ASIA: Dengue fever is raging across Southeast Asia, prompting the World Health Organization to warn that the region could face the worst outbreak of the mosquito-borne virus in nearly a decade.

The disease, sometimes called the “bone breaker” illness because of the excruciating joint pain it causes, has flared across the region from ultramodern Singapore to poor Vietnam. There are four different types of dengue, and none have a cure or vaccine.

Cambodia is currently one of the most worrisome spots, where the disease has attacked about 25,000 people and killed nearly 300 children under age 15 so far this year. That’s about three times more than the number of cases for all of 2005, according to WHO.

Sick children have overwhelmed ill-equipped hospitals there, forcing babies burning up with fever to wait for beds outside with IV drips attached to their arms.

The last major outbreak to hit Southeast Asia was in 1998, when about 350,000 cases were reported region wide, including nearly 1,500 deaths. Indonesia and Thailand were not included in that tally.

John Ehrenberg, WHO’s regional adviser on vector borne diseases, said it could potentially reach that level again this year.

“It looks like it might be a bad year,” he said. “I think we’re in the building-up stage, but it could very well peak by August or September.”

Malaysia has seen a 50 percent jump in cases this year over the same period in 2006, with more than 1,000 patients admitted every week for the past month and 56 deaths recorded through June, according to Health Ministry figures.

In Indonesia, more than 100,000 infections have been reported this year, including 1,100 deaths. That compares to 114,000 cases and the same number of fatalities for all of 2006, said Nyoman Kandun, a senior Health Ministry official who predicted the number will hit 200,000 by year’s end.

More than a dozen children infected with dengue filled beds in Jakarta’s Tarakan Hospital. Some had IV drips in their hands while others had tubes coming from their noses.

Muhammad Wildan, 5, was hospitalized last week and remained in critical condition due to internal bleeding. Doctors said he’s lucky his family did not wait any longer to bring him in.

“It did not come to us that it was dengue,” said Padmi Sari, the boy’s grandmother. “We thought it was just a common fever.”

Singapore, known for its spotless streets and cutting-edge health facilities, has also not escaped dengue this year. The government has reported nearly 5,000 cases and at least three deaths. Early rains also caused a surge in cases in Thailand with more than 20,000 cases reported through June, including 17 deaths, officials said.

In Vietnam, which also typically logs a high number of annual cases, health officials have seen a 40 percent increase over last year reporting more than 33,000 infections this year and 32 deaths.

In addition to joint pain, rashes, nausea, severe headaches and high fever that typically accompany the disease, patients stricken with a more serious form, called dengue hemorrhagic fever, can experience internal bleeding, liver enlargement and circulatory shut down.

“You don’t want to have people staying at home and starting to bleed,” Ehrenberg said. “By the time they go to the hospital they’re in shock and they will die.”

The disease is not nearly as lethal as malaria, which kills more than 1 million people annually. But WHO estimates dengue infects up to 50 million people every year worldwide, mostly in Asia and Latin America. About a half million of those cases are severe, and some 19,000 deaths were recorded in 2002.

“We always think next year it will get better, but we always find next year it gets worse,” said Kroeger Axel, a dengue research coordinator at the WHO in Geneva. “There’s a very clear upward trend.”

He said outbreaks run in cycles, occurring roughly every four years. Mosquitoes breed in stagnant pools of water ranging from flower pots to old tires, and residents across the region are urged to avoid letting water collect near houses.

INDIA: The 2006 estimates released by the National AIDS Control Organization (NACO), supported by UNAIDS and WHO, indicate that national adult HIV prevalence in India is approximately 0.36%.

As part of its continuing effort to know its epidemic better, the Indian Government has greatly expanded and improved its surveillance system in recent years and increased the population groups covered. In 2006, the government created 400 new sentinel surveillance sites and facilitated National Family Health Survey-3, which is a population based survey.

Launching the third phase of the National Programme, Dr. Anbumani Ramadoss, Union Minister for Health and Family Welfare said, “Revision of estimates based on more data and improved methodology marks a significant improvement in systems and capabilities to monitor the spread of HIV, a sign of the progress we have made in understanding the epidemic better. This is welcome progress. Unfortunately, the new figures still point towards a serious epidemic with the potential to trigger off if the prevention efforts identified in the NACP III are not scaled up rapidly and implemented in the desired manner. We must remember that India has nearly 301 lakh people living with HIV. These are people facing stigma, discrimination and irrational prejudice everyday of their lives and need all our support and understanding.” The Minister called upon his colleagues in the medical profession and civil society organizations to fight stigma and discrimination.

Resulting from a more robust and enhanced methodology, the revised estimates will be used to improve planning for prevention, care and treatment efforts. “While it is good news that the total number of HIV infections is lower than previously thought, we cannot be complacent. The steady and slow spread of the HIV infection is a worrying factor. The better understanding of India’s epidemic has certainly enabled us to have more focused HIV prevention and treatment strategies and more effective deployment of resources,” said Mr. Naresh Dayal, Secretary Health and Chair of the National AIDS Control Board.

The new methods developed for the revised estimates has also been used to “back-calculate” the prevalence for years since 2002 based on the new set of assumptions and measures. These figures allow a fair comparison of year-on-year trends in HIVprevalence. They show an epidemic that is stable overtime with marginal decline in 2006.

Commenting on the new estimates and guarding against their misinterpretation, Sujatha Rao, Additional Secretary and Director General, National AIDS Control Organization said, “The calculation of figures for several years, using the new model helps us understand that the new lower estimates do not mean a sharp decline in the epidemic.” Cautioning against an easing off the momentum of the HIV response she added, “Using a similar methodology led to downward revision in estimates in some countries such as Zambia and Rwanda. We will convince all stakeholders to stay energized and to retain the hard-fought gains of the last decade”

Showing confidence in the commitment of the Indian leadership, Dr. Denis Broun, UNAIDS Country Coordinator said, “The trends evident from the latest estimates validate India’s national AIDS strategy. Taking encouragement from the new lower estimates the national authorities should increase the strength of their HIV programmes. We must scale-up efforts to reach universal access to HIV prevention, care and treatment. Though the proportion of people living with HIV is lower than previously estimated, India’s epidemic continues to be substantial in numbers. Despite the lower prevalence estimate the cost of prevention efforts required to control the epidemic remains the same.”

WHO Representative, Dr. Salim Habayeb commended the vision of the Government of India in the last 15 years for addressing the HIV epidemic. He also commended the efforts of the states, civil society, partner agencies as well as the valuable role of the media in facilitating the creation of an enabling environment. “The HIV burden remains substantial. India’s efforts, especially those in prevention, are noteworthy and should be further scaled up along with provision of Universal Access to treatment for those who need it.”

HIV prevalence shows signs of slight decline among general population

While overall, the HIV epidemic shows a stable trend in the recent years, there is variation between states and population groups. The good news is that in Tamil Nadu and other southern states with high HIV burden where effective interventions have been in place for several years, HIV prevalence has begun to decline or stabilize.

New pockets of high HIV prevalence identified

HIV continues to emerge in new areas. The 2006 surveillance data has identified selected pockets of high prevalence in the northern states. There are 29 districts with high prevalence, particularly in the states of West Bengal, Orissa, Rajasthan and Bihar.

HIV prevalence continues to be high among vulnerable groups

The 2006 surveillance figures show an increase in HIV infection among several groups at higher risk of HIV infection such as people who inject drugs and men who have sex with men. The HIV positivity among Injecting Drug Users (IDU) has been found to be significantly high in metro cities of Chennai, Delhi, Mumbai and Chandigarh. Besides, the states of Orissa, Punjab, West Bengal, Uttar Pradesh and Kerala also show high prevalence among IDUs.

While data does suggest that HIV prevalence levels are declining among sex workers in the southern states, overall prevalence levels among this group continue to be high, necessitating a scaling up of focused prevention efforts among these groups.

“Only by controlling the epidemic among the vulnerable groups can the dynamic of the epidemic be broken,” said Sujatha Rao, Additional Secretary and Director General, NACO.

Regulatory Authority on Safe Blood being established

Underscoring the priorities, the Minister of Health called for the need for strong measures to regulate the blood collection and distribution system in the country to make it world class. He stated that the Ministry of Health is establishing a regulatory authority which will regulate access to safe blood at affordable prices.

WHO Southeast Asia