February 15, 2002

'31'

    A central team from National Institute of Communicable Diseases (NICD) consisting of Dr. Dipesh Bhattacharya, Joint Director (Zoonosis); Dr. Avdesh Kumar, Deputy Director (Epidemiology) and Dr. Kaushal Kumar, Deputy Director (Medical (Entomology) visited Chandigarh, Shimla and the affected area of village Hat Koti, Jubbal tehsil, Shimla district, Himachal Pradesh on February 14, 2002. The team interacted with the Medical Superintendent, Professors and Heads of Internal Medicines, Microbiology and Community Medicine at PGI Chandigarh. The Chief Medical Officer, Shimla accompanied the team to the affected area.

        The index case was that of Randhir Singh who repeatedly visited forest for hunting on January 25/26, 2002. The onset of illness was on February 2, he took some treatment on February 4, however, expired on February 5. According to the findings of the team, 10 cases have been reported so far, out of which eight were admitted in PGI from February 9 to 13, one case at IGMC, Shimla; and one death occurred on February 15.

        The patients belonged to the age group of 25-40 years and had fever, cough, chest pain, prostration and haemotysis. On examination, no rash, hepatic, renal, and central nervous system involvement was discerned. Chest X-Ray revealed pneumonitis. The sputum examination of three patients was done which revealed only pus cells and no organism was seen. However, culture is under process. The condition of all patients is stable, except for one who is critical. All patients are being given antibiotics and supportive treatment. All cases are related to the index case. The incubation period has been observed as varying from 3-7 days.

        The authorities of PGI Chandigarh have been asked to conduct autopsy of bodies, collect biopsy, serum and sputum specimens for processing at PGI as well as NICD, Delhi. The Resident Commissioner of Himachal Pradesh informed NICD that one of the patients who had visited Himachal Pradesh to condole the death of Randhir (index case) returned to her village Phanpur in Uttranchal and fell seek with similar symptoms. She was taken to Shimla for treatment where she expired this morning.

        In response to their request, Director, NICD has already written to the Director General of Health Services, Uttaranchal to take following steps to prevent an outbreak in the community.

• The concerned village may be quarantined
• To provide chemoprophylaxis to the close contacts of the dead patient.
• Any case with similar complaints of fever, cough or haemotysis in the village must be treated with appropriate and sysmptomatic treatment in the same village so that infection can be contained in that area.
• To send a team of doctors to that area to provide medical support and education regarding the infection.