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MALARIA - BOTSWANA: PALAPYE
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Date: Sat 16 Apr 2014
Source: All Africa [edited]
http://allafrica.com/stories/201404160757.html


The Palapye Administration Authority has registered 47 cases of malaria this year [2014], as was revealed by Palapye Primary Hospital spokesperson, Ms Mpho Modibedi in an interview recently. She stated that of the 47 cases of malaria recorded in the region, Palapye recorded the highest number, 19.

"Other affected villages include Seolwane, Malaka, Makoro, ... Lechana, Lerala, Lecheng, and Matolwane. So far, 2 people have died from malaria," said Ms Modibedi.

She attributed the malaria outbreak to heavy rains in the first quarter, which resulted in pools of stagnant water that provided breeding areas for mosquitoes. She added that the high mobility of people in and around Palapye, who frequently travelled to malaria endemic areas, also contributed to the outbreak in the sub-district.

To combat the problem, Ms Modibedi said the Palapye District Health Management Team conducted community sensitisation through health education on malaria.

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[Botswana reported 308 malaria cases in 2012 (WHO, World Malaria Report, http://www.who.int/malaria/publications ... t_2013/en/). Malaria is endemic in southern Zimbabwe and areas of South Africa close to eastern Botswana, where the town of Palapye is located. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/169.]

YELLOW FEVER - AFRICA (04): DEMOCRATIC REPUBLIC OF CONGO
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Date: Thu 24 Apr 2014
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_04_24_yellowfever/en/


Yellow fever in the Democratic Republic of Congo [DRC]
------------------------------------------------------
On 12 Mar 2014, 2 events of yellow fever were reported in the North and in the South of DRC, [where] 6 laboratory-confirmed cases with yellow fever virus infection were reported. Of these, 3 were from Bondo health zone [equivalent of district], Orientale Province, 2 from Buta health zone, Orientale Province and 1 from Kikondja health zone, Katanga Province. In total 139 suspected, probable, and confirmed cases, including 6 deaths were reported.

In Bondo district, the index case was a 40-year-old man who became ill with fever and jaundice on 10 Dec 2013. His yellow fever vaccination status is not known. Laboratory confirmation was conducted by the Institute National of Biomedical Research (INRB) in Kinshasa, which showed IgM positive by ELISA test. Reconfirmation of the laboratory test was conducted by the regional reference laboratory for yellow fever at the Institut Pasteur in Dakar, Senegal with a more specific test for yellow fever (plaque reduction neutralization test or PRNT), with exclusion of other arbovirus.

The 2nd case was reported in the same health zone on 30 Jan 2014 and laboratory-confirmation was conducted on 11 Mar 2014. The patient's vaccination status for yellow fever is not known.

Preliminary outbreak investigations revealed that in Bondo and the health district of Buta, at least 116 suspected cases were reported.

In Kikondja district, the index case was a 19-year-old woman reported by the Health Center of Ntwadi on 17 Feb 2014. The case was laboratory-confirmed by INRB and IP Dakar. Following identification of the index case, an outbreak investigation was conducted in 3 villages, Katongue, Kimbuvu, and Lukila, where 23 suspected cases were identified.

The International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG)*, approved the provision of 559 876 doses of yellow fever vaccine and operational costs for a reactive mass vaccination campaign.

A reactive mass vaccination campaign is being planned for 1 May 2014. The campaign will be headed by the Ministry of Health, DRC, with support from the GAVI Alliance [formerly the Global Alliance for Vaccines and Immunisation], Medecins sans Frontieres (MSF), and other partners. WHO is closely supporting the management of the outbreak in monitoring, preventive and control activities in the field, and in resource mobilization.

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

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[With a total of 139 suspected and confirmed yellow fever virus infections in 2 locations, there is real cause for concern. One hopes that the reactive mass vaccination campaign scheduled to begin 1 May 2014 will bring a halt to transmission. On 18 Jul 2013, Mod.BM pointed out, "Epidemics have become recurrent in the Democratic Republic of Congo (DRC), and these outbreaks tend to be endemic. We must recognize that cases of yellow fever are underestimated because most often they are not reported or go undiagnosed when we also know that many causes of fever may be suspected in the same subject without a definitive diagnosis. Broad awareness [campaigns] should be undertaken within the population to reduce the spread of these diseases and yellow fever in particular."

Maps of the DRC can be accessed at http://www.mapsofworld.com/democratic-r ... al-map.jpg and http://healthmap.org/promed/p/194. - Mod.TY]

DENGUE/DHF UPDATE (34): AFRICA
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******
Mozambique
Date: Sat 26 Apr 2014
From: Eduardo Samo Gudo, MD PhD [edited]


On 10 Apr 2014, Mozambique health authorities confirmed an outbreak of dengue fever centered in Pemba, the capital city of Cabo Delgado province in the north of Mozambique.

On 11 Mar [2014], local health authorities in Cabo Delgado reported an increased number of acute febrile patients who tested negative for Plasmodium, but presented with mild signs of hemorrhage in the skin or gums. With support of Field Epidemiology and Laboratory Training Program (FELTP), the Ministry of Health initiated an outbreak investigation.

From 22 reported suspected cases, 16 were laboratory confirmed as recent dengue virus infection using a battery of testing which included rapid tests in the field, IgM and NS1 antigen detection ELISA at Virus Isolation Laboratory, National Institute of Health in Maputo.

For further characterization and confirmation, blood samples were submitted to the Centre for Emerging and Zoonotic Diseases, National Institute for Communicable Diseases, National Health Laboratory Service in South Africa. Serological and molecular tests confirmed the findings from Mozambique. Further typing through molecular sequencing of PCR products and typing RT-PCR confirmed dengue 2 virus as the causative agent of the outbreak.

The Ministry of Health and local authorities are co-coordinating efforts to respond to and control the outbreak, including active case management, vector control measures, public health awareness and education. Most confirmed cases presented mildly and no deaths have been reported to date.

This is the 1st confirmed report of dengue fever in Mozambique since 1984 when an outbreak of dengue 3 [virus] was confirmed.

--
Eduardo Samo Gudo, MD PhD
Scientific Director of National Institute of Health
Moputo, Mozambique
samogudojr@gmail.com

[The 21 Apr 2014 edition of All Africa (http://allafrica.com/stories/201404220522.html) reports that there are 30 confirmed dengue cases in Cabo Delgado province.

ProMED thanks Dr. Gudo for this 1st hand report of a dengue outbreak in Mozambique. These kinds of 1st hand reports are very valuable, especially those from Africa, which do not come in frequently.

A HealthMap/ProMED-mail map showing the location of Cabo Delgado in Mozambique can be accessed at http://healthmap.org/promed/p/32600. - Mod.TY]

UNDIAGNOSED DISEASE, FATAL - UGANDA: WEST NILE REGION, REQUEST FOR INFORMATION
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Date: 28 Apr 2014
Source: Chimpreports.com East Africa [edited]
http://chimpreports.com/mobile/http://c ... -nile.html


A strange disease has broken out in West Nile region claiming 4 lives and sending 64 to hospitals. Obongi County MP [Member of Parliament] Fungaroo Caps, while addressing the press at Parliament today [28 Apr 2014], said the disease has symptoms of Ebola and cholera though not yet confirmed.

"It is a contagious disease which kills very fast. Moyo district is the most affected, and particularly Obongi county," Fungaroo added. The health centre of Obongi is already congested as more patients continue to flock in. "Tents are immediately required since patients are on the open veranda."

The disease reportedly broke out on Saturday [26 Apr 2014], and the Ministry of Health was alerted, but nothing has been done so far. "We call upon all charity organizations and other NGOs to quickly help us," Fungaroo appealed. He further observed that there is no proper treatment being given to the soaring numbers of patients apart from simple dehydration interventions.

"Women are the most affected, especially in Aliba and Imara sub-counties. Worse still, there is no ambulance on the ground."

People are being transported on boda bodas [motorcycle taxis] instead, which has caused more infections [of the drivers].

[Byline: Honeywell Dickens Okello]

--
Communicated by:
Jonathan Dyal
Johns Hopkins University School of Medicine
<jdyal1@jhmi.edu>

[We thank Jonathan for this report. He added that television broadcasts said that tests for cholera were negative.

The WHO Factsheets say:
- Cholera has a short incubation period, from less than one day to 5 days, and produces an enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients.

- Ebolavirus disease (EVD) has an incubation period of from 2-21 days. It is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache, and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.

The difference in the diarrhoea is that with cholera it is watery, clear and much more frequent than with EVD.

The Uganda Virus Research Institute (UVRI) -- where I worked 50 years ago, when it was the East African Virus Research Institute -- has the reagents to test for both ebolaviruses and Marburg virus. But West Nile district is quite remote from the capital, Kampala and the UVRI. The West Nile district (now a region containing several districts) was where the 1st isolation of West Nile virus (WNV) was made from a fever patient. WNV causes a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea, or rash. Cholera and Ebola do not cause joint pains.

We would be glad to receive any follow-up reports. We received follow-up to only one of the 5 outbreaks listed below; we would still like to know what those were due to. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/97.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (15): AFRICA
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In this update:
[1] Cholera - UK (England) ex Tunisia (Hammamet) 2013, suspected
[2] Cholera - Nigeria

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[1] Cholera - UK (England) ex Tunisia (Hammamet) 2013, suspected
Date: Mon 28 Apr 2014
Source: Daily Mail [edited]
http://www.dailymail.co.uk/travel/artic ... nisia.html


A holidaymaker is launching legal action against a travel company claiming his break to Tunisia was ruined after he contracted cholera. The man was on a romantic getaway with his partner when he claims to have been hit by the infection, which is usually confined to developing countries.

The 47-year-old alleges he suffered diarrhea throughout the 12-day break at the Sol Azur Hotel, and was doubled over in pain throughout the trip. He believed it to be food poisoning but visited a doctor when the symptoms continued after he returned home to be diagnosed with cholera -- a bacterial infection caused by eating food which has been in contact with feces.

The architect, from Telford, Shropshire, said the 1st thing the couple noticed when they arrived at the 3-star hotel in September 2013, was the smell of 'raw sewage'. 'We arrived in the middle of the night, and the 1st thing we noticed was the smell of raw sewage -- it was absolutely unbelievable,' he said.

[Byline: Carol Driver]

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[This case is not likely to be cholera, based on the complaint of abdominal pain (cholera is usually painless) and in reviewing WHO statistics on worldwide cholera, there has not been a case officially reported from Tunisia in the past 10 years. It is possible that a non-O1, non-O139 _Vibrio cholerae_ was involved or a non-cholera vibrio such as _V. parahaemolyticus_.

In 2012, it was reported (http://allafrica.com/stories/201208030056.html) that systematic analyses of the wastewater samples detected in the presence of _Vibrio cholerae_ in one single sample from the Rades Meliene-based wastewater treatment station. The Public Health Ministry reassured the public that such germs represent no risk for the people's health, which is confirmed by the epidemiological situation characterised by the absence of human cases of cholera since 1982. However, cases of cholera were reported in travelers to Tunisia in 1997 (http://www.eurosurveillance.org/ViewArt ... cleId=1038) in a German vacationer in Mahdia, Tunisia which was identified as an O1 _V. cholerae_. The Sol Azur Beach Hotel is in Hammamet, Tunisia about a 2-hour drive from Mahdia. - Mod.LL]

[The Sol Azur Beach Hotel is one of the cheapest in the area, and has not had good reviews on the internet in 2013. - Mod.JW

Maps of Tunisia can be seen at http://www.planetware.com/i/map/TUN/tunisia-map.jpg and http://healthmap.org/promed/p/30696. - Sr.Tech.Ed.MJ]

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[2] Cholera - Nigeria
Date: Sat 12 Apr 2014
Source: AllAfrica, Weekly Trust [edited]
http://allafrica.com/stories/201404140670.html


A new wave of cholera epidemic blowing across the country may have claimed hundreds of lives since January 2014 and does not seem to be abating anytime soon with the onset of the rainy season, Weekly Trust findings reveal.

The Nigerian Centre for Disease Control (NCDC) has confirmed an outbreak of the infectious disease in 14 states, where it said 9006 cases were reported, with 106 deaths in the 1st quarter of 2014, adding that the situation was not this critical in 2013. But state health officials say the casualty figures for the last 3 months could be much higher as deaths that happened outside health facilities, which are many, are not officially reported, while many others do not even know the cause of death.

The NCDC report shows that Bauchi, where 6910 cases were reported with 48 deaths, is the worst hit of the 14 states; Kano had 1270 cases with 16 deaths, while 3 of the 28 cases in the Federal Capital Territory (FCT) ended in fatalities.

In Kaduna State, 350 cases were recorded with 19 deaths, while 4 died from the 97 cases reported in Benue, 6 died in Taraba from the 190 cases reported and 6 again in Ebonyi from 16 recorded cases.

The NCDC report said the lot of the country turned for the worst in the 12th week [week of 17 Mar 2014]. Between weeks 1 and 12 of 2014, 9006 cholera cases with 81 lab-confirmed and 106 deaths from 58 local government areas (13 States and the FCT -- Federal Capital Territory, the home of Abuja, the capital of Nigeria) were reported.

But Bauchi State Commissioner for health, Dr Abubakar Sani Malami, told a news brief on Thu 10 Apr 2014, that 59 people died of cholera in the state in the last 3 months. He said 54 of them died in their homes and 5 in hospital. "The state recorded a high casualty figure because some of the victims were treating themselves at home," he said.

Local health workers and Medecins Sans Frontieres (MSF) told Weekly Trust in Zamfara that over 1117 cholera cases were reported in at least 5 local government areas of the state within 2 weeks. These are Gusau, Durumi, Gukkuyum, Sakura, and Maradu. At least 72 of the victims died of the infection, not including those who died before they could get medical help, local officials said. But reports by MSF indicate that the death toll from the epidemic could be as high as 350 people in Zamfara alone. Hospital sources said about 90 fresh cases were reported at the Shagari Primary Health Care Center among other health facilities in the state this week alone. Many more are being expected.

One of the worst hit communities in Plateau State is Anguwan Yashi, in Namu area of Qua'an Pan Local Government Area, which recently saw the influx of thousands of refugees from neighbouring Nasarawa State fleeing from communal crisis, putting pressure on the only source of drinking water and other facilities in the village. The Plateau State government has confirmed that 11 people died of cholera while the community puts the casualty figure at more than 30. None could, however, dispute that over 100 people had been infected and treated from the disease.

"Both indigenes of the village and the displaced have been affected because we now live together. And I can count over 10 of the indigenes that have died from this disease, including my brother's wife, my neighbor, and her daughter," said Alhaji Abubakar Sadiq, the district head of Namu. Cholera outbreaks were reported in several other parts of the state with no official records of cases, sometimes due to the remote nature of such locations or just because of the attitude of the people to health issues.

At least 2 local areas of Sokoto State have experienced an outbreak of cholera in 2014, Tambuwal and Kebbe, where scores of people have died of infection, investigations by Weekly Trust revealed. But the state government said only 13 out of the 152 cases reported there ended in fatalities. In Barkeji alone, a village located along Sokoto-Jega road in Tambuwal local government area where the disease was said to have first surfaced, 31 cases and 5 deaths were recorded between 10 and 21 Oct 2013 officials said. In Kebbe local government area, about 20 kilometres [12.4 mi] from Tambuwal, the disease resurfaced in 6 riverine communities, including Bakin Dutse, Tuna, 'Yar-Romo, Nabasa, Fakku, and Bashi, with 8 deaths out of 121 cases reported.

Scores of people in Kano metropolis are now bedridden and agonizing as a result of the sudden outbreak of cholera in some parts of the state. The cholera epidemic struck the communities 10 days ago and has so far claimed the lives of over 12 persons.

In Lagos state cholera outbreak in 5 local government areas has so far claimed at least 3 persons, while scores of victims were treated and discharged, state commissioner for health, Dr Jide Idris, said. "Although, many of the cases have been treated and discharged in several health facilities, 3 have been confirmed dead. Most of the suspected cases are from Ajeromi, Apapa, Lagos Island, Oshodi-Isolo and Surulere local government areas," Idris said.

[Byline: Ruby Leo, Lami Sadiq, Onimi Alao, Abubakar Auwal, Isa Liman, Ahmed Mohammed]

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Nigeria has been hit quite hard by cholera this year (2014). - Mod.LL

Maps of Nigeria can be seen at http://www.un.org/Depts/Cartographic/ma ... igeria.pdf and http://healthmap.org/promed/p/62. - Sr.Tech.Ed.MJ]

[Cholera can be effectively treated with home-made oral rehydration sugar-salt solutions http://rehydrate.org/solutions/homemade.htm#recipe, but if that does not produce any improvement,the patient should be hospitalized.
- Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/62.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (16): AFRICA
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in this update:
[1] Cholera - Somalia (Mudug Region)
[2] Cholera - Congo DR (Katanga Province)

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[1] Cholera - Somalia (Mudug Region)
Date: Wed 30 Apr 2014
Source: Radio Bar-kulan [edited]
http://www.bar-kulan.com/2014/04/30/cho ... ug-region/


At least 3 children have been reported to have died of cholera in an outbreak in Ba'adweyne village in the central Somali region of Mudug.

Mohamed Said Ahmed, an official from Ba'adweyne told Bar-kulan that the cholera cases have been reported in the area 3 days ago. He added that there has not been any emergency response to counter the outbreak and appealed for immediate assistance.

Meanwhile, Dr Mohamed Ahmed Shino who is one of the medical practitioners in Galkayo Hospital stated that at least 13 people affected by the cholera outbreak including elderly and children have been admitted to the hospital. Dr Shino believes that the cholera outbreak was caused by contaminated water coupled with a searing heat in the region.

--
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[Maps of Somalia can be seen at http://www.ephotopix.com/image/africa/s ... al_map.gif and http://healthmap.org/promed/p/28197. - Sr.Tech.Ed.MJ]

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[2] Cholera - Congo DR (Katanga Province)
Date: Wed 23 Apr 2014
Source: Radio Okapi [in French, machine trans., edited]
http://radiookapi.net/actualite/2014/04 ... cinq-mois/


Approximately 1054 cholera cases including 43 deaths have been recorded between November 2013 and April 2014 in the city of Likasi, located 120 km [74.5 mi] north of Lubumbashi (Katanga). The health district of Likasi has delivered this figure on [Wed 23 Apr 2014], during the weekly meeting of epidemiological surveillance.

The doctor inspector of this health district, Dr Gaspard Ilunga Dipata, regretted that the number of sick due to cholera continues to increase in spite of the awareness, the chlorination of water, and disinfection. He has indicated that the cholera treatment center records an average of 3 cases per day, the majority from the commune of Kikula.

The NGO Oxfam is also committed to repairing the leaks of water observed in the Regideso [charged with the production and distribution of water to residential, commercial, and industrial customers] piping system.

Between October 2012 and June 2013, the city of Likasi registered 894 cholera cases including 34 deaths.

--
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[Likasi (former official names: Jadotville (French) and Jadotstad (Dutch)) is a city in Katanga Province, in the south-east of the Democratic Republic of Congo (http://en.wikipedia.org/wiki/Likasi). - Mod.LL

Maps of the Democratic Republic of the Congo can be seen at http://www.mapsofworld.com/democratic-r ... al-map.jpg and http://healthmap.org/promed/p/16370. - Sr.Tech.Ed.MJ]

[OXFAM and the government should also consider distributing the recipe for home-made oral rehydration solution to households in the hardest hit areas. Cholera can be effectively treated with this http://rehydrate.org/solutions/homemade.htm#recipe, but if that does not produce any improvement, the patient should be hospitalized. - Mod.JW ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (17): AFRICA
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In this update:
Africa
[1] Cholera - Uganda (West Nile Subregion)
[2] Shigellosis - Angola (Luanda Province) suspected

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[1] Cholera - Uganda (West Nile Subregion)
Date: Thu 1 May 2014
Source: New Vision [edited]
http://www.newvision.co.ug/news/655136- ... ts-92.html


The number of people hospitalized following an outbreak of cholera in the West Nile districts of Moyo and Adjumani is now over 92, health officials have said. And the infection has caused the death of one more person, a 45-year-old, bringing the number of the dead to 5. Dr. Dominic Lomureju, the Moyo district health inspector, said the number of admissions at the Obongi Health Centre IV (the main health facility containing the epidemic) were now 90, with 28 cases discharged.

Two more cases are admitted at the Lefori Health Centre III, in Lefori Sub County, Dr. Jimmy Opigo, the district health officer said. Drani Buga Geoffrey, the in-charge of the health centre, said the 2 admitted were children aged 5 and 9.

The cholera epidemic, which was 1st reported on 26 Apr [2014] in Obongi County, presents with high fever, abdominal pain, diarrhea and vomiting, resulting in dehydration. If untreated, it can kill. Opigo said the disease was likely to spread to the rest of Moyo district if measures like sensitizing the local people about sanitation and proper disposal of human feces, were not made a priority.

[Byline: John Agaba and Lazerous Amoli]

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[A HealthMap/ProMED-mail map of Uganda is available at http://healthmap.org/promed/p/97.]

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[2] Shigellosis - Angola (Luanda Province) suspected
Date: Wed 30 Apr 2014
Source: Noticias ao Minuto [in Portuguese, machine trans., edited]
http://www.noticiasaominuto.com/mundo/2 ... os-num-mes


In statements to the Lusa agency, the chief of the department of public health, the Provincial Director of Health of Luanda, Regina Anthony, said that the outbreak struck mostly the area of Cuca, in the commune of Hojis. According to Regina Antonio, the outbreak was notified at the beginning of March (2014), the deaths having been recorded mostly in children younger than 5 years. She mentioned the late arrival at the hospitals as the reason for more than a dozen deaths, adding that the screening continues to verify the actual number of deaths.

There was no need to do a laboratory study to determine the causative agent of diarrhea and confirmed that it was caused by the bacterium _Shigella_," said the doctor [presumably because of blood in the feces. The URL includes the words "diarreia hemorragica" (hemorrhagic diarrhea - Mod.JW]. As preventive measures, health authorities have moved to that community to identify the actual number of people affected and make recommendations. Diarrhea is the 3rd most severe disease in Angola, after malaria and acute respiratory diseases.

Regina Anthony said that in view of the heavy rains, conducive to the increase in the number of cases of diarrhea, the Ministry of Health has carried out actions of prevention, with emphasis on the areas of greatest risk, which have already recorded outbreaks of cases of cholera. "Our greatest concern is prevention."

--
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[A HealthMap/ProMED-mail map of Angola is available at http://healthmap.org/promed/p/12461.]

UNDIAGNOSED DEATHS, HUMAN, AVIAN, FISH - SUDAN: CYANIDE SUSPECTED
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Date: Thu 1 May 2014
Source: Radio Dabanga.org [edited]
https://www.radiodabanga.org/node/72125

[Apologies for duplicate posting. The original version did not go out to the AHEAD or EDR lists. - ProMED.]

"Apart from the unusual increase of cancer cases among the people in Wadi Halfa [Northern State, Sudan], fish are dying, and birds drop
dead from the sky," a resident from Wadi Halfa told Radio Dabanga. A resident said the government was allowing gold exploration. "It
allowed its gold exploration companies to use cyanide."

"Cyanide spreads through the air, and can reach places over a distance of 150 km [about 93 miles]. [But see comment below]. This has caused the large increase of cancer cases, and the pollution of the water and the air, with the result that large numbers of dead fishes are now floating on the Nile, and birds are dropping dead."

The Sudanese government planned to transform the Nile, the only stretch of fertile land north of Khartoum, into a string of 5 reservoirs. The Merowe dam, built by Chinese, German and French companies on the Nile's 4th cataract, was completed in 2009. It doubled Sudan's electricity generation, but displaced more than 50 000 people from the Nile valley to arid desert locations. Thousands of people who refused to leave their homes were flushed out by the reservoir, and protests were violently suppressed.

"Next in line are the Kajbar and Dal dams," Peter Bosshard, the policy director of International Rivers wrote in 2011. The Kajbar dam on the Nile's 3rd cataract would create a reservoir of 110 square kilometers [about 42 square miles], and generate 360 megawatts of electricity. The project would displace more than 10 000 people and submerge an estimated 500 archeological sites. The Dal Dam on the 2nd cataract is planned to have a capacity of 340-450 megawatts. It would displace 5000 to 10 000 people.

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

[[Cyanide is a naturally occurring chemical that is found in low
concentrations throughout nature including in fruits, nuts, plants,
and insects. It has been used by the mining industry to separate gold
and silver particles from ore for over 120 years. With proper
management, cyanide can be used safely and without harming the
environment, despite its toxicity.

Cyanide is also a useful industrial chemical; over one million tonnes
of it are used annually in electroplating, metal processing, the
production of organic chemicals and plastics, and in photographic
applications [2]. The mining industry uses less than 20 percent of the
global production of industrial cyanide [2, 4].

Cyanide, in the form of a very dilute sodium cyanide solution, is used
to dissolve and separate gold from ore [3]. Cyanide leaching is
considered to be a much safer alternative to extraction with liquid
mercury, which was previously the main method of removing gold from
ore [5]. Cyanide leaching has been the dominant gold extraction
technology since the 1970s, although small-scale and artisanal miners
continue to use mercury in some areas of the world [3]. In Canada,
more than 90 percent of mined gold is extracted from ore using cyanide
[3].

The concentration of cyanide used in this process is normally in the
range of 0.01 percent and 0.05 percent sodium cyanide (100 to 500
parts per million) [2]. As part of their best practices, mines use as
little cyanide as possible for safety, environmental, and economic
reasons [2]. Cyanide leaching is usually done along with a physical
process like milling, crushing, or gravity separation. The pH of the
resulting slurry is raised by adding lime or another alkali to ensure
that cyanide ions do not change into toxic cyanide gas (HCN) [6]. The
gold is then further concentrated and reduced, before being smelted
into gold bullion.

Cyanide is toxic in large doses and is strictly regulated in most
jurisdictions worldwide to protect people, animals, and the aquatic
environment. Cyanide prevents the body from taking up oxygen,
resulting in suffocation, which may be fatal to humans and animals
without prompt 1st aid treatment [7]. However, people and animals can
rapidly detoxify non-lethal amounts of cyanide without negative
effects, and repeated small doses can be tolerated by many species
[3]. Some long-term health effects including goiter and depressed
thyroid function have been observed in people who have a diet high in
cyanide-containing plants such as cassava, and [8].

In fact, "[d]espite its high human toxicity, there have been no
documented accidental human deaths due to cyanide poisoning in the
Australian and North American mining industries over the past 100
years. which indicates that the hazard of cyanide to humans has been
controlled by minimizing the risk of its handling and of industrial
exposure" [6, p. 4]. Even in areas where cyanide is used extensively
by artisanal miners with limited waste containment and safety
practices, "human fatalities are relatively minimal particularly when
compared with [those due to] mercury or other hazards" [9, pp.
109-110].

In high concentrations, cyanide is toxic to aquatic life, especially
fish, which are 1000 times more sensitive to cyanide than humans [10].
Because the greatest environmental threat from cyanide to aquatic life
is from intentional or unintentional discharges into surface waters,
water monitoring and water management on mine sites is very important
[11]. Regulations frequently limit the amount of cyanide which may be
discharged into the environment, and there are a number of water
treatment technologies available to remove cyanide from mine water
[2].

Birds and other wildlife are also potentially at risk from cyanide
poisoning if they are using tailings ponds for drinking or swimming
[12]. [Tailing ponds are areas where tailings (leftover waterborne
rock) is pumped into a pond to allow the settling out of solid
particles from the water. - Wikipedia]. In order to prevent wildlife
fatalities, cyanide levels in tailings ponds can be reduced to safe
levels by minimizing the amount of cyanide used, removing cyanide in
waste streams and recycling it, and by using chemical or biological
reactions to convert the cyanide into less toxic chemicals [13]. A
standard of 50 mg/L weak acid dissociable (WAD) cyanide is widely
accepted to be a safe level for water accessible to wildlife, and has
essentially eliminated the number of migratory bird deaths from this
cause [6, 11]. Only a few hundred birds are killed by cyanide each
year [11]. Deterrents like fencing, polyethylene balls, and netting
are also used to keep birds out of water bodies on mine sites [3].

Cyanides do not cause cancer, and do not build up in the food chain
[12]. They do not persist in the environment, and are quickly broken
down into less toxic chemicals by sunlight and air. So if birds are
falling from the sky and fish are dying, the concentration of cyanide
must be very high. However, it is unlikely to travel the distances
mentioned in this article, as it would dissipate in the air. If it did
travel that far, there would be scores of dead people. So while this
article discusses hydro-power plants, dead animals, sick people and
gold mining, it seems like a thorough epidemiological investigation is
needed into why the people are ill and there are dead birds and fish.
It may likely not be cyanide but some other chemical or metal.

Portions of this comment were extracted from
http://www.miningfacts.org/environment/ ... in-mining/.

Sudan may be found on the interactive HealthMap/ProMED-mail map at
http://healthmap.org/promed/p/30885.

References:
1. Canada, Canadian Food Inspection Agency. Natural Toxins in Fresh
Fruit and Vegetables. 2012 [cited 2012 June 14]; Available from:
http://www.inspection.gc.ca/food/consum ... 2276685336.
2. Minerals Council of Australia. Fact Sheet -- Cyanide and its Use by
the Minerals Industry. 2005.
3. Eisler, R. and S.N. Wiemeyer. Cyanide Hazards to Plants and Animals
from Gold Mining and Related Water Issues. Reviews of Environmental
Contamination and Toxicology, 2004. 183: p. 21-54.
4. InfoMine. Summary Fact Sheet on Cyanide. n.d. [cited 2012 July 30];
Available from:
http://www.infomine.com/publications/do ... yanide.pdf.
5. Ophardt, C.E. Conversion of Gold Ore to Gold Metal. Virtual
Chembook: Gold Processing. 2003 [cited 2012 July 30]; Available from:
http://www.elmhurst.edu/~chm/vchembook/327gold.html.
6. Australia Government, Department of Resources, Energy and Tourism.
Cyanide Management. 2008. Commonwealth of Australia.
7. Canada, Health Canada. Cyanide. Environmental and Workplace Health
2008 [cited 2012 June 11]; Available from:
http://hc-sc.gc.ca/ewh-semt/pubs/water- ... ex-eng.php.
8. International Cyanide Management Institute. Cyanide Facts. 2012
[cited 2012 June 21]; Available from:
http://cyanidecode.org/cyanidefacts.php.
9. Hinton, J.J., M.M. Veiga, and A.T.C. Veiga. Clean artisanal gold
mining: a Utopian approach? Journal of Cleaner Production. 2003. 11.
10. UNEP/OCHA. The Cyanide Spill at Baia Mare, Romania: Before, During
and After. P. Csagoly, Editor. 2000. The Regional Environmental Center
for Central and Eastern Europe.
11. Mudder, T., M. Botz, and K.A. Hagelstein. A Global Perspective on
Cyanide Use and Management. [Online course] 2006 Version: 10 July 2006
[cited 2012 February 2]; Available from:
http://www.edumine.com/xutility/html/me ... =Xcyunara0.
12. Laberge Environmental Services. Cyanide -- The Facts. 2001 [cited
2012 July 25]; Available from:
http://www.geology.gov.yk.ca/pdf/MPERG_2001_2.pdf.
13. Botz, M. Overview of Cyanide Treatment Methods. The Gold
Institute, Editor. 1999. Available from:
http://www.infomine.com/publications/docs/Botz1999.pdf.
- Mod.TG]]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (18): AFRICA
***************************************************
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ProMED-mail is a program of the
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http://www.isid.org

In this update:
[1] Cholera - Nigeria (Plateau State)
[2] Diarrhea - Somalia (Galguduud Region)

******
[1] Cholera - Nigeria (Plateau State)
Date: Tue 6 May 2014
Source: Leadership [edited]
http://allafrica.com/stories/201405060094.html


At last 20 people have been feared killed, while 32 are currently hospitalized following a cholera outbreak in Barkin town of Barkin Ladi local government, Plateau State. A member of the community confided in Leadership that 20 people had so far lost their lives as a result of the outbreak.

The council chairman, Emmanuel Loman, in a telephone interview in Jos, the state capital, however, said only 5 people had lost their lives to the outbreak of the disease, while 32 were hospitalized and were responding to treatment. He said the council had made drugs available for the treatment of those hospitalized and had also set aside a day to sensitise the people on the need to wash fruits very well before eating them and to live in a clean environment.

Loman identified poor hygiene as one of the major causes of cholera and advised the people to keep their environment clean, wash fruits before eating, avoid staying in a congested environment, and report to the nearest hospital for appropriate action in cases of frequent stooling and vomiting in their area.

[Byline: Achor Abimaje]

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******
[2] Diarrhea - Somalia (Galguduud Region)
Date: Sun 20 Apr 2014
Source: Somali Current [edited]
http://www.somalicurrent.com/2014/04/20 ... dp-camp-2/


At least 16 internally displaced people (IDPs) from Abud-waaq district were reported to have been seriously suffering from diarrhea. Those people live in a concentrated IDP Camp called Dayacan in Abud-waaq, where hundreds of civilians displaced by the ongoing fighting inside south and western Somalia live.

Head of Social Affairs of Abud-waaq district Kalif Abdisamad Ali, speaking to the media, said that they have taken those 16 persons who were in a dire condition to a privately owned hospital in Abud-waq district. Mr. Kalif added that those people took contaminated water stored in tanks in the camp and then used it for drinking. He mentioned that there are fears of possibly spreading the disease to the other people in the camp.

--
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[The etiology of the diarrhea outbreak in the internally displaced persons [IDP] camp in Central Somalia is unclear, but cholera is common, often referred to as acute watery diarrhea. - Mod.LL

A HealthMap ProMED-mail map of Nigeria can be accessed at http://healthmap.org/promed/p/62 and for Somalia at http://healthmap.org/promed/p/125.]

RABIES - ZIMBABWE (02): (MANICALAND) HUMAN, CANINE
**************************************************
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Date: Fri 9 May 2014
Source: Manica Post [edited]
http://www.manicapost.com/index.php?opt ... Itemid=131


Another child has succumbed to the deadly rabies virus at Rusape General Hospital after being attacked by a rabid dog at her parents' home in St Theresa, Makoni West [Manicaland Province]. Sources at Rusape General Hospital confirmed the death of CM (2) on Wednesday [7 May 2014] as the rabies-related deaths continue to rise in the district.

The minor was attacked by a rabid dog about a month ago [April 2014] and her condition deteriorated on Sunday [4 May 2014] when her parents rushed her to St Theresa Hospital where she was transferred to the district referral hospital. Apart from being infected with the deadly virus, CM sustained injuries which were treated at St Theresa. Her parents were advised to take her to Rusape General Hospital for rabies vaccines, but did not do so after failing to raise money for the doses. The rabies vaccine costs [USD] 35 per dose.

The rabid dog which attacked [the child] is said to be alive and prowling the area, raising rabies scare and serious concerns over the safety of children, who are particularly at higher risk because of their proximity to pets.

"She died this morning. She was exhibiting some schizophrenic behaviour prior to her death. The condition could not be reversed as the rabies had taken long before being treated and was already manifesting," said a source at the hospital. A relative [of the child] who refused to be named blamed St Theresa medical staff for the death of the child. "When she was bitten by the dog, her parents took her to the local hospital where the nurses just treated the wound and told the parents to look for [USD] 80 to take her to the veterinary department for tests to determine whether or not the dog had rabies.

"This scared off her poor parents who opted to stay with her home, yet the correct procedure was to refer the minor to Rusape General Hospital for rabies treatment. They must have assigned an ambulance to transfer her to Rusape because rabies can only be treated within 24 hours," said the source.

The incident came barely a month after 6 pupils from Chigudu Primary School (Chiendambuya) were bitten by rabid dogs prowling the area. The worst attacked victim was a Grade Zero pupil. The victim was admitted at Rusape General Hospital for several days and had his face stitched. Poor implementation of licensing and vaccination of pets are the main reasons for the menace, which need to be addressed immediately. In situations where the owner refuses, the community contacts local law enforcement officials amid consensus that one need not make choices between human life and animal rights when it comes to stray dogs.

Makoni District Medical Officer, Dr Alfred Kumbirai, confirmed the incident and said all victims were treated and discharged. Dr Kumbirai could not take further questions, saying he was on leave. He referred The Manica Post to hospital medical superintendent Dr Tembo, who was not readily available for comment. The Makoni District Veterinary Officer Dr Edwin Kupahwana is on record encouraging the community to eliminate all suspected rabid dogs as they were a danger to the community, especially children.

Rabid animals lose their fear of humans and wander into human dwellings.

--
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[Sometimes we get too used to the numbers and fail to see the human tragedy embedded in them. If treatment with immunoglobulin and vaccine had been initiated soon after this child was attacked, she would be alive and thriving. With family poverty and a weak infrastructure she was condemned to die and in pain from the moment she was bitten.

Rabies is a countrywide problem in Zimbabwe and has been so for some years. There are no hard numbers latterly; OIE merely reported "+" for human cases and deaths from 2009 to 2012; 2008 and 2013 were blank. Gideon listed the following numbers of animals reported with rabies: 2008 (209), 2009 (213), 2010 (234), 2011 (184), 2012 (160), and 2013 (blank); see: http://web.gideononline.com/web/epidemi ... type=drugs.

For maps of Zimbabwe, see: http://www.lib.utexas.edu/maps/africa/z ... o-2002.jpg and http://healthmap.org/r/3EUp. Manicaland Province is in the east on the border with Mozambique. For Rusape, see: http://www.fallingrain.com/world/ZI/00/Rusape.html. For a description of Rusape, go to: http://en.wikipedia.org/wiki/Rusape. - Mod.MHJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (19): AFRICA
*********************************************************
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******
Cholera - Nigeria (Zamfara), NOT
Date: Tue 13 May 2014
From: Agatha Bestman <nigeria-medco@oca.msf.org> [edited]


This is concerning the post dated 12 Apr 2014 on cholera in Nigeria. Medecins Sans Frontieres is quoted to have treated over 1117 cholera cases in Zamfara in at least 5 local government areas (LGAs) of the state within 2 weeks. We have not made such a report.

We are not currently responding to any cholera outbreaks in Zamfara. We do weekly surveillance, and no cases have been reported by Shagari Primary health centre or any of the LGAs mentioned in Zamfara in 2014. We did respond to a cholera outbreak in Gusau LGA in October 2013 and so presume this is an old report.

--
Ruby Siddiqui
Epidemiologist
Medecins Sans Frontieres - UK

Agatha Bestman
Medical Coordinator
Medecins Sans Frontieres - Nigeria
<nigeria-medco@oca.msf.org>

[ProMED thanks MSF personnel for correcting information regarding the current cholera situation in Zamfara State. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/62.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (20): AFRICA
******************************************************************
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*****
Cholera - Nigeria (Gombe State)
Date: Thu 15 May 2014
Source: Spy Ghana [edited]
http://www.spyghana.com/high-cholera-ca ... -in-gombe/


Gombe State Government [Nigeria] says it has recorded 5 cases of cholera in the state this month [May 2014] and intensifying efforts to check further occurrence of the disease. The state's epidemiologist, Dr Joshua Abubakar, said in Gombe on Wed 14 May 2014, that over 30 cases of gastroenteritis were also reported in the state recently.

Abubakar said that 5 of the 30 reported cases of vomiting and diarrhoea were confirmed as cholera. He said that the cholera cases were reported from Akko Gombe and Yamaltu/Deba local government areas of the state.

The epidemiologist said that there was no single case of cholera reported in the state in 2013. He advised the residents of the state to imbibe personal hygiene and ensure that they washed their hands with soap or potash and water, after using the toilet. He also advised them to drink clean and uncontaminated water, and wash vegetables and fruits before eating them.

--
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[Maps of Nigeria can be seen at http://www.un.org/Depts/Cartographic/ma ... igeria.pdf and http://healthmap.org/promed/p/1280. - Sr.Tech.Ed.MJ]

DENGUE/DHF UPDATE (36): AFRICA
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*****
Tanzania (Dar es Salaam)
10 May 2014

Dengue at least 305 cases; Municipality most affected, with cases increasing "at an alarming rate," Kinondon.

[A HealthMap/ProMED-mail map showing the location of Tanzania in East Africa can be accessed at http://healthmap.org/promed/p/200. - Mod.TY]

--
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CHOLERA, DIARRHEA AND DYSENTERY UPDATE (21): SOUTH SUDAN (CENTRAL EQUATORIA)
****************************************************************************
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Date: Thu 15 May 2014
Source: ReliefWeb, South Sudan Ministry of Health press release [edited]
http://reliefweb.int/report/south-sudan ... outh-sudan


Ministry of Health, Republic of South Sudan is concerned of the ongoing cholera situation in Juba, and it's formally declaring cholera outbreak in Juba, Central Equatoria State. To date [15 May 2014], 18 suspected cholera cases have been reported in Juba with one death, one of whom was laboratory confirmed on 6 May 2014, following tests conducted by the AMREF laboratory in Nairobi. The 18 suspected cases reported so far originate from Gudelle 2, Gudelle 1, Juba Nabari, Jopa, Kator, Gabat, Mauna, Newsite, MTC, Nyakuron, and Munuki block A. There are 14 suspected cases currently admitted at the isolation ward in Juba Teaching Hospital, 6 males and 8 females, and one case at IBI clinic in Gudelle. The 1st index case did not seek treatment and has reportedly improved, while the 2 contacts of the confirmed case are well and have not developed any symptoms and signs.

The Ministry of Health and WHO have taken steps to conduct comprehensive investigations and are currently on the ground following up all the contacts of the cases. The Ministry of Health is aware of the appalling conditions of the IDPs [internally displaced persons] in the camps; namely overcrowding, poor hygiene and sanitation favorable for a potential cholera outbreak; however, the Ministry is working with health and WASH cluster partners on the ground to ensure that the risk of the outbreak spreading is minimized.

The Ministry of Health with the support of WHO, UNICEF, MSF, IOM and Medair have conducted cholera vaccination campaigns in Mingkaman, Malakal, Bor, Tomping and Juba III in an effort to prevent a possible cholera outbreak among the IDPs. However, a lot of interventions still need to be put in place such as water and sanitation to ensure that outbreak is promptly contained.

Over 80 000 people have been fully vaccinated against cholera with 2 doses in IDP camps. With more coverage expected in Bor where the 1st round has already happened, and plans are in place to conduct the OCV [oral cholera vaccination] campaign in Bentiu. It's important to note that the confirmed case had only received one dose of the cholera vaccine.

--
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[This could be the beginning of a major outbreak of cholera given the overall conditions in the area. It would be useful to see if the previous mass immunization with a cholera vaccine could have blunted the impact of cholera in this population. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/27439.]

SCHISTOSOMIASIS - SUDAN: (DARFUR)
*********************************
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Date: Wed 7 May 2014
Source: All Africa, Radio Dabanga report [edited]
http://allafrica.com/stories/201405070440.html


The Federal Ministry of Health has revealed that the Darfur states are on the list of Sudanese states most stricken by schistosomiasis (bilharzia).

In particular the population of South Darfur is suffering from the disease. Bilharzia there has risen by 70 percent, which brings it to an equal level with the state of North Kordofan. "The mortality rates due to schistosomiasis are very high," an official of the Health Ministry reported to the press on Tuesday [6 May 2014]. There are no localities in Sudan free of bilharzia.

Schistosomiasis is a type of infection caused by parasites that live in fresh water, such as rivers or lakes, in subtropical and tropical regions worldwide. Symptoms can develop a few weeks after someone is infected, and include flu-like symptoms, such as a fever and muscle aches, skin rash, and coughing.

More serious symptoms can develop months, and possibly years, after infection, and include cystitis, blood in the urine, bloody diarrhea, abdominal pain or cramps, vomiting blood, and paralysis of the legs. Doctors refer to this as chronic schistosomiasis.

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[Schistosomiasis is endemic in Sudan. A recent survey from Southern Kordofan State (Abou-Zeid AH et al. Schistosomiasis infection among primary school students in a war zone, Southern Kordofan State, Sudan: a cross-sectional study. BMC Public Health. 2013 Jul 11;13:643) found a prevalence of 27 percent in school children. Another survey from the River Nile State (Elmadhoun WM et al. Situation analysis of schistosomiasis and soil-transmitted helminthes in River Nile State, Sudan. Trans R Soc Trop Med Hyg. 2013 Mar;107(3):195-9) found that the prevalence of _Schistosoma haematobium_ in schoolchildren in the River Nile State was 1.7 percent with variation between localities (range = 0.58-3.5 percent). No _S. mansoni_ infection was detected, and the prevalence rate for intestinal helminthes was 0.1 percent. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/96.]