Kyasanur Forest disease (KFD) is caused by Kyasanur Forest disease virus (KFDV), a member of the virus family Flaviviridae. KFDV was identified in 1957 when it was isolated from a sick monkey from the Kyasanur Forest in Karnataka (formerly Mysore) State, India. Since then, between 400-500 humans cases per year have been reported.
Hard ticks (Hemaphysalis spinigera) are the reservoir of KFD virus and once infected, remain so for life. Rodents, shrews, and monkeys are common hosts for KFDV after being bitten by an infected tick. KFDV can cause epizootics with high fatality in primates.
Transmission: Transmission to humans may occur after a tick bite or contact with an infected animal, most importantly a sick or recently dead monkey. No person-to-person transmission has been described.
Large animals such as goats, cows, and sheep may become infected with KFD but play a limited role in the transmission of the disease. These animals provide the blood meals for ticks and it is possible for infected animals with viremia to infect other ticks, but transmission of KFDV to humans from these larger animals is extremely rare. Furthermore, there is no evidence of disease transmission via the unpasteurized milk of any of these animals.
Signs & Symptoms: After an incubation period of 3-8 days, the symptoms of KFD begin suddenly with chills, fever, and headache. Severe muscle pain with vomiting, gastrointestinal symptoms and bleeding problems may occur 3-4 days after initial symptom onset. Patients may experience abnormally low blood pressure, and low platelet, red blood cell, and white blood cell counts.
After 1-2 weeks of symptoms, some patients recover without complication. However, the illness is biphasic for a subset of patients (10-20%) who experience a second wave of symptoms at the beginning of the third week. These symptoms include fever and signs of neurological manifestations, such as severe headache, mental disturbances, tremors, and vision deficits.
The estimated case-fatality rate is from 3 to 5% for KFD.
Risk of exposure: KFD has historically been limited to the western and central districts of Karnataka State, India. However, in November 2012, samples from humans and monkeys tested positive for KFDV in the southernmost district of the State which neighbors Tamil Nadu State and Kerala State, indicating the possibility of wider distribution of KFDV. Additionally, a virus very similar to KFD virus (Alkhurma hemorrhagic fever virus) has been described in Saudi Arabia.
People with recreational or occupational exposure to rural or outdoor settings (e.g., hunters, herders, forest workers, farmers) within Karnataka State are potentially at risk for infection by contact with infected ticks. Seasonality is another important risk factor as more cases are reported during the dry season, from November through June.
Diagnosis: Diagnosis can be made in the early stage of illness by molecular detection by PCR or virus isolation from blood. Later, serologic testing using enzyme-linked immunosorbent serologic assay (ELISA) can be performed.
Treatment: There is no specific treatment for KFD, but early hospitalization and supportive therapy is important. Supportive therapy includes the maintenance of hydration and the usual precautions for patients with bleeding disorders.
Prevention: A vaccine does exist for KFD and is used in endemic areas of India. Additional preventative measures include insect repellents and wearing protective clothing in areas where ticks are endemic.
29-Jan-2019: Rajasthan Zika strain is endemic to Asia
The Zika virus that infected 159 people in an outbreak in Rajasthan last year, could have been circulating in India for several years and is endemic to Asia. Pune’s National Institute of Virology (NIV), an institute under the Indian Council of Medical Research (ICMR), is the first to sequence full Zika virus genomes from India.
People in the region may have been previously exposed to the virus, building herd immunity that may limit future outbreaks.
During the latter half of 2018, India recorded its first major Zika outbreaks in Rajasthan and Madhya Pradesh. Around then, the ICMR said the Rajasthan virus had been sequenced and was closely related to a virus that had caused large epidemics and birth defects in Latin America in 2015.
While endemicity means that large outbreaks, such as the Brazilian one, may not occur in India, serosurveys are needed to confirm this. In a serosurvey, a sample of the population is tested for Zika antibodies.
29-Dec-2018: India asks US health agency CDC to ‘withdraw or modify’ travel advisory
India has asked the United States’ public health agency, the Centers for Disease Control and Prevention, to “withdraw or modify” an advisory it issued on December 13 warning people against travelling to Rajasthan due to an outbreak of the Zika virus.
India has sent a rebuttal to CDC along with all research done on the Zika strain in India, the cases reported, measures taken, etc..
The CDC had said the virus was endemic to India and pointed out “there is an unusual increase in the number of Zika cases in Rajasthan and surrounding states”. It cautioned pregnant women against travelling to such areas. This is because Zika infection during pregnancy can cause serious birth defects.
The health agency classified its alert under Level 2, which requires “enhanced protection”. Level 1 advises “usual precautions” and Level 3 advises against “non-essential travel”.
The government took exception to the use of “endemic” in the advisory as Zika outbreaks in India have been contained within small areas.
Indian government has sent a dossier on “all the research done on Zika in India”. Research by scientists at the Indian Council of Medical Research have reportedly shown that Zika strains in the country are less virulent than in Brazil and are not associated with microcephaly.
The National Institute of Virology in Pune has said that the gene responsible for causing microcephaly in Brazil is absent in the Indian strain after genome sequencing of the Zika virus spreading in India. The research findings of the virology institute have also been sent to CDC.
The Zika virus is transmitted mainly by Aedes mosquitoes, including Aedes aegypti, which also carries dengue. Most infected people either show no symptoms or only mild symptoms such as fever, rash, joint pain, conjunctivitis and, possibly, muscle pain and headaches that may last a week.
8-Oct-2018: Monitoring of Zika Virus Disease cases in Rajasthan
Few cases of Zika virus disease have been reported in Jaipur, Rajasthan. The present outbreak in Jaipur, Rajasthan was detected through the ICMR surveillance system. As directed by Sh. J. P. Nadda, Union Health Minister, a 7-member high level Central team was deputed to Jaipur immediately following detection of first case to assist State Government in control and containment measures.
The situation is being reviewed at the level of Union Minister of Health and monitored on a daily basis by the Secretary, Health. A high level Joint Monitoring Group of Technical Experts headed by DGHS has met twice to monitor the preparedness and response measures. Another High Level Central Team is already placed in Jaipur (since 5th October, 2018) to further oversee and assist containment operations on the field. Till date a total of 22 positive laboratory confirmed cases have been detected. A Control Room has been activated at the National Centre for Disease Control (NCDC) to undertake regular monitoring of the situation.
All suspect cases in the defined area and mosquito samples from this area are being tested. Additional testing kits are provided to the Viral Research and Diagnostic Laboratories. The State Government has been supplied with IEC material prepared to create awareness about Zika virus disease and its prevention strategies. All pregnant mothers in the area are being monitored through NHM. Extensive surveillance and vector control measures are being taken up in the area as per protocol by the state government. The State Government has been supplied with IEC material prepared to create awareness about Zika Virus diseases and its prevention strategies.
Zika virus disease is an emerging disease currently being reported by 86 countries worldwide. Symptoms of Zika virus disease are similar to other viral infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache.
In India, the first outbreak was reported in Ahmedabad in January/February 2017 and second outbreak in July,2017 from Krishnagiri District in Tamilnadu. Both these outbreaks were successfully contained through intensive surveillance and vector management.
The disease continues to be on disease surveillance radars of Union Health Ministry although it is no longer a Public Health Emergency of International Concern vide WHO notification since 18th November, 2016.
The situation continues to be monitored regularly.
15-May-2017: Centre confirms 3 Zika cases in Gujarat
Ministry of Health and Family Welfare(MoHFW) reported three laboratory-confirmed cases of Zika virus disease in Bapunagar area, Ahmedabad District, Gujarat. Three cases are confirmed in two pregnant women and one in an elderly man.
Congenital central hypoventilation syndrome (CCHS) is a disorder of the autonomic nervous system that affects breathing. It causes a person to hypoventilate (especially during sleep), resulting in a shortage of oxygen and a buildup of carbon dioxide in the blood. It have two forms of presentation, a classic form that usually begin shortly after birth in newborns, and a milder later-onset presentation in toddlers, children and adults.
Affected infants hypoventilate upon falling asleep and exhibit a bluish appearance of the skin or lips (cyanosis). Other features may include difficulty regulating heart rate and blood pressure; decreased perception of pain; low body temperature; sporadic profuse sweating; Hirschsprung disease; constipation; learning difficulties; eye abnormalities; and a characteristic facial appearance (having a short, wide, somewhat flattened face). They can also have tumors of neural crest origin, such as neuroblastoma, ganglio-neuroblastoma, and ganglioneuroma. The later-onset form is milder, and some cases may present as infants and children who die suddenly and unexpectedly (“SIDS” and “sudden unexplained death of childhood [SUDC]”).
CCHS is caused by a variation (mutation) in the PHOX2B gene and is inherited in an autosomal dominant manner. However, over 90% of cases are due to a new mutation in the affected person and are not inherited from a parent. Diagnosis is made with the clinical symptoms and the genetic test showing the variation in the PHOX2B gene. Treatment typically includes mechanical ventilation or use of a diaphragm pacemaker. People who have been diagnosed as newborns and adequately ventilated throughout childhood may reach the age of 20 to 30 years, and can live independently. In the later-onset form, people who were diagnosed when they were 20 years or older have now reached the age of 30 to 55 years.