BIOTERRORBIBLE.COM: India has three BSL 4 labs entitled "All India Institute of Medical Sciences" in New Delhi, India, "Centre for Cellular and Molecular Biology" in Hyderabad, India, and "High Security Animal Disease Laboratory" (HSADL) in Bhopal, India. Coincidentally, Bhopal is the same city which had the world's largest "gas leak" which killed and injured over half a million people in 1984. Based on recent bio-terror news and events, the government of India appears to be preparing its population for a major bio-terror pandemic. India is also home to a few highly publicized monkey attacks which may be scapegoated as the root cause of a future pandemic.

Title: Monkey Injures Several People In India
 November 13, 2007
Red Orbit

Abstract: A wild monkey went on a rampage in a low-income neighborhood in the Indian capital, injuring several people, most of them children, police said Monday.

Police sub-inspector Gaje Singh told The Associated Press that the attacks started late Saturday in the Shastri Park area of New Delhi, adding that it was not immediately possible to give an exact tally of the injured. Local news reports said as many as 25 people were injured.

Singh said officers were patrolling the neighborhood in search of the rogue animal.

“But the monkey hasn’t been spotted yet,” Singh said.

People in Shastri Park often sleep outside their homes or on open roofs to escape the heat.

Neighborhood resident Naseema, who goes by one name, carried her 1-year-old daughter into her house in attempts to escape the animal. “The monkey followed me in and buried its teeth in my baby’s leg,” she told the Times of India newspaper.

As New Delhi’s forest cover shrinks, rhesus macaque monkeys have overrun its government buildings, temples and residential areas, occasionally biting passers-by or snatching food from them. A government official died last month when he fell from his balcony during an attack by wild monkeys.

Part of the problem is that devout Hindus believe monkeys are manifestations of the god Hanuman and feed them bananas and peanuts, encouraging them to frequent public places.

Last year, the Delhi High Court reprimanded city authorities for not doing enough to stop the animals from terrifying residents.

City authorities have experimented with using langurs – a larger and fiercer kind of monkey – to scare or catch the macaques, but the problem persists (Red Orbit, 2007).

Title: India Prepares For Bioattacks At 2010 Commonwealth Games
 December 23, 2009
 Bio Prep Watch

Abstract: Almost eight battalions of India’s National Disaster Response Force have readied themselves with prophylaxis for anthrax and nerve gas antidotes in preparation for the 2010 Commonwealth Games that will take place in New Delhi.

Nearly 71 nations are expected to take part in the 2010 Commonwealth Games and the 8,000 personnel from the eight battalions will be at all stadiums to fight any eventuality created by terrorists looking to cause panic or create terror.

“The profile of terrorists is changing. Gone are the days when only uneducated unemployed youth got into terrorism,” Alok Awasthi, Commandant of NDRF, told Mid Day. “Now well educated and techno-savvy youth are getting indoctrinated and hence we have to be ready to understand their mindset. Hence we have been asked to be on alert during the Commonwealth Games.”

The NRDF’s main areas of concentration during the games will be the possibility of bioterrorism, especially through anthrax attacks or chemical warfare agents such as nerve gas, mustard, phosgene, hydrogen cyanide and cyanogen chloride.

To combat the potential attacks, the NDRF will be equipped with Residual Vapour Detectors, Chemical Agent Monitors, Water Poisoning Detector kits and three color detector papers. Devices for decontamination from the agents will also be available.

“We will be carrying out mock drills in the venue of Commonwealth Games from January to create awareness among the people and also to test our teams,” Awasthi said (Bio Prep Watch, 2009)

Title: Terror Attacks 'Likely' In India During Commonwealth Games
Date: 2010
Source: Metro

Abstract: Fears about the safety of competitors, together with concerns about sanitation in the athletes' village, prompted a number of teams to think carefully about taking part in Delhi.

The Scottish team has travelled to India despite security worries (PA)

All nations have now confirmed their participation, although stars such as Geraint Thomas, Phillips Idowu and Elena Baltacha have withdrawn from the competition, which is set to get underway on October 3rd.

Although most athletes have been persuaded to compete, leading international security firm Control Risks has now warned that terrorists are likely to target India during the event.

Chietigj Bajpaee, a senior analyst for Control Risks, told the Observer: 'I think there is a relatively high likelihood of attacks taking place, but these attacks may not target the Games venues themselves.’

He advised that athletes should avoid using public transport or visiting tourist attractions and markets.

Mr Bajpaee added that as Indian authorities planned to use most of their security resources guarding the venues, terrorists would find that other parts of Delhi were more vulnerable to attacks (Metro, 2010)

Title: Commonwealth Games Prepared For Bioterror
Date: July 30, 2010
Bio Prep Watch

Abstract: There have been no specific threats leveled at the Commonwealth Games, which will be held in India in October, but intelligence agencies have said there is enough of a generic threat to require them to be prepared for all manner of attack, including bioterror.

To protect the games against such organizations as Al-Qaeda and the Pakistan-based Lashkar-e-Toiba, the games will utilize a four-layered security cover designed to fight all potential threats, EconomicTimes.IndiaTimes.com reports.

One Al-Qaeda commander, Ilyas Kashmiri, warned in February that foreign teams should stay away from the games. Thirty-three teams are currently scheduled to participate in the games. Lashkar-e-Toiba, experts have said, is believed to be planning terror acts against India.

The outer layer of security at the games involves the use of a massive police and paramilitary presence with perimeter fencing. Inner layers will use frisking and baggage checks for potential chemical, biological and nuclear weapons. Inside those security levels will be security officials tasked with keeping an eye on actions inside of venues.

In the event of an attack, foreign delegates have already been briefed on evacuation drills and contingency plans for the Games village and the Jawaharlal Nehru Stadium, which will hold the opening and closing ceremonies, EconomicTimes.IndiaTimes.com reports (Bio Prep Watch, 2010)

Title: India To Stage Chemical Emergency Exercise Event
September 9, 2010
Bio Prep Watch

Abstract: A joint team comprised of the National Disaster Response Force and the Indian Army will represent India during an international chemical emergency exercise planned for October in Tunisia.

The exercise is planned by the Organization for Prohibition of Chemical Weapons, which is comprised of a group of 15 countries that have signed a treaty to enable a coordinated response to any chemical, biological, radiological or nuclear attack, the Times of India reports.

J. S. Notay, an advisor for the National Authority for Chemical Weapons Convention, told the Times of India that he was excited about the upcoming exercise.

“While the upcoming exercise in Tunisia will be the third in the series of such events that is held once every five years, India will be participating for the first time considering that the NDRF came into existence in 2005,” Notay said, the Times of India reports.

Participants got a sneak preview of what to expect during a demonstration this week in Talegaon, near Pune.

The demonstration simulated a scenario of a chemical bomb blast at a sports complex and an elaborate response by the Indian team to search out and rescue people trapped under the rubble and in the parking lot.

K.M. Singh, a member of the National Disaster Management Authority who was also on hand for the demonstration, told the Times of India that he believed it was important for all member-countries to know the kind of coordinated response they are supposed to mount in the event of a CBRN attack.

“The NDRF is equipped with some of the best available rescue equipment while the training and infrastructure needs too are being taken care of well,” Singh told the Times of India. “Two more NDRF battalions are to come up soon at Patna in Bihar and Vijaywada in Andhra Pradesh to add to the existing eight battalions. In the last three years, the NDRF teams have been summoned for search and rescue missions on 91 occasions involving calamities such as cyclones, earthquakes, building collapses and post-tsunami relief operation, among others. The force has saved or rescued close to 1.36 people, collectively for these occasions” (Bio Prep Watch, 2010).

Title: India To Take Part In OCPW Response Simulation
Date: September 16, 2010
Bio Prep Watch

Abstract: A joint team of the National Disaster Response Force and the Indian Army will represent India at an international chemical emergency exercise in Tunisia this October.

The exercise, dubbed ASSISTEX-3, is planned by the Organization for Prohibition of Chemical Weapons, the Times of India reports. The OPCW is comprised of a group of 15 countries, including the United Kingdom, Germany, France, Denmark, Switzerland and Italy, that have signed a treaty that enables a coordinated response to a CBRN attack on any of the member countries.

J.S. Notay, advisor for the National Authority for Chemical Weapons Convention, told the Times of India that this is the first time that India will take part in the exercise, which is held once every five years.

Notay, along with K.M. Singh, a member of National Disaster Management Authority, recently attended and reviewed a search and rescue demonstration by the joint team at the CRPF camp in Talegaon, near Pune, India.

The scenario was a simulation of a chemical bomb blast at a sports complex and featured an elaborate response by the Indian team to find and rescue people trapped under the rubble, the Times of India reports.

“It is crucial for all member-countries to know the kind of coordinated response they are supposed to mount in the event of any member country calling for help to deal with CBRN emergencies,” Singh told the Times of India (Bio Prep Watch, 2010).

Title: Commonwealth Games 2010: Athletes Warned Of Rising Terrorism Threat
Date: September 25, 2010
Source: Guardian

Abstract: Athletes and business leaders planning to attend the Commonwealth Games in Delhi have been privately warned to expect terrorist attacks on tourist sites and public spaces across 
India, the Observer has learned.

After a week in which the Games appeared to be in serious danger of cancellation, some athletes have now started to arrive in Delhi. The first representatives of England arrived on Thursday, while Scottish and Welsh competitors were due to fly in yesterday.

But a risk analysis provided to a number of national teams – believed to include some from the UK – and major corporations has highlighted the terrorist threat overshadowing the event.

The alarming assessment, by one of the world's leading security firms, helps explain why the Commonwealth Games Federation president, Michael Fennell, warned yesterday that there was still great concern about the security and safety of athletes and officials.

In a damning indictment of Delhi's ability to protect visitors, the UK-based firm Control Risks warned that the diversion of security resources to protecting the main stadiums left India without the capacity or capability to protect soft targets, with local police not up to the job.

The firm has advised its clients to stay away from tourist attractions, public places and government buildings, and not to travel by public transport.

Chietigj Bajpaee, the company's south Asia senior analyst, told theObserver that Control Risks had advised clients to expect terrorist attacks on soft targets around India in the days running up to the Games and during the Games themselves, from 3 to 14 October.

"I think there is a relatively high likelihood of attacks taking place, but these attacks may not target the Games venues themselves," he said.

"We have advised against using public transport, advised against going to certain areas, advised against going to tourist attractions in the weeks leading up to and during the event, given that security resources will be concentrated on securing the Games themselves, so other parts of the city and the country will be vulnerable.

"We have also advised that if you are a team participant you may be more vulnerable than a tourist. We have advised avoiding areas around government buildings or anything that could be considered a soft target, such as marketplaces."

The advice was vindicated when two Taiwanese tourists were shot outside the Jama Masjid, one of the largest mosques in India, in the heart of Delhi last Sunday. Initial attempts by the police to deny terrorist involvement were met with widespread disbelief and officials later pointed the finger at the Indian mujahideen, which had claimed responsibility and promised further attacks. One report, citing police sources, suggested the group had hired gunmen to attack westerners on sight.

The security warnings come at the end of a terrible week for India in which several national teams threatened to withdraw from the competition, voicing dismay at the ramshackle condition of the Games village, the collapse of a footbridge to the main stadium and the tourist shooting.

To add to visitors' concerns, the Royal Institution of Chartered Surveyors has now expressed serious misgivings about the quality of the stadiums. The institution's head in India, Sachin Sandhir, warned of serious shortcomings in the public and sporting infrastructure, despite the estimated £6.3bn spent on the Games.

"The last-minute dash to complete most venues has resulted in huge compromises on quality of projects, bypassing of clearances, and exploitation of workers," he said.

He said structures caving in or showing signs of damage so soon after being built – a ceiling within the main stadium also collapsed last week – "raise serious concerns on the structural quality, viability and safety of venues, and are indicative of the gross violations of building codes and regulations and the level of adherence to ethical professional practices".

Sandhir criticised the Games as a wasted opportunity for India to showcase its talents, blaming rampant corruption, inefficiency, a lack of trained and qualified professionals, and the allocation of construction works to ill-suited agencies. "The absolute disregard to the use of standard material and equipment has also seriously jeopardised safety of venues," he said.

In a verdict which will do little to reassure those heading for Delhi, he added: "We can now only wait and watch and be hopeful that not all the venues were subjected to this lackadaisical approach to development and, in fact, some of these will actually deliver to international standards."

Some athletes have now started to arrive in Delhi, but while organisers believe that their swift reaction to international protests – which included the prime minister, Manmohan Singh, taking personal charge – may have helped turn a corner, many parts of the city and its key Games-related projects still resemble a badly drained building site.

The first members of Team England to arrive have been staying in a five-star hotel after shocked officials deemed accommodation in the Games village unacceptable. Craig Hunter, England's chef de mission, said he was glad to see the work was being done to improve conditions in the village, but added "we are in a phase of looking at the detail, making sure that fire and safety equipment and procedures are in place and that the apartments are clean and safe. Our next wave of athletes arrives on Sunday and a lot still needs to happen before then. So more and swift action is required."

Yesterday, Fennell said there had been considerable improvements but that there was still a lot to do if the Games were to go ahead as planned. "What is of great concern is the safety and security of athletes and officials," he said.

About 7,000 athletes from 71 countries were expected to travel to Delhi, but several have pulled out, citing security fears, concerns over the accommodation and the ongoing dengue fever problem – worsened by large pools of stagnant water that have proved a breeding ground for mosquitos – as reasons enough to stay at home.

Australia's world discus champion, Dani Samuels, said the mosque shooting had led to her decision to pull out.

English diver Peter Waterfield, a previous gold and silver medal winner, said he was putting his family first and would not put himself at risk by travelling.

"I have a wife and two young children who were very concerned about me attending the event and this decision is one that we have made as a family. I hope that people will understand and respect this," he said.

Among the potential banana skins India must still negotiate are a court verdict due out on Tuesday on the hugely contentious Hindu-Muslim dispute involving the religious site at Ayodhya, in Uttar Pradesh, which has claimed thousands of lives in recent years. Security forces around the country have been placed on alert as a ruling is delivered on whether a Hindu temple or Muslim mosque can be built there.

The task of keeping order will be made more difficult by the decision to assign at least 40% of police in the capital to Games security, including inspectors in charge of anti-terrorism squads.

But Delhi's police commissioner, YS Dadwal, said that he was completely satisfied with security arrangements. "I assure international athletes that there is foolproof security for the Commonwealth Games," he said. "There is no doubt over it" (Guardian, 2010)

Title: WikiLeaks: India Faces Bioterror Threat, Said Cable
Date: December 17, 2010
Source: NDTV

Abstract: US diplomats were concerned that India could be the target of a biological terror attack, with fatal diseases such as anthrax being released into the country before spreading around the world, according to diplomatic cables released by WikiLeaks.

The confidential cables revealed that a senior Indian diplomat told the US in 2006 that concerns about biological weapons were "no longer academic", adding that intelligence suggested terror groups were increasingly discussing biowarfare, the Guardian reported on Friday.

"(Diplomat) YK Singh reported that Indian intelligence is picking up chatter indicating jehadi groups are interested in bioterrorism, for example seeking out like-minded PhDs in biology and biotechnology," a cable from the US embassy in New Delhi sent to Washington said.

"He compared the prospects for nuclear terrorism ('still in the realm of the imaginary') to bioterrorism ('an ideal weapon for terrorism ... anthrax could pose a serious problem ...it is no longer an academic exercise for us')."

Another cable warns that "advances in the biotech sector and shifting terrorist tactics that focus on disrupting India's social cohesion and economic prosperity oblige the (Government of India) to look at the possibility of terror groups using biological agents as weapons of mass destruction and economic and social disruption".

It also warns terrorists could easily find the material they need for bioterrorism in India and use the country as a base for launching an international campaign involving the spread of fatal diseases.

"The plethora of indigenous highly pathogenic and virulent agents naturally occurring in India and the large Indian industrial base - combined with weak controls - also make India as much a source of bioterrorism material as a target," diplomats warned.

"Release in an Indian city could facilitate international spread ... Delhi airport alone sees planes depart daily to numerous European, Asian, Middle Eastern and African destinations, as well as non-stop flights to Chicago and Newark.

"Terrorists planning attacks anywhere in the world could use India's advanced biotechnology industry and large biomedical research community as potential sources of biological agents.

"Given the strong web of air connections Delhi shares with the rest of the world and the vulnerabilities that might be exploited at airports, a person wittingly or unwittingly could easily take hazardous materials into or out of the country."

Though its author admitted the chance of such an attack was slim, the cable referred to Indian government intelligence, passed to the US, indicating that Islamic extremist groups were "seeking to recruit or employ biology/biotech PhD holders from within India".

The cable focused particularly on the lack of preparedness of Indian authorities for such an attack, assessing Indian government assurances that the country could defend itself against bioterrorism to be "unconvincing".

Scientists attached to the US embassy had been shown photographs taken by a senior Indian army officer from "frontline field laboratories for diagnostics of infectious diseases" which "demonstrated a host of poor laboratory security and safety practices, including families sleeping in labs and disposable gloves being washed for re-use or being disposed of as non-hazardous biological waste", the cable reported.

The dispatch is one of many dealing with the threat of terrorism in India sent by diplomats in New Delhi both before and after the 26/11 Mumbai attacks that were carried out by the Pakistan-based Lashkar-e-Toiba (LeT) group in November 2008.

Earlier cables focused more on the radicalisation of Muslims within India.

One is optimistic. "India's over 150 million Muslim population is largely unattracted to extremism. India's growing economy, vibrant democracy, and inclusive culture, encourage Muslims to seek success and social mobility in the mainstream and reduces alienation," it said.

Though the Muslim community in India "suffers from higher rates of poverty than most other groups in India, and can be the victims of discrimination and prejudice ... the vast majority remain committed to the Indian state and seek to participate in mainstream political and economic life", the cable said.

"Only a small number of young Muslims have ... gravitated toward pan-Islamic and pro-Pakistan organisations, which sometimes engage in acts of violence" (NDTV, 2010).

Title: Man Falls To Death From Rooftop After Monkey Attack
Date: February 22, 2011
Times of India

Abstract: After two elephants injured a Korean couple at Amber, it was the turn of monkeys on Monday to create a ruckus. A 42-year-old businessman fell from the third floor of his house after being attacked by a group of monkeys in Galta Gate area in the morning. He died on the spot. 

According to the police, the deceased, Giriraj Prasad Gupta, was a resident of Raghunath Colony in Galta Gate and owned a shop in Surajpole. He used to take a stroll on the rooftop of his third floor along with his wife every morning, said his father 
Brij Bihari Gupta

At around 6 am, Giriraj asked his wife to go down and get tea for him. 

"She had taken a few steps down the stairs when a group of moneys jumped to the rooftop from another house and attacked Giriraj," said a police officer. 

His wife told police that while trying to scare away the monkeys, Giriraj asked her to run for safety. 

"As his wife climbed down the stairs, she saw the monkeys attacking Giriraj," said the officer adding that the he fell head-on to the ground. "Giriraj's brother, who was in his room on the second floor, heard a loud thud and peeped out of the window. He saw Giriraj and rushed outside. But he had died on the spot," said the officer. 

Nevertheless, the victim was rushed to 
SMS Hospital by family members, but declared brought dead. The hospital informed the police following which a post-mortem was conducted. 

"We have handed over the body to the family members. A physical verification of the spot will be conducted on Tuesday," said the officer. 
(Times of India, 2011).

Title: Anthrax Found In 26 Drinking Wells In India
Date: January 10, 2012
Source: Bio Prep Watch

Abstract: A group of students from Palamur University in Andhra Pradesh, India, found deadly anthrax bacteria in the ground water of more than 26 habitations during research for a project.
Pawan Kumar, the head of the department of microbiology, sent the students to nearby villages to obtain water samples of colored water from open water bodies to test in the laboratory. After examining the water, Kumar suspected that the samples contained Bacillus anthracis, the bacteria that causes anthrax. The Center for Cellular and Molecular Biology confirmed his fears, the Deccan Herald reports.
“The water has Bacillus anthracis bacteria which causes anthrax, a zoonotic disease that is transmissible to humans through handling or consumption of contaminated animal products,” Kumar said, according to the Deccan Herald.
The water samples were collected from Kodangal, Midjil, Papireddyguda, Khillaghanapuram, Atmakur, Aamanagallu, Lingala, Devarakonda and Alampur. The water had been contaminated from raw sewage, animal and blood products.
“The villagers in these places, even in a tourist spot such as Alampur, drink this water day in and day out," Venkat Reddy, a student, said, the Deccan Herald reports. "They are suffering from unknown diseases, many with ulcers so we want to go further and seek protected water for our people."
Humans can become infected with anthrax by handling products or consuming undercooked meat from infected animals. Infections can also occur from inhaling spores in contaminated anthrax products or in the intentional release of spores during a bioterrorist attack (Bio Prep Watch, 2012).

Title: Flip Side Of India’s Polio Success Story
Date: January 15, 2012
Telegraph India

Abstract: India’s health ministry, celebrating a year of freedom from wild polio, now faces a dilemma that public health experts had predicted years ago: the very vaccine it is using to fight polio is causing more polio paralysis than the wild poliovirus.

India observed last Thursday as a milestone, marking a full year without polio caused by a wild poliovirus.

But surveillance data show that last year, seven children in India developed polio from vaccine-derived poliovirus (VDPV), the medical term for a virus from the oral polio vaccine (OPV) that has regained the ability to cause disease.

Such infections occur when virus from the OPV, after being excreted by vaccinated children, regains neuro-virulence and the ability to circulate in the environment and strikes other vulnerable children.

Public health experts also estimate that between 100 and 180 children in India develop vaccine-associated polio paralysis (VAPP) each year, a rare but serious side effect of the OPV they had received to protect them from the wild poliovirus. As opposed to VDPV infection, VAPP affects the vaccinated children themselves.

“Our war on polio isn’t over,” said T. Jacob John, a former head of virology at the Christian Medical College, Vellore.

“Even if India remains free of wild polio in 2012 and 2013, it will need to pencil a strategy to eradicate all of polio — including VDPV (infections) and VAPP.”

Paediatricians and public health experts emphasise that it is the OPV alone that has helped India achieve the current zero level of wild polio — after thousands of infections each year during the 1980s and 1990s.

“It is the OPV that is even now preventing tens of thousands of children in India from getting polio every year. It is important to appreciate the huge number of cases this vaccine is averting,” said Hamid Jafari, head of the National Polio Surveillance Project, a joint initiative by the health ministry and the World Health Organisation.

“We are not out of the woods yet. India will need to continue using the OPV for several years to secure eradication, to maintain high levels of immunity among children, and to prevent any re-emergence of polio,” Jafari told The Telegraph.

Wild poliovirus circulation persists in Pakistan, Nigeria and Afghanistan. Health officials are wary that the movement of people, which had once carried polio from India into Angola, might now bring polio back into India from these countries.

Both VDPV infections and VAPP are long-recognised problems linked with the OPV, which is made from weakened but live viruses. Many countries, including America and Britain, have switched to an alternative, inactivated and injectible polio vaccine (IPV) made from killed viruses with no risk of vaccine-linked polio.

India’s public immunisation programme relies exclusively on the use of the OPV, and the IPV is used in India only in the private sector. The Indian Academy of Paediatrics recommends three doses of the IPV at six, ten and 14 weeks after birth, to be given along with routine doses of the OPV.

Polio control experts are particularly worried about VDPV. Global surveillance efforts picked up 430 cases of VDPV from several countries between July 2009 and March 2011. As long as OPV is used, virologists, say the world is at risk of VDPV causing polio in unprotected children.

Achieving a polio-free world will require the “cessation of all OPV” and with it the elimination of the risk of VAPP or VDPV infections, two immunisation experts, Stephen Cochi and Robert Linkins, from the Centers for Disease Control in the US said this week in the Journal of Infectious Diseases.

The India Expert Advisory Group, a body of international experts advising India on polio, had last July urged the health ministry to develop a road map for the eradication of all polio: that is, both wild and vaccine-linked polio.

In the six months since then, the health ministry has not articulated how it plans to approach the polio endgame.

“We have been struggling to eradicate the wild virus,” said Ajay Khera, deputy commissioner for immunisation in the health ministry.

“We have no policy yet on what to do after eradication of the wild poliovirus. We are waiting for a global consensus to emerge on the way forward.” Public health experts have long predicted financial and logistical hurdles in future efforts to replace OPV with IPV.

“The solutions aren’t going to be easy,” John said from Vellore.

The IPV is expensive and there are concerns that the industry may not have enough of the vaccine to supply it to India. But an articulation of vaccine policy by the government may stimulate the industry into bolstering capacity, John said.

In a commentary three years ago in the Indian Journal of Medical Research, calling on the government to pencil an endgame eradication strategy, John and a Bijnore-based paediatrician, Vipin Vashishta, had cited a Sanskrit proverb: “Do not wait to dig a well till the house starts burning.”

“The fire is here now,” John said yesterday. “But it appears that India hasn’t even decided to dig the well” (Telegraph India, 2012)

Title: Suspected Polio Case Appears In India
Date: March 13, 2012

Abstract: On Feb 25, 2012, the World Health Organization director general, Dr. Margaret Chan notified India's minister of Health and Family Welfare, Ghulam Nabi Azad that 
India was officially removed from the list of polio-endemic countries after successfully remaining polio free for one year.

However, the good news in India may be short-lived. On Monday, Mar 12, it was reported that an 18-month-old girl was admitted to a hospital in Kolkata showing symptoms of paralysis resembling polio according to Hindustan Times report.

The report says the mother said her daughter began dragging her feet after she was given routine vaccination, not polio, at a primary health center in February. She was later admitted with symptoms of paralysis with disability in movement and fever.

The child's stool samples have been sent to the National Institute of Virology in Pune and School of Tropical Medicine in Kolkata for testing to determine if it is indeed the paralysis is caused by a wild poliovirus, or hopefully, a non-poliovirus associated acute flaccid paralysis.

Health authorities in India will set up an intensive surveillance program in the child’s village of Indrabala in light of the girl’s mother saying that other children are suffering the same symptoms.

The last confirmed case of polio in India was on Jan 13, 2011 in a 2-year-old girl from the West Bengal state (Examiner, 2012).

Title: Suspected Polio Case Endangers India's Eradication Record
Date: March 13, 2012

India's removal from the list of "polio endemic" countries has been threatened by a suspected case of the disease in the east of the country.

A year without a recorded new case of polio – a major step towards its total eradication in India – was celebrated as a major success in the battle against the disease worldwide when it was announced last month.

On Tuesday, however, medical authorities were investigating a case of paralysis in a poverty-stricken area in the state of West Bengal.

"It is a suspected case of polio. In medical parlance, the symptoms are called acute flaccid paralysis. The patient is under observation," Kumar Kanti Das, superintendent of Baruipur subdivisional hospital, told the local Hindustan Times newspaper.

The mother of the affected child – an 18-month-old girl – was reported as saying that several other children in her neighbourhood had shown similar symptoms.

The case occurred not far from where the last identified new polio victim was found in January 2011.

With no new cases since that identification, India was taken off the list of "polio endemic countries" in late February by the World Health Organisation.

Another two years are needed to pass without a case of the disease before the country of 1.2bn inhabitants would formally be declared free of the disease.

India's prime minister, Manmohan Singh, hailed the passing of a year without a case as giving "hope that we can finally eradicate polio not only from India but from the face of the entire Mother Earth".

However, the new case will raise fears that the fight against polio in India is yet to be won.

Last year, Sir Liam Donaldson, the UK's former chief medical officer who now chairs the independent monitoring board of the Global Polio Eradication Initiative, said the final success of the eradication campaign, which has seen cases reduced by 99% in 20 years, was "on a knife-edge". In some places, particularly sub-Saharan Africa, polio has even made a comeback. Other countries where the disease is still endemic include Nigeria, Afghanistan and Pakistan.

In India, a mass vaccination campaign involving more than a million volunteers reduced cases nationally by 94% between 2009 and 2010, from 741 to 42, and down to the single case last year.

The success was attributed to a combination of highly motivated local workers, philanthropy, the involvement of international health bodies and support of local government (Guardian, 2012)

Title: Drug-Defying Germs From India Speed Post-Antibiotic Era
Date: May 7, 2012
Source: Bloomberg

Abstract: Lill-Karin Skaret, a 67-year-old grandmother from Namsos, 
Norway, was traveling to a lakeside vacation villa near India’s port city of Kochi in March 2010 when her car collided with a truck. She was rushed to the Amrita Institute of Medical Sciences, her right leg broken and her artificial hip so damaged that replacing it required 12 hours of surgery.

Three weeks later and walking with the aid of crutches, Skaret was relieved to be home. Then her doctor gave her upsetting news. Mutant germs that most antibiotics can’t kill had entered her bladder, probably from a contaminated hospital catheter in India. She risked a life-threatening infection if the bacteria invaded her bloodstream -- a waiting game over which she had limited control, Bloomberg Markets magazine reports in its June issue.

“I got a call from my doctor who told me they found this bug in me and I had to take precautions,” Skaret remembers. “I was very afraid.”

Skaret was lucky. Eventually, her body rid itself of the bacteria, and she escaped harm from a new type of superbug that scientists warn is spreading faster, further and in more alarming ways than any they’ve encountered. Researchers say the epicenter is India, where drugs created to fight disease have taken a perverse turn by making many ailments harder to treat.

India’s $12.4 billion pharmaceutical industry manufactures almost a third of the world’s antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune in a pool of resistance that thwarts even high-powered antibiotics, the so-called remedies of last resort.

Medical Tourism
Poor hygiene has spread resistant germs into India’s drains, sewers and drinking water, putting millions at risk of drug-defying infections. Antibiotic residues from drug manufacturing, livestock treatment and medical waste have entered water and sanitation systems, exacerbating the problem.

As the superbacteria take up residence in hospitals, they’re compromising patient care and tarnishing India’s image as a medical tourism destination.

“There isn’t anything you could take with you traveling that would be useful against these superbugs,” says Robert Moellering Jr., a professor of medical research at Harvard Medical School in Boston.

The germs -- and the gene that confers their heightened powers -- are jumping beyond India. More than 40 countries have discovered the genetically altered superbugs in blood, urine and other patient specimens. CanadaFranceItalyKosovo and South Africa have found them in people with no travel links, suggesting the bugs have taken hold there.

Post-Antibiotic Era
Drug resistance of all sorts is bringing the planet closer to what the World Health Organizationcalls a post-antibiotic era.

“Things as common as strep throat or a child’s scratched knee could once again kill,” WHO Director-General Margaret Chan said at a March medical meeting in Copenhagen. “Hip replacements, organ transplants, cancer chemotherapy and care of preterm infants would become far more difficult or even too dangerous to undertake.”

Already, current varieties of resistant bacteria kill more than 25,000 people in Europe annually, the WHO said in March. The toll means at least 1.5 billion euros ($2 billion) in extra medical costs and productivity losses each year.

“If this latest bug becomes entrenched in our hospitals, there is really nothing we can turn to,” says Donald E. Low, head of Ontario’s public health lab in Toronto. “Its potential is to be probably greater than any other organism.”

Promiscuous Plasmids
The new superbugs are multiplying so successfully because of a gene dubbed NDM-1. That’s short for New Delhi metallo-beta- lactamase-1, a reference to the city where a Swedish man was hospitalized in 2007 with an infection that resisted standard antibiotic treatments.

The superbugs are proving to be not only wily but also highly sexed. The NDM-1 gene is carried on mobile loops of DNA called plasmids that transfer easily among and across many types of bacteria through a form of microbial mating. This means that unlike previous germ-altering genes, NDM-1 can infiltrate dozens of bacterial species. Intestine-dwelling E. coli, the most common bacterium that people encounter, soil-inhabiting microbes and water-loving cholera bugs can all be fortified by the gene.

What’s worse, germs empowered by NDM-1 can muster as many as nine other ways to destroy the world’s most potent antibiotics.

Untreatable Killers
NDM-1 is changing common bugs that drugs once easily defeated into untreatable killers, saysTimothy Walsh, a professor of medical microbiology at Cardiff University in Wales. Or as in Skaret’s case, the gene is creating silent stowaways poised to attack if they find a weakness -- or that can pass harmlessly when the body’s conventional microbes win out.

Cancer patients whose chemotherapy inadvertently ulcerates their gastrointestinal tract are especially vulnerable, says Lindsay Grayson, director of infectious diseases and microbiology at Melbourne’s Austin Hospital.

“These bugs go straight into their bloodstream,” Grayson says. Newborns, transplant recipients and people with compromised immune systems are at higher risk, he says.

Six infants died in a small hospital in Bijnor in northern India from April 2009 to August 2010 after NDM-1-containing bacteria resisted all commonly used antibiotics.

India Vulnerable
India is susceptible because it has many sick people to begin with. The country accounts for more than a quarter of the world’s pneumonia cases. It has the most tuberculosis patients globally and Asia’s highest incidence of cholera.

Most of India’s 5,000-plus drugmakers produce low-cost generic antibiotics, letting users and doctors switch around to find ones that work. While that’s happening, the germs the antibiotics are targeting accumulate genes for evading each drug. That enables the bugs to survive and proliferate whenever they encounter an antibiotic they’ve already adapted to.

India’s inadequate sanitation increases the scope of antibacterial resistance. More than half of the nation’s 1.2 billion residents defecate in the open, and 23 percent of city dwellers have no toilets, according to a 2012 report by the WHO and Unicef.

Uncovered sewers and overflowing drains in even such modern cities as New Delhi spread resistant germs through feces, tainting food and water and covering surfaces in what Dartmouth Medical School researcher Elmer Pfefferkorn describes as a fecal veneer.

Tap Water
Germs with the NDM-1 gene existed in 51 of 171 open drains along the capital’s streets and in two of 50 samples of public tap water, Walsh found in 2010.

Abdul Ghafur, an infectious diseases doctor in Chennai, southern India’s largest city, sees patients every week who suffer from multidrug-resistant infections. He and others who used to successfully combat infections with such common antibiotics as amoxicillin now must use more-expensive ones that target a broader range of germs but typically cause greater side effects. Some infections don’t respond to any treatment, evading all antibiotics, he says.

That’s bad news because the more frequently the NDM-1 gene is inserted into different bacteria, the more likely it will enter virulent forms of E. coli, sparking outbreaks that may be impossible to subdue, says David Livermore, who heads antibiotic resistance monitoring at the U.K.’s Health Protection Agency in London.

Black Death

The gene may even spread to the microbial cause of bubonic plague, the medieval scourge known as Black Death that still persists in pockets of the globe.

“It’s a matter of time and chance,” says Mark Toleman, a molecular geneticist at Cardiff University. Plasmids carrying the NDM-1 gene can easily be inserted into the genetic material ofYersinia pestis, the cause of plague, making the infection harder to treat, Toleman says.

“There is a tsunami that’s going to happen in the next year or two when antibiotic resistance explodes,” says Ghafur, 40, seated at a polished wooden table in a consulting room in Chennai as patients fill 20 metal chairs in the waiting area, forcing others into the corridor. “We need wartime measures to deal with this now.”

R.K. Srivastava, India’s former director general of health services, says the government is giving top priority to antimicrobial resistance, including increasing surveillance of hospitals’ antibiotics use.

Name Shame
At the same time, it’s trying to preserve the country’s health-tourism industry. Bristling that foreigners coined a name that singles out their capital to describe an emerging health nightmare, officials say the world is picking on India for troubles that impede all developing nations.

When Indian researchers joined international teams studying the NDM-1 gene, the government questioned the data and methods of the scientists, among them Chennai microbiologist Karthikeyan K. Kumarasamy.

“These bacteria were present globally,” says Nirmal K. Ganguly, a former director general of the Indian Council of Medical Research and one of 13 members of a government task force created in September 2010 to respond to the NDM-1 threat.

“When you are blamed, the only reaction is that you put your back to the wall and fight.”

Ulterior Motive?
S.S. Ahluwalia, a former deputy opposition leader in the upper house of India’s parliament and a member of the Bharatiya Janata Party, says Western rivals want to muscle in on the medical tourism industry. Josef Woodman, founder of the guidebook “Patients Beyond Borders,” values the industry globally at $54 billion a year.

“These reports are meant to destabilize India’s emergence as a health destination,” says Ahluwalia, whose term ended in April.

About 850,000 medical tourists traveled to India in 2010 for treatments from lifesaving cancer operations to cosmetic surgeries, generating $872 million in revenue, according to the Associated Chambers of Commerce and Industry of India, or Assocham. The number of foreign patients is predicted to almost quadruple by 2015, the trade body says.

Manish Kakkar, a doctor researching infectious diseases at the New Delhi-based Public Health Foundation of India and a task force member, says the government has its priorities wrong.

“We have been in a phase of denial,” he says. “Rather than responding to the situation scientifically, we’ve completely diverted attention, saying that it’s attacking our medical tourism.”

‘That’s What’s Scary’
Kakkar and others worry about NDM-1 because unlike germs such as VRE, short for the vancomycin-resistant enterococci bug that can cause infection around a patient’s surgical incision, NDM-1 is spreading beyond hospitals.

Two travelers from the Netherlands picked up an NDM-1 bug in their bowels after visiting India in 2009 although they hadn’t received medical care there, says Maurine Leverstein-van Hall, a clinical microbiologist at the University Medical Center in the Dutch city of Utrecht.

“That’s what’s scary,” she says. “It’s not just surgery or being near a hospital. In some way, you get it through the food chain or through the water.”

For now, it’s impossible to tell how common NDM-1 infections are or how often the mutant germs kill because testing and surveillance are inadequate in developing countries, says Keith Klugman, the William H. Foege chair of global health at Emory University’s Rollins School of Public Health in Atlanta.

‘Perfect Breeding Ground’
Cardiff’s Walsh estimates 100 million Indians carry germs that harbor the NDM-1 gene, based on an extrapolation of studies in New Delhi and from neighboring Pakistan.

“It’s not measured, and that’s the problem,” says Klugman, who pinpoints India as the epicenter.

India’s jammed cities, poor sanitation and abundant antibiotics produce an ideal incubator, Harvard’s Moellering says.

“You have almost no control over the prescription of antibiotics,” says Moellering, who has studied drug resistance for four decades. “You have horrible sanitation problems in many parts of the country. You have incredible poverty, and you have crowding. When you put those four things together, it’s the perfect breeding ground for multidrug-resistant bacteria.”

Antibiotics even pollute India’s rivers, streams and soil. The bacteria that thrive in these places do so because they’ve developed resistance to the drugs they encounter. People or animals who ingest the water or soil may become colonized by the resistant germs.

Mining Cipro
Until the government built a pipeline to a modern sewage plant in 2010, the Patancheru Enviro Tech Ltd. treatment facility on some days released the equivalent of 45,000 daily doses of ciprofloxacin into the Isakavagu stream outside Hyderabad in southern India, Swedish researchers reported in 2007. The plant treated wastewater from drug-making factories.

Residue from ciprofloxacin, a mainstay treatment for E. coli infections, was so prevalent in river sediment downstream that lead researcher Joakim Larsson of the University of Gothenburg jokes, “Had ciprofloxacin been a little bit more expensive, we could probably mine it from the ground.”

India’s antibiotics overload is forcing doctors to rely on ever-more-powerful drugs. Many now turn to a class called penicillin-based carbapenems to treat ailments as routine as urinary tract infections, says Grayson, who was editor-in-chief of medical text “Kucer’s The Use of Antibiotics” (Hodder Arnold/ASM Press, 2010).

‘Antibiotic Stewardship’
NDM-1 has rendered even carbapenems useless, sometimes leaving no way to fight infections. Two drugs potentially capable of treating NDM-1 bacteria have toxic side effects in some patients that include an increased risk of death.

“It’s an example of why we need to have good surveillance and why we need to have good antibiotic stewardship,” says Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention in Atlanta. “We are looking at the specter of untreatable illness.”

Drugmakers have been slow to respond with new medicines. Most abandoned antibiotic discovery during the past decade, says Karen Bush, a microbiologist at Indiana University in Bloomington. She led teams that developed five bacteria-fighting drugs beginning in the 1970s in laboratories that are now part of AstraZeneca Plc (AZN)Bristol-Myers Squibb Co. (BMY), Johnson & Johnson and Pfizer Inc. (PFE)

Companies instead pursued hypertension and high-cholesterol drugs that patients take for a lifetime rather than a few weeks, she says.

International Uproar
Kumarasamy, the Chennai microbiologist, says he thought he was doing his country a favor when he helped track down the cause of unexplained deaths inside India. Instead, he sparked an international uproar over NDM-1.

Beginning in June 2000, Kumarasamy, now 36, studied bacteria and went from hospital to hospital in Chennai to collect specimens. He says he witnessed a steady increase in difficult-to-treat infections. Patients were dying, and doctors couldn’t identify what type of resistant germs killed them, he says.

“No matter how skilled or intelligent the doctor is, they are helpless when it comes to these infections,” he says over lunch of rice and curry in a noisy Chennai food court. He didn’t keep a tally of the deaths.

Kumarasamy, who received a Bachelor of Science degree from Navarasam Arts & Science College in Tamil Nadu state in 1997, says he began isolating bacteria from the blood, sputum, pus and urine of patients and freezing the samples. He quit his lab job in 2007 to study resistant germs for a doctorate in microbiology at the University of Madras. He’s winding up his thesis on carbapenem-resistant bacteria.

Festering Bedsores
Kumarasamy’s curiosity spiked in 2008 when he realized he was dealing with something totally new. He reached out to Walsh, whose Cardiff lab was at the forefront of international antibiotic resistance research.

Around that time, Walsh was studying the case of a diabetic stroke patient of Indian origin. The man had festering bedsores and had been transferred from New Delhi to his home in Swedenfor treatment. When bacteria cultured from his urine and feces evaded more than a dozen drugs, including last-resort carbapenems, Christian G. Giske, a clinical microbiologist at Stockholm’s Karolinska University Hospital, sent the samples to Walsh’s lab.

Stockholm Hotel
In a hotel room in the Swedish capital, Walsh and Giske named the gene that made the bacteria immune to virtually all these antibiotics New Delhi metallo-beta-lactamase-1.

Beta-lactams are a class of antibiotics that includes penicillins, cephalosporins and carbapenems. Beta-lactamase is an enzyme that destroys those drugs. Metallo-beta-lactamases are so named because they contain zinc and destroy carbapenems, the most powerful beta-lactams.

Kumarasamy, suspecting something similar in his own specimens, asked Walsh to share the DNA sequence of this new bacterial gene. Walsh did -- and Kumarasamy got a match.

Kumarasamy began visiting Chennai hospitals anew to look for drug-resistant specimens. He also got samples from researchers in India’s northern Haryana state.

When his collection was added to those Walsh and his colleagues were studying, the researchers discovered the same NDM-1 gene from four countries: India, Pakistan, Bangladesh and the U.K. For most of the British patients, the link was recent travel to India or neighboring Pakistan.

In Kumarasamy’s samples from inside India, many cases emerged in people who hadn’t recently been hospitalized. That suggested the bacteria were spreading in the community.

‘Unsung Hero’
“He is India’s unsung hero,” Walsh says.

The University of Madras initially thought so, too. It feted Kumarasamy after he became the youngest scholar from the 155-year-old institution to have research appear in any publication of the British medical journal “The Lancet.” His August 2010 paper, in “The Lancet Infectious Diseases,” became that publication’s most-read article that year.

The mood soured a few days later. Officials at India’s Ministry of Health & Family Welfare balked at the gene’s name, which threatened medical tourism’s public image.

“There was a lot of stress and tension, and I could not sleep properly for two months,” says Kumarasamy, who says he developed gastric reflux and heartburn.

The next month, authorities at the ministry grilled the eight Indian contributors to the “Lancet” report, including lead author Kumarasamy, according to two co-authors who declined to be identified because their employers don’t permit them to speak to the media.

‘Batten Down the Hatches’
Officials questioned their data and chastised them for sending specimens overseas without approval, saying the researchers had violated a 13-year-old regulation, according to two in the group.

The Indian Council of Medical Research says it requires researchers to submit detailed proposals to send any bacterial collections abroad. The process may take at least four months.

“The regulations were already in place,” says Sandhya Visweswariah, a professor at the Indian Institute of Science in Bangalore.

The researchers countered that the rules were nebulous and were rarely enforced.

“It is suppression of scientific freedom,” Walsh says of the government behavior. “They just try to batten down the hatches and make everything very, very difficult and pretend nothing has happened.”

Front-Page News
After front-page stories on the superbug appeared in Indian newspapers, the government formed an antibiotic resistance task force. It recommended in April 2011 that antibiotic use be tracked in the country’s 100,000 hospitals to find excessive prescribing. The group advised making it harder to get antibiotics without a prescription by requiring pharmacists to keep records for two years to aid audits and inspections.

Current rules make a prescription mandatory, but regulations are rarely enforced and it’s easy to get potent antibiotics, even intravenous ones, without a doctor’s assent. The group advised enacting rules allowing drug inspectors to immediately cancel the license of pharmacists dispensing unprescribed antibiotics.

Task force member Ganguly says tracking antibiotic use will be difficult.

“How do you regulate 1.2 billion people with so much diversity?” he asks.

Dying Babies
While Kumarasamy was documenting NDM-1 in Chennai hospitals, pediatrician Vipin Vashishtha was discovering how deadly the gene can be.

In June 2010, new father Sanjeev Thakran, 28, rushed his half-hour-old son in a car through monsoon-soaked streets to Vashishtha’s Mangla Children’s Hospital in Bijnor. His wife, Lalita, had delivered baby Tapas in a maternity hospital across town three weeks early, and the infant was laboring for air.

Nurses in green scrubs warmed the 4-pound (1.8-kilogram) newborn in a dome-covered crib and fed him milk and medicines through a nasal tube. About 2 feet away, a frail-looking baby was connected to a ventilator, Sanjeev Thakran says.

Vashishtha, seated on a leather swivel chair in his consulting room, recalls thinking that Tapas might need only a few days of intensive care. Instead, the baby spent weeks in and out of the unit. Blood sometimes trickled from his nose and shriveling umbilicus, according to medical records.

Even though he was being treated with a carbapenem, the most powerful class of antibiotic, bacteria raged inside his tiny lungs and bloodstream, eventually attacking membranes covering his brain and spinal cord.

Incurable Scourge
Other infants in the eight-crib neonatal intensive care unit were suffering, too. Vashishtha, 48, had tried several antibiotics without success. When carbapenems didn’t work, he says, he felt helpless because he knew he was dealing with a potentially incurable scourge.

Tapas died 11 weeks after he was admitted. Lab results identified the culprit a month later: NDM-1. The gene was in bacteria known as Klebsiella pneumoniae. The germ exists in people’s gastrointestinal tract and can cause pneumonia and urinary-tract infections in hospital patients.

The lab also found two soil-borne species that normally cause trivial infections but that were suddenly becoming killers.

Tapas was one of 14 infants at the hospital who were infected with NDM-1-containing bacteria over the course of 17 months. Six of the babies died. Among the eight survivors, half developed meningitis, arthritis or water on the brain, Vashishtha wrote to an Indian medical journal in February 2011.

‘Horrific Period’
“It was the most horrific period,” Vashishtha says as he fixes his eyes on the playpen where he amuses children in his office. “I was losing neonates at regular intervals. I suspected we were dealing with something quite different, something quite new.”

Vashishtha says he has improved infection control, walling off part of the ICU for contagious, complicated cases.

He can’t, however, control what happens outside his hospital. Sewage from nearby homes flows in an open drain along one wall of the two-story building.

Bijnor, like other small cities in Uttar Pradesh, lacks a modern underground drainage system. During the rainy season, it’s impossible not to wade through sewage water, the doctor says.

‘Wash Hands Properly’
So far, Vashishtha has prevented more NDM-1 deaths. He fumigates his wards every four weeks and applies fresh paint every three months. He keeps hand-sanitizing liquid in his office, along the corridors and next to every bed in intensive care. Nurses must wash their hands with running water and soap and scrub with an antimicrobial sanitizer before handling patients.

“The first and foremost step to avoiding hospital-acquired infection is to wash hands properly,” he says.

India’s major hospitals are marshaling tactics from common cleanliness to computerized databases to outsmart resistant bacteria and prevent more tragedies.

Artemis Health Institute, a private, 300-bed specialty hospital in Gurgaon, southwest of New Delhi, employs an infection-control officer who collects data every month on the hospital’s four most troublesome bacteria to review patterns of drug resistance. The officer, Namita Jaggi, also serves as national secretary of a Buenos Aires-based group that collates infection information worldwide.

‘Infection Surveillance 24/7’
About 3 miles (4.8 kilometers) away, cardiac surgeon Naresh Trehan’s medical complex,Medanta-The Medicity, requires patients transferring from other hospitals to be screened for resistant bacteria. This procedure, routine in some Nordic countries, isn’t standard in India.

Medanta has a strict hand-washing policy and a 40-member team to monitor infections, says Trehan, 65, who trained in cardiac surgery at New York University and worked at Bellevue Hospital in Manhattan before returning to India in 1988.

“We have a very senior person whose sole responsibility is to keep the whole hospital under infection surveillance 24/7,” he says.

Livermore at the U.K.’s Health Protection Agency says these efforts may not be enough in a country where 626 million people defecate in the open and that treats only 30 percent of the 10.1 billion gallons of sewage generated each day. Even the most modern hospitals can’t exist as islands of cleanliness, he says.

“How does the hospital -- however good its surgeons and physicians -- isolate itself when its patients, staff and food all come from outside, where they are exposed to this soup of resistance?” he asks.

‘Hope for the Future’
Bush, the antibiotics researcher, has been investigating novel ways to fight bacteria since 1977. She says combinations of existing drugs, including an experimental compound from AstraZeneca in late-stage patient studies, may neutralize some carbapenem-destroying enzymes.

Should these mixtures pan out, they may help the superdrugs regain at least some of their potency, potentially extending their usefulness for a decade or more, she says.

A drug candidate from Basel, Switzerland-based Basilea Pharmaceutica AG (BSLN) in early-stage trials shows some promise against NDM-1, she says.

“What’s frustrating is to see that companies refused to address the issue until the last few years,” Bush says. “There are still some that are trying, and that’s the hope for the future.”

‘Very Cautious’
Drugs that could once again tackle the world’s most resistant germs would be a relief for people worldwide, Norway’s Skaret among them. She spent more than six months fearing a microbial time bomb until she learned that the NDM-1 supergerms had passed from her system.

Even though she escaped physical harm, Skaret says, NDM-1 made her feel isolated. She says therapists, concerned about their own exposure, refused to help her with rehabilitation to recover from the car accident. Neighbors who delivered food were careful not to get too close.

“When they heard about it, they were very cautious,” she says.

If Walsh’s projection is accurate, 100 million Indians may be carrying the NDM-1 gene unwittingly and doing little to contain its spread. The number of countries reporting NDM-1 will continue to grow as more bacteria pick up the gene and people transport it around the globe.

To prevent a worldwide catastrophe, microbiologists Kumarasamy and Walsh -- along with scores of scientists and doctors inside and outside India -- are sounding an alarm.

“Combine sophisticated medicine, poor sanitation and heavy antibiotic usage, and you have a rocket fuel to drive the accumulation of resistance,” Livermore says. “That surely is what India has created” (Bloomber, 2012).

Title: New Chemical And Biological Sensor Facility Inaugurated In India
Date: May 31, 2012

Abstract: India’s Defense Research & Development Organization recently inaugurated a new state of the art chemical and biological sensor facility in Gwalior, Madhya Pradesh, India,at the Defense Research and Development Establishment.

The DRDE is a defense laboratory meant to develop novel technologies and products for the defense of chemical and biological terrorism. The DRDO works under India’s Ministry of Defense’s Department of Defense Research and Development.

“Its time to strengthen our capabilities in area of nuclear, chemical and biological warfare,” Vijay Kumar Saraswat, a scientific advisor to the DRDO, said. “I congratulate the dedicated members of DRDE who have not only developed a wide range of NBC technologies but also translated them into products and taken them to users.”

Saraswat said that the future of warfare and terrorism will involve asymmetrical wars, proxy wars and low intensity conflicts. In such cases, biological and chemical agents along with cyber warfare will become more common.

India’s DRDO takes on design and development projects with the goal of producing the world’s top weapon systems and equipment as the country needs them. The organization works in multiple areas of military technology including life sciences, simulation, advanced computing, naval systems, materials, missiles, engineering systems, electronics, combat vehicles, armaments and aeronautics (BioPrepWatch, 2012)

Title: Indian CBR Material Remains Vulnerable
Date: June 21, 2012

Abstract: A new study suggests that chemical and biological weapons material in India remains poorly secured and could fall into the wrong hands.

The joint study, conducted by Indian and British researchers, said the situation was first brought to the Indian government three years ago after 14,000 tons of chemicals disappeared in the state of Madhya Pradesh, according to DNAIndia.com.

Former Union Home Secretary GK Pillai said such material is vulnerable to theft in India, especially when it is being transported. He said he fears the bulk of the stolen chemicals might have ended up in explosives made by Maoist rebels, though it also might have been used in illegal mining operations.

In a 2011 incident that was widely publicized, a metal pipe containing radioactive Cobalt-60 was found in a Delhi scrap yard. It was eventually traced back to the chemistry department at Delhi University, from where it was sold to the scrap dealers at an auction.

There have also been less noticed cases of radioactive exposure in India, including an incident where Tritium contaminated drinking water in 2009 and sickened 90 people.

“These incidents show while elaborate security structures have been put in place to prevent radioactive material falling into the hands of malicious actors, thus far it has not provided to be completely foolproof,” the study concluded, DNAIndia.com reports.

The study also concluded that large facilities containing chemical and biological material, particularly those under the protection of the Central Industrial Security Force, are generally well-protected. At medium and small facilities, however, the level of protection can vary greatly (BioPrepWatch, 2012)

Title: India Building Bio-Radar
Date: June 25, 2012

Abstract: The Indian military recently announced that it is attempting to build a nanotechnology-based bio-radar system to act as an early warning system against bioterrorism.

V. K. Saraswat, the scientific advisor to India’s defense minister and the director general of the Defense Research and Development Organization, said that the Defense Bioengineering and Electomedical Laboratory will lead in the system’s development, according to NewIndiaExpress.com.

V. Padaki, DEBEL’s director, said the bio-radar’s components will be able to detect the existence of dangerous chemical and biological material and then communicate that information to a central control room.

Padaki also said that the use of nanosensors would increase the system’s overall sensitivity beyond conventional technology.

DEBEL, which operates under the DRDO, recently opened a new facility in Bangalore. The laboratory is known predominantly for carrying out research and development in the areas of aero-medical equipment, biomedical engineering and life support systems for the armed forces, according to TheHinduBusinessLine.com.

Saraswat said the DRDO expects the new facility to cut Indian imports of military life-support systems, including those to protect against chemical and biological weapons, by nearly 70 percent.

“We shouldn’t miss this bus the way we have missed the other engineering revolutions. DRDO is creating bio clusters to learn and create new usable models from biological concepts,” Saraswat said, TheHinduBusinessLine.com reports (BioPrepWatch, 2012).

Title: India Reports More Than 100 Deaths Due To H1N1 Influenza
Date: July 9, 2012

Abstract: The respiratory virus that swept the globe during the World Health Organization (WHO) - declared 2009 pandemic hasn’t totally gone away. Currently, for example, reported outbreaks in 
El Salvador and Bolivia have affected hundreds and taken several lives.

In Indiaaccording to a Zeenews.com report Monday, health officials have reported 102 fatalities in 13 states during the first half of the year. This compares to a total of 75 deaths reported for all of 2011.

Nationwide, 1,568 cases have been reported, with Maharashtra state reporting the most cases (544) and fatalities (25) in the first half of 2012.

Rounding out the top five states in terms of number of cases include 310 in Karnataka, 210 in Tamil Nadu, 150 in Rajasthan and 143 in Andhra Pradesh.

India experienced 1,763 fatalities in 2010 and 981 in 2009.

A recent report from the Centers for Disease Control and Prevention (CDC) published in The Lancet Infectious Diseases last month reported revised estimates of the number of deathsdue to pandemic influenza A H1N1 may be about 15 times higher than the originally calculated number of 18,500 reported laboratory-confirmed cases (Examiner, 2012)

Title: Study: India Not Prepared For CBR Attack
Date: July 23, 2012

Abstract: While India is at risk for chemical, biological and radiological attack, the government may not be prepared enough to counter terrorism on a priority basis, according to a recent study.

The Observer Research Foundation and the Royal United Services Institute conducted the joint study and determined that small- and medium-sized industries in India see CBR threats as a future issue and are unwilling to invest in security. In addition, the country does not have a body dedicated to deal with CBR threats, LiveMint.com reports.

“The National Disaster Management Authority (NDMA) forms an important backbone in responding to CBR incidents, man-made or otherwise, (but) its focus remains on a post-disaster response,” the study said, according to LiveMint.com.

The study also found that the NDMA emphasizes natural disasters as a result of their frequency. As a result, the response from the country on CBR issues is inadequate for the NDMA to develop any kind of policy.

“The lack of a central database containing updated information on incidents, intelligence or reports of CBR terrorist attacks, sabotage, material thefts, intentional misuse or illegal trading has been found as a major lacuna in India’s current approach,” the study said, according to LiveMint.com.

The study emphasized 54 incidents, including the 1985 release of hexacyclo-pentadiene in Kochi that injured 200 people and a 2001 acid attack against five women for not wearing veils in Srinagar by the Lashkar-e-Jhangvi group (BioPrepWatch, 2012).

Title: Dozens Of Children Treated For Diphtheria At Delhi Hospital
Date: September 10, 2012
Global Dispatch

Abstract: In a 
follow-up to a report Thursday, the number of children being treated for the bacterial disease, diphtheria, continues to rise, particularly at Delhi’s Maharishi Valmiki Infectious Disease hospital.

According to a Times of India report, more than two dozen kids are being treated for the potentially lethal, vaccine-preventable infection.

“Over the past two weeks, we have been flooded with cases of diphtheria. At present, 26 patients are admitted with the disease in the hospital,” said Dr Seema Mukherjee, a senior doctor at the hospital. She said that most patients are from Haryana, UP and the NCR.

Laboratory tests have confirmed that the five children who died at two slum colonies in the last 10 days as previously reported were suffering from diphtheria.

One physician noted that diphtheria cases increase after monsoon season. Poor vaccination coverage is blamed on this outbreak although diphtheria is covered under the government of India’s universal immunization program.

Diphtheria is caused by a potent toxin produced by certain strains of the bacterium,Corynebacterium diphtheriae.

Diphtheria is extremely contagious through coughing or sneezing. Risk factors include crowding, poor hygiene, and lack of immunization.

Symptoms usually appear within a week of infection. This infection is characterized by a sore throat, coughing and fever very similar to many common diseases like strep throat. Additional symptoms may be bloody, watery discharge from the nose and rapid breathing. However, a presumptive diagnosis can be made by observing a characteristic thick grayish patch (membrane) found in the throat. In more severe cases, neck swelling and airway obstruction may be observed.

In the tropics, cutaneus and wound diphtheria is much more common and can be a source of transmission.

The real serious danger is when the toxin that is produced by the bacterium gets into the bloodstream and spreads to organs like the heart and nervous system. Myocarditis, congestive heart failure and neurological illnesses of paralysis that mimic Guillain-Barre syndrome are most severe. Even with treatment, fatalities are still seen in up to 10% of cases.

Diphtheria can be treated and cured successfully with antitoxin and antibiotics if started early enough.

The prevention of diphtheria is through vaccination. Immunity does wane after a period of time and revaccination should be done at least every 10 years (Global Dispatch, 2012)

Title: India Reporting Outbreaks Of Cholera, Scrub `Typhus And Japanese Encephalitis
Date: September 23, 2012
Outbreak News

Abstract:  Health officials in different parts of India are battling a variety of infectious disease outbreaks to include the bacterial disease, cholera, the mite-borne infection, scrub typhus and the mosquito-borne disease, Japanese encephalitis.

In Pune, doctors have been noticing a considerable increase in water-borne diseases like gastroenteritis, diarrhoea, typhoid and jaundice in Pune over the last two months. Lack of rainfall and water shortage are compelling people to use water that may not be clean, says a report in the Times of India.

Included in this list is nine cases of cholera that were reported in the city in one week. S T Pardeshi, medical officer of health (MoH), Pune Municipal Corporation (PMC) said, ”Nine cases of cholera in a week is a high number but not an outbreak. We are monitoring the situation and there is no need to panic,” he added.

Cholera is an acute bacterial intestinal disease characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water)  due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.

It is caused by the bacterium, Vibrio cholerae. Serogroups O1 and O139 are the types associated with the epidemiological characteristics of cholera (outbreaks).

The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals.

Drinking water can be contaminated at the source, during transport or during storage at home.

Food can be contaminated by soiled hands, during preparation or while eating.

Beverages and ice prepared with contaminated water and fruits and vegetables washed with this water are other examples. Some outbreaks are linked to raw or undercooked seafood.

The incubation for cholera can be from a few hours to 5 days. As long as the stools are positive, the person is infective. Some patients may become carriers of the organism, which can last for months.

Cholera is diagnosed by growing the bacteria in culture. Treatment consists of replacement of fluids lost, intravenous replacement in severe cases. Doxycycline or tetracycline antibiotic therapy can shorten the course of severe disease.

There is an oral vaccine available in some countries but it is not available in the U.S. Cholera prevention is the same as in other causes of traveler’s diarrhea.

In Himachal Pradesh, health officials report 2 additional fatalities due to scrub typhus, bringing the total to 10 this season.

The Business Standard reports that 155 patients have tested positive for the infection so far.

Scrub typhus is an infectious disease that is transmitted to humans from field mice and rats through the bite of mites that live on the animals. The main symptoms of the disease are fever, a wound at the site of the bite, a spotted rash on the trunk, and swelling of the lymph glands.

Scrub typhus is caused by Orientia tsutsugamushi, a tiny parasite about the size of bacteria that belongs to the family Rickettsiaceae.

In northern India, the Voices of America report an outbreak of Japanese encephalitis, which has affected hundreds of children.

Pediatrician, Dr. K.P. Kushwaha said, “We had the highest number of patients admitted in one day, which was 550 patients, we never got such figures in the past. In the current cases of encephalitis, the children not only have swelling in their brains, but their skin, kidney, liver and heart also have swelling”.

Infectious disease expert with the Gates Foundation, Dr. Julie Jackobson said that the zoonotic infection is one that will never be eliminated.

According to the World Health Organization (WHO):
Japanese encephalitis is a viral disease that infects animals and humans. It is transmitted by mosquitoes and in humans causes inflammation of the membranes around the brain. Intensification and expansion of irrigated rice production systems in South and South-East Asia over the past 20 years have had an important impact on the disease burden caused by Japanese encephalitis.

Japanese encephalitis (JE) is a disease caused by a flavivirus that affects the membranes around the brain. Most JE virus infections are mild (fever and headache) or without apparent symptoms, but approximately 1 in 200 infections results in severedisease characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and death. The case fatality rate can be as high as 60% among those with disease symptoms; 30% of those who survive suffer from lasting damage to the central nervous system. In areas where the JE virus is common, encephalitis occurs mainly in young children because older children and adults have already been infected and are immune.

The virus causing Japanese encephalitis is transmitted by mosquitoes belonging to the Culex tritaeniorhynchus and Culex vishnui groups, which breed particularly in flooded rice fields.

Japanese encephalitis is a leading cause of viral encephalitis in Asia with 30,000-50,000 clinical cases reported annually. It occurs from the islands of the Western Pacific in the east to the Pakistani border in the west, and from Korea in the north to Papua New Guinea in the south. Because of the critical role of pigs, its presence in Muslim countries is negligible. JE distribution is very significantly linked to irrigated rice production combined with pig rearing (Outbreak News, 2012)