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Decline in Japanese Encephalitis, Kushinagar District, Uttar Pradesh

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Decline in Japanese Encephalitis, Kushinagar District, Uttar Pradesh LETTERS Viral infections by mosquitoes References Address for correspondence: Yong Poovorawan, continue to challenge public health in Center of Excellence in Clinical Virology, 1 Weaver SC, Osorio JE, Livengood JA, Department of Pediatrics, Faculty of Medicine, Thailand. In evidence of this, we dem- Chen R, Stinchcomb DT. Chikungunya onstrated that CHIKV has become virus and prospects for a vaccine. Expert Chulalongkorn University, Bangkok 10330, established in northeastern Thailand. Rev Vaccines. 2012;11:1087–101. http:// Thailand; email: [email protected] Surveillance and clinical recognition dx.doi.org/10.1586/erv.12.84 2. Volk SM, Chen R, Tsetsarkin KA, will not prevent future outbreaks, but Adams AP, Garcia TI, Sall AA, et al. rather will assist in organizing an early Genome-scale phylogenetic analyses of response to outbreaks and thus mini- chikungunya virus reveal independent mize unnecessary illness and death. emergences of recent epidemics and vari- ous evolutionary rates. J Virol. 2010;84: 6497–504 http://dx.doi.org/10.1128/JVI. Acknowledgments 01603-09. We thank Padet Siriyasatien for pro- 3. Hammon WM, Rudnick A, Sather GE. Decline in Japanese viding us with laboratory test kits and pro- Viruses associated with epidemic hemor- rhagic fevers of the Philippines and Thai- Encephalitis, tocols. We thank the staff of Bueng Kan land. Science. 1960;131:1102–3. http:// Kushinagar District, Provincial Hospital for their contribution dx.doi.org/10.1126/science.131.3407.1102 in sample collection and the staff at the 4. Pongsiri P, Auksornkitti V, Theamboon- Uttar Pradesh, Center of Excellence in Clinical Virology, lers A, Luplertlop N, Rianthavorn P, Poovorawan Y. Entire genome charac- India Faculty of Medicine, Chulalongkorn Uni- terization of Chikungunya virus from the versity, for their hard work in performing 2008–2009 outbreaks in Thailand. Trop To the Editor: Kakkar et al. re- laboratory tests. Biomed. 2010;27:167–76. cently concluded that the low-quality 5. Suangto P, Uppapong T. Chikungunya surveillance data on acute encepha- This research is supported by Na- fever. Annual epidemiological surveil- litis syndrome (AES)/Japanese en- tional Research University Project; Office lance report 2009, Bureau of Epidemiol- ogy, Department of Disease Control, Min- cephalitis (JE) in Kushinagar Dis- of Higher Education Commission (WCU- istry of Public Health. [cited 2014 Mar trict, India, provide little evidence to 007-HR-57); Integrated Innovation Aca- 18]. http://www.boe.moph.go.th/Annual/ support development of prevention demic Center, Chulalongkorn University; Annual%202552/Main.html and control measures and to estimate Centenary Academic Development Project 6. Epidemiological Information Center, Communicable Disease Epidemiological the effect of interventions (1). Analy- (CU56-HR01); the Ratchadaphiseksom- Section, Bureau of Epidemiology. Re- sis of the surveillance data, however, phot Endowment Fund of Chulalongkorn ported Cases of Diseases under Surveil- does provide evidence supporting University (RES560530093); the Outstand- lance 506, 53rd week [cited 2014 Mar the effect of an ongoing intervention ing Professor of the Thailand Research 18]. http://203.157.15.4/wesr/file/y56/F56 533_1393.pdf (i.e., JE vaccination). Fund (DPG5480002); and King Chulalong- 7. Rianthavorn P, Prianantathavorn K, In accordance with the surveil- korn Memorial Hospital Thai Red Cross Wuttirattanakowit N, Theamboonlers A, lance protocol, cerebrospinal fluid Society; the Ratchadaphiseksomphot En- Poovorawan Y. An outbreak of chikun- and/or serum samples from AES pa- dowment Fund (S. Vongpunsawad and P. gunya in southern Thailand from 2008 to 2009 caused by African strains with tients admitted to the Baba Raghav Linsuwanon); MK Restaurant Company A226V mutation. Int J Infect Dis. Das Medical College (Gorakhpur, In- Limited; and The Siam Cement Pcl. 2010;3:e161–5. http://dx.doi.org/10.1016/ dia) are tested for IgM against JE at the j.ijid.2010.01. 001. field laboratory of National Institute of Nasamon Wanlapakorn, 8. Kosasih H, Widjaja S, Surya E, Hadiwijaya SH, Butarbutar DP, Jaya UA, Virology (NIV) at Gorakhpur (2). The Thanunrat Thongmee, et al. Evaluation of two IgM rapid im- samples are tested by using the ELISA Piyada Linsuwanon, munochromatographic tests during cir- developed by NIV Pune (Pune, India), Paiboon Chattakul, culation of Asian lineage Chikungunya which has a specificity of 85% (range Sompong Vongpunsawad, virus. Southeast Asian J Trop Med Public Health. 2012;43:55–61. 77%–95%) and sensitivity of 71% Sunchai Payungporn, 9. Schuffenecker I, Iteman I, Michault A, (range 71%–75%) (3). Patients with and Yong Poovorawan Murri S, Frangeul L, Vaney MC, et al. samples negative for JE are considered Author affiliations: Chulalongkorn Univer- Genome microevolution of chikungunya to have JE-negative AES. sity, Bangkok, Thailand (N. Wanlapakorn, viruses causing the Indian Ocean outbreak. PLoS Med. 2006;3:e263. http://dx.doi. We obtained the line-list of AES T. Thongmee, P. Linsuwanon, S. Vongp- org/10.1371/journal.pmed.0030263 patients from the NIV laboratory at unsawad, S. Payungporn, Y. Poovorawan); 10. Duong V, Andries AC, Ngan C, Sok T, Gorakhpur for 2008–2012. Analysis and Bueng Kan Provincial Hospital, Bueng Richner B, Asgari-Jirhandeh N, et al. Re- of the surveillance data indicated that Kan, Thailand (P. Chattakul) emergence of Chikungunya virus in Cam- bodia. Emerg Infect Dis. 2012;18:2066–9 251 (8.2%, range 4%–14.7%) of the DOI: http://dx.doi.org/10.3201/eid2008.140481 http://dx.doi.org/10.3201/eid1812.120471. 3,047 AES patients from Kushinagar 1406 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 8, August 2014 LETTERS were positive for JE IgM and there- a small proportion of AES patients. India, 2011–2012. Emerg Infect Dis. fore considered to be JE case-patients. Although the quality of AES surveil- 2013;19:1361–7 . 2. Directorate of National Vector Borne Dis- JE incidence per 100,000 persons in lance needs to be improved, as Kakkar eases Control Programme. Guidelines for the district declined from 2.3 cases in et al. suggested (1), further studies are surveillance of acute encephalitis syndrome 2010 to 0.81 in 2011 to 0.58 in 2012 needed to understand the etiology of (with special reference to Japanese encepha- (Figure). The decline in JE incidence JE-negative AES in the district and the litis) [cited 2013 Sep 11]. http://www.nvb- dcp.gov.in/Doc/AES%20guidelines.pdf since 2010 could be a consequence risk factors for transmission. These 3. World Health Organization Regional of JE vaccination activities in Kushi- studies might include systematically Office for Southeast Asia. Fourth bi- nagar. In 2010, a mass vaccination investigating patients and environ- regional meeting on the control of Japa- campaign with 1 dose of JE vaccine mental samples for enteroviral and nese encephalitis. Report of the meeting Bangkok, Thailand, 7–8 June 2009 (SA 14–14–2 strain) was conducted other etiologic agents. [cited 2013 Aug 15]. http://www.wpro. among children 1–15 years of age. who.int/immunization/documents/docs/ Subsequently, the vaccine was intro- Prashant Ranjan, JEBiregionalMeetingJune2009final.pdf duced into the childhood vaccination Milind Gore, Sriram Selvaraju, program as a 1-dose strategy in 2011 K.P. Kushwaha, D.K. Srivastava, Address for correspondence: Manoj Murhekar, and a 2-dose strategy in 2013. Unfor- and Manoj Murhekar National Institute of Epidemiology, Indian tunately, information about evaluated Author affiliations: Indian Council of Council of Medical Research, Chennai-600 coverage of JE vaccine is not avail- Medical Research National Institute of 070, India; email: [email protected] able from the district. On the other Epidemiology, Chennai, India (P. Ran- hand, the average annual incidence jan, S. Selvaraju, M. Murhekar); Indian of JE-negative AES during the same Council of Medical Research National period was 16 cases per 100,000 per- Institute of Virology, Gorakhpur, India sons (95% CI 14.8–17.2), and this in- (M. Gore); and Baba Raghav Das Medi- cidence has remained relatively stable cal Collage, Gorakhpur (K.P. Kushwaha, D.K. Srivastava) since 2008. Babesiosis With the isolation of enterovi- DOI: http://dx.doi.org/10.3201/eid2008.131403 ruses from JE-negative AES patients, Surveillance, waterborne transmission has been References New Jersey, USA, hypothesized, and the focus of inter- 1. Kakkar M, Rogawski ET, Abbas SS, 2006–2011 vention has shifted toward improving Chaturvedi S, Dhole TN, Hossain SS, sanitation and water quality. However, et al. Acute encephalitis syndrome surveil- To the Editor: Since zoonotic enteroviruses were detected only in lance, Kushinagar District, Uttar Pradesh, babesiosis was first identified in the United States in 1966 (1), its inci- dence and geographic range have increased (2). Previous studies have demonstrated increases in transfu- sion-associated cases in recent years (3). In 2011, babesiosis became na- tionally notifiable as its emergence and the potential for transfusion-as- sociated cases were recognized (2,4). We assessed New Jersey, USA, sur- veillance data for 2006–2011 to char- acterize case information (incidence, potential transfusion associations, geographic distribution) in a state where babesiosis is endemic. In New Jersey, babesiosis case reporting began in 1985. A retrospec- tive study identified an upward trend during 1993–2001; eight of 21 coun- Figure. Annual incidence of Japanese encephalitis (JE) and JE-negative acute encephalitis ties reported cases (5). In 2005, the syndrome (AES), Kushinagar District, Uttar Pradesh, India, 2008–2012. New Jersey Department of Health Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 8, August 2014 1407.
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