Global & Disaster Medicine

About 600 million Indians are facing high to extreme stress over water

Al Jazeera

India Water Crisis Document

“…..India is suffering from the worst water crisis in its history and millions of lives and livelihoods are under threat. Currently, 600 million Indians face high to extreme water stress and about two lakh people die every year due to inadequate access to safe water1. The crisis is only going to get worse. By 2030, the country’s water demand is projected to be twice the available supply, implying severe water scarcity for hundreds of millions of people and an eventual ~6% loss in the country’s GDP….”


Salmonella Adelaide Infections Linked to Pre-Cut Melon: Ten more ill people from five states were added to this investigation since the last update on June 8, 2018.


  • Case Count: 70
  • States: 7
  • Deaths: 0
  • Hospitalizations: 34
  • Recall: Yes

Photo of pre-cut melon.

People infected with the outbreak strain of Salmonella, by state of residence, as of June 18, 2018

WHO review on Rift Valley Fever


Key facts

  • Rift Valley fever (RVF) is a viral zoonosis that primarily affects animals but can also infect humans.
  • The majority of human infections result from contact with the blood or organs of infected animals.
  • Human infections have also resulted from the bites of infected mosquitoes.
  • To date, no human-to-human transmission of RVF virus has been documented.
  • The incubation period (the interval from infection to onset of symptoms) for RVF varies from 2 to 6 days.
  • Outbreaks of RVF in animals can be prevented by a sustained programme of animal vaccination.

Rift Valley fever (RVF) is a viral zoonosis that primarily affects animals but also has the capacity to infect humans. Infection can cause severe disease in both animals and humans. The disease also results in significant economic losses due to death and abortion among RVF-infected livestock.

RVF virus is a member of the Phlebovirus genus. The virus was first identified in 1931 during an investigation into an epidemic among sheep on a farm in the Rift Valley of Kenya.

Since then, outbreaks have been reported in sub-Saharan Africa. In 1977 an explosive outbreak was reported in Egypt, the RVF virus was introduced to Egypt via infected livestock trade along the Nile irrigation system. In 1997–98, a major outbreak occurred in Kenya, Somalia and Tanzania following El Niño event and extensive flooding. Following infected livestock trade from the horn of Africa, RVF spread in September 2000 to Saudi Arabia and Yemen, marking the first reported occurrence of the disease outside the African continent and raising concerns that it could extend to other parts of Asia and Europe.

Transmission in humans

The majority of human infections result from direct or indirect contact with the blood or organs of infected animals. The virus can be transmitted to humans through the handling of animal tissue during slaughtering or butchering, assisting with animal births, conducting veterinary procedures, or from the disposal of carcasses or fetuses. Certain occupational groups such as herders, farmers, slaughterhouse workers, and veterinarians are therefore at higher risk of infection.

The virus infects humans through inoculation, for example via a wound from an infected knife or through contact with broken skin, or through inhalation of aerosols produced during the slaughter of infected animals.

There is some evidence that humans may become infected with RVF by ingesting the unpasteurized or uncooked milk of infected animals.

  • Human infections have also resulted from the bites of infected mosquitoes, most commonly the Aedes and Culex mosquitoes and the transmission of RVF virus by hematophagous (blood-feeding) flies is also possible.
  • To date, no human-to-human transmission of RVF has been documented, and no transmission of RVF to health care workers has been reported when standard infection control precautions have been put in place.
  • There has been no evidence of outbreaks of RVF in urban areas.

Clinical features in humans

Mild form of RVF in humans

The following are clinical features of the mild form of RVF in humans:

  • The incubation period (the interval from infection to onset of symptoms) for RVF varies from 2 to 6 days.
  • Those infected either experience no detectable symptoms or develop a mild form of the disease characterized by a feverish syndrome with sudden onset of flu-like fever, muscle pain, joint pain and headache. Some patients develop neck stiffness, sensitivity to light, loss of appetite and vomiting; in these patients the disease, in its early stages, may be mistaken for meningitis.
  • The symptoms of RVF usually last from 4 to 7 days, after which time the immune response becomes detectable with the appearance of antibodies and the virus disappears from the blood.

Severe form of RVF in humans

While most human cases are relatively mild, a small percentage of patients develop a much more severe form of the disease. This usually appears as 1 or more of 3 distinct syndromes: ocular (eye) disease (0.5–2% of patients), meningoencephalitis (less than 1% of patients) or haemorrhagic fever (less than 1% of patients).

The following are clinical features of the severe form of RVF in humans:

  • Ocular form: In this form of the disease, the usual symptoms associated with the mild form of the disease are accompanied by retinal lesions. The onset of the lesions in the eyes is usually 1 to 3 weeks after appearance of the first symptoms. Patients usually report blurred or decreased vision. The disease may resolve itself with no lasting effects within 10 to 12 weeks. However, when the lesions occur in the macula, 50% of patients will experience a permanent loss of vision. Death in patients with only the ocular form of the disease is uncommon.
  • Meningoencephalitis form: The onset of the meningoencephalitis form of the disease usually occurs 1 to 4 weeks after the first symptoms of RVF appear. Clinical features include intense headache, loss of memory, hallucinations, confusion, disorientation, vertigo, convulsions, lethargy and coma. Neurological complications can appear later (after more than 60 days). The death rate in patients who experience only this form of the disease is low, although residual neurological deficit, which may be severe, is common.
  • Haemorrhagic fever form: The symptoms of this form of the disease appear 2–4 days after the onset of illness, and begin with evidence of severe liver impairment, such as jaundice. Subsequently signs of haemorrhage then appear such as vomiting blood, passing blood in the faeces, a purpuric rash or ecchymoses (caused by bleeding in the skin), bleeding from the nose or gums, menorrhagia and bleeding from venepuncture sites. The case-fatality ratio for patients developing the haemorrhagic form of the disease is high at approximately 50%. Death usually occurs 3 to 6 days after the onset of symptoms. The virus may be detectable in the blood for up to 10 days, in patients with the hemorrhagic icterus form of RVF.

The total case fatality rate has varied widely between different epidemics but, overall, has been less than 1% in those documented. Most fatalities occur in patients who develop the haemorrhagic icterus form.

Outbreaks that have occurred since 2000:

Severe form of RVF in humans

2016, Republic of Niger: As of 11 October 2016, Ministry of Health reported 105 suspected cases including 28 deaths of RVF in humans in Tahoua region.

2012 Republic of Mauritania: The Ministry of Health in Mauritania declared an outbreak of RVF on 4 October 2012. From 16 September 2012 (the date of onset of the index case) to 13 November 2012, a total of 36 cases, including 18 deaths were reported from 6 regions.

2010, Republic of South Africa: From February to July 2010, the Government of South Africa reported 237 confirmed cases of RVF in humans, including 26 deaths from 9 provinces.

2008–2009, Madagascar: From December 2008 to May 2009, the Ministry of Health, Madagascar reported 236 suspected cases including 7 deaths.

2008, Madagascar: The Ministry of Health, Madagascar reported an outbreak of RVF on 17 April 2008. From January to June 2008, a total of 476 suspected cases of RVF including 19 deaths were reported from 4 provinces.

2007, Sudan: The Federal Ministry of Health, Sudan, reported an outbreak of RVF on 28 October 2008. A total of 738 cases, including 230 deaths, were reported in Sudan between November 2007 and January 2008.

2006, Kenya, Somalia and Tanzania: From 30 November 2006 to 12 March 2007, a total of 684 cases including 234 deaths from RVF was reported in Kenya. From 19 December 2006 to 20 February 2007, a total of 114 cases including 51 deaths was reported in Somalia. From 13 January to 3rd May 2007, a total of 264 cases including 109 deaths was reported in Tanzania.

2003, Egypt: In 2003 there were 148 cases including 27 deaths of RVF reported by the Ministry of Health of Egypt.

2000, Saudi Arabia and Yemen: There were 516 cases with 87 deaths of RVF reported by the Ministry of Health of Saudi Arabia. In 2000, the Ministry of Public Health in Yemen reported 1087 suspected cases, including 121 deaths.


Because the symptoms of Rift Valley fever are varied and non-specific, clinical diagnosis is often difficult, especially early in the course of the disease. Rift Valley fever is difficult to distinguish from other viral haemorrhagic fevers as well as many other diseases that cause fever, including malaria, shigellosis, typhoid fever, and yellow fever.

Definitive diagnosis requires testing that is available only in reference laboratories. Laboratory specimens may be hazardous and must be handled with extreme care. Rift Valley fever virus infections can only be diagnosed definitively in the laboratory using the following tests:

  • reverse transcriptase polymerase chain reaction (RT-PCR) assay
  • IgG and IgM antibody enzyme-linked immunosorbent assay (ELISA)
  • virus isolation by cell culture.

Treatment and vaccines

As most human cases of RVF are relatively mild and of short duration, no specific treatment is required for these patients. For the more severe cases, the predominant treatment is general supportive therapy.

An inactivated vaccine has been developed for human use. However, this vaccine is not licensed and is not commercially available. It has been used experimentally to protect veterinary and laboratory personnel at high risk of exposure to RVF. Other candidate vaccines are under investigation.

RVF virus in host animals

RVF is able to infect many species of animals causing severe disease in domesticated animals including cattle, sheep, camels and goats. Sheep and goats appear to be more susceptible than cattle or camels.

Age has also been shown to be a significant factor in the animal’s susceptibility to the severe form of the disease: over 90% of lambs infected with RVF die, whereas mortality among adult sheep can be as low as 10%.

The rate of abortion among pregnant infected ewes is almost 100%. An outbreak of RVF in animals frequently manifests itself as a wave of unexplained abortions among livestock and may signal the start of an epidemic.

Ecology and mosquito vectors

Several different species of mosquito are able to act as vectors for transmission of the RVF virus. The dominant vector species varies between different regions and different species can play different roles in sustaining the transmission of the virus.

Among animals, the RVF virus is spread primarily by the bite of infected mosquitoes, mainly the Aedes species, which can acquire the virus from feeding on infected animals. The female mosquito is also capable of transmitting the virus directly to her offspring via eggs leading to new generations of infected mosquitoes hatching from eggs.

However, when analysing RVF major outbreaks, 2 ecologically distinct situations should be considered. At primary foci areas, RVF virus persists through transmission between vectors and hosts and maintains through vertical transmission in Aedes mosquitoes. During major outbreak in primary foci, the disease can spread to secondary foci through livestock movement or passive mosquitoes dispersal and amplifies in naïve ruminants via local competent mosquitoes like Culex, Mansonia and Anopheles that act as mechanical vectors. Irrigation schemes, where populations of mosquitoes are abundant during long periods of the year, are highly favourable places for secondary disease transmission.

Prevention and control

Controlling RVF in animals

Outbreaks of RVF in animals can be prevented by a sustained programme of animal vaccination. Both modified live attenuated virus and inactivated virus vaccines have been developed for veterinary use. Only 1 dose of the live vaccine is required to provide long-term immunity but this vaccine may result in spontaneous abortion if given to pregnant animals. The inactivated virus vaccine does not have this side effect, but multiple doses are required in order to provide protection which may prove problematic in endemic areas.

Animal immunization must be implemented prior to an outbreak if an epizootic is to be prevented. Once an outbreak has occurred animal vaccination should NOT be implemented because there is a high risk of intensifying the outbreak. During mass animal vaccination campaigns, animal health workers may, inadvertently, transmit the virus through the use of multi-dose vials and the re-use of needles and syringes. If some of the animals in the herd are already infected and viraemic (although not yet displaying obvious signs of illness), the virus will be transmitted among the herd, and the outbreak will be amplified.

Restricting or banning the movement of livestock may be effective in slowing the expansion of the virus from infected to uninfected areas.

As outbreaks of RVF in animals precede human cases, the establishment of an active animal health surveillance system to detect new cases is essential in providing early warning for veterinary and human public health authorities.

Public health education and risk reduction

During an outbreak of RVF, close contact with animals, particularly with their body fluids, either directly or via aerosols, has been identified as the most significant risk factor for RVF virus infection. Raising awareness of the risk factors of RVF infection as well as the protective measures individuals can take to prevent mosquito bites is the only way to reduce human infection and deaths.

Public health messages for risk reduction should focus on:

  • reducing the risk of animal-to-human transmission as a result of unsafe animal husbandry and slaughtering practices. Practicing hand hygiene, wearing gloves and other appropriate individual protective equipment when handling sick animals or their tissues or when slaughtering animals.
  • reducing the risk of animal-to-human transmission arising from the unsafe consumption of fresh blood, raw milk or animal tissue. In the epizootic regions, all animal products (blood, meat, and milk) should be thoroughly cooked before eating.
  • the importance of personal and community protection against mosquito bites through the use of impregnated mosquito nets, personal insect repellent if available, light coloured clothing (long-sleeved shirts and trousers) and by avoiding outdoor activity at peak biting times of the vector species.

Infection control in health care settings

Although no human-to-human transmission of RVF has been demonstrated, there is still a theoretical risk of transmission of the virus from infected patients to healthcare workers through contact with infected blood or tissues. Healthcare workers caring for patients with suspected or confirmed RVF should implement Standard Precautions when handling specimens from patients.

Standard Precautions define the work practices that are required to ensure a basic level of infection control. Standard Precautions are recommended in the care and treatment of all patients regardless of their perceived or confirmed infectious status. They cover the handling of blood (including dried blood), all other body fluids, secretions and excretions (excluding sweat), regardless of whether they contain visible blood, and contact with non-intact skin and mucous membranes.

As noted above, laboratory workers are also at risk. Samples taken from suspected human and animal cases of RVF for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.

Vector control

Other ways in which to control the spread of RVF involve control of the vector and protection against their bites.

Larviciding measures at mosquito breeding sites are the most effective form of vector control if breeding sites can be clearly identified and are limited in size and extent. During periods of flooding, however, the number and extent of breeding sites is usually too high for larviciding measures to be feasible.

RVF forecasting and climatic models

Forecasting can predict climatic conditions that are frequently associated with an increased risk of outbreaks, and may improve disease control. In Africa, Saudi Arabia and Yemen RVF outbreaks are closely associated with periods of above-average rainfall. The response of vegetation to increased levels of rainfall can be easily measured and monitored by Remote Sensing Satellite Imagery. In addition RVF outbreaks in East Africa are closely associated with the heavy rainfall that occurs during the warm phase of the El Niño–Southern Oscillation (ENSO) phenomenon.

These findings have enabled the successful development of forecasting models and early warning systems for RVF using satellite images and weather/climate forecasting data. Early warning systems, such as these, could be used to trigger detection of animal cases at an early stage of an outbreak, enabling authorities to implement measures to avert impending epidemics.

Within the framework of the new International Health Regulations (2005), the forecasting and early detection of RVF outbreaks, together with a comprehensive assessment of the risk of diffusion to new areas, are essential to enabling the implementation of effective and timely control measures.

WHO response

For the 2016, Niger outbreak, WHO sent a multisectoral national rapid response team, including members from the Ministry of Health, veterinary services and Centre de Recherche Médicale et Sanitaire (CERMES). The unit was deployed for field investigation on 31 August 2016.

In Niger, the WHO Country Office provides technical and financial support for surveillance, outbreak investigation, technical guidelines regarding case definition, case management, shipment of samples, and risk communication.

The Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and WHO are coordinating on animal and human health and providing additional support to Niger for the outbreak response.

WHO is working with partners in the Global Outbreak Alert and Response Network (GOARN) to coordinate international support for the response. The International Federation of Red Cross and Red Crescent Societies (IFRC) and UNICEF are supporting outbreak response.

Dogs are being infected with Guinea worms, and no one knows how.

NY Times

“……If the answer isn’t found soon, or if the worms begin to spread widely into other species — a handful already have been found in cats and even baboons — then 32 years of work to end the scourge may crumble….”


1 dead and dozens are missing from a ferry that sank on Indonesia’s Lake Toba.


Kenya’s Rift Valley fever outbreak: 26 human cases have been reported and 6 deaths


On 8 June 2018, the Ministry of Health (MoH) for Kenya confirmed an outbreak of Rift Valley fever. The first patient was admitted to a hospital in Wajir County in north-eastern Kenya on 2 June with fever, body weakness, and bleeding from the gums and mouth. The patient reported having consumed meat from a sick animal; the patient died the same day. On 4 June, two relatives of the index patient were admitted. Blood samples were collected and sent to the Kenya Medical Research Institute, one of which was confirmed positive for Rift Valley fever on 6 June. As of 16 June, a total of 26 human cases have been reported from Wajir (24 cases) and Marsabit (2 cases) counties, including seven confirmed cases and six deaths (case fatality ratio (CFR) = 23%); six patients have been discharged while one is still hospitalized. A high number of deaths and abortions among livestock, including camels and goats, has been reported in Garissa, Kadjiado, Kitui, Marsabit, Tana River, and Wajir counties. People living in these counties were reportedly consuming meat from dead and sick animals.

Public Health Response

Preparedness activities for Rift Valley fever have been ongoing since February 2018 in reaction to the heavy rains and flooding in Kenya. An alert was issued to all County Directors in February 2018 and a general national alert was communicated in May 2018.

The following actions have been taken since the outbreak was confirmed:

  • On 8 June, the MoH and Ministry of Agriculture convened an emergency meeting with the Ministry of Livestock (MoL) and key stakeholders. A health sector task force meeting was held, and partners pledged their support to Rift Valley fever control.
  • On 14 June, the MoH activated the Emergency Operations Centre, with an Event Manager and supporting technical team.
  • On 14 June, a multi-sectoral investigation teams has been deloyed in Wajir County to support the county health teams. Another team will soon be dispatched to support the Marsabit County team.
  • As part of ongoing preparedness activities, active surveillance for Rift Valley fever is being strengthened in affected and at-risk counties, as well as contact tracing in Wajir and Marsabit counties. In Wajir County, five treatment centres have been established.
  • Active case searching and community sensitization activities are ongoing in the affected areas. Guidelines for vector control and other informational materials have been dispatched to Wajir County, and messages are being disseminated through Community Health Volunteers.
  • A ban on slaughtering animals and restriction of livestock movement has been imposed in the affected areas.

WHO risk assessment

Outbreaks of Rift Valley fever are not uncommon in Kenya. The last documented outbreak occurred from November 2014 through January 2015 in north-eastern Kenya; in 2006, a large outbreak killed more than 150 people. The CFR has varied widely in documented outbreaks but the overall CFR tends to be less than 1%.

Kenya’s prior experience with responding to Rift Valley fever outbreaks combined with the preparedness activities undertaken over the preceding months is of benefit. However, the high number of reported deaths and abortions in livestock is concerning, especially because the event affects nomadic communities for which diet is predominantly based on animal products. The high volume of movement of cattle and people in this area increases the risk of further spread of the outbreak both within Kenya, and to neighbouring countries.

WHO advice

Rift Valley fever is a mosquito-borne viral zoonosis that primarily affects animals but also has the capacity to infect humans. The majority of human infections result from direct or indirect contact with the blood or organs of infected animals. Herders, farmers, slaughterhouse workers and veterinarians have an increased risk of infection. Awareness of the risk factors of Rift Valley fever infection and measures to prevent mosquito bites is the only way to reduce human infection and deaths. Public health messages for risk reduction should focus on:

  • Reducing the risk of animal-to-human transmission resulting from unsafe animal husbandry and slaughtering practices. Practicing hand hygiene and wearing gloves and other personal protective equipment when handling sick animals or their tissues or when slaughtering animals is recommended.
  • Reducing the risk of animal-to-human transmission arising from the unsafe consumption of raw or unpasteurized milk or animal tissue. In endemic regions, all animal products should be thoroughly cooked before eating.
  • Reducing the risk of mosquito bites through the implementation of vector control activities (e.g. insecticide spraying and using larvicide to reduce mosquito breeding sites), use of insecticide-impregnated mosquito nets and repellents, and wearing light coloured clothing (long-sleeved shirts and trousers).
  • Restricting or banning the movement of livestock to reduce spread of the virus from infected to uninfected areas.
  • Routine animal vaccination is recommended to prevent Rift Valley fever outbreaks. Vaccination campaigns are not recommended during an outbreak as they may intensify transmission among the herd through needle propagation of the virus. Outbreaks of Rift Valley fever in animals precede human cases, thus the establishment of an active animal health surveillance system is essential to providing early warning for veterinary and public health authorities.

WHO advises against the application of any travel or trade restrictions to the Kenya based on the current information available on this event.

For more information on Rift Valley fever, please see the link below:

Clusters of MERS-CoV in Saudi Arabia


Between 12 January through 31 May 2018, the National IHR Focal Point of The Kingdom of Saudi Arabia reported 75 laboratory confirmed cases of Middle East respiratory syndrome coronavirus (MERS_CoV), including twenty-three (23) deaths.

Details of the cases

Among these 75 cases, 21 cases were part of four distinct clusters (2 health care and 2 household clusters). The details of these clusters are described below, followed by a table listing all 75 laboratory confirmed cases reported to WHO during this time period:

  • Cluster 1: From 2 through 4 February, a private hospital in Hafer Albatin Region reported a cluster of three (3) health care workers in addition to the suspected index case (four [4] cases in total).
  • Cluster 2: From 25 February through 7 March, a hospital in Riyadh reported six (6) cases, including the suspected index. No health care workers were infected.
  • Cluster 3: From 8 through 24 March, a household cluster of 3 cases (index case and 2 secondary cases) was reported in Jeddah. No health care workers were infected.
  • Cluster 4: From 23 through 31 May, a household cluster was reported from Najran region with eight cases including the suspected index case. This cluster is still under investigation at the time of writing. As of 31 May, no health care workers have been infected and the source of infection is believed to be camels at the initial patient’s home.

As of 31 May, the total global number of laboratory-confirmed cases of MERS-CoV reported since 2012 is 2,220, including 1,844 cases that have been reported from the Kingdom of Saudi Arabia. Among these cases, 790 MERS-CoV associated deaths have occurred since September 2012.

The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because, like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Community and household awareness of MERS and MERS prevention measures in the home may reduce household transmission and prevent community clusters.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. Therefore, in addition to avoiding close contact with suspected or confirmed human cases of the disease, people with these conditions should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be or potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

Ebola and the bush meat trade


“…….For 25 years, Patrick Matondo has earned a living buying and selling monkeys, bats and other animals popularly known as bush meat along the Congo River. Standing on the riverbank in Mbandaka, a city affected by the deadly new outbreak of the Ebola virus, the father of five said that for the first time he’s worried he won’t be able to support his family.

“Since Ebola was declared, business has decreased by almost half. It’s really, really bad,” the 47-year-old said, hanging his head…..”

The 5.3M earthquake Osaka during morning rush hour Monday, killing at least 4 and injuring 214


The number of people with jaundice symptoms in Thalakkulathur grama panchayat is up to 84 as the Health Department suspects that the “welcome drink” served at a private party had led to the outbreak

The Hindu

“……Sources in the department said adulterated ice blocks were reportedly used while mixing the drink. Many of the ice factories are unaware of the hygienic practices to be followed while making ice blocks….”



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