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CHOLERA, DIARRHEA & DYSENTERY (10): AFRICA
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[1] Cholera - Mozambique (Cabo Delgado, Niassa)
Date: Wed, 6 Mar 2013 18:03:19 +0100
Source: AllAfrica, The Herald report [edited]
http://allafrica.com/stories/201303060421.html


Health authorities say that a cholera outbreak in the northernmost province of Cabo Delgado has spread to Cuamba district in the neighboring province of Niassa. Up to Sun 2 Mar 2013, 33 cases of cholera had been diagnosed in Cuamba, although none of the patients had died, said the health authorities.

Cases continue to be diagnosed in the Cabo Delgado provincial capital Pemba, and the districts of Mecufi and Metuge, Radio Mozambique quoted the authorities as saying yesterday, 5 Mar 2013.

The radio reported that in the 1st 3 days of March 2013, there were 16 new cases, bringing the total number since the start of the year to 704 cases.

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[Maps of Mozambique can be seen at http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf and http://healthmap.org/r/1hcW. - Sr.Tech.Ed.MJ]

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[2] Cholera - Republic of Congo (Pointe-Noire)
Date: Fri 1 Mar 2013
Source: Afriquejet, Pan African News Agency [PANA] report [edited]
http://www.afriquejet.com/201303012890/ ... Congo.html


A cholera epidemic which hit Congo's 2nd largest city, Pointe-Noire, has left 8 people dead from the 289 cases reported, Radio Congo Friday quoted the director of the health office in Pointe-Noire, Jean-Pierre Michel Ndzondault, as saying.

The Congolese government blames the spread of the disease on the recent torrential rain in the city coupled with poor sanitation of the area. Officials said if measures are not taken quickly, the epidemic could worsen during the forthcoming rainy season.

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LASSA FEVER - NIGERIA (07): (KEBBI) SUSPECTED
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Date: Thu 28 Feb 2013
Source: Leadership, Nigeria [edited]
http://leadership.ng/nga/articles/48808 ... _jega.html


Lassa fever has claimed the lives of 8 people in Jega local government area of Kebbi State, while 3 others are still undergoing medical treatment at the Federal Medical Centre (FMC), Birnin Kebbi. A nurse at the FMC, Birnin Kebbi, who spoke on condition of anonymity, said they received the cases on Wed 27 Feb 2013 and that 3 people were confirmed dead on the spot, while 2 others died the following day.

The nurse further explained that on Friday [29 Feb 2013] 5 people were brought from the same local government, and one died in the night; another one passed away the following day, while the remaining 3 people are still undergoing medical treatment. "I was on duty on Wednesday [27 Feb 2013] when they brought them, and they were admitted in the A and E ward before they were taken to the main ward. You know, it is an airborne disease. The state government took care of their drugs free of charge," he said. One of the relatives of the deceased said that, initially, they assumed it was poison that had afflicted them, but on coming to the hospital, they discovered that it was Lassa fever. Efforts to contact the state commissioner of health, Alhaji Shehu Sambawa, were unsuccessful, as his line could not be reached.

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[Lassa fever is an acute viral illness that occurs in West Africa. The cause of the illness was found to be Lassa virus, named after the town in Nigeria where the 1st cases were found. The virus, a member of the virus family _Arenaviridae_, is a single-stranded RNA virus and is zoonotic, or animalborne. In areas of Africa where the disease is endemic, Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80 per cent of people infected with the virus, the remaining 20 per cent have a severe multisystem disease. Lassa fever is also associated with occasional epidemics, during which the case fatality rate may reach 50 per cent.

According to the CDC Special Pathogens website (http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... lassaf.htm): The number of Lassa virus infections per year in West Africa is estimated at 100 000 to 300 000, with about 5000 deaths. The reservoir of Lassa virus is a rodent known as the "multimammate rat", belonging to the genus _Mastomys_. _Mastomys_ spp. rodents breed very frequently, produce large numbers of offspring, and are numerous in the savannas and forests of West, Central, and East Africa. _Mastomys_ rodents readily colonize human homes.

About 15-20 per cent of patients hospitalized for Lassa fever die from the illness. However, overall, only about one per cent of infections with Lassa virus result in death. The death rates are particularly high for women in the 3rd trimester of pregnancy and for fetuses, about 95 per cent of which die in the uterus of infected pregnant mothers. Ribavirin, an antiviral drug, has been used with success in treatment of Lassa fever patients. It has been shown to be most effective when given early in the course of the illness. Otherwise, patients should receive supportive care consisting of maintenance of appropriate fluid and electrolyte balance, oxygenation, and blood pressure, as well as treatment of any other complicating infections.

Previously, ProMED-mail reported that 22 local government areas in 9 states of Nigeria had reported outbreaks of Lassa fever. Kebbi may be the 10th state.

A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/1qGF. A map showing the boundaries of the states of Nigeria can be accessed at http://www.ialnigeria.com/home/index.ph ... Itemid=128. - Mod.CP]

LASSA FEVER - NIGERIA (08)
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Date: Sat 9 Mar 2013
Source: Daily Trust, via AllAfrica.com [edited]
http://allafrica.com/stories/2013030902 ... ?viewall=1


Scientists at Nigeria's only hospital that specializes in the treatment of Lassa fever, Irrua Specialist Hospital, Benin were unanimous that this year [2013] is likely to be the worst since 1969 when the 1st case was recorded in Lassa, Borno State, going by early signs. "With the number of patients currently on admission and those who have so far died from the illness, Nigeria may record the worst Lassa fever epidemic this year," head of nurses, Lassa Fever Ward, Irrua Specialist hospital, Mrs Rebecca Atafo told Weekly Trust. Mrs Atafo said the pathetic death of a family of 3, which was wiped out by the dreaded illness in January 2013, shows the gravity of the problem at hand.

The hospital record obtained by the Weekly Trust shows that 100 patients were brought to the institution in January 2013 alone, out of whom 40 died. According to the breakdown of the cases by the scientist at the research and documentation centre of the hospital, Ikponwonsa Ordia, Edo State has the highest figure of 38 reported cases out of whom 15 died. Ondo State has the 2nd highest with 19 patients, out of whom 8 died; this was followed by Taraba State with 8 cases brought to the hospital, out of whom 3 died. Other states include Benue with 6 patients, Plateau (2 patients), Rivers, Nasarawa and Ebonyi (one each), as well as Abuja (5) among others.

Ordia said that by the end of February 2013, the number of patients brought to the hospital had risen to 190, out of whom 100 died, while 30 are still in critical condition. He said these figures only represented cases brought to the hospital in Irruah, when the situation has gotten too bad to handle, explaining that many more must have died from the illness across the country. He said the victims from Taraba and Ebonyi States are health workers, wondering what could have happened to the patients they got infected from and their families.

Chief medical director of the hospital, Professor George Akpede said although the outbreak has been reported in more than 13 states, the epidemic may be countrywide. Confirmed cases from affected states show that the death rate is higher than the official statistics had revealed. Reports from Plateau State showed that the virus has claimed 3 lives from the village of Tuwan in Kanke local government area of the state alone. Health workers were unanimous that the illness is not limited to Tuwan alone.

In Nasarawa State, 5 cases were confirmed within Tudun Gwandara, in Karu Local Government Area after diagnoses at the Dalhatu Araf Specialists' Hospital (DASH) in Lafia. There was also an official confirmation of one death from the illness in the state. Weekly Trust [newspaper] also learned that the virus claimed 2 lives in Ebonyi State out of the 6 confirmed cases, apart from the one listed by doctors at Irrua.

Prof Akpede said there had been a 60 per cent increase in suspected cases and an 80 per cent increase in confirmed cases across the country. He said more than 51 million Nigerians are at risk, with the annual number of illnesses estimated at 3 million and the annual number of deaths estimated at about 58 330. He said 15-20 per cent of patients hospitalized for Lassa fever die from the illness. "The death rate during epidemic is, however, far higher, ranging between 30 and 60 per cent. The death rate is particularly high for women in the 3rd trimester of pregnancy and for the fetus, about 95 per cent of which die in the uterus of infected pregnant mothers," he revealed.

Former commissioner for health in Edo State Moses Momoh agreed that there is really a Lassa fever epidemic across the country. He said the disease, which is seasonal and restricted to Edo central, has now spread to all parts of the state and now occurs all year round. "It is no longer a seasonal disease," he noted, while calling for joint action by stakeholders to tackle the menace.

Worried by the upsurge of the disease, the federal government has sent an intervention team to some of the affected states to "investigate and put in place preventive measures to avoid the spread of the disease." Minister of health Onyebuchi Chukwu said the team went with drugs from the ministry and with personal protection equipment; they will investigate the cases. They will do contact tracing and mount environmental control. "Then, they will meet with the state officials to come up with information and education materials that can be distributed to people in their own languages," he said. The minister said the aim of distributing the information materials in the vernacular was to facilitate awareness on prevention.

However, experts, advice the federal government to find a lasting solution to the menace instead of waiting for an outbreak before deploying its men to affected areas. "Why would the government wait for an outbreak before it begins to think of printing information materials on prevention to residents of the affected areas? What purpose would that serve in the 1st place," a medical doctor with a private hospital in Jalingo, Dr Joseph Banjamin, queried. He said that for a disease that is seasonal, intervention was supposed to be an all-round thing. "Between last year [2012] and now, what has really been done in the area of prevention across the country, especially since the areas prone to attacks are known? Are health centres more empowered to deal with the situation now than they were last year? How equipped is the specialist hospital in Irrua to deal with the spread?" he asked.

Director of administration of Irrua Specialist Hospital Mr Tony Edeko said the manpower and equipment available at the hospital are grossly inadequate to deal with the rising cases of Lassa fever. He said the hospital requires more isolation facilities and dialysis machines in addition to manpower to enable it to deal with the new reality. A former vice chancellor of the Ambrose Alli University, Ekpoma, Professor Dennis Agbonlahor, has said poor funding and lack of political will are responsible for the prevalence of Lassa fever endemics in Nigeria. Prof Agbonlahor said the Nigerian government had yet to show enough commitment towards Lassa fever eradication over the years.

The former AAU VC said funds donated by foreign donors for establishment of Lassa fever laboratories in each of the zones of the federation were collected by some officials of the Federal Ministry of Health but never accounted for.

Prof Agbonlahor said Lassa fever has claimed more lives than more publicized infectious diseases such as meningitis, HIV/AIDs, acute diarrhea, among others. He said over 100 000 lives had been lost to Lassa fever between 1969 and 2013, adding that many unrecorded deaths occurred in rural areas.

Prof Agbonlahor said 23 states in Nigeria were affected by Lassa fever in 2012 out of which 87 deaths were recorded. He said Lassa fever cases were confirmed in Nigeria only 39 years after its 1st outbreak in 1969 because there were inadequate laboratory diagnostic facilities for confirming suspected cases of Lassa fever. Prof Agbonlahor said vaccination against Lassa fever in the country has not been possible due to lack of funding and political will. He urged the federal government to establish zonal diagnostic offices for Lassa fever across the country and to also show more interest and concern on the control and eradication of the disease.

Meanwhile, Dr Nasidi Abdulsalami, director, Nigeria Centre for Disease Control, said there has been no new case of Lassa fever since drugs were sent to Ondo and Benue. He said the cases in Ondo are still confined to Ose Local Government Area. "But we are expanding our reach on prevention, not just with Lassa fever but other similar diseases as well. As you know, this is the season. We are in a meeting to increase the reach of prevention. We are also implementing and strengthening the early warning and reporting system to catch any suspected new case," he said.

[byline: Vincent Egunganga, Lami Sadiq, Hir Joseph]

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[This review describes vividly the extent of the current epidemic of Lassa fever affecting central and northern Nigeria but neglects consideration of the fact that the reservoir host of Lassa virus is the rodent known as the "multimammate rat" belonging to the genus _ Mastomys_. These rodents produce large numbers of offspring and are numerous in the savannas and forests of west, central, and east Africa. Most relevant is their habit to readily colonize human homes. The _Mastomys_ spp. rodents shed the virus in their urine and faeces. Therefore, the virus can be transmitted through direct contact with these materials, through touching or eating food contaminated with these materials, or through cuts or sores. Because _Mastomys_ rodents often live in and around homes and scavenge human food remains or poorly stored food, transmission by this means is common. Contact with the virus also may occur when a person inhales tiny particles in the air contaminated with rodent excretions. Therefore, control of human infection will require general improvement of living conditions and rodent control rather than reliance on deployment of medical care and a vaccine which does not yet exist.

A map of the states of Nigeria can be accessed at: http://quacked.com/image-110-nigeria.htm. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1qGF.]

METHANOL POISONING - LIBYA: (TRIPOLI) FATAL
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Date: Mon 11 Mar 2013
Source: BBC News [edited]
http://www.bbc.co.uk/news/world-africa-21747409


At least 51 people have died after drinking tainted homemade alcohol in Tripoli, Libyan health officials say. They say 378 have been taken to the capital's hospitals since Saturday [9 Mar 2013], and the number may rise further.

A hospital official told the BBC the deaths occurred from methanol poisoning and that many patients were undergoing kidney dialysis for treatment. The consumption and sale of alcohol is illegal in Libya, but it is available on the black market.

The Libyan health officials say 38 people have now died in Tripoli hospitals and another 13 as they were travelling to neighboring Tunisia for treatment.

A state of emergency has been declared in the capital's hospitals. The alcohol in question is a cheap local brew known as Bokha. It is distilled from various fruits like figs, dates, or grapes.

But industrial spirits -- like methanol -- are sometimes used to increase the potency of the drink, the BBC's Rana Jawad in Tripoli reports. Health risks after drinking methanol include kidney failure, blindness, seizures, and death.

Interior ministry official Hussein al-Amry told the BBC that special units had surrounded locations where the homemade alcohol was thought to have been brewed.

He added that the ministry was prepared to use force if the owners did not comply with an order to vacate the premises. Alcohol is also smuggled into Libya from Tunisia, Algeria, and Malta.

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[Libya's capital, Tripoli, can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/5UVm.

Methanol (wood alcohol) is produced from the destructive distillation of wood. Epidemics of methanol toxicity have resulted from the consumption of methanol-contaminated whiskey or other alcohol products. The formation of 2 toxic metabolites, formaldehyde and formic acid, causes methanol poisoning. The elimination rate depends upon the folate pool. In primates it is generally small and consequently primates (including humans) are more sensitive to methanol toxicity than other animals.

Methanol is widely available in formulations including antifreeze, windshield washer fluid, Sterno canned heat, shellacs, various paints, paint removers, varnishes, duplicating fluids, and gasoline additives.

Fatalities have been reported after ingestion of 15 ml or 3 teaspoons of a 40 per cent solution, although 30 ml is generally considered a minimal lethal dose. With aggressive medical care it is possible to survive the ingestion of 500-600 ml. However, consumption of as little as 10 ml may cause blindness, depending on the amount and individual tolerance.

Methanol is well absorbed from the gastrointestinal tract, and peak levels occur generally within 30-90 minutes. It is distributed into tissues, so concentrations in the vitreous humor and optic nerve are high. The highest concentrations are found in the kidney, liver, and gastrointestinal tract, with smaller concentrations in the brain, muscle, and adipose tissues.

Methanol is oxidized 10 times more slowly than ethanol. Consequently there is a longer elimination half-life.

Onset of symptoms varies between 40 minutes and 72 hours after ingestion. Co-ingestion with alcohol will delay the appearance of symptoms, but the absence of symptoms does not exclude serious toxicity. The usual latent period is 12-24 hours.

Clinical signs may include headache, vertigo, lethargy, and confusion, which are common in mild to moderate ethanol intoxications. Coma and convulsions appear in severe cases, probably as a result of cerebral edema. Methanol produces little to no euphoria, unlike ethanol.

Blurred vision, decreased visual acuity, and photophobia (sensitivity to light) are common complaints. Constricted visual fields, fixed and dilated pupils, retinal edema, and hyperemia of the optic disk are common clinical findings. Prompt initial therapy is necessary to reverse symptoms, though visual defects have persisted in up to 25 per cent of severe cases.

Methanol is a mucosal irritant and may produce nausea, vomiting, and abdominal pain, not unlike large doses of ethanol.

Early in the clinical course, gut decontamination with ipecac or lavage may be indicated. However, if the methanol is mixed with ethanol, these patients may not realize something is out of the ordinary until it is too late for this type of treatment to be helpful.

Intravenous administration of ethanol in a 10 per cent dextrose solution may be helpful. As ethanol prolongs the elimination half-life of methanol, the treatment may take several days and the patient should be hospitalized. Dialysis may be necessary to prevent kidney failure as well. Hemodialysis remains an effective treatment. - Mod.TG]

VIRAL HEMORRHAGIC FEVER - SUDAN: (SENNAR) SUSPECTED: REQUEST FOR INFORMATION
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Date: 15 Mar 2013
Source: Gert van der Hoek <gertvanderhoek@gmail.com>
http://radiotamazuj.org/en/article/outb ... e-hospital


An outbreak of viral haemorrhagic fever has been reported in Sudan's Sennar state, according to an anonymous medical source speaking to Radio Tamazuj from the area.

Two cases of the disease have been reported so far in the state although conditions and facilities in the hospital are said to provide an inadequate response to the outbreak.

"There are a lot of cases, for instance if the patient is admitted and got discharged or died then somebody is immediately replaced in that place in which that bed is supposed to be disinfected or exposed to sunlight, but these things we don't have here," the source claimed.

The same source also reported an outbreak of tuberculosis, stressing that the hospital compound is one source of disease transmission. They called upon competent authorities to rehabilitate the hospital and improve its sanitation with infrastructural development including toilets.

"The throat tuberculosis is rampant and it's transmitted from the hospital it is not coming from outside. I saw two cases of hemorrhagic fever. I am recommending to Sennar hospital that at least the authorities should provide good toilets. You always find toilets closed for 24 hours," the source added.

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[Many thanks to Gert van der Hoek for this communication. Further details from informed local sources would be appreciated. - Mod.SH

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1A1E.]

CHOLERA, DIARRHEA & DYSENTERY UPDATE (11): AFRICA
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In this update:
[1] Cholera - South Africa (Limpopo Province)
[2] Cholera - Republic of Congo (Pointe-Noire)


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[1] Cholera - South Africa (Limpopo Province)
Date: Mon 18 Mar 2013
Source: INet Bridge, South African Press Association (SAPA) [edited]
http://news.howzit.msn.com/limpopo-cholera-scare


A Zimbabwean man found to have cholera has sparked fears of an outbreak in Limpopo. The 25-year-old man was diagnosed with the infection on Wed 13 Mar 2013, after tests conducted on him revealed he had the _Vibrio cholerae_ bacterium.

The man was allegedly kept at the Lindela Repatriation Camp before he was deported to Harare, Zimbabwe 2 weeks ago. He returned to South Africa and was kept at a shelter in Musina, where he became ill. He was taken to the local hospital where he is still undergoing treatment.

Limpopo MEC [Member of the Executive Council] for health Norman Mabasa confirmed 17 Mar 2013 the 1st tests conducted on the man had discovered _V. cholerae_. He said they were working very hard to establish the facts surrounding the man's illness.

"We are worried about the possibility of a cholera outbreak." He said a team from the provincial department would work with the national response team "to guide us on curbing the outbreak".

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[Maps of South Africa can be seen at http://www.sa-venues.com/maps/south-afr ... vinces.htm and http://healthmap.org/r/5Zdq. - Sr.Tech.Ed.MJ]

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[2] Cholera - Cholera - Republic of Congo (Pointe-Noire)
Date: Fri 15 Mar 2013
Source: UN Integrated Regional Information Networks (IRIN) [edited]
http://www.irinnews.org/Report/97661/Ch ... k-in-Congo


An influx of migrants from the countryside into the Republic of Congo's 2nd largest city, Pointe-Noire, is exacerbating a cholera outbreak that began in November 2012. The outbreak infected at least 389 and killed 10, according to the health ministry and local authorities.

"Heavy rain in the port city in recent weeks and sanitation problems triggered the cholera outbreak," said Health Minister Francois Ibovi.

According to the mayor of Pointe-Noire, Roland Bouiti Viaudo, the booming city has seen a large influx of migrants from rural areas. "People build and settle in prohibited areas, including [around] sewers, blocking the free flow of wastewater, which explains the repeated outbreaks of cholera," he told IRIN. "To stop the disease... everyone -- the authorities, NGOs and communities -- should mobilize and become aware of this danger."

In early March 2013, during a council of ministers' meeting, the government announced that emergency aid had been released to combat the outbreak, but it did not specify the amount.

Health authorities in Pointe-Noire, a city of more than 800 000, have set up an intensive cholera treatment centre on the grounds of the 200-bed Loandjili Hospital. "This center is run by 6 specialists in infectious diseases and the gastrointestinal tract. It also has a team of 28 nurses with disposable gowns, gloves, masks, and shoes to avoid contamination," said the country's director-general of health, Alexis Elira Dokekias.

"So far... of all cases reported by the Pointe-Noire health services, 347 have already returned home, 10 have died, and 32 are still hospitalized," he said.

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[Maps of the Republic of Congo can be seen at http://www.un.org/Depts/Cartographic/ma ... /congo.pdf and http://healthmap.org/r/5Op6. - Sr.Tech.Ed.MJ

Fri 15 Mar 2013, was the 200th anniversary of the birth of John Snow, an early epidemiologist who discovered contaminated water as the source of cholera in 1854. The following (http://www.guardian.co.uk/news/datablog ... holera-map), is a discussion of the discovery:

How often does a map change the world? In 1854, one produced by Doctor John Snow, altered it forever.

In the world of the 1850s, cholera was believed to be spread by miasma in the air, germs were not yet understood, and the sudden and serious outbreak of cholera in London's Soho was a mystery. So Snow did something data journalists often do now: he mapped the cases. The map essentially represented each death as a bar, and you can see them in the smaller image above [to see the map, refer to the source URL above]. It became apparent that the cases were clustered around the pump in Broad (now Broadwick) street.

There were some outliers though and Snow wrote that:
In some of the instance, where the deaths are scattered a little further from the rest on the map, the malady was probably contracted at a nearer point to the pump."

One 59-year-old woman sent daily for water from the Broad street pump because she liked its taste. Wrote Snow:
"I was informed by this lady's son that she had not been in the neighbourhood of Broad Street for many months. A cart went from broad Street to West End every day and it was the custom to take out a large bottle of the water from the pump in Broad Street, as she preferred it. The water was taken on Thursday 31 August, and she drank of it in the evening, and also on Friday. She was seized with cholera on the evening of the latter day, and died on Saturday."

At a local brewery, the workers were allowed all the beer they could drink -- it was believed they didn't drink water at all. But it had its own water supply too and there were consequently fewer cases.

In nearby Poland street, a workhouse was surrounded by cases but appeared unaffected: this was because, again, it had its own water supply.

It turned out that the water for the pump was polluted by sewage from a nearby cesspit where a baby's nappy contaminated with cholera had been dumped. But Snow didn't just produce a map; it was one part of a detailed statistical analysis.

As the Public Health Perspectives blog says, it changed how we see data visualisations, and how we see microbes. Snow was born 200 years ago (15 Mar 1813) and is the subject of an exhibition at the London School of Hygiene and Tropical Medicine. - Mod.LL]

MALARIA - ZIMBABWE
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Date: Thu 21 Mar 2013
Source: The Zimbabwean [edited]
http://www.thezimbabwean.co.uk/life/hea ... d.html?utm_


At least 55 deaths and 123 969 cases of malaria have been recorded this year [2013] countrywide, a 2-fold increase in prevalence of the disease compared to last year [2012], says a government official.

"We have experienced a surge of both malaria incidents and deaths this year [2013]. In 2012, by week 9, we recorded 67 000 cases and 49 deaths, while this year over the same period, the figure is 123 696 and 55 deaths," said National Malaria Case Management Focal Person in the Ministry of Health and Child Welfare, Staneford Mashaire, in an exclusive interview.

In week 9, 124 000 cases of malaria and 4 deaths were recorded nationally, compared to 10 000 cases and 9 deaths last year [2013]. Mashaire attributed the outbreak to recent floods that hit many areas. "There is one confirmed outbreak in Mutasa, while Goromonzi and Chiredzi are not yet confirmed. We received a petition from Mashonaland East requesting inside door residual spraying, as cases of malaria were on the increase. We have since deployed reaction teams to assess the ground for further assessment in both areas," he said.

Mashaire added that out of the country's 63 health districts, spraying was done in 45 districts, but Goromonzi was not included. Mosquito net distribution is carried out in 30 districts prone to malaria. "Of the 30 districts, 23 have received their nets, including Mutasa, where we have just distributed 90 000 nets to 37 433 households. We also conducted public awareness programmes, recruited and trained 150 village health workers to offer rapid tests and treat patients in the community in order to curb the outbreak," said Mashaire.

In Matabeleland South, the department is doing a pre-elimination exercise, whereby if a person presents him/herself with malaria, the whole family or community is traced for treatment. "In other provinces, we are in control exercises, where we just treat an individual who is reportedly ill," he said.

Malaria is a disease caused by the plasmodium parasite, mainly acquired after a bite from an infected female anopheles mosquito. According to SADC health statistics, Mozambique and Zambia are high transmission endemic countries, and most areas of Zimbabwe that share borders with these 2 countries are affected by malaria from outside the borders. In Zimbabwe, more than 50 percent of the population resides in malaria transmission risky areas.

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[Malaria data for Zimbabwe can be found here: http://www.who.int/malaria/publications ... zwe_en.pdf.

The report says that 100 percent of cases are treated with ACT (artemisinin combination therapy) and that RDT (rapid diagnostic testing) has replaced microscopy for diagnosis. 95 percent of the expenditures on malaria control comes from sources outside Zimbabwe. Failure of therapy is reported to be 1.9 percent, but no data are available since 2007. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1AY4.]

TYPHOID UPDATE - ZIMBABWE
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Zimbabwe (Harare)
Date: Sun 24 Mar 2013
Source: Zim Eye [edited]
http://www.zimeye.org/?p=76589&cpage=1


Zimbabwe's capital city Harare has encountered a catastrophic outbreak of the typhoid disease that has spread across the city killing people in the way.

7 people have already died in barely 6 months as the waterborne disease largely attributed to the city's dirty waters rose to become a national disaster. This comes as it was reported that for several years people have been drinking faeces from the council supplied waters. Since the end of 2012, the city of Harare and surrounding areas are yet again faced with a spike of typhoid and diarrhea. The official cumulative figures for typhoid since October 2011 are 6843 suspected and 142 confirmed patients with typhoid and 7 deaths, reports by the Medecins Sans Frontieres/Doctors Without Borders (MSF) reveal.

In this latest period of an outbreak that 1st started in October 2011, health authorities recorded over 3525 patients with suspected typhoid fever and 5 deaths since November 2012 -- in the city of Harare alone.

Typhoid is a bacterial, water-borne disease transmitted by the ingestion of food or water contaminated with feces of an infected person. This happens in conditions of poor sanitation, and poor supply of clean water. In areas where sanitary facilities are well developed and maintained, there has been virtual elimination of typhoid. In many parts of Harare, water supplies are still irregular as taps remained dry most of the time leaving people with no option but to rely on wells. Especially in suburbs like Mbare, water and sanitation conditions are favourable to water-borne diseases like cholera and typhoid.

"Our biggest fear is a cholera outbreak in the city," says Harare City Council Director of Health Services Dr Prosper Chonzi. "But we hope with support from partners such as the Ministry of Health, the World Health Organization, MSF and other actors involved in water and sanitation issues we can avert this."

Health education and hygiene promotion activities were ongoing around Harare, he adds, especially in areas which have not been affected by the outbreak. Fortunately, the number of people affected seems to be decreasing as of late.

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[

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1ob5, http://healthmap.org/r/1Ayf, http://healthmap.org/r/1AY4.]

DENGUE/DHF UPDATE (24): AFRICA
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- Kenya (Mombasa). 24 Mar 2013. Dengue at least 15 cases.
http://www.standardmedia.co.ke/?article ... %20Mombasa

[This is the 1st ProMED-mail report of dengue cases in Kenya. The above report quotes a health authority as indicating that dengue is significantly underreported in Africa. An additional report on 25 Mar 2013 indicates that 2 Mombasa dengue cases were dengue positive in tests done by the Kenya Medical Research Institute (KEMRI) in Kilifi
http://www.standardmedia.co.ke/?article ... ue%20fever.

A HealthMap-ProMED-mail interactive map can be accessed at http://healthmap.org/r/62B-. - Mod.TY

RABIES - ZIMBABWE: (MANICALAND) SUSPECTED
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Date: 1 Apr 2013
Source: AllAfrica/The Herald [edited]
http://allafrica.com/stories/201304010589.html


2 people have died from suspected rabies, while 400 others were bitten by dogs in one week alone throughout the country.

The vaccination status of the majority of the offending dogs was not known, a weekly national disease surveillance report has revealed. According to the report compiled by the Ministry of Health and Child Welfare and various partners working in the health sector, 397 dog bites were recorded in the week ending 17 Mar 2013. Of these, only 23 were inflicted by vaccinated dogs. "The vaccination status of 374 dogs was unknown," reads part of the report.

The highest number of dog bites were in Manicaland (84) and Midlands (60). The report further says that during the same week, 2 people died of rabies.

"Two suspected rabies cases, which later turned into 2 deaths, were reported this week. The cases were reported from Mutasa and Chipinge districts in Manicaland province," reads the report.

It is the law in Zimbabwe to vaccinate dogs against rabies.

According to the government's weekly report, 4 people have died of rabies since the beginning of the year [2013], while the total number of people who have been bitten by dogs stands as 4890 to date.

The World Health Organisation seeks to eliminate rabies in the region by 2020. Other countries have since eliminated the disease, but in Zimbabwe, rabies is still a cause for concern.

Statistics from the Ministry of Health and Child Welfare show that 11 people died of rabies in 2012, and a further 17 450 people were bitten by dogs the same year.

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[The latest year for OIE reports of animal rabies in Zimbabwe is 2011: Manicaland (16), Mashonaland Central (13), Mashonaland East (38), Mashonaland West (18), Masvingo (23), Matabeleland North (7), Matabeleland South (38), and Midlands (31). These reports are essentially only of farm livestock and dogs. Logically, there will be a significant secondary reservoir of cases in wildlife. Until the economy turns around in Zimbabwe, we can expect this chronic situation to persist. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1AY4.]

LASSA FEVER - NIGERIA (09): (RIVERS), FATALITY
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Date: Sat 30 Mar 2013
Source: Daily Trust, allAfrica.com [edited]
http://allafrica.com/stories/201304010094.html


Lassa fever has killed one in person in Rivers state. Rivers State Commissioner for Health Dr. Sampson Parker, who disclosed this to a journalist in Port Harcourt, said the deceased died at the University of Port Harcourt Teaching Hospital before help could come his way. He said: "Just a few days ago, my attention was drawn to the isolation of the virus in a suspected case, and we lost the patient before any spirited attempt could be made to rescue him."

The commissioner said the state government has risen to the challenges of the Lassa fever outbreak by intensifying surveillance and consolidating the established control structures. He said an isolation ward has been designated and equipped "for this purpose at the University of Port Harcourt Teaching Hospital, and a multi-disciplinary task force has already fashioned an integrated approach to ensure that the disease is contained." He said the state government has procured sufficient drugs and consumables to manage exposed persons and called on the people to maintain the best hygiene and cleanliness as well as to keep rodents out of their houses and working places.

Last year [2012], the state recorded an outbreak of Lassa fever which claimed many lives.

[Byline: Victor Edozie]

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[Lassa fever continues to cause problems in Nigeria. The most recent report described extensive outbreaks in central and northern Nigeria (see: Lassa fever - Nigeria (08) 20130314.1585). The current report describes a fatal case in Rivers state, which is located in the extreme south of Nigeria.

The reservoir host of Lassa virus is the rodent known as the "multimammate rat" belonging to the genus _ Mastomys_. These rodents produce large numbers of offspring and are numerous in the savannas and forests of west, central, and east Africa. Most relevant is their habit to readily colonize human homes. The _Mastomys_ spp. rodents shed the virus in their urine and faeces. Therefore, the virus can be transmitted through direct contact with these materials, through touching or eating food contaminated with these materials, or through cuts or sores. Because _Mastomys_ rodents often live in and around homes and scavenge human food remains or poorly stored food, transmission by this means is common. Contact with the virus also may occur when a person inhales tiny particles in the air contaminated with rodent excrement. Therefore, control of human infection will require general improvement of living conditions and rodent control rather than reliance on deployment of medical care and a vaccine which does not yet exist.

A map of the states of Nigeria showing Rivers state in the far south can be accessed at: http://quacked.com/image-110-nigeria.ht ... igeria.htm. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1qGF.]

DENGUE/DHF UPDATE (30): AFRICA
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Angola
Date: Mon 1 Apr 2013
Source: RFI [in Portuguese, trans. Mod.TY, summ. edited]
http://www.portugues.rfi.fr/africa/2013 ... -de-dengue


Health authorities announced to the press on Monday [1 Apr 2013] in Angola's capital the registration of at least 6 dengue cases at a time when there are rising malaria cases.

The press announcement was made by the director of Public Health of Angola. Adelaide de Carvalho said that 6 dengue cases have been registered by the Luanda General Hospital.

Frequent rains that have hit some regions of the country have multiplied lack of sewerage and drinking water.

The episodes of dengue are thus raising concerns of the authorities, since this disease is viral and does not present the same clinical [picture as] malaria, which is controlled in terms of sanitary health services. The authorities are thus obliged to take quick and effective action to prevent dengue from becoming endemic, which would have unpredictable consequences for the public health of the country.

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[ProMED-mail does not usually post reports when there are relatively few dengue cases. However, since dengue reports from Africa are so few, this report from Angola is of interest. It does make one wonder how many dengue infections are misdiagnosed as malaria.

A HealthMap/ProMED-mail map of Angola can be accessed at http://healthmap.org/r/6jhj. - Mod.TY]

YELLOW FEVER - AFRICA (13): GHANA (UPPER WEST)
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Date: Wed 10 Apr 2013
Source: AFENET (African Field Epidemiology Network) [edited]
http://www.afenet.net/new/index.php?opt ... id=156〈=en

The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) recently participated in the investigation of a yellow fever outbreak in Jirapa district, located in the northwestern corner of the Upper West Region of Ghana. The outbreak was first reported on 7 Feb 2013 by the District Health Director of Jirapa district, who also happens to be a resident of the GFELTP. The 1st case of jaundice was identified at St Joseph's Hospital in Jirapa district, which was then followed by 10 other cases in a space of 4 weeks from 7 Feb to 4 Mar 2013.

An initial investigation of the suspected outbreak was done by the Upper West Regional and Jirapa District Health Management Teams (DHMT). They were later joined by the Disease Surveillance Department and 8 Cohorts V and VI residents of the GFELTP for a follow up investigation from 13 to 17 Mar 2013.

Blood samples from all the suspected cases were sent through the Regional Health Directorate to the National Public Health Reference Laboratory (NPHRL) for confirmation. Prior to the receipt of feedback from the NPHRL, 3 of the suspected cases died. The outbreak team together with the DHMT reviewed records of cases of jaundice at St Joseph's Hospital, they sensitized the district and sub district health workers on the need for active surveillance, the team also followed-up on the contacts of probable case, reviewed records of all the other cases at the hospital, they visited the case patient at the regional hospital and assessed yellow fever, measles, meningitis, and acute flaccid paralysis (AFP) activities in the district.

The follow up investigation aimed to determine the extent of the suspected outbreak, identify the source and individuals at risk, identify risk factors of the outbreak, determine yellow fever vaccination coverage, evaluate the outbreak investigation, and recommend additional control and preventive measures needed.

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[There have been sporadic cases of yellow fever (YF) in Ghana in recent years, including this one (2013). Curiously the report above does not mention whether a follow up vaccination campaign is planned or underway in the affected locality. Recently, the 1st phase of a mass vaccination campaign was conducted in November 2011 and targeted a population of 5.8 million people covering 40 districts (8 regions). A YF reactive campaign was carried out in 3 more districts. The 2nd phase, planned for 2012, targeted 1.7 million people spanning 17 districts.

It is gratifying to learn the health system in Ghana is very responsive to yellow fever cases in a timely way in this situation, with active surveillance and laboratory support. It is also good to learn that the situation above was used as a field training mechanism for the Ghana Field Epidemiology and Laboratory Training Program (GFELTP) that will fill a much needed niche in public health services.

A map showing the location of the Upper West Region of Ghana can be accessed at http://en.wikipedia.org/wiki/Regions_of_Ghana and a HealthMap/ProMED-mail map of Ghana at http://healthmap.org/r/1qG-. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (13): AFRICA
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In this update:
Africa
[1] Cholera - Uganda (Hoima District)
[2] Cholera - Angola

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[1] Cholera - Uganda (Hoima District)

Date: Wed 17 Apr 2013
Source: AllAfrica, New Vision (Uganda) report [edited]
http://allafrica.com/stories/201304171325.html


Following a suspected cholera outbreak in Kigorobya Sub-county, Hoima district, 3 people have been confirmed dead while 16 others are hospitalized. The District Health Inspector, Fred Byenumi, told New Vision on Tuesday evening [16 Apr 2013], that the suspected outbreak has been reported in Kapaapi and Kibiro parishes along Lake Albert shores.

"But we are yet to confirm if it is cholera we are taking samples to the national research center in Entebbe to ascertain if it is the one but according to the symptoms it seem to be cholera, once we confirm we shall declare to you," Byenumi explained. He said as part of interventions they have opened a cholera treatment center at Runga landing site in Kigorobya Sub County that will also handle all emerging cases.

He said the disease that was first reported in the area on Thu 11 Apr 2013, is suspected to have spread from Nebbi and Arua the neighboring districts due to the usual interaction between the 2 neighboring areas people that trade along Lake Albert shoreline.

James Mugenyi Mulindambura, the area district Councilor blamed the spread on poor sanitation standards in the area. He has said the government should have a deliberate program to improve sanitation in the area.

"We have sensitized the people about latrine construction and usage since most of them do not have them (latrines) but they seem can't manage to have proper sanitary facilities which are expensive and out of reach for most of these people given the nature of soils," he said.

Meanwhile, every year at the onset of the rainy season there are reported cholera outbreaks in the same sub county. In 2012, the deadly disease claimed the lives of 12 people and more than 600 were hospitalized in the same sub county.

[Byline: Robert Atuhairwe]

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[Maps of Uganda can be seen at http://en.wikipedia.org/wiki/Districts_of_Uganda and http://healthmap.org/r/5miP. - Mod.LL]

******
[2] Cholera - Angola
Date: Wed 10 Apr 2013
Source: Angola Press Agency (Angop) [in Spanish, machine trans., edited]
http://www.portalangop.co.ao/motix/es_e ... 1f830.html


Today [10 Apr 2013], it was reported in Luanda that as of 7 Apr 2013, 1050 cases of cholera with 18 deaths had been reported in the country since January [2013].

A source from the Ministry of Health told ANGOP that the provinces most affected were Cunene (339), Uije (286), Luanda (170), and Benguela (149). The most deaths, 7, were registered in Luanda.

In the most recent epidemiological week, from 1-7 Apr 2013, 38 cases of cholera were reported, without any deaths, with Benguela leading the list with 31 cases, Cunene with 4, and Huila with 3. Compared to last week, there was a decrease in the number of cases by 21 percent, from 48 to 38.

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[Maps of Angola can be seen at http://www.mapsofworld.com/angola/angol ... l-map.html and http://healthmap.org/r/1iGj. - Mod.LL]

Starker Anstieg von Hepatitis-A-Infektionen in Ägypten

Vervierfachung der Infektionen bei Reiseheimkehrern. Experten raten dringend zur Impfung.

Seit November 2012 sind in Deutschland zirka viermal so viele Hepatitis-A-Fälle (insgesamt 39) nach Reiseaufenthalten in Ägypten aufgetreten wie in den Vorjahren. Auch in den Niederlanden, Dänemark, Norwegen, Schweden und England gab es einen Anstieg. Laut einer auf http://www.eurosurveillance.org publizierten Studie sind seit November in diesen Ländern 80 Fälle bei Reiserückkehrern gemeldet worden - die Dunkelziffer dürfte deutlich höher sein. mehr...

oder http://de.nachrichten.yahoo.com/vorsich ... 17859.html

Grüsse
Alexander