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MALARIA - EGYPT: (ASWAN) REQUEST FOR INFORMATION
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Date: Fri 30 May 2014
From: Abdallah Samy <samyasu@aol.com> [edited]


Malaria in Aswan, Egypt
-----------------------
Today [30 May 2014], Egypt's health ministry announced the presence of 11 cases positive for malaria in Aswan. Most of these cases now attend the clinics at Edfu Fever Hospital. Most Egyptian news reported that all of these cases came from a single village in Edfu (Al-Adwa).

[A Ministry of Health team works in the field] for disease surveillance and to evaluate the possibility of disease risk. Scientists in Egypt are interested in knowing if these cases are imported from a neighboring country or not.

A new call for a malaria control program in Egypt may be needed after the successful control program for malaria and the absence of malaria infection circulation during the last years.

--
Abdallah Samy
Ain Shams University (Cairo, Egypt) and the University of Kansas (USA)
<samyasu@aol.com>

[Egypt reported 179 malaria cases in 2012 (World Malaria Report 2013, http://www.who.int/malaria/publications ... t_2013/en/) but it is not reported whether they were imported or autochthonous cases.

There is still malaria in Egypt and 2 studies from 2009 highlight the focus in El-Fayoum Governorate (Faiyum Oasis). The 1st study (Dahesh SM et al: Malariometric parasitological survey in El-Fayoum Governorate, Egypt. J Egypt Soc Parasitol. 2009; 39(1): 213-25; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19530623) found 52 cases of _Plasmodium falciparum_ out of 7236 examined. In 74 percent of the parasite positive cases gametocytes were found.

The 2nd study (Dahesh SM et al: Socioeconomic and environmental factors affecting malaria infection in Fayoum Governorate, Egypt. J Egypt Soc Parasitol. 2009; 39(2): 511-23; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19795758) found that the risk of malaria infection increased with the decrease in socioeconomic status and educational level. The indoor use of 5 percent malathion did not affect the malaria infection.

Thus, the reported focus in Aswan seems to be new, and ProMED will be happy to post further information. - Mod.EP

Maps of Egypt can be seen at http://www.fao.org/ag/AGP/AGPC/doc/Coun ... s/fig1.jpg and http://healthmap.org/promed/p/12468. - Sr.Tech.Ed.MJ

A map showing Edfu, a sacred site on the Nile is at
http://www.asia-pictures.net/egypt/imag ... 20Ombo.jpg.

Photos and history of Edfu temple are at
http://www.sacred-destinations.com/egypt/edfu. - Mod.JW]

HEPATITIS - KENYA: (NYERI)
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Date: Fri 30 May 2014
Source: The Star [edited]
http://www.the-star.co.ke/news/article- ... t-outbreak


2 pupils of Karichuta Primary School in Kieni East sub county [Nyeri County] have been admitted after a disease outbreak in the school. The children, one aged 5 and the other aged 13, were admitted at Nyeri Provincial General Hospital on Tue 26 May 2014. 8 other pupils were treated and discharged. The symptoms of the disease are yellow eyes, diarrhea, vomiting, fatigue and stomach ache.

More than 44 pupils have been affected. Some 34 pupils were discharged after screening. School headmaster Wanjohi Muriuki said the Ministry of Health has screened the pupils but did not say exactly which disease it is. He said children do not share food in school but carry their own.

Parents have urged the government to take immediate action. One parent, said his Standard 3 daughter had the symptoms last week. He said she is yet to recover despite visiting several hospitals. Another parent said her son in Standard 6 had similar symptoms last week but was treated and discharged from Nanyuki District Hospital. Area member of the county assembly Marete Ring'iru said the disease was brought by potato sellers from Rift Valley who visited the region recently.

"The government should close down the school so that the parents can take their children for treatment," he said. Ring'iru said the outbreak has spread to neighboring villages. He urged the government to take urgent measures to control the spread. Nyeri county acting health director Dr David Ndegwa said the cases were reported at Kiamuthaga Dispensary in Kieni. He said the cases were referred to Narumoro Health Centre. "The medics at Narumoro Health Centre referred them to Nyeri PGH. We sent an ambulance to evacuate the 8 kids," Ndegwa said. Health executive Dr Charles Githenji said the county government will educate the residents on public health.

[Byline: Wambugu Kanyi]

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[A cluster of icteric [jaundice] disease in a school-aged population suggests hepatitis A, a primarily waterborne viral disease. In a developing world environment, cases will occur primarily in children, as the seroprevalence of the infection is close to 100 percent by age 10. Hepatitis E is also primarily enterically transmitted but can cause outbreaks in adults as well, with very significant morbidity and mortality in pregnant women, particularly. - Mod.LL

Photo of yellow eyes at
http://yourstdhelp.com/images/jaundicehepa.jpg. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/174.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (33): SOUTH SUDAN (CENTRAL EQUATORIA)
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Date: Sun 1 Jun 2014
Source: Zee News [edited]
http://zeenews.india.com/news/world/tol ... 36403.html


The number of people dying from a cholera outbreak has reached 27 in the South Sudanese capital of Juba, with suspected cases more than doubling from 395 cases last week to 892, the UN humanitarian agency OCHA [UN Office for Coordination of Humanitarian Crisis] said on Sat 31 May 2014.

According to OCHA, South Sudan, living conditions in displacement sites continue to deteriorate due to flooding caused by heavy rains, especially in Jonglei, Unity, and Upper Nile states, Xinhua reported.

"Out of the cholera cases reported, 62 percent are men aged 20-34 years (41 percent)," OCHA said in its latest report. "The case fatality rate of 3 percent is still above emergency thresholds, indicating late presentation of people at health facilities."

Cholera broke out in Juba where 5 months of conflict between the pro-government troops and anti-government forces have left thousands homeless and disrupted food supplies and health services. Aid agencies have warned that the situation is dire and may worsen as the rainy season hits. Hundreds of thousands of people in South Sudan are living in displaced persons camps, which are congested and lack clean water.

--
Communicated by:
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[The combination of poor sanitaryfacilities and lack of clean water, internally displaced persons due to civil strife, and heavy rains are at work to cause this expanding _V. cholerae_ epidemic in South Sudan. A case fatality rate of 3 percent reflects poor access to any medical care and the absence of oral rehydration solutions. Although cholera can cause profound watery diarrhea, it is secretory in nature, and absorption of fluids is not affected.

A map of the province, showing Juba and Yei, can be found at https://maps.google.com/maps?safe=off&q ... CAgQ_AUoAw. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/8402.]

DENGUE/DHF UPDATE (39) - AFRICA
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Dengue - Tanzania: (Dar es Salaam)
Date: Wed 28 May 2014
Source: WHO/AFRO, Epidemic & Pandemic Alert and Response (EPR), Outbreak News [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html

Dengue outbreak in the United Republic of Tanzania (situation as of 30 May 2014)
----------------------------------------------------------------------
This is an update on the confirmed dengue fever outbreak notified to the World Health Organization by the Ministry of Health and Social Welfare (MoH&SW) on 4 Feb 2014.

As at 30 May 2014, the dengue fever outbreak has spread to 7 regions on the mainland and 2 regions in Zanzibar. The geographical distribution of cases and deaths is as follows: mainland (1017 confirmed cases out of a total of 2121 suspected cases including 4 deaths) and Zanzibar (1 confirmed case out of 8 suspected cases, and no deaths). 99 per cent of the cases of the mainland were reported from the following 3 districts of Dar es Salaam: Kinondoni, Temeke, and Ilala. Of the 4 deceased cases, 1 had presented with dengue haemorrhagic fever (DHF) and 1 with multiple organ failure.

Dengue fever response
---------------------
The Dengue Fever Response Task force established by the Ministry of Health continues to hold its regular meetings to review the current situation and propose additional preventive and control measures. The following measures are currently being implemented with support from WHO and partners: advocacy for resources to implement all activities described in the dengue fever response plan; enhancement of surveillance; training of health care workers and laboratory staff on the management of dengue cases and diagnostic, confirmation, and monitoring of dengue fever and integrated vector management. A 2nd press statement on the dengue fever outbreak situation in the country was issued by the Government on 12 May 2014. WHO continues to provide guidance to the MoH&SW mainland and MOH Zanzibar through among others, deployment of experts in the areas of epidemiology/surveillance, vector control, and provision of rapid diagnostic kits.

Based on the current information available for this event, WHO, does not recommend that any travel or trade restrictions be applied to the United Republic of Tanzania, both mainland and Zanzibar.

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[Further to earlier updates issued on this emergency [ProMED-EAFR posts 20140514.410491 and 20140529.413539], this report shows that the dengue fever outbreak in the United Republic of Tanzania has spread to at least 7 regions on the mainland and 2 regions in Zanzibar.

With support from the WHO and partners, the Ministry of Health and Social Welfare has rolled out comprehensive interventions to curb the raging outbreak.

A map showing the regions of Tanzania can be accessed at http://www.pesptz.org/images/map2.jpg, and the HealthMap/ProMED-mail interactive map of the country can be accessed at http://healthmap.org/promed/p/200. - Mod.JFW]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (34): AFRICA
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In this update:
Africa
[1] Cholera - Nigeria (Ogun State)
[2] Cholera - Sudan (White Nile State)
[3] Diarrhea, not cholera - South Africa (North West Province)

******
[1] Cholera - Nigeria (Ogun State)
Date: Mon 26 May 2014
Source: Vanguard [edited]
http://www.vanguardngr.com/2014/05/chol ... pitalised/


No fewer than 20 persons, mostly children have been hospitalized following cholera outbreak in Idi-Araba NITEL area of Ikorita, Local Government Area of Ogun State. The epidemic was said to have affected four communities in the area and forced residents to flee.

Vanguard's investigation revealed that the abandoned refuse dumpsite in the area might have been responsible for the outbreak. It was gathered that residents used to dump refuse in a canal in the area which eventually blocked the drainage and wreaked a lot of havoc. At the time of this report, no fewer than 20 casualties were recorded including an old man.

Chairman, Ogo-Oluwa Community Development Area, Nurudeen Bisiriyu, told Vanguard that 4 communities had been affected. Bisiriyu also said the canal had been turned to refuse dumpsite and had led to the collapse of a building after a heavy downpour last week.
According to him, "about 20 children have been taken to hospitals because of the cholera. In fact, Alhaji Abu, whose house was behind the dumpsite has been diagnosed of the disease. We have written letters to the local government, the lawmaker from this place, Olakunle Oluomo, the Chairman and the health officials of the local government, but none of them has replied our letters."

When contacted, the Director of Information in the council, Prince Tola Osunlaja said the council had begun moves to relocate the dumpsite.
He however, explained that the dumpsite had been there before the present administration came on board, saying, notwithstanding, the council executive had secured another place to be used as a dumpsite.

[Byline: Daud Olatunji]

--
Communicated by:
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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/618. - Sr.Tech.Ed.MJ]

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[2] Cholera - Sudan (White Nile State)
Date: Tue 27 May 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/73832


More than 100 citizens in Sudan's White Nile state have suffered from watery diarrhoea, suspected of being cholera. A local hospital has received about 1000 diarrhea cases.

Hamid Ali, the Minister of Health in White Nile has denied that the infections among the 154 citizens were cholera. "All the laboratory tests attributed the infections to 2 reasons: contaminated water and vegetables." Ismail Nawai, the locality commissioner, said that the infection was caused by contaminated vegetables as well. The most recent victim was the resident engineer who was transferred to Khartoum for treatment from Zilaita area.

Ed Duwaim hospital has received about 1000 cases of watery diarrhoea. Reportedly, a number of people has died, although the number has not yet been specified. Dr Mohamed Abdel Gadir, the Medical Director of the hospital, has explained to Radio Dabanga that the high number of people suffering from the disease is owing to the contamination of drinking water throughout the state.

A local source told Radio Tamazuj last Friday [23 May 2014] that over 106 cases of diarrhea had been recorded in El Salam locality. 3 persons died.

--
Communicated by:
ProMED-mail
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[Maps of Sudan can be seen at http://www.mapsofworld.com/sudan/sudan- ... l-map.html and http://healthmap.org/promed/p/27480. - Sr.Tech.Ed.MJ]

******
[3] Diarrhea, not cholera - South Africa (North West Province)
Date: Mon 2 Jun 2014
Source: The Citizen [edited]
http://citizen.co.za/188671/bloemhof-te ... -negative/


Tests done to check for cholera in Bloemhof, in the North West, were negative, the National Institute for Communicable Diseases (NICD) said on Mon 2 Jun 2014.

"The tests were negative, so cholera has been excluded now," Professor Lucille Blumberg told Sapa. "The source of the problem is contaminated water and that needs to be fixed."

The institute was conducting more tests to check for other viruses, like those that cause gastroenteritis.

Earlier, the North West health department confirmed that two more babies had died from diarrhoea in Bloemhof, where water contamination left the town without water last week. "One baby was seven-months-old and the other was 13-months-old," said spokesman Tebogo Lekgethwane. The circumstances surrounding their deaths were similar to the first baby that died last Wednesday, he said.

Dozens of residents went to local clinics to be examined last week following the contamination. Five babies were admitted to hospital for observation.

The Lekwa-Teemane municipality shut down its water supply system more than a week ago. The national water affairs department on Friday, 30 May 2014, said the system had been cleaned and sanitised, and water was restored on Thursday evening, 29 May 2014. But residents said the water coming out of taps was still brown on Friday, 30 May 2014, and residents were asked to boil the water first before using it.

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[There is no direct evidence for cholera at this time, if the municipal water is fecally contaminated, it will likely grow coliforms but this does not prove an etiology. More information is needed. - Mod.LL]

[Maps of Sudan can be seen at http://www.mapsofworld.com/sudan/sudan- ... l-map.html and http://healthmap.org/promed/p/25492. - Sr.Tech.Ed.MJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (35): SOUTH SUDAN
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Date: Mon 2 Jun 2014
Source: Radio Tamazuj [edited]
https://radiotamazuj.org/en/article/110 ... s-affected


The cumulative number of cholera cases in South Sudan since the start of the outbreak has risen to 1106. Medical reports suggest that the outbreak is being contained in some areas, while in others, new cases have been found.

According to UN Humanitarian Coordinator Toby Lanzer, the number of cases as of this morning [2 Jun 2014] was 1106. He said cases have now been confirmed also at Kajo Keji and Yei in Central Equatoria, and at Kaka in Upper Nile State.

A situation report by the Ministry of Health and World Health Organization on Saturday [31 May 2014] found that the cumulative number of cases as of the end of the day on Sat 31 May 2014 was already 1078, with 27 fatalities, while another 896 patients were discharged after successful treatment. This means that about 28 new cases were recorded between midnight Saturday and early Monday [2 Jun 2014], in other words in a period of just about one day.

Last week, the number of cases in Northern Bari Payam, hitherto one of the most affected neighborhoods, declined compared to the previous week. But the number of cases remained high in Munuki and also rose significantly in Rejaf payam. Gumbo area in Rejaf payam, which is on the east bank of the Nile just opposite from Juba, saw 164 suspected or confirmed cholera cases between 23 Apr and 31 May 2014.

Health officials say that those who contract cholera typically have been drinking from unsafe water sources, eating foods sold on the roadside or at makeshift markets, or practicing poor hygiene.

--
Communicated by:
ProMED-mail
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[The reported number of cholera cases in South Sudan continues to increase. Most of the cases to date are in or around Juba. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/8402.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (36): AFRICA
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Diarrhea, rotavirus - Zimbabwe (Mashonaland West Province)
Date: Wed 4 Jun 2014
Source: AllAfrica, The Herald report [edited]
http://allafrica.com/stories/201406040278.html


A diarrhea outbreak has hit Chinhoyi [Mashonaland West Province] with about 1000 cases recorded in the last 3 weeks, amid fears that the bug could result in fatalities.

The outbreak, which is being blamed on the rotavirus, started about 3 weeks ago. About 309 cases were recorded last week [week of 26 May 2014], with 202 of them being children under the age of 5. The seriously affected have been admitted at Chinhoyi Provincial Hospital, while others are being given oral rehydration solution.

Makonde district medical officer Dr Paradzai Mudzengerere confirmed the outbreak and said a comprehensive awareness campaign was underway. "We have seen an increase in the number of diarrheal cases in recent weeks and we attribute that to the onset of the winter season where the rotavirus is very active," he said.

Government has come up with an immunization programme to deal with the rotavirus which thrives in low temperatures. The program was carried out about 2 months ago and more than 60 percent coverage was recorded in Chinhoyi.

[Byline: Walter Nyamukondiwa]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Maps of Zimbabwe can be seen at http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf and http://healthmap.org/promed/p/2357. - Sr.Tech.Ed.MJ]
]rotavirus[/url] - Zimbabwe (Mashonaland West Province)[/b]
Date: Wed 4 Jun 2014
Source: AllAfrica, The Herald report [edited]
http://allafrica.com/stories/201406040278.html


A diarrhea outbreak has hit Chinhoyi [Mashonaland West Province] with about 1000 cases recorded in the last 3 weeks, amid fears that the bug could result in fatalities.

The outbreak, which is being blamed on the rotavirus, started about 3 weeks ago. About 309 cases were recorded last week [week of 26 May 2014], with 202 of them being children under the age of 5. The seriously affected have been admitted at Chinhoyi Provincial Hospital, while others are being given oral rehydration solution.

Makonde district medical officer Dr Paradzai Mudzengerere confirmed the outbreak and said a comprehensive awareness campaign was underway. "We have seen an increase in the number of diarrheal cases in recent weeks and we attribute that to the onset of the winter season where the rotavirus is very active," he said.

Government has come up with an immunization programme to deal with the rotavirus which thrives in low temperatures. The program was carried out about 2 months ago and more than 60 percent coverage was recorded in Chinhoyi.

[Byline: Walter Nyamukondiwa]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Maps of Zimbabwe can be seen at http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf and http://healthmap.org/promed/p/2357. - Sr.Tech.Ed.MJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (37): SOUTH SUDAN
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Date: Wed 4 Jun 2014
Source: Radio Tamazuj [edited]
https://radiotamazuj.org/en/article/cen ... -spreading


The Director General of Health, Central Equatoria State [South Sudan], Dr Paul Tingwa, says that cholera is still spreading in the state, particularly in Juba Nabari and Rajaf Payams of Juba County, but also to other counties including Yei, Kajo-Keji and Lainya County. In an interview with Radio Tamazuj on Wednesday, 4 Jun 2014, the health official stressed that control of cholera is not the responsibility of the ministry alone, but of every person in South Sudan.

He warned residents of west Nile not to drink water directly from the river before boiling, and also encouraged people to follow health regulations as one way of eradicating cholera from South Sudan.

Dr. Tingwa said that up to yesterday evening [3 Jun 2014] the cases of cholera have increased to 1138 cases, most of them in Juba itself, the national capital.

Another humanitarian official, UN Assistant Secretary-General Toby Lanzer, said that the number was higher than that, putting it at 1209 as of the end of the day on Monday, 2 Jun 2014, citing the "latest consolidated data." There have been at least 29 fatalities so far.

Health officials say that those who contract cholera typically have been drinking from unsafe water sources, eating foods sold on the roadside or at makeshift markets, or practicing poor hygiene.

One of the hardest hit neighborhoods, Gumbo of Rajaf Payam, which is on the east bank of the Nile just opposite from Juba, saw 164 suspected or confirmed cholera cases between 23 Apr 2014 and 31 May 2014.

--
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["And the beat goes on." The outbreak continues and likely will do so for some time, given the conditions in South Sudan. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/8402.]

MALARIA - EGYPT (02): (ASWAN)
*****************************
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Date: Sat 7 Jun 2014
Source: Ahram Online [edited]
http://english.ahram.org.eg/NewsContent ... Aswan.aspx


Al-Ahram's Arabic website reported 2 more cases of malaria have been reported in Edfu's fever hospital in Aswan governorate.

Another 15 cases have been reported in the area since May [2014], although 2 of the patients have been cured and left hospital, according to the deputy health minister responsible for Aswan, Mohamed Azmy. Egypt suffered from a malaria epidemic from 1942-1944, when around one million people were infected and 200 000 died.

--
communicated by:
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[This report strongly indicates that a new focus of malaria has been established in Southern Egypt. We assume that none of the patients have been travelling and that they are not immigrants from malaria endemic areas, for instance from the Sudan.

The dry climate of Egypt usually results in a short life span of anopheles mosquitoes and thus limited transmission. The mosquito _Anopheles sergentii_ is the commonest _Anopheles_ species in the oasis and the commonest malaria vector here, and was described from Aswan nearly 20 years ago in a single study (Cope SE, et al. New record of the malaria vector _Anopheles sergentii_ in the southern Nile Valley of Egypt. J Am Mosq Control Assoc. 1995; 11(1): 145-6).

In 1942, however, _A. gambiae_ was found in Egypt from the Sudan border all the way up to 200 miles (300 km) south of Cairo in the Nile valley, but was pushed back by a larvicidal campaign which eradicated _A. gambiae_ in Egypt and Sudan north of Khartoum. The presence of _A. gambiae_ in Egypt in 1942 explains the outbreak of 1942-44 described in the post.

Studies are needed to determine the _Anopheles_ species responsible for the present transmission in Aswan as well as active case detection to identify clinical cases and gametocyte carriers for treatment. - Mod.EP

Maps of Egypt can be seen at http://www.fao.org/ag/AGP/AGPC/doc/Coun ... s/fig1.jpg and http://healthmap.org/promed/p/12468. - Sr.Tech.Ed.MJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (39): SOUTH SUDAN
********************************************************
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Date: Tue 10 Jun 2014
Source: Shanghai Daily, Xinhua News Agency report [edited]
http://www.shanghaidaily.com/article/ar ... ?id=223370


The UN Office for the Coordination of Humanitarian Affairs (OCHA) said that a total of 1459 cholera cases, including 31 deaths, have been reported in South Sudan by [Sat 7 Jun 2014], UN spokesman Stephane Dujarric told reporters on [Mon 9 Jun 2014]. "The outbreak is spreading to Yei and Kajo Keji in Central Equatoria State," Dujarric said at a daily news briefing.

WHO reported that 7 cases have been confirmed in the Juba Protection of Civilians areas as of [Sun 8 Jun 2014], with additional suspected cases under investigation.

Since the outbreak of cholera in the capital Juba in mid-May 2014, the reported cholera caseload has doubled every day, the UN Children's Fund (UNICEF) said. After the 1st case was confirmed in Juba on 15 May 2014, more than 130 additional cases were treated, UNICEF said on 19 May 2014.

Since January 2014, UNICEF has warned of the threat of cholera, due to the desperate overcrowding of camps following continued violence, and now the rainy season. In May 2014, UNICEF said that unless nutrition treatment is scaled up immediately, up to 50 000 children under the age of 5 are likely to die.

In response to the cholera outbreak, UNICEF has helped establish a cholera treatment center (CTC) at the Juba Teaching Hospital. It also provided life-saving supplies, including medicines, protective gear, and equipment, and is expanding preventive measures to halt further spread across the country.

On the protection of civilians sites, OCHA said that the relocation of 13 500 internally displaced persons from Tomping is expected to start on 16 Jun 2014.

In Malakal, Upper Nile State, the UN secretary-general's special representative for South Sudan, Hilde F Johnson, on [Mon 9 Jun 2014] inaugurated a new protection of civilians site, Dujarric said. "The new facility can accommodate between 8000 and 9000 internally displaced persons."

"The relocations have already started in Malakal," he said. " As of 7 Jun 2014, some 3100 had moved to the new site."

--
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["And the beat goes on." The outbreak continues and likely will do so for some time, given the conditions in South Sudan. - Mod.LL

Maps of the Republic of South Sudan can be seen at https://docs.unocha.org/sites/dms/South ... p_2684.pdf and http://healthmap.org/promed/p/8402. - Sr.Tech.Ed.MJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (40): AFRICA
*********************************************************
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ProMED-mail is a program of the
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In this update:
Africa
[1] Cholera - Uganda (Namayingo District)
[2] Cholera - Congo DR (South Kivu Province)

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[1] Cholera - Uganda (Namayingo District)
Date: Tue 10 Jun 2014
Source: The Monitor [edited]
http://www.monitor.co.ug/News/National/ ... p6ky5hz/-/


The Ministry of Health is missing in action in Namayingo District more than 2 weeks after a cholera outbreak that has so far claimed the lives of at least 3 people and seen another close to 100 admitted in different health facilities. The district health inspector, Mr Musenze Mutumba, told this newspaper at the weekend [7-8 Jun 2014] that the district had recorded 61 new cases last week alone, bringing the number of cases in hospital to 94, up from 33 recorded in the previous week.

Matters have been complicated by lack of capacity in terms of drugs, medical personnel and resources to handle the magnitude of the problem. The district has 1 medical doctor who is stationed at the 60-bed Buyinja Health Centre IV, and 113 other medical workers stationed in its 23 health facilities.

The vice chairperson of the district, Ms Anastansia Koni Ndira, who is also the woman councillor representing Sigulu Islands in the district council, said the matter was addressed to the Ministry of Health when the 1st cases were reported, but that they had not received any response. The only intervention, she said, was that of the NGO, Star EC (which is involved in the fight against HIV), which delivered Jik and other disinfectants when the epidemic 1st broke out.

[byline: Asuman Musobya]

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[A HealthMap/ProMED-mail map is available at http://healthmap.org/promed/p/22958.]

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[2] Cholera - Congo DR (South Kivu Province)
Date: Mon 2 Jun 2014
Source: Radio Okapi [in French, machine transl, edited)
http://radiookapi.net/actualite/2014/06 ... maine-fizi


The chief physician of the area of health of Fizi, Dr Delphin Asende Ehebelo, claims to have identified about 52 cases of cholera in a week in the locality of Baraka (Sud-Kivu [South Kivu Province]). He has delivered this information on Sunday [1 Jun 2014] to the journalists in Bukavu, in South Kivu.

Dr Delphin Asende has explained the reasons for the resurgence of this epidemic to Baraka: "Baraka does not have drinking water. There are 77 fountains that have been constructed for a population estimated at 80 000 people. Some people go out to draw water from the lake, which constitutes a large fireplace of diseases."

He regretted that the population consumes the water of Lake Tanganyika without observing appropriate hygiene measures. The cholera treatment center of Baraka had registered, last May 2014, 50 cases. The districts most affected by the disease were among other areas, Mwemezi, Aebaz and Macampagne, where water taps were not installed.

According to the chief physician of the area of health of Fizi, no deaths have been recorded. Baraka often faces cholera caused by poor sanitation and lack of drinking water in several neighborhoods.

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MALARIA - EGYPT (03): (ASWAN)
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Date: Wed 11 Jun 2014
From: Volker Klinnert <arzt-1@kair.diplo.de> [edited]


According to several sources, malaria cases seen in the fever clinic in Edfu, eastern Aswan, Egypt were all _Plasmodium vivax_, all autochthonous infections, all in Al-Adwa village near Edfu, many in the same family.

Treatment was done with Coartem (artemether/lumefantrine); primaquine is supposed to be given in the immediate future. Blood samples taken from more than 1000 inhabitants in the region were negative for _Plasmodium vivax_. Studies on the anopheles vector are on the way.

--
Dr Volker Klinnert
German embassy clinic, Cairo
<arzt-1@kair.diplo.de>

[ProMED-mail thanks Dr Volker Klinnert for this important information. It seems that the cluster is geographically very close, and it is important to genotype the parasite to get an idea of whether this is just a single introduction into a new area.

It is especially important to distinguish between tropical and temperate _P. vivax_ by haplotyping the isolates. Temperate _P. vivax_ has an incubation period of 6 to 9 months, and if found here, investigations should be expanded to include a possible introduction within a much longer period.

ProMED-mail will be happy to post further news including information on the _Anopheles_ species found in the area. - Mod.EP

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (41): SOUTH SUDAN
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Date: Mon 16 Jun 2014
Source: Radio Tamazuj [edited]
https://radiotamazuj.org/en/article/cho ... -more-1700


South Sudan's Ministry of Health announced that 1720 cholera cases including 37 deaths have been reported in South Sudan since the start of the outbreak, according to data current to Sat 14 Jun 2014.

In a weekly media briefing on the cholera situation, Dr Lul Riek, the chairman of the national task force to combat the outbreak, said the 5 most affected areas last week were in Gumbo with 98 cases, Tongping with 40 cases, Gudele One with 38 cases, Gurei with 27, and New Site with 31. The other 3 affected payams were Rajaf with 114 cases followed by Northern Bari with 77 cases and Munuki also with 77. Dr Lul said due to the increase of cholera, 2 centers of cholera treatment have been opened in Nyakuron West and Gumbo.

Dr. Lul said that week-to-week data show a decline in the number of cases since late May 2014, but he said they are still very much concerned by steady numbers of new cases. He said that people not obeying health regulations have been the main problem causing fatalities, many of which happened in homes rather than health facilities.

"We still have the problem of people's attitude that when we ask them to wash their hands before preparing their food, some people continue to forget it," the doctor said. The population continues to be at high risk of contracting cholera because they continue to drink unsafe water, consume un-hygienically prepared food, practice open defecation, and participate in handling and burial of people who have died from cholera, he said.

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[Since the last report 7 days prior to this one, there have been 241 more cases registered and a total of 6 more deaths. A case fatality rate of 2.1 percent is calculated from these numbers, which is higher than considered acceptable by WHO. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/8402.]

UNDIAGNOSED HEMORRHAGIC FEVER - SUDAN: (RED SEA) REQUEST FOR INFORMATION
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Date: Fri 13 Jun 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/74886


The United Popular Front (UPF), a coalition of eastern Sudanese factions, and activists in the Red Sea state have reported a vast spread of the hemorrhagic fever throughout the state, while the state government has renounced to report about the case.

The UPF political secretary, Daoud Mahmoud, told Radio Dabanga that hemorrhagic fever has alarmingly spread in Red Sea state, "but the state government and health authorities have imposed a blackout on the disease, which kills people in eastern Sudan on a daily basis."

Mahmoud appealed to the World Health Organization and the Federal Ministry of Health to act immediately and save eastern Sudan, and in particular Red Sea, from the disease.

Viral hemorrhagic fever is a general term for a severe illness, sometimes associated with bleeding, that may be caused by a number of viruses.

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[Undiagnosed hemorrhagic fevers have been reported sporadically in various parts of Sudan. If these are, in reality, of virus etiology, as the report indicates, cases may be caused by a variety of viruses the have been known to occur in Sudan. There is no information provided in the report above that suggests any specific virus, nor is it indicated that samples are being taken to permit laboratory diagnosis of the disease. It is not clear why the Sudan government has imposed a blackout on information concerning the disease in the Red Sea state. ProMED would appreciate receiving additional information as it becomes available.

Maps of Sudan can be seen at http://sites.duke.edu/stefanijones/file ... dan-UN.jpg and http://healthmap.org/promed/p/27475. - Mod.TY]

[ProMED-mail post Undiagnosed illness - Sudan (RS): RFI 20140617.2544550 is about an undiagnosed outbreak in Port Sudan (the capital city of the Red Sea state) where MERS-CoV is postulated. The media report did not provide any symptoms other than to postulate that it might be MERS-CoV. The possibility exists that these 2 outbreaks may in fact be one outbreak or 2 separate outbreaks or perhaps not a specific outbreak at all. - Mod.MPP]

DENGUE/DHF UPDATE (41): AFRICA
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Africa
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Tanzania and Mozambique. 9 Jun 2014. Dengue in Mozambique as of 8 May 2014, 243 cases. Tanzania, mainland as of 19 May 2014 (susp) 2121 cases, (conf) 1017 cases; deaths 4; Zanzibar (susp) 8 cases, (conf) 1 case.
http://www.nathnac.org/travel/news/deng ... 090614.htm

[A HealthMap/ProMED-mail map showing the location of Tanzania in East Africa can be accessed at http://healthmap.org/promed/p/200 and Mozambique at http://healthmap.org/promed/p/177. - Mod.TY]