Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

West Nile virus: Another impending outbreak in India?

Health Ministry takes stock of the public health measures for controlling West Nile Virus

A section of the media has reported that a seven year old boy from Malappuram District of Kerala is suffering from a West Nile Virus (WNV), a mosquito-borne disease, mostly reported in the continental United States.

Union Minister of Health and Family Welfare is closely monitoring the situation and has spoken to the State Health Minister of Kerala in this regard. He has directed for all support to be extended to Kerala in its prevention and management.

Secretary (HFW) held a meeting with Additional Chief Secretary Shri Rajeev Sadanandan, Kerala and reviewed the situation. The Health Ministry has dispatched a multi-disciplinary Central team from National Centre for Disease Control (NCDC). The Central team includes Dr. Ruchi Jain, RHO Trivandrum, Dr Suneet Kaur, Assitant Director, NCDC, Dr E Rajendran, Entomologist, NCDC, Calicut and Dr Binoy Basu, EIS Officer, NCDC. The team will support the State Health Authorities in managing the disease.

The Indian Council of Medical Research (ICMR) has also been alerted and a close watch is being maintained at Central and State level. There are no reports available so far for spread of this virus in other parts of the country… (Press Information Bureau, Ministry of Health and Family Welfare, March 14, 2019)

Facts about West Nile Virus

. West Nile Virus is a member of the flavivirus genus and belongs to the Japanese encephalitis antigenic complex of the family Flaviviridae.

· The virus was first isolated in a woman in the West Nile district of Uganda in 1937.

· It is commonly found in Africa, Europe, the Middle East, North America and West Asia.

· Presence of WNV was documented in north- eastern region of India during the year 2006 from four districts (Japanese encephalitis (JE) endemic areas) of Assam; in which 11.6% of serum samples of AES (acute encephalitis syndrome) cases were found positive for IgM against WNV (these samples were negative for IgM against JE virus). During an outbreak of AES in Kerala, in May 2011, presence of WNV was confirmed in clinical specimens. Since then, WNV encephalitis cases have regularly been reported in Kerala (National Health Portal of India).

· The virus is maintained in nature in a cycle involving transmission between birds and mosquitoes. Humans, horses and other mammals can be infected.

· Transmission: Humans acquire the infection through the bites from infected mosquitoes. The virus may also be transmitted through contact with other infected animals, their blood, or other tissues. Transmission may also occur through organ transplant, blood transfusions and breast milk. There is one reported case of transplacental (mother-to-child) WNV transmission. To date, no human-to-human transmission of WNV through casual contact has been documented.

· Incubation period: 3-14 days.

· Clinical features: West Nile virus infection may mimic either dengue or chikungunya like illness.

. The infection is asymptomatic in 80% of infected persons; in some cases, the infection may lead to West Nile fever or severe West Nile disease (also called neuroinvasive disease, such as West Nile encephalitis or meningitis or West Nile poliomyelitis).

. Symptoms of West Nile fever include fever, headache, tiredness, body aches, nausea, vomiting, skin rash on the trunk of the body (occasionally) and swollen lymph glands. Most people recover completely, but fatigue and weakness can last for weeks or months

. Symptoms of severe disease include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. Recovery might take several weeks or months. It is potentially fatal.

Diagnosis is by detection of IgM antibodies in CSF and serum specimens via IgM antibody capture ELISA, neutralisation assays, viral detection by RT-PCR assay, and virus isolation by cell culture. Serum IgM antibody may persist for more than a year.

Treatment is supportive for patients with severe infection which involves hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections.

There is no vaccine available for humans.

Prevention: The most effective way to prevent infection is to prevent mosquito bites. Use insect repellent, wear long-sleeved shirts and pants, treat clothing and gear and take steps to control mosquitoes indoors and outdoors.

Morning Medtalks with Dr KK

1. Overweight and heart burn: Being overweight or obese increases the odds of having GERD and experiencing heartburn.

2. Eating larger meals distends the stomach, pushes the contents up toward the esophagus and loosens the LES.

3. NIH: Light physical activity such as gardening, strolling through a park, and folding clothes might be enough to significantly lower the risk of cardiovascular disease among women 63 and older. This reduces the risk of cardiovascular disease events such as stroke or heart failure by up to 22 percent, and the risk of heart attack or coronary death, by as much as 42 percent. [JAMA Network Open.]

4. Catheter ablation, appears no more effective than drug therapies in preventing strokes, deaths, and other complications in patients with atrial fibrillation. However, patients who get the procedure experience much greater symptom relief and long-term improvements in the quality of life, including fewer recurrences of the condition and fewer hospitalizations, than those who get only drugs. The findings are from two new studies published in the March 15 issue of the Journal of the American Medical Association.

5. Frequent changes to health care environments and protocol have contributed to an increased rate of burnout among physicians that has escalated into a public health crisis a recent report from the Harvard Global Health Institute concludes.

6. 2018 Survey of America’s Physicians Practice Patterns and Perspectives, found that 78 percent of respondents experienced feelings of professional burnout, a 4 percent increase from the results of a 2016 survey conducted by the Physicians Foundation.

7. Drugs typically contain the actual drug, or active pharmaceutical ingredient (API), and inactive ingredients (excipients). Inactive ingredients "are not intended or expected to have a direct biological or therapeutic effect but instead are added to alter the physical properties of an oral solid dosage form (tablet or capsule) to facilitate absorption; to improve stability, taste, and appearance; or to render the therapeutic tamper resistant. Increasing numbers of clinical reports describe allergic reactions to excipients such as lactose and chemical dyes, write Reker and colleagues in March 13 in Science Translational Medicine.

The researchers conducted a comprehensive analysis of 18 of the most commonly prescribed active ingredients (54 unique medications).

Of 38 commonly used excipients that are known to cause allergic reactions, lactose was used in 44.82% of all solid oral dosage forms in the databases searched, followed by corn starch (36.54%), polyethylene glycol (36.03%), povidone (35.8%), and carboxymethylcellulose (21.38%). Other oral medications include peanut oil, wheat starch, artificial dyes, and certain sweeteners.

For most medications, the amount of inactive ingredients accounted for half of the pill and for some that amount reached 99%.

Dated: 16 th March, 2019

Current Temperature Status and Warning for next 24 hours.

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 15 th March to 0830 hrs IST of 16 th March, 2019)

Heat Wave:

.Yesterday, No heat wave conditions were observed.

Temperatures Recorded at 1730 Hours IST of 15 th March, 2019:

Maximum Temperature

• Temperature’s more than 40.0°C was recorded at isolated places over Rayalaseema. (Annexure-1).

• Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at a few places over Rayalaseema, Assam & Meghalaya and Sub-Himalayan West Bengal& Sikkim; above normal (1.6°C to 3.0°C) at most places over Coastal Andhra Pradesh and Telangana; at many places over Chhattisgarh and Nagaland, Manipur, Mizoram & Tripura; at a few places over Lakshadweep, Kerala, Tamilnadu & Puducherry, South Interior Karnataka, Vidarbha, Madhya Maharashtra, Konkan & Goa and Saurashtra & Kutch and at isolated places over Odisha, Marathawada and Jammu & Kashmir. They were appreciably below normal (-3.1°C to -5.0°C) at most places over East Rajasthan; at many places over Punjab, west Rajasthan, Haryana, Chandigarh & Delhi; at a few places over Andaman & Nicobar Islands and Madhya Pradesh; below normal (-1.6°C to - 3.0°C) at most places over Gujarat region and West Uttar Pradesh and at isolated places over Himachal Pradesh, Uttarakhand, Bihar, Jharkhand and East Uttar Pradesh and near normal over rest parts of the country. (Annexure-2).

• Yesterday, The highest maximum temperature of 40.5°C was recorded at Anantpur (Rayalaseema) over the country.

Heat Wave Warnings for Next 24 hours(From 0830 hrs IST of 15 th to 0830 hrs IST of 16 th March 2019):-


GAPIO Midyear Conference

at Antigua

4 th  and 5 th  May 2019

in collaboration with

American University of Antigua (AUA)

Antigua Medical Association (AMA)


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