Indian scientists warn of "mutant measles" virus
BMJ 2001
Ganapati Mudur, New Delhi

Indian scientists have warned that India may be witnessing the emergence of
a highly lethal measles-like virus, causing encephalitis in adults and
children.

Scientists investigating an outbreak of encephalitis among adults in the
town of Siliguri, in West Bengal, told the health ministry this week that
the disease was caused by a mutant measles virus that affects the brain,
lungs, or kidneys.

"For now, we're calling this a variant of measles," Dr Nirmal Kumar 
Ganguly, director general of the Indian Council of Medical Research, told the BMJ.

This is India's third outbreak since 1998 of a highly fatal illness
involving the brain or the kidneys and attributed to the measles virus. The
unexplained outbreak in February this year killed at least 28 people,
including two doctors and five nurses in a clinic. The infection spread
through droplets in air expelled by patients during the terminal phase of
the illness, which is marked by pneumonia.

Epidemiologists say that adequate protection and barrier nursing helped to
quell the outbreak. Investigations had ruled out vector borne infections
common in India, such as cerebral malaria or Japanese encephalitis. Tissue
samples studied at the National Institute of Virology in Pune showed
antibody signatures of measles in 17 samples collected. Measles virus
antigen was detected in brain tissues of two patients. The diagnosis has
also been confirmed through other tests for the virus.

"A measles-like virus that is highly fatal to adults and spreads through
droplets in the air is very worrying," said Dr T Jacob John, a leading
Indian virologist, formerly with the Christian Medical College in Vellore.
"This doesn't look like a one-time event. India may even have had early
warnings."

Two years ago a team from the National Institute of Virology had isolated
the measles virus from five adults in Bombay with acute renal failure and
neurological symptoms. Four of the patients died, but none had a rash. The
institute had also isolated the measles virus in two highly fatal outbreaks
of encephalitis among children aged under 12 years in three statesHaryana,
Gujarat, and Andhra Pradeshduring 1998.

"In those previous outbreaks, immunisation seems to have failed to protect
against this virus," said Dr Ganguly.

The National Institute of Virology had said last year that the absence of a
rash and unusual symptoms may mean that measles was re-emerging in India
despite widespread vaccination coverage. Virologists say that genetic
studies of the virus are necessary.






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