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CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2007 (39)
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Cholera - Uganda (Arua, Hoima)
Date: Thu 20 Sep 2007
Source: AllAfrica, The Monitor (Kampala) report [edited]
<http://allafrica.com/stories/200709191044.html>


An outbreak of cholera in the West Nile district of Nyadri (in Arua) has
killed one person and left 8 others hospitalized.

"Our investigation shows that the outbreak came from the DR Congo [DRC] and
some cases were contracted during a funeral of a person who died of the
disease," Dr Aldo Pariyo, the officer in charge of Maracha Health
sub-district said yesterday, 19 Sep 2007.

He said that 5 of the 8 cases reported at Maracha Health Centre were
Congolese. Olufe and Oleba sub-counties that border the DRC are said to be
the most affected areas.

Meanwhile, reports from Hoima that the district is also worried of a
possible outbreak of the disease, especially in areas around the shores of
Lake Albert. The district director of Health Services, Dr Joseph Ruyonga,
said his office was still verifying information concerning a reported
outbreak. "The Nkondo LCI [local council, smallest administrative unit]
chairperson has reported to my office that the disease has killed 2 of his
residents," Mr Ruyonga told Daily Monitor.

[byline: Warom Felix Okello]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[The Arua and Hoima districts can be seen on a map of the country at
<http://www.un.org/Depts/Cartographic/ma ... ganda1.pdf>. - Mod.LL]

RIFT-TAL-FIEBER, HUMAN - KENIA: REQUEST FOR INFORMATION
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[1]
Date: Thu 20 Sep 2007
Source: Reuters Africa [edited]
<http://africa.reuters.com/top/news/usnBAN053630.html>


Kenya says Rift Valley fever returns, 2 dead
--------------------------------------------
Rift Valley fever has killed 2 women in Kenya, the government said on Thu
20 Sep 2007, raising fears of another outbreak of the disease that claimed
more than 150 lives earlier this year.

Officials had first worried that the 2 women who died in Nakuru district, a
tourist hotspot, had [contracted] the Ebola virus, which broke out last
week [initially in April - Mod.CP] in the nearby Democratic Republic of the
Congo.

"This is not an Ebola outbreak, it is Rift Valley fever," government
spokesman Alfred Mutua told reporters in Nairobi. Transmitted to humans by
mosquito bites or close contact with contaminated animals, Rift Valley
fever can cause havoc in Kenya's important meat trade.

The movement of livestock was temporarily halted earlier this year [2007]
when the 1st outbreak spread from Kenya to Somalia and Tanzania, killing
more than 100 people in each country. In severe cases, the disease triggers
haemorrhaging in humans, causing the victim to vomit blood or bleed to
death. Outbreaks of the fever, named after the vast fissure running from
Syria down to Mozambique, are thought to be cyclical. A 1997-1998 outbreak
killed hundreds of Kenyans.

(byline: Juliana Adhiambo)

******
[2]
Date: Thu 20 Sep 2007
Source: The Standard newspaper (Nairobi) [edited]
<http://www.eastandard.net/hm_news/news. ... 1143974837>


Disease probe starts
--------------------
Samples taken from 3 people who died of a mysterious disease in Molo have
been forwarded to Kenya Medical Research Institute (Kemri) for analysis.
Rift Valley provincial medical officer [PMO], Dr John Odondi, said the
samples would be analysed to establish the cause of death. He said no new
cases have been reported.

"There are no new reports of people suffering from similar symptoms as the
deceased," Odondi said. Two women and a man, who died in the last 3 days in
Kuresoi and Sirikwa areas, complained of severe headaches, fever and
coughs. "We suspect these were isolated cases, but we have ruled out
Ebola," he said.

Speaking to The Standard in Nakuru, the PMO said they have directed
relatives of the 3 to bury them. This weekend [15-16 Sep 2007] 2 women
died, while a man succumbed to the mysterious illness on Monday 17 Sep
2997]. Odondi deployed inspectors to the affected areas after area MP, Mr
Moses Cheboi, told Parliament that 2 of his constituents had died of a
mysterious illness.

The Government on Wednesday [19 Sep 2007] ruled out that the disease could
be the deadly Ebola. Deputy Director of Medical Services, Dr Shahhanaaz
Shariff, said the mysterious disease could not be Ebola saying those who
died did not exhibit excessive bleeding.

[byline: Beatrice Obwocha]

--
communicated by:
ProMED-mail rapporteur Joseph P Dudley

[It is not absolutely clear that these 2 reports from the Reuters Africa
news agency and the Nairobi newspaper The Standard refer to the same 2
women. The place names are different (Molo, Kuresoi and Sirikwa), but the
description of the illness of the 2 deceased patients, reported in The
Standard newspaper, is compatible with a diagnosis of Rift Valley fever.
Clarification and laboratory confirmation of the diagnosis of Rift valley
fever in the Molo cases are awaited. - Mod.CP

Molo: population 90 000 (21 000 urban) (1999), west of Nakuru:
<http://www.fallingrain.com/world/KE/8/Molo.html>
Kuresoi: administrative division, separate from Molo, pop. 41 000 (100
percent rural) (1999)
<http://en.wikipedia.org/wiki/Nakuru_District>
Sirikwa: no map or locality information found on web - Mod.JW]

EBOLA HEMORRHAGIC FEVER - DEMOKRATISCHE REPUBLIK KONGO ( 06 )
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Date: Fri 21 Sep 2007
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5jor ... ZK_IvoQ5RA>


A suspected death from Ebola virus has been reported in a new province in
eastern Democratic Republic of the Congo where more than 170 people are now
feared to have died from the disease in 4 months.

The new case was in East Kasai [Kasai Oriental], a central province
neighbouring the West Kasai [Kasai Occidental] where the latest outbreak
was 1st reported. There have been many deaths at a health centre in the
East Kasai town of Mwene-Ditu in recent days and samples from one that
showed Ebola-like symptoms are being studied in Kinshasa, said Benoit
Kebelo, a doctor heading a government emergency response team.

Mwene-Ditu is around 180 km (112 miles) south east of Kananga, capital of
West Kasai province, where 5 Ebola cases and one of shigellosis were
confirmed on 11 Sep 2007. Kebolo told AFP everyone should remain cautious
about the cause of the latest death. He added that "increasing awareness"
of Ebola among the population was leading to many reported symptoms that in
most cases are not linked to the outbreak.

2 more patients died from Ebola and related illnesses this week around
Kampungu, around 250 km (155 miles) north west of Kananga, and the centre
of the new epidemic, Kebolo said. These bring to 172 the number of
confirmed dead out of 381 reported cases of patients suffering symptoms
from various illnesses including Ebola, shigellosis, which is similar,
acute malaria or gastroenteritis, according to a new World Health
Organisation toll.

There is no known cure for Ebola, which causes massive internal bleeding,
and on average is fatal in around 80 per cent of cases. Shigellosis, a type
of infectious dysentery, is treatable with antibiotics, but is still fatal
in around 40 per cent of cases. Symptoms of the epidemic -- high
temperature, bloody diarrhoea, visible hemorrhaging -- were 1st seen on 27
Apr 2007 in the Kampungu region of West Kasai. Around Kampungu, a WHO
survey of the cases, shows a marked increase in the number of ill between
22 and 31 Aug 2007, with an average of 15 cases per day and a peak of 12
deaths on 27 Aug 2007. In early September [2007] the spread of the diseases
slowed. Over the past 6 days it fell to between one and 2 new registered
cases a day, with only a maximum 2 deaths per day. "It's encouraging, but
we must still be prudent in analysing this reduction," Kebelo warned. There
is no certainty that the epidemic has ended, he added. It could be a
remission during the incubation period for Ebola (15-21 days) "before a new
explosion," he cautioned.

Meanwhile, a team of 10 WHO officials -- including a virologist, 3
epidemiologists, and Canadian specialists in setting up laboratories --
have arrived in Kananga and will be operational next week analysing samples.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[This report includes the unwelcome news that the current Ebola
haemorrhagic fever outbreak affecting the Kasai Occidental province of the
Democratic Republic of the Congo may have spread eastwards to the Kasai
Oriental province. It suggests also, however, that the Ebola fever outbreak
in Kasai Occidental may be less extensive than initially supposed and may
now be in decline. Further information is awaited.

A map of the Democratic Republic of the Congo showing the boundaries of the
Kasai Occidental and Kasai Oriental provinces and the location of Kananga
can be accessed at
<http://www.lib.utexas.edu/maps/africa/c ... _pol98.jpg>. - Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (40)
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Cholera - Uganda (Buliisa)
Date: Sun 23 Sep 2007
Source: AllAfrica.com and The Monitor (Kampala) [edited]
<http://allafrica.com/stories/200709230043.html>


The cholera epidemic that was reported in Hoima District and several
parts of West Nile District has expanded to Buliisa District. "There
is an outbreak of cholera in the district," Dr Francis Nyakoojo, the
Buliisa District director of health services said on Wed 19 Sep 2007.
He said the deadly disease has so far claimed the lives of 2
residents and left over 30 people hospitalized.

He said the patients are admitted at Buliisa Health Centre. He said
the areas most affected by disease are Bugoigo, Biiso and Wanseko.
Dr. Nyakoojo said many residents of the affected areas on the shores
of Lake Albert have no toilets. He said the residents excrete in
nearby bushes, while fishermen ease themselves in the lake. He said
poor human waste management exposes residents to such diseases.

[Byline: Francis Mugerwa]

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

[The Buliisa District has recently been carved out of the western
part of the Masindi District of Uganda as can be seen at
<http://www.lcd.org.uk/africa/uganda/ima ... agemap.gif>.
- Mod.LL]

Angola - Cholera / Polio

Die Ausbrüche, die im Januar 2006 begannen und sich bis Mitte dieses Jahres mit etwa 100.000 registrierten Erkrankungen und 3.500 Todesfällen zu einer der größten Epidemien des Landes ausweiteten, sind jetzt weitgehend abgeklungen. Mit am stärksten betroffen war die Hauptstadt Luanda. Mit Einzel- und Gruppenerkrankungen ist örtlich in nächster Zeit weiterhin zu rechnen. Risiko für andere Darminfektionen, speziell Durchfallerkrankungen landesweit. Polio zirkulierte nach einer Pause von 4 Jahren seit 2005 erneut durch Reimport von Wildviren; im letzten Jahr wurden nur noch 2 Fälle entdeckt, im Jahr davor waren es noch 10. In diesem Jahr wurden bisher wiederum 10 Erkrankungen gemeldet. Hygiene und Impfschutz (Polio) beachten. / Quelle: crm

AFFENPOCKEN, HUMAN - REPUBLIK KONGO
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Date: 25 Sep 2007
Source: IRIN [edited]
<http://www.irinnews.org/Report.aspx?ReportId=74469>


At least 60 people have been affected by an outbreak of monkeypox in
the northern department of Likouala in the Republic of Congo, a
health official has said.

"We had registered 62 probable cases, which were confirmed through a
rapid laboratory test," Jean-Vivien Mombouli, the director of
research at the national public health laboratory (Laboratoire
national de sante publique), said on 24 Sep [2007]. According to
testimonies from the villagers, Mombouli said, there were at least
150 cases in the district. Most of those affected were refugees from
the Democratic Republic of the Congo younger than 15. "The clinical
signs confirmed the disease," he said.

Monkeypox is a rare viral disease found mostly in the rainforest
countries of central and West Africa, characterized by a high fever
accompanied by intense fatigue and [pox-like] lesions, Mombouli said.
"There is no treatment or vaccine for the disease," he said. "The
recovery is spontaneous." [In fact, smallpox vaccination protects
against infection, or failing that, mitigates the severity. -
Mod.JW] Infection follows physical contact with animals, especially
monkeys, during the preparation of meat, he said. According to
Mombouli, the virus had adapted to the human species. "If we neglect
the virus and let it evolve, it will become more virulent and lethal," he said.

The outbreak started in January [2007], with the last case being
registered at end-August [2007]. The disease was spread out over a
200km [124-mile] radius in Likouala and affected villages along the
River Oubangui. The river is a natural border between the Congo
Republic, Democratic Republic of the Congo, and the Central African
Republic [see map URL below].

Meanwhile, 4 experts from the Centers for Disease Control and
Prevention (CDC) in Atlanta, GA, are expected in Brazzaville this
week [24-28 Sep 2007] to analyse samples taken by Congolese health
experts in the affected areas in order to identify the origin of the
outbreak, which so far remains unknown.

--
Communicated by:
Otavio Silva <otavio_uff104@yahoo.com.br>

[A recent review by Parker, Buller and Schultz (Future Microbiology
2: 17-34, Feb 2007) has identified monkeypox virus infection as an
emerging zoonotic disease. Zoonotic monkeypox virus is maintained in
a large number of rodent and, to a lesser extent, nonhuman primate
species in West and central Africa. Although monkeypox virus was
discovered in 1958, the prototypic human cases were not witnessed
until the early 1970s. Before this time, it is assumed that
infections were masked by smallpox, which was then widely endemic.

Nevertheless, since the 1970s, reported monkeypox virus infections of
humans have escalated, as have outbreaks with reported human-to-human
transmission. This increase is likely due to numerous factors, such
as enhanced surveillance efforts, environmental degradation and human
urbanization of areas where monkeypox virus is maintained in its
animal reservoir(s) and, consequently, serve as a nidus for human
infection. Furthermore, viral genetic predispositions enable
monkeypox virus to infect many animal species, represented in
expansive geographic ranges.

Monkeypox virus was once restricted to specific regions of Africa,
but its range has expanded, suggesting that human monkeypox
infections could continue to intensify. As a zoonotic agent,
monkeypox virus is far less sensitive to typical eradication measures
since it is maintained in wild-animal populations. Moreover, human
vaccination is becoming a less viable option to control poxvirus
infections in today's increasingly immunocompromised population,
particularly with the emergence of HIV in Sub-Saharan Africa. An
increased frequency of human monkeypox virus infections, especially
in immunocompromised individuals, may permit monkeypox virus to
evolve and maintain itself independently in human populations.

The apparent increased frequency of human monkeypox virus infections
in Africa may be a consequence of the increased prevalence of
immunocompromised individuals in the human population, promoting
maintenance of the virus in humans and possibly enhanced virulence. - Mod.CP]

[Although monkeypox virus has been isolated from monkeys and human
cases have been associated with contact with monkeys, the reservoirs
of the virus most likely are rodents. The giant pouched rat
(_Cricetomys_), rope squirrels (_Funisciuris_ sp.) and dormice
(_Graphiuris_ sp.) are suspected. All of these were incriminated in
the epidemic spread by exotic pets in the USA in 2003 -- see Hutson
et al. 2007 & ProMED refs. below. In that epidemic, spread was not
from meat but by the respiratory route and possibly from handling the
animals (hand-to-mouth contact). More field research is needed to
define the range of the virus and its relationship to its mammalian
reservoirs. There is just one documented instance of human-to-human
transmission.

References:
-----------
Levine RS, Peterson AT, Yorita KL, Carroll D, Damon IK, Reynolds MG.
2007. Ecological niche and geographic distribution of human monkeypox
in Africa. PLoS ONE 31:e176.

Hutson CL, Lee KN, Abel J, Carroll DS. 2007. Monkeypox zoonotic
associations: insights from laboratory evaluation of animals
associated with the multi-state US outbreak. Am J Trop Med Hyg. 76:757-6

A photo of a child with monkeypox and further information is at:
<http://news.bbc.co.uk/2/low/health/3380177.stm>

A map of the countries of the Congo Basin can be accessed at:
<http://www.lib.utexas.edu/maps/africa/c ... _pol98.jpg>

ProMED thanks Leah Roberts
<hisz-alertmail-eng-bounces@levlista.rsoe.hu> for sending in this
same report. - Mod.TY/JW]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (42)
**********************************************
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<http://www.isid.org>

In this update:
Africa
[1] Cholera - Sierra Leone (Northern, Western Areas)
[2] Cholera - Senegal (Saint-Louis)
[3] Cholera - Angola (Benguela)

******
[1] Cholera - Sierra Leone (Northern, Western Areas)
Date: Thu 27 Sep 2007
Source: IOL (Independent Online, South Africa) [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 295C157912>


At least 20 people have died from cholera in the past 2 weeks in the
poverty-stricken West African country of Sierra Leone, a government
health official said Thu 27 Sep 2007.

Alhassan Sesay, director of disease prevention and control in the
ministry of health, said 15 of the deaths were recorded in the
northern district of Kambia, near the border with Guinea, while 5
were registered in a village on the outskirts of the capital Freetown.

Emergency health workers have been drafted to both areas to step up
treatment and prevention campaigns to stem the outbreak that has
struck dozens of people, he told reporters.

The last major cholera epidemic hit the war-scarred country in 2006
killing at least 77 people over a 3-month period between the months
of August and October.

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

[A map of the country showing the reported areas can be found at
<http://www.un.org/Depts/Cartographic/ma ... errale.pdf>. - Mod.LL]

******
[2] Cholera - Senegal (Saint-Louis)
Date: Thu 27 Sep 2007
Source: AllAfrica, Agence de Presse Senegalaise (Dakar) report [in
French, trans. Mod.LL, edited]
<http://fr.allafrica.com/stories/printab ... 80801.html>


Around 15 cases of cholera have been reported since 18 Sep 2007 in
Saint-Louis, notably in the neighborhoods of Pikine and Balacos, news
sources have reported. The same source specified that 11 of the cases
are now recovered.

Administrative and sanitary authorities are trying to sensitize the
population on the importance to adopt hygienic practices in their
everyday life. Following a visit on Wed 26 Sep 2007, by the Director
of Medical Prevention, Pape Coumba Faye, further control plans are
being formulated.

--
Communicated by:
Coulibaly Sidi
<sidi_couly@yahoo.ca>

[A map of Senegal showing the city and province of Saint-Louis in the
north can be found at
<http://www.un.org/Depts/Cartographic/ma ... enegal.pdf>. - Mod.LL]

******
[3] Cholera - Angola (Benguela)
Date: Fri 28 Sep 2007
Source: AllAfrica.com, Angola Press Agency (Luanda) report [edited]
<http://allafrica.com/stories/200709280369.html>


Angola Press has learned 3 cases of cholera were recorded over the
last 24 hours [27-28 Sep 2007] in Balombo District hospital, raising
the figure to 90 since the outbreak began.

A source with the mentioned hospital informed that the cases did not
end up in death. The same source added that 21 patients are still in
hospital due to this illness and 8 have already been discharged.

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

A map of Angola showing the location of Benguela in the western part
of the country can be found at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>.

After dominating the ProMED-mail cholera updates in 2006 and early
2007, the number of reports related to cholera from Angola has slowed
dramatically since May 2007. - Mod.LL]

TUBERCULOSIS - UGANDA: DEADLY STRAIN, REQUEST FOR INFORMATION
****************************************
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Date: Mon 1 Oct 2007
Source: AllAfrica New Vision (Kampala) report, [edited]
<http://allafrica.com/stories/printable/ ... 10036.html>


A deadly strain of tuberculosis (TB) is on the increase in Uganda,
the Uganda National Association of Nurses and Midwives has warned.
Janet Obuni, the association's president, on Saturday [29 Sep 2007]
said each carrier of the drug-resistant disease [with active
pulmonary tuberculosis] was capable of infecting about 20 people in a
lifetime. "Without strict precautions, a bigger number of people will
be infected because this type of TB is dangerous as most of the
infected people stay with their families. The congestion in urban
area and other places may also add to the infection risks."

A medical staff at Mulago Hospital revealed that they had recorded 71
cases of the deadly TB strain. "So far, there is no clear medication
for the patients. The strain threatens to cause a global pandemic,
but in Uganda its magnitude is not yet established. "Other cases were
reported in Arua, Mbarara, Kabale, Mbale, and Soroti districts, Obuni
said. Addressing journalists in Entebbe, Obuni appealed to the
Government to intervene, [and reported that] 10 members of the
association from different districts returned from Kenya's capital,
Nairobi, where they were trained in methods of tackling the serious
disease. "Although we have received some training in the management
of multi-resistant TB from an international body, we still need the
Government to avail us drugs in order to check the disease before it
runs out of hand," Obuni said.

[Byline: Gladys Kalibbala]

--
Communicated by:
Coulibaly Sidi
<sidi_couly@yahoo.ca>

[The news release does not specify the exact identity of the strain,
although presumably it refers to an extremely drug-resistant (XDR)
strain. XDR tuberculosis has caused high mortality among HIV
co-infected patients in KwaZulu-Natal, South Africa. As mentioned in
previous ProMED-mail postings, XDR tuberculosis has now spread
throughout South Africa and probably into neighboring countries that
share borders and migrant work forces with South Africa. Uganda,
however, is separated by several countries from South Africa (see map
at <http://www.uyaphi.com/search/map/africa>.)

Genotyping analysis of XDR strains from KwaZulu-Natal revealed that
85 percent of the 46 isolates tested belonged to the KwaZulu-Natal
family of tuberculosis strains, which had been recognized in the
province for a decade
(<http://content.nejm.org/cgi/content/full/356/7/656>). Whether cases
of XDR tuberculosis that occur outside of KwaZulu-Natal have this
genotype is not known. Further information on the 'deadly' strain in
Uganda would be appreciated. - Mod.ML]

MARBURG HEMORRHAGIC FEVER - UGANDA (06): NEW CASE
*********************************************************************
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Date: Tue 2 Oct 2007
Source: Earth Times.org [edited]
<http://www.earthtimes.org/articles/show/117556.html>


Another Marburg case in Uganda after man breaches infected mine
-----------------------------------------------------------------------------------
A Ugandan man tasked with guarding a Marburg virus-infected mine
crept into the underground [mine] only to be infected with the
Ebola-like disease, health officials said Tuesday [2 Oct 2007]. The
mine was closed when the epidemic struck the western area situated in
a forest reserve, killing one person, but the 58 miners were
monitored by the health ministry, as were the people they had come in
contact with.

The epidemic was declared over in early August [2007] but health
ministry officials said that a man who was guarding the closed mine
"sneaked" in, contracting the disease and that he is currently under treatment.

Uganda has contained an outbreak of Marburg disease among gold
miners, but contacts of the 2 known cases must now make sure they
don't spread the deadly virus through sexual activity, the World
Health Organisation (WHO) said on Fri 17 Aug 2007.

WHO expert Pierre Formenty said investigators had collected hundreds
of bats from the mine, which they suspect may be a possible reservoir
of the disease.

"The mine was closed but one person, purportedly guarding the mine,
sneaked in quietly and got the problem. We have taken his contacts
and are tracking down all the other people who may have come to him,"
said Paul Kaggwa, the ministry's spokesman.

Authorities believe the virus might have been transmitted from the
hundreds of thousands of bats dwelling in the scores of tunnels of
the mines or from monkeys in a government forest reserve where the
mines are situated.

The Marburg virus which is similar to but less virulent than Ebola,
was isolated in 1967 in Germany's Marburg Virus Institute from
monkeys which were imported from Uganda.

An Ebola outbreak in the Congo has killed 6 people since April [2007].

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

[A major outbreak of Marburg hemorrhagic fever occurred among gold
miners in the Democratic Republic of Congo between 1998 and 2000,
causing 128 deaths among 154 cases. An outbreak in Angola in
2004-2005 killed 150 people among 163 cases, The Uganda outbreak of
2007 is also associated with a mining community, but has affected
only a few miners

A miner died on 14 Jul 2007 and another was confirmed 13 Aug 2007 as
having survived this rare viral hemorrhagic disease. The WHO Weekly
Epidemiological Record of Fri 17 Aug 2007 (<http://www.who.int/wer/
2007/wer8233/en/index.html>) stated that the mine authorities have
identified one additional suspected case and 2 individuals who were
taken ill in mid-June 2007 and have since recovered. Other miners
under surveillance for Marburg hemorrhagic fever had been at the mine
for approximately 8 months with no movements outside the mining area
during that time, but no other cases were detected among miners or
health care workers at the mine.

This new case (only the 3rd confirmed case) reveals that the virus is
still lurking in the environment of the mine, but an association with
bats or monkeys is still conjecture. - Mod.CP]

TUBERKULOSE - UGANDA (02): MDR, SUSPECTED, REQUEST FOR INFORMATION
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Date: Wed 3 Oct 2007
Source: Daily Monitor [edited]
<http://www.monitor.co.ug/news/news09252.php>


A new but rare multi-drug resistant strain of tuberculosis is on the
rise in the country, medical experts have revealed. The disease is
highly contagious. The alarm bells were sounded over the weekend by
10 Ugandan nurses, who have just completed a refresher course in
Nairobi, Kenya, on how to handle patients with the
multidrug-resistant chronic disease. The nurses said the most
affected districts are Kampala, Gulu, Hoima, Soroti, Kabale, Mbarara,
Mbale, and Arua.

At a press conference in Entebbe, the nurses under their umbrella
organisation, the Uganda National Association for Nurses and
Midwives, said medical reports suggest that the disease, currently on
the increase in Uganda, has metamorphosed from the globally known TB
-- an infectious disease that attacks the lungs, to a drug-resistant version.

Ms Janet Obuni, a nurse who led the team, said the disease is on the
increase in Uganda because TB patients are misusing drug regimes
meant to cure the lung illness, making them ineffective in treating
the disease, "hence the emergence of multidrug-resistant tuberculosis
(MDR-TB) which is becoming a serious global public health concern."
"For this TB to be contained, the nurses need to be trained on how to
handle it before it spreads," Ms Obuni said.

A nurse from Soroti Hospital, Ms Mary Asio, told reporters that she
is currently handling 3 patients suffering from the disease, one of
whom has failed to respond to TB treatment 4 times. "We have nothing
to do now because he has received the treatment for 32 months yet it
is supposed to be for 8 months," Ms Asio said, adding that doctors
are now worried that the patient "may infect his family members." The
nurses, however, provided no statistical data to back up their claims
of the disease increase.

The WHO (World Health Organization) has described the
multidrug-resistant TB when the TB bacteria are resistant to at least
isoniazid and rifampicin, the 2 most powerful anti-TB drugs.

Dr Sam Zaramba, the director general of health services in the
Ministry of Health confirmed the occurrence of the strain in a
telephone interview. Without going into specifics he said a number of
cases had been registered at "some treatment centres," adding that
the government had responded by sending the team of nurses to Kenya
for training on how to handle patients. The MDR-TB is much more
difficult and costly to treat than drug susceptible TB, with a single
patient requiring between USD 10 000-20 000, (UGX 17.6m-UGX 35.2m)
according to medical reports from cases being handled in neighbouring Kenya.

Back home [in Kenya], TB drugs are given free to patients in all
government hospitals, but patients reportedly fear to swallow them
because they claim that they have side effects such as burns on the
body. But patients can avoid the side effects of the drugs by feeding
on a balanced diet, said Dr Clare Ojoru, the officer in charge of the
TB ward at Mulago. She, however, added that "because there is laxity
in patients to take their drugs, the multiresistant TB is on increase."

The nurses appealed to the government to provide them with protective
gear so that "we don't acquire the disease", and called for a routine
screening especially in schools around the country, to quickly
identify any new cases. Early this year [2007], the WHO country
office called for a declaration of TB as a national emergency in
efforts to combat the disease.

[Byline: Alice Lubwama]

--
Communicated by:
Gustaf Rydevik, M.Sc.
<gustaf.rydevik@smi.ki.se>

[ProMED-mail thanks Gustaf Rydevik for bringing this news release to
our attention. Whether the strains that are causing tuberculosis
unresponsive to medical therapy in Uganda are MDR (resistant to
isoniazid and rifampin) or XDR (resistant to isoniazid, rifampin,
fluoroquinolones, and at least one of the 3 injectable
anti-tuberculosis drugs capreomycin, kanamycin, and amikacin) will
depend on results of drug susceptibility testing. From the news
releases, it is unknown if drug susceptibility testing has actually
been performed in these cases.

WHO (<http://www.who.int/tb/publications/2006/istc_report.pdf>)
recommends drug susceptibility testing as follows:

"Drug susceptibility testing (DST) to the first-line antituberculosis
drugs should be performed in specialized reference laboratories that
participate in an ongoing, rigorous quality assurance program. DST
for first-line drugs is currently recommended for all patients with a
history of previous antituberculosis treatment: patients who have
failed treatment, especially those who have failed a standardized
retreatment regimen, and chronic cases are the highest
priority...Patients who develop tuberculosis and are known to have
been in close contact with persons known to have MDR tuberculosis
also should have DST performed on an initial isolate. Although HIV
infection has not been conclusively shown to be an independent risk
factor for drug resistance, MDR tuberculosis outbreaks in HIV
settings and high mortality rates in persons with MDR tuberculosis
and HIV infection justify routine DST in all HIV-infected
tuberculosis patients, resources permitting."

WHO estimates that of the 424 000 cases of MDR-TB that occur
annually, 17 percent are actually XDR
(<http://www.who.int/entity/tb/features_a ... index.html>).
According to the WHO, however, "few national TB programmes have
capacity for drug-susceptibility testing (DST) for the 1st-line drugs
and even fewer have the capacity to test for 2nd-line drug resistance."

Other issues raised by the news release are the availability of fully
potent 2nd-line drugs, availability of personal protective equipment
(such as, disposable class N95 face masks) for healthcare
professionals, as well as knowledge about tuberculosis and actual
practice of optimal patient care of tuberculosis patients among
healthcare professionals in developing countries. In regard to the
last issue, a recent study documented inadequate knowledge and
practice concerning tuberculosis among recent Pakistani medical
school graduates (<http://www.thenews.com.pk/print1.asp?id=74470>). - Mod.ML]

[Information on actual sensitivity testing on the drug resistant
cases mentioned in the above newswire would be greatly appreciated. - Mod.MPP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (43)
**********************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[bCholera - Sierra Leone (Northern, Western Areas)[/b]
Date: Wed 3 Oct 2007
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200710031132.html>


A deadly cholera epidemic has broken out in several regions of Sierra
Leone. Since the 1st week of September 2007, at least 523 people have
been infected in Kambia district in northern Sierra Leone, close to
the border with Guinea, and in the eastern town of Kenema, and Newton
on the outskirts of the capital Freetown, according to the Ministry of Health.

"We have the personnel and enough drugs to quickly and professionally
intervene," The Kambia District medical officer Joseph Kandeh told
IRIN. Nonetheless, 30 people died from the disease in September
[2007], the Ministry said.

The district medical officer for Kenema, Yankuba Bah, said that
people are reluctant to seek treatment when they get sick as they do
not have confidence in public hospitals. "Most patients only visit
government hospitals when they are in a precarious condition," he
said. Bah also said that most of the people infected are women. They
are more exposed to the disease, he said, because they fetch water
from streams and work in crowded markets.

Cholera and other waterborne diseases occur each year during the
rainy season as heavy rains lead to the contamination of streams and
wells from uncollected garbage and effluent. In 2006, 2560 cholera
cases were recorded in Sierra Leone during the rainy season between
August and October, with 77 deaths.

Less than 50 percent of people outside Freetown have access to clean
water and toilets, according to the UN, and most depend on streams
and rainfall for their drinking water.

--
Communicated by:
Otavio da Silva
<otavio_uff104@yahoo.com.br>

[A map of Sierra Leone showing the reported areas can be found at
<http://www.un.org/Depts/Cartographic/ma ... errale.pdf>. - Mod.LL]

Angola - Masern
05.10.2007

349 Erkrankungen mit 12 Todesfällen wurden bisher in diesem Jahr in der zentralen Bie-Provinz registriert; die Dunkelziffer ist sicher höher. Der deutsche Impfkalender der STIKO sieht zwei MMR-Impfungen vor, möglichst im frühen Kleinkindesalter, die allerdings auch später jederzeit nachgeholt werden können. Der Impfschutz sollte anlässlich einer Reise überprüft und ggf. ergänzt werden. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (44)
**********************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Cholera - Senegal
Date: Thu 4 Oct 2007
Source: XinhuaNet [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Senegalese national Health Director Professor Oumar Faye Thursday [4
Oct 2007] said 1060 new cholera cases had been reported across
several regions in the country, local press reported.

"Within the last 5 days, we've witnessed a slight increase in the
number of reported cases," according to the director, who said "the
upsurge in new cases could be attributed to the fact that the country
was experiencing a dry season and unhygienic practices."


"There are 6 regions which have been affected, including Saint-Louis,
Touba, Louga, Thies, Dakar, and Diourbel," Faye said, describing the
situation as "alarming."

According to the "Le Quotidien" daily, the worst-hit areas are Touba
with 222 cases, Mbacke with 79, Bambey with 20, Louga with 48 and
Saint-Louis with over 30.

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

[A map of the western Africa country of Senegal can be found at:
<http://www.un.org/Depts/Cartographic/ma ... enegal.pdf>. The
areas involved are primarily in the western parts of the country. - Mod.LL]

CHOLERA, DIARRHEA& DYSENTERY UPDATE 2007 (46)
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International Society for Infectious Diseases
<http://www.isid.org>

******
Cholera, diarrhea - West Africa
Date: Sun 7 Oct 2007
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, WHO [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


In Niger, from January to August 2007, 13 276 cases and 6 deaths were
reported due to diarrhea. This is almost double as compared to the year
2006 at the same period; 24 cases and 2 deaths due to cholera were reported
in July 2007.

In Togo, the Togolese Red Cross reports elevated numbers of people
suffering from gastroenteritis.

In Sierra Leone, the MoH reported 523 cases of acute watery diarrhea with
30 deaths in the Kambia district since early September 2007.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[A map of West Africa can be found at
<http://www.un.org/Depts/Cartographic/ma ... africa.pdf>. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 ( 48 )
**********************************************
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 - Nigeria (Bauchi)
[2] Cholera - Nigeria (Benue)

******
[1] Cholera - Nigeria (Bauchi)
Date: Fri 12 Oct 2007
Source: The Tide [edited]
<http://www.thetidenews.com/article.aspx ... olumn=NEWS>


No fewer than 5 persons, including 2 women, 2 children and a
middle-aged man, were killed in Bauchi Sun 7 Oct 2007, by cholera.
Secretary to the state's branch of the Nigerian Red Cross, Alhaji
Adamu Abubakar, confirmed the deaths. He told newsmen in Bauchi that
about 35 other persons had been infected by the epidemic, adding that
the victims were currently responding to treatment at the Specialist
Hospital, Bauchi. Abubakar said that a special unit had been created
at the hospital for the treatment of infected persons.

Abubakar said that the epidemic was more pronounced in Gwallaga,
Korar Ran, Kofar Durmi, and Bakin Kura areas of the metropolis. The
Red Cross secretary attributed the outbreak to poor sanitary
condition in the metropolis, adding that the various flood disasters
experienced in the area in 2007, had also contributed to the outbreak.

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

[A map of Nigeria showing the state and city of Bauchi in the
northeast can be found at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

******
[2] Cholera - Nigeria (Benue)
Date: Fri 12 Oct 2007
Source: AllAfrica.com, Daily Trust (Abuja) report [edited]
<http://allafrica.com/stories/200710120759.html>


A total of 5 persons have lost their lives from a suspected outbreak
of cholera in parts of Makurdi, the Benue state capital. The News
Agency of Nigeria (NAN) reports that communities where deaths have
been recorded included Idye Village, Logo 2, and Wadata suburb of
Makurdi, areas where pipe-borne-water could be regarded as "liquid
gold."

When NAN visited the affected communities yesterday [11 Oct 2007],
mourners, families, and friends of those who lost their lives to the
dreaded water-related disease were seen in clusters discussing the
issue and how to find a solution to the problem.

At a hospital in Wadata suburb, which is host to Hausa community
resident in Makurdi, Dr Jona Ibuku, a medical doctor told newsmen
that the hospital recorded the death of a 12-year-old girl on Sat 6
Oct 2007.

Ibuku said the hospital was inundated on a daily basis with people
who might have contracted the disease and warned people to be
cautious about the water they drank and food they ate.

NAN reports that in 2005, gastroenteritis broke out in some
communities in the state and killed several persons, a situation
which caused the government to award contract for the rehabilitation
of the Makurdi Water Works to meet the water needs of the town. NAN
also reports that the contract was, however, abandoned due to the
inability of the federal government to pay its counter-fund for the
project.

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

[Makurdi in the Benue state is in southern Nigeria and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]