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Tracking the next pandemic: Avian Flu Talk

1000 deaths in Nepal - current - Event Date: September 21 2006
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    Posted: September 21 2006 at 5:03am
"This morning there was news of 1000 deaths in Nepal...here we go again."

(still looking - not on any major search engines - )


Just contacted by source of 1000 new deaths in Nepal.  This is breaking news - today - Last time I suggested another user post the thread when I first got news of trouble and I am asking users here to scan the net to verify this story.

At this point it may be encephalitis - which in some opinions could be connected to an Avian strain.

Will update this thread as new news comes in.

Help appreciated.

(Back tracking articles - so far news black out on this story - however this data may give a hint)

KATHMANDU, Aug 22 - The outbreak of Japanese encephalitis in the Terai districts of western Nepal has claimed several lives in the past two days, pushing the death toll to 41 this summer, even as many have been admitted to hospitals for treatment, according to reports.
A report from Kailali said 13 persons died on Saturday and Sunday alone mounting the death toll to 18 in the district. Four persons died on Saturday while six others succumbed to the disease on Sunday at Seti Zonal Hospital. Similarly, three persons died at Tikapur Hospital Saturday increasing the death toll there to eight so far.

At present, 91 such patients are undergoing treatment at the two hospitals.

In Dang, two persons died due to the disease on Sunday, adding the death toll to five in the past one week. Fifteen patients are undergoing treatment at Ghorahi Hospital in Dang.

A report from Bardiya said three-year-old Tejrani Tharu of Patabhar VDC-4 in Bardiya district died due to Japanese encephalitis, Saturday. The death toll has now climbed to three in the district.

In Bhairahawa Gudiya Sahani, 7, of Bayarghari-7, died due to the disease on Sunday.

In Banke, a total of 14 persons fell prey to the disease this summer while 25 persons are undergoing treatment at Bheri Zonal Hospital (BZH) and Nepalgunj Medical College hospital.

According to hospital sources, of the 14, twelve persons died at BZH, while two others succumbed to the disease at the medical college hospital. END

Japanese encephalitis has not been lab confirmed.

Comment : This was on August 22. Depending on the outbreak - and severity - numbers may have greatly increased and have not been released to the media.
 
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Could be bullet flu again, I'll start looking too.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 21 2006 at 5:37am
Originally posted by Cruiser Cruiser wrote:

Could be bullet flu again, I'll start looking too.


I know. My first thought was - well they're having a revolution and there are some pretty high death totals going on in the conflict.

However - some time ago - when speaking to people in Indonesia we were seeing Enceph... hooking to Avian in some strains. It is a long shot.
For all reading this thread.. this news is very premature and needs to be verified. If we can't nail it down I will ask Albert to pull the thread if he wishes to do so.

NOTE : This has happened before.

http://www.hpa.org.uk/cdr/archives/archive05/News/news3805.htm

Japanese encephalitis in India and Nepal

 Since July 2005, there has been an outbreak of Japanese encephalitis (JE) occurring in northern India and Nepal which has so far affected over 5000 people, mainly children, with over 1000 deaths reported (1). The outbreak has affected the states of Uttar Pradesh (3551 cases, 764 deaths) and neighbouring Bihar (238 cases, 58 deaths) in India and most regions of Nepal (1540 cases, 259 deaths); western, mid-western, and far-western regions of Nepal have been most affected.

JE is transmitted by the bite of the Culex spp mosquito and is endemic in many parts of India. Thousands of cases are reported each year (2). Peak transmission season ( betwen May and October) in northern India occurs during and just after the monsoon season when major outbreaks coincide with heavy rains and flooding. Case numbers in the region are reported to be higher this year than in previous years.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 21 2006 at 5:39am
Thanks for the post...I'll be looking...Thank you source for us. 
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Here is a story that deserves a look.
 
 
Five die of unidentified disease in western Nepal
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Five people died of unidentified disease at remote Chamchet village of western Gorkha district during last two weeks, local Nepal Samacharpatra daily reported here on Thursday.

"Five people including two children died of unidentified disease in the area, some 150 km northwest of capital Kathmandu," the Nepali language daily reported, quoting Gopal Lama, former village chief, as saying.

But, officials at the District Health Office said they were uninformed about the disease in the area.

Although there is a sub-health post at the village, only a female health volunteer has been working there for last two years, according to daily.

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Perhaps it is a continuation of their government relocation program
 
 
Nepal's Disappeared
 

The Nepalese government has decided to reveal the whereabouts of all those disappeared by the state since Feb. 1996. The information will be made public on Sept. 20.

Amik Sherchan, who is both health minister and deputy prime minister confirmed the news when speaking to the press on Monday.

This is a landmark decision and a change of stance for the government. Prime Minister Girja Prasad Koirala had earlier disagreed with the idea of making this information public before the Maoists disclosed who they had disappeared.

This news has been long awaited by the people of Nepal.

Nepal saw many random disappearing cases across the country in the decade-long conflict between the government and the Maoist rebels.

According to the Society of the Family of Disappeared Citizens by the State an estimated 5,000 Nepalese were disappeared by the government.

In August, the kith and kin of the disappeared arrived in Kathmandu, capital of Nepal.

Since then they have been knocking on the doors of human rights agencies, activists and world bodies. It became a common sight to see them agitating in front of the prime minister's office and clashing with police.

Standing up against the government's and the Maoists' apathy over furnishing information, the families of the disappeared have staged 24-hour hunger strikes, sit-in protests, and demonstrations. They have also demanded compensation from both parties engaged in the disappearing business.

When I went to learn more from the families of the disappeared who were agitating in the capital, I found that many are certain that their relatives have already been killed by the Maoists or the Army. To my surprise, they were willing to exhume the dead bodies and they want to have a last glance of their beloved ones.

Bimala, a lean and thin woman of 34 years of age and a mother of 24-year-old son, Gore, has a heart-shocking story representative of thousands like her.

It was back in 2003, that day her husband had sent a parcel from Qatar. She knew a colleague of her husband, from the neighboring district, had brought the parcel so she asked her son to collect it.

Surprisingly, the day passed by but neither her son nor the parcel arrived at home. The following day, she discovered that nobody knew where her only child was.

Since then Bimala has cried every day and is anxious with worry over her son. There are many shocking stories like Bimala's in Nepal.

A large number of those disappeared belong to the student wings of various political parties, including the Maoists.

Data from the UNHCR and NHRC suggest that more than 2,500 were disappeared by the state and the Maoists. The fate of 563 persons disappeared by the state, 315 persons disappeared by the Maoists, and 58 persons disappeared by unknown groups is still a mystery, according to the NHRC.

Earlier, the NHRC located 1,205 people disappeared by the state, 435 by the Maoists and 15 by the unidentified group.

Even though Maoist chief Prachanda, had pledged to disclose the details of abductees, no information has yet been given. It is to be hoped that the Maoists will heed the voices of the thousands of Nepalis looking for answers.
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I'm off to search
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Connection between Avian and Encephalitis occurence :

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/feb1605nejm.html

Avian flu caused encephalitis in Vietnamese boy

Feb 16, 2005 (CIDRAP News) – Researchers studying acute encephalitis cases in Vietnam discovered an unexpected cause of death in a 4-year-old boy, and possibly his 9-year-old sister: avian influenza.

The two cases, described in the Feb 17 issue of the New England Journal of Medicine, differ from most other known human cases of H5N1 avian flu, which typically have been marked by fever, respiratory symptoms, and pneumonia. The report was written by Menno D. de Jong, MD, PhD, of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, and several colleagues.

The findings should prompt healthcare providers to broaden their ideas about the clinical spectrum of H5N1 infection in humans, de Jong and colleagues write.

"These cases emphasize that avian influenza A(H5N1) should be included in the differential diagnosis of a much wider clinical spectrum of disease than previously considered and that clinical surveillance of influenza H5N1 should focus not only on respiratory illnesses, but also on clusters of unexplained deaths or severe illnesses of any kind," the report states. "Awareness of the full clinical spectrum is essential to appropriate management of the illness, since treatment with antiviral agents is likely to be beneficial only when it is started early in the course of illness."

Both children died in hospitals in southern Vietnam in February 2004, the article says. The 9-year-old girl arrived on Feb 1 with a 4-day history of fever, watery diarrhea without blood or mucus, and increasing drowsiness. She had no respiratory symptoms, and her chest radiograph was clear. She became comatose and died the following day; acute encephalitis of unknown origin was listed as the cause. Her body was not autopsied.

The girl's little brother was admitted to the same hospital in Dong Thap province on Feb 12, 2004, having suffered fever, headache, vomiting, and severe diarrhea for 2 days. A chest radiograph was normal.

Within days, his diarrhea and stupor worsened. He was transferred to a hospital in Ho Chi Minh City on Feb 15 but fell into a coma within 12 hours of the transfer. By Feb 16, a chest radiograph showed bilateral infiltrates. He died the next day, with acute encephalitis reported as the cause. No autopsy was performed, but samples were taken for an ongoing study of the causes of acute encephalitis.

When researchers examined those samples at different times over the succeeding months, they ruled out several possible causes before they found the H5N1 virus in the boy's throat, rectal swabs, serum, and cerebrospinal fluid.

Encephalitis and encephalopathy are rare complications of infection with human influenza viruses, and it is extremely rare to isolate flu virus from cerebrospinal fluid, the report states. While certainty isn't possible, the girl's history makes it likely that she died of the same illness as her brother.

The two children had little interaction with poultry, later investigation showed. They used water from a nearby canal for drinking and washing, although they boiled the water before drinking. The family had once owned healthy fighting cocks; they were culled as part of measures to contain an H5N1 outbreak in poultry.

"The source of transmission may have been domestic ducks present in the canal near the children's house," the article says. "Direct transmission from sister to brother appears unlikely considering the interval between their illnesses.

"Further research is needed to determine whether host factors, which may determine a person's susceptibility to disseminated or central nervous system infection, or a particularly neurologically virulent strain of the virus is involved," researchers conclude. "The presence of viable virus in the feces of our patients has important implications for transmission, infection control and public health."

Michael Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of this Web site, called the information preliminary but of great concern.

"These cases may represent an 'intermediate human clinical presentation' between the classic gastrointestinal infection in wild waterfowl and the typical human infection," he said via e-mail today. "It is also likely that we are missing a number of similar infections in humans in Southeast Asia as patients presenting with this type of illness would not be typically tested for influenza virus."


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Originally posted by HappyCamper HappyCamper wrote:

Thanks for the post...I'll be looking...Thank you source for us. 


Thanks. If nothing else and even if the 1000 number is very high -
we have an enceph outbreak - and some further digging pulled up some disturbing data hooking (in some cases) H5N1 to initiating Enceph in humans which was fatal.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 21 2006 at 6:32am
All I found in the 3 Nepals and surrounding city newpapers was 500 were missing for a storm...
 
and 45 dealth for a gas explosion. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 21 2006 at 6:54am
I found much info on encephalitis deaths from last year, I admittidly don't have the strongest search engines, nothing new. Since we all know China's penchant for keeping it's news close to the breast, we may not see this in headlines for a long time if ever.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 21 2006 at 7:19am
I am amazed at how many articles I found re:1000 deaths, most are from last year and past.  THis one caught my attention.  Excerpt from article.  As if Nepal doesn't have enough problems, add snakes to their list.
 

In Asia alone, it has been estimated that four million snake bites occurs each year of which 50% are envenomed resulting in 100,000 annual deaths.

A baseline epidemiological study conducted from 1980 to 1985 in 15 district hospitals in collaboration with the WHO found 3189 treated cases of which 144 victims. It has been estimated that 150 to 200 ophitoxaemia related deaths occur annually in Nepalese hospitals. The WHO estimated over 20,000 cases and 1000 deaths from ophitoxaemia in Nepal.
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Any updates on this story??
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Working on updates for this story. It is definitely off the mainstream radar all together. Even the followup on the spread of the Japanese Encephalitis is a tough go of it.

You aren't going to find this on Google, that is for sure - CNN, FOX, etc.
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Medclinician - how do you find this info? Is there a search engine I can download, or do you get it from contacts?
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One more die of Chikungunya in Cherthala
ALAPPUZHA: One more person who was undergoing treatment for Chikungunya died here today. He has been identified as Renjith of Cherthala Vettakkal Tharayil. Opposition leader Oommen Chandy who visited the disease hit areas demanded the intervention of ministers to take measures on a war footing to control the disease.

It has been reported that the disease was detected in Kottayam district. The disease is suspected to have detected at the FACT Kadavu in Chingavanam. Almost fifty persons have been hospitalized at the medical college hospital due to fever. http://www.kaumudi.com

The Hindu Times said on the 12th Sept  , 1 was dead , 7 maybe sick maybe something else gave the fever .They also said 1000 affected maybe .
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Chikungunya is a relatively rare form of viral fever caused by an alphavirus that is spread by mosquito bites from the Aedes aegypti mosquito, though recent research by the Pasteur Institute in Paris claims the virus has suffered a mutation that enables it to be transmitted by Aedes Albopictus (Tiger mosquito). This was the cause of the actual plague in the Indian Ocean and a threat to the mediterranean coast at present, requiring urgent meetings of health officials of France, Italy and Spain, but nothing seems to be moving that way.

The disease was first described by Marion Robinson[1] and W.H.R. Lumsden[2] in 1955, following an outbreak on the Makonde Plateau, along the border between Tanganyika and Mozambique, in 1952. Chikungunya is closely related to O'nyong'nyong virus[3].

Chikungunya is generally not fatal. However, in 2005-2006, 200 deaths have been associated with chikungunya on Réunion island and a widespread outbreak in Southern India (especially in Tamil Nadu,Karnataka Kerala and Andhra Pradesh); see Recent outbreaks below. Tamil Nadu reportedly had the largest number of cases, as of July 2006, specifically centered around the southern districts of Madurai and Tirunelveli, with the number of reported cases increasing greatly in Salem,Chennai and Chengalpattu districts.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2006 at 5:42am
Looks like this Chikungunya is rampant over there but mostly is taking the elderly.   It is very curious though that most info on the disease says it is very rarely fatal yet there appears to be many deaths???
 
 
 

Two more die of suspected Chikangunya fever
Alappuzha Kerala | September 21, 2006 8:37:34 PM IST
 
Two more suspected Chikungunya deaths were reported today from the Cherthala area of this district taking the death toll to 24.

District Medical officials said Lisamma (67), a resident of Cherthala municipal ward and K K Padmanabhan (84) from Vattackal died this morning of the suspected disease.

Yesterday, Purushan (68) and Pankajaskshy (86) both of Thanneermukkom panchayat and Divakaran (82) from Mararikulam in this district died of the suspected disease.

Around 600 people were undergoing treatment at the taluk hospital in Cherthala. Nearly 200 people were affected with the suspected disease in the neighbouring Ambalappuzha and Kayamkulam taluks.

The test results of the blood samples of affected people were awaited, the officials added.

The doctors were still in the dark for an effective treatment for the viral fever affecting people in the region.

The Deputy Medical Officer Jagan Mohan said the patients needed thorough prognosis. Apart from providing treatment, an awareness programme should be chalked out to prevent the spread of the disease, Dr Mohan added.

 
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Originally posted by rodin33 rodin33 wrote:

Medclinician - how do you find this info? Is there a search engine I can download, or do you get it from contacts?



This came from a direct personal contact - not media. The contact (thus far) has been highly reliable and I have checked with them this morning because the link may have been pulled.

I understand people here are concerned that we report verifiable data - no wild blog type rumors -

The problem is on this one - is that there is enough background activity disease wise in the area and some rather obscure ties I have found of cases of encephalitis and Avian occuring together that if verifiable - this outbreak has some serious implications. But as I mentioned earlier - if we can't pin it down, I would rather it be removed than put up something flakey.

On this one, which I have followed with a reporter on the scene at one time and residents who have posted data concerning the area, the local government statements are not reliable and you will notice when it was first posted as an airport bio hazard alert - it was pulled off very quickly from the site (a glitch somehow deleted 3 pages - the same days as this was on the display).

From CIA online tracking of the political situation in this area - we are looking at a very unstable area in between China and India. There is heavy drug trafficking, human sex trade, AIDS, TB, and bad sanitation.
There was a report of massive bird deaths, several, and then the story concerning  the 14 drop dead - blood in nose and mouth victims - with a quick coverup story.

Teams have been sent in here. And despite denials, this is an ideal breeding spot for an Avian or other serious disease outbreak.

It has been my concern that based on data I put together from news and talking to people in Vietnam, there is a new strain of Avian which has gone systemic (bypassing stomach acid barrier) and can even bypass the blood brain barrier.

This strain would be extremely virulent and also difficult to diagnose.

All these hypothesis definitely need to be verfied by hard core science and report of cases and analyzing patients.

This is an area to continue watching, irregardless of what little information is in the media, or how difficult it is to find on the main search engines.

If there is some type of outbreak here, then it is not going to just go away. There will be more data as time goes on.
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This is from the same area .

Leopard caught, taken to vet hospital
KALPETTA: A tired and sickly leopard which strayed into a forest-fringe village near here was caught by people and taken to a veterinary hospital.

The slow-moving leopard was first sighted behind a house at Palakkuni near Sultham Batheri. Though the villagers initially became panicky, they soon realised that the animal was suffering from some disease.

The Forest authorities were informed and the feline was bound by throwing a rope noose around its neck and feet.

The leopard was later taken to the Veterinary College at Pookkode, where it was kept under observation, a Wildlife official said.  http://www.kaumudi.com
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Originally posted by Candles Candles wrote:

One more die of Chikungunya in Cherthala

It has been reported that the disease was detected in Kottayam district. The disease is suspected to have detected at the FACT Kadavu in Chingavanam. Almost fifty persons have been hospitalized at the medical college hospital due to fever. http://www.kaumudi.com

The Hindu Times said on the 12th Sept  , 1 was dead , 7 maybe sick maybe something else gave the fever .They also said 1000 affected maybe .



Thanks for the help Candles.  Deja Vu.

Chikungunya in La Réunion Island (France)

17 February 2006

Between 28 March 2005 and 12 February 2006, 1 722 cases of chikungunya have been notified by physicians from a sentinel network in La Réunion, including 326 cases reported during the week 6 to 12 February. Estimations from a mathematical model indicate that 110 000 people may have been infected by chikungunya virus since March 2005 in La Réunion, including 22 000 persons during the week 6 to 12 February. During the first week of February, other countries in the south west Indian Ocean have reported cases: Mauritius (206 cases) and the Seychelles (1 255 cases).

Because of the extensive outbreaks in the region, WHO is planning to send a team from the Regional Office for Africa (AFRO) and headquarters to assess the control measures under way. These include anti-vectoral activities; an extensive public health education campaign using mass media to sensitize the population about protective measures; and reinforcement of epidemiological surveillance and vectoral surveillance. The team will discuss a sub-regional strategy for surveillance and control of chikungunya and other arboviruses with national authorities. They will visit La Réunion, Madagascar, Mauritius and coordinate with the AFRO vector control mission to the Seychelles.

Chikungunya, a viral disease, is transmitted to humans by infected mosquitoes, typically Aedes aegypti, although there may be other competent mosquito vectors. The name, chickungunya, comes from the Swahili for stooped walk, reflecting the physique of a person suffering from the disease. The disease has been described in Africa, South-East Asia, southern India and Pakistan. It occurs principally during the rainy season.

Chikungunya is rarely fatal. Symptoms appear between 4 and 7 days after the patient has been bitten by the infected mosquito. A high fever and headache occur, with significant pains in the joints (ankles, wrists) and can persist for several weeks. The main preventive measure is to stop the proliferation of mosquitoes by reducing their breeding grounds.


Comment : Remember this little incident and the head of France. It did spread to the mainland and then faded from the limelight.

These "rarely fatal" - shades of low path bugs may come back to haunt us. No doubt we have some odd activity going from China (Quinqui) to India and Nepal is dead in its path.

This one was and is much tougher than X number of cases in Thailand or whatever country to track down. But totally unscientific - I have a bad feeling about this particular area - period.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2006 at 6:42am
It makes me uneasy that they are admitting they don't know exactly the cause and merely suspect Chikungunya, along with they are using Ayurvedic medicines to treat.  This many deaths is a big concern along with the lack of test results.  Previous article...
 
 

Health

Three more suspected Chikanguniya deaths in Cherthala
Alappuzha Kerala | September 17, 2006 9:35:46 PM IST
 

Three more suspected Chikanguniya deaths were reported from the Cherthala area in this district today, taking the total number of victims to 15, hospital sources said.

The deceased were identified as Renjith, 36, Nagendra Senoy, 78 and Rajesh, 24. While Renjith died in a private hospital, Nagendra died at his residence and Rajesh in the Cherthala taluk hospital.

Meanwhile, Leader of the Opposition Oommen Chandy today visited the Cherthala taluk hospital to meet the patients admitted there.

Nearly 600 suspected Chikanguniya patients were admitted in the taluk hospital.

Later, talking to newspersons, Mr Chandy demanded that the Government announce immediate financial assistance for the victims.

He also demanded that the ministers come to the area and direct the relief operations from the spot.

Meanwhile, Santhigiri Ayurveda and Siddha Vaidyasala was holding camps in the area and distributing Ayurvedic medicines to the people to check further spread of the disease
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2006 at 8:37am
Originally posted by Cruiser Cruiser wrote:

It makes me uneasy that they are admitting they don't know exactly the cause and merely suspect Chikungunya, along with they are using Ayurvedic medicines to treat.  This many deaths is a big concern along with the lack of test results.  Previous article...
 
 
 
Ayurvedic medicines could be anything. From what I understand about this term: ayurvedic, it is a holistic approach. It could be that this term is being used as a cover for...uh Tamiflu. Speculation of course but why use this term ayurvedic? Why not give a specific herb or concoction? It seems strange to me. I'm getting a bad feeling about this. Dead
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Our approach to West Nile virus encephalitis should work well for Japanese encephalitis, or avian flu encephalitis, for that matter.
 
I'd be happy to email the trial documents to anybody who wants them. If you need them in a hurry, just download the WNV trial documents from our website, www.genomed.com. The treatment is exactly the same.
 
I think we may well have a general viral antidote.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2006 at 11:32am
WHO has has an ongoing eye on Nepal...
 
Japanese encephalitis is considered to be hyperendemic in northern India and southern Nepal.
 

Excerpt....(4 pages)

In Full Here...

Disease Burden

Japanese encephalitis (JE) is a mosquito-borne, zoonotic arbovirus infection, in which pigs play the role of amplifying host in rural areas. The virus exists in a transmission cycle between mosquitoes and pigs and/or water birds. Humans, who become infected only incidentally when bitten by an infected mosquito, are a dead-end host.

The disease is endemic with seasonal distribution in parts of China, the Russian Federation’s south-east, and South and South-East Asia. Annual incidence ranges from 6 to 10 cases per 100 000 inhabitants within heavily endemic areas such as Thailand and Viet Nam.
 
JE is a leading cause of severe central nervous system infection in Asia and Australia, where 30 000–50 000 cases are reported annually. Of these cases, about 30–35% are fatal, and 50% result in permanent neuropsychiatric sequelae.
 
JE also poses risks to travellers and to military personnel deployed overseas. Large outbreaks of JE, often involving adults, have been reported on the Indian subcontinent,
 
and the disease is currently considered hyperendemic in northern India and southern Nepal as well as in parts of central and southern India. The spread of JE in new areas has been correlated with agricultural development and intensive rice cultivation supported by irrigation programmes.

Most JE infections are asymptomatic. Clinical disease varies from a nonspecific febrile illness, which may include cough, nausea, vomiting, diarrhoea and photophobia, to a severe disease with meningoencephalitis, aseptic meningitis or a polio-like flaccid paralysis. About 30% of survivors have persistent motor deficits and about 20% have severe cognitive and language impairment.

Virology

JE virus (JEV) is a member of the genus Flavivirus in the family Flaviviridae, together with YFV and DV (see above).

JEV belongs to the same serological group as West Nile virus (WNV) (see below); Kunjin virus in Australia and Papua New Guinea; the Murray Valley encephalitis virus (MVEV) also in Australia, Papua New Guinea and western Indonesia, and the St. Louis encephalitis virus (SLEV) in North and South America. All these viruses are transmitted by Culex mosquitoes (Cx. tritaeniorhynchus). Wild birds and pigs play a major role in the enzootic cycle of JEV, which replicates in both species and in the mosquito. Humans occasionally may be bitten by an infected mosquito but are dead-end hosts and contribute little to the spread of the natural infection.

The 10 976 nucleotide-long JEV single-stranded RNA genome encodes, as for other flaviviruses, structural proteins C (capsid), prM (precursor to membrane protein M) and E (envelope), and nonstructural proteins NS1–NS5 which are involved in genome replication and viral protein processing. The 53 kD surface glycoprotein E is responsible for the viral attachment to cellular receptors, specific membrane fusion, and elicitation of virus-neutralizing, haemagglutination-inhibiting and anti-fusion antibodies. Four major genotypes of JEV exist, which show different geographic distribution, but all belong to the same serotype.

Vaccine

JE control programmes include mosquito control (spraying of pesticides, impregnated mosquito nets), pig control (segregation, slaughtering, and vaccination) and human vaccination. Several vaccines are now available and others are under development.

  • A purified formalin-inactivated JE vaccine made from either the Nakayama strain or the Beijing strain of JEV propagated in mouse-brain tissue (Biken and Kaketsuken) has been successfully used to reduce the incidence of JE in China (Province of Taiwan), Japan, the Republic of Korea, Thailand and Viet Nam. Immunogenicity studies in areas devoid of endemic transmission have indicated that three doses of the vaccine are required to provide adequate level of antibody. Since 1988, this vaccine has gradually been introduced into the EPI in Thailand and administered with the fourth dose of DTP at 18 months.
  • Another formalin-inactivated JE vaccine is prepared in China from the P3 strain of JEV propagated in primary Syrian hamster kidney-cell cultures. This strain is more immunogenic and confers greater protection in mice than the Nakayama strain. This used to be the most widely used JE vaccine worldwide.
  • Other inactivated JE vaccines have been developed using better standardized cell substrates, including Vero cells. Vero cell-derived inactivated JE vaccines have been developed in China where the vaccine is now licensed, as well as by Biken and Chemo-Sero Therapeutic Research Institute in Japan.
  • Now being the most widely used JE vaccine in China, the live, attenuated JEV strain SA 14-14-2 was obtained after 11 passages in weanling mice followed by 100 passages in primary hamster kidney cells at the National Institute for Control of Pharmaceutical and Biological Products (NICPBP) in Beijing in the early 1970s. This strain was shown to be safe and immunogenic in mice, pigs, horses and humans. Expanded field trials in southern China involving more than 200 000 children confirmed the strain safety and yielded efficacies of 88–96% over 5 years. The SA 14-14-2 strain also elicits seroconversion rates of 99–100% in nonimmune subjects. The live attenuated SA 14-14-2 vaccine is produced on primary hamster kidney cells, lyophilized, and administered subcutaneously to children at one year of age and again at two years in annual spring campaigns. In a case–control study in Nepal, an efficacy of 99.3% was reported after a single dose of the vaccine. Currently, more than 60 million doses are distributed annually in southern and western China, and the vaccine is exported to Nepal and the Republic of Korea. Efforts are ongoing to produce the vaccine to GMP standards.
  • The SA 14-14-2 strain also has been adapted to growth on primary dog-kidney cells and on Vero cells at WRAIR for use as an inactivated vaccine. Phase I and II studies of an inactivated SA 14-14-2 strain propagated in Vero cells have been carried out, showing excellent safety and immunogenicity profiles (Intercell, Vienna). A Phase III trial of the vaccine is scheduled to start in 2005.
  • Live attenuated recombinant JE vaccine candidates based on poxvirus vectors (NYVAC, ALVAC) expressing the prM, E, NS1 and NS2A proteins have been tested in monkeys and in humans, but their development was stopped.
  • A most promising genetic approach has been the construction of a chimeric live-attenuated vaccine that comprises the prM and E coding sequences of the JEV SA 14-14-2 strain inserted in Phase into the 17D YFV strain genome. The resulting virus can be cultivated on Vero cells, has proved to be highly immunogenic in rhesus monkeys and to protect against intracerebral and intranasal challenges with wild-type JEV. The prototype vaccine, ChimeriVax-JE (Acambis), has been tested successfully in 99 adults in the USA, showing good safety and immunogenicity; 94% of the vaccinees developed JEV-neutralizing antibodies after a single dose. There was no interference with chimeric vaccination by prior immunity to YF, but a slight interference was noted in persons given YF 17D 30 days after ChimeriVax-JE. The vaccine is under Phase II clinical trials with promising early results. A first paediatric evaluation of the vaccine is scheduled for 2005 in Thailand.
  • Other attempts at developing new JE vaccines have focused on DNA vaccines. A single intramuscular immunization of DNA carrying the prM and E coding sequences from JEV or WNV protected mice and horses from virus challenge. The use of multivalent combination DNA vaccines designed to immunize against multiple flaviviruses is an interesting area of development, although the immunogenicity of DNA vaccines in humans first needs to be greatly improved.

Research Priorities

  • Evaluation of efficacy of JE vaccines against JE virus strains circulating in different geographic regions
  • Standardization of neutralizing assays for evaluation of JE vaccines in field trials

Vector-Borne Viral Infections: 1,2,3,4 | Next page

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CDC's Travelers' Health: Yellow Book shows Potential Health Hazards to Travelers.
 
Information for International Travel, 2005-2006
The Yellow Book is published every two years by CDC as a reference for those who advise international travelers of health risks.
 
See this site for Full Details....
 
 
Excerpts-

Asia

Countries included in this region (view map):

South Asia East Asia Southeast Asia

  • Afghanistan
  • Bangladesh
  • Bhutan
  • British Indian Ocean Territory
  • India
  • Maldives
  • Nepal
  • Pakistan
  • Sri Lanka

  • China
  • Hong Kong SAR1
  • Japan
  • Macau SAR
  • Mongolia
  • North Korea
  • South Korea
  • Taiwan

1Special Administrative Region


  • Brunei
  • Burma (Myanmar)
  • Cambodia
  • East Timor
  • Indonesia
  • Laos
  • Malaysia
  • Philippines
  • Singapore
  • Thailand
  • Vietnam
 
 
Excerpt...(see site for other infection details...)
 
Vector-borne infections: Malaria is found in focal areas of China and North and South Korea. Japanese encephalitis (JE) is found in wide areas of China and Japan and focally in Korea. Transmission of malaria and JE is seasonal in many areas. Reported infections in travelers are rare. Other vector-borne infections include dengue, which has caused outbreaks in mainland China, Hong Kong, and Taiwan; spotted fever caused by R. sibirica (China, Mongolia); murine typhus; Oriental spotted fever caused by R. japonica (Japan); rickettsialpox (Korea); scrub typhus (especially in China, Korea, and Japan); tick-borne encephalitis (in forested regions northeastern China and in South Korea); visceral and cutaneous leishmaniasis (in rural China); lymphatic filariasis (in focal coastal areas of China and South Korea); and Crimean-Congo hemorrhagic fever* (in western China).
 
 
 
Excerpt...(see site for other infection details...)
 
Zoonotic infections: Rabies is common in the region and poses a risk to travelers. Q fever* is widespread. Anthrax* is endemic in much of the region, and cases occur sporadically. Plague* is endemic in India, and outbreaks have occurred. Echinococcosis* is highly endemic in focal rural areas. An outbreak of Nipah virus (encephalitis) occurred in Bangladesh in early 2004, and person-to-person spread may have occurred. Macaques throughout the region are infected with B virus (Herpes).
................................................................................................
 
 
TIC born infections are on the rise...  we will see this due to "global warming" trend" over a very large area.
 
 
In full here...
 
 
Excerpt...
 

Tick-borne encephalitis

  Vector-Borne Viral Infections
- Disease Burden
- Vaccine
- WHO Encephalitis homepage
 
 

Disease Burden

The endemic area for tick-borne encephalitis (TBE) spreads from Alsace-Lorraine in the west to Vladivostok and north-eastern regions of China in the east, and from Scandanavia to Italy, Greece and Crimea in the south. TBE also is endemic in North Japan, where the virus has repeatedly been isolated

from blood samples of sentinel dogs, ticks, and rodent spleens. TBE is a serious acute central nervous system infection which may result in death or long-term neurological sequelae in 35–58% of patients.
 
The fatality rate associated with clinical infection is 0.5–20%. The proportion of cases involving subclinical infection varies between 70% and 98%. Symptomatic infection occurs in all age groups.
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2006 at 9:44pm
Thanks to everyone - you're all great AFT detectives.Cool
 
One thing I noticed when we were looking into the other story about Nepal, was that "mysterious illness" is used pretty losely in the media over there  (of course, that's just the kind of language that makes all of us sit up straight in our chairs).  We need to keep an eye on countries like this, but also realize that the "mysterious illness" label means something different over there than it does here or in other developed nations. The healthcare system is extremely poor in Nepal, which makes it possible for diseases to go undiagnosed, if not untreated.  Just recently,  alot of health care workers went on strike and they had to close several dozen facilities temporarily.  There were also stories from recent years about the Maoist rebels targeting the infrastructure (even water treatment).
 
A sad story for such a beautiful country. I never realized there are so many countries like Nepal and Indonesia that are living in these conditions.
 
 
Some statistics:
 
According to the Human Development Report 2004, Nepal ranks 140th out of 177 nations on the Human Development Index. The country features in the ‘low human development’ category with respect to most of the indicators with a significant portion of the population (over 80 percent) surviving on less than $2 per day (OCHA, 2002).
Not only poor infrastructure but also the security situation has made it difficult to reach remote districts and has restricted the collection of humanitarian data. Frequent general strikes and blockades have seriously hampered movement in the country.
As a result of household food shortages, diseases, environmental conditions, and inadequate care and feeding practices, malnutrition is prevalent. Approximately 50% of Nepalese children are stunted, 48% are underweight and 10% are wasted
The state of sanitation is poor and no significant statistical improvements are identifiable during the previous decade. Only 27% of rural households have access to adequate sanitation. In the urban areas the coverage is 75%.
The most prominent diseases such as diarrhoeal disease, dysentery, cholera and typhoid are associated with poor sanitation, lack of hygiene and contaminated water supplies. Other outbreaks concern vector-borne diseases such as malaria, Japanese encephalitis and kala-azar (visceral leishmaniasis). The seasonal trend is that most outbreaks occur from March to October and peak in the rainy season from June to August. Moreover, outbreaks of ARI are common during the cold season.
 
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 23 2006 at 5:51am
Truly exceptional teamwork on this one and some really impressive and valuable data. Avian, the most serious high path, took several years of mixing in China, before it became a serious threat. No doubt there are numerous pockets and breeding grounds for a potential Pandemic. Thanks to all for helping research this one. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 23 2006 at 7:18am
Originally posted by dwmoskowitz dwmoskowitz wrote:

Our approach to West Nile virus encephalitis should work well for Japanese encephalitis, or avian flu encephalitis, for that matter.
 
I'd be happy to email the trial documents to anybody who wants them. If you need them in a hurry, just download the WNV trial documents from our website, www.genomed.com. The treatment is exactly the same.
 
I think we may well have a general viral antidote.


This is good to know. The idea there is an anti-viral that will work and is in use is reassuring. As has been commented on, it would have been appropriate to state the exact medicine in use. Thanks much and heading for the website.

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I'd be happy to discuss the meds involved with anybody who has a question. But I'd like people to start at our website. To download the protocol, which is completely free, you have to provide an email address. That way, I can at least try to keep track of who's using our protocol. We need to capture any data produced with our protocol.
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"Our business is public health(TM)"
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Nepal health officials rule out outbreak

August 22, 2006

KATMANDU, Nepal --Nepalese health officials ruled out Tuesday a mysterious disease outbreak in a mountain village, saying seven people who died there in less than two weeks had died of a variety of causes.

 
On Saturday the Kathmandu Post reported 14 unexplained deaths in Betini, Nuwakot district, sparking concerns that a deadly disease had struck the village, possibly bird flu. The report said the disease first struck dogs and chicken in June.

Two teams of health workers were sent from a district hospital to investigate the deaths in Betini, about 30 miles northwest of the capital Katmandu, but found no mysterious outbreak, Bikash Lamichane, a doctor at a local hospital said on the telephone Tuesday

The health workers discovered that only seven had died, five of chronic diseases including asthma and kidney problems, and two of diarrhea, Lamichane said.

There are not many hospitals or doctors in the villages in Nepal and patients in the mountainous region have to walk for hours if not days to reach the nearest road to get to a hospital

 
"In a time of universal deceit, telling the truth is a revolutionary act."   G Orwell
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 23 2006 at 1:01pm
It seems that a lot of the trouble is TICS. 
 
And guess what...  TICS  RIDE BIRDS ALL OVER THE WORLD.
 
Do TICS have H5N1???
...............................................
 
A voice in my head said... Move Away from the Coast.
......................................
As much as I love the country up that way...I had to cross Nepal off my list of places to visit... guess I won't be visiting any country on a latitude south of Bath Maine.
 
After reading all this-
An Excerpt-
 
 
 
Treatment
 
When a case of ehrlichiosis is suspected, treatment should be started immediately. A typical candidate for treatment is somebody with a flu-like illness who has leukopenia and thrombocytopenia and who has had potential exposure to ticks in an endemic area, especially between April and September.

The best drug is doxycycline, 100 mg twice daily for 10 to 14 days given orallyor intravenously. Chloramphenicol, the rifamycins, and some of the newerquinolones may be active against some or all ehrlichial infections, but clinical experience with these agents is limited.
Prevention
This is a tick-borne illness that can be prevented by insect bite prevention measures, as outlined in Chapter 7.  (no wonder they are now spraying)
 
OTHER TICK-BORNE DISEASES IN THE USA
...................................................................
Lyme disease (Chapter 10) and ehrlichiosis are not the only illnesses transmitted
by ticks in the United States.
 
Rocky Mountain spotted fever,
 
Colorado tick fever,
 
tick paralysis,
 
tularemia,
 
babesiosis, and
 
relapsing fever
 
are some of the other
important diseases.
 
A summary of the tick vectors that spread these diseases and
their geographic distribution appears on the following page.
 
..............
 
 
Here are the little Darlings....
 
 

Important Ticks in the USA

...........................................
 
The deer tick (Ixodes scapularis) is found in great abundance from Virginia

to Maine, as well as in Wisconsin and Minnesota, while its first cousin

the western deer tick (Ixodes pacificus, the black-legged tick) is active

along the West Coast. The deer tick is a very small tick, much smaller than

the dog tick or wood tick. Deer ticks, both adults and nymphs, are dark

reddish brown and have black legs and a pear-shaped body. All stages,

especially nymphs and adults, feed on people. The deer tick is the most

important carrier of Lyme disease and is the only known carrier of babesiosis.

It is also the primary transmitter of human granulocytic ehrlichiosis.

The American dog tick (Dermacentor variabilis) is widely distributed

in the eastern half of the United States and is also found on the West Coast.

It resembles the wood tick in appearance. The unfed female has silverygray

markings on the shield on her back; the rest of the body is reddish

brown. It is bigger than other ticks—approximately one-eighth inch to onequarter

inch long—and although it prefers dogs, it does bite people. The

dog tick is the most important transmitter of Rocky Mountain spotted fever.

It also transmits tularemia and probably transmits human granulocytic

ehrlichiosis. The dog tick can cause tick paralysis.

The Rocky Mountain wood tick (Dermacentor andersoni) is a hard tick

that resembles the American dog tick and the Pacific Coast tick. The female

has silvery-gray markings on the shield on her back; the rest is reddish

brown. This tick is the prime carrier of Rocky Mountain spotted fever in the

West, and it also transmits tularemia and Colorado tick fever (mountain

fever). It is the most important cause of tick paralysis in the United States.

The Lone Star tick (Amblyomma americanum) is found throughout the

southeastern United States, with a high density in the Ozarks. Adults are

about one-quarter inch long; nymphs, which are the most aggressive biters,

are pinhead size. The ticks are reddish brown, and the female has a

white mark on the middle of her back. The smaller male has lacy white

markings on the rear edge of his back. Lone Star ticks transmit monocytic

ehrlichiosis, tularemia, and probably a variant form of Lyme disease.

Relapsing fever ticks (Ornithodoros hermsi, O. parkeri, O. talaje, O.

turicata) are soft ticks that transmit relapsing fever, a spirochetal disease.

Their bites can be painful. Relapsing fever ticks are widely scattered west

of the Mississippi River. Adults are oval-shaped and colored gray to pale

blue. Larvae and nymphs are gray.

The brown dog tick (Rhipiceohalus sanguineus) is found throughout

the United States wherever you find dogs. Although suspected of carrying

ehrlichiosis, these ticks are probably not disease transmitters. The male is

uniform dark brown. The female is brown but the shield on her back is

darker than the rest of her body.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 24 2006 at 5:26am
Originally posted by Mahshadin Mahshadin wrote:

Nepal health officials rule out outbreak

August 22, 2006

KATMANDU, Nepal --Nepalese health officials ruled out Tuesday a mysterious disease outbreak in a mountain village, saying seven people who died there in less than two weeks had died of a variety of causes.

 
On Saturday the Kathmandu Post reported 14 unexplained deaths in Betini, Nuwakot district, sparking concerns that a deadly disease had struck the village, possibly bird flu. The report said the disease first struck dogs and chicken in June.

Two teams of health workers were sent from a district hospital to investigate the deaths in Betini, about 30 miles northwest of the capital Katmandu, but found no mysterious outbreak, Bikash Lamichane, a doctor at a local hospital said on the telephone Tuesday

The health workers discovered that only seven had died, five of chronic diseases including asthma and kidney problems, and two of diarrhea, Lamichane said.

There are not many hospitals or doctors in the villages in Nepal and patients in the mountainous region have to walk for hours if not days to reach the nearest road to get to a hospital

 


These people are definitely going to have to get a new PR person and publicist. The original strange article with the 14 deaths and the subject of a massive thread on here is not the current topic. It is truly strange that we are hearing a mirror release months later to an entirely different situation in which there are considerably more documented deaths occuring.

Time to reconnect and check on the progress of the "non-existent" outbreak in Nepal.
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    Dr. Moskowitz,

I would greatly appreciate your sharing with me your protocol to treat BF. I have been following this site for some time, and am so grateful to all of you for this most important information. What do you think of Sambucol (Elderberry extract)? I have seen it recommended, but am worried that it increases the cytokine storm. Also, an RN who treats ARDS patients rec'd keeping patients on the "dry side", and not pushing too many fluids. Your thoughts, please? Thank you in advance!!!   
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Thanks so much for your interest.

As I mentioned above, anybody at all can download our protocol for bird flu for free. Just go to our homepage (www.genomed.com), and scroll down to the bottom half of the page. There's a link for "Avian influenza trial," just below the link for "West Nile virus trial." Both protocols are the same, because we think the blood pressure drugs we use may be a general viral antidote.
 
I know nothing about elderberry: either what might be in it, or how it might work. Decreasing the cytokine storm seems the best way to fight most, if not all, viruses, so I would be leery of something that could increase it.
 
Interferon was used for SARS, and didn't work at all.
 
Virology is in transition. Since Jenner's smallpox vaccine 300 years ago, doctors have wanted to amplify the immune response. Now it turns out that what's killing people is their own overactive immune response. Virologists are finding it hard to believe, although there is a vanguard (Cathy Laughlin at the NIAID, Malik Peiris in Hong Kong, Terence Stumpey at the CDC) who believe it's the host's immune response at fault, not the virus.
 
Best regards,
Dave
David W. Moskowitz MD
CEO & Chief Medical Officer
GenoMed, Inc.
"Our business is public health(TM)"
St. Louis, Missouri, USA www.genomed.com
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 26 2006 at 4:49am
Originally posted by dwmoskowitz dwmoskowitz wrote:

 
Interferon was used for SARS, and didn't work at all.
 
Virology is in transition. Since Jenner's smallpox vaccine 300 years ago, doctors have wanted to amplify the immune response. Now it turns out that what's killing people is their own overactive immune response. Virologists are finding it hard to believe, although there is a vanguard (Cathy Laughlin at the NIAID, Malik Peiris in Hong Kong, Terence Stumpey at the CDC) who believe it's the host's immune response at fault, not the virus.
 
Best regards,
Dave


Just a few med geek comments:

In laymen's terms, the T-Cells and immune system gets dumb as you get older. It loses the ability to identify through markers or whatever what is you and what is not. The root of most diseases is self attack by the immune system. So many conditions are auto-immune and damage caused by free radicals - this is where a lot research should be headed.

You know those little mitochondria back in some distant age decided to migrate and become cellular symbiotic organs and cells are kind of a group effort after several million years.

The protein folding deal with the ideal 3d configuration slipping, etc. Well, people are on this stuff. Now the nasty part is there is a program here. It is not accidental. As genetic husks, we turn ourselves off, and the wheels kick in to clear the planet for the next generation.

Over reaction to the attack - like analphylactic shock sets the stage for system collapse and death. But of course if you immuno-suppress - it's open season for the hundreds of flora already there to grow. Typical AIDS patient.

It is great to have you here. Now if we can get away from Lancet and Journal of medicine being 50% drug ads, maybe we can make some progress.
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