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CHOLERA, DIARRHEA AND DYSENTERY UPDATE (41): AFRICA
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Africa
[1] Cholera - Guinea
[2] Cholera - Congo DR (South Kivu)
[3] Cholera - Somalia
[4] Cholera - Guinea-Bissau, Niger, Senegal


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[1] Cholera - Guinea
Date: Wed 28 Aug 2013
Source: Afriquinfos.com [machine trans. edited]
http://afriquinfos.com/articles/2013/8/ ... 229484.asp


The cholera epidemic has produced 8 deaths among 27 cases reported in the locality of Banfele, located in the prefecture of Kouroussa in Upper Guinea, it was learned from sources close to the Department of Health. The epidemic was declared in this area on 3 Aug 2013 and has caused the mobilization of health services, which have deployed a logistics team to halt the spread of the disease.

Solutions have been distributed to the populations of Banfele, and latrines and other wells used by the inhabitants have been disinfected. In addition to these 8 deaths, there have been 10 more caused by cholera in Low Guinea and in Middle Guinea, in the prefecture of Mamou, among the 150 cases reported in these 2 regions since the month of January 2013.

The Ministry of Health and Public Hygiene has, among other measures to counteract this epidemic, conducted awareness campaigns in areas which have experienced cases of cholera.

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[2] Cholera - Congo DR (South Kivu)
Date: Wed 21 Aug 2013
Source: Radio Okapi (Kinshasa) [machine trans. edited]
http://radiookapi.net/actualite/2013/08 ... ne-minova/


19 cases of cholera have been registered in a week in the locality of Kasunyu in the territory of Minova (South Kivu). This information was delivered on Tue 20 Aug 2013 by the chief physician of the area of Minova, Dr. Chito-ryu Bagula, who attributes the resurgence of this disease to the consumption of water from Lake Kivu and the absence of public latrines. He called on the inhabitants of Kasunyu to observe sanitary practices to avoid a greater spread of the disease.

Approximately 15 000 inhabitants of the locality of Kasunyu use water from Lake Kivu for consumption and other domestic needs. "The only existing wells may not be sufficient for the entire population of this locality," stated Dr. Chito-ryu Bagula. The leader of the locality of Kasunyu, Safari Murebua, said that the swampy terrain does allow the building of latrines.

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[3] Cholera - Somalia
Date: Tue 13 Aug 2013
Source: RFI.fr (Radio France Internationale) [machine trans. edited]
http://www.rfi.fr/afrique/20110813-soma ... ie-urgence


Somalia, already the victim of famine, is now faced with an epidemic of cholera. The WHO says it is very concerned about the spread of the disease in the country. Cholera has already killed 181 people at least since the beginning of 2013, according to the WHO.

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[4] Cholera - Guinea-Bissau, Niger, Senegal
Date: Sat 17 Aug 2013
Source: The Global Dispatch [edited]
http://www.theglobaldispatch.com/guinea ... ths-79357/


The West African country of Guinea-Bissau has reported 700 cases of cholera thus far in 2013, making it the country in the region with the most cases, according to an IRIN (the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs) report.

Guinea-Bissau's poorest region, southern Tombali, is the worst hit, with 225 cases and 21 deaths as of late July [2013], said Nicolau Almeida, a health ministry director.

The UN Children's Fund (UNICEF) reported last month [July 2013] that there have been 742 cases in Guinea-Bissau, 416 in Niger and 368 in Sierra Leone. The outbreak in Guinea-Bissau is a continuation of the 2012 epidemic, when 3359 people contracted cholera.

"To confirm a new epidemic, the 2012 outbreak should have been declared over" by demonstrating the absence of _Vibrio cholerae_ in diarrhea [cases], said Inacio Alvarenga, an epidemiologist with WHO.

"For reasons I'm not aware of, the government did not test cases in the 1st weeks of the year [2013]. These cases did not disappear but got spread around," he continued. "I don't think we will hit the 2008 level [when 14 204 people were infected and 225 killed], but the disease risks will be lingering for several months like in 1996-1998."

IRIN does point out that the numbers so far this year [2013] in Guinea-Bissau are down from 2012 levels.

[Byline: Robert Herriman]

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LASSA FEVER - SIERRA LEONE: (SOUTHERN), REQUEST FOR INFORMATION
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Date: Sat 31 Aug 2013
Source: All Africa [edited]
http://allafrica.com/stories/201309020391.html


A report reaching Concord Times indicated that a number of staff of Medicine San Frontiers (MSF) have allegedly died of Lassa fever in the municipality of Bo [Southern Province].

The report stated that a nurse, driver and a community health officer, alongside her 2 children, lost their lives after being allegedly infected with the disease; a situation which has left some section of the Bo population worried.

MSF's project coordinator in Bo, John Mark, told Concord Times in an interview that they were doing all they could to curb the infection and death rate among their staff.

"It is really difficult to ascertain whether it is our staff or patients brought to the referral clinic that are responsible for this dreadful disease," Mark said. "Suspected Lassa fever patients' blood specimens are usually taken to the Kenema government hospital Lassa department for testing, and if proven positive or infected, they (staff) will be transferred to Kenema for treatment."

He maintained that their nurses at the Gondama clinic use preventive measures and gear to keep themselves free from the Lassa fever disease and any other dreadful disease(s).

[Byline: Problyn J. Alpha]

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[Lassa fever virus (LFV) is endemic in West Africa, although ProMED-mail has not received reports of cases there since 2010. Lassa fever has not as yet been confirmed in these individuals. More information on the results of laboratory tests for LFV would be greatly appreciated.

Presuming these individuals do have Lassa fever, it is not clear if these unfortunate victims acquired their LFV infections in the hospital or elsewhere, probably from environments contaminated by the multimammate rodent reservoir host. LFV infections are usually not fatal; some 80 per cent of human infections are asymptomatic. Non-fatal cases may have severe multisystem disease, where the virus affects several organs such as the liver, spleen, and kidneys. The incubation period of Lassa fever ranges from 6 to 21 days. More detailed information can be accessed at http://www.who.int/csr/disease/lassafever/en/.

A photograph of a _Mastomys_ multimammate rat can be viewed at http://ec.europa.eu/research/rtdinfo/sp ... 2_3759.jpg.

The HealthMap/ProMED-mail interactive map of Sierra Leone is available at http://healthmap.org/r/8jOJ. - Mods.TY/MPP]

LASSA FEVER - LIBERIA: (BONG), FATAL CASES
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[1]
Date: Tue 10 Sep 2013
Source: The Daily Observer, Monrovia [edited]


Bong County Health Officer Dr. Samson Azoakoi told journalists that 12 Lassa fever cases have been reported from Phebe Hospital in Bong County in Central Liberia over the past 2 months. Of these, there have been 8 fatalities based on clinical diagnosis. Tissue specimens have been sent out of the country for confirmation. The Lassa fever belt in Liberia occurs predominantly in Lofa, Bong and Nimba Counties across the northern tier of counties bordering Guinea.

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Communicated by:
Dr. Richard A. Nisbett
VP for Research and Sponsored Programs
WVS Tubman University in Harper City, Liberia
& Vanderbilt Institute for Global Health, Nashville TN, USA
<rnisbett@tubmanu.edu.lr>

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[2]
Date: Wed 11 Sep 2013
Source: All Africa [edited]
http://allafrica.com/stories/201309110405.html


Eight persons have reportedly died in Bong County and 4 are said to be hospitalized following an outbreak of Lassa fever months ago, Sampson Arzuakoi, head of the county health team, told journalists in Gbarnga on Tuesday [10 Sep 2013]. Dr. Arzuakoi said 6 of the victims died at hospitals in Bong, and the rest, who contracted the disease in Gbarnga, died at the Jackson Fiah Doe hospital in Tappita, Nimba County after travelling for treatment. He said the Ministry has already taken measures to stop the spread of the epidemic and would embark on sensitization campaigns and immunisation[?] in the county.

Explaining more on the dreaded fever and its dangers to humans, Arzuakoi said the disease was transmitted by a specific rat which had no hair on its tail. Arzuakoi said the symptoms of Lassa fever include severe headache, high fever and vomiting [and bleeding?] that passes through all the openings in the human body. He advised persons with such symptoms to rush to the nearest hospital for medical attention. "The epidemic is in Bong," Arzuakoi warns citizens.

Lassa fever has over the years risen to be a quiet killer with victims ignorant of its presence, according to him. Cases of infection, he said, have been reported in Gbarnga, Suakoko and other parts of Bong. "This Lassa fever thing has been reported in other areas in the county for a while now," he said. He said the rat, which lives in and around many homes in Africa, has been identified as the carrier of the virus.

When the Ministry of Health deployed medical experts some weeks ago to Bong, many would have assumed it was for some common epidemic that was ravaging the county's 13 administrative districts. Such supposition would be wrong because the speedy deployment of these health experts was to control the outbreak of Lassa fever. Unfortunate as it may sound; Lassa fever has claimed some lives, not only in Bong, but in other parts of Liberia.

[Byline: Selma Lomax]

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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 originated. The virus, a member of the virus family _Arenaviridae_, is a single-stranded RNA virus and is zoonotic, or animal-borne. Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80 percent of people infected with the virus, the remaining 20 percent have a severe multisystem disease. Lassa fever is an endemic disease in portions of West Africa. It is recognized in Guinea, Liberia, Sierra Leone, as well as Nigeria. However, because the rodent species which carry the virus are found throughout West Africa, the actual geographic range of the disease may extend to other countries in the region. Individuals at risk are those who live or visit areas with a high population of _Mastomys_ rodents infected with Lassa virus or are exposed to infected humans.

Primary transmission of the Lassa virus to humans can be prevented by avoiding contact with _Mastomys_ rodents, especially in the geographic regions where outbreaks occur. Storing food away in rodent-proof containers and keeping living areas clean help to discourage rodents from entering homes. When caring for patients with Lassa fever, further transmission of the disease through person-to-person contact or nosocomial routes can be avoided by taking preventive precautions against contact with patient secretions (together called VHF [Viral Haemorrhagic Fever] isolation precautions or barrier nursing methods) [http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... manual.htm]. Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course. The disease can be treated.

Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. These include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult. The anti-viral drug ribavirin can be used in treatment of severe cases. Currently, there is no protective vaccine.

A map of Liberia, showing the location of Bong county in the centre of the country, can be accessed at: http://www.mapsofworld.com/liberia/libe ... l-map.html. - Mod.CP

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (46): AFRICA
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Africa
[1] Sierra Leone (Western Rural District)
[2] Cholera - Nigeria (Oyo State)

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[1] Sierra Leone (Western Rural District)
Date: Mon 9 Sep 2013
Source: All Africa.com, Concord Times (Freetown) [edited]
http://allafrica.com/stories/201309091526.html


Residents of Grafton old camp in the Western Rural District of Freetown are calling on non-governmental organizations to come to their aid in the wake of the current cholera outbreak that has hit the locality.

Speaking to Concord Times in an exclusive interview, section chief of the camp, Ya-Alimamy Kamara, revealed that women and children are the most affected due to the unhygienic state of the camp as a result of children openly defecating within the environs of the camp. For this, she said they are calling on humanitarian organizations and other stakeholders to help them fight the outbreak.

"The camp currently lacks public toilet facilities, and the food being sold to people within the community is not well protected," she said, adding that plans are underway to sensitize inhabitants of the camp on sanitation issues.

A driver residing in the camp said the community has become overcrowded and that residents are not cleaning their dwelling places. According to him, the police have a role to play in maintaining sanity in the community.

[Byline: Ibrahim Jaffa Condeh]

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

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[2] Cholera - Nigeria (Oyo State)
Date: Thu 5 Sep 2013
Source: Agence France-Presse (AFP) [edited]
http://www.iol.co.za/news/africa/choler ... ii4ejbI3ng


Cholera has killed 8 people in southern Nigeria, and 10 others have been hospitalized, health officials said on Thursday [5 Sep 2013] in the latest outbreak to hit the country following a heavy rainy season.

Nigeria suffered cholera epidemics during the rainy seasons of 2010 and 2011, with nearly 2000 people killed over 2 years. While 2012 saw few reported infections, health officials warn that Nigeria remains vulnerable to further outbreaks because of its high population density and poor sanitation in many areas.

"We have 8 deaths and 10 people in the hospital," said Cosmas Oni, spokesman for the health ministry in southwestern Oyo state, adding that the outbreak was confirmed on Monday [2 Sep 2013].

"We have also embarked on a campaign to enlighten the people on the need to always clean their environment and drink clean water because the whole place is reeling with dirt," Oni told AFP.

Cholera outbreaks occur regularly during the rainy season in Nigeria, when downpours wash contaminants into wells used by families. The rainy season typically runs from April to September.

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (48): AFRICA
***************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Africa
[1] Cholera - Rwanda (Rusizi District)
[2] Diarrhea - Mozambique (Zambezia Province)

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[1] Cholera - Rwanda (Rusizi District)
Date: Sat Sep 2013
Source: The New Town [edited]
http://allafrica.com/stories/201309160438.html


At least 26 people have been treated for cholera at Nkombo Island since August 2013, with hundreds of others at the risk of contracting the disease.

According to the director of Nkombo Health Centre, Didas Mukeshimana, the disease outbreak is attributed to low access to clean and safe water at the island. No deaths have so far been recorded, officials said. The statistics were announced during a meeting to discuss how to avert the outbreak on the Lake Kivu Island this week that brought together local health and grassroots leaders, district officials and residents.

Nkombo Island is approximately 11 km from Kamembe town. The island, which is one of the 18 sectors that make up Rusizi District, covers an area of 21 sq km and is populated by about 17 000 residents. Sector officials said access to clean water in the area is still at around 30 per cent. Residents mainly rely on water they fetch from Lake Kivu, believed to be contaminated. "The low access to potable water is complicating efforts to improve hygiene and sanitation in this village," Mukeshimana said.

Saturday Times saw women and children fetching water from Lake Kivu. Some of them said they use the lake water in several domestic activities, including cooking, washing kitchen utensils and clothes as well as bathing. Some claimed that some area residents drink the unsafe water without boiling it.

[Byline: Jean Pierre Bucyensenge]

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[2] Diarrhea - Mozambique (Zambezia Province)
Date: Sun 15 Sep 2013
Source: RFI [in Portuguese, machine trans. edited]
http://www.portugues.rfi.fr/africa/2013 ... a-zambezia


A diarrhea outbreak caused at least 5 deaths in Zambezia province in central Mozambique.

Despite the provincial health authorities announcement that the outbreak of diarrhea and vomiting is already controlled, the truth is that the risk of severity continues to be a reality, because the provincial bodies have already launched an appeal to strengthen preventive measures.

"Every family and individual must continue with these preventive measures," said Horca Naera, director of health and social action of Alto Molocue in Zambezia province, one of the most populated areas of Mozambique. "The treatment of water for consumption as well as washing of hands after use of the latrine are essential measures that people have to take," Naera underlined in a meeting with the press.

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YELLOW FEVER - AFRICA (24): NIGERIA, CARDS, CASES, SUSPECTED, REQUEST FOR INFORMATION
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Date: Mon 16 Sep 2013
Source: Channels [edited]
http://www.channelstv.com/home/2013/09/ ... tober-1st/


The federal government of Nigeria through its health ministry has announced that the issuance of a new yellow fever [YF] card has commenced, and the replacement would take full effect on 1 Oct 2013.

The Minister of Health, Professor Onyebuchi Chukwu, who made this known at an event in Abuja, disclosed that the new yellow card, also known as international certificate of vaccination and prophylaxis, will have advanced features.

It should be recalled that there was a diplomatic face-off between Nigeria and South Africa over 18 months ago which led to the deportation of over 125 Nigerians.

The health minister advised that international travellers need not risk their trips with fake yellow fever vaccination cards, as genuine cards used to certify vaccinations against yellow fever, cholera, and smallpox can easily be obtained at the public health department of the federal ministry of health and the nation's airports, seaports, and land borders.

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[It is good to learn that the Ministry of Health is dealing with the sale of fake YF vaccination cards, which has been a problem this year (2013). Vaccination and the issuance of legitimate cards is important not only for international travelers but also for preventing cases within Nigeria.

The occurrence of YF cases in Nigeria this year [2013] is confusing. The number of suspected YF cumulative cases for 2013 as of 8 Feb 2013 was 38 cases. Curiously, Nigeria Weekly Epidemiology Report Vol. 3 no. 25 issued on 28 Jun 2013 (http://www.health.gov.ng/images/OtherWe ... ek_25_.pdf) makes no mention of YF cases. However, the report for week 30 (no URL available) indicates:

Suspected new cases: 7
Laboratory confirmed cases: 0
Discarded cases: 64
Pending laboratory results: 110
Deaths: 0

It is not clear why the large numbers of pending cases are not confirmed. It would be unusual indeed if these suspected cases are, in fact, YF virus infection with no resulting fatalities. No reports of YF cases in Nigeria have been reported to WHO this year [2013], as is required by international agreement. Surrounding countries certainly need to know whether YF cases are occurring in Nigeria, with details on time and place of occurrence. ProMED would appreciate receiving clarification of the current YF situation in Nigeria.

Travelers should be aware that an international yellow fever certificate only becomes valid 10 days after vaccination, so getting the vaccination at the airport on the day of travel is too late to permit entry to a country that demands evidence of YF vaccination. Be sure to get vaccinated well in advance.

The figures above are cumulative since January 2013. Since the clinical picture of these cases resembled that of yellow fever, it would be important to discover by testing patient specimens what other viral hemorrhagic fever (VHF) is occurring, and what the final diagnosis of the YF negative cases was. It could be Lassa or another VHF.

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

LASSA FEVER - NIGERIA (10): 23 STATES AFFECTED
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Date: Fri 27 Sep 2013
Source: The Nigerian Tribune [edited]
http://tribune.com.ng/news2013/index.ph ... --don.html


An expert in the treatment of Lassa fever has disclosed that the disease has spread from 6 states of the country in 2009 to 23 in 2013.

Director of the Institute of Lassa Fever Research and Control at the Irrua Specialist Teaching Hospital [ISTH], Irrua, Edo State, Dr Daniel Asogun, said this on Thursday [26 Sep 2013] while speaking during the 2013 World Lassa Fever Day. He added that at least 93 persons have died from complications associated with Lassa fever between January 2011 and September 2013.

Of the number of deaths recorded, 17 people have so far died in 2013. Dr Asogun attributed the decline in the number of deaths to the awareness that is being created by the institute. He said that through the activities of the Institute of Lassa Fever Research and Control at the ISTH, fatal cases of Lassa fever at the hospital have dropped from between 60 to 80 per cent at the start of the new millennium to between 30 to 45 per cent. "Awareness of the infection is at a high level as is the index of suspicion among clinicians, a prerequisite for early diagnosis and favorable outcome," he pointed out.

He emphasised the need for the establishment of more diagnostic centres for the treatment of Lassa fever across the country so as to reduce the burden on the institute at ISTH, appealing to the federal government to pay more attention to the fight against the scourge through allocation of funds to build infrastructure as well as personnel.

The medical practitioner said that millions of Nigerians were unaware of the dangers posed by Lassa fever and, as a result, are not taking preventive measures to avoid the disease.

[Byline: Banji Aluko]

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[This report contained some ambiguities which have been removed to retain the basic message that Lassa fever is now a serious problem in 23 of the 36 states of Nigeria. It is worthy to note that Thu 26 Sep 2013 was World Lassa Fever Day.

Nigeria is divided into 36 states and Abuja, the federal capital territory. The states are further divided into 774 Local Government Areas. A map of the states of Nigeria can be accessed at: http://commons.wikimedia.org/wiki/File: ... nglish.png. - Mod.CP

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

RABIES - GHANA (02): (ASHANTI) CANINE, HUMAN
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Date: Fri 27 Sep 2013
Source: Joy Online [edited]
http://edition.myjoyonline.com/pages/ne ... 113822.php


Veterinary officers have called for emergency pet vaccination in the Ashanti Region following the death of 4 children this year [2013] from rabies at the Komfo Anokye Teaching Hospital. The children were aged between 5 and 6 years. The Director of the Veterinary Services in the region, Dr Kofi Quansah-Forson, warns more people are likely to die from the disease because the last mass vaccination campaign in the region happened a decade ago. Dr Quansah-Forson told Luv FM's Erastus Asare Donkor that last year [2012], 12 people also died of rabies infections in the region. "We believe these people would not have lost their lives if the government and stakeholders had supported or found money for the veterinary service to undertake a coordinated rabies vaccination throughout the region," he told Erastus.

Vaccination of pets is voluntary; hence only a few people undertake regular tests or vaccinate their pets regularly. Dr Quansah-Forson says that the bad attitude toward pet vaccination by pet owners holds a "hidden danger" that needs immediate action. Last year [2012], veterinary clinics recorded only 476 cases of dog bites, with 14 of the pets involved testing positive for rabies, Dr Quansah-Forson revealed. He said the upsurge of reported cases of dog bites at their offices is alarming. "Between January to August this year [2013], 210 people are on record to have been bitten by dogs in the region," he revealed. He observed that Ghana's efforts at controlling child mortality and control of emerging diseases is being threatened by the increasing deaths from rabies. "A death from rabies which is a preventable disease is unpardonable," he stressed. He recommended a mass vaccination campaign to end the trend.

Rabies is transmitted from animals to humans, and it is caused by a virus. It is known to be present in more than 150 countries and territories of all continents except Antarctica. According to the World Health Organisation (WHO), about 60 000 people, mostly in Asia and Africa, die of rabies every year. Rabies virus infects domestic and wild animals and is spread to people through close contact with infected animals' saliva via bites or scratches. The main route of rabies transmission to humans is the bite of rabid dogs.

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[Two people (in this instance adults) died from a rabies outbreak in the Asunafo North and Asunafo South Districts in the Brong-Ahafo Region of Ghana between February and April this year (2013). At that time the Regional Director of Veterinary Services appealed to the general public to ensure their pets, especially dogs and cats, were vaccinated annually against the disease to avert any future occurrences. He 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.

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 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 stated that the 2 people died because they reported to the hospital late. Dr Gbeddy revealed at that time that the 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.

A map of the regions of Ghana can be accessed at: http://en.wikipedia.org/wiki/Districts_of_Ghana. - Mod.CP]

[The Ashanti region is in the southern central part of the country and shares its norther border with the Brong-Ahafo Region. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/8AUo.]

UNDIAGNOSED ILLNESS - SOUTH SUDAN: (JONGLEI) FATAL, REQUEST FOR INFORMATION
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Date: Mon 30 Sep 2013
Source: Sudan Tribune [edited]
http://www.sudantribune.com/spip.php?article48243


An unknown disease is said to have killed at least 15 South Sudan People's Liberation Army (SPLA) soldiers at Manybol, a military camp in Pibor County in Jonglei State. Speaking to the Sudan Tribune on Monday [30 Sep 2013], the Commissioner of Pibour [sic] County, Joshua Konyi Irer, described the disease as serious and fatal. The Commissioner who visited Manybol 5 days ago [25 Sep 2013] said 3 soldiers died on the day he was at the military camp. "The patients die after a short time," he added.

The Commissioner expressed fears that the yet-to-be diagnosed disease could wipe out the entire SPLA unit in the area saying that 15 soldiers had died since the disease broke out in the 2nd week of September [2013]. He said those infected with the disease are unable to move and complain of headache and fever. No civilian in Manybol is yet to die from the disease but there are fears it could spread to the civilian population.

Attempts by Sudan Tribune to get a comment from the SPLA Commanding Officers in Manybol and the SPLA Spokesperson in Juba were unsuccessful.

Medecins Sans Frontiers (MSF) doctors made a visit to Manybol early this month [September 2013] to assess some of the patients suffering from the disease but MSF's communications officer in Juba, Judy Waguma, said it was not possible to ascertain the disease without a full medical examination.

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[The news report above describes a rapidly fatal febrile illness among soldiers in a military camp during the past 2 weeks in Pibor County, South Sudan. We are not told of additional symptoms or signs, other than fever, headache, and inability to move. Febrile illnesses that could possibly occur in South Sudan and that have a relatively high case-fatality rate include typhoid fever, plague, yellow fever, Crimean-Congo hemorrhagic fever (CCHF) (ProMED-mail posts Crimean-Congo hem. fever - Uganda (04): clarification 20130826.1903826), anthrax (http://www.who.int/hac/crises/sdn/sitre ... st2011.pdf and http://www.radiomiraya.org/index.php/he ... #gsc.tab=0) and meningococcal meningitis (ProMED-mail post Meningitis, meningococcal - South Sudan: (ML) fatal, sg A 20130504.1690719); but more clinical information is obviously necessary to complete a list of possible causes for this outbreak. (There has been a hepatitis E outbreak in South Sudan this year (2013), but fatalities due to hepatitis E mainly involve pregnant women.) Unfortunately, the 3 Medecins Sans Frontieres (MSF) clinics in Pibor County, said to be the only source of formal healthcare in Jonglei state, were looted and torched in December 2011 (http://en.wikipedia.org/wiki/Pibor_County).

Pibor is one of 11 counties in Jonglei State, which is one of the 10 states of South Sudan. Jonglei forms most of the eastern part of the country; it is a very poor state and its economy is dependent upon livestock and agriculture (http://en.wikipedia.org/wiki/Jonglei). - Mod.ML

Maps of the Republic of South Sudan can be seen at http://healthmap.org/r/5RYm and http://en.wikipedia.org/wiki/South_Suda ... d_counties. - Mod.JFW]

RABIES - DEMOCRATIC REPUBLIC OF CONGO: (SOUTH KIVU), HUMAN-TO-HUMAN TRANSMISSION
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Date: Mon 7 Oct 2013
Source: METRO, Reuters report [edited]
http://metro.co.uk/2013/10/07/infant-wi ... m-4136540/


A baby was one of 10 to die in a rabies outbreak in the Democratic Republic of Congo [DRC].

A baby infected with rabies unwittingly spread the disease by biting its father and brother, a medical charity has revealed. The infant was among 10 people to die in an outbreak in the war-ravaged DRC. Another 154 people have been infected.

The baby's 27-year-old father and 7-year-old brother were both treated and have recovered, Medecins Sans Frontieres [MSF] told Metro. Team leader Dr Jantina Mandelkow said: "I held my breath when I heard that a child dying of rabies had bitten and infected his father and brother; it was horrific. It's an impossible situation. Family members would obviously want to be with those who are ill, but when a person has rabies, they can be a danger to people around them."

MSF teams have vaccinated 106 people in eastern Lemera but fear there could be at least 20 more untreated cases.

Rabies originates in stray dogs, and MSF is demanding that the Congolese government vaccinate domestic animals, as many people cannot afford the GBP 3.75 [USD 6.00] fee. Healthcare has been severely debilitated by [political] instability that has claimed 5.4 million lives since the outbreak of civil war in 1998.

"Rabies leads to death without treatment, and people in Lemera were incredibly scared; many walked for days to get to the hospital for treatment," Dr Mandelkow added. "With vaccinations unavailable elsewhere, they had nowhere else to turn. The situation in Lemera is exceptional and must be urgently addressed."

[Byline: Aidan Radnedge]

--
Communicated by:
Michelle Sellors <michelle.sellors@masta.org>

[Lemera is located in the province of South Kivu in the Democratic Republic of Congo.

The above report is lacking in specific detail. It is presumed that the baby contracted infection from a dog-bite and in turn infected its father and elder brother, apparently by biting them, a rather unusual route of transmission of infection. It is not clear why the baby, unlike its family members, did not received post-exposure prophylaxis.

The circumstances surrounding the deaths of another 10 people are not explained other than that anti-rabies treatment in the Democratic Republic of Congo is expensive and not widely available. A programme to vaccinate domestic dogs announced in a ProMED-mail report in 2004 does not appear to have been undertaken due to lack of finance.

We thank Edith Marshall, DVM, MPVM, DACVPM, Adjunct Associate Professor, Washington State University Paul G. Allen School for Global Animal Health for submitting a similar report from the MSF website:
http://www.msf.org.uk/article/drc-famil ... ies-horror

More specific information regarding this case of human-to-human transmission of rabies virus infection would be appreciated. - Mod.CP

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (56): AFRICA
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In this update:
Africa
[1] Cholera - Nigeria (Zamfara)
[2] Cholera - Togo (Maritime)

******
[1] Cholera - Nigeria (Zamfara)
Date: Fri 11 Oct 2013
Source: Nigerian Bulletin [edited]
http://www.nigerianbulletin.com/threads ... lgr_NK-2So


A cholera outbreak in Rini Village and Bakura town in the Bakura Local Government Area of Zamfara State has claimed 2 lives and left 130 persons hospitalized. Alhaji Dandare Dakko, Vice Chairman of the Local Government, made the disclosure on Thursday [10 Oct 2013] while addressing the families of victims at a camp in Rini Village.

Dakko said that the outbreak affected 102 people in Rini Village and 32 students of the Government Science Secondary School, Bakura. The sick were being treated at the Bakura General Hospital. Dakko urged the families of affected people to exercise patience as government was making efforts to assist them.

Doctors from Medecins Sans Frontieres (Doctors Without Borders) were seen rendering assistance to the victims at Rini Village and Bakura town.

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[An interactive HealthMap of the country can be found at http://healthmap.org/r/1qGF. - Mod.LL]

******
[2] Cholera - Togo (Maritime)
Date: Fri 11 Oct 2013
Source: Iciome [in French, machine trans. edited]
http://www.icilome.com/nouvelles/news.a ... 4375&pays=


The Ministry of Public Health has reported cases of severe diarrhea and cholera in the south of the country and called on the population to observe the rules of hygiene in a press release published on Fri 11 Oct 2013, according to the national daily Togo-Presse.

"Cases of serious diarrhea and cholera [have been] reported for a few weeks in the health regions of the Maritime, including the capital Lome," it was said in the release.

Faced with this situation, the Ministry of Health has called on the population to observe the rules of hygiene in order to "break the chain of infection and prevent the occurrence of new cases."

It drew particular attention to avoiding eating raw foods, boiling or treating any water for consumption with chlorine or bleach, protecting food from dust, flies, and any other insects, and to immediately consult the nearest public health center in cases of diarrhea.

The Maritime area is the southern part of Togo and includes the Togolese capital and has the highest human density of the country, which has a population of 6 million inhabitants.

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

VIRAL HEMORRHAGIC FEVER - SUDAN: (DARFUR) REQUEST FOR INFORMATION
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Date: Fri 11 Oct 2013
Source: AllAfrica, Radio Dabanga (Hilversum) [edited]
http://allafrica.com/stories/201310140342.html


Several areas in Darfur's East Jebel Marra are reportedly witnessing the outbreak of a "mysterious disease" that is especially affecting young children. Symptoms of the disease include face and leg swelling, and small rashes "that quickly turn into bruises". A source explained that 3 adults had also been infected, but got better after being treated at the El Fasher Hospital. "4 children, however, who were also transferred to El Fasher 4 days ago were not cured and their health continues deteriorating," the source continued. He stressed that dozens of other children are suffering from the same symptoms, and the number of cases continues rising, "amid a complete lack of treatment possibilities" in the areas affected. These areas include Koshna, Karfola, Dali, Massaliet, Nimra, Dubbo, Kenjara, and Shurfa.

Speaking to Radio Dabanga, activists are appealing to the central government to allow [humanitarian] organisations to access the stricken areas of East Jebel Marra. They also [request] that the World Health Organisation sends a medical team to check what is happening in those areas, as "the government has denied access to doctors, medicines, and treatments for a very long time now."

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[The description of the haemorrhagic disease affecting children, and to a lesser extent some adults, in the East Jebel Marra region of Darfur region of Sudan is not sufficiently precise to propose a specific diagnosis, and enquiries by ProMED-mail have been unproductive so far. In recent months this region of Sudan successfully eradicated an extensive outbreak of yellow fever by a comprehensive programme of vaccination. The presence of hemorrhagic disease in children rather than adults might be indicative of a return of yellow fever virus infection.

Maps of Sudan can be accessed at http://www.ezilon.com/maps/images/afric ... -Sudan.gif and http://healthmap.org/r/3EpA. - Mod.CP

Photo of typical Darfur landscape & children:
http://img.static.reliefweb.int/sites/r ... lmarra.jpg
- Mod.JW]

RIFT VALLEY FEVER - SOUTH SUDAN: (EAST EQUATORIA, UPPER NILE) REQUEST FOR INFORMATION
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Date: Wed 16 Oct 2013
Source: AllAfrica, Government of South Sudan (Juba) press release [edited]
http://allafrica.com/stories/201310170240.html


An outbreak of Rift Valley fever disease has been reported in South Sudan's Eastern Equatoria and Upper Nile states, a government official has announced. Rift Valley fever is a viral disease spread primarily by mosquitoes, which can affect both humans and animals. This was revealed by Dr. Aluma Araba, the Director of Vector and Disease Control in the national Ministry of Agriculture Forestry and Tourism.

Dr. Araba said the disease can also be transmitted by taking unpasteurized milk or by eating not-well-cooked meat of an infected animal. "This is the 1st time we are reporting an outbreak of Rift Valley fever disease. We are preparing with emergency response but it would require decision makers to allocate more resources to fight this serious disease", said Dr. Araba.

South Sudan reportedly has the biggest animal resources in Africa, and such an outbreak could have serious consequences for the country's livestock if no quick measures are taken to mitigate the outbreak. Rift Valley fever disease was 1st discovered in Kenya in 1931. It's largely believed to have made its way into the new country through the movement and trade of livestock across the borders.

A workshop [has been established] to develop a contingency plan to map and identify the high-risk areas so that emergency responses can be directed [there], explained Dr. Bernard Betty, the head of ILRI [International Livestock Research Institute] team. She said it would take the collective efforts of government, stakeholders, and NGOs, among others, to bring the outbreak under control. The director for research and development in the Ministry of Agriculture, Professor Erneo B.Och, described the workshop as "tangible" [?] and said the taskforce will be formulated together with [relevant] Ministries and other key stakeholders to stop "losing this important sector and human life". He said South Sudan will stop at nothing less than food security and human protection.

[Byline: Abdulrazig Juma Abdalla]

--
Communicated by:
ProMED-mail
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[This government press release conveys no more information than the notification of an outbreak of Rift Valley fever [presumably in livestock] in the Eastern Equatoria and Upper Nile states of South Sudan. Further precise information is requested.

Rift Valley fever (RVF) is a mosquito-borne viral disease that typically occurs in various areas of sub-Saharan Africa, where virus activity varies from a low-level enzootic cycle to explosive outbreaks covering large areas. Periodically, Rift Valley fever virus (RVFV) spreads to other areas, including northward into Egypt in 1977 and eastward across the Red Sea into Saudi Arabia and Yemen in 2000. How RVFV travels is unclear but probably involves movement of infected livestock or mosquitoes.

The 1st reported outbreak of RVF in Sudan occurred in 1973 in sheep and cattle in White Nile state; shortly thereafter, RVFV was isolated from a herd of cattle in northern Khartoum. Serologic surveys have detected RVFV antibodies in domestic livestock and in humans from different Sudanese states, including Nile, Khartoum, Kassala, El Gezira, Sennar, and White Nile. A recent seroepidemiologic survey reported a high prevalence of RVFV IgG (immunoglobulin G) among febrile patients admitted to New Halfa Hospital in Kassala state. New Halfa is an extensively irrigated agricultural area about 500 km (310 miles) east of Khartoum. Although the presence of IgG does not indicate recent infection, it does suggest considerable circulation of RVFV in the area at some time in the past. [For further information see: Imadeldin E. Aradaib et al., Rift Vally fever, Sudan, 2007 and 2010, in Emerging Infectious Diseases, Volume 19, Number 2 -- February 2013 http://wwwnc.cdc.gov/eid/article/19/2/1 ... rticle.htm.]

[N.B. with respect to the above, South Sudan became an independent state on 9 Jul 2011, following a referendum that passed with 98.83 percent of the vote. It is a United Nations member state and a member state of the African Union.]

A map of the Republic of South Sudan showing the location of the states mentioned in the above report can be accessed at: https://docs.unocha.org/sites/dms/South ... p_2684.pdf. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3q1_.]

RABIES - COTE D'IVOIRE
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Date: Thu 10 Oct 2013
Source: Le Nouveau Reveil [in French, abbreviated & translated]
http://www.lenouveaureveil.com/a.asp?n=477292&p=3510


Cote d'Ivoire: 15 cases of rabies detected in 9 months
------------------------------------------------------
On the occasion of World Rabies Day, 4 Oct 2013, it was revealed that the number of animals able to transmit rabies virus infection now includes horses, oxen and sheep. This information was provided by Dr. Joseph Benie of the National Institute of Public Health.

Subsequently he announced that that 15 people had died so far this year [2013] from rabies virus infection in Cote d'Ivoire.

Professor Emmanuel Bissagnene, an Infectious Diseases expert, stated that: "Rabies is a viral disease transmitted from animals to humans by a bite, a scratch, or by contact with a mucous membrane. He added that rabies is a 100 percent fatal infection, with patients exhibiting extreme agitation, followed by anxiety and finally paralysis.

Professor Bissagnene urged people to get vaccinated against rabies because: "There is no cure; only rabies vaccine can protect against this disease."

This World Rabies Day event was organised by Sanofi Pasteur in collaboration with the National Institute of Public Health.

--
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ProMED-FRA
<promed@promedmail.org>

[Although rabies virus infection is clearly a major problem in Cote d'Ivoire, this is the 1st report received by ProMED-mail. The recommendation for the population to seek rabies virus vaccination seems unrealistic [in view of the cost]. More feasible and less expensive strategies should feature control and vaccination of domestic dogs, with human vaccination limited to those requiring post-exposure prophylaxis.
- Mod.CP

It is recommended that the vaccine series should be given in conjunction with rabies immune globulin. The US CDC recommendations for vaccination are given at http://www.cdc.gov/rabies/resources/aci ... tions.html
and for immune globulin at
http://www.cdc.gov/rabies/medical_care/hrig.html
- Mod.JW

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

LASSA FEVER - NIGERIA (11): (EBONYI) NOSOCOMIAL, ALERT
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Date: Thu 17 Oct 2013
From: ikenna ozioko <ikozioko@yahoo.com>


Lassa Fever, human, Abakaliki, Nigeria
--------------------------------------
3 cases of Lassa fever have been reported among doctors working in the Federal Teaching Hospital, Abakaliki, Ebonyi state, Nigeria.

--
Communicated by:
Ikenna Ozioko
Federal Teaching Hospital Abakaliki
Nigeria
<ikozioko@yahoo.com>

[ProMED commends the Federal Teaching Hospital Abakaliki for sending this alert directly to us, and asks all health institutions seeing cases of significance to international health to consider doing the same through the SUBMIT INFO button at the top of the ProMED Home page <www.promedmail.org>.

Physicians in Nigeria or abroad who see febrile residents or tourists coming from Ebonyi State, Nigeria, in the last 3 weeks (the incubation period of Lassa fever), should consider testing for Lassa fever. I am sure that the Federal Teaching Hospital Abakaliki has swiftly implemented the proper procedures to avoid further spread of the disease from patients to staff. All health workers in Nigeria should wear proper protective gear when treating suspected Lassa patients, because you never know if they may have come from an endemic area.

*****Health workers in countries across Nigeria's borders should take the same precautions with febrile visitors from Nigeria.

The Summary Table on the front page of Nigeria's IDSR Weekly Report as at 27/09/2013 from Nigeria shows 16 cases of Lassa fever (1 fatal) for Week 37 in September 2013. Inside the report on p.4 appears the following:

"Lassa fever update for week 38 as 27th September, 2013
-------------------------------------------------------
2.1. In the reporting week (Week 38) 2013, no suspected Lassa fever case/death was reported
compared with 28 cases with 1 death (CFR, 3.57 percent) from Edo State same period in 2012.
2.2. Between week 1 & 38 2013, 1150 suspected Lassa fever cases with 154 lab confirmed and 34 deaths (CFR, 2.96 percent) were reported in 27 LGAs across 13 States compared with 1357 cases with 169 lab confirmed 107 deaths (CFR, 7.89 percent) in 42 LGAs (23 States) the same period in 2012 (Figure 5).
2.3. National Lassa fever Rapid Response team had conducted post-outbreak survey in the affected States."
- Mod.JW

Abakaliki is the capital city of the present-day Ebonyi State in southeastern Nigeria. The inhabitants are primarily members of the Igbo nation. It was the headquarters of the Ogoja province before the creation of Ebonyi State in 1996. [A correction has been made regarding the location of Abakaliki. See ProMED-mail posting Lassa fever - Nigeria (12): (EB) nosocomial 
20131030.2030154. - Sr.Tech.Ed.MJ]

A map showing the location of Ebonyi state can be accessed at: http://www.ebonyionline.com/about-ebonyi-state/.

Lassa fever is an acute viral illness that occurs in West Africa. The illness was discovered in 1969 when two missionary nurses died in Nigeria, West Africa. The cause of the illness was found to be Lassa virus, named after the town in Nigeria where the first cases originated. Lassa virus, a member of the virus family _Arenaviridae_, is a single-stranded RNA virus and is zoonotic, or animal-borne. Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80 percent of people infected with the virus, the remaining 20 percent have severe multisystem disease. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50 percent.

The reservoir, or host, of Lassa virus is a rodent known as the "multimammate rat" of the genus _Mastomys_. It is not certain which [of the 8] species of _Mastomys_ are associated with Lassa fever; however, at least 2 species carry the virus in Sierra Leone. _Mastomys_ rodents breed very frequently, produce large numbers of offspring, and are numerous in the savannas and forests of West, Central, and East Africa. In addition, _Mastomys_ generally readily colonize human homes. All these factors together contribute to the relatively efficient spread of Lassa virus from infected rodents to humans.

Lassa fever may also spread through person-to-person contact. This type of transmission occurs when a person comes into contact with virus in the blood, tissue, secretions, or excretions of an individual infected with the Lassa virus. The virus cannot be spread through casual contact (including skin-to-skin contact without exchange of body fluids). Person-to-person transmission is common in both village and health care settings, where, along with the above-mentioned modes of transmission, the virus also may be spread in contaminated medical equipment, such as reused needles (in-hospital transmission is called nosocomial).

For further information see: http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... lassaf.htm. - Mod.CP]