Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]
<https://www.newindianexpress.com/cities/vijayawada/2019/nov/30/state-records-14-swine-flu-deaths-this-year-2069229.html>

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.

3rd December 2019
https://watchers.news/2019/12/03/at-least-25-dead-as-days-of-heavy-rain-hit-tamil-nadu-india/

At least 25 people were killed in various rain-related incidents in Tamil Nadu, India since November 29, 2019. 17 of the victims died after a wall collapsed following a continuous heavy downpour in Coimbatore on Monday morning, December 2.

Among the fatalities were 10 women. Around 1 305 huts and 465 tiled-roof houses were damaged, while 1,000 people were evacuated to government relief centers in Tuticorin, Cuddalore, and Tirunelveli districts as the north-east monsoon intensifies.

Schools remain closed on Monday including those in the districts of Chennai, Chengalpet, Kancheepuram, Tiruvallur, Cuddalore, and Tuticorin, as the areas received 90 mm (3 inches) rain in the past 36 hours.

A flood alert has been issued to residents near the banks of Bhavani River in this western district of Tamil Nadu as a dam built across it has burst in the wake of torrential rains in catchment areas, officials said on Monday.

Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]
<https://stockdailydish.com/encephalitis-claims-73-lives-in-bihar/>

Bihar Health Minister Mangal Pandey on [Sat 30 Nov 2019] said the state government is doing its best to save children, as the death toll due to acute encephalitis syndrome [AES] in Muzaffarpur mounted to 73.

Pandey said doctors and nurses are being called in from Patna for additional help. "We are trying everything and anything that can save children's lives. Everything is being made available from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna," he said. "There is a protocol regarding what kind of medicines and facilities should be given and we are doing the same. We are monitoring things regularly and trying to save our children."

Recalling the situation that prevailed 5 years ago, Pandey said a team that was formed to ascertain the cause of this disease concluded that sleeping empty stomach at night, dehydration due to humidity and eating lychee on empty stomach were some of the causes of encephalitis.

"Our government has tried to spread awareness which will be beneficial as well. Advertisement in newspapers, radio jingles, pamphlets and mic [microphone] announcements are going to spread awareness regarding the disease. Health ministry is also working on it," he said.

On being asked about spread of ASE in Gorakhpur last year [2018], he said, "From Gorakhpur to Muzaffarpur region, this disease had spread last year and the Union government had worked on this and we will continue to fight it now."

"This incident in Muzaffarpur is very saddening and we also feel bad when children of our nation die like this. Not the whole district is affected but a large part is suffering from it," he added.

From [1 Jan 2019], until now [5 Dec 2019], 220 children were admitted in Sri Krishna Medical College and Hospital in Muzaffarpur due to AES, out of which 62 lost their lives.

As per the data of SKMCH hospital, 235 children were admitted, of which 89 died; in 2013 - 90 children were admitted, of which 35 died; in 2014 - 334 children were admitted, of which 117 died; in 2015 - 37 children were admitted, of which 15 died; in 2016 - 31 children were admitted, of which 6 died; in 2017 - 44 children were admitted, of which 18 died; and in 2018 - 43 children were admitted, of which 12 died.

Meanwhile, Minister of State for Union ministry for home affairs, Nityanand Rai, visited Sri Krishna Medical College and Hospital to review the situation after the outbreak of AES.

Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks.
======================
[The dates within which these AES cases have occurred is not stated. The urgency that has prompted Behar health officials to request the aid of physicians and nurses from adjoining Patna suggests that the AES outbreak is going on currently. The uncertainty about the etiology of AES continues. It is curious that the above report makes no mention of negative or positive tests for Japanese encephalitis among the AES patients, although that virus is endemic in northeastern India, including Bihar state. Neighboring Uttar Pradesh state has had JE cases as well this summer (2019) but has intensified its JE vaccination program.

The issue of the aetiology of AES has been under discussion for a long time. Lychee fruit contain toxins. Encephalopathy and hypoglycaemia have been associated with consumption of lychee fruit contains phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. http://promedmail.org/post/20150201.3132842). However, the current cases cannot be due to lychee consumption, since the season for that fruit has passed.

AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible.

Reference:
Ravi V, Hameed SKS, Desai A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019;84 Suppl:19-24. <https://doi.org/10.1016/j.ijid.2019.01.008>.

Available at:
<https://www.ijidonline.com/article/S1201-9712(19)30019-0/pdf> - ProMED Mod.TY]

[Maps of India:
<http://www.mapsofindia.com/maps/india/india-political-map.htm> and
HealthMap/ProMED maps available
at:<http://healthmap.org/promed/p/364>, and Bihar, India:
<http://healthmap.org/promed/p/46246>]
Date: Tue 26 Nov 2019
Source: Millennium Post [edited]
<http://www.millenniumpost.in/kolkata/health-dept-calls-for-tighter-vigilance-in-light-of-scrub-typhus-scare-387709>

Taking a serious note of reports of scrub typhus from some parts of the state [West Bengal], the state health department has directed chief medical officers of health (CMOH) of all districts to be alert and vigilant and send details of all cases to the department. "Scrub typhus is a disease that can be treated with antibiotics if it is detected early. So, early detection is of the utmost importance. We have directed all hospitals to conduct blood tests if fever continues for a period of 5 days in a patient," a senior official of the state health department said.

The department has now equipped 19 hospitals across the state with facilities of kits for blood tests related to scrub typhus. The School of Tropical Medicine has been conducting blood tests related to the disease for many years. "If a patient is diagnosed with the disease, then the doctors have been advised to start treatment immediately," the official added.

According to sources in the health department, the Institute of Child Health (ICH) in Park Circus has had 300 cases of scrub typhus since August this year [2019]. The ICH has sent details of all these cases to the department.
======================
[The laboratory method by which the diagnosis of scrub typhus was made in these patients is not stated. Scrub typhus presents clinically with chills, fever, headache, muscle pain, and sometimes with a macular or maculopapular rash and eschar at the site of the chigger bite; confirmation requires laboratory testing, usually by indirect fluorescent antibody (IFA) assay, but this will require a 4-fold rise in antibody titre between acute and convalescent specimens. Results from a single acute serum sample are unreliable, as it takes 7-10 days for IgG antibody to be detectable, and antibody will be present in a high percentage of healthy people in an endemic region. The Weil-Felix test is unreliable (<https://www.ncbi.nlm.nih.gov/pubmed/16941792>) and molecular methods like polymerase chain reaction (PCR) may not be available in endemic regions.

ProMED-mail has posted multiple reports of scrub typhus in several Indian states in the past, especially since 2011. For background information, see ProMED-mail post Scrub typhus - India (05): background http://promedmail.org/post/20111208.3546.

Kolkata, formerly known as Calcutta, with a population of 4.5 million residents in 2011, is the capital of the Indian state of West Bengal; it is the principal commercial, cultural, and educational centre of East India (<https://en.wikipedia.org/wiki/Kolkata>).

Kolkata can be found on a map of West Bengal at
<https://www.google.com/maps/place/Kolkata,+West+Bengal,+India>. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
West Bengal State, India: <http://healthmap.org/promed/p/323>]
Date: Mon, 2 Dec 2019 09:33:36 +0100 (MET)

Chennai, India, Dec 2, 2019 (AFP) - A menacing white foam covered one of India's most famous beaches in Chennai for the fourth straight day Monday creating a new pollution hazard for the country.   Children have been playing and taking selfies in the clouds of white suds on Marina Beach, even though they give off an acrid smell and fishermen have been told not to go into the sea nearby.   Doctors have warned that skin problems could be caused by the foam, which forms every monsoon season but has been particularly bad this year.    Word has not got through to the hundreds of families who throng India's longest urban beach, letting children happily skip in the toxin-filled froth.

The Tamil Nadu Pollution Control Board said it is analysing samples from the foam which has spread several kilometres along the beach.   "It is definitely not good for people to go into the foam but they just do not understand the risks," said Pravakar Mishra, a scientist at the National Centre for Coastal Research in Chennai who has seen the clouds of foam grow in recent years.   Authorities were also on alert for a repeat of a 2017 incident when thousands of fish were killed by pollution that hit beaches around the same time.

Fisherman Jeyaseelan, 30, said customers do not want to buy even the small amount of fish he has been able to catch in recent days.   "Everyone thinks it is contaminated," he said. "My wage has been cut to next to nothing."    Marina Beach has been a centrepiece of Chennai life for more than a century. At weekends, tens of thousands fill the once-pristine sands where the pollution is another sign of India's struggle to keep up with its growing economy.   Experts blame heavy rain in recent days that has carried untreated sewage and phosphate down to the sea.   According to Mishra, much of the foam comes from washing detergent residue that mixes with other waste.

Only 40 percent of sewage in Chennai and other big cities gets proper treatment, the researcher added.    "The rest flows into the sea and this is what happens."   Mishra is setting up a buoy to monitor pollution levels in the sea just as Delhi now has a network of monitoring stations for its notoriously dirty air.   "Pollution is now a bigger threat to India's beaches than the rising seas," said Mishra, highlighting the sewage, micro plastic that is killing fish and the bags and cups that cover the sand.   Mishra said volunteers had collected nearly a tonne of plastic and other waste in just two hours at a Chennai beach during a recent cleanup.
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