Wüstenschiff

YELLOW FEVER - AFRICA (15): ETHIOPIA (SOUTHERN NATIONS, NATIONALITIES AND PEOPLES]
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In this posting:
[1] UN OCHA report
[2] WHO report

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[1] UN OCHA report
Date: Mon 27 May 2013
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb [edited]
http://reliefweb.int/report/ethiopia/et ... 7-may-2013


Following the confirmation of yellow fever cases on 15 May 2013, the Ethiopian Health and Nutrition Research Institute's Public Health Emergency Management center (EHNRI/PHEM) formally notified the situation to WHO as per the International Health Regulation (IHR), which requires notification of a confirmed case of yellow fever to the WHO IHR Focal Point. To date, a total of 105 cases have been reported to EHNRI/PHEM from South Ari, Benatsemay, and Selmago woredas [districts] of South Omo zone in SNNPR [Southern Nations, Nationalities and Peoples region]. The Regional Health Bureau (RHB), with close support from EHNRI and WHO, is implementing the standard prevention and control strategy that is composed of reactive vaccination, vector control, case management, and enhanced surveillance; and has finalized to initiate the reactive vaccination of 20 000 people in 4 kebeles [smallest administrative unit of Ethiopia] in South Ari woreda where the confirmed cases were reported.

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Ota Masaki, MD, PhD
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[ProMED-mail thanks Dr Ota Masaki for sending in this report. This is the 1st ProMED-mail report of yellow fever cases in Ethiopia.

The SNNPR, Southern Nations, Nationalities and Peoples' Region, is one of the 9 ethnically-based administrative regions (kililoch) of Ethiopia. The 2007 census estimates the population at 14 929 548, of whom 13 433 991 are estimated to be rural inhabitants. A map showing the SNNPR location can be accessed at http://en.wikipedia.org/wiki/Southern_N ... es'_Region and a HealthMap/ProMED-mail interactive map of Ethiopia at http://healthmap.org/r/76YC. - Mod.TY]

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[2] WHO report
Date: Fri 31 May 2013.
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_05_31/en/


Yellow fever in Ethiopia
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The Ministry of Health of Ethiopia is launching an emergency mass vaccination campaign against yellow fever from 10 Jun 2013. This is in response to laboratory confirmation of 6 cases in the country on 7 May 2013.

The campaign aims to cover more than 527 000 people in the 6 districts of South Ari, North Ari, Benatsemay, Selamago, Hammer, and Gnangatom and one administrative town (Jinka) in South Omo Zone of the Southern Nations, Nationalities and Peoples' region (SNNPR) of Ethiopia.

The International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG11) will provide over 585 800 doses of yellow fever vaccine for the mass vaccination campaign run by the Ministry of Health in Ethiopia, with support from the GAVI Alliance [Global Alliance for Vaccines and Immunization] and other partners. WHO is closely supporting the outbreak investigation, capacity building for case management, resource mobilization for outbreak management, and monitoring preventive and control activities in the field.

The 6 laboratory confirmed cases are from South Omo, in the Southern Nations, Nationalities and Peoples' region. The cases were identified through the national surveillance programme for yellow fever. The index case was a 39 year old man who presented with fever and jaundice and haemorrhagic signs in January 2013. He was laboratory confirmed by IgM (antibody test). Differential diagnosis for other flaviviruses was negative.

The laboratory confirmation was done by Institute Pasteur in Dakar, Senegal, a WHO regional reference laboratory for yellow fever.

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[One hopes that this is a small outbreak in a limited area. Although the index case occurred in January 2013, only 6 more cases have been reported. No mention is made in either of the 2 reports above on previous yellow fever vaccination campaigns in the SNNPR, so the immune status of the population is not defined.

One also hopes that the vaccination campaign to be initiated on 10 Jun 2013 will prevent further cases. - Mod.TY]

DENGUE/DHF UPDATE (46): AFRICA
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Africa
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Madeira Island (Portugal) ex Angola. 29 May 2013. Dengue (susp.) 12 cases, (conf.) 2 cases.
http://www.theglobaldispatch.com/madeir ... ola-33197/

[This is anther example of movement of dengue-infected people to distant countries. Because Madeira Island has recently undergone a dengue outbreak and vector mosquitoes are present, these cases present a risk of ongoing transmission and resumption of a dengue outbreak.

Maps
Angola: http://www.mapsofworld.com/angola/angol ... l-map.html and http://healthmap.org/r/1iGj
Madeira Island: http://www.100destinos.com/imagenes/mapa-de-madeira.gif and http://healthmap.org/r/4tNJ. - Mod.TY]

YELLOW FEVER - AFRICA (16): ETHIOPIA, NIGER
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Date: Tue 4 Jun 2013
Source: UK National Travel Health Network and Center (NaTHNaC) [edited]
https://www.nathnac.org/pro/clinical_up ... 040613.htm


Yellow fever activity update: Ethiopia and Niger
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This updates the previous clinical update of 21 Feb 2013. In Africa, 34 countries are considered at risk of yellow fever (YF) [1]. In February 2013, NaTHNaC [National Travel Health Network and Centre] reported on confirmed cases in Chad, Cote d'Ivoire, Democratic Republic of Congo, Nigeria, Republic of Congo, Sudan, and Togo [2]. Since then, in March 2013, cases of yellow fever have also been reported from Niger and Ethiopia.

Niger
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As of 15 Apr 2013, a yellow fever case has been confirmed in Diffa district, Niger. A mass-vaccination campaign has not been conducted in the district, however, an extensive epidemiological investigation is ongoing together with active case searching to identify additional suspected cases [3].

Ethiopia
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As of 7 May 2013, 6 confirmed cases of yellow fever have been reported from South Omo, in the Southern Nations, Nationalities and Peoples' region in Ethiopia. The Ministry of Health in Ethiopia is launching an emergency mass-vaccination campaign on 10 Jun 2013 in 6 districts: Benatsemay, Gnangatom, Hammer, North Ari, Selamago, South Ari, and one administrative town (Jinka) in the South Omo Zone of the Southern Nations [4].

Advice for health professionals
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Under International Health Regulations (2005) countries are no longer required to automatically report YF outbreaks to WHO [5]. Surveillance and reporting in YF risk countries can be poor. When undertaking YF risk assessment, health professionals should refer to individual country information where details relating to YF disease risk areas and recommendations for YF vaccination are given.

In addition, health professionals are encouraged to access the NaTHNaC Outbreak Surveillance Database where verified and unverified outbreaks of YF are posted, as well as newly published guidance on the recommendations for the use of yellow fever vaccination booster dose.

Advice for travellers
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YF is transmitted to non-human primates or humans via the bite of an infected mosquito. In Africa, the virus is transmitted via the bite of _Aedes_ spp. mosquitoes that feed predominantly during daylight hours.

Travellers should take mosquito bite avoidance measures and seek advice regarding YF vaccination before travelling to YF risk areas. YF vaccination is recommended for personal protection for all travellers aged 9 months and older to countries with a risk of YF.

Full details of YF vaccination recommendations can be found on the NaTHNaC's Country Information Pages. Details of the countries that require proof of YF vaccination as a condition of entry (under the International Health Regulations (2005) are also provided.

References
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1. World Health Organization. Yellow Fever Vaccination Recommendations in Africa, 2011. [Accessed 4 Jun 2013]; available at http://gamapserver.who.int/mapLibrary/F ... africa.png.
2. National Travel Health Network and Centre. Clinical Update: Yellow fever activity in Chad, Cote d'Ivoire, Nigeria. 21 February 2013. [Accessed 4 Jun 2013]; available at http://www.nathnac.org/pro/clinical_upd ... 210213.htm.
3. World Health Organization. Regional Office for Africa. Epidemic & Pandemic alert and Response (EPR). Outbreak Bulletin 26 Apr 2013; 3(3). [Accessed 4 Jun 2013]; available at http://www.afro.who.int/en/clusters-a-p ... -2013.html.
4. World Health Organization. Yellow fever in Ethiopia. 31 May 2013. [Accessed 4 Jun 2013]; available at http://www.who.int/csr/don/2013_05_31/en/index.html.
5. World Health Organization. International Health Regulations. About the IHR. 2013. [Accessed 4 Jun 2013]; available at http://www.who.int/ihr/about/en/.

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[Yellow fever (YF) remains a significant health risk in Africa's endemic area. Sporadic cases occur frequently, as noted in the 9 countries cited above for this year (2013). The Sudan (Darfur) outbreak that began in September 2012 and carried over to 2013 was the worst in Africa in the past 20 years. In addition to the countries listed above, on 27 Feb 2013 Cameroon registered 1184 cases of yellow fever since the beginning of the year [2013], of which 111 cases were confirmed, and Ghana registered 11 YF cases between 7 Feb-4 Mar 2013 (see ProMED-mail posts listed below). Individuals residing, working, or traveling in any of these endemic YF countries should be vaccinated.

A HealthMap/ProMED-mail map of Africa showing the countries mentioned can be accessed at http://healthmap.org/r/2r-O. - Mod.TY]

MALARIA - TANZANIA: (KAGERA) REQUEST FOR INFORMATION
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Date: Sun 9 Jun 2013
Source: Sabahi [edited]
http://sabahionline.com/en_GB/articles/ ... wsbrief-04


The Tanzanian government has sent a team of experts to investigate a malaria outbreak in Kagera region, Tanzania's Daily News reported on Saturday [8 Jun 2013]. More than 20 people, mostly children, have died of malaria in Kagera since the end of May [2013].

Deputy minister of health Seif Rashid said the government has ordered more medication to be sent to Rubya Hospital in Muleba District, where 30 to 40 new cases of malaria are reported daily. "We have enough ALu [artemether lumefantrine] drugs to last 280 days and quinine for 30 days at Rubya Hospital where an outbreak of malaria has been reported since [25 May 2013]," Rashid said, denying rumours of a shortage. "We are doing everything to serve the public and the situation is under control."

Irenei Kiria, executive director of Tanzanian health advocacy organization, Sikika, said there is a shortage of malaria drugs caused by the ministry's laxity in procuring enough medication from abroad. "This is a serious matter and we urge the ministry to urgently address it because there is no reason why people should die from malaria or lack of drugs," he said.

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[It is difficult to know precisely what is happening, but clearly the incidence of malaria in the area is higher than normal and the supply of drugs for treatment seems inadequate. A surge of transmission seems the most probably explanation. An increase in resistance to drugs used for treatment would be expected to evolve more slowly. Alternatively, the cases were treated with a drug of inferior quality and progressed to severe malaria even with a fatal outcome. ProMED-mail will be happy to post further information. - Mod.EP

Maps of Tanzania can be seen at http://www.ezilon.com/maps/africa/tanzania-maps.html and http://healthmap.org/r/2*Ka. - Sr.Tech.Ed.MJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (20): AFRICA
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[1] Cholera - Angola (Huila Province)
Date: Mon 10 Jun 2013
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb, Government of Angola report [edited]
http://reliefweb.int/report/angola/598- ... hu%C3%ADla


Some 23 people have died in the southern Huila province victims of cholera, from February 2013 to the present day, in a total of 598 cases recorded by the local sanitary authorities.

This was said to Angop [Angola Press Agency] on Sun 9 Jun 2013, by the chief of department for Public Health and Endemic Disease Control, Joao Kiala. He said that most of the deaths were recorded in Lubango district, with 14 cases.

Joao Kiala stated that 6 patients are currently admitted in the Center for Cholera Treatment of Lubango city, all in the favorable recovery phase.

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[Maps of Angola can be seen at http://www.un.org/Depts/Cartographic/ma ... angola.pdf and http://healthmap.org/r/7dvc. - Mod.LL]

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[2] Cholera - Ghana (Greater Accra Region)
Date: Fri 31 May 2013
Source: GhanaWeb [edited]
http://www.ghanaweb.com/GhanaHomePage/N ... ?ID=275633


Just when it is assumed that cholera outbreak has been brought under check, the Ghana Health Service (GHS) has recorded 2 cases of cholera in the Greater Accra Region for the 1st quarter of 2013.

According to the Regional Health Directorate, as at December 2012, the country had a total of 2487 cholera cases with 26 deaths recorded. This was however an improvement over previous year's [2011] record of 6882 cholera cases with 48 deaths.

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[Maps of Ghana can be seen at http://www.lib.utexas.edu/maps/africa/ghana_pol96.jpg and http://healthmap.org/r/75XQ. - Mod.LL]

RABIES - GHANA: (BRONG-AHAFO) CANINE, HUMAN
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Date: Wed 12 Jun 2013
Source: Ghana Business News, Ghana News Agency (GNA) [edited]
http://www.ghanabusinessnews.com/2013/0 ... ong-ahafo/


A total of 2 people died from a rabies outbreak in the Asunafo North and Asunafo South Districts in the Brong-Ahafo Region between February and April this year [2013]. Dr Kenneth Gbeddy, Brong-Ahafo regional director of veterinary service, in an interview with the Ghana News Agency in Sunyani on Wednesday [12 Jun 2013], said the 2 people, a man and a woman, were the victims, but did not disclose their districts. He said veterinary officers were undertaking vaccination exercises to bring the situation under control, adding that last year [2012], 2 people also died from rabies in the Tano North District and Tano South District of the Region.

Dr Gbeddy pointed out that the service was concerned about the rabies outbreak because it could infect all mammals, including dogs, cats, horses and cattle, when they come in contact with infected wildlife. He appealed to the general public to ensure their pets, especially dogs and cats, were vaccinated annually against the disease to avert any future occurrences. The regional director of the veterinary services advised people who are bitten by dogs or cats to rush to the nearest hospital for vaccination and careful examination to save their lives, and explained that the 2 people died because they reported to the hospital late.

Dr Gbeddy said dogs and other animals suspected to have rabies should not be killed, but must be chained by the owner for 2 weeks to be monitored, because dogs infected with rabies would die 10 days after biting a person. He said after the dog had died, the person bitten should be vaccinated against rabies, since any delay could cause the person's [death].

Dr Gbeddy stated that veterinary sponsored programmes by the Municipal and District Assemblies had stopped due to lack of funds and were no longer undertaking surveillance or monitoring in rural areas to vaccinate animals free of charge. He pointed out that stray dogs in the communities were dangerous and should be captured and killed under the assemblies' bylaws, and noted that people were dying because of non-enforcement of the bylaws.

Dr Gbeddy mentioned that aggressive dogs, dogs hiding in dark places, dogs that bite any animal on sight, dripping of saliva from the mouth and sudden change of barking were some of the signs of dogs being infected with rabies. He asked the general public to report such sudden changes in their dogs to the veterinary personnel in order to eliminate them from the communities, since their presence was a threat to human life. Dr Gbeddy noted that dogs and cats were human friends and needed to be cared for to make their stay in the communities comfortable.

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[Rabies remains a persistent problem in Ghana despite good surveillance and education programmes. However, the cessation of surveillance and monitoring in rural areas due to a lack of funding is an unwelcome development.

The Brong-Ahafo Region is located in the south of Ghana. It is bordered to the north by the Black Volta River; to the east by Lake Volta; to the south by the Ashanti Region; and to the west by the Ivory Coast's eastern border. Its capital is Sunyani. A map showing the locations of the Asunafo North and Asunafo South Districts can be accessed at http://en.wikipedia.org/wiki/File:Brong ... tricts.png, and the HealthMap/ProMED-mail interactive map of Ghana and the Brong-Ahafo Region is at http://healthmap.org/r/2J3y. - Mod.CP]

RABIES - SPAIN (02): (CASTILE-LA MANCHA) ex MOROCCO, CANINE, HUMAN EXPOSURE
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Date: Tue 11 Jun 2013
Source: The Telegraph [edited]
http://www.telegraph.co.uk/news/worldne ... -1975.html


A pit bull that attacked 4 children and an adult in central Spain was infected with rabies, marking the 1st recorded case of the disease on the Iberian Peninsula in almost 4 decades.

Authorities in Castile-La Mancha [province] have declared a state of high alert and ordered the compulsory vaccination of all dogs and cats within an 18 mile [about 29 km] radius of where the attacks took place.

The owner of the dog has been arrested for several counts of criminal negligence resulting in injury, and for failing to have the correct license for a dangerous breed. It is thought that he deliberately doctored veterinary records of the pit bull cross after bringing it into Spain from Morocco.

The dog bit 3 children, aged 2, 6 and 12, as well as a 17 year old boy in the village of Arges, near Toledo [Castile-La Mancha province], early this month [June 2013]. It was immediately destroyed and was confirmed to have been rabid following tests on Monday [10 Jun 2013]. All were discharged after being given rabies inoculations, apart from the 2 year old, who was kept in hospital after being bitten in the face.

The regional government has ordered all cats, dogs, and ferrets in the danger zone to be vaccinated against the disease within 15 days. Some 60 000 dogs in 56 villages are thought to be at risk. "We have also forbidden dogs to be allowed off the lead in public spaces until the danger has passed," confirmed Tirso Yuste, head of the regional Agriculture department.

At least 7 dogs have already been identified as having high levels of rabies [see comment] and have been put in quarantine for one month.

Mainland Spain was officially declared rabies free in 1975 after successful campaigns to stamp out the disease. There have been occasional examples recorded in Spain's North African enclaves of Ceuta and Melilla, cities on Morocco's Mediterranean coast.

It is understood that the rabid pit bull cross was bred in Spain but spent 4 months in Morocco, only returning within the last month [sometime between 11 May 2013 and 10 Jun 2013].

[byline: Fiona Govan]

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[The above media report includes some points that are in need of clarification (for example, what is the meaning of "dogs identified as having high levels of rabies"?). However, it illuminates a worrying, repeated situation.

In February 2012, a rabid puppy was imported to the Netherlands from Morocco via Spain (see 3 postings in "see also"). The incident was described in a paper published in March 2012 (ref). The conclusions of the authors included the following observations:

"The owners tried to import the dog in a legal way, yet the international legislations were not followed properly by the consulted veterinarians in Morocco and Spain and customs in Spain and the Netherlands. In hindsight, the European dog passport was incorrectly issued by a Spanish veterinarian as, according to the EU legislation, dogs/animals from outside the European Union should be vaccinated for rabies and kept in quarantine for 3 months upon arrival. Customs at 3 locations upon arrival and leaving in Spain and arrival in the Netherlands failed to check the vaccination status of the dog.

"Veterinarians and customs officials across Europe should be aware of the risk of rabies importation by animals from within and outside Europe.

"Illegal importation of animals from rabies-endemic countries outside the EU probably occurs frequently. France reported 9 illegally imported rabid puppies and dogs over the last 10 years, of which 7 were imported from Morocco. Therefore the public should be made aware of the risks involved in bringing home a living souvenir, and of the rules and regulations governing such an action."

Reference
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GG van Rijckevorsel, CM Swaan, JP van den Bergh, A Goorhuis, D Baayen, L Isken, et al. Rabid puppy-dog imported into the Netherlands from Morocco via Spain, February 2012. Eurosurveillance 2012; 17(10), 8 Mar 2012. http://www.eurosurveillance.org/ViewArt ... leId=20112.
- Mod.AS

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7i*a, http://healthmap.org/r/74ug.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (21): AFRICA
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In this update:
Africa
[1] Cholera - Congo (Pointe-Noire Department)
[2] Diarrhea, fatal - South Africa (Northern Cape Province)
[3] Diarrhea, fatal - South Africa (KwaZulu-Natal Province)


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[1] Cholera - Congo (Pointe-Noire Department)
Date: Thu 13 Jun 2013
Source: AfriqueJet [edited]
http://www.afriquejet.com/news/7897-hea ... noire.html


A cholera epidemic, plaguing Congo's commercial city of Pointe-Noire [Pointe-Noire Department] since November 2012, has killed 16 people out of the 1054 cases recorded, according to a report issued by health officials here Thursday [13 Jun 2013].

The report calls for a new reinforced plan to respond to the scourge with a focus on resources mobilization advocacy, the identification of all heath and social communities, sanitation, the reinforcement of the warning mechanism and the medical treatment.

Cholera hit Pointe-Noire following the 17-18 Nov 2012 torrential rains which claimed the lives of scores of people and caused heavy material damage, leaving many others homeless. Their return to their infected houses triggered the resurgence of diarrhea and other waterborne diseases.

Pointe-Noire is a poorly sanitized city with people using unsafe water and eating unhealthy food.

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[An interactive map of the Congo can be found at: http://healthmap.org/r/1Ahz. - Mod.LL]

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[2] Diarrhea, fatal - South Africa (Northern Cape Province)
Date: Mon 3 Jun 2013
Source: Leadership, News Agency of Nigeria (NAN) report [edited]
http://leadership.ng/news/030613/outbre ... uth-africa


The News Agency of Nigeria (NAN) reports that an outbreak of diarrhea, which started 2 weeks ago, has killed 5 children so far in Upington town in the Northern Cape province of South Africa. NAN also reports that the number of patients that have been treated at Gordinia Hospital has risen to 450. Medical authorities in the province said that the epidemic is the worst in 30 years.

Dr Mark Atkins, Northern Cape Paediatric surgeon, said that they are trying to establish the cause of the epidemic. "We basically see a large number of children coming in for treatment daily and we treat them for what we diagnose from the laboratory. "We treat the symptoms and we are sending in all the necessary samples to the laboratory to try and establish what is causing the diarrhea," Atkins said.

He said the National Health Department has intensified its search for the source of the diarrhea outbreak. "We are still waiting for the results of water and stool samples that have been sent to the University of Pretoria for laboratory test." He urged the residents of the area to take precautionary measures to prevent the disease from spreading.

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[An interactive map of South Africa can be found at: http://healthmap.org/r/1EPe. - Mod.LL]

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[3] Diarrhea, fatal - South Africa (KwaZulu-Natal Province)
Date: Thu 6 Jun 2013
Source: The New Age, South African Press Association (SAPA) report [edited]
http://www.thenewage.co.za/98071-1010-5 ... its_Durban


At least 151 people have been admitted to Durban hospitals in the past 3 months suffering from diarrhea, resulting in the deaths of 2 children. The deputy head of eThekwini metro's communicable disease service, Dr Ayo Olowolagba, said in a statement that most of those treated were children, half of whom came from Durban's Inanda area. Other reported cases were in Amaoti, Ntuzuma, Mayville, and KwaMashu [all in KwaZulu-Natal Province].

He said the city was trying to identify the cause, while at the same time educating local populations on hygiene. An eThekwini metro spokesman said he could not immediately confirm when the 2 deaths had taken place.

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[An interactive map of South Africa can be found at: http://healthmap.org/r/1EPe. - Mod.LL]

YELLOW FEVER - AFRICA (18): DEMOCRATIC REPUBLIC OF CONGO (KASAI-ORIENTAL) REQUEST FOR INFORMATION
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Date: Fri 14 Jun 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_06_14_y ... index.html


Yellow fever in the Democratic Republic of Congo
------------------------------------------------
The Ministry of Health of the Democratic Republic of Congo (DRC) is launching an emergency mass vaccination campaign against yellow fever from 20 Jun 2013, following laboratory confirmation of 6 cases in the country on 6 Jun 2013.

The 6 laboratory-confirmed cases were reported from 3 health zones [in Kasai-Oriental province]: Lubao (4 cases), Kamana (1 case) and Ludimbi-Lukula (1 case). They were identified through the national surveillance programme for yellow fever. The laboratory confirmation was done by the Institute Pasteur in Dakar, Senegal, a WHO regional reference laboratory for yellow fever.

Preliminary outbreak investigation revealed that the index case is a 16 year old boy from Kisengua village in the Lubao Health Zone who became ill on 1 Mar 2013. The outbreak investigation team has also identified 51 suspected cases, including 19 deaths, in the 3 health zones. Serum samples have been taken from 13 patients and are being analyzed in the National Institute of Biomedical Research (INRB).

The mass vaccination campaign aims to cover at least 503 426 people in the 3 affected health zones.

The International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) will provide 559 000 doses of yellow fever vaccine for the mass vaccination campaign run by the Ministry of Health in DRC, with support from the GAVI Alliance, Medicins Sans Frontiers (MSF) and other partners. WHO is closely supporting the management of the outbreak in monitoring, preventive and control activities in the field, and resource mobilization.

The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotation fund. It is represented by United Nations Children's Fund (UNICEF), MSF, the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat. The stockpile is supported by the GAVI Alliance.

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[Through the ongoing national yellow fever [YF] surveillance program, a total of 6 YF cases dating back to March 2013 have been confirmed in 3 health zones in Kasai-Oriental province. And following extended epidemiological investigations into the cases, an additional 51 suspected YF cases with 19 deaths were identified, signaling the presence of a huge YF outbreak in the province; hence, reactive YF vaccination is slated for 20 Jun 2013. Further etiological information on whether the outbreak is due to sylvatic or urban transmission vectors would be appreciated.

A HealthMap/ProMED-mail interactive map of the DRC can be accessed at http://healthmap.org/r/7jHr. - Mod.JFW]

[Yellow fever occurs sporadically in rural areas of the DRC. Cases occurred in 2008, 2010, and 2012. Unlike the outbreak mentioned above by Mod.JFW, the previous 2010 and 2012 cases were single ones that were identified through the national surveillance programme for yellow fever. Laboratory confirmation was done at Institut National de Recherche Biomedicale Kinshasa (INRB) and reconfirmed by a WHO regional reference laboratory for yellow fever, Institut Pasteur, Dakar, Senegal. The 2008 outbreak was larger and 10 deaths were reported in Lutembo in south west Democratic Republic of Congo among diamond miners expelled from Angola, but were not laboratory confirmed. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (22): AFRICA
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Cholera - Nigeria
Date: 14 Jun 2013
Source: Federal Ministry of Health - Nigeria [edited]
http://onehealthnigeria@googlegroups.com


In reporting [week 23], 2013, 7 suspected cholera cases with 0 deaths were reported in Kwara state compared with 15 cases with 0 deaths from Kaduna and Zamfara states in the same period in 2012.

From week 1-23, 2013, only 12 suspected cholera cases with one death (CFR, 8.33 percent) were reported from 5 LGAs in 4 states compared with 290 suspected cholera cases including 4 deaths (CFR, 1.38 percent) from 17 LGAs in 4 states within the same period in 2012.

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[A interactive HealthMap of the country can be found at: http://healthmap.org/r/1qGF. - Mod.LL]

RABIES - SPAIN (03): (CASTILE-LA MANCHA) ex MOROCCO, TRAVEL ALERT
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Date: Fri 21 Jun 2013
Source: Health Protection Report, Volume 7, No 25 [edited]
http://www.hpa.org.uk/hpr/infections/travel.htm


Imported canine rabies: Toledo, Spain
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The Spanish authorities have instituted precautionary public health measures following an incident in Toledo [Castile-La Mancha province], central Spain, on 1 Jun 2013, involving an illegally-imported dog -- subsequently confirmed to have rabies and euthanised -- that attacked several people including children in the city [1].

These 3 areas of increased risk of rabies have been delineated (based on the dog's movements prior to the incident in Toledo):
- a perimeter of 20-km [about 12-mile] radius around the city of Toledo, Castile-La Mancha province;
- the municipality of Huesca, Aragon province;
- the municipalities of Girona and Barcelona, including Barcelona city, Catalonia province.
A map of the areas affected is available on the PHE rabies incident webpage [2].

A NaTHNaC clinical update provides further information and advice for both travellers and health professionals [3].

References:
1. "Rabies in Spain: update 19 June 2013" (https://www.gov.uk/government/news/rabi ... -june-2013), PHE website news story advising those travelling to the risk areas to avoid contact with wild and domestic animals, but -- if licked, scratched or bitten by a wild or domestic animal -- to wash the area thoroughly with soap and water and seek urgent medical advice either in Spain, or on their return [to the UK] from their GP or NHS Direct.
2. Rabies Incidents webpage, 19 Jun 2013 (HPA legacy website), http://www.hpa.org.uk/Topics/Infectious ... Incidents/.
3. National Travel Health Network and Centre (NaTHNaC). "Imported canine rabies: Toledo, Spain -- update on areas of increased risk", clinical update, 18 Jun 2013, http://www.nathnac.org/pro/clinical_upd ... 180613.htm.

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[Canine rabies has been eradicated throughout most of Western Europe, and the majority of the population is unaware of any potential risk, such as that presented by the illegal importation of dogs from rabies endemic areas. In this particular incident, people (and other canines) may have been exposed to the imported animal before it was recognised to be rabid. While the risk of exposure is low, it is prudent that travellers to this popular holiday destination should be advised of the current situation. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7cqq.]

YELLOW FEVER - AFRICA (19): DEMOCRATIC REPUBLIC OF CONGO (KASAI-ORIENTAL)
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Date: Sat 15 Jun 2013
Source: The Global Dispatch [edited]
http://www.theglobaldispatch.com/yellow ... ign-83225/


The Ministry of Health of the Democratic Republic of Congo (DRC) is launching an emergency mass vaccination campaign against yellow fever from 20 Jun 2013, following laboratory confirmation of 6 cases in the country on 6 Jun 2013.

The mass vaccination campaign aims to cover at least 503 426 people in the 3 affected health zones of Lubao, Kamana and Ludimbi-Lukula [Kasai-Oriental province], where cases have been confirmed.

According to the World Health Organization (WHO), the 6 laboratory-confirmed cases were reported from 3 health zones: Lubao (4 cases), Kamana (1 case) and Ludimbi-Lukula (1 case). They were identified through the national surveillance program for yellow fever. The laboratory confirmation was done by the Institute Pasteur in Dakar, Senegal, a WHO regional reference laboratory for yellow fever.

Preliminary outbreak investigation revealed that the index case is a 16-year-old boy from Kisengua village in the Lubao Health Zone who became ill on 1 Mar 2013. The outbreak investigation team has also identified 51 suspected cases including 19 deaths, in the 3 health zones. Serum samples have been taken from 13 patients and are being analyzed in the Institute National of Biomedical Research (INRB).

According to the CDC, yellow fever virus is found in tropical and subtropical areas in South America and Africa. The virus is transmitted to humans by the bite of an infected mosquito.

Illness ranges in severity from a self-limited febrile illness to severe liver disease with bleeding. Yellow fever disease is diagnosed based on symptoms, physical findings, laboratory testing, and travel history, including the possibility of exposure to infected mosquitoes.

There is no specific treatment for yellow fever; care is based on symptoms. Steps to prevent yellow fever virus infection include using insect repellent, wearing protective clothing, and getting vaccinated.

[Byline: Robert Herriman]

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[The 6 cases are the same ones reported in the 14 Jun 2013 ProMED-mail post (archive no. 20130616.1775298). The new information in the above report is that these cases have been laboratory confirmed as yellow fever (YF) by the WHO reference laboratory, the Institute Pasteur in Dakar, Senegal. Another important piece of new information in the above report is the occurrence of the 51 suspected cases including 19 deaths, indicating that the outbreak is likely to be much more extensive than originally reported if these cases are indeed YF ones. That makes the initiation of the vaccination campaign urgent.

A HealthMap/ProMED-mail interactive map of the DRC can be accessed at http://healthmap.org/r/7jHr. - Mod.TY]

DENGUE/DHF UPDATE (52): AFRICA
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Africa
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- Angola (Luanda province). 19 Jun 2013. Dengue more than 300 cases; deaths 1. Dengue cases in Portugal acquired in Angola 79 cases.
http://www.healio.com/pediatrics/emergi ... -in-Angola

[The more complete USA CDC report on this outbreak indicated that there are 517 suspected cases of which 313 are laboratory confirmed. This report is available at http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6224a6_w

Maps of Angola can be accessed at http://www.mapsofworld.com/angola/angol ... l-map.html and http://healthmap.org/r/2_1M. - Mod.TY]

DENGUE/DHF UPDATE (54): AFRICA
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Tanzania (Dar es Salaam)
Date: Fri 28 Jun 2013
Source: Daily News [summ., edited]
http://dailynews.co.tz/index.php/featur ... er-no-cure


The child of [GS] was suffering from high fever which, initially, she suspected to be malaria, a disease endemic in Dar es Salaam city. She decided to go to a nearby drug store to buy malaria tablets, which she administered to her child, but the child did not respond to treatment.

[GS] was surprised. At first she thought her child had been bewitched and wanted to turn to a witchdoctor. But when she sought the advice of her husband, he decided that they see a medical doctor.

At the hospital, the doctor said diagnosis had shown that the child had contracted a little known disease called "dengue fever" whose symptoms very much resembled those of malaria. The symptoms of the disease include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the dengue virus.

When Tanzanian health care authorities launched an investigation into the outbreak of the disease in the city, it came to light that 20 people had been infected with the disease. A statement by the Ministry of Health and Social Welfare said the confirmation was made on [12 Jun 2013], after dengue fever suspects were referred to the laboratory of the National Institute for Medical Research (NIMR) in Dar es Salaam for screening.

The screening exercise was headed by a panel of medical researchers from the ministry in collaboration with health experts from the Field Epidemiology and Laboratory Training Programme and Ilala Municipal Council, said the ministry's deputy director of health services (intervention), Ms Janeth Mgamba. Following this discovery, the ministry was duty-bound to alert members of the public to dengue fever outbreak in the country so that they could take control as well as preventive measures.

Apart from Tanzania, earlier this year [2013], dengue outbreaks have been reported in Somalia and in neighbouring Kenya where the majority of cases were pinpointed in the Indian Ocean coastal town of Mombasa. Health authorities in Tanzania have become increasingly concerned with an apparent rise in the cases of dengue fever in the country, especially in Dar es Salaam and neighbouring areas.

Cases are also increasing in Zanzibar. The ministry responsible for health has thus appealed to members of the public who have developed malaria-like symptoms to report to health facilities in their localities for diagnosis of dengue fever or DHF as a measure to contain the outbreak.

As there is no available vaccine against the disease, members of the public are advised to take control measures, which include reducing the habitat and the number of mosquitoes and limiting exposure to bites as well as using appropriate clothing. Currently vector control is the available method for the dengue and DHF prevention and control while research on dengue vaccines for public health use is in process, says WHO.

[Byline: Augustine Sangi]

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[Although there have been several reports of dengue virus in East Africa (1), there is a dearth of literature on dengue fever transmission in Tanzania. However, a report by Moi (2010) documented 2 cases of dengue virus type 3 genotype III among travellers returning to Japan from Tanzania in 2010 (2). The current newswire therefore confirms dengue virus transmission has reached epidemic levels in Dar es Salaam, prompting national authorities to initiate the corresponding surveillance and response interventions to control and prevent further transmission.

References
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1. Sang, RC (2007). Dengue in Africa. TropIKA.net; available at http://www.tropika.net/review/061001-De ... rticle.pdf
2. Moi ML, Takasaki T, Kotaki A, et al: Importation of Dengue Virus Type 3 to Japan from Tanzania and Cote d'Ivoire. Emerg Infect Dis. 2010; 16(11): 1770-2. doi: 10.3201/eid1611.101061; available at http://wwwnc.cdc.gov/eid/article/16/11/ ... rticle.htm.

A map showing the regions of Tanzania can be accessed at http://en.wikipedia.org/wiki/Regions_of_Tanzania, and the HealthMap/ProMED-mail interactive map of the country can be accessed at http://healthmap.org/r/7qWz. - Mod.JFW]

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Angola (national). 24 Jun 2013. Dengue at least (susp.) 834 cases, (conf.) 657 cases; deaths 10. City most affected: Luanda 831 cases.
http://news.xinhuanet.com/english/healt ... 482839.htm

Maps of Angola can be accessed at http://www.un.org/Depts/Cartographic/ma ... angola.pdf and http://healthmap.org/r/2_1M. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (23): AFRICA
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In this update:
Africa
[1] Cholera - Congo DR (Katanga Province)
[2] Diarrhea - Liberia (Montserrado County)

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[1] Cholera - Congo DR (Katanga Province)
Date: Sun 30 Jun 2013
Source: Ghana Broadcasting Corporation (GBC), UN Radio report [edited]
http://gbcghana.com/index.php?id=1.1437763


A cholera epidemic in the Democratic Republic of the Congo's Katanga province has killed 257 people, according to the UN Office for the Coordination of Humanitarian affairs (OCHA).

More than 11 000 cholera cases have been reported in the province since the beginning of 2013. The outbreak has been concentrated on the main city of Lubumbashi where over 6000 cases have been reported since May 2013.

Aid agencies in the region say the outbreak was due to lack of clean water sources and poor sanitation, especially among the internally displaced population.

OCHA spokesperson in Geneva Jens Larke says humanitarian partners are therefore focusing on water treatment and hygiene information campaigns to stem the spread of the disease. Organizations on the ground estimate that they will need an additional USD 1.9 million to urgently implement water, sanitation, and hygiene projects in local communities. Many of the worst hit areas are also highly insecure and with limited access because of clashes between the Congolese army and the Mai-Mai group "Bakata Katanga," and between the Mai-Mai and various self-defence groups. Katanga has in recent years been a relatively stable province in Congo DR, but due to the proliferation of armed groups, there are now some 350 000 internally displaced people of whom over 43 000 have been displaced in the 1st quarter of 2013 alone.

[Byline: Patrick Maigua]

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[An interactive map of the country can be found at http://healthmap.org/r/7u6V. - Mod.LL]

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[2] Diarrhea - Liberia (Montserrado County)
Date: Tue 25 Jun 2013
Source: AllAfrica, The Informer (Monrovia) report [edited]
http://allafrica.com/stories/2013062610 ... ?viewall=1


Deplorable sanitary condition in Samukai Camp, a former displaced camp in Upper Caldwell Township [outside Monrovia], has left 1 person dead and 2 others affected.

The deceased, believed to be in his 40s, is said to have died recently from a serious 'running stomach' while being rushed to a nearby clinic. Residents of the area told WASH [Water, Sanitation and Hygiene] Reporters & Editors Network of Liberia that 2 others including a 7-year-old child have suffered severe diarrhea for a week now, but were rescued by the nearby clinic, where they got treatment.

It is not clear whether the latest cases are the result of cholera, but residents said the developments have been triggered by a fresh outbreak of a water-borne disease. Other residents have attributed the situation to the lack of toilet facilities in the community.

Samukai Camp used to be an internally displaced camp, where civilians from Monrovia and other parts of Montserrado fled for refuge during the Liberian civil war. Now, it is a residence of over 1800 people including children.

It stated that 1.2 million Liberians use unsanitary or shared latrines; 1.7 million have no latrine at all and defecate in the open like those in Upper Caldwell.

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[An interactive map of the country can be found at http://healthmap.org/r/7u6W. - Mod.LL]