Wüstenschiff

Uganda - Meningokokken-Krankheit
06.11.2007

Der seit September aus dem NW gemeldete Ausbruch hat sich im Arua-Distrikt ausgebreitet, diesen aber bisher nicht überschritten. Bis Ende Oktober wurden von dort insgesamt 68 Erkrankungen mit 19 Todesfällen gemeldet. Die Region an der Grenze zur DRC ist von Einheimischen und Flüchtlingen dicht besiedelt, touristisch aber nicht erschlossen. Risiko-Reisende (z.B. Hilfseinsätze) in dieser Region sollten weiterhin geimpft sein. / Quelle: crm

Uganda - Epidemische Konjunktivitis
06.11.2007

Ein örtlicher Ausbruch infektiöser Bindehautentzündungen, trivial dort auch als "red eye disease" bezeichnet, wird aktuell aus Moyo, einer Stadt im N an der sudanesischen Grenze, gemeldet. Betroffen sind vorwiegend Schüler. Der Erreger, gewöhnlich ein Enterovirus, ist nicht bekannt. Die Übertragung erfolgt durch direkten Kontakt wie auch über Gegenstände, z.B. Handtücher. Kontakte mit Erkrankten und gemeinsame Benutzung von Gegenständen meiden, Hygiene beachten, bei Auftreten von Symptomen sofort Arzt aufsuchen. / Quelle: mehr

Angola - Malaria
06.11.2007

Nach Beginn der Regenzeit im Oktober ist landesweit wieder mit einem höheren Übertragungsrisiko zu rechnen. Besonders hohe Fallzahlen werden aus der südzentral gelegenen Huila-Provinz gemeldet. Adaequate Prophylaxe (Mückenschutz und vorbeugende Tabletteneinnahme) beachten. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (55)
**********************************************
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] Diarrhea - Zimbabwe: (Matabeleland North)
[2] Diarrhea - South Africa: (Mpumalanga)

******
[1] Diarrhea - Zimbabwe: (Matabeleland North)
Date: Wed 7 Nov 2007
Source: Reuters Foundation AlertNet, UN Integrated Regional
Information Networks (IRIN) report [edited]
<http://www.alertnet.org/thenews/newsdes ... acd7f0.htm>


More than 3000 cases of diarrhea have been reported in Bulawayo,
Zimbabwe's 2nd city, in the last 2 months, as residents struggle with
water shortages.

"We have so far recorded 3600 cases of diarrhea since the 1st cases
of the outbreak were reported in August 2007, and since then figures
from the city's Health Department indicate that we have been getting
between 300 and 400 new cases of diarrhea every week," said Phathisa
Nyathi, spokesman for the Bulawayo City Council. "We expect the
situation to worsen until we get adequate rains and the water supply
situation normalizes."

Since the outbreak was 1st reported in August 2007, the city has
experienced a 10-fold increase in cases, from 300 to 3600, up to the
2nd week of November 2007.

Low rainfall and an inability to keep up with the demands of a
growing population in a depressed economic environment have left many
of Bulawayo's 1.5 million residents in the grip of water shortages
and often having to obtain water from unprotected sources.

Health Minister David Parirenyatwa said his ministry was monitoring
the situation in Bulawayo and Harare, where diarrhea outbreaks have
also been registered. "We have teams that are dealing with the
outbreak and people are getting treatment in Harare and Bulawayo, and
we have put in programs to contain the outbreak."

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

[This posting illustrates that the lack of water, in addition to
flooding, leads to waterborne diseases. The city and its province can
be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

******
[2] Diarrhea - South Africa: (Mpumalanga)
Date: Wed 7 Nov 2007
Source: IOL (Independent Online, South Africa) [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 746C504834>


More than 400 people have received medical treatment in the Nkangala
area in Delmas, Mpumalanga, since a diarrhea outbreak began there 2
weeks ago, the health department said on Wed 7 Nov 2007.

"Yesterday, 6 Nov 2007, the number of patients treated for diarrhea
came up to 425, most cases were reported over the weekend. We have
sent more nurses to the area," said spokesperson Mpho Gabashane.
Gabashane said most of the patients treated at the clinics were
toddlers. He said they had not yet identified the cause of the
disorder. He said no deaths had been reported yet.

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

[Mpumalanga province is located in the northeastern part of the
country and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.

The outbreaks discussed in this update can also be located on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - Mod.LL]

Rift-Tal-Fieber in Sudan - update
WHO - 07.11.2007

Human cases of Rift Valley Fever (RVF) continue to increase, with 228 cases and 84 deaths reported as of 7 November. Fifteen localities in White Nile, Sinnar, and Gazeera, States are affected. More than 25 human samples have proved positive for Rift Valley fever by PCR or ELISA testing. Laboratory results from three cases in Khartoum state have been found negative for RVF. Results of tests on animal samples remain unavailable. The appearance of RVF disease in humans is typically preceded by infection in animals. The RVF virus circulates between animals via mosquitoes. During an outbreak, the most significant risk factor for human infection is close contact with infected domestic animals, particularly with their body fluids either directly or via aerosols. However, at times of high vector densities the relative importance of mosquito-to-human transmission may increase. With no specific treatment and no effective human vaccine, intensive social mobilization to raise awareness of the risk factors of RVF infection and the protective measures individuals can take to prevent exposure, is the only way to reduce human infection and deaths.

During RVF outbreaks, intensive public health messages for risk reduction should focus on:

reducing the risk of animal-to-human transmission as a result of unsafe animal husbandry and slaughtering practices. Gloves and other appropriate protective clothing should be worn and care taken when handling sick animals or their tissues or when slaughtering animals.
reducing the risk of animal-to-human transmission arising from the unsafe consumption of fresh blood, raw milk or animal tissue. In the epizootic regions, all animal products (blood, meat and milk) should be thoroughly cooked before eating.
the importance of personal and community protection against mosquito bites through the use of impregnated mosquito nets, personal insect repellent if available, by wearing light coloured clothing (long-sleeved shirts and trousers) and by avoiding outdoor activity at peak biting times of the vector species.

WHO continues to work closely with the Sudan Ministry of Health, as well as other UN and international bodies to support an effective control program for protecting human populations.

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 ( 56 )
**********************************************
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, refugee camps - Congo DR: (North Kivu)
[2] Cholera, Ugandan rebels - Sudan: (Western Equatoria)

******
[1] Cholera, refugee camps - Congo DR: (North Kivu)
Date: Fri 9 Nov 2007
Source: Reuters Foundation AlertNet, Office of the UN High
Commissioner for Refugees (UNHCR) report [edited]
<http://www.alertnet.org/thenews/newsdes ... 06b1f3.htm>


UNHCR and its partners have stepped up this week efforts to curb the
spread of cholera which broke out in early October 2007 in 5 camps
hosting some 45 000 internally displaced persons (IDPs) in the
Mugunga area west of Goma in the troubled North Kivu province of the
Democratic Republic of the Congo (DRC). According to health workers,
by the end of October 2007, there were a total of 439 suspected cases
of cholera, 189 of them reported over a 5-day period (24-28 Oct
2007). The latest reports from the camps indicate that the cholera
situation appears to be stabilizing as the number of new suspected
cases is slightly dropping.

North Kivu province is facing the worst internal displacement since
the end of the civil war in 2004. Some 375 000 Congolese have been
forced to leave their homes in the North Kivu province since last
December 2006 due to continued fighting between government forces,
renegade troops, and rebels. More than 160 000 were newly displaced
just over the past 2 months.

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

[A map of the Democratic Republic of the Congo showing the location
of Goma in North Kivu can be found at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[2] Cholera, Ugandan rebels - Sudan: (Western Equatoria)
Date: Fri 9 Nov 2007
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5hzM ... itZfEO2qMQ>


An outbreak of cholera has swept a camp housing Uganda's rebel Lord's
Resistance Army (LRA), infecting its leader Joseph Kony, his deputy
Vincent Otti, and scores of fighters, a spokesman said Fri 9 Nov
2007. The outbreak, caused by recent flooding and poor sanitation in
the Sudan-Democratic Republic of Congo frontier hideout, was 1st
reported in September 2007, but details of fatalities remain unclear.

Scores of LRA fighters were seen Thursday [8 Nov 2007] buying
medicine in the border outpost of Nabanga, according to a top
official from the Sudan People's Liberation Movement (SPLM), which
governs the semi-autonomous region of southern Sudan.

There were no reports of fatalities.

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

[Nabanga is a border town in Sudan's Western Equatoria province near
the Congo DR border. The province can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>.

The outbreaks discussed in this update can also be located on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - Mod.LL]

UNDIAGNOSED ILLNESS - ANGOLA: REQUEST FOR INFORMATION
*****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[The following 3 posts all are about the same disease, but each
offers a different perspective and different information. - Mod.TG]

[1]
Date: Sun 4 Nov 2007
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5gnP ... aqmd3YdCfg>


An unidentified disease has killed 5 people and led to more than 100
being hospitalized over the past 2 weeks in the outskirts of the
Angolan capital Luanda, health officials said Saturday [3 Nov 2007].

"We don't know what it is at this stage", Luanda health official Vita
Vemba told state radio, while announcing the setting up of a special
commission comprising health, environment, and local government officials.

The independent financial daily A Capital on Saturday [3 Nov 2007]
blamed pollution in city's Cacuaco quarter for the rash of illnesses.
The director of the newspaper, Tandala Francisco, told AFP that 2
weeks ago, Cacuaco residents began complaining of a foul smelling
"green thick smoke" emanating from the chimney of a petroleum unit in
the area. The factory has since been closed.

Symptoms including "sleepiness, tiredness, and difficulty with
speech," witnesses told A Capital. Authorities meanwhile refused comment.

Vemba however dispelled fears of a cholera or fever outbreak.

Oil-rich Angola's sole refinery is located in Cacuaco.

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

******
[2]
Date: Wed 7 Nov 2007
Source: All Africa.com, UN Integrated Regional Information Networks
(IRIN) report [edited]
<http://allafrica.com/stories/200711070852.html>


An undiagnosed disease that has affected 200 and left at least 4 dead
in Cacuaco, about 20 km (12.5 mi) north of the Angolan capital,
Luanda, has health organizations scrambling to identify the illness.

The 1st cases were reported in early October [2007]. "What we know is
that new cases keep arriving at the hospital," Balbina Felix, disease
control officer at the World Health Organization (WHO) in Luanda, told IRIN.

According to the Municipal Hospital in Cacuaco, 20 new cases per day
have been reported since Monday [5 Nov 2007], with symptoms that
include weakness, drowsiness, muscular spasms, a confused state of
mind, dizziness, and difficulty to walk and speak. Approximately 208
000 people live in the coastal municipality.

Felix described the illness as a "clinical neurological disorder,"
and dismissed fever or cholera as possible culprits, but health
organizations are still in the dark. Identifying the disease has
become a priority, to help prevent further transmission and treat
fatally ill patients.

On Monday [5 Nov 2007], a delegation comprised of Health ministry
officials, Cacuaco municipal officials, and representatives of WHO,
the US-based Centre for Disease Control (CDC), and the Angolan
military health services visited affected areas.

Over 2700 Angolans succumbed to cholera in 2006, and the waterborne
disease has already killed over 400 people this year [2007]. In 2005
the country experienced the largest-ever recorded outbreak of Marburg
hemorrhagic fever, a rare but fatal disease caused by a virus from
the same family as the Ebola virus.

A WHO statement released on Tuesday [6 Nov 2007] said the
organization had deployed "an international team of experts in
clinical toxicology, epidemiology, and environmental health, as well
as laboratory personnel, to assist the Ministry of Health in the
ongoing investigation" and "experts from the Centers for Disease
Control (CDC), based in Luanda, have also offered support for the
investigation."

The teams would "support the Ministry of Health ... provide advice on
case- and risk-management, and identify laboratories for analysis of
human and environmental samples to investigate the cause and the
source of the disease". According to Felix, samples have already been
sent to the CDC in Atlanta, USA, and to testing facilities in France,
the UK, and Germany.

The Ministry of Health has advised the population to observe
individual and collective measures, particularly related to hygiene,
to avoid risk and report to the nearest health facility at the 1st
sign of illness.

This report does not necessarily reflect the views of the United Nations.

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

******
[3]
Date: Wed 7 Nov 2007
Source: Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/L07587684.htm>


International health officials are investigating the emergence of a
mysterious disease in Angola that has killed at least 4 people and
sickened more than 200.

The illness, which leads to weakness, muscular spasms, mental
confusion, and speech impairment, surfaced in Cacuaco, near Luanda,
in early October [2007], the World Health Organization (WHO) said in
a press release sent to Reuters late on Tuesday [6 Nov 2007].

It has since spread to 7 neighborhoods in the municipality, about 20
km (12.5 mi) north of the Angolan capital and home to some 200 000 people.

"As of 1 Nov 2007, more than 200 cases including 4 deaths have been
reported," the WHO said in its statement.

Experts from the WHO, U.S. Centers for Disease Control and Prevention
(CDC), and the Angolan government are investigating the outbreak.
"The Ministry of Health advised the population to observe the
individual and collective measures, especially food hygiene, to avoid
all risk factors related to solid wastes and to go to the nearest
health facilities if suffering from any signs of sickness," the WHO added.

Angola suffered an extensive cholera outbreak last year [2006] that
killed at least 1800 people. Some 150 Angolans died in 2004-2005
after contracting Marburg virus, a close relative of the feared Ebola virus.

The oil-rich southwestern African nation is struggling to rebuild its
health system, which was devastated during a 27-year civil war that
ended in 2002. Millions were left vulnerable to malnutrition and
other diseases due to the conflict. An estimated one-quarter of
babies and toddlers die before the age of 5.

Although former colonial power Portugal established a rudimentary
health system while ruling Angola, services crumbled after
independence in 1975.

[Byline: Zoe Eisenstein; editing by Paul Simao, Mary Gabriel]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The symptoms described in each of these articles do not fit chlorine
gas or phosgene gas. Those gasses are most often associated with
'green smoke'. And indeed, the 'green smoke' may be nothing more than
a coincidence and have nothing to do with the actual illness.

There are some reports that the illness involves an abandoned case of
chloroquine whose expiration date is 2009. However, the symptoms do
not match a chloroquine overdose unless the chloroquine is tainted
with an as yet unknown toxin.

Samples from some victims have allegedly been sent to a couple of
laboratories but precisely what samples from the victims or the
environment have not been reported.

Clearly the situation remains a mystery. - Mod.TG

The HealthMap/ProMED-mail interactive map of Angola can be accessed at
<http://healthmap.org/promed?v=-12.3,17.5,5>. - CopyEd.MJ]
...................................tg/mj/dk

RIFT-TAL-FIEBER - SUDAN (04)
******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 9 Nov 2007
Source: FAO-EMPRES Web site [edited]
<http://www.fao.org/ag/againfo/programme ... s/home.asp>


FAO Statement on Rift Valley fever in Sudan
--------------------------------------------
Rift Valley fever (RVF) outbreaks have been reported by WHO in humans
in Sudan in White Nile, Sinnar, and Gezira states on 5 Nov 2007. RVF
is a dangerous mosquito-borne zoonotic disease affecting ruminants
and humans. People contract infection through mosquito bites or
direct contact with infected biological material and liquids such as
blood during slaughtering or when handling animal abortions.

While sometimes difficult to identify, usually RVF is already well
established in animal populations by the time the 1st human cases are observed.

"The source of RVF in animals needs to be identified and veterinary
control measures put in place in order to reduce the public health
risk, to limit the impact on livelihoods and to avoid further
spread," said J. Domenech, Chief Veterinary Officer of FAO. This is
of particular importance during this time of the year given that
major trade movements of ruminants are expected because of the
upcoming Muslim religious events, the Hajj and Eid Al-Adha. [The Hajj
begins 18 Dec 2007; Eid Al-Adha is on 20 Dec 2007. - Mod.AS] He
emphasized the importance of informing population groups at risk on
measures that may be applied to protect people from becoming
infected. FAO closely monitors the developments and has offered
technical assistance to Sudan to support animal disease investigation
and animal management aspects.

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

[Unfortunately -- similarly to numerous past cases -- RVF has been
again detected by human rather than animal sentinels. And contrary to
the previous outbreak in Somalia, Kenya and Tanzania which began at
the end of 2006, the current outbreak has not been preceded by a
warning based upon climatic-ecological analyses.

Up to now, no information (official or otherwise) from Sudan is
available on suspected clinical cases in animals (predominantly
mass-abortions and offspring mortality). In addition to the grave
public health aspects, the disease may have devastating impact upon
the livestock industry and the livelihood of animal owners.

RVF was initially recorded in Sudan in 1936 (antibodies in humans).
An extensive epizootic was described in 1973, accompanied by virus
isolations from affected animals. 1973 is the year officially
reported by Sudan's veterinary authorities as the last year of RVF
occurrence. However, a limited epizootic was reported in 1976 (Ref.
Eisa et al., 1980. An outbreak of Rift Valley fever in the Sudan
--1976. Trans.R. Soc. Trop. Med. Hyg. 74, 417-419). This epizootic
was later suspected to be a possible source of the major 1977-78 RVF
epizootic/epidemic in Egypt (Ref. Gad et al., 1986. A possible route
for the introduction of Rift Valley fever virus into Egypt during
1977. J Trop Med Hyg. 89(5):233-236). The authors concluded:
"Reintroduction of RVF or other diseases from Sudan into Egypt will
be facilitated by the construction of new roads linking the two countries."

An epizootic of RVF which occurred in Egypt between April and August
1997 was also attributed to introduction from the Sudan (Ref. Abd
el-Rahim et al., 1999. An epizootic of Rift Valley fever in Egypt in
1997. Rev. Sci. Tech. OIE 18(3):741-748). The authors concluded:
"Importation of infected ruminants, especially camels from the Sudan,
is the principal source of infection. Aswan, the nearest Egyptian
province to the Sudan, is the focus of RVF virus infection in Egypt."

The epidemiology of RVF, including the possible role of animal
movements in its spread, has been subject to past discussions.
Subscribers are referred to the commentaries of Peter Roeder in
20070112.0164 and of Glyn Davies in 20070324.1024.

FAO's Animal Health Manual No. 17 "Recognizing Rift Valley Fever"
(2003) is available online at
<ftp://ftp.fao.org/docrep/fao/006/y4611E/y4611E00.pdf>. - Mod.AS]

[The HealthMap/ProMED-mail interactive map of Sudan can be accessed at
<http://healthmap.org/promed?v=13.8,30,5>. - CopyEd.MJ]

Südl. Afrika: Botsuana, Namibia, Südafrika, Swasiland - Malaria
12.11.2007

Während der Regenzeit, die im November beginnt und bis April/Mai andauert, muss in den ausgewiesenen Malariagebieten mit einem zunehmenden Übertragungsrisiko gerechnet werden. Empfohlene Vorbeugung beachten. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (57)
**********************************************
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, refugee camps - Congo DR: (North Kivu)
[2] Diarrhea - South Africa: (Mpumalanga)

******
[1] Cholera, refugee camps - Congo DR: (North Kivu)
Date: Mon 12 Nov 2007
Source: Reuters Foundation AlertNet, Office of the UN High
Commissioner for Refugees (UNHCR) report [edited]
<http://www.alertnet.org/thenews/newsdes ... 5a106f.htm>


The UN refugee agency and its partners have stepped up joint efforts
to curb the spread of cholera in camps hosting some 45 000 internally
displaced Congolese in the troubled province of North Kivu. The
potentially fatal diarrheal disease broke out in early October 2007
in 5 camps for internally displaced people (IDPs) located in the
Mugunga area of North Kivu, which is located in the east of the
Democratic Republic of the Congo.

Latest reports from the camps indicate that the cholera situation
appears to be stabilizing, with the number of new suspected cases
dropping slowly but steadily. Health workers said that at the end of
October 2007 there were 439 suspected cases of cholera, 189 of them
reported from 24-28 Oct 2007.

In the last 4 days of October, 103 new cases were recorded, or about
25 per day, while in the 1st 8 days of November 2007 medical
personnel registered 135 new cases, an average of 16 a day.

"Last week we stepped up our aid efforts in the IDP camps close to
Goma [the main town of the area, located not far east of Mugunga], in
partnership with UN sister agencies and NGOs (non-governmental
organizations)," UNHCR Representative Eusebe Hounsokou said. "The
upsurge of cholera is only one of the many symptoms of the worsening
humanitarian tragedy in North Kivu," he added.

[Byline: Jens Hesemann]

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

[A map of the Democratic Republic of the Congo showing the location
of Goma in North Kivu can be found at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[2] Diarrhea - South Africa: (Mpumalanga)
Date: Sun 11 Nov 2007
Source: SABC News [edited]
<http://www.sabcnews.com/south_africa/he ... 72,00.html>


At Delmas, in Mpumalanga, 60 more people are being treated for severe
diarrhea. More than 640 people have contracted the disease since its
outbreak late in October 2007.

Test results have given the drinking water in the town a clean bill
of health and authorities suspect that borehole water may be infected.

Health Department spokesperson Mpho Gabashane says additional
resources have been made available to deal with the outbreak.

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

[Mpumalanga province is located in the northeastern part of the
country and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.

The outbreaks discussed in this update can also be located on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - Mod.LL]

Rift-Tal-Fieber in Sudan - update 2
WHO - 14.11.2007

As of 14 November 2007, 329 human cases, including 96 deaths (case-fatality rate, 29%) have been reported from White Nile, Sennar, Gazeera States. Cases reported in Khartoum State are not indigenous cases but were imported from one of the other affected States. The most rapid increase in human cases has been seen in Gazeera State, which now accounts for more than half of the human cases. The cases being reported in Gazeera State are in an area close to irrigation canals and are linked to naturally occurring cycles involving livestock and mosquitoes which are abundant in the irrigation zone.

On 11 November the Sudanese Federal Ministry of Animal Resources and Fisheries reported to Office International des Epizooties (OIE) that Rift Valley Fever had been found on 29 October in samples taken from animals in White Nile State. It is anticipated that following this declaration, a well-integrated control program for limiting the disease in both human and animal populations will now be implemented.

The Food and Agricultural Organization of the United Nations has deployed a senior animal health expert to the country to assist veterinary services with prevention and control measures in animals. The Ministry of Health and WHO Country Office have presented a plan for the prevention and control of the disease in humans to international donors in Khartoum. The WHO Eastern Mediterranean Regional Office and WHO headquarters are supporting the national response, mobilizing epidemiologists and working with partners to enhance national laboratory capacity for RVF.

Social mobilization activities are now under-way to alert the local population to the human health risks associated with this disease in animals. However, more intensive efforts are urgently needed, using all locally available media, including television and radio channels, as well as community and religious leaders, to ensure that at-risk communities are fully aware of the measures that need to be taken to reduce the risk of human infection.

Unknown illness in Angola
WHO - 16.11.2007

An outbreak of a disease of unknown etiology is currently ongoing in Cacuaco municipality, Angola. The first cases were reported on 2 October. As of 15 November 2007, a total of 370 cases had presented for treatment at the Municipal Hospital in Cacuaco.

It is anticipated that additional unreported cases may be occurring within communities among patients preferring to remain at home or to receive treatment from traditional healers. The clinical symptoms of the disease are extreme drowsiness, waking only to painful stimuli. Patients recover slowly, over a number of days, but remain ataxic with many unable to walk unaided. The symptoms are most extreme in children.

The neurological indication is of a cerebellar abnormality with no sign of peripheral neuropathy. Reflexes are normal. The case presentation suggests a toxicological cause, however, the etiological agent has not yet been identified. Samples taken from patients have been tested for 300 organic solvents and a general drug screen covering 800 compounds has also been carried out.

These tests have so far proved negative. Tests for cadmium, lead, mercury and manganese have shown levels within the normal range. Environmental samples, as well as food and drinking water, have also been taken and results of tests are awaited.

Epidemiological investigations so far have not revealed a common source or route of exposure, and these investigations are now being extended in scope.

HEMORRHAGIC FEVER - UGANDA (BUNDIBUGYO): MARBURGVIRUS SUSPECTED,
REQUEST FOR INFORMATION
***************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 14 Nov 2007
Source: Daily Monitor (Uganda) [Edited]
<http://www.monitor.co.ug/artman/publish ... ugyo.shtml>


Strange viral disease kills 20 in Bundibugyo
--------------------------
A strange viral disease with symptoms similar to the Marburg
hemorrhagic fever has hit Bundibugyo District in the west, killing
about 20 people in less than 2 weeks.

The Chief Administrative Officer, Mr Elius Byamungu, said the disease
mainly hit Kikyo village on the foothills of Mt. Rwenzori. He said
the area has since been sealed off.

He said the disease is highly infectious and kills within 3 days.
"It has claimed over 20 people and among them is one of our staff who
has been treating patients at a health centre at Kikyo," Mr Byamungu
said.

"The patients develop high fever, vomit and catch diarrhoea before
they die. It is very deadly and strange." Mr Byamungu said efforts to
contain the disease have proven futile and they have appealed to the
Ministry of Health.

He said blood samples of the victims have already been sent to South Africa.

"We sent out samples to South Africa but we haven't got the results,
you can contact Dr [Sam] Okware and Dr [Sam] Zaramba for more
information," he said.

Dr Okware, the Director of Community Health, said they are yet to
establish the name of the disease. He said someone can catch the
disease through close range contact with a patient.

"Yes, the disease has been reported but we are still investigating.
In September [2007], we took specimen and it was negative on Marburg.
But it seems to be an infectious disease caused by small mammals like
cats," he said.

Dr Okware said the main symptoms are high fever, vomiting, abdominal
pain and skin rashes. He said they suspected the disease to be
Leptospirosis -- a rare disease caused by [bacteria spread from]
small mammals.

The symptoms are similar to the Marburg fever which claimed one life
at Kitaka mines in the western district of Kamwenge in August [2007].
Dr Okware said 13 villages had been affected and 3 health workers at
Kikyo Health Centre IV infected.

[Byline: Felix Basiime, Al-Mahdi Ssenkabirwa, & Joseph Mugisa]

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

[With the history of a recently contained small outbreak of Marburg
hemorrhagic fever in Uganda in the past several months (see
references for 2007 below), it is understandable that the diagnosis
of Marburgvirus for another outbreak of hemorrhagic fever in Uganda
is being entertained. In addition, the observation that there have
been 3 cases among health care workers also strengthens the suspicion
that either Marburgvirus or Ebolavirus may be the causative agent as
these hemorrhagic viruses are often associated with nosocomial
enhancement of transmission, especially in remote areas where
observing universal precautions requires protective gear such as
gloves, masks and gowns that are not routinely available due to
severe resource limitations.

The outbreak of Marburgvirus earlier this year was associated with
mine workers in Kitaka mine, located in Kakasi Forest Reserve in
Kamwenge district. (see map of Uganda available at: For a map of
Uganda see
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg>.
Kemwenge is located almost due west of Kampala one district removed
from the border with the Democratic Republic of the Congo. The
current outbreak is occurring in Bundibugyo district which borders
with the Democratic Republic of the Congo and is one district removed
from Kemwenge district where the earlier Marburvirus cases were
located.

The comment that specimens sent for testing in September 2007 were
negative may not apply to the above outbreak, but may in fact apply
to specimens of contacts of the affected mine workers in the earlier
outbreak, but may not have included all individuals who had contact
with the implicated mine. Outbreaks of hemorrhagic fevers have been
associated with mine workers in the past (see Viral hemorrhagic fever
- Uganda (Kamwenge): Marburg susp., RFI 20070801.2475 for a
discussion and review of this topic, with relevant references on the
identification of hemorrhagic fever viruses in bats).

Ebolavirus has also been the causative agent for hemorrhagic fever
outbreaks in Uganda (see references below). In addition,
Congo-Crimean hemorrhagic fever and yellow fever are possible. The
curiosity in the above newswire is the mention of small mammals such
as cats as possibly being involved in the transmission cycle of what
is going on in Bundibugyo. This tidbit had this moderator wonder if
plague (caused by _Yersinia pestis_) should also be considered as
Uganda is endemic for plague, and has plague outbreaks periodically
(see below references for plague reports in Uganda during 2007).

Clearly more information from knowledgeable sources would be appreciated.

For additional maps of recent ProMED-mail postings in Uganda and
surrounding countries, see the maps at HealthMap.org available at
<http://healthmap.org/promed?v=1.3,32.4,6>. - Mod.MPP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 ( 58 )
**********************************************
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 - Congo DR-Uganda border: (Rukwanzi Island)
[2] Cholera - Mozambique: (Cabo Delgado)

******
[1] Cholera - Congo DR-Uganda border: (Rukwanzi Island)
Date: Tue 13 Nov 2007
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN) [edited]
<http://allafrica.com/stories/200711130620.html>


Authorities in the Democratic Republic of Congo (DRC) have ordered
the partial evacuation of a disputed island in Lake Albert, where
health workers are unable to tackle a cholera outbreak partly because
of security concerns linked to the discovery of oil.

"We have just ordered the section head and police on the ground to
evacuate children and the elderly" from Rukwanzi Island, which lies
on a poorly-defined border separating DRC and Uganda, said Dieudonne
Rwabona, acting district commissioner in DRC's northeastern region of
Ituri. Since 5 Oct 2007, police on the island have reported 57 cases
of cholera with 3 fatalities.

"Things are getting worse. Just in the last 2 days, we registered 6
cholera cases. Since there is no healthcare infrastructure, we treat
the sick ourselves with our own first aid medicines," a police
commander on the island said on 12 Nov 2007.

"They don't have access to [clean] water or healthcare where they
are. Those who develop diarrhea are told to take a boat to Tchomia, a
lakeside town where there is an isolation ward," said Eustace
Kyroussis from the WHO in Bunia, Ituri's main town.

Rukwanzi, with an area of 12 sq km (4.6 sq mi), is home to about 3000
people, mostly fishermen and their families. The recent discovery of
oil under Lake Albert has exacerbated the territorial dispute. Troops
from DRC and Uganda exchanged gunfire near the island in August 2007
and, despite a fence-mending meeting between their respective
presidents, again in September 2007.

"It's an island that shouldn't really be habitable," said Kyroussis.

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

[A map of Lake Albert bordered by Congo DR and Uganda can be found at
<http://encarta.msn.com/map_701513898/Albert_Lake.html>.
Not shown on the maps found by the moderator, Rukwanzi is reported to
be close to the southern tip of the lake. - Mod.LL]

******
[2] Cholera - Mozambique: (Cabo Delgado)
Date: Tue 13 Nov 2007
Source: Reuters Africa [edited]
<http://africa.reuters.com/top/news/usnBAN332587.html>


A total of 15 people have died and hundreds of others have been
admitted to hospital following an outbreak of cholera in the northern
Mozambican province of Cabo Delgado, health authorities said on Tue
13 Nov 2007.

Quinhas Fernandes, the provincial chief doctor, said that at least
400 new cases have been reported in the past 2 weeks in Cabo Delgado.
"Cholera is always an emergency situation, it's still under control
but we are going to boost campaigns ... in order to avoid its rapid
spread," he told Reuters.

In 2006 over 44 000 cases of cholera were recorded in the province.
Over 39 000 cases have been recorded since January [2007], officials
said. [Despite these numbers, WHO had reports of only 6309 cholera
cases in Mozambique for 2006 with 29 deaths
<http://www.who.int/wer/2007/wer8231.pdf> - Mod. LL]

The new outbreak has been blamed on contaminated water and poor
sanitary conditions. Health authorities in Cabo Delgado have warned
that the outbreak could rise as the rainy season reaches its peak,
particularly in the Impirre district, where most of the 15 deaths
occurred.

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

[It is not clear where the total number of cholera cases reported in
this posting is derived from. Cabo Delgado is located in the
northeastern part of Mozambique, bordering the Indian Ocean as can be
found at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf> - Mod.LL]

MILZBRAND, HUMAN, BOVINE - ZAMBIA (WESTERN PROVINCE)
**************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 14 Nov 2007
Source: Xinhua [edited]
<http://news.xinhuanet.com/newscenter/20 ... 075384.htm>


Zambia Post reported on 14 Nov 2007 that 6 villagers in Mongu
District in Zambia's Western Province were hospitalized after
contracting anthrax from diseased beef.

Along with other measures, the local government has provided vaccines
for domestic livestock and has urged local farmers not to panic,
saying it will work exhaustively to control the disease. Local
veterinary officials have advised residents not to eat meat from
diseased carcasses.

The report says that Mongu District health agency has requested the
central government to urgently dispatch 23 000 units of anthrax
vaccine for vaccination of livestock in villages surrounding the area
where anthrax was discovered to prevent a large scale outbreak.

[Byline: Jinhai Liu]

--
Communicated by:
ProMED-mail Rapporteur Dan Silver

[Our thanks to Dan for finding and translating this report via China.

Mongu in Western Zambia has long been enzootic for anthrax. And
unfortunately, reactive livestock vaccination will do little to
control this disease in the medium term, much less the long term. It
is an area with poor roads and weak infrastructure, and therefore the
District Veterinary Officers have problems responding to any reports
of livestock problems, and especially acute problems. Thus, we see
this situation, where response comes as a reaction to human cases. To
cost-effectively control livestock anthrax, one must have a program
of routine annual vaccination of at-risk herds and flocks. It is even
more efficient if there is surveillance for unexpected livestock
deaths so that they can be promptly investigated, whether due to
poisonings, blackleg, or even anthrax. - Mod MHJ]