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DENGUE/DHF UPDATE (94): AFRICA
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Africa
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Burkina Faso. 5 Nov 2013. Dengue 33 cases hospitalized.
http://www.fasozine.com/index.php/red-p ... e-recenses

[ProMED-mail seldom receives dengue reports from Africa, and would welcome more as they become available.

Maps of Burkina Faso can be accessed at http://www.ezilon.com/maps/images/afric ... ina-Fa.gif and http://healthmap.org/r/1KlN. - Mod.TY]

YELLOW FEVER - AFRICA (26): SUDAN, SUSPECTED
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Date: Tue 19 Nov 2013
Source: Crofsblogs [edited]
http://crofsblogs.typepad.com/h5n1/2013 ... efweb.html


Via ReliefWeb, a report from the government of Sudan and WHO: Yellow fever in Sudan situation report no 3, 19 Nov 2013 - Sudan
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3 suspected cases of viral haemorrhagic fever (VHF) in Kassala State were recently reported.

A total of 40 suspected cases of yellow fever (YF), including 10 deaths, were reported from 3 Oct-17 Nov 2013 in 13 localities in West and South Kordofan.

More than 80 000 people were vaccinated in West Kordofan and South Kordofan in small scale vaccination campaign conducted over the last 3 weeks.

Communicable disease surveillance system is strengthened in White Nile, Gezira, Kassala, Gedarif, and Khartoum.

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[The outbreak appears to be spreading, and now has been reported from 3 states -- West and South Kordofan and now, Kassala. Kassala is to the east of the 2 affected Kordofan, separated by Khartoum state. The 3 suspected Kassala cases may represent spillover via seasonal agricultural workers who may have acquired their infections in the Kordofan states. The proximity of these cases to the populous Khartoum state and national capital is of concern. The 3 new cases in Kassala are suspected. It is not clear from this report if the 37 cases in West and South Kordofan have been laboratory confirmed or not. It is good to learn that 80 000 people in West and South Kordofan have been vaccinated over the past 3 weeks. One hopes that an aggressive vaccination campaign in all the areas where cases have occurred will continue and contain the outbreak promptly before it can spread further.

A HealthMap/ProMED-mail interactive map of Sudan can be accessed at http://healthmap.org/r/1A1E and a map showing the Sudan states at http://sites.duke.edu/stefanijones/file ... dan-UN.jpg. - Mod.TY]

UNDIAGNOSED FEBRILE ILLNESS - NIGER, TANZANIA: REQUEST FOR INFORMATION
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Date: Wed 20 Nov 2013
Source: Center for Infectious Disease Research and Policy (CIDRAP) News [edited]
http://www.cidrap.umn.edu/news-perspect ... -outbreaks


Health officials in Africa are investigating 2 separate outbreaks of unknown illness, a small one in Niger that has killed nearly a third of patients and a larger one in Tanzania in which no deaths have been reported so far, the World Health Organization (WHO) African regional office said today [20 Nov 2013].

In Niger, the outbreak as of the middle of October [2013] had sickened 23 patients in 2 villages in Tera District, located in the country's Tillaberi Region. The area is located in far south western Niger, not far from the Burkina Faso and Mali borders. According to the WHO report, 7 deaths have been reported.

Symptoms included fever, dysphagia, nosebleeds, vomiting, neck pain, submandibular lymphadenopathy, and ulceronecrotic tonsil lesions. However, none of the patients had a pseudomembrane at the back of the throat, which is a hallmark feature of diphtheria. Also, nosebleed, which occurred in 5 patients, isn't a common diphtheria symptom.

Throat swabs from 5 patients were negative for diphtheria, and blood tests from 2 patients were negative for mononucleosis. These tests were done at the Centre for Medical and Health Research (CERMES), a Pasteur Institute lab that operates under Niger's public health ministry.

Given the unusual symptoms, negative lab tests for diphtheria, and high case fatality rate, further investigations are needed to determine the outbreak's scope, source, and risk of further spread, WHO said. The office said that WHO is assisting Niger's health ministry investigators and has deployed an epidemiologist to provide technical support in coordinating the work.

Meanwhile, Tanzania's health ministry is investigating an unknown disease in Kasulu district [Kigoma region], located in the north western part of the country not far from the Burundi border. Since late August [2013], 794 illnesses have been reported, none of them fatal, according to a separate WHO outbreak report.

The main symptoms are fever, headache, vomiting, and abdominal pain, but tests for dengue fever conducted on some of the patients were negative. WHO said more tests are under way to determine the cause of the outbreak and that health officials are weighing several possibilities, including dengue fever, yellow fever, and hepatitis A or E.

In response to the outbreak, health officials have intensified health education about environmental hygiene and sanitation and have strengthened surveillance and lab analysis of samples, according to the report.

Sharon Sanders, editor-in-chief of the infectious disease message board FluTrackers, told CIDRAP News that the group's volunteers follow developments in the 2 countries, but added that Africa is a challenging area to monitor, because the news coming out of the region is sparse. She said malaria and cholera seem to be chronic in the area over the past months, and health officials in Niger recently detected the country's 1st diphtheria cases in 7 years.

She said it's not unusual to see news stories about "unknown" diseases appear in the African media, which are usually resolved in a few weeks after global health groups arrive to assist with testing. However, Sanders said it is unusual for a WHO division to report an unknown disease outbreak.

"We are going to carefully watch this," Sanders said, adding that reports of nasal bleeding in the Niger outbreak patients are worrying and that she would like to know if bleeding is a feature in any of the Tanzanian cases.

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ProMED-mail rapporteur Mary Marshall

[The information provided for the Niger outbreak is general, and does not provide enough specific information to suggest which etiological agent may be responsible for these cases. However, one possibility is Lassa fever virus, which is endemic in neighboring Nigeria. The reservoir host for that virus is the multimammate mouse, _Mastomys_, 2 or more species of which are present in the Tillaberi region in south western Niger (http://maps.iucnredlist.org/map.html?id=12868) along the Nigeria border. The USA CDC (http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... lassaf.htm) lists Lassa fever clinical signs as, "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." No mention of tonsil lesions similar to those in the Niger cases is made in the CDC description. Other possibilities include Marburg and Ebola virus infection, although no mention is made of a maculopapular rash that is common with infections by these viruses. If these are yellow fever cases, one would think that symptoms of that disease are specific enough to raise suspicions of that etiology. A confirmed case of yellow fever occurred in Niger in April 2013 (see ProMED-mail archive no. 20130609.1762775) and Niger health authorities should be familiar with that disease.

Although dengue has been ruled out in the Tanzania febrile disease outbreak, no mention is made about testing for chikungunya virus infections. However, no mention is made of acute and persistent arthralgia that is characteristic of infections with that virus. There are many other infectious agents that can cause the symptoms seen in the Tanzania cases.

ProMED-mail would appreciate receiving further information about these 2 outbreaks, and especially laboratory results, as they become available.

Maps showing the location of the Tillaberi region in Niger can be accessed at http://en.wikipedia.org/wiki/Tillabéri_Region and http://healthmap.org/r/6_*-; the Kigoma region in which the Kasulu district in Tanzania is located can be seen at http://en.wikipedia.org/wiki/Kigoma_Region and http://healthmap.org/r/9f1T. - Mod.TY]

YELLOW FEVER - AFRICA (27): SUDAN, CONFIRMED
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Date: Tue 26 Nov 2013
Source: Government of Sudan, WHO, Situation Report No. 4 [edited]
http://reliefweb.int/report/sudan/yello ... ember-2013


Institute Pasteur in Dakar has reconfirmed the current outbreak as yellow fever (YF).

Between 3 Oct and 24 Nov 2013, a total of 44 suspected cases of YF were reported, including 14 deaths.

A total of 12 localities in West and South Kordofan are affected by the current outbreak.

The communicable disease surveillance system has been strengthened in White Nile, Gezira, Kassala, Gedarif and Khartoum.

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[These yellow fever (YF) cases have now been laboratory confirmed. The number of YF cases has increased from 40, with 10 deaths, reported on 19 Nov 2013; to 44 cases and 14 deaths in the above report of 26 Nov 2013. The 19 Nov 2013 report indicated that suspected YF cases occurred in 13 localities in West and South Kordofan, and the above report indicates 12 localities in those states are involved, so apparently the outbreak is not spreading to other places. The previous report also indicated that there were suspected YF cases in Kassala state, but no mention of them is made in the above report. With the YF vaccination campaign that has been implemented, one hopes that the outbreak will soon be brought under control.

A HealthMap/ProMED-mail interactive map of Sudan can be accessed at http://healthmap.org/r/1A1E, and a map showing the Sudan states is at http://sites.duke.edu/stefanijones/file ... dan-UN.jpg. - Mod.TY]

[It would be important to know if the mosquito vector in those places is _Aedes aegypti_ or another species. - Mod.JW]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (65): AFRICA
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In this update:
[1] Cholera - Ethiopia (Somali Region), prisoners
[2] Cholera - Nigeria (Ebonyi State)
[3] Cholera - Togo

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[1] Cholera - Ethiopia (Somali Region), prisoners
Date: Thu 28 Nov 2013
Source: Mareeg [edited]
http://www.mareeg.com/ethiopia-cholera- ... aden-jail/


About 55 inmates have been feared dead from the outbreak of cholera in the notorious prison locally known as "Jail Ogaden" in the regional capital of Jigjiga [Somali Region], and several others are in a severe condition following the outbreak of the disease. This also followed a report that in the last week [up to 28 Nov 2013], about 45 inmates have died in the cells after the guards forced them to drink from contaminated water Jerry cans.

A visit to "Jail Ogaden" in the regional capital of Jigjiga revealed that about 55 people [died] over the weekend [week ending 24 Nov 2013] after stooling and vomiting consistently. "I saw their (inmates') corpses, about 55, lying among the prisoners, while others [were] vomiting and stooling continuously," said a relative visitor.

The notorious prison in the regional capital of Jigjiga has the capacity of 400 inmates; however, currently it holds several thousand inmates, which is more than it should. This is not the 1st time that a cholera outbreak has happened in the notorious Jail Ogaden in the regional capital of Jigjiga.

The Puppet Administration of Ogaden did not carry out an awareness campaign to the jails and environs on how best to sanitize environment in order to stop the spread of the disease in and around the "Jail Ogaden."

[Byline: Ahmed Abdi]

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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/84ip.]

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[2] Cholera - Nigeria (Ebonyi State)
Date: Thu Nov 28 2013
Source: This Day Live [edited]
http://www.thisdaylive.com/articles/cho ... yi/165370/


A total of 4 persons have been reported dead following the outbreak of cholera in Ikwo Local Government Area of Ebonyi State, while one other person was said to be receiving treatment at an undisclosed hospital in the state.

The state Deputy Governor, Chief Dave Umahi, who confirmed the death toll yesterday, 27 Nov 2013, assured the state that modalities had been put in place by the state government to ensure that the outbreak doesn't claim more lives.

The deputy governor who disclosed this during the commencement of Maternal Newborn and Child Health Week at Afikpo North Local Government Area, added that the death of the 4th person following the continued cases of cholera-related incident had been uncovered in Ikwo Local Government Area of the state.

Umahi enjoined the people to always ensure they keep their environment clean and drink potable water provided by the state government, adding that in its effort to ensure that the state does not record any more cases of cholera and other diseases, the state has embarked on construction of Oferekpe and Ukawu water schemes.

[Byline: Benjamin Nworie]

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[3] Cholera - Togo
Date: Tue 26 Nov 2013
Source: Thomson Reuters Foundation, Plan UK report [edited]
http://www.trust.org/item/20131126131150-g965n/


Thousands of chlorine tablets are being distributed to combat an outbreak of cholera in Togo. The global children's charity Plan International has provided 120 000 of the pills to help clean water in the affected areas. The outbreak has now spread outside the capital Lome and as far north as the Central Region.

At least 130 cases of cholera have been identified. A total of 7 people have died so far. Some of the cases have come from the fishing area of Katanga in the capital Lome, which is considered to be one of the sources of the outbreak. "It seems that some people do not follow the hygiene rules and some continue to drink water without cleaning it with chlorine pills," says Mohamed Bah, Plan's country director in Togo. In addition to the chlorine pills, Plan has also provided soap, rubber gloves and water purification tablets.

"Children under 5 are particularly vulnerable. Poor access to water and poor hygiene and sanitation conditions put them at extra risk of infection. But cholera is easy to prevent by improving basic hygiene, access to clean water and sharing information," adds Mr Bah.

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

[The World Health Organization says:
"Cholera is an easily treatable disease. The prompt administration of oral rehydration salts to replace lost fluids nearly always results in cure. In especially severe cases, intravenous administration of fluids may be required to save the patient's life."
http://www.who.int/topics/cholera/treatment/en

The remedy can be homemade using the recipe given at:
http://rehydrate.org/solutions/homemade.htm#recipe
with diagram at: http://rehydrate.org/images/diy3.gif. - Mod.JW]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (67): AFRICA
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In this update:

Africa
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[1] Cholera - Angola (southern provinces)
[2] Cholera - Zimbabwe (Masvingo Province)

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[1] Cholera - Angola (southern provinces)
Date: Thu 5 Dec 2013
Source: UN Office for the Coordination of Humanitarian Affairs [edited]
http://www.irinnews.org/report/99273/dr ... ern-angola


A protracted drought followed by the onset of the rainy season in southern Angola has triggered a sharp increase in cholera cases, mainly concentrated in Cunene province, where over 1000 infections and 48 deaths were recorded during a 2-week period in November 2013, according to figures from the Ministry of Health. Cholera is endemic in Angola, where nearly half of the population lives in conditions conducive to the spread of the illness, according to the WHO.

A year-long outbreak that started in the slums of the capital Luanda in February 2006 and spread to 16 out of 18 provinces resulted in over 80 000 reported cases and 3000 deaths.

So far, the current outbreak has remained almost entirely confined to Cunene, although neighboring Huila province has also recorded some cases. Since January 2013, the country as a whole has recorded just over 5600 cholera cases and 190 deaths, about 70 percent of them in Cunene.

A drought that started at the end of 2011 is now affecting over 1.8 million people, with 5 provinces in the south worst affected, among them Cunene. Acute malnutrition rates as high as 25 percent in areas experiencing food shortages due to the drought have left children highly susceptible to waterborne illnesses including cholera, notes a November 2013 statement from UNICEF.

Pedro Kawilila, a UNICEF representative based in Cunene, says the drought has also forced people to resort to drinking "very dirty water." Cunene's largely rural population relies on "chimpakas," natural and man-made depressions in the ground that store rainwater, primarily as a source of water for their livestock. However, at the height of the drought, when wells and boreholes ran dry, they started collecting stagnant water from the chimpakas for domestic use.

"Cunene is a province that has a problem with the supply of safe water," commented Manuel Eduardo, a WASH (water, sanitation and hygiene) specialist working as a consultant for UNICEF in Cunene. "What's needed is a strong programme in terms of people being able to treat water at home and construction of more boreholes. There are boreholes, but some have dried up, and others haven't been maintained. Open defecation is the norm in the province, added Eduardo. "They don't construct latrines, and before the rain, they didn't have enough water to wash their hands and so on."

The lack of safe water and sanitation meant that even before the onset of the rainy season, UNICEF had reported over 1500 cholera cases in Huila, Cunene, and Benguela provinces between January and July 2013, resulting in 62 fatalities. "When the rain started in October 2013, it made it worse," Kawilila told IRIN in a phone interview. "Because of open defecation, the rain swept that stuff into water sources."

[Byline: Kristy Siegfried]

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[2] Cholera - Zimbabwe (Masvingo Province)
Date: Wed 4 Dec 2013
Source: Bulawayo24 [edited]
http://bulawayo24.com/index-id-news-sc- ... 39727.html


A cholera outbreak has hit Chiredzi with 5 cases recorded so far, Masvingo provincial medical superintended Dr Robert Mudyirandima has said. Dr Mudyirandima said the 5 cases were members from the same family.

"We are not yet sure of the source of the outbreak, but we suspect that a member of the family could have traveled outside the district, or they had a visitor who passed on the bacterium to them," he said.

Dr Mudyirandima dismissed suspicion that the bacteria could have been in drinking water, saying people in that community got water from a common source. He said that if it was in drinking water, more people would have been affected instead of one family.

According to the weekly disease surveillance report, the latest outbreak brings the number of recorded cholera cases to 11 since the beginning of 2013. The last cases of cholera were reported in March 2013 in Beitbridge and Chiredzi.

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[The World Health Organization says: "Cholera is an easily treatable disease. The prompt administration of oral rehydration salts to replace lost fluids nearly always results in cure. In especially severe cases, intravenous administration of fluids may be required to save the patient's life" http://www.who.int/topics/cholera/treatment/en.

The remedy can be homemade using the recipe given at: http://rehydrate.org/solutions/homemade.htm#recipe with diagram at: http://rehydrate.org/images/diy3.gif. - Mod.LL

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

HEPATITIS E - TANZANIA: (KIGOMA)
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Date: Fri 13 Dec 2013
From: Vaccine News Daily [edited]
http://vaccinenewsdaily.com/world_healt ... -tanzania/


The World Health Organization (WHO) recently confirmed that a previously reported and unknown illness in Tanzania's Kigoma Region is the result of hepatitis E virus. 15 out of the 46 samples tested at a lab in Nairobi, Kenya, were positive for hepatitis virus E. The WHO said arrangements are ongoing for molecular characterisation tests and genotyping.

Between 20 Aug 2013 and 29 Oct 2013, the region's Buhigwe District experienced 690 acute febrile illness cases with no deaths. Most patients presented with vomiting, loss of appetite, generalized body weakness, abdominal pain, high fever, and headache. A small proportion of the cases experienced diarrhoea and jaundice. There was a delay in detection and confirmation of the outbreak because most of the initial cases were treated as malaria, due to similar clinical symptoms. Approximately 61 percent of reported cases occurred in individuals below the age of 15 years. Approximately 54 percent of the cases occurred in females.

After the hepatitis E outbreak was confirmed, Tanzania's Ministry of Health and Social Welfare began conducting further field investigations to determine the magnitude, source, and risk factors for the outbreak. Prevention and control measures are ongoing.

The WHO did not recommend any trade or travel restrictions be applied to Tanzania with respect to the recent event.

[Byline: Paul Tinder]

--
Communicated by:
a correspondent who has requested anonymity

[This report is posted in response to ProMED-mail's request for information of 23 Nov 2013, entitled "Undiagnosed febrile illness - Niger, Tanzania: RFI" archive no 20131123.2069748. It is likely, but not confirmed here, that the outbreak of a the febrile disease in Nigeria is likewise the result of hepatitis E virus infection.

Hepatitis E is usually self-limiting but may develop into fulminant hepatitis (acute liver failure). Hepatitis E virus is transmitted via the faecal-oral route, principally via contaminated water. Hepatitis E is found worldwide and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, while genotype 3 is usually seen in the developed countries and does not cause outbreaks. Globally, 57 000 deaths and 3.4 million cases of acute hepatitis E are attributable to infection with hepatitis E virus genotypes 1 and 2.

The highest seroprevalence rates are observed in regions where low standards of sanitation increase the risk for transmission of the virus. Over 60 percent of all hepatitis E infections and 65 percent of all hepatitis E deaths occur in East and South Asia, where seroprevalence rates of 25 percent are common in some age groups.

There is no available treatment capable of altering the course of acute hepatitis. Prevention is the most effective approach against the disease. As hepatitis E is usually self-limiting, hospitalization is generally not required. However, hospitalization is required for people with fulminant hepatitis and should also be considered for infected pregnant women. The risk of infection and transmission can be reduced by maintaining quality standards for public water supplies and establishing proper disposal systems to eliminate sanitary waste. (For further information, see WHO fact sheet at http://www.who.int/mediacentre/factshee ... index.html.

A HealthMap/ProMED-mail interactive map of Tanzania can be seen at http://healthmap.org/r/9f1T and a map showing the regions of Tanzania at http://commons.wikimedia.org/wiki/File: ... egions.svg. - Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (68): AFRICA
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In this update:
Africa
[1] Cholera - Nigeria (Kano State
[2] Cholera - Nigeria (Lagos State)
[3] Cholera - Angola (Huambo Province)

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[1] Cholera - Nigeria (Kano State)
Date: Fri 13 Dec 2013
Source: Daily Times [edited]
http://www.dailytimes.com.ng/article/ch ... spitalised


An outbreak of cholera, a disease that causes unrestrained stooling and vomiting, has hit Kano state killing about 10 persons while 70 have been recorded hospitalized following the outbreak in 2 local government areas of the state.

A source who spoke under anonymity disclosed that about 10 persons have been killed by the cholera outbreak and that the health control unit of the health ministry received over 300 cases of cholera from various locations in the state.

Speaking with newsmen on Thu 12 Dec 2013, the state Deputy Director, Public Health and Disease Control, Dr Tijjani Husaini said 70 persons were only recorded hospitalised who are the victims from Nasarawa and Dala local government areas. Dr Tijjani said the patients are currently receiving medical attention at the Infectious Disease Hospital in Kano metropolis. He said, most of the victims were found to have been affected after visiting some of their infected relations.

He warned people to desist from drinking unclean water and always wash their hand with soap after visiting toilet, pointed that people should also wash vegetables and fruits before eating and avoid taking uncooked food.

[Byline: Lara Adejoro]

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[Maps of Nigeria can be found at http://www.un.org/Depts/Cartographic/ma ... igeria.pdf and http://healthmap.org/r/1qGF. - Mod.LL]

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[2] Cholera - Nigeria (Lagos State)
Date: Mon 9 Dec 2013
Source: Vanguard [edited]
http://www.vanguardngr.com/2013/12/chol ... 15-deaths/


A Consultant Public Health Physician and Epidemiologist with the Lagos State Ministry of Health, Dr Ismail Abdul-Salam has disclosed that 15 deaths have so far been recorded out of 354 suspected cases of cholera in the state.

Speaking at a stakeholders' forum organized by the State Ministry of the Environment, Office of Environmental Services, Abdul-Salam, who presented a lecture entitled, 'Prevention and Control of Cholera,' said the figures were obtained from a study carried out following the outbreak of cholera in the state.

"The 1st case of suspected cholera outbreak in Lagos was reported in 19 Sep 2013 on Lagos Island and later at Amuwo Odofin Local Government Area. "As at the 12th week into the outbreak, 15 councils had reported at least one suspected case of cholera with 354 suspected cases. There are currently 15 labs and 109 Epilink confirmed cases. 15 deaths have been recorded. The case fatality rate is 12 percent," he said.

Noting the results indicated that the majority of the patients ate a local salad popularly called 'Abacha' and due to poor sanitary environment, he said prompt intervention management of cases at secondary health facilities, and availability of cholera kits and other consumables prevented the disease from spreading.

[Byline: Olasunkanmi Akoni]

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[A case-fatality rate of 12 percent for cholera is quite high, 5-10 times higher than what is usually seen. - Mod.LL]

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[3] Cholera - Angola (Huambo Province)
Date: Wed 11 Dec 2013
Source: Angola Press Agency (Angop) [edited]
http://www.portalangop.co.ao/angola/en_ ... 35610.html


According to the provincial supervisor for epidemiology watch, Artur Braga, 5 new cases of cholera are recorded daily in Huambo Municipality since a cholera outbreak took place in November 2013, which claimed 8 lives. Braga told Angop that up to date 95 cases have been notified.

He pointed out the areas of Calomanda, Macolocolo, Calundo, Santo Antonio Chiva, and Benfica Frederico, in the suburbs of the capital city [Huambo], as the most endemic zones.

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[Maps of Angola can be seen at http://www.mapsofworld.com/angola/angol ... l-map.html and http://healthmap.org/r/2y7O. - Mod.LL]

HEPATITIS C - EGYPT: SILENT EPIDEMIC
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Date: Mon 16 Dec 2013
Source: Worldcrunch [summ., edited]
http://www.worldcrunch.com/culture-soci ... h/c3s14456


After being unemployed for 3 years, a 26 year old man was offered a job at a local bank on the condition that he take a blood test. It was then that he discovered he had been infected with hepatitis C virus (HCV), which can cause liver disease and eventually hepatocellular carcinoma -- better known as liver cancer.

The bank consequently withdrew its offer, and the man fell victim to the social stigma associated with hepatitis C and other chronic diseases. In fact, Egypt has the highest prevalence of HCV in the world, with 10-14 per cent (8 to 10 million people) infected with HCV, and about 1.5 million in need of treatment. Gamal Esmat, professor of liver disease at Cairo [University], notes that the vast majority of these are in the Nile Delta region. HCV's high prevalence in Egypt is in part due to a mass state campaign in the 1960s and 1970s to treat schistosomiasis using improperly sterilized glass syringes and needles.

But a new treatment for HCV could radically change the situation. In collaboration with the Ministry of Health and other global organizations, the National Hepatology and Tropical Medicine Research Institute (NHTMRI) plans to introduce a new HCV treatment in 2014. Unlike previous treatments -- antiviral drugs that treat HCV by boosting the immune system -- the new treatment cures the virus within 12 weeks at a 97 per cent effectiveness rate and with no side effects. Known as "direct acting antiviral agents", the new HCV treatment combats the disease by targeting the infected liver cells and destroying the virus' replication machinery.

Abou el-Resh Pediatric University Hospital, Cairo (Ashashyou), Raymond Schinazi, an American research scientist of Italian-Egyptian descent at Atlanta's Emory University, was the founder of Pharmasset Inc, the company that originally developed the drug. Schinazi's team of researchers worked for over 6 years, finding what they consider to be the cure: the PSI-7977 molecule, now named "sofosbuvir", which the US Food and Drug Administration (FDA) approved on 8 Dec [2013].

The "silent epidemic"
---------------------
Born and raised in Alexandria, Schinazi and his family left Egypt during the large-scale Jewish exodus that took place in the 1950s and 1960s. Schinazi says he still has a close relationship with Egypt and hopes his collaborative research will eventually help cure those infected in his country of birth. "When I 1st heard of HCV, I thought to myself: This is my next target," he says. "My dream was to one day find a cure for it and help my mother country," says Schinazi, who sold his company and the drug patent to US company Gilead Sciences for USD 11.4 billion.

There are currently over 6 drug companies competing for the production of an HCV cure. But unlike the other drugs in the market, sofosbuvir is also pan-genotypic, which means that it can be used to treat infected people with all [known HCV] genotypes worldwide -- including genotype 4, which is most common in Egypt.

Dubbed the "silent epidemic", hepatitis C has infected about 170 million people worldwide and has caused about 350 000 deaths per year from HCV-related diseases. "Our aim is to provide a treatment for HCV which is safe, effective and with minimal side effects," says Manal al-Sayed, professor of pediatrics at Ain Shams University and a member of the National Committee for the Control of Viral Hepatitis. "Our challenge will be to have it at affordable prices for all," she adds. With prospects of the cure costing as much as USD 100 000 in the US, many are concerned it would be unaffordable for most Egyptians. Egyptian authorities, doctors, Ministry of Health members and others are currently negotiating with major pharmaceutical companies producing this and other treatments to reduce costs. Nevertheless, Egyptian authorities and doctors remain hopeful of bringing HCV treatment to Egypt at 5 per cent of the global price, with the rest subsidised by government authorities.

[byline: Leyla Doss]

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[Hepatitis C is bloodborne, and symptoms are often not visible until 20 years after infection. It can range in severity from a mild illness lasting for a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer -- despite treatment and the likelihood of a total cure looking promising in the near future. Therefore more attention must be focused on preventing the infection process of hepatitis C virus infection.

According to the US Centers for Disease Control and Prevention (CDC), almost 20 per cent of the Health Ministry's budget has been allocated to care and treatment and just a 1 per cent expenditure on infection control. In Egypt, there are approximately 165 000 new cases of infection each year, and 70 per cent of them are related to inefficiencies of the health care system. For example, equipment is often not sterilized according to acceptable standards, and infection is very often transmitted through improperly screened blood transfusions of infected patients. Other modes of infection include the sharing of unsterilized needles and unsterilized tools for pedicures, manicures and tattoos. However over the past 6 years, there have also been extensive campaigns to raise awareness about hepatitis C virus infection. WHO says Egypt is one of only 2 developing countries that provide free universal treatment for HCV. - Mod.CP

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

HEPATITIS C - EGYPT (02): INCIDENCE AND PREVALENCE
**************************************************
A ProMED-mail post
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International Society for Infectious Diseases
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Date: Fri 20 Dec 2013
Source: Source: GIDEON (Global Infectious Disease & Epidemiology Network) [edited]
http://www.gideononline.com


re: ProMED-mail Hepatitis C (02): silent epidemic 20131218.2123499
------------------------------------------------------------------
The following background data on Hepatitis C in Egypt are abstracted from Gideon [http://www.gideononline.com] and the Gideon e-book series. [1,2].

Incidence and prevalence
------------------------
Hepatitis C is the commonest cause of chronic liver disease in Egypt. The nationwide carriage rate in 1997 was estimated at 6 to 8 million, or 18.1 per cent of the population -- the highest rate in the world. A study published in 2010 estimated the yearly rate at 500 000 new cases (0.7 per cent of the population); while a study published in 2013 estimated the yearly rate at fewer than 150 000 cases. An analysis published in 2009 predicted that 127 821 deaths from chronic liver disease and 117 556 deaths from hepatocellular carcinoma would occur in Egypt over the next 20 years.

The high rate of hepatitis C infection in Egypt is largely attributed to previous mass-injection (antimony tartrate) treatment campaigns for schistosomiasis, which involved repeated use [of] non-sterilized needles. 84 per cent of patients who had received intravenous schistosomiasis therapy during the 1980s were found to be HCV-positive; and anti-_Schistosoma_ antibodies were found in 29 per cent of patients with chronic hepatitis C infection (2013 publication). There is also evidence for ongoing transmission of hepatitis C from parents to children co-infection by other hepatotropic viruses is common. 72.0 per cent of children with hepatitis C are seropositive toward hepatitis E virus. (2008 publication); and occult hepatitis B is present in 3.9 per cent of patients with hepatitis C (2010 publication).

Prevalence surveys
------------------
- 29.8 per cent of viral hepatitis cases (2001)
- 3.6 per cent of acute hepatitis patients hospitalized in Cairo (2002)
- 8 per cent of acute hepatitis among military recruits (2012 publication)
- 2.02 per cent of asymptomatic children ages 1 to 9 years (2007 publication)
- 21 per cent of acute hepatitis in children (2013 publication)
- 78.5 per cent of patients with hepatocellular carcinoma (2008 publication)
- 89.2 per cent of patients with hepatocellular carcinoma and 49.3 per cent of those with other forms of cancer (2012 publication)
- 18 per cent of dental instruments tested in Alexandria (HCV RNA, 2012 publication)

Seroprevalence surveys
----------------------
- 14.7 per cent of persons ages 15 to 59 years, nationwide (2008)
- 5 per cent to 15 per cent of pregnant women, 5 per cent to 25 per cent of blood donors and 0 per cent to 40 per cent of other groups (meta-analysis, 2013 publication)
- 24.8 per cent of blood donors, nationwide -- highest rates in the central and north-eastern Nile River delta, and the Nile River valley south of Cairo (1993)
- 4.3 per cent of blood donors (2006 to 2012)
- 8 per cent of blood donors (2006 publication)
- 16.8 per cent of blood donors (2011 publication)
- 11.95 per cent of volunteer blood donors (2009 publication)
- 9.02 per cent of blood donors in Minya Governorate (2000 to 2008)
- 3.5 per cent of blood donors in Alexandria (2007 to 2008)
- 13.9 per cent of healthy persons and 78.5 per cent of hepatocellular carcinoma patients (literature review, 2009 publication)
- 5.8 per cent of healthy children ages 6 to 15 (Alexandria, 2011 publication)
- 65 per cent of children ages 1 to 9 years in Cairo (2011 publication)
- 9.7 per cent of university students
- 22.1 per cent of army recruits
- 13.6 per cent to 19 per cent (Cairo) to 20.8 per cent (Alexandria, 1992 to 1994) of blood donors
- 10.9 per cent of persons in El-ghar village, Zagazig (2006 to 2007)
- 2.7 per cent of voluntary student blood donors in Mansoura (2006 publication)
- 19 per cent of pregnant women in Alexandria (2000 publication)
- 15.8 per cent of pregnant women in the Nile Delta (2006 publication)
- 7.4 per cent of pregnant women in Assiut (2010 publication)
- 8.6 per cent of pregnant women (2010 publication)
- 12.1 per cent of rural school children
- 51 per cent of adults above age 40 (Nile Delta)
- 75.8 per cent to 83 per cent of patients with hepatocellular carcinoma (2001 publication)
- 2 per cent of Bedouins in Al Arish (Northern Sinai) and 5 per cent in Nuweiba (Southern Sinai) (2001)
- 23.4 per cent (urban) to 27.4 per cent (rural) of the population of Sharkia Governorate (2004 publication)
- 14.3 per cent of tourism workers in South Sinai governorate (1996 publication)
- 72.9 per cent of persons with elevated serum hepatic enzymes in Ismailia (2009 publication)
- 8.5 per cent of patients with chronic fascioliasis (1998 publication)
- 51.7 per cent of multitransfused thalassemic children (2011 publication)
- 19.5 per cent of multitransfused thalassemic patients (2009 to 2010)
- 34.4 per cent of multitransfused thalassemic patients and 19.2 per cent of their family members (2013 publication)
- 82 per cent of multitransfused patients with beta thalassemia (2013 publication)
- 76 per cent of children with beta thalassemia (Mid-Delta, 2010 to 2011)
- 35 per cent of hemodialysis patients in Al Gharbiyah Governorate (2011)
- 40 per cent of hemophiliac children (2012 publication)
- 18.5 per cent of patients admitted to a rheumatology department (Cairo, 2011 publication)
- 16.6 per cent of health care workers at the National Liver Institute (Nile Delta, 2008 to 2010)
- 63 per cent of IDU, vs. 27.5 per cent of controls (1995 publication)
- 15.8 per cent of prisoners (2013 publication)
- 8.5 per cent of STD patients (1993 to 1995)
- 12.3 per cent of barbers and 12.7 per cent of their clients in Gharbia (2010 publication)
- 84 per cent of patients who had received intravenous schistosomiasis therapy during the 1980s (2011 publication)
- 2.4 per cent of first-generation Egyptian migrants living in the Netherlands (Amsterdam, 2009 to 2010).

References
----------
1. Berger SA: Infectious Diseases of Egypt, 2013. 415 pages, 53 graphs, 2324 references. Gideon e-books, http://www.gideononline.com/ebooks/coun ... -of-egypt/
2. Berger SA: Hepatitis C: Global Status, 2013. 181 pages, 163 graphs, 2251 references. Gideon e-books. http://www.gideononline.com/ebooks/dise ... al-status/

--
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Geographic Medicine
Tel Aviv Medical Center
Israel
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[ProMED-mail thanks Steve Berger for making these data generally available. Professor Berger has offered to make the primary references available on request. - Mod.CP

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

UNDIAGNOSED DEATHS - SUDAN: (NORTH DARFUR) CHILDREN, REQUEST FOR INFORMATION
****************************************************************************
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Date: Fri 27 Dec 2013
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/62786


Residents of Saraf Omra locality in North Darfur have complained about the high death rate among children due to the outbreak of fevers. Relatives said, "24 children died in the hospital during a week's time."

Relatives of patients in the Saraf Omra hospital revealed to Radio Dabanga that it is "overcrowded with patients, especially children." They pointed out that the symptoms of the diseases are high fever, coughs, headaches and vomiting, and that the doctors have not diagnosed the diseases. "However, they prescribe injections and syrups despite the non-diagnosis," a relative said.

Many of the children died 2 days after the fever started; 24 children died within a week's time, according to the relatives.

They said they had asked the hospital administration to contact the North Darfur state Ministry of Health in El Fasher and send a medical team to diagnose and contain the diseases. The administration, however, refused and gave them the phone number of the ministry to contact it directly.

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[The above news release reports 24 deaths from one or more unspecified diseases in children in a 2-week span in a "hospital" in the town of Saraf Omra, North Darfur. The diseases were characterized by high fever, cough, headache and vomiting. A previous news release on 2 Oct 2013 said that in Saraf Omra, "it is difficult to find a household without a sick patient. Sources told Radio Dabanga the most common diseases are conjunctivitis, diarrhea, cough, malaria and allergies. Local citizens noted the area has no hospitals or doctors, but only health centers run by assistants" (https://www.radiodabanga.org/node/36490).

North Darfur, with a population of about 1 583 000 (in 2006), is one of the 5 states (Central, East, North, South and West Darfur) that compose the Darfur region of western Sudan (http://en.wikipedia.org/wiki/North_Darfur). Al-Fashir is the capital of the state. For a map of Sudan showing the location of North Darfur, see http://en.wikipedia.org/wiki/File:North ... puted).svg. The location of Saraf Omra, North Darfur can be accessed at https://maps.google.com/maps?hl=en&gbv= ... ab80,Saraf.

This region has many displaced people living in camps where malnutrition is compounded by extreme overcrowding, shortage of clean water, inadequate latrines and appalling sanitary conditions. Many families have no shelter other than small, tarpaulin-covered huts that are highly vulnerable to heavy rains and winds. However, the news release does not state the conditions in which the 24 children lived before their deaths.

Diseases that could account for these childhood deaths include acute lower respiratory infections, diarrheal illnesses, malaria, measles, severe dengue, meningococcal disease, yellow fever, leptospirosis, injuries sustained in armed conflict and neonatal infections. In December 2012 ProMED-mail posted a report on a potentially fatal disease in Saraf Omra characterized by vomiting, diarrhea, yellow and green eyes [Undiagnosed disease - Sudan: (Darfur) RFI 20121223.1465553], and in October 2013 ProMED-mail posted a report on a hemorrhagic disease affecting children in Saraf Omra, causing "face and leg swelling, and small rashes that quickly turn into bruises" [Viral hemorrhagic fever - Sudan: (Darfur) RFI 20131016.2005262]. There had been an extensive outbreak of yellow fever in the recent past in this region of Sudan. The information given in the news release above, however, is insufficient to identify the cause(s) of the 24 deaths in children. ProMED-mail would appreciate any additional information from knowledgeable sources about these cases. - Mod.ML

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/4-5_.]

RABIES - CONGO REPUBLIC (02): (POINTE-NOIRE), HUMAN
***************************************************
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Date: Sat 28 Dec 2013
Source: Afrique en ligne [edited]
http://www.afriquejet.com/news/14767-he ... congo.html


An epidemic of rabies that broke out in Pointe-Noire, [Republic of] Congo last August [2013] has killed 9 people, according to the country's Health and Population Ministry. The Ministry said the 435 people who were bitten by dogs include 250 [males] and 185 [females], some of them children less than 15 years old. One person was bitten by a cat.

Civil security agents have launched an operation to capture and vaccinate stray dogs and other animals in Pointe-Noire, [Rep. of] Congo's main economic centre, in a bid to fight the epidemic. However, the vaccines are reported to be out of stock. "We have only some 50 doses left when we need at least 3000," Dr Cyprien Ngouala, Civil Security director, said.

According to Dr Joseph Ngala, Principal Doctor in Pointe-Noire, rabies is a very dangerous disease caused by bites from infected animals like dogs, cats, and monkeys. The virus is transmitted by saliva.

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[The Republic of Congo is located in Central Africa, bordered by Gabon, Cameroon, the Central African Republic, and the Democratic Republic of the Congo. Pointe-Noire is the 2nd largest city in the Republic of Congo, after the capital of Brazzaville, and an autonomous department since 2004. Before this date, it was the capital of the Kouilou region (now a separate department). It is on a headland between Pointe-Noire Bay and the Atlantic Ocean. Pointe-Noire is the main commercial centre of the country and has a population of 715 334 (2007), expanding to well over one million when the entire metropolitan area is taken into account.

It is presumed that the shortage of vaccine referred to above is of vaccine suitable for use in protection and post-exposure treatment of the human population and not a vaccine suitable for control of rabies in domestic animals and wildlife. The number of people dying as a result of rabies virus infection is alarming, particularly since rabies vaccine for the protection of humans was the earliest human vaccine to become generally available and one the highest achievements of French medical science. - Mod.CP

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (01): AFRICA
***************************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
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In this update:
[1] Cholera - Nigeria (Kano State)
[2] Cholera - Angola

******
[1] Cholera - Nigeria (Kano State)
Date: Thu 2 Jan 2014
Source: Channels TV [edited]
http://www.channelstv.com/home/2014/01/ ... -kills-25/


At least 22 adults and 3 children have been confirmed dead, while some 600 others are infected following a fresh cholera outbreak in Kano State in northwestern Nigeria.

An epidemiologist with the state's Infectious Diseases Hospital (IDH), Dr. Tijjani Hussaini, told journalists that the 3 children died in the early hours of Thu 2 Jan 2014. At least 20 persons are receiving treatment, while 5 were discharged. There are also over 40 men and women at the diarrhea treatment unit of the hospital," he said.

Within the last month, an estimated 39 reported deaths caused by cholera occurred around the metropolitan city of Kano.

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

******
[2] Cholera - Angola
Date: Fri 3 Jan 2014
Source: RTP Noticias [machine trans. edited]
http://www.rtp.pt/noticias/index.php?ar ... &visual=49


Cholera caused the deaths in Angola of 221 people out of a total of 6655 registered cases in 2013, even though the case-fatality rate (CFR) was lower than in 2012, the Director of National Public Health (DNSP) reported. The data were contained in a balance sheet on the cholera epidemic in 2013 prepared by DNSP and sent by the Lusa Agency.

According to the document, the CFR in 2013 was 3.3 percent, lower than the 2012 6 percent CFR. The cases reported in 2013 were highest in the province of Cunene, with 57.8 percent of the total number of cases, followed by the provinces of Huila, with 21.6 percent, and Uije, with 4.2 percent.

Despite the increased number of deaths in the province of Cunene, the highest CFR was verified in Malanje province, with 21 percent, followed by the province of Lunda Norte, with 10 percent. The fact that the Cunene province in southern Angola has been the most affected by the epidemic is due to the long period of drought, more than 2 years, which also affected parts of Huila province, also in the south of the country.

The DNSP also reported that, compared to 2012, there was a significant increase in the number of cases (as compared to 4457), the deaths having also increased from 135 to 221.

"In analyzing the trend of the epidemic in 2013, the highest incidence was observed in the months of October and November [2013], in which the highest peak was in the month of November 2013 with 2118 cases," the report added. The height of that peak was produced by cases in the province of Huambo in central Angola, which had not had cases earlier in 2013, but this outbreak has waned according to local health authorities, with the number of cases decreasing from a daily average of 15 to one.

In 2006, the 2nd year of statistical data collection by the DNSP, the country registered 69 476 cases and 2773 deaths, but the trend has been decreasing until 2013.

--
Communicated by:
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[Drought can be as significant a risk factor for cholera outbreaks as flooding.

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

[

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

HEPATITIS E - UGANDA: (KARAMOJA) DEATHS
***************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Mon 6 Jan 2014
Source: The Global Dispatch [edited]
http://www.theglobaldispatch.com/uganda ... ead-83591/


An outbreak of hepatitis E virus infection confirmed on New Year's Eve [31 Dec 2013] in the Karamoja [sub-region] of Uganda has to date [6 Jan 2014] resulted in 344 people sickened and 13 fatalities, according to a report from the Ugandan news source, The Observer. The Health Ministry's director general of health services, Dr Jane Ruth Aceng, explained that the outbreak is attributed to unsafe water sources like rivers and ponds, poor sanitation and hygiene and low latrine coverage in the district. "Karamoja sub-region is prone to this disease because of its low latrine coverage and lack of safe drinking water," Aceng said.

According to the WHO, hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. The ingestion of raw or uncooked shellfish has also been identified as the source of sporadic cases in endemic areas. The risk factors for hepatitis E are related to poor sanitation in large areas of the world and shedding of the hepatitis E virus in feces. It is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a fulminant form of hepatitis E develops (acute liver failure), which can lead to death.

Fulminant hepatitis occurs more frequently during pregnancy. Pregnant women are at greater risk of obstetrical complications and mortality from hepatitis E, which can induce a mortality rate of 20 percent among pregnant women in their 3rd trimester.

Globally, there are approximately 20 million incidents of hepatitis E infections every year.

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[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, while genotype 3 is usually seen in the developed countries and does not cause outbreaks. Globally, 57 000 deaths and 3.4 million cases of acute hepatitis E are attributable to infection with hepatitis E virus genotypes 1 and 2.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. Over 60 percent of all hepatitis E infections and 65 percent of all hepatitis E deaths occur in East and South Asia, where seroprevalence rates of 25 percent are common in some age groups. In Egypt, half the population aged above 5 years is serologically positive for the hepatitis E virus (http://www.who.int/mediacentre/factshee ... index.html).

Karamoja sub-region can be seen on the map at <>. The HealthMap/ProMED-mail interactive map of Uganda can be seen at http://healthmap.org/r/9Jhj. - Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (02): 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 - Namibia (Kunene Region)
[2] Cholera - Nigeria (Kano, Zamfara States)
[3] Cholera - Congo DR (South Kivu Province)

******
[1] Cholera - Namibia (Kunene Province)
Date: Tue 7 Jan 2014
Source: Bernama [edited]
http://www.bernama.com.my/bernama/v7/wn ... id=1005687


The number of cholera cases in Kunene Region in north western Namibia has risen to 107, up from 85 cases reported on Sunday afternoon, 5 Jan 2014, while the number of fatalities remains at 7.

At least 28 of the 60 patients admitted to the State hospital at Opuwo for treatment since 28 Dec 2013 have been discharged, says the acting director of health in Kunene Region, Ndahepele Jason, who told Nampa on Monday [6 Jan 2014] that some of the patients who were admitted more recently were just treated at clinics and sent back home. He added that the Directorate of Health was receiving support from different stakeholders, mainly the Office of the Governor, the Namibia Red Cross Society, and the Kunene Regional Council.

Jason said, "5 tents are still expected from Omusati Region so that we can establish a cholera isolation camp or facilities at the hospital premises."

Of the 7 people who have died of the disease, 4 died at Etanga village some 100 kilometers [62 miles] away from Opuwo, in the Epupa Constituency, where people resorted to drinking water from contaminated earth dams or traditional wells because of a lack of proper water facilities.

The clinic there has also been struggling with treatment of cholera patients because of this lack of water.

The only functioning source of water which supplies government institutions at the village has run dry.

Jason said the water shortage at the Etanga clinic has been temporarily solved with containers of water being transported from Opuwo to the clinic. "We sent out an investigation team to determine the source of the outbreak so we can establish if it is an imported infection or if it originated from within the region," he noted.

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[An interactive map of the area can be found at: http://healthmap.org/r/7F8f.]

******
[2] Cholera - Nigeria (Kano, Zamfara States)
Date: Fri 10 Jan 2014
Source: The Windsor Star, Associated Press (AP) report [edited]
http://www.windsorstar.com/health/Offic ... story.html


A Nigerian health official says a cholera epidemic has killed 71 people and infected 2165 since November 2013 in northern Kano state. Centre for Disease Control project director AbdulSalam Nasadi told reporters on Friday, 10 Jan 2014, that most cases are centered on Kano city, the country's 2nd largest [city].

Northern Zamfara state also has recorded hundreds of cholera cases. Nasadi said health officials have deployed to oversee cleanups and advise people on the need for cleanliness.

Lack of proper sanitation and clean water, pit toilets, mounds of uncollected garbage and storm drains blocked by garbage are among issues that contribute to health threats.

UN figures indicate half of Nigeria's more than 160 million people do not have safe water and 1/3rd do not have proper toilets.

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[An interactive map of the area can be found at: http://healthmap.org/r/1qGF.]

******
[3] Cholera - Congo DR (South Kivu Province)
Date: Wed 8 Jan 2014
Source: Radio Okapi [in French, machine transl., edited]
http://radiookapi.net/sante/2014/01/08/ ... les-sange/


The chief doctor of the area of health of the Ruzizi River (South Kivu Province), Delphin Babikire Byamungu, indicated Tuesday, 7 Jan 2014, that 80 cases of cholera, including 2 deaths, have been recorded in the city of Sange these last 8 days.

According to the physician, the drinking water is at the base of the rapid spread of this disease. "The flooded river impeded the functioning of the water supply system in this city. We are asking them to boil water before drinking," he said.

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[The original source URL reported the date as Tue 7 Dec 2013, but since the day of the week was wrong, it is likely that the date was in January 2014. - Mod.LL

An interactive map of the area can be found at: http://healthmap.org/r/9Mw7.]