- Hello Jeff - I am not sure what we have here. It appears
that there may be a mutant HBV virus in India. HDV also know as Hepatitis
Delta virus - and is only present in patients who are infected with Hepatitis
B Virus, is being blamed for deaths and illness in India.
-
- As you will note below, even the experts are not sure
what is going on. Hopefully, more information will be forthcoming. If
there is a novel HBV agent, it can be very serious and could certainly
spread throughout Asia and the world.
-
- Sadly, it appears the outbreak may be due to medical
provider negligence.
-
- I will keep you updated.
-
- Patty
-
-
- [1] Date: Mon 23 Feb 2009 From: Jose Manuel Echevarria
-
- A comment --------- As far as I know, no mutant hepatitis
B virus (HBV) infection producing 30 percent mortality among infected
persons has ever been reported to date anywhere. If a virus was involved,
just superinfection of HBV carriers by hepatitis D virus (HDV), also
known as hepatitis delta agent, would be responsible for an outbreak
of acute liver disease with such a high mortality rate, otherwise
additional symptoms may suggest yellow fever or other serious diseases
that may include hepatic involvement as a complication. This possibility
has been, however, apparently ruled-out by laboratory studies. Since
such mutant HBV would represent a novel and most relevant viral agent,
detailed information concerning laboratory evidences that support
such an explanation for the outbreak should be given by regional
or federal health authorities as soon as possible.
-
- -- Jose M Echevarria, MSc PhD Virologist Head, Service
of Diagnostic Microbiology National Centre of Microbiology Instituto de
Salud Carlos III Majadahonda, Madrid Spain
-
- [The most recently available statement from India, posted
below, gives the number of hospitalised cases in this outbreak as
108 and the number of deaths as 35. There is no additional information
on the outcome of laboratory investigations. - Mod.CP]
-
- ******
-
- [2] Date Sun 22 Feb 2009 Source: Prensa Latina online
(in Spanish, machine trans., edited]
-
- http://www.prensalatina.com.mx/Article.asp?ID=%7B26B
- BA932-2470-42DE-8FCC-EE6D64A0CA51%7D&language=ES>
-
-
- One of the 7 doctors arrested in the Indian state of
Gujarat for negligence in a fatal outbreak of hepatitis B, was prosecuted
for manslaughter, reports today's [22 Feb 2009] Times of India newspaper.
-
- The researchers found that most patients who contracted
the disease and eventually died were treated by him. The outbreak
was due to the use of poorly sterilized syringes, experts noted.
As of Saturday night [21 Feb 2009], the death toll in Modasa had
reached 35, while 108 others are hospitalized in that locality of
Gujarat, said the newspaper.
-
- A doctor who runs a clinic opposite the Modasa public
health centre is the 1st doctor accused of murder, while 6 others
face various charges under the Medical Negligence Act. Health officials
revealed that the focus of this outbreak of liver disease has spread
to Malpur, Bayad, and Idar Taluka, all in Sabarkantha district, where
Modasa is also located.
-
- -- Communicated by: HealthMap Alerts via ProMED-mail
<mailto:promed@promedmail.org>promed@promedmail.org
-
- [A map showing the location of Sabarkantha district in
Gujarat state can be accessed at http://en.wikipedia.org/wiki/File:Map_GujDist_North.png.
The HealthMap/ProMED-mail interactive map of India showing the location
of Gujarat state can be accessed at
- http://healthmap.org/promed/en?g=1262958&v=23.467,73.3,5
- . - Mod.CP]
-
-
- ORIGINAL REPORT
-
- Date: Fri 13 Feb 2009 Source: Thaindian News [edited]
- http://www.thaindian.com/newsportal/health/eleven-die-of-hepatitis-d-in-gujarat-district_100154892.html
-
-
- A total of 11 deaths due to hepatitis-D were reported
so far in Modasa taluka of Gujarat's Sabarkantha district in the
last 5 days, health officials here said. Officials said 21 patients
are admitted to various hospitals in the area so far, and 5 were
rushed to the civil hospital in Ahmedabad Friday [13 Feb 2009].
-
- "We have asked for a central team from the National
Institute of Communicable Diseases (NICD) and the Director General
of Health Services (DGHS), and the team is arriving shortly,"
said Chief District Health Officer (CDHO) H.F. Patel.
-
- A 3-member team from the B.J. Medical College, Ahmedabad,
led by Nayan Qadri, has already arrived in Modasa Thursday [12 Feb
2009]. "At present, 5 doctors and 27 paramedics are in the area,"
Patel said.
-
- The hepatitis-D virus (also called delta virus) is a
small circular RNA virus and affects humans only in the presence
of hepatitis-B infection. It is transmitted by blood and blood products.
The risk factors for infection are similar to those for hepatitis-B
virus infection. The hepatitis-D virus most often infects intravenous
drug users, Patel said. "We have published 25 000 pamphlets,
and we are circulating them as part of our awareness campaign,"
he said.
-
- -- Communicated by: ProMED-mail Rapporteur Brent Barrett
-
- [In ProMED archive no. 20030712.1718, Mod.CP wrote the
following about Hepatitis D virus infections: Because hepatitis delta
virus (HDV) is dependent on hepatitis B virus (HBV) for replication,
HBV/HDV co-infection can be prevented with either pre- or post-exposure
prophylaxis for HBV. HDV infection can be acquired either as a co-infection
with HBV or as a superinfection of persons with chronic HBV infection.
Persons with HBV/HDV co-infection may have more severe acute disease
and a higher risk of fulminant hepatitis (2-20 percent) compared
with those infected with HBV alone; however, chronic HBV infection
appears to occur less frequently in individuals with HBV/HDV co-infection.
Chronic HBV carriers who acquire HDV superinfection usually develop
chronic HDV infection. In long-term studies of chronic HBV carriers
with HDV superinfection, 70-80 percent have developed evidence of
chronic liver diseases with cirrhosis compared with 15-30 percent
of patients with chronic HBV infection alone. Thus, prevention of
HDV superinfection depends primarily on education to reduce risk
behaviors. In some Latin American countries in the Amazon River Basin,
periodic epidemics of HDV infection have occurred among chronic HBV
carriers in relatively isolated regions. Disease related to HDV infection
in these outbreaks has been very severe, with rapid progression to
fulminant hepatitis and case-fatality rates of 10-20 percent. The
cause of the atypical course of HDV infection in these populations
is unknown.
-
- The modes of HDV transmission are similar to those for
HBV, with percutaneous exposures the most efficient. Sexual transmission
of HDV is less efficient than for HBV. Perinatal HDV transmission
is rare. The serologic course of HDV infection varies depending on
whether the virus is acquired as a co-infection with HBV or as a
superinfection of a person with chronic HBV infection. In most persons
with HBV/HDV co-infection, both IgM antibody to HDV (anti-HDV) and
IgG anti-HDV are detectable during the course of infection. However,
in about 15 percent of patients, the only evidence of HDV infection
may be the detection of either IgM anti-HDV alone during the early
acute period of illness or IgG anti-HDV alone during convalescence.
Anti-HDV generally declines to sub-detectable levels after the infection
resolves, and there is no serologic marker that persists to indicate
that the patient was ever infected with HDV. Hepatitis Delta antigen
(HDAg) can be detected in serum in only about 25 percent of patients
with HBV-HDV co-infection. When HDAg is detectable, it generally
disappears as HBsAg disappears, and most patients do not develop
chronic infection. - Mod.CP]
-
- [The basis on which the HDV diagnosis was made in this
Indian outbreak was not indicated in the above report. ProMED requests
information about any laboratory tests done in these cases and further
information about the outbreak as it becomes available.
-
- The administrative headquarters of the Sabarkantha district
is Himmatnagar, 80 km (50 miles) from Ahmedabad. The District has
a population of over 2 million in its 7390 sq km (2853 sq mi) area.
-
- A map showing the location of Sabarkantha district in
Gujarat state can be accessed at
-
-
- http://en.wikipedia.org/wiki/File:Map_GujDist_North.png
-
-
- A HealthMap/ProMED-mail interactive map of India showing
the location of Gujarat state can be accessed at
- http://healthmap.org/promed/en?v=22.9,79.6,5 - Mod.TY
-
-
- Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural
Economics
- Univ of West Indies Please visit my "Emerging Diseases"
message board at:
- http://www.emergingdisease.org/phpbb/index.php Also my
new website:
- http://drpdoyle.tripod.com/ Zhan le Devlesa tai sastimasa
- Go with God and in Good Health
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