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A New Way To Make The Most Powerful Malaria Drug

In Malaria, Uncategorized on April 15, 2013 at 10:39 am

 

An extract of sweet wormwood has been used in China for thousands of years to treat malaria, but being able to make mass quantities of the extract has been elusive, until now.

An extract of sweet wormwood has been used in China for thousands of years to treat malaria, but being able to make mass quantities of the extract has been elusive, until now.

Researchers in California described Wednesday their new method for mass-producing the key ingredient for the herbal drug artemisinin, the most powerful antimalarial on the market. Already, the French drugmaker Sanofi is ramping up production at a plant in Italy to manufacture the ingredient and the drug.

Global health advocates say they expect this new method of producing artemisinin will at last provide a stable supply of the drug and cut the overall cost of malaria treatment.

Up until now, artemisinin has only been available commercially as an extract of the relatively scarce sweet wormwood plant. As global demand for the drug has climbed in the past decade, the price of that extract has been highly erratic. Between 2003 and 2004, the price of the compound jumped from just over $100 a pound to almost $550. By 2007, artemisinin prices had crashed. Then, two years later, prices almost doubled.

http://www.npr.org/blogs/health/2013/04/10/176807016/a-new-way-to-make-the-most-powerful-malaria-drug

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Citing Malaria, Natalie Gulbis withdraws from Founders Cup

In Malaria, Uncategorized on March 24, 2013 at 12:29 pm
Natalie Gulbis

Natalie Gulbis withdrew from the RR Donnelley LPGA Founders Cup in Phoenix Tuesday night with her management team confirming that she contracted malaria while on the tour’s Asian swing.

Gulbis first became ill playing the HSBC Women’s Champions in Singapore two weeks ago. She withdrew after the first round with her team reporting she was being medically treated for flu-like symptoms, but had not been diagnosed with malaria.


 

“Natalie originally became ill in Singapore and she was treated and medically cleared to fly home,” according to a statement released jointly by the LPGA and IMG, Gulbis’ management company. “Natalie continues to be treated at home and is expected to be at full strength in three weeks. Natalie’s well-being is a top priority for both the LPGA and IMG, and steps continue to be taken to ensure the well-being of Natalie and all the players on the LPGA Tour now and for future events. LPGA doctors have been consulted and believe she is on appropriate medications, under great care, and her prognosis is excellent.”

According to the Center for Disease Control, malaria is a “serious and sometimes fatal disease,” if not treated properly. It’s caused by a parasite that infects a certain kind of mosquito that feeds on human beings. The CDC reports that about 1,500 cases of malaria are diagnosed in the United States each year with the vast majority among travelers and immigrants returning from parts of the world where malaria transmission occurs, including South Asia.

The LPGA reports that tournament founding partner Scottsdale Healthcare will be on-site in Phoenix Wednesday to provide a blood draw for players, caddies and family members wishing to be screened.

http://www.golfchannel.com/news/golftalkcentral/citing-malaria-gulbis-withdraws-from-rr-donnelley/?cid=email_WendesdayNL_20130313

Relentless spike in dengue cases alarming in Borneo

In Dengue Fever, Uncategorized on February 18, 2013 at 7:17 pm

by Jonathan Chia, reporters@theborneopost.com. Posted on February 19, 2013, Tuesday

Read more: http://www.theborneopost.com/2013/02/19/relentless-spike-in-dengue-cases-alarming/#ixzz2LIdW4A2Q

342 cases reported so far this year, number more than double that of same period last year

KUCHING: Dengue cases continue to soar statewide with 86 cases reported from Feb 6 till yesterday, and only Selangor has more cases in the nation so far this year.

Combined with the 256 cases reported from Jan 1 till Feb 5, the total number of 342 cases has more than double the total reported during the same period last year.

State Health Department director Datu Dr Zulkifli Jantan, when contacted yesterday, said there were only 158 cases during the corresponding period last year.

“As of now, Sarawak remains the state with the second highest number of dengue cases reported, after Selangor.”

Concern over the rising number of dengue cases was highlighted by the Health Department’s deputy director (Public Health) Dr Jamilah Hashim at the launching the state-level SC Johnson Anti Aedes Inter-School Rangers Competition at SMK Matang Jaya here two weeks ago.

She had said that as of Feb 5, 2013, a total of 256 dengue cases were reported, as compared to 84 cases during the same period last year.

Dr Jamilah added that the state registered 1,519 dengue cases last year, which was the fifth highest nationwide.

“The dengue cases started to increase in August last year and it continue to climb until today
(Feb 5). If we look at the data from our daily surveillance, the acceptable number of cases by the Ministry of Health for a week is only 30 cases, but since August, we have breached that number.”

She disclosed that the ministry had issued an instruction to the department to reduce the number of cases to below 30 cases per week by Feb 13.

Dr Jamilah said in order to win the war against dengue, everyone had to play their roles in preventing the breeding of dengue mosquitoes.

“We really need the people to inspect their house compounds, just 10 minutes per week. Aedes mosquito’s life cycle is just one week so if we can tackle that one week cycle then we will be able to break the life cycle and it will not grow to be Aedes.”

Read more: http://www.theborneopost.com/2013/02/19/relentless-spike-in-dengue-cases-alarming/#ixzz2LIdBeMx3

Dengue spreading fast, says WHO

In Dengue Fever, Uncategorized on January 21, 2013 at 8:35 am

January 20, 2013 in Health & Fitness

Dengue is the world’s fastest-spreading tropical disease and represents a “pandemic threat,” infecting an estimated 50 million people across all continents, the World Health Organisation (WHO) said on Wednesday.

Report by Reuters

Transmitted by the bite of female mosquitoes, the disease is occurring more widely due to increased movement of people and goods — including carrier objects such as bamboo plants and used tyres — as well as floods linked to climate change, the United Nations agency said.

The viral disease, which affected only a handful of areas in the 1950s, is now present in more than 125 countries — significantly more than malaria, historically the most notorious mosquito-borne disease.

The most advanced vaccine against dengue is only 30% effective, trials last year showed.

“In 2012, dengue ranked as the fastest spreading vector-borne viral disease with an epidemic potential in the world, registering a 30-fold increase in disease incidence over the past 50 years,” the WHO said in a statement.

Late last year, Europe suffered its first sustained outbreak since the 1920s, with 2 000 people infected on the Portuguese Atlantic island of Madeira.

Worldwide, two million cases of dengue are reported each year by 100 countries, mainly in Asia, Africa and Latin America, causing 5 000 to 6 000 deaths, said Raman Velayudhan, a specialist at the WHO’s control of neglected tropical diseases department.

But the true number is far higher as the disease has spread exponentially and is now present on all continents, he said.

“The WHO estimates that on average about 50 million cases occur every year. This is a very conservative estimate,” Velayudhan said, adding that some independent studies put the figure at 100 million.

“Dengue is the most threatening and fastest spreading mosquito-borne disease. It is pandemic-prone, but it is a threat only. Definitely a bigger threat now than ever,” he said

Malaria caused more deaths but was on the decline, affecting fewer than 100 countries.

Speaking to a news briefing after the WHO released a report on 17 neglected tropical diseases affecting 1 billion people, Velayudhan said: “The mosquito has silently expanded its distribution.

“So today you have [the] aedes mosquito in over 150 countries. The threat of dengue exists all across the globe.”

In Europe, the aedes mosquitoes that cause both dengue and chikungya disease have spread to 18 countries, often via the importation of ornamental bamboo or second-hand tires, he said.

“But we are trying to address this in a more systematic way, by controlling entry of vectors at points of entry — seaports, airports, as well as the ground crossings,” Velayudhan said, noting that it was hard to detect mosquitoes and their eggs.

The WHO also said it aimed to eliminate globally two neglected tropical diseases, dracunculiasis, known as guinea worm disease, in 2015, and yaws, or treponematoses, in 2020.

Symptoms of dengue

Dengue causes flu-like symptoms that subside in a few days in some sufferers. But the severe form of the disease requires hospitalisation for complications, including severe bleeding, that may be lethal.

There is no specific treatment but early detection and access to proper medical care lowers fatality rates below 1%, according to the Geneva-based WHO.

“You have to bear in mind that it has no treatment and vaccines are still in the research stage,” Velayudhan said.

The most advanced, being developed by French drugmaker Sanofi SA, proved only 30% effective in a large clinical trial in Thailand, far less than hoped, according to results published in September.

But researchers said it did show for the first time that a safe vaccine was possible.

Dengue, aka “Breakbone Fever,” Is Back in Florida

In Dengue Fever, Uncategorized on December 31, 2012 at 9:28 am
The vicious virus has re-established itself in the South, and mosquitoes are carrying it north.

By |Posted Friday, Dec. 21, 2012, at 11:14 AM ET

Tiger mosquito.

Asian tiger mosquitos, like the one seen above, can carry dengue fever and have been seen as far north as Chicago

Photo by Roger De Marfé/iStockphoto/Thinkstock.

In the autumn of 1885, people in Austin, Texas, began to feel sick. One after another, they developed a chill and then a soaring fever. They vomited and broke out in rashes. Their most distinctive symptom was agonizing pain behind their eyes and in the bones of their arms and legs. And when the fever subsided, lack of appetite and deep exhaustion left them unable to work for weeks or months.

Austin had been founded only 46 years before, and it was still small, with just 22,000 people. By the time the epidemic was over, 16,000 of them had fallen ill. A local doctor who described the outbreak in the Journal of the American Medical Association the following year added: “I am informed that other cities … had as many cases in proportion to the population as did Austin.”

The illness that took out Texas that fall had already devastated Charleston, S.C., in 1828and Savannah, Ga., in 1850, and it would go on to sicken half the population of Galveston, Texas, in 1897; one-quarter of Monroe, La., in 1922; and one out of every nine people in Miami in 1934. It was dengue—a mosquito-borne virus popularly known as “breakbone fever” for the pain it caused. From the 1820s to the 1940s, it caused recurring epidemics roughly every 10 years.

World War II mosquito-eradication programs broke the chain of transmission between humans and insects, and by the time the war ended, dengue had retreated to the tropics and was no longer a problem in the United States.

That may be about to change. At the annual meeting of the American Society of Tropical Medicine and Hygiene last month, researchers from the University of Florida revealed thatdengue has reappeared in Key West, Fla. The virus they found was not a one-time visitor imported by a tourist or a stray mosquito; it has been on the island long enough to become a genetically distinct, local strain.

The Florida researchers didn’t want to talk about their presentation because they hope to get it published soon in a medical journal. But it turns out other tropical-disease experts have been watching dengue’s return to the United States for a while and wondering what it will mean.

“It really is just a matter of time until dengue re-establishes itself in certain areas here,” says Amesh Adalja of the Center for Biosecurity of the University of Pittsburgh Medical Center. “The U.S. has been lucky that it has escaped so far.”

Dengue is already a pandemic elsewhere. Among insect-borne diseases, malaria gets the headlines: It causes about 219 million cases per year and about 660,000 deaths. But dengue is right behind it, racking up potentially 100 million infections per year around the world and putting about 500,000 people in the hospital, most of them children. It causes fewer deaths—25,000 per year—than malaria, but its prolonged illness keeps people from working and depresses both personal incomes and gross national product.

Dengue is also becoming more common. Between World War II and about 1970, severe dengue epidemics were recorded in only nine tropical countries; now the disease occurs routinely in more than 100. The primary driver has been the growth of slums as people leave rural areas to search for work. When migrants settle at the fringes of a city, they are beyond the reach of its infrastructure—water lines, sewer systems, and trash disposal—and they cope by digging latrines, storing water in jugs and barrels, and consigning trash to open dumps. All of those strategies create small pools of stagnant liquid, exactly the kind of habitat that the main dengue-carrying mosquitoes prefer. (The pools can be very small, less than an ounce.)

Dengue infects only humans and other primates—there is no intermediate host that harbors it, such as birds for West Nile virus—and people are its main vehicle for moving around the globe. After a bite, the virus replicates in the blood for four to seven days; once the fever starts, there are at least two and up to 10 days when the victim can cause an infection in the next mosquito that bites him or her. In the two weeks between the initial bite and the end of the infectious stage, a traveler can unknowingly transport the virus from an area where it is common—a marketplace in Singapore, a river terrace in Thailand, a beach in the Caribbean—to somewhere it has never been before.

The Centers for Disease Control and Prevention estimates that more than 2,700 peoplebetween 1977 and 1995, and more than 360 between 2001 and 2004, had that experience: being bitten somewhere, coming home, and getting sick afterward. In most cases, the disease went no further, but sometimes it kept spreading. There was a 122-person outbreak in Hawaii in 2001, the first time the virus had been seen in the islands since 1944. There were 25 cases in Brownsville, Texas, in 2005 and 90 cases in Key West between 2009 and 2010. In the last case, the outbreak extended over the winter, when cooler temperatures should have knocked out local mosquitoes.

“That was the winter when the H1N1 pandemic flu was circulating, and whatever dengue cases we had would have been masked by that and went unrecognized,” says Danielle Stanek of the Florida Department of Health. “When the flu settled down and we realized there were still dengue cases, that was a wake-up call for us.”

Local spread of dengue is still happening in Florida. On Key West, 5 percent of people show immunologic evidence of having had a dengue infection, and the disease is found farther north as well. This year, four residents caught “locally acquired” dengue, two in Miami and two near Orlando, Fla. Another 112 were diagnosed with dengue they had caught somewhere else and brought there.

The CDC’s experts assume there are more cases that haven’t been counted, and not just in Florida. “When you’re seeing a patient early on, dengue looks like a lot of other acute (fever-causing) illnesses,” says Kay Tomashek, chief of epidemiology in the agency’s dengue branch. “If you are a physician in New York and you see a patient with fever, headache, and muscle pain, you might not be thinking about that.”

Detecting imported cases is important because the more frequently the disease comes across the border, the more risks from it increase. And not just the risk of catching the disease. There are four types of dengue, distributed unevenly across the tropics and subtropical zone. Becoming infected with any one causes the classic breakbone fever. But if you acquire and recover from one type and then contract a different type even years later, you are more likely to develop the disease’s worst version, dengue hemorrhagic fever. DHF disrupts the circulation, sends patients into shock, and kills up to 1 in 5.

The U.S. outbreaks to date, as well as the locally adapted Key West strain, are all caused by the first type, known as DEN-1. But 10 of the imported cases in Florida this year were in tourists from Central and South America, where DEN-2, DEN-3, and DEN-4 circulate as well.

Could more dengue outbreaks happen? To spark one, you need three things. First, imported virus: check. Second, a population with no immunity. The United States has that, since dengue was last widespread in the 1940s. And third, mosquitoes that can transmit it. Those are already widespread.

The spraying campaigns that ended U.S. epidemics of malaria and dengue in the 1940s turned out to be only a temporary solution. National eradication programs petered out in 1972, and the main dengue vector, Aedes aegyptiquickly returned; it is now in 23 states and ranges as far north as New York City. In 1985, a second species that can spread dengue—Aedes albopictus, better known as the Asian tiger mosquito—arrived in Texas in a shipment of used tires from the Pacific Rim that had been stored outdoors and held puddles of rainwater. It is now in 26 states and has been found as far north as Chicago.A. albopictus is what entomologists call a “less competent” vector; it doesn’t spread the disease as efficiently as A. aegypti does. But it has other abilities that have huge significance for disease transmission: It bites all day long, not just at dawn and dusk, and it can survive both winter temperatures and drought.

Because there is no vaccine for dengue, the best hope of stopping its advance relies on individual action, such as getting people to wear repellent and persuading them to scour their homes and properties for small puddles—underneath a planter, inside a tiki torch—after every rain. Or convincing them to stay inside. Researchers theorize the 2005 Brownsville outbreak was smaller than the 2009 Key West because of the “Texas lifestyle” of sealed, air-conditioned houses—so different from the patio culture of Hawaii and Key West.

It’s impossible to say, at this point, if climate change will move the risks of dengue farther north. Researchers disagree on whether higher temperatures automatically mean bigger mosquito populations, since the insects are also affected by unpredictable changes in rainfall, humidity, and wind. But barring some other factor that no one can foresee, the experts agree: Dengue is coming.

“It may not swamp the entire U.S.,” Adalja acknowledged. “But the entire South already harbors those mosquitoes, and that is bad enough. Dengue shouldn’t have to swamp the entire country for us to make it a priority.”

Malaria Re-appears in Greece

In Malaria, Uncategorized on November 15, 2012 at 9:48 am
The Wall Street Journal
HEALTH INDUSTRY
Updated November 14, 2012, 4:07 a.m. ET

Health Scourge Hits Greece

Malaria, Once Mostly Eradicated, Returns as Crisis Erodes Government Safety Net

By ALKMAN GRANITSAS

SKALA, Greece—Manolis Giannakakos doesn’t remember how he got to the hospital. What he does recall is a searing pain that felt like someone was driving screws into his skull and then violent chills and delirium.

image

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Doctors told the 56-year-old math teacher in this small town near Sparta he had a dangerous disease mostly eradicated from Greece in 1974: Malaria.

“When I was still in grade school I remember this was a big problem,” Mr. Giannakakos said. “But never in my life did I believe it would return.”

Over the past two years, more than 50 endemic cases of the mosquito-borne parasitic illness and more than 100 imported cases have been identified in Greece. No one has died yet, but the disease can be debilitating and recur for years.

The return of malaria, a scourge in developing countries, to Greece is a disturbing indicator of the nation’s decline since it crashed in 2009 under the weight of a debt binge. Since then, Greece has seen decades of advances in public health rolled back, as a flood of illegal immigrants, a dysfunctional government and budget cuts ravage a once proud health-care system.

Everything from cancer drugs to syringes is in short supply. Doctors and nurses aren’t being paid. Efforts to monitor and contain outbreaks of infectious disease are faltering.

In addition to malaria, public-health officials say they are worried about rises in everything from infectious respiratory-tract diseases and skin conditions to tuberculosis and HIV.

These afflictions comes as people have less cash for health care. Studies show that up to a third of Greeks can no longer afford the drugs and tests prescribed by their doctors; routine checkups and vaccinations for children are falling.

The town of Skala overlooks a 20-square-mile marshy plain where the Evrota River empties into the Aegean Sea. The water is a boon, nourishing the thirsty orange groves. But it also makes the area a perfect breeding ground for mosquitoes, including malaria-carrying anopheles.

For years, Skala has attracted immigrants who come to harvest oranges and olives in the summer and autumn. Recent arrivals have come from Afghanistan, Pakistan and Bangladesh, all countries where malaria is rife.

Officials estimate that 1,500 to 3,000 immigrants—accounting for 15% to 30% of the local population—are crowded into houses, shacks, tent camps and even abandoned stables in Skala and surrounding towns.

It is unclear who first carried the malaria parasite that has spread around Evrota, but epidemiologists said mosquitoes, which have a typical flying range of about 3 miles, likely bit an infected immigrant and then transmitted it to others.

The Greek government was slow to respond to the first cases. Greece’s Center for Disease Control—prodded by European Union health authorities—only stepped in after an outbreak was well under way last year, local officials say.

The local mayor, Jannis Gripiotis, a doctor by training, said he began seeking help from Athens after some malaria cases were discovered in 2008. Instead of acting, Dr. Gripiotis said, Greek officials “decided to cover it up. They called me crazy.”

Greece’s CDC denies any coverup and says it has no record of any malaria cases in 2008 nor is it aware of any warnings issued by the mayor that year.

In 2009, six locally acquired malaria cases were confirmed in Evrota, the municipality that includes Skala, something independent public-health experts said should have triggered preventive measures by Athens. In 2010 there was one further confirmed case of endemic malaria and the next year the overall number of cases in the area jumped to 57, of which 34 were confirmed as being locally acquired.

That same year, 2011, 40 cases of the P.vivax infection—the parasite behind the outbreak—were reported in five different areas of Greece from individuals with no travel history to an endemic country.

“You know that the mosquito that can carry the parasite is present in this country…and you know that there are immigrants arriving from malarial countries,” said Apostolos Veizis, Greek program director for Doctors Without Borders, which began providing free health checks to immigrants in Evrota in March. “What do you have to do to ring the alarm bell and raise the level of surveillance?”

Even as alarms sounded, Greece’s spiraling economic crisis was taking its toll on the country’s public-health services. To help meet debtors’ demands, the government has slashed local-government budgets by 60% over the past three years as it saddled local governments with more health-care responsibilities.

Provincial governments, which used to help control malaria by aerial spraying of insecticides to kill mosquito larvae, were abolished in 2011, leaving it unclear who would take over. Amid the cutbacks, few local governments made it a priority.

In the past two years, Mayor Gripiotis said he appealed to the central government for money to map the local mosquito population, conduct door-to-door health screenings and begin spraying. He said he never received a response. This year he spent €300,000 ($381,000) from his own budget to spray and expects to do the same next year.

“I will find the money somewhere,” he said. “But I’m dying here and the problem is not a local issue, this is a blight on all of Greece.”

In response to questions from The Wall Street Journal, Health Minister Andreas Lycourentzos said recently he would secure funding this year for the municipality in combating the outbreak.

The scourge has begun to ease. Greece’s CDC began doing door-to-door screenings, which has helped bring down the confirmed malaria cases of infection in Evrota to eight this year from 34 last year.

The Greek CDC is weighing sending a second team to Evrota next year, if it has adequate funds, and has developed a national three-year suppression plan for the rest of Greece.

But the disease has now spread to other areas of the country, and it will take several years of spraying and other efforts to eradicate malaria, officials say.

Doctors Without Borders—which normally works in developing countries—is considering setting up a mission in another potential hot spot: the center of Athens, where thousands of immigrants live in crowded, unsanitary conditions and without access to basic health care. “Tuberculosis cases need more attention, there is quite a lot of underreporting of the disease here in Greece,” the group’s Dr. Veizis said.

 

http://online.wsj.com/article/SB10001424052970204789304578089463387817162.html?mod=djemHL_t

INDIA’S DENGUE FEVER EPIDEMIC RAISES ALARM

In Dengue Fever, Uncategorized on November 8, 2012 at 2:46 pm

Country has become the focal point for a mosquito-borne plague that is sweeping globe

By GARDINER HARRIS NYT NEWS SERVICE

Originally published November 7, 2012 at 12:01 a.m., updated November 6, 2012 at 6:07 p.m.

NEW DELHI — An epidemic of dengue fever in India is fostering a growing sense of alarm, even as government officials have publicly refused to acknowledge the scope of a problem experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in a handful of countries in the 1950s, dengue is now endemic in half the world’s nations.

“The global dengue problem is far worse than most people know, and it keeps getting worse,” said Raman Velayudhan, the World Health Organization’s lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful for many who catch it. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, and it’s pierced the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

In India’s capital, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets outside the hospital entrance recently.

Officials say 30,002 people in India had been sickened with dengue fever through October, a 59 percent jump from the 18,860 recorded in 2011. But the real number of Indians who get dengue fever annually is in the millions, several experts said.

“I’d conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations,” said Scott Halstead, a tropical disease expert.

A senior Indian government health official, who agreed to speak about the matter only on the condition of anonymity, acknowledged that official figures represent a mere sliver of dengue’s toll. The government only counts cases of dengue that come from public hospitals and have been confirmed by laboratories, the official said. Such a census, “which was deliberated at the highest levels,” is a small subset that is nonetheless informative and comparable from one year to the next, he said.

“There is no denying that the actual number of cases would be much, much higher,” the official said. “Our interest has not been to arrive at an exact figure.”

The problem with that policy, said Manish Kakkar, a specialist at the Public Health Foundation of India, is that India’s “massive underreporting of cases” has contributed to the disease’s spread. Experts from around the world said that India’s failure to construct an adequate dengue surveillance system has impeded awareness of the illness’s vast reach, discouraged efforts to clean up the sources of the disease and slowed the search for a vaccine.

“When you look at the number of reported cases India has, it’s a joke,” said Harold Margolis, chief of the dengue branch at the Centers for Disease Control and Prevention in Atlanta.

Neighboring Sri Lanka, for instance, reported nearly three times as many dengue cases as India through August, according to WHO, even though India’s population is 60 times larger.

Part of India’s problem is that some officials view reports of dengue infections as politically damaging. A central piece of evidence for those who contend that India suffers hundreds of times more dengue cases than the government acknowledges is a recent and as yet unpublished study of dengue infections in West Bengal that found about the same presence of dengue as in Thailand, where almost every child is infected by dengue at least once before adulthood.

“I would say that anybody over the age of 20 in India has been infected with dengue,” said Timothy Endy, chief of infectious disease at Upstate Medical University in Syracuse.

For those who arrive in India as adults, “you have a reasonable expectation of getting dengue after a few months,” said Joseph Vinetz, a professor of medicine at the University of California San Diego. “If you stay for a longer period, it’s a certainty.”

Twenty years ago, 1 of every 50 tourists who returned from the tropics with fever was infected by dengue; now, it is 1 in 6.

http://www.utsandiego.com/news/2012/nov/07/tp-indias-dengue-fever-epidemic-raises-alarm/

US West Nile outbreak second-worst at more than 4,500 cases

In Uncategorized, West Nile Virus on October 21, 2012 at 7:40 pm

By Marice Richter

DALLAS Oct 17 (Reuters) – The number of West Nile virus cases across the United States has topped 4,500, with another 282 cases reported last week, making 2012 the nation’s second-worst year on record for the mosquito-borne disease, government figures showed on Wednesday.

The Centers for Disease Control and Prevention said 4,531 cases have been reported this year, the highest number since the record outbreak of 2003, when 9,862 cases were reported.

Another 15 deaths from the disease were reported last week, bringing the total to 183, the CDC said.

Almost 70 percent of the cases have been reported in eight states: Texas, California, Louisiana, Mississippi, Illinois, South Dakota, Michigan and Oklahoma. More than one-third were in Texas, with Dallas-Fort Worth at the center of the outbreak.

Just over half of the cases reported to the CDC this year have been of the severe neuroinvasive form of the disease, which can lead to meningitis and encephalitis.

The milder form of the disease causes flu-like symptoms and is rarely lethal.

http://af.reuters.com/article/commoditiesNews/idAFL1E8LHDA120121017

West Nile Virus Leaves Man Disabled Years after Bite

In Uncategorized, West Nile Virus on October 2, 2012 at 2:08 pm

BY JEFF SHANE,

PUBLISHED: OCTOBER 1

In northwest Indiana, where I have raised vegetables for 20-odd years, mosquitoes flourish when rain fills the swamp pools in the backwaters of the Kankakee River.

In August 2004, those pools spawned a particularly righteous throng. One afternoon, they found me. I had unzipped my bug-protection hood to write some notes about what I was planting. Bitten sharply on the chest, I slapped and missed. Then I was lanced on the left temple. That was her last act. The gangly bug lay flat on my palm — and so began my odyssey into the world of West Nile that even eight years later is not entirely concluded.

The Centers for Disease Control and Prevention says this year is the worst summer for West Nile virus since the disease arrived in the United States, probably in 1999. If so, my tale is a cautionary one.

A week after being bit by that mosquito, I was at a cooking conference in Vermont, working 10-hour days cutting vegetables, joking around the kitchen, making new friends. The third day, I woke with a fever and ached deeply in my bones. I figured it was a bizarrely ferocious flu.

Two days later, I had a temperature of 104, was losing the ability to walk and suddenly realized that I could not move my left arm. The friends who drove me to the hospital had to all but carry me into the emergency room. Within two hours, I had been X-rayed, CT-scanned, MRI’ed, and spinal-tapped. The tests showed extremely high white blood cell counts. There were lesions on my spinal cord, and the virus had caused my brain to swell: I had encephalitis.

As the doctors theorized about Lyme disease or a rampant herpes virus, I remembered that vicious bite of 10 days earlier and placed my bet that it was West Nile. Sure enough, there were West Nile antibodies in my spinal fluid, and the doctors put me on a serious regimen of steroids and antibiotics. Within a few days, both arms were flaccid and my legs began to fail me.

My wife and friends were at my side, but I recall little of those first days other than being stunned by this new life situation. I’d had sports injuries in the past but had never been in a hospital, rarely visited doctors and secretly applauded myself on my innate good health. Now, I could barely move. I was a spry 47 year old and could barely move. Adding to that, the medical community seemed to share the same sense of bewilderment I felt. There was no regimen of pills, no shot, no miracle cure.

The nurses became my heroes. I lived in a new world of urinals and wheelchairs, sleeplessness and a slide into more paralysis. All I had to rely on to deal with my new condition was my sense of humor and truisms that my father had cheerfully passed on to me and my siblings from his Kansas childhood during the Depresssion: “Nobody ever said life was fair” and “A little rain must fall.”

Doing me in

The virus, or my own immune system’s punch-drunk response — the doctors weren’t certain — was still killing nerve cells. Pain was rarely a big problem, but the illness was doing me in quietly and stealthily.

My physical therapy was canceled because I could no longer walk. My farm muscles were melting away. As bones settled and ligaments let go, my hospital bed became a rack where I found no comfort. Sleep came a few hours at night, medication useless.

The lowest moment came during an attempt at showering a few weeks into my illness. A sweet and tough older nurse was trying to spray me down when I slumped off the shower chair, feeling so weak that I asked to return to bed. As I passed a mirror, supported in her arms, I saw the shrunken person I was now. I remembered my father’s body ravaged by cancer: spindles for limbs, a pathetic little belly, eyes shrunken and dull. I lay there and cried off and on for the next few days.

I lost 40 pounds during that first month, though they fed me double rations. I began to feel real fear.

The anterior horn nerve cells at the top of the spinal cord that controlled my muscles — the same cells attacked in polio and Lou Gehrig’s disease — were dying. My body was so unsupported by tissue and muscle that my shoulders threatened to dislocate. My arms flopped over the side of the bed. I could barely speak. My lungs struggled in my sallow chest.

It seemed incredible: A persistent mosquito had followed nature’s prerogative and brought me to this. According to the CDC, the disease first identified in Uganda in the 1930s had traveled thousands of miles within a bug and alighted in New York 13 years ago. Birds became the vector for the virus, migrating and spreading disease throughout the country. This summer, the virus has sickened people innearly every state.

Feeling as if I had failed my caregivers, my family and myself, I focused my hopes on getting to Chicago and its world-renowned rehabilitation hospital. Chicago was home when I was not on the farm, and I had all the resources of family and friends there to count on. By mid-September, after five weeks of treatment brought no improvement, I was flown out of Vermont by air ambulance and started rehab the morning after my arrival.

A therapist strapped my hands to a sort of elevated bicycle wheel that I was supposed to crank, and she moved on to other patients. I still recall the look of surprise and muted frustration on her face when she returned a few minutes later to find my arms fallen uselessly out of the contraption, the flaccid muscles hopeless for this mode of therapy.

I was in the post-polio division, tended to by neurologists as famous as world-class athletes and by nurse’s aides who fed me, cleaned me from stem to stern and taught me not to buzz too often, especially at night. My siblings flew in to visit, sit by my bedside, read to me and roll my wheelchair to the park down the street. My son, 11 at the time, and my wife bravely endured, willing me to keep my spirits up, feeding me on little doses of love, salted with humor.

I fended off the psychiatrist obsessed with putting me on antidepressants and overruled proposed 3 a.m. shots of blood thinner that was supposed to keep me from dying from a blood clot. There was no real therapy, just visits from young and shiny residents intrigued by my strange, slowly deteriorating condition. My doctors were stymied and began planning to discharge me — in theory, to somehow gain the strength at home to return for therapy.

Then my older sister, a scientist and Internet bloodhound, found a new source for information and guidance: a doctor in Jackson, Miss. Neurologist Arturo Leis of the Methodist Rehabilitation Centerhad treated as many cases of West Nile as anyone in the country. She persuaded my reluctant doctors to consult him.

And then I heard Leis’s voice on the speakerphone explaining that I should no longer be getting weaker as a result of the virus alone and that my symptoms suggested that some secondary, dangerous process was killing more nerve cells. He advised massive doses of IV steroids. My doctors quickly agreed, wordlessly forgetting their plan to send me home.

Going home in a wheelchair

It was autumn when I finally left rehab and saw Lake Shore Drive again, sitting in my wheelchair aboard the ambulance taking me home. The lake was bluer than I remembered amid the sere of late summer, with yellowed grass and tumbling leaves. My wife and son were waiting, soon joined by Bouma, a towering man from Mongolia who for months would be my caretaker.

The steroids brought the first, timid signs of recovery. Faint nerve signals moved muscles even as I called myself “baloney on a slab” and knighted my useless left hand “the claw.” I still could not sleep, overspilled my urinal nightly and came to understand more plainly the value of an enema.

My son said a soft goodbye each day on his way out to school. I would cry sometimes when he left, trying instead to think about my father’s homespun admonitions, my wife’s constant efforts to help me heal and the underpaid heroes who had tended to me in Vermont and Chicago.

I started outpatient therapy and saw an acupuncturist whose needles and herbs rallied my hope. And then one December night at home, in a foul mood, I demanded that someone help me out of my wheelchair — and jerked myself up and tottered a few feet to the table. I started to be able to walk again.

As uncalled and silent as the virus when it crept in, so my recovery began.

West Nile’s aftereffects

The mosquitoes are still multiplying in the heat out in the country. Hurricane Isaac’s remnants provided them with one final birthing bonanza before their demise in the season’s first hard frost.

The CDC, meanwhile, advises that immunity to West Nile for those who have been exposed to the virus should, in most cases, be lifelong.

Although I have regained fairly robust health and returned to farming, my left arm has little strength and my shoulders and upper back have only half the muscle they had before 2004.

I visited Art Leis in Mississippi about five years ago. He tested my nerves and muscles, evaluated my whole history, and stated that my case of West Nile was one out of 30,000: I had been too healthy to get so sick, I had been too sick to recover so well. There was still no certainty as to whether the virus alone ravaged me or whether my own immune system had joined the attack.

Of the more than 3,500 cases of West Nile reported to CDC in this record-setting year, a little more than half developed into encephalitis, meningitis or another disease classified as “neuroinvasive” such as mine. All these years later, I continue to recover, feeling my shoulder blade reattach and surprising myself by sprouting a miniature triceps on my left arm.

Strange as it might seem, because of all that I have learned about myself and my place in the world — where I have been carried by strangers who became heroes and by family and friends — I would not trade these lessons even to be made whole again.

When he’s not working on his organic farm, Shane is a chef in Chicago

http://www.washingtonpost.com/national/health-science/west-nile-virus-leaves-man-disabled-years-after-the-bite-of-an-infected-mosquito/2012/10/01/b552c768-0408-11e2-91e7-2962c74e7738_story.html?hpid=z5

Dengue Fever Confirmed in Florida

In Dengue Fever, Uncategorized on October 1, 2012 at 2:46 pm

MIAMI (AP) — South Florida health officials say they’ve confirmed the state’s first case of dengue fever this year in a 7-year-old girl.

The Miami-Dade County Health Department said Thursday that the girl had not been traveling and contracted the flu-like illness in Florida. She has recovered.

Dengue fever is spread by the Aedes aegypti mosquito, a species common in the southeastern U.S. and the tropics. It’s sometimes called “breakbone fever” because of the severe joint pain it can cause in extreme cases.

Dengue fever was once thought eradicated in the U.S. No cases were reported in Florida for more than half a century until a small number of people were diagnosed with the illness in 2009 and 2010.

Health officials say residents can protect themselves by reducing their exposure to mosquitos.

http://usatoday30.usatoday.com/news/nation/story/2012/09/27/dengue-fever-confirmed-in-florida-girl/57848484/1

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