70 Hospialized Patients in Rampur Assam Raise Concerns

Recombinomics Commentary 14:36
December 14, 2008

A population of 34,825 has been covered in the 0-3 km area (in Rampur) by active surveillance. A total of 8 cases of URI and fever have been detected.

Passive surveillance is done in all health facilities. 70 cases of URI and fever have been detected

In 0-3 km radius, a population of 7,926 have been surveyed (in Barpeta) and the surveillance in 3-10 km is being initiated.

90 cases of fever with URI have been detected in the 0-3 km area.

The above comments are from the December 11 report from the Ministry of Health and Family Welfare entitled “Status Report on Avian Influenza in Assam.” The comments contain two significant differences from earlier media reports on the surveys of people in the cull zones.

In the Rampur block of the Kamrup district (see updated map), there were initially 30 cases with URI (upper respiratory tract infections) and 14 cases in area hospitals. In the above report, the number of patients in the 0-3 km zone dropped to 8, but the number of hospitalized patients rose to 70, raising concerns that these patients had serious infections.

Similarly, the numbers above represent a significant change for Barpeta. Earlier there were 60 URI cases in the 0-3 km area (from 6,032 surveyed people), which were 30-60 fold higher than other than other regions surveyed. The earlier survey covered about 20% of the population. Although the population covered has been increased to 25%, the number of URI cases has increased to 90, raising concerns that these cases are linked to the outbreaks (see updated map).

Moreover, recent media reports describe four cullers in Chirang who have developed similar symptoms.

Although bird flu has been said to have been excluded for most of these cases, the rationale for the exclusion remains unclear. The report stated that the URI or hospitalized cases did not have contact with poultry (the cullers were not noted in the earlier government report), the cases were within the 0-3 km exclusion zone, so they clearly were in close proximity to the confirmed H5N1. Moreover, the high concentration of H5N1 leads to infections in wild birds and animals, which create additional exposure opportunities, as does infections of people.

The number of ventilators in the area has increased from 2 to 5, raising additional concerns.

More detail on how symptomatic patients are excluded, as well as testing, rather than survey results, would be useful