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HEMORRHAGIC FEVER - UGANDA (02): (BUNDIBUGYO), MARBURG NOT
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Date: Fri 16 Nov 2007
Source: The New York Times, Reuters report [edited]
<http://www.nytimes.com/reuters/world/in ... fever.html?>


A mysterious fever has killed 14 people and infected 37 others in
western Uganda over the last 3 months, a Health Ministry official
said on Friday [16 Nov 2007]. Sam Okware said the fever, though
deadly, was not hemorrhagic. Blood samples from it had already tested
negative for the killer Marburg virus that infected 3 people in a
nearby district in August [2007], killing one.

Victims of the fever in Uganda's Bundibugyo District, on the border
with Democratic Republic of Congo, [DRC] died not from bleeding but
from dehydration because of severe diarrhoea. All had complained of
fever and abdominal pains before dying. "We're investigating but we
really don't know what it is," Okware said. "We tested for Marburg,
thank God it was negative. It is most likely a virus, but we haven't
identified it." Okware said the disease was unlikely to be Rift
Valley fever, which has killed 96 people in neighbouring Sudan. "It
could also be leptospirosis, which comes from contact with rodents,
or typhus fever. [Neither of these diseases is a viral disease. -
Mod.CP]. There are a lot of funny viruses in those mountains," he
said. New cases were still emerging regularly. "It is not at all
contained," he said.

In 2000, Uganda was hit by an epidemic of the deadly Ebola virus, in
which those infected often bleed to death. It infected 425 people,
just over half of whom died.

[Byline: Daniel Wallis, Ibon Villelabeitia)

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[Marburg virus infection has been excluded now by laboratory testing.
Furthermore the occurrence of a similar hemorrhagic fever is unlikely
on the basis of symptomatology. The cause of the outbreak remains
obscure and the evidence for involvement of a viral agent is not
strong. Many possibilities remain in view of a previously suggested
association between rodent abundance in the environment and the
disease, and also the predominance on patients of symptoms of
dehydration and diarrhea. Further information is requested.

A convenient map of Uganda is available via the HealthMap.org website at
<http://healthmap.org/promed?v=1.3,32.4,6>. - Mod.CP]

TRYPANOSOMIASIS (SCHLAFKRANKHEIT) - SÜDAFRIKA ex MALAWI (02)
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Date: 16 Nov 2007
From: Lucille Blumberg <lucilleb@nicd.ac.za>


Trypanosomiasis was confirmed in a British soldier who acquired the
infection on a field exercise in the Kasunga National Park, Malawi.
This is the 5th case of trypanosomiasis in travellers to this area
that has been managed in South Africa this year [2007].

The patient presented with acute onset of fever, headache, and
rigors, and a trypanosomal chancre on the thigh. Large numbers of
trypanosomes were noted on a peripheral blood smear. He had a
profound thrombocytopenia, laboratory evidence of a DIC [disseminated
intravascular coagulation] and marked leucopenia. Mild renal and
hepatic dysfunction, and acute respiratory distress syndrome
complicated the acute illness. There was no clinical evidence of
involvement of the central nervous system but examination of the
cerebrospinal fluid will be done only once the peripheral
parasitaemia is cleared and there is an improvement in the
coagulation parameters. He is responding well to suramin treatment.

In November 2005, 2 other travellers were also treated in South
Africa for trypanosomiasis acquired in the Kasunga National Park,
Malawi. Tourists visiting game reserves in central and east African
countries should be alerted to the danger of this disease for which
there are no effective preventive measures, but which if acquired,
requires expert diagnosis and treatment.

[Lucille Blumberg, John Frean, Paul Williams]

--
Dr. Lucille Blumberg
National Institute for Communicable Diseases
No.1 Modderfontein Road, Sandringham
Johannesburg, South Africa
<lucilleb@nicd.ac.za>

[The report confirms our previous report from February 2007 that also
Malawi is an endemic country. We have no data on cases in the
indigenous population. More information on African trypanosomiasis
can be found at Programme Against African Trypanosomiasis (PAAT).
<http://www.fao.org/ag/againfo/programme ... /home.html>. - Mod.EP

Maps of South Africa and Malawi can be found via the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - CopyEd.MJ]

[ProMED-mail would like to thank Drs. Blumberg, Frean and Williams
for this 1st hand report on the importations of African
Trypanosomiasis cases from Malawi to South Africa. We apologize for
the delay in posting -- it was a victim of overzealous server spam
filtering. - Mod.MPP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 ( 59 )
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In this update:
Africa
[1] Cholera - Congo DR: (Orientale)
[2] Cholera - Congo DR: deaths

******
[1] Cholera - Congo DR: (Orientale)
Date: Fri 16 Nov 2007
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5jvz ... bfCDde1D9g>


Some 272 cases of cholera, including 8 deaths, have been detected since the
beginning of September [2007] in a north eastern district of the Democratic
Republic of Congo, a WHO official said on Fri 16 Nov 2007. The cases have
occurred in the Tchomia health zone within the Ituri district, said Eustace
Kyroussis, head of the WHO office in the area.

Numerous cases have been detected on the small island of Rukwanzi in Lake
Albert, recently inhabited by fishermen and their families, said local
official Dieudonne Rwabona. "On Rukwanzi, an island of 3 square kilometres
(1.2 square miles), there is no health center nor latrine," Rwabona said.

Congolese police have begun evacuating the families from the island and
sending them back to their villages of origin. The cholera outbreak in the
region has essentially been due to a lack of drinkable water, forcing
residents to consume non-treated water from Lake Albert.

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[A map of Congo DR can be found at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. The Ituri
district is a part of Province Orientale and can be found on the northeast
part of the country. The island of Rukwanzi, located at the southern end of
Lake Albert, is disputed territory between Congo DR and Uganda, which has
been exacerbated by the recent discovery of oil under Lake Albert. - Mod.LL]

******
[2] Cholera - Congo DR: deaths
Date: Mon 12 Nov 2007
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb [edited]
<http://www.reliefweb.int/rw/fullMaps_Af ... penElement>


The URL above shows, for each health zone in the Democratic Republic of
Congo, the distribution of deaths from cholera.

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EBOLA HEMORRHAGIC FEVER - CONGO DR ( 13 )
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[1]
Date: Mon 19 Nov 2007
Source: Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/L19449576.htm>


Health officials in the Democratic Republic of Congo on Monday [19 Nov
2007] declared the end of an outbreak of deadly Ebola haemorrhagic fever,
believed to have killed up to 187 people over 8 months. Congo's Health
Ministry and the World Health Organization (WHO) said that a 42 day period
following the death of the last Ebola victim had ended on 13 Nov 2007.
Despite not recording a new Ebola infection in over a month and a half,
officials said it was standard practice to wait 42 days -- twice Ebola's
maximum incubation period -- before announcing the end of an outbreak. "In
view of the positive results attained, it is my duty to announce today [19
Nov 2007] ... the end of the Ebola epidemic," Health Minister Victor
Makwenge Kaput told journalists in the capital, Kinshasa.

People began falling ill in April [2007] in the village of Kampungu in
Western Kasai province with Ebola-like symptoms, including fever and muscle
pain, followed by vomiting, diarrhoea, and internal haemorrhaging. The
presence of the disease was not confirmed until September [2007]. Experts
from WHO and the medical charity Medecins Sans Frontieres (MSF) rushed to
bring in tonnes of medical equipment and sanitation products, and 2 mobile
laboratories to help deal with the crisis. The remoteness of the affected
areas and Congo's lack of infrastructure, much of it damaged by years of
neglect and a 1998-2003 war, magnified the problems of tackling the
outbreak in the former Belgian colony.

It remains unclear how many of a total of 264 suspected cases were due to
Ebola, which has no cure and kills 50 to 90 per cent of its victims.
Outbreaks of typhoid fever and _Shigella_, a bacterial infection, both of
which have symptoms similar to Ebola, occurred simultaneously in the
affected areas. Of 110 samples taken from suspected Ebola victims, 26
tested positive for the disease.

The health officials said on Monday [19 Nov 2007] that epidemiologists were
trying to determine the origin of the outbreak, which they suspect may have
been transmitted by migrating bats, which were hunted and eaten by local
villagers. Ebola is transmitted by contact with the blood, secretions,
organs, or other bodily fluids of infected people. Western Kasai is east of
Kikwit, the site of an Ebola outbreak in 1995 in the former Zaire, which
killed 250 out of 315 people infected.

[byline: Joe Bavier, Daniel Flynn)

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[2]
Date: Tue 20 Nov 2007
Source: IRIN (UN Integrated Regional Information Networks) [edited]
<http://www.irinnews.org/Report.aspx?ReportId=75401>


Health officials in the Democratic Republic of Congo (DRC) said an outbreak
of Ebola haemorrhagic fever, which claimed the lives of 21 of the 26 people
infected in the Kasai Occidental province, is now over. "We can say today
that the Ebola epidemic has been completely brought under control," Health
Minister Makwenge Kaput told reporters on 19 Nov 2007. He said authorities
had waited 42 days since the last Ebola-related death in Kampungu village
before making the announcement double the time of the 21 day incubation
period of the virus.

Some 264 people had fallen ill in Kampungu since April [2007], including
187 fatalities, but experts confirmed only 26 cases of Ebola, according to
Eugene Kabambi, communications officer for the UN World Health Organization
in DRC. Vital Mondonge, the officer in charge of disease control and
prevention at the health ministry, said the Ebola epidemic had coincided
with outbreaks of typhoid, shigellosis (a bacterial infection), and
malaria, which share some symptoms with the deadly virus.

Ebola is characterised by fever, diarrhoea, severe blood loss, and intense
fatigue. It is transmitted through direct contact with the bodily fluids of
infected people or of other primates. There is no cure, and health experts
say between 50 and 90 per cent of victims die. The best way of halting its
spread is through prevention, prompt detection, and the isolation of
suspected cases. The DRC has experienced Ebola epidemics in 1976 in
Yambuku, Orientale province, in Kikwit, Bandundu, in 1995, where at least
250 deaths were reported, and in Watsa, Orientale, in 1999.

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[Welcome news, but unfortunately the true extent and origin of the Ebola
disease outbreak remains unclear, and strategies to avoid future
recurrences cannot yet be determined.

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

RIFT VALLEY FEVER - SUDAN ( 08 )
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Date: Wed 21 Nov 2007
Source: Sudan Tribune online, Agence France-Presse report [edited]
<http://www.sudantribune.com/spip.php?article24836>


As of 20 Nov 2007 nearly 100 people have died of suspected Rift Valley
fever with over 360 more infected, Sudan officials said on Tuesday [20 Nov
2007], after initially being slow to confirm an outbreak of the deadly disease.

The Health Ministry said 94 people had died and 362 been infected in the
suspected outbreak concentrated in White Nile, Sinnar, and Al-Jazira
states, south of Khartoum. Ministry epidemiologist Issam Mohammed Abdallah
released the figures in a meeting with health officials, the official SUNA
news agency reported. Abdallah said the disease could be transmitted by
eating uncooked meat, drinking unpasteurised milk, or close proximity to
infected animals. Fear of contracting the disease has caused a significant
decline in meat consumption, the Khartoum press reported.

On 9 Nov 2007, the World Health Organization (WHO) said more than 80 people
had died of suspected Rift Valley fever and that more than 25 of almost 230
suspected cases in Sudan had been confirmed by laboratory analysis. There
are no vaccines for humans who contract Rift Valley fever, usually via
mosquitoes. Victims usually experience fever, general weakness, back pain,
dizziness, vomiting of blood, and extreme weight loss at the onset of the
illness. Many patients recover within a week but others can die, including
those with weakened immune systems, experts say.

The fever was 1st isolated in Kenya's Rift Valley region in 1930s but has
since been recorded elsewhere on the continent and overseas.

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[According to this report the number of cases has increased by 33 since the
statement issued by WHO on 14 Nov 2007. The number of fatalities, however,
has been reduced by 2. - Mod.CP

The animal health aspects of this epidemic are rather poorly covered; see
Sudan's report to the OIE (Office International des Epizooties; World
Organisation for Animal Health), dated 11 Nov 2007, and Mod PC's commentary
in ProMED-mail 20071114.3694). From a subscriber's response we note that no
information is available on limitations concerning exports of livestock
from Sudan, including to the Arab peninsula. A newspaper in Yemen cited an
official expressing concern on the possible introduction of Rift Valley
fever; see "Yemen unable to combat bird flu and Rift Valley fever, report
says" at <http://yementimes.com/article.shtml?i=1104&p=front&a=2>. - Mod.AS]

Unknown illness in Angola - Update
WHO - 21.11.2007

The investigation of an outbreak of unknown origin in Angola has revealed extremely high levels of bromide in plasma sampled from several affected patients.

As of 19 November 2007, over 390 cases had been identified and treated at the Municipal Hospital in Cacuaco. About 64% of those affected are children below 15 years old.

Toxicological tests carried out in Munich, Germany, detected very high levels of bromide in 5 out of 6 plasma samples taken from affected patients. Bromide intoxication has been one of the working hypotheses being explored by WHO and partners as a cause of the outbreak.

The laboratory results provide an important focus for testing on human, environmental and food samples to confirm these bromide levels. Additional samples are currently on the way to a laboratory in the UK for testing for bromides.

On Wednesday 21 November WHO deployed further technical and operational support to assist Angolan health authorities, including a field coordinator, clinician, two epidemiologists, food safety expert, laboratory specialist, and a logistician. This team will support further epidemiological studies, case management, social mobilization and risk communication, environmental investigations and laboratory testing to confirm the cause of the outbreak, and to support response and control measures.

HEMORRHAGIC FEVER - UGANDA (03): (BUNDIBUGYO)
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Date: Mon 19 Nov 2007
Source: New Vision (Kampala) allAfrica.com [edited]
<http://allafrica.com/stories/200711200060.html>


The mysterious viral outbreak in western Uganda's Bundibugyo district has
been contained, Dr Sam Okware, the health ministry's commissioner of health
services, has confirmed. The disease has symptoms similar to Marburg
[hemorrhagic] fever. "There are no more infections, and deaths have
reduced. The patients are also recovering quickly. The viral attack has
been contained, and we hope there will be no more deaths," Dr. Okware said.
By press time, the Centers for Disease Control and Prevention in the United
States had not yet determined what the disease was, after analyzing the 20
blood samples Uganda's health ministry sent them.

One more person died of the virus last week. This raises the death toll to
14 people over the last 3 months. "There is a likelihood that it might be
Rift Valley fever, typhus fever or leptospirosis, which comes from contact
with rodents [that is, endemic typhus and leptospirosis only]," Dr Okware
explained. He said that if it is Rift Valley fever there is need for
greater care. "This disease is very infectious, since it is transmitted by
mosquitoes from animal to animal and from animals to man."

Dr Okware said the viral outbreak had been clustered into 3 groups. The 1st
he said comprised a family who may have eaten an infected goat. All the 15
family members were infected, and 4 of them, including a boy, died. The 2nd
involved a patient admitted to the labor ward in Kikyo Health Centre who in
due course infected 5 other people with the virus. Four of them died days
later. Okware said the 3rd group was infected after handling the bodies of
the victims without any protective gear. Six of the 20 who were infected died.

According to the team from Bundibugyo, the disease is in 12 villages of the
district.

[byline: Conan Businge]

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[The cause of this outbreak of lethal disease remains obscure. A viral
causation is still favored, but there is little supporting evidence. None
of the locally proposed diagnoses seem appropriate. The outcome of
laboratory investigation at the Centers for Disease Control and Prevention
in Atlanta is awaited.

An interpretive map of Uganda is available at
<http://healthmap.org/promed?v=1.3,32.4,6>. - Mod.CP]

Rift Valley Fever in Sudan - update 3
WHO - 22.11.2007

Human cases of Rift Valley fever (RVF) continue to occur in Sudan, with more than 221 cases reported in the last two weeks. As of 21 November 2007, 436 human RVF cases, including 161 deaths have been reported from White Nile, Sennar, and Gazeera States. In addition 15 cases including 3 deaths were reported in Khartoum State, but they were most likely infected in the other affected areas. Gazeera State continues to report the most human cases, and now accounts for 271 cases and 100 deaths.

In RVF outbreaks, the vast majority of human infections result from direct or indirect contact with the blood or organs of infected animals. The virus can be transmitted to humans through the handling of animal tissue during slaughtering or butchering, assisting with animal births, conducting veterinary procedures, or from the disposal of carcasses or fetuses. Human infections have also resulted from the bites of infected mosquitoes. Humans may also become infected with RVF by ingesting the unpasteurized or uncooked milk or meat of infected animals.

Key public health measures include social mobilization, to help people who come into contact with cattle, sheep and other animals, to adopt safe handling and slaughtering practices; epidemiological measures such as active case finding; supportive clinical measures; vector control to stop the spread of disease, primarily between animals but also from animals to humans; and laboratory diagnosis capacity.

The national response to the outbreak is being managed by an inter-ministerial Task Force, with the participation, inter alia, of the Federal Ministry of Health and the Federal Ministry of Animal Resources and Fisheries. This Task Force is responsible for managing integrated action to control the spread of the disease and to decrease the impact on human and animal health. In support of the Task Force, State and Federal Ministers of Health met on 20 November to discuss the response activities and called for systematic measures to control the spread of disease in animal populations, including controls on animal movement.

The WHO Eastern Mediterranean Regional Office and WHO headquarters continues to support the Sudan Federal Ministry of Health in its role as part of the national Task Force, through the provision of technical support.

Continued, integrated intensive social mobilization 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.

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (60)
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Cholera, diarrhea - Djibouti
Date: Fri 23 Nov 2007
Source: PR Newswire [edited]
<http://sev.prnewswire.com/health-care-h ... 007-1.html>


The American Agency for International Development (USAID) is
providing USD 100 000 in emergency funding to the UN Children's Fund
(UNICEF) for medical supplies and to facilitate an intensive health,
sanitation, and hygiene campaign to prevent the further spread of
diarrhea in Djibouti.

Since January 2007, limited access to safe drinking water and poor
sanitation and hygiene conditions led to a surge in diarrhea and
cholera in Djibouti, primarily affecting Djibouti city and nearby
Dikhil and Tadjourah districts, according to the Djibouti Ministry of
Health. A total of 3 surges in reported cases of diarrhea and cholera
in January, April, and September 2007 have drained the resources of
local government and relief agencies to adequately respond. The
ministry reported more than 1000 diarrhea cases since early September
2007 and reports over 40 new cases per day.

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[A map of Djibouti in northeastern Africa can be found at
<http://www.merriam-webster.com/maps/ima ... ti_map.gif>. - Mod.LL]

The outbreaks discussed in this update can also be located on the
HealthMap/ProMED-mail interactive map at
. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (61)
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In this update:
Africa
[1] Cholera - Mozambique: (Zambezia)
[2] Cholera - Mozambique: (Maputo)
[3] Cholera - Uganda: (Nebbi)

******
[1] Cholera - Mozambique: (Zambezia)
Date: Tue 27 Nov 2007
Source: News24 [edited]
<http://www.news24.com/News24/Africa/New ... 42,00.html>


Health authorities in the central Zambezia province in Mozambique
were on high alert after the deaths last week of 2 people out of more
than 20 reported cases of cholera, the daily Noticias reported on Tue
27 Nov 2007. It was reported that health authorities in the Chire
region of Morrumbala district had increased the amount of diagnostic
equipment used in the treatment of cholera in the districts of the
province located near the Malawian border.

In October 2007, health authorities reported the death of 2 people in
the same province, while another 6 were hospitalised in the same
district. Authorities blamed the occurrence of the transmittable
disease on the consumption of contaminated water.

Cholera outbreaks had often been reported in Mozambique's rural and
urban centers during the rainy season, which began in November 2007.
Health officials were encouraging residents to boil or treat their
water before drinking it or using it to wash vegetables and fruit.

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[The Zambezia province in central Mozambique can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>.
- Mod.LL]

******
[2] Cholera - Mozambique: (Maputo)
Date: Wed 28 Nov 2007
Source: Agencia de Informacao de Mocambique (Maputo) [edited]
<http://allafrica.com/stories/200711281033.html>


Four people have died out of the 222 cases of cholera diagnosed in
Maputo city and province since the current outbreak began in October
2007, according to Mozambican Health Minister Ivo Garrido.

"If we do not remain on maximum alert, then the number of cases may
increase, and we may lose many more lives," warned Garrido. He
stressed that all people suffering from severe diarrhea and vomiting,
the main symptoms of cholera, should be taken urgently to the nearest
health post.

Garrido pointed out that in the 1st 10 years after Mozambican
independence in 1975, there were no cholera outbreaks, even though
living standards were lower than they are now. He attributed this
success to the post-independence health education campaigns, to the
regular days of voluntary cleaning of city neighborhoods, and to the
close links then between the Health Ministry and local communities.
But with the passage of time, the close ties between health staff and
communities declined, and increased population put huge stresses on
the city water and sanitation systems. There are now cases of urban
neighborhoods with one latrine for more than 20 households.

--
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[The Maputo province in southern Mozambique can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>.
- Mod.LL]

******
[3] Cholera - Uganda: (Nebbi)
Date: Mon 26 Nov 2007
Source: AllAfrica.com and The Monitor (Kampala) [edited]
<http://allafrica.com/stories/200711262072.html>


More cases of the recent cholera outbreak in Panyimur Sub-county of
Nebbi have been reported, with the number of victims now at 162. One
person had already been reported dead. The District Health Inspector,
Mr Anthony Andrionzi, said poor hygiene and sanitation is escalating
the spread of the deadly disease. He said most cases are emerging
from neighboring DR Congo, where there is lack of health facilities.

Andrionzi said that some cholera victims in Congo are fleeing into
the area in search of medical facilities. Mr Andrionzi said some of
the Congolese have been hiding their identities to access medication,
stretching the available resources in health centers. Most affected
parishes include Parwo and Pangere in Parombo, Uguta and Kituna in
Akworo and Nyakagei parish in Panyimur Subcounty.

According to the latest statistics, Dei centre has 59 cases; Panyimur
HC III has 22 cases, while Parombo and Akworo sub counties registered
81 cases. A fresh outbreak of the disease was 1st reported in Akworo,
Parombo and Panyimur, with 42 cases. As a result of the poor hygiene
and sanitation, there has been a sharp increase in cholera cases in
the last 3 weeks.

He said the lakeshores of Dei are the most affected areas, since
there is poor waste disposal in the area. At Dei center, 8 to 10
cases are reportedly registered daily.

[Byline: Warom Felix Okello]

--
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[Nebbi province is in northwestern Uganda, bordering Congo DR, and
can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>.
- Mod.LL]

UNDIAGNOSED DEATHS - ZAMBIA: REQUEST FOR INFORMATION
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Date: Wed 28 Nov 2007
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5hiW ... YpznJ7x7tw>


The health minister [Brian Chituwo] announced Tuesday [27 Nov 2007]
that 4 people have died and 20 others were put under quarantine
following the outbreak of an unknown disease in southern Zambia.

Brian Chituwo said the government has dispatched medical experts to
investigate the cause of the disease and assess the situation in
Namwala, a small town in the southern province of Zambia.

"The 4 died before the medical team arrived in the area," Chituwo
said. The 20 patients have been quarantined in an effort to contain
the spread of the disease, which has symptoms of vomiting and
backache, the minister said.

Chituwo said the disease was detected last Sunday [?25 Nov 2007] by
local medical practitioners following the death of the 4 patients.

--
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[Speculation on a differential diagnosis with the symptoms given
above -- vomiting and backache -- is a "fun" challenge. Checking the
possible list of infectious agents that would produce the clinical
spectrum of a cluster of severe, fatal infections associated with
vomiting and backache in Zambia using the GIDEON (Global infectious
disease and epidemiology network) database
(<http://www.gideononline.com>), comes up with a list of the
following possible diagnoses (and probability of occurrence) -- which
includes viral, bacterial, and parasitic diseases:

Rift Valley fever (30.8 percent probability), leptospirosis (27.5
percent), influenza (2.4 percent), malaria (11.5 percent), meningitis
-- bacterial (9.2 percent), relapsing fever (3.2 percent), septicemia
--bacterial (1.8 percent), legionellosis (1.4 percent). Other
diseases mentioned with a less than one percent probability include:
typhoid and enteric fever, _Bunyaviridae_ infections -- misc.,
rabies, tuberculosis, typhus -- endemic, _Streptococcus suis_
infection, yellow fever, trypanosomiasis -- African, Q-fever,
brucellosis, yersiniosis, ornithosis, trichinosis, infectious
mononucleosis or EBV (Epstein-Barr virus) infection, poliomyelitis,
toxoplasmosis.

Even more fun is the possible list of other diseases that might
produce the same type of cluster, but anywhere in the world (not
necessarily seen in Zambia at present). This list (according to the
GIDEON network would include: hantavirus infections -- Old World,
Ebola, Lassa fever, typhus -- scrub, dengue, hantavirus pulmonary
syndrome, and Crimean-Congo hemorrhagic fever to mention a few.

In the see also section below one can find a listing of prior
disease/outbreak related ProMED-mail postings from Zambia, going back
to 1995. Human and zoonotic diseases reported on ProMED-mail in this
period include: anthrax, cholera, rabies, plague, suspected Ebola
virus infection (a cluster of 3 suspected cases that were ultimately
diagnosed as schistosomiasis, gum disease, and pneumonia), measles,
polio, and undiagnosed deaths without any further information on the
clinical presentation of these undiagnosed deaths. There were also 2
undiagnosed veterinary outbreaks -- one involving bovines, one
involving wild birds. All of these prior reported outbreaks could
produce clusters of illness that might be associated with vomiting
and backaches as well.

The process of speculation on possible etiologic agents for this
above-mentioned outbreak would be even more "fun" if there were more
information available from knowledgeable sources in the region --
such as the age distribution of cases, possible common exposures,
other symptoms associated with the illness, and information on the
animal health in the surrounding region to help rule in or rule out
the possibility of a zoonotic disease outbreak. ProMED-mail would be
grateful to receive more information from knowledgeable sources.

Namwala can be seen in the northern part of the Southern Province in
Zambia on the following map
<http://www.lib.utexas.edu/maps/africa/zambia_pol01.jpg>.

For the interactive HealthMap/ProMED-mail map of Zambia showing other
ProMED-mail postings in Zambia and in neighboring countries, see
<http://healthmap.org/promed?v=-14,27.8,5>. - Mod.MPP]

Uganda - Ebola
29.11.2007

Kampala (AP) Einem neuen Ausbruch der Ebola-Seuche im Westen Ugandas (Region of Bundibugyo, nahe der Grenze zu DR Kongo), sind mindestens 16 Menschen zum Opfer gefallen. Insgesamt seien bislang 51 Fälle der hämorrhagischen Fieberkrankheit registriert worden. / Quelle: pr inside und BBC

HEMORRHAGIC FEVER - UGANDA (04): (BUNDIBUGYO), EBOLA CONFIRMED
**************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Fri 30 Nov 2007
Source: allAfrica.com [edited[
<http://allafrica.com/stories/200711291106.html>


Uganda: Ebola Strikes Again
------------------------------------
The strange viral disease that struck the western district of
Bundibugyo in August [2007] and has to date killed 16 people has been
confirmed by the Health Ministry to be Ebola haemorrhagic fever, a
deadly disease for which there is no cure.

Announcing the existence of the Ebola [virus] in the country
yesterday, Dr Sam Zaramba, the director general of health services
said; "The Ministry of Health would like to inform the public that
the mysterious disease outbreak in Bundibubyo has now been confirmed
to be Ebola." The confirmatory laboratory tests, initially carried
out at the National Institute of Virology in South Africa and later
at the US-based Centre for Disease Control, comes months after the
disease spread to 14 villages in the affected district.

Dr Zaramba yesterday denied reports that the government had known
about the deadly epidemic outbreak weeks earlier but concealed it in
order not to scare away foreign dignitaries who were scheduled to
attend the just concluded Commonwealth Heads of Government Meeting in
Kampala. "It would be unethical for me to keep quiet (about an
epidemic outbreak). It is true we knew there was a strange disease in
western Uganda but had not got the conclusive confirmation that it
was Ebola until today (Thursday) [29 Nov 2007] morning," he stressed.
He said the laboratory diagnostic process was so arduous and
protracted that out of 20 (blood) samples sent to foreign capitals,
"only eight tested positive".

Dr William Sikyewunda, the district director of health services for
Bundibugyo said latest reports indicate the disease had killed at
least 27 residents and 51 others were infected, mainly in Bubukwanga
and Kasitu sub-counties. But other unconfirmed reports put the total
death toll to date at 50.

The government yesterday dispatched a team of health officials from
the Ministry of Health headquarters in Kampala to strengthen rapid
response capability in the trouble spots. "The initial supplies and
drugs for case management have been mobilised and isolation
facilities are already operational in Bundibugyo Hospital and Kikyo
Health centre (IV)," the ministry said in the press statement.

The chairman of the National Ebola taskforce, Dr Sam Okware, said the
Ebola strain identified in the western enclave is "completely
different" from the four known sub types of the heamorrhagic fever
namely; Ebola Sudan, Ebola Zaire, Ebola Reston (that only affects
monkeys) and Ebola Tai (Ivory Coast).

The common symptoms of Ebola, that causes death in 70 to 90 percent
of all clinically ill cases; include very high fever, diarrhea,
vomiting associated with red eyes and a measles-like rash. Health
officials issued a countrywide wide Ebola alert and urged the public
to be vigilant and promptly report any suspected cases to the nearest
health facility or call the cell phone hotlines 0772507799,
0772409810.

Daily Monitor has established that a core group of specialized staff
from World Health Organization, Unicef, MSF - France and Afrinet left
for Bundibugyo yesterday to join local medics and bolster case
management of patients, contact tracing and public education. "Ebola
is spread by close contact with body fluids of an infected person or
people who have died of the disease. Anybody handling suspected cases
must use appropriate protective wear," the official warning statement
said.

Medical experts say the incubation period for the Ebola virus is
between two to 21 days, depending on the strain. By last evening,
information emerged that Bundibugyo hospital medical superintendent
only identified as Dr Ssesanga and Dr Joshua Akure, another medic and
employee of International Air Ambulance were down with illnesses
suspected to be Ebola.

Ebola last struck Uganda in the northern district of Gulu in October
2000 and killed 224 people, including Dr Mathew Lukwiya, the then
medical superintendent of Lacor hospital, who first identified and
later relentlessly spearheaded the fight against the disease. It was
believed that Ugandan soldiers who were by then returning from the
Democratic Republic of Congo brought the disease into the country.
The WHO says Ebola has in the past four months killed 160 out of 352
infected persons, especially in the southern province of DRC's Kasai
Occidental, which is about 2, 000 kilometres away from Uganda. The
virulent disease was first identified in the Western Equatorial
province of Sudan and in a nearby region of former Zaire (now
Democratic Republic of Congo) in 1976 and about 1500 cases with over
1000 deaths have been documented ever since.

Just like Marburg fever, the Ebola virus' natural reservoir is still
a puzzle, experts have said, but it seems to reside in African rain
forests and in areas of the Western Pacific, according to the United
Nations health agency but is said to be part of a group of
negative-stranded RNA viruses, known as Filoviridae and mostly not
airborne.

[Byline: Tabu Butagira & Al-Mahdi Ssenkabirwa: Additional reporting
by Jane Nafula]
--
Communicated by:
ProMED-mail <promed@promedmail.org>


**************
[2]
Date: Fri 30 Nov 2007
Source: Agence France Press report [edited]
<http://afp.google.com/article/ALeqM5gyd ... pceBWqN2jQ>


Ebola confirmed as killer virus in Uganda
---------------------------------------------------
A virus that killed 16 people and infected more than 50 others in
western Uganda has been confirmed as Ebola, the health ministry said
Thursday [29 Nov 2007]. The deadly virus was confirmed in samples
flown to a laboratory in Atlanta in the United States, the ministry
said. "We have been on the ground and we are deploying more people to
manage the situation," said Sam Zaramba, the country's top medical
official.

Zaramba said the first case was reported on November 10 in Bundibugyo
district on the border with the Democratic Republic of Congo (DRC),
where three patients were currently in an isolation ward. "It is a
dangerous disease as is any other haemorrhagic fever, but the WHO
(World Health Organisation) and officials from CDC (Centre for
Disease Control) are working with us to remain in control of the
situation," Zaramba explained.

An outbreak of Ebola, a highly contagious disease that can have
fatality rates as high as 90 percent, killed at least 170 people in
northern Uganda in 2000. It spreads by direct human contact,
especially through blood contact. A similar Ebola outbreak killed at
least 26 people in DR Congo's West Kasai region in recent weeks,
according to the country's Health Minister Victor Makwenge Kaput. The
WHO says Ebola has killed at least 1200 people since it was first
discovered in DRC and Sudan in 1976.

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

[The most striking feature of this report is the statement that: "the
Ebola strain identified in the western enclave is completely
different from the four known sub types of [Ebola/heamorrhagic fever
[virus], namely; Ebola Sudan, Ebola Zaire, Ebola Reston (that only
affects monkeys) and Ebola Tai (Ivory Coast)". Further information is
awaited concerning the origin of the outbreak and any relationship
with mining operations or proximity to bat colonies.

An interpretive map of Uganda is available at
<http://healthmap.org/promed?v=1.3,32.4,6>. - Mod.CP]

[ProMED thanks Naomi Bryant <naomi.bryant@uclh.nhs.uk> for receipt of
a similar report. - Ed.LM]

Mass Bromide poisoning in Angola - update 2
WHO - 30.11.2007

As of 29 November 2007, 468 confirmed cases of bromide poisoning have been identified in the ongoing outbreak of a neurological disease in the Cacuaco municipality, Luanda Province, Angola. The cases have been treated at the Municipal Hospital in Cacuaco.

Toxicology laboratories in Munich (Germany) and Birmingham (UK) have detected very high levels of bromide in blood samples of patients. In addition, laboratories in Geneva (Switzerland) and Munich have detected very high levels of sodium bromide (>80%) in table salt samples collected in the households of patients.

These findings provide a clear indication that this outbreak is very likely due to bromide poisoning which occurred through use of table salt highly contaminated with sodium bromide. It is still unknown how the salt samples were contaminated. Additional food samples are currently being analysed to identify any potential secondary source of exposure.

WHO continues to provide support to the Angolan Health Authorities for further epidemiological studies, environmental investigations, laboratory analysis, case management, risk communication, and social mobilization actions, including a salt replacement campaign.

UNDIAGNOSED DEATHS - ZAMBIA (02): PNEUMONIC PLAGUE SUSPECTED
************************************************************
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 30 Nov 2007
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5gZ9 ... aI2bWSiyIA>


A mysterious disease, which broke out in the south of Zambia, killing
4 people, is now suspected to be pneumonic plague, the health
ministry said Friday [30 Nov 2007].

Ministry of Health spokesman, Canicius Banda, said preliminary
findings indicate that the disease that has killed 4 people and
affected over 60 patients could be pneumonic plague but the findings
were not yet conclusive. "Our preliminary findings point to pneumonic
plague," Banda said.

A total of 4 people died and 64 others were put under quarantine last
week following the outbreak of the disease in Namwala, a small town
in the Southern Province of Zambia. Banda said the movement of people
in the area had been banned with immediate effect in order to contain
the disease, which had symptoms of vomiting and backache.

Medical experts had also begun spraying all the houses in the area to
get rid of fleas and rodents suspected to be spreading the disease.
The government has also urged people in Namwala to be calm after word
went round that the disease could be the deadly Ebola virus,
prompting panic.

"We have carried out the tests and it is not Ebola. People should not
panic, the situation is under control," Health minister Brian Chituwo
said.

Pneumonic plague, which is fatal if left untreated, develops when
plague bacteria infect the lungs, and can cause a public health
emergency due to its high degree of contagion.

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

[Primary pneumonic plague (one percent of natural plague
presentations) arises as a result of inhalation of plague bacilli in
infectious aerosols, such as would be produced when there are
pneumonic complications (secondary plague pneumonia) in bubonic or
septicemic plague. It is, importantly, the form of the disease that
would be most likely if _Yersinia pestis_ were to be used in an
aerosol as a biological weapon. Such an aerosol would likely be used
in an indoor setting to avoid the outdoor UV radiation inactivation
of the organism.

Primary plague pneumonia has a short incubation period of 1-3 days,
after which there is sudden onset of flu-like symptoms including
fever, chills, headache, generalized body pains, weakness, and chest
discomfort. A cough develops with sputum production, which may be
bloody, and increasing chest pain and difficulty in breathing. As the
disease progresses, hypoxia (low oxygen concentration in the blood)
and hemoptysis (coughing up blood) are prominent. The disease is
invariably fatal unless antimicrobial therapy commences within 24
hours of exposure.

Patients with primary pneumonic plague generate large quantities of
infectious aerosols that pose a significant risk to close contacts.
CDC (US Centers for Disease Control and Prevention) guidelines
identify contacts within 2 meters (6.5 feet) as being at greatest
risk and do not consider the organism likely to be carried through
air ducts or vents. Persons who have been in contact with pneumonic
plague patients or handling potentially infectious body fluids or
tissues without appropriate protection should receive preventive
antimicrobial therapy.

Namwala is located in the Southern Province of Zambia and can be
found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. -
Mod.LL

The HealthMap/ProMED-mail interactive map of Zambia can be accessed at
<http://healthmap.org/promed?v=-14,27.8,5>. - CopyEd.MJ]