More than 60 people at Jaimakashala in Rolpa district in mid-western Nepal have been taken ill due to a mysterious disease that spread in the village 3 days ago.

According to Tuesday’s [12 May 2009], most of the victims are women, elderly, and children.  An official at the District Public Health Office informed that a team of health workers has been dispatched to the disease-hit area, some 270 km (168 mi) west of Kathmandu, to take stock of the situation and to offer treatment to the sick.

All patients have similar symptoms of acute headache, fever, and vomiting up blood, a health worker said.  He said that the disease may have been caused due to consumption of polluted water and inadequate sanitation. With no health worker at the local health post, the patients could not receive treatment on time.

Unless the described hematemesis (vomiting up blood) was associated with intense vomiting leading to esophageal tears and subsequent bleeding, hematemesis is not usually associated with the variety of microorganisms that are usually the culprits in waterborne gastroenteritis outbreaks. The mention of acute headache and fever as a predominant finding does have one wonder about malaria and the encephalitides such as Japanese encephalitis, although the possibility of entrance of one of the hemorrhagic fevers such as CCHF (Crimean-Congo hemorrhagic fever) or one of the old world hantaviruses is there as well.  ProMED-mail would greatly appreciate receiving more information from knowledgeable sources in the region.