Congo fever and dengue similarities: ICMR calls for review of dengue cases

2011

Syed Akbar

Hyderabad, Feb 3: With many doctors unable to distinguish between dengue and Congo fever based on symptoms, the Indian Council of Medical Research has asked health officials to review cases of fever that have been declared as dengue, particularly in rural areas.

The ICMR suspects that some of the fever cases that had been diagnosed as dengue may actually be those of Congo fever. The State and several parts of the country have witnessed many cases of death related to dengue. The emergence of a new serotype of dengue virus, dengue-4 or Denv-4, has further complicated the task of doctors, many of whom had no first hand experience of treating patients suffering from Crimean-Congo haemorrhagic fever.

The symptoms of Denv-4, which was first reported in Hyderabad in 2007, and those of Congo fever interlap making it difficult to diagnose the case at first sitting. Since Congo fever had not been reported in the country prior to January this year, many doctors suspect complicated cases of fever as those of dengue. In both the cases haemorrhage or bleeding is common. The fatality rate of Congo fever, however, is higher. Common dengue is mild, while cases related to serotype Denv-4 may turn out to be fatal.

Cases of dengue haemorrhagic fever have increased in the country since 1990 after the common dengue virus underwent mutation leading to change in the virus "lineage especially with regard to Denv-2 and Denv- 3", according to Dr D Cecilia of the National Institute of Virology. Dr Cecilia's team has recently found re-emergence of Denv-4 in Maharashtra after a gap of 35 years. Denv-4 cases have thus far been rare.

"It's true that unless thorough clinical investigation is done, it is difficult to differentiate between dengue and Congo fevers initially because the symptoms of both are almost the same such as haemorrhage and fever," says Dr K Subhakar of Government Chest Hospital in the city. He agrees that the blood samples collected need to be studied properly to find out whether it’s a dengue virus or Congo fever virus.

While the NIV has called for a close monitoring of Denv-4 cases, senior physician of Care Hospitals Dr S Vijay Mohan accepts that some Congo fever cases are being passed off as dengue fever mainly because of ignorance about this new disease.

"Except the four cases in Gujarat, it hasn’t been found anywhere in India. Since symptoms of the two diseases are more or less the same, only a blood test can reveal whether it’s dengue fever or some other kinds of viral fever. There are hundreds of country-specific viruses, causing unknown fevers. Unless, a specific test to detect the Congo fever virus is conducted, it
will be difficult to point out the nature of the fever causing virus," he adds.

Even as the ICMR has suggested a review of dengue cases from rural areas, a study by NIV scientists warns that the high degree of diversity in the envelope gene observed for the Denv-4 viruses circulating in the subcontinent indicates that the "serotype is evolving". And if this happens, there may be newer dengue strains.

Burden of non-communicable diseases: Kerala has the highest central obesity, Andhra Pradesh the least

By Syed Akbar
Hyderabad, Feb 1: People in Andhra Pradesh are the slimmest among the Dravidian lot if the size of the waist is taken into account.
The Indian Council of Medical Research in its latest survey report on the risk of non-communicable diseases points out that only 14 per cent of people in Andhra Pradesh fall in the category of central obesity. The
figure for Kerala is 43 per cent and Tamil Nadu is 25 per cent.Karnataka was not covered under the study in the first phase, which included Andhra Pradesh, Kerala, Tamil Nadu from South India.
The waist circumference is one of the sensitive indicators for abdominal obesity. Abdominal obesity has got a stronger association with coronary heart diseases as compared to BMI.
The higher the obesity or underweight levels in a population, the higher the risk of non-communicable diseases line hypertension, cardiac problems, diabetes, cancers of colon and breast, and osteoporosis.
Grade I overweight people form 15 per cent in Andhra Pradesh, 18 per cent in Tamil Nadu and 22 per cent in Kerala. The obesity of grade 2 and above is 5 per cent in Tamil Nadu and Kerala and 4 per cent in
Andhra Pradesh.
A cut-off level of 102 cm in males and 88 cm in females have been recommended for developed countries. However, lower cut-off levels of 90 cm in males and 80 cm in females has been fixed for Indians.
Stating that lack of physical activity leads to obesity, hyper-lipidemia, diabetes mellitus, hypertension, and coronary heart disease, the ICMR survey noted that "most time spent is mainly related to work only". The
mean time spent in travel related activities (cycling/ walking) is a low 31 minutes per day in Andhra Pradesh. Also the mean time spent in recreational activities is low (4 minutes per day) in the State.
Referring to nutritional inadequacy, a major risk factor of many non- communicable diseases, the survey said 99 per cent of people in Tamil Nadu had less than five servings of fruits and vegetables a day. The
figures for Andhra Pradesh and Kerala are 88 and 87 respectively. On an average people consumed fruits only two days in a week in Andhra Pradesh, and Tamil Nadu and three days in a week in Kerala.
"Overall, the population of states in low category of physical activity were  66 per cent in Tamil Nadu, 68 per cent in Andhra Pradesh, 76 per cent in Kerala. The population of state detected with pre hypertension
stage was 43 per cent in Andhra Pradesh and Tamil Nadu. However, the stage I and stage II hypertension among people was recorded between 17 per cent in Andhra Pradesh," ICMR report said.

Green salads: Beware of contaminated ready-to-eat vegetables, they cause gastro, typhoid and intestinal bleeding

By Syed Akbar

Hyderabad, Jan 31: Green salads are not always healthy, and may cause severe health  complications if
proper standards are not maintained. 
The Codex Alimentarius Commission, which comes out with the "food book", warns that green salads
have been found to be contaminated with heavy metals and a variety of harmful bacteria that cause
diseases ranging from typhoid to intestinal bleeding and gastroenteritis. The problem gets worse if
natural manure like cattle dung or polluted water is used for leafy vegetables, which have a tendency to
absorb harmful elements.
The green salad, which many consider to be healthy for its ability to prevent cancer, can be contaminated with human faeces if polluted water is used in the orchards. If natural manure like cow or buffalo dung is used, the final product can be contaminated with animal faeces. If a food is contaminated with faeces, whether human or animal, it carries the risk of bacterial, viral, helminth and protozoan infections.
Health experts point out that if a hotel does not serve properly cleaned and washed green salad, it poses
the risk of infectious diseases. "People with weak immune system are at risk. Many hotels do not observe
strict cleanliness regime when it comes to serving green salads. Certain leafy vegetables like lettuce,
spinach, pudina and spring onion have the tendency to take in dangerous elements. They stay in the
plant body and pass on to human beings when consumed," says Dr P Ramachandra Murthy, expert in
internal medicine.
According to Codex, a body under Food and Agriculture Organisation of the United Nations, "international and national concerns have grown in response to recent outbreaks and illnesses related to fresh leafy vegetables. A broad array of microbial pathogens have been associated with these products as reported in international outbreak data".
Doctors have found enterohemorrhagic Escherichia coli, Salmonella enterica, Campylobacter  species,Shigella species, Hepatitis A virus, Norovirus, Cyclospora cayetanensis, Cryptosporidium parvum,
Yersinia pseudotuberculosis and Listeria monocytogenes thriving on green salads.
"One has to be extra careful about consuming ready-to-eat greens as no cooking is  involved. Cooked
vegetables carry almost no risk of diseases as the harmful agents are killed during cooking. Green salads
and vegetable salads carry the risk of spreading infection," cautions senior physician Dr MA Azeem.
Infectious diseases expert Dr Suneetha Narreddy says the impact of these infections can be as simple a self limiting acute gastroenteritis (vomiting and diarrhea) to a severe infection involving multiple organs and can potentially be fatal.  “Ready to eat vegetables and greens should have potable water during harvest, picking and processing. Processing area should be restricted to the essential people who are trained in the handling of perishable foods. Salads and green leafy vegetables can be disinfected by spraying them with vinegar and hydrogen peroxide,” she adds.
While enterohemorrhagic Escherichia coli cause intestinal bleeding and gastroenteritis, Salmonella species cause typhoid and paratyphoid. Hepatitis A virus is known to cause severe liver problems including jaundice. Norovirus is the main culprit responsible for non-bacterial gastroenteritis.

US lifts defence sanctions on India: America to benefit from the move in the long run

2011

Syed Akbar

Hyderabad, Jan 25: The US government's decision to lift "sanctions" on Indian defence units will ultimately help the United States, though India gets benefited initially.

The US government lifted its "sanctions" or export curbs on DRDO and ISRO units, which it had imposed in 1998 soon after the Pokhran nuclear tests. The US had earlier eased sanctions against some of the firms, but continued with the curbs on key units. It has now lifted these curbs too.

According to Defence sources, the lifting of curbs or the unilateral sanctions will benefit Indian firms and boost the R & D work including new and existing Space and Defence projects. But it will also boost business opportunities for US firms in the longer run. Incidentally, US sees a flourishing Space and Defence market in India since it is fast developing indigenous technologies in both the areas.

The Indian firms that are now free to import and export equipment and spare parts to the US include Bharat Dynamics Ltd (BDL), which makes India's missiles and munitions; four subsidiaries of DRDO (Armament Research and Development Establishment (ARDE), Defense Research and Development Lab (DRDL), Missile Research and Development Complex; and Solid State Physics Laboratory); and four subsidiaries of ISRO (Liquid Propulsion Systems Center (LPSC), Solid Propellant Space Booster Plant (SPROB),
Sriharikota Space Center (SHAR), and Vikram Sarabhai Space Center (VSSC).

Though US authorities did not use the terms "sanctions" Indian firms were denied supply of equipment and spares during the last 13 years. India had to develop many spareparts and equipment using the indigenous technology.

ISRO has been urging the US to lift curbs on Vikram Sarabhai Space Centre,  Satish Dhawan Space Centre, and Liquid Propulsion Centre. Three other ISRO units were removed from the "embargo list" four years ago. ISRO had been hopeful of lifting of sanctions since it had collaborated with NASA on the Chandrayaan-1 mission. The collaboration led to the discovery of water molecules on the moon.

The US decision is being seen as a "strategic move" to allow US companies to trade with the Indian organisations. Incidentally, India has proposed FDI in defence sector and the US thought that it was the opportune time to ease trade restrictions with India for bilateral benefit.

WHO may impose ban on TV advts targeting young children with unhealthy food items

2011

Syed Akbar

Hyderabad, Jan 24: After pictorial warning on tobacco products, there will soon be restrictions on TV commercials promoting unhealthy food stuff for children.

The World Health Organisation, which has successfully implemented pictorial warning on tobacco products, has now asked all its member-countries including India to impose restrictions on TV commercials that target young children with unhealthy food items.

The Indian Council of Medical Research has drafted certain recommendations on what not to eat to stay fit. Once these guidelines are finalised, restrictions will be imposed on TV commercials trying to sell unhealthy foods. Policy makers and health experts will meet in Geneva in September to discuss the impact of TV commercials on the eating habits of young children and the need to contain them.

While welcoming the WHO's recommendations, city health experts believe that TV advertising is responsible for a large share of the marketing of unhealthy foods. "Children throughout the world are exposed to marketing of foods high in fat, sugar or salt, which increases the potential of younger generations developing noncommunicable diseases during their lives. Systematic reviews of evidence show that advertisements influence children's food preferences, purchase requests and consumption patterns." Some of the food stuff shown on TV commercials are of low nutritional value.

According o ICMR expert group chairman Dr B Narasinga Rao, the body does not need much sodium. "Intakes of 1.1 grams to 3.3 grams of sodium or just 2.8 grams to 8.3 grams of common salt is considered to be safe and adequate for healthy adults". But the WHO has found that most of the food stuff advertised for children in TV commercials contain high fat, sugar and salt, and they are responsible for the spurt in non-communicable diseases.

"Non-communicable diseases or lifestyle diseases are caused by the diet we eat. They are also influenced by stress. Control of diet and eating of healthy food right from the childhood will reduce the risk of non-communicable ailments like cardiovascular diseases, cancers and diabetes," said senior cardiologist Dr Bharath Reddy.

The WHO recommendations come in the wake of reports that 4.3 crore children including 1.1 crore living in India, are obese or overweight. "The advertisements on the food and snacks are highly influential on children, and influence their food choices dramatically. Majority of the food that gets advertised doesn't comprise of good nutritional values," argues bariatric surgeon Dr Nandakishore Dukkipati.

Since in these advertisements, food is associated with a celebrity - film star, sports personality etc., and kids get influenced and tend to go for them, leading to overweight and obesity amongst them, Dr Nandakishore said adding that food advertisements also give subliminal suggestions making them prone to eat food high in calories leading to overweight.

Crimean-Congo Haemorrhagic Fever: CCHF has high mortality rate, is highly infectious

2011
By Syed Akbar
Hyderabad, Jan 20: City hospitals are ill-equipped to tackle cases of the highly infectious Crimean-Congo Haemorrhagic Fever if the disease breaks out here. Worse, most doctors are unaware of the clinical manifestation of CCHF and it is unlikely that they have had direct interaction with a CCHF patient.

"We studied about CCHF in one of our microbiology lessons. But I have never come across a CCHF patient in my career so far," confessed an expert in internal medicine attached to a corporate hospital.
Infectious diseases specialist Dr Suneetha Narreddy said since CCHF was not a common disease, it would be difficult for a doctor to diagnose it. "Doctors first look for common diseases and then go for uncommon diseases. But chances are that no doctor here will look for CCHF since it has not been reported here earlier," she said. CCHF, the first cases of which have just been diagnosed in India, spreads fast through body fluids from person to person. Its transmission from animal to humans is through tick bites.

It is such a dangerous disease that the National Institute of Virology has warned that any serum samples from an infected person should be sent through a three-level isolation box to NIV, Pune, for confirmatory diagnostic tests.
CCHF was first diagnosed in 1944 in the Ukraine.
Though it has been causing havoc regularly in different parts of the world, it was not reported in India till recently. Early this month, the disease was diagnosed in Ahmedabad and so far it has caused the death of three people.
Given its highly infectious nature and the regular movement of large numbers of people between Gujarat and AP, doctors and health experts fear that any outbreak of CCHF in Hyderabad will precipitate a medical emergency. Most hospitals do not have special isolation wards fulfilling the WHO standards for Congo fever patients.
Senior physician, Dr Aftab Ahmed, said, "Since it is a viral disease, antibiotics do not work and the treatment has to be supportive. What matters is early diagnosis of the disease. It has one of the highest mortality rates with 40 per cent of patients succumbing to it."
Doctors at the government-owned Sir Ronald Ross Institute of Tropical and Communicable Diseases (Fever Hospital) also admit that they do not have a WHO-standard isolation ward to deal with Congo fever cases.
According to the National Institute of Virology, an individual is said to be suffering from CCHF if he manifests an acute febrile (fever) illness, with bleeding/haemorrhagic manifestations or acute unexplained death, plus at least one of the following: (a) tick bite in the previous three weeks (b) contact with livestock in the previous three weeks and or (c) direct physical contact, or contact with body fluids, of someone with a similar illness in the previous three wee