http://ia.rediff.com/news/2006/oct/14dengue.htm
India and now Pakistan with surges in dengue patients. Something to watch carefully.
Karachi under dengue grip, 17 dead
PTI | October 14, 2006 | 15:53 IST
After India and Nepal, dengue has now spread its tentacles in Pakistan with its port city Karachi reporting 17 deaths due to the vector-borne disease. Apart from the 17 dead, hospitals in Karachi have admitted around 700 suspected dengue patients, prompting authorities to order emergency measures at all government and private hospitals. “After proper tests we had some 230 of these patients testing positive for the virus. Most of them have been treated successfully, but 17 have died due to complications in different hospitals,” Health Secretary Naushad Sheikh said on Saturday. Though he ruled out a red alert situation in this industrial hub of Pakistan, he said the spread of the virus was being closely monitored so that it did not turn into an epidemic. Since the monsoon rains, hospitals have reported around 700 suspected cases of the virus, which is spread by aedes mosquito that breeds in clean water containers and buckets, and bites during the daytime, health officials said. . . .
I think this is very interesting. Two days ago I posted on the India site that I thought it would be quite suspicious if India’s border countries started to report outbreaks of dengue. China issued an alert yesterday and now this today.
With 230 positive and 17 of those dead that is a 7.4 CFR. Way to high for simple dengue.
witness – at 11:53 you are right all of this needs to be watched closely.
Even if this is Dengue proper - obviously something has changed significantly about it and it is now posing a much more extensive and dangerous threat. So, even if this truly is Dengue - I will be watching this closely. If it has changed it’s mode of contagion (can it change from a mosquito vector to a H2H form?), or expanded the environment it can survive in, and increased in virulence - then it is just as problematic from a pandemic perspective as H5N1.
And of course, there is always the distinct possibility that it is NOT Dengue.
And there is also the observation that this phenomenon bears out the hyperevolutionary phase that viruses worldwide seem to have embarked upon. Tom DVM has spoken of this at length and with an abundance of fact. We are seeing it in real time.
Anon_451 : the tests were only performed on patients who reported to a hospital, i.e. patients with symptoms severe enough to go or be brought to a hospital. The real CFR is therefore most certainly much lower than you calculated and could be in line with “normal” expectations for dengue.
We are now at the end of the monsoon season in the whole of South Asia, with a lot of water everywhere, perfect breeding grounds for mosquitoes. This is the time for outbreaks of dengue. There is no H2H transmission of the dengue virus and to my knowledge at this time also no sign of H5N1 rearing its ugly head. The situation should be watched, yes, but let’s not jump to unwarranted conclusions.
Albert - I do not see anyone here jumping to conclusions - rather asking questions that are begged from the info released to date. Just because you declare that all is well - does not provide enough information for me to reconcile the other information we have before us. Again, as I said in a previous thread - could we please just fuss at the information and quit worrying about whether someone is “too concerned” or not? I am responsible for my own assessment and reaction - just as you are. Please quit telling me how I should react to information. Explaining additional information is great - but don’t tell me how I should personally respond.
I wonder also if due to weather conditions, etc. this year, maybe there are far more mosquitos than usual? Perhaps it is just a “really bad year” vs normal seasonal outbreaks? Tough to say. But there were lots of Dengue outbreaks prior to 1918 so that’s one reason to keep a sharp eye on this one.
Dengue in India is changing year to year. They’ve put it in four categories. This year is worse than last year, but 1996 was the worst year. Yahoo article here: http://tinyurl.com/ym63dj
Rule of thumb: Know what is endemic in an area. This includes infrastructure and its many facets. Whatever it is, if it’s (meaning harmful in this case) there before a disaster, it has the potential to become a severe problem after a disaster. Think ‘tsunami’ and Indonesia.
LauraB – at 16:00 But there were lots of Dengue outbreaks prior to 1918 so that’s one reason to keep a sharp eye on this one.
Really? This is new info to me. Can you point me to some info on this LauraB?
LauraB – at 16:00 But there were lots of Dengue outbreaks prior to 1918 so that’s one reason to keep a sharp eye on this one.
Really? This is new info to me. Can you point me to some info on this LauraB so I can learn about it?
There are many diseases in the third world countries that share similar flu-like symptoms. Dengue is one of them.
Dengue is one among many of the diseases that H5N1 is often initially misdiagnosed as, in Indonesia, at least. Testing is not always done in third world countries where mosquito-borne and water-borne diseases are endemic, and sometimes a disease like dengue (in particular) is the assumed diagnosis. I have seen a few toggle-text machine-translated news reports from Indonesia indicating this.
There is the possibility that an outbreak of H5N1 could be “hidden” in an outbreak of dengue (or some other disease). If hundreds of people were taken ill to the hospital with in a few days, it would not seem out of the realm of possibility that only the first few would be tested, and the rest, suffering from the same symptoms, assumed to have the same disease and get the same diagnosis. It is possible that some of the patients might have Dengue, some might have H5N1 instead, or some could have H5N1 and Dengue. One could not really know unless they were all tested. And I don’t believe that would, or does, happen.
So I think it is something to keep an eye on, as well as other outbreaks or epidemics of any other disease with similar symptoms as H5N1 involving hundreds or more people.
One dies in Nepal
Nepal reported its first dengue related death on Saturday. On the basis of a clinical test it was confirmed that a resident of the Tikulim area of Gaur died of dengue, the state-run National News Agency (RSS) reported. …
Authorities said that there was no dengue case in Nepalgunj in Banke district bordering India. All suspected dengue patients in the Nepalgunj Medical College were diagnosed negative, they said
Still bends my mind that they are not testing for h5n1. Well… as the saying goes “you can’t find what you don’t look for”.
TJDucky—good point about possible co-infections.
If all this is just dengue, we may have (yet another) new strain on our hands and another rewrite for the parasitology text books.
Let’s just keep watching.
Witness found this article and she/he posted it in the India topic and news thread.
Difficulties differentiating dengue from H5N1 infections, including clinical features and lab results, are discussed on this thread
Edna - I don’t have a link. I just remember reading it in Barry’s book. And if this is the time of year that Dengue normally erupts, then the same thing could have been happening in 1918. Like anon-22 said, there are a lot of similarities and in places like India where there are limited resources to test for either disease. We just want to make sure all the cases are Dengue and not AF.
SPANISH FLU DIAGNOSED AS DENGUE: JOHN BARRY
http://www.nyam.org/news/2229.html
The New York Academy of Medicine
Best Selling Historian John Barry Lectures on the Flu Pandemic of 1918 and Its Relevance to Public Health Today NEW YORK CITY, Nov. 18 – An audience of over 40 people gathered at the Academy last night to hear a lecture on the pandemic flu by John M. Barry, historian and best-selling author of The Great Influenza (Viking 2004). He began by describing the flu of 1918, known as the “Spanish flu,” as the most violent pandemic the world has ever seen. Although the first wave of influenza was mild, appearing in Kansas in the spring of 1918, World War I brought back a second wave in a lethal form, which rapidly spread among the troops and killed almost 200,000 in October of 1918 alone. The strain was so virulent, Barry explained, that it killed at least 40 million people, “certainly killing more people in 24 weeks, than AIDS has killed in 24 years.” Often misdiagnosed by doctors as cholera, typhoid fever or dengue fever, the symptoms of the 1918 flu were far more devastating than those of today’s flu, which is mostly marked by fever or muscle pain. Reading a letter written by a doctor to a colleague regarding one of the first army camps hit by the pandemic, Barry portrayed a virus so toxic that it resembled a plague more than a flu: “These men start with what appears to be an ordinary attack of la grippe of influenza,” the letter said. “When brought to the hospital they very rapidly develop the most vicious type of pneumonia that has ever been seen. A few hours later you began to see the cyanosis (turning blue from lack of oxygen) extending from their ears and spreading all over the face until it is hard to distinguish the colored men from the whites.” Other agonizing symptoms flu victims experienced were bleeding from the skin, eyes and ears, intestinal hemorrhaging, paralysis of the spine and hysteria.
maryrose - at 9:38.
I remember that part from Barry. Today there was a boy age 11 who had been misdiagnosed with typhoid and is now an H5N1 fatality.
They seem to stubbornly resist testing patients for H5N1 unless there are chickens nearby that have died, unfortunately.
why is it that when we hear nothing from somehvere, like for instance Africka, or during some larger sport events that someone is nevoursly mumbeling “they must hide somthing,. something is goeing on” ? And then when we actualy have some local insight, and with firsthand exeperience we end up saying the same? “something is going on, I dont like anyone to tell me that its not… and so on..
please let me remind everyone to play nice. It is very legitimate to say your opinion on a subject, specialy when you actualy have some insight, and fighting any kind of overreaction and rumours are one of this forums most impotant task! If we wanna join a collective freak out party there is more forums to choose from..
debate and p l a y n i c e . . .
Urdar-Norge – at 16:18 You are absolutely right. Many of the countries that we are watching have annual out breaks of different disease which mimic the flu. The good doctors and nurses there work very hard to treat the people and give them the very best medical care that they can. I think everyones concern (and I include myself in this). Is that these people have seen so much for so long, you have a tendency to drop your guard. They see someone coming in that looks like a dengue patient and they respond accordingly. 99% of the time they are right. But once the mind set of “Oh OK another dengue patient” sets in, they may miss an H5N1 patient that slips in under the radar. Net result is a lot of very dedicated HCW’s go down for the count because they did not see something coming at them.
But you are right we need to stop saying that they are hiding something until we have proof otherwise.
I am also suspicious when things seems to be not normal. I find the info on mosqitos dengue in higher altitude to be good and notisable information. Many things that has to to with climate these days are not “normal” any more. Dolphins playing in my fjord today, they dont belong this high up north.. Same thing may explain the mosquito mystery, maybe the climate has changed the habitats?
Just wanted to note that the forum needs all sides of the debates, views and knowlegde. I know realy well how differnt a situation seems from far away. When avian-flu came to scandinavia on a short wisit last year, it was some very stong reactions on the pictuers and reports. People tended to read alot out of it. The real situation was not so dramatic lucily :)
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