOU DO IT??!! Dont dare me either or i mite try!Not to leave anyone out ..okieman has a sis to help and they sre doing a helluva job!thank you each and every one.
re: “WHO epidemiologist is taking orders for sandwiches”
I’d watch to see if any chicken salad was ordered. :/
Hey, Trey - today I’m also doing a birthday party for a 7yo at the same time! :-)
hope this doesn’t scroll
The mystery disease which so far claimed 24 lives is expected to be identified till tomorrow. The disease reportedly affected around 4000 locals of five VDCs, phattepur, Matehiya, Gangapur, Holiya and Narainapur of the district.
For the record I want to point out two things.
1. The mosquito causing dengue and the mosquito carrier for malaria are different breeds. The Aedes mosquito carrys dengue and yellow fever (viral). The anopheles mosquito transmits a parasite that is carried in the red blood cells.
2. Once you have malaria, as I’m sure all these people have already had malaria because its endemic there, you won’t test positive. So can’t we conclude that all will have the parasites except for newborns? They adapt to the parasites or they die right? They are afterall not taking daily quinine tablets are they? In cerebral malaria they have stiff necks, and progress to a unarousable coma. The cerebral malaria is caused of clogging of the brain’s micro circulation by parasitized red blood cells. The brain shuts down, and the people die. What doesn’t make sense is a sudden epidemic of cerebral malaria. Sure it’s a consequence of malaria especially in children but sudden outbreaks? Not unless malaria is undergoing some new changes like dengue.
DennisC – at 16:14
Read the article a little closer. The part about insects biting/stinging is in a different location in Nepal and unrelated to that in Banke.
DennisC - at 16:13: The sting of the insect leads to pain as that of a hornet sting, swelling of the area, vomiting and unconsciousness.
Any EMT would say that those reactions are not common, but are precisely typical of someone having a severe allergic reaction to an insect sting. One person’s reaction like that would not be atypical, but a bunch of reactions like that in unrealted people would be rare.
Want to see a couple of photos taken in Bardiya, July 2006?
:-(
Can’t find any flickr photos taken in Banke just now, but older photos of the Rapti riverbank show elephants, water buffalo and children.
Found someone who’s in Nepal and has Sept. photos from Nepalgunj
Right, I just figured that out. Two locations.
Okieman – at 16:26
Thanks, I wasn’t seeing that.
hahahahaah!!daang you go girl!hahah! http://tinyurl.com/sgcg8 This one from yestersay says 400 affected.
Mystery disease kills 20 in Nepal November 2, 2006
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A Nepali patient ® waits for treatment in the emergency ward of Nepal’s Bir Hospital in Kathmandu. At least 20 people have died of an unidentified disease over the past two weeks in west Nepal.
At least 20 people have died of an unidentified disease over the past two weeks in west Nepal.
“The outbreak of disease has killed 20 people, most of them elderly and children, and over 400 have been affected in three villages in Banke district,” said Jaya Bahadur Karki, chief of the public health office in the region Tuesday, 510 kilometres (320 miles) west of Kathmandu.
“The symptoms of the disease include headache, high fever, shivering and fainting. The health workers have not been able to identify the disease properly,” Karki said, adding the affected area had “poor hygiene habits and sanitation facilities”.
Local media Tuesday reported that the disease has killed at least 36 people in the district.
Chief district officer Narendra Raj Sharman told AFP a medical team has already been sent to the area to diagnose the disease and collected blood samples of more than 200 patients.
Hundreds of people die every year in Nepal from pneumonia, diarrhoea and tuberculosis.
Copyright
This thing is beginging to lood serious. Does anyone here know some one in Nepal? This is looking just about what I thought the start would look like- A bunch of cases that keeps growing day after day in a remote place where the health care system is little or non-existent. Even the rate of growth is about right. Notice that there was even a pig die off in Nepal back in Mar and notice what they said then “The disease is believed to be air borne”:
woops!wrong mouse!
Dennis C:
Are you saving all those old articles? Slows my computer down. I agree with you at 16:38-Nepal is the perfect spot, rural but independent, haven for smuggling across the border, and those poor shepards keeling over was almost exactly like Barry described. Like I said before, glad you started this thread. Looks like they’re going to try real hard to contain whatever it turns out to be.
Dennis C:
And I really didn’t like the story that Witness posted in mid-August about an epidemic in Central Nepal with very, very, worrying symptoms that had begun in June and was still ongoing. http://tinyurl.com/y69e4u
“Unprecedented epidemic of an unidentified disease has killed at least 14 people, including seven children, in Netini VDC, a far eastern village of the district [central Nepal], in the past two weeks. The disease, which was first detected in dogs and chicken in the last week of June, had started spreading to humans. Major symptoms of the disease are high fever together with bleeding from nose and mouth at the time of death.” http://tinyurl.com/y69e4u
Dennis C - Thank you so much for saving those articles.
Gee Pixie at 16:52 - I never read that article that Witness posted. Wish I hadn’t now. Oh my.
Commonground - at 16:56
We know too much, don’t we?
Leo7 – at 16:48
I don’t really save them all, just some. I have an external drive for such things. I don’t want the “system” to try slip things by with selective memory. I have my “good stuff” = survival on a flash drive with a copy flash drive in my bug out bag. (although I don’t think I will ever bug out except for a forest fire).
I am hoping this will all be a false alarm. But as I said before,Nepal has all the earmarks of the start of something (just what, I don’t know). I hope it is just a result of their flood back at the first of Aug and not what we fear.
Is it possible to get a map of the general area and start plotting red dots where these outbreaks in Nepal and India are taking place? (I am sorry, but I have a family funeral to attend this weekend and can’t do this) I think it would be important to “see” the geography of this as it plays out. Also I saw (sorry - forgot to grab the link as I was shutting my office computer down) that Pakistan is also having a similar “mystery” type of illness going on and is offering to pay half of the malaria confirmation test if people go to the hospital to be tested. I guess that the test is too expensive for most people to afford, so they are either not seeing an MD at all or are having the MD’s just assume it is malaria and are treating the patients for it without a confirmatory test.
Pixie – at 16:52
So we had pigs die in Mar. Dogs and chickens in June- then a “few” people in mid Aug, and now we have 4000 sick at the first of Nov.
Now if I put the numbers to the 14 in mid Aug and 4000 now, that is an increase of 285 time or about 2^8 in 10 weeks or so. IF it is all the same problem, we are taking a doubling every week or so and IF it has about a week incubation time, then we are talking an R0 of around 2. Not good. Hopefully not all these cases are the same and are just complications from their Aug flood.
I think I will go work on the greenhouse and relax.
Sniffles – at 17:12
Already ahead of you on trying to get a map put together. I tried to do so last night. Unfortunately the data set I am using does not have most of the populatated places (the villages) that are mentioned in the news articles. I will continue to try to put something together. When I do, I will email it to DemFromCT for posting here on the fluwiki forum.
Until I can find better to download for use in ArcView, you can use the system that is at this link to see where the villages mentioned in the news articles are located. It is interesting that many of them are linked by a gravel road.
Directions:
Select Banke District
Select the map features, all of them
Select pdf
Oh yeah, when the pdf comes up change it from 100% size to 50% size.
I thought it was clarified to be 400. Wasn’t it? (Treyfish at 16:35)
Pixie et al. - so, out of blood taken from and tested from 521 people, 479 have NOT come back as infected with malaria? Having difficulty wording this but I’ll try - how is an RO calculated when there is more than 1 pathogen that is endemic in the population and yet there seems to have to be some other(s) pathogens present at the same time, perhaps mixing with endemic pathogen? Quite mixed up, perhaps I am. And I’m not the cat in the hat. Thanks for all that each of you do.
DennisC – at 17:16 We need to watch this very close. If your numbers are right then that tracks with all the numbers I have put together and I would concur with your RO Rate. Really need to know what this is.
Does anyone know anyone in Nepal where we can get some first hand information?
anonymous et al - 20:14
We’re all trying to figure it out. You are right that there are a lot of endemic background diseases in these areas. And, as Leo7 pointed out, with malaria it is probable that everybody around Banke has been exposed to malaria to some degree or another (one reason travelers to these areas are so susceptible is that we have zero prior exposure and immunity, unlike the local population). So, as Leo7 says, many people in this aresa should test positive for malaria since it is so endemic and they have been exposed since early childhood. And, of course, they can have latent malaria while they also have another infection too at the same time, making attempts to figure out what is happening very difficult.
Calculating an R0 would be easier if the potential dual illness did not present with very similar symptoms, I suppose. But dengue, malaria, influenza (and a few other illnesses), all present with symptoms that could be confused, at least initially. If the viruses have changed their symptomatic presentation in any way, all bets are off. Right now it does not look like they are able to easily diagnose either dengue or malaria in dengue and malaria endemic areas in Nepal (they really should be familiar with both of those presentations at the top teaching hospitals), which makes some of us here wonder what has changed. Also, if a few people are diagnosed with dengue or malaria, it will be quickly assumed that the vast majority of others in an epidemic area are infected with the same thing if they present with symptoms that are at all similar. Here, in the winter, in the middle of flu season, most physcians will not bother to test you for flu A or B if they know they are in the midst of a seasonal flu epidemic - if you have a fever and feel like you were run over with a truck, they will assume you have it. The same assumptions are operative elsewhere.
I’m very curious about the 479 people who have NOT come back as infected with malaria too. Are they not done working on the sample batch yet? Or are these true negatives?
Official state newspaper says 4,000. Maybe someone can e-mail the editor asking them to verify the number? (My e-mail has the potential to be DOWN this weekend due to a server upgrade in progress or I’d do it.)
Dunno about you guys, but I’m concerned enough about this to make a prep run this weekend to buy a few things I’ve been putting off. If this turns out to be a bad case of common cold/exaggeration, no biggie; I’ll have the preps I need for when TS DOES hit the fan.
However, if TS HAS HTF here … well, everyone on this board can draw their own conclusions, I think, at this point.
The following UN website (IRIN News dot org)provides a gallery of photos of the Nepal flooding and the villagers who live in the Banke district. Click on the photo that says “Nepal Flood Crisis” (right hand side)
Okieman - at 19:16
That map is incredible. [http://tinyurl.com/ymow2v ] How you found a map that goes to the level of villages and shows the footpaths, I don’t know. Genius, Okieman!
Looking at the map, the towns mentioned in the reports are all in a line, connected by footpaths as you said. The towns go, in order, from West to East, or Left to Right:
Phattepur - Holiya - Gangapur - Matehiya - Narainapur
Right now, the problem is really localized. You could contain it with the right measures (army/police). The problems, for now, seem to be concentrated in this particular corner of Banke district:
The mystery disease which so far claimed 24 lives is expected to be identified till tomorrow. The disease reportedly affected around 4000 locals of five VDCs, phattepur, Matehiya, Gangapur, Holiya and Narainapur of the district. http://tinyurl.com/yf4twv
Thirty-one people have died……in three VDCs of Banke Holia, Fattepur and Gangapur http://tinyurl.com/y5aqt9
ReliefWeb has a very good map of the areas affected by the August floods in Banke district.
The towns mentioned where this epidemic is localized and where the people died from the “mystery illneess” recently (Phattepur, Holiyaj, Gangapur, Matehiya, Narainapur)are most definitely in the area most affected by those floods, as is clearly shown on the ReliefWeb map:
Tiger Lily - 21:07
Just looking at the pics from the “Nepal Food Crisis”! Really noticing the caption under photo 10.
“Due to hunger, many families are digging out the wheat stocks from the wet ground and grinding the mud-filled wheat for food. © Naresh Newar/IRIN “
Just imagining the possibilities of all kind of disease transmission from that mud - whether they’re eating it, wading in it, or even inhaling the grindings in the process.
Should probably change my name to Ms.D.Pressed
P.S. Thanks Pixie
The overall population of the Banke district, Nepal, is around 400,000.
Tiger Lilly - at 21:07:
Thanks for the photos and a view of the real people. All that disruption and malnutrition would really leave them wide open to any variety of disease.
“grinding the mud-filled wheat for food.”
What a horrible situation. We worry about ourselves regressing to 1900′s standard of living and these poor people are barely surviving by Black Plague standards. In 2006.
I will not complain again..I will not complain again….
anonymous et al – at 21:28
“Due to hunger, many families are digging out the wheat stocks from the wet ground and grinding the mud-filled wheat for food. © Naresh Newar/IRIN “
There is a chance you may have put your finger on what is occuring in Banke. Wheat is susceptible to a fungus called Ergot. In the U.S. measures are taken to keep it out of the human food supply and animal’s feed supply. It can be more prevelant during humid or flood weather events. Here is a link to wikipedia if you want to learn more:
This may also cause insanity, convulsions, or death, due to limited circulation to the brain. Other symptoms include strong uterine contractions, nausea, seizures, and unconsciousness
RE: THE AUG 18, 2006 REPORT
“The disease, which was first detected in dogs and chicken in the last week of June, had started spreading to humans.
Major symptoms of the disease are high fever together with bleeding from nose and mouth at the time of death.”
I am still not convinced this [Aug 18 report]wasn’t H5N1 because: dogs and chickens sick first, children sick, high fever and bleeding. IMHO, there is a good chance it was H5N1.
So any other victims of an unknown disease with similar symptoms arising from the same area is highly suspect for H5N1. For me anyway.
IMHO.
Grace RN – at 22:53
I still think the verdict is out concerning what the disease is, but I do not believe the government in Nepal is going to very forthcoming with information. I just checked on-line news sites for any additional news. Nothing. Not only nothing new, but no mention of the “mystery disease” at all. If it is H5N1 then it will raise it’s ugly head again and there will be no hiding it.
I threw the Ergot theory (or some other grain fungus) out on the table because of the flooding.
Pixie and all others working hard on tracking this development - excellen job as always. This thread is like some kind of disease/CSI/mystery novel. Let’s hope it is malaria and nothing more ominous. Keep up the great work!
This is an interesting excerpt from Wikipedia regarding malaria:
“Parasitic Plasmodium species also infect birds, reptiles, monkeys, chimpanzees and rodents.[26]”
It doesn’t say anything about dogs or mules.
One observation, if this was malaria they would have figured that out already. Its safe to say they have had time to run a battery of labs, and get the results. Its either something off the wall or they know what it is and arent saying anything IMO. Id give this till Monday then if we dont here what it is. Id say let the PPF go up a few notches. I hate it when we dont here anything and are left to speculate.
One observation, if this was malaria they would have figured that out already. Its safe to say they have had time to run a battery of labs, and get the results. Its either something off the wall or they know what it is and arent saying anything IMO. Id give this till Monday then if we dont here what it is. Id say let the PPF go up a few notches. I hate it when we dont hear anything and are left to speculate.
Hi all, I’ve just re-read this whole thread again, and everytime I want to make a point, someone else has made it a little further down! So there’s nothing original in my post here, just random thoughts.
It’s tragic but the reality is in large areas of the world, horrible infectious diseases that kill a lot of people are never properly diagnosed.
It could be anything, and it could be a combination of malaria, dengue, flu, or other infectious diseases that no one has thought to test for. Just cos they found malaria in a couple of people doesn’t really mean anything, cos a) the others could still be infected by something else, b) it could be an ‘incidental finding’ ie irrelevant to what the patient actually died of, or c) it could all just be something some official made up, to soothe everyone.
The locals don’t seem to buy that it’s malaria.
Dengue could look exactly the same as H5N1, clinically.
They need the army and police to go in cos large areas of Nepal are under the control of Maoist insurgents, and I doubt that any moderately high level official will go anywhere without army and police protection. So that doesn’t tell us anything,
Remember that there was a big flood back in Aug and people were having to swim around in water with human waste. This could still be anything. But we should watch very closely.
WOW!!
This is the first time I’ve looked at this thread. Started seeing it mentioned in other threads. Scary stuff. Great work!. I printed it out and got 45 pages!
Could someone here that’s been following this closely post a summary on a new thread “Nepal II” ?
Thanks!
Indian envoy holds talks with Nepal PM
Shirish B Pradhan (PTI)
Kathmandu, November 4, 2006|18:15 IST
Indian Ambassador to Nepal Shiv Shanker Mukherjee on Saturday called on Prime Minister Girija Prasad Koirala and discussed the current political situation in the country, including the ongoing peace talks with the Maoists and the issue of the rebels’ arms management.
<snip>
I have to wonder if that was all they discussed. Do you think the “mystery disease” of Banke District (on the Indian border) was also discussed.
What they do, not what they say.
Treatment Still Eludes Malaria Patients
THT Online Banke, November 4
Patients suffering from cerebral malaria patients across the Rapti river complained on Friday that treatment was still beyond their reach.
Meanwhile, 45-year-old Shantidevi Yadav of Holiya-1 died on Friday for want of medical treatment a local, Sohanlal Yadav, said over phone. Several malaria patients are awaiting treatment, he said. With Yadav’s death, the malaria toll in the last two weeks has climbed to 40.
Though physicians had referred 12 patients to the Bheri Zonal Hospital on Wednesday, saying the patients were at high risk, just one patient was brought to the hospital in a vehicle on Thursday. The District Public Health Office (DPHO) Banke does not even know where they are.
The DPHO said the patients could not be brought to the hospital as the affected areas were virtually inaccessible.
Chief of the DPHO Banke, Jaya Bahadur Karki, said the vehicle has been arranged for bringing the patients to the hospital. “Several people will be needed to bring the patients up to the Rapti river. “We cannot make such an arrangement,” he said, adding: “No one is cooperating with us to ferry the patients.”
Physicians said malaria patients will die if they are not treated at the earliest.
DPHO chief Karki said requests are being made for necessary cooperation to carry the patients, adding that a tractor will head for the Rapti river tomorrow to ferry the patients. He said a patient was rushed to the Bheri Zonal Hospital in a vehicle yesterday.
DPHO chief Karki, however, said: “A team of physicians from the Nepalgunj Medical College arrived in the malaria-affected areas on Friday. All the physicians are busy treating patients, he added.
ICU unit closed for want of docs
Himalayan News Service Birgunj, November 3:
The Intensive Care Unit (ICU) of the Birgunj-based Nara-yani Sub-Regional Hospital (NSRH) has been closed since October 30.
The unit was closed as senior doctors of the hospital — chief of the ICU Dr Arun Kumar Jha, Dr Birendra Pradhan and Dr Sushil Chaudhari — left for India to take part in the international conference of physicians, a source at the hospital said.
Due to the closure, needy patients have been forced to head for hospitals in Raksaul or the capital for treatment.
However, the hospital administration said the ICU had been closed from October 30 till November 12 for maintaining equipment and cleaning them. The ICU was also closed for four days during Tihar for cleaning it up, the source said. “As the equipment were not fumigated for a long time, clean-up was carried out by closing the service,” acting medical superintendent of the hospital Dr Lal Babu Yadav said.
“The ICU was closed after shifting two patients admitted to the unit to another ward of the hospital,” said a medical officer at the ICU.
“It is an act on negligence on the part of doctors to attend the conference by closing the sensitive unit,” said a former member of the Hospital Development Committee, Nagendra Chaudhari, adding: “Patients’ welfare was neglected by closing the unit in the name of absence of doctors”.
Comment: This story seemed a little odd, but considering the local I assumed this hospital was out in a very rural location. However, after looking into the city of Birgunj I discovered this:
About Birgunj: Birgunj is situated about 3 KM from the Indian northern border Raxaul. It is a main entry point to Nepal from India for routes such as Calcutta and Patna. Majority of all the foreign goods shipped to Nepal by sea go through Calcutta-Haldia Port to Raxaul to Birgunj then reach to main cities like Kathmandu. Hence Birgunj is an important land entry point for goods to Nepal.
Tiger Lily – at 11:23
If we take the “look at what they do and not what they say” approach- There is an outbreak of a mystery illness and the doctors decide to leave town and the hospital is taking the time to “fumigate”. What does that sound like?
Surely these are not connected. The problem with this Nepal story is that there is so little information and so much one can “read into” it.
Hummmm.
GraceRN @ 22:09 - Amen.
DennisC -at 11:31
“Surely these are not connected. The problem with this Nepal story is that there is so little information and so much one can “read into” it.”
I agree. Too many dots and not enough information.
IMO: Two weeks would be enough time for a pair of doctors to travel to a location where they could be trained on diagnostic techniques, use of new equipment, and two weeks would be an adequate amount of time to train on such equipment, as-well-as install said equipment, etc. etc.
I’m running late for a meeting. Gotta run.
From what I’m reading, if the dots are conected then they start in June with human illness and before that with animal illness. I don’t see how an August flood can connect in this unless it was a catalist of what was already happening?
Linda, flooding would give many more places for disease carrying mosquitos to breed in. Flooding would displace many people from their homes, destroy food stocks and make travel difficult if not impossible in some areas. Poor sanitation, malnourishment and decreased protection from mosquitos could all cause widespread health problems(malaria, etc.) such as we’re seeing here. Or it could be H5N1, in which case the flooding could easily worsen the situation. All we can do is wait and see.
MaMa..Thank you. When I see it laid out like that, I feel silly for having posted the question…seems to me that we are possibly then seeing a combination of many things. This could be why there are so many diagnosis; what seems strange is the lack of any reference to H5N1. …hopefully H5N1 isn’t mixed in with it all but if it’s not then it seems that they woulkd say so. I find it hard to believe they haven’t tested for it…or did I somehow miss where they did?
MaMa..Thank you. When I see it laid out like that, I feel silly for having posted the question…seems to me that we are possibly then seeing a combination of many things. This could be why there are so many diagnosis; what seems strange is the lack of any reference to H5N1. …hopefully H5N1 isn’t mixed in with it all but if it’s not then it seems that they would say so. I find it hard to believe they haven’t tested for it…or did I somehow miss where they did?
Linda, no problem. As you said this could be a combination of any number of things and likely is, that’s the hard part, not really knowing. As for testing for H5N1, likely there has not been any(my assumption), or not til WHO gets there anyway. I could be wrong, but I don’t think regional hospitals there have labs capable of running the tests. In addition, the region has been suffering since the flooding with many people homeless and hungry. From what some of the reports are saying many people are not even able to get to places to recieve medical attention. What a horrible situation for these people to be in.
In India, 17 infants have died in a certain hospital in the last 3 days from “infections”. (I saw this on the RSOE HAVARIA Emergency site today. I’ll try to find a source and come back) But: You all are such super sleuths, I am wondering if you can check to see if there are any connections of this spate of deaths in terms of location,symptoms etc to the nepalese outbreak. One other comment: way back in the thread, a posting said one villager commented that every member of her family was sick. Since usually the adult female mosquito (vector of malaria) only requires two blood meals to inoculate her eggs before laying, they either had 1. a very unusual, very hungry mosquito in their room one night, or 2. the bad luck to have their particular family run into a hoard of similarly infected mosquitoes with the unusual cerebral form of the plasmodium, or 3.it isn’t malaria. Following Occam’s razor, I vote 3.
http://hisz.rsoe.hu/alertmap/woalert_read.php?id=8253&lang=eng
I don’t know if this link will get you to the exact article, but it will at least get you to the map where you can click on the flashing icon over India and read. The hospital where all the infants died is in Kolkata state in the I think West Bengal district. The hospital claims that many infant deaths in 3 days in not unusual. How horrific a commentary on their health care.
Is anyone able to comment on how long it can take from first exposure to the malaria parasite due to an insect bite, until it might kill a person? Is there at least a minimal amount of time to use as a guideline? What I am wondering here is, if the August flood triggered more mosquitoes to breed, has enough time elapsed between that flood and now, to cause a wider number of deaths from malaria.
What we have is June dogs and chickens sick, starts to spread to humans Aug Flood Nov Still no adaquate medicial care blood test taken still no dx. Lots of negatives for malaria. High RO
Malaria is common for these people I would think the locals would know malaria when they saw it. Whatever it is the flood could have exasperated the RO. I still hate this lack of information, hope we get an answer soon
…”if the August flood triggered more mosquitoes to breed, has enough time elapsed between that flood and now, to cause a wider number of deaths from malaria. “
Yes.
beehiver at 14:20
It was posted earlier that it takes 7–20 days from the mosquito bite to show symptoms, and sometimes as long as 6 months. I believe that was for the Garden Variety of Malaria. Could not find similar info for Cerebral Malaria.
I’m just rambling…sharing my thoughts
As Linda pointed out, I think it is odd too that H5N1 is absent of mention. I’d feel better if they announced that they had tested a few people for H5N1 and it was all negative. But malaria, dengue, chikunganya…they are what they are. Still, it leaves me with that pink elephant feeling.
But as others have pointed out too there are many other diseases with similar symptoms floating around there and it seems like a boiling pot of viruses. I do hope with the health care system in that part of the world overstrained that they aren’t missing something. Together with the unsettling recent WHO report I still feel that they likely are missing things. I think after the mosquitos stop being active in Nepal, northern India, and other more semi-tropical/temperate regions things will clear up. The picture will either elicit an anxious sigh of relief, or be scary. We’ll see.
Incubation Period
Following the infective bite by the Anopheles mosquito, a period of time (the “incubation period”) goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days. The shorter periods are observed most frequently with P. falciparum and the longer ones with P. malariae.
Antimalarial drugs taken for prophylaxis by travelers can delay the appearance of malaria symptoms by weeks or months, long after the traveler has left the malaria-endemic area. (This can happen particularly with P. vivax and P. ovale, both of which can produce dormant liver stage parasites; the liver stages may reactivate and cause disease months after the infective mosquito bite.)
Such long delays between exposure and development of symptoms can result in misdiagnosis or delayed diagnosis because of reduced clinical suspicion by the health-care provider. Returned travelers should always remind their health-care providers of any travel in malaria-risk areas during the past 12 months.
Uncomplicated Malaria
The classical (but rarely observed) malaria attack lasts 6–10 hours. It consists of:
Classically (but infrequently observed) the attacks occur every second day with the “tertian” parasites (P. falciparum, P. vivax, and P. ovale) and every third day with the “quartan” parasite (P. malariae).
More commonly, the patient presents with a combination of the following symptoms:
In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected. Conversely, in countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation (“presumptive treatment”).
Physical findings may include:
In P. falciparum malaria, additional findings may include:
Diagnosis of malaria depends on the demonstration of parasites on a blood smear examined under a microscope. In P. falciparum malaria, additional laboratory findings may include mild anemia, mild decrease in blood platelets (thrombocytopenia), elevation of bilirubin, elevation of aminotransferases, albuminuria, and the presence of abnormal bodies in the urine (urinary “casts”). Severe Malaria
Severe malaria occurs when P. falciparum infections are complicated by serious organ failures or abnormalities in the patient’s blood or metabolism. The manifestations of severe malaria include:
Other manifestations that should raise concern are:
Severe malaria occurs most often in persons who have no immunity to malaria or whose immunity has decreased. These include all residents of areas with low or no malaria transmission, and young children and pregnant women in areas with high transmission.
In all areas, severe malaria is a medical emergency and should be treated urgently and aggressively.
Severe malaria occurs when P. falciparum infections …
I don’t know how to BOLD
NawtyBits – at 15:26 bold
us three ‘ s before and three after.
This does not look like malaria to me. Any Doc care to wieght in
DennisC at 15:29
thanks
This thread has got way too long and takes for ever to open - I will start a new one for you.
New thread is here
I will copy across the news links and Pixie’s timetable