Wüstenschiff

TYPHUS - Kamerun - Flüchtlinge aus Zentralafrika
******************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Date: Mon 3 Dec 2007
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN) [edited]
<http://allafrica.com/stories/200712031146.html>


Most of the 45 000 Central African Republic (CAR) refugees living in
eastern Cameroon are diseased, malnourished, and generally in bad
health, non-governmental organisation (NGO) and UN workers say.

The refugees arrive "very weakened, after long days of walking and a
lot of stress and they live in very difficult conditions," Eric
Grimaldi of Medecins Sans Frontieres (MSF) told IRIN.

Once settled in some 60 villages in eastern Cameroon, their health
does not improve significantly. For every 10 000 people, there are
between 3 and 7 deaths per day among the refugees. According to MSF,
the situation is particularly bad in the village of Ngaoui in
Adamaoua Province, home to 5 000 refugees and receiving 100 new
refugees a month.

"[The refugees] suffer from malnutrition, typhoid and amoebic
diseases," said a nurse in a missionary hospital in the small eastern
town of Letta. "The health of the refugees is really very bad... And
they always arrive in a critical state to begin with."

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

[A map of Cameroon showing the long eastern border with the Central
African Republic can be found at
<http://www.un.org/Depts/Cartographic/ma ... meroon.pdf>. - Mod.LL]

Maniok Lebensmittelvergiftung - Kamerun - Flüchtlinge aus der Zentralafrikanischen Republik
*******************************************************
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: Mon 3 Dec 2007
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN) [edited]
<http://allafrica.com/stories/200712031146.html>


Most of the 45 000 Central African Republic (CAR) refugees living in
eastern Cameroon are diseased, malnourished, and generally in bad
health, non-governmental organisation (NGO) and UN workers say.

The refugees arrive "very weakened, after long days of walking and a
lot of stress and they live in very difficult conditions," Eric
Grimaldi of Medecins Sans Frontieres (MSF) told IRIN. Once settled in
some 60 villages in eastern Cameroon, their health does not improve
significantly. For every 10 000 people, there are between 3 and 7
deaths per day among the refugees. According to MSF, the situation is
particularly bad in the village of Ngaoui in Adamaoua Province, home
to 5000 refugees and receiving 100 new refugees a month.

According to the UN Children's Fund (UNICEF), 17.2 percent of refugee
children under 5 are malnourished. MSF has registered several cases
of tuberculosis and about 50 cases of a rare paralytic disease called
"konzo." Known as "the disease of the poor," it results from
exclusive consumption of the bitter manioc plant, which, though
inexpensive, is poor in vitamins and nutrients.

Manioc also contains salt cyanide, which can be toxic if improperly
cooked. The result can be irreversible paralysis of the lower limbs,
as well as hearing and sight problems.

"We have met families where several children are now paralysed,"
MSF's Grimaldi said, adding that the Cameroonian authorities do not
have the material or human resources to prevent the disease and very
few doctors know how to treat it.

The nutritional situation was "so alarming" according to MSF, that in
July [2007] the UN Refugee Agency (UNHCR), the World Food Programme
(WFP), MSF, and another aid agency, CARE, in collaboration with the
Cameroonian Public Health Ministry, began monthly food distributions.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Some of the following regarding konzo was derived from
<http://www.itg.be/itg/DistanceLearning/ ... ntsp13.htm>:

Konzo is characterized by an acute isolated and symmetrical
hypertonic paraparesis, which is permanent but non-progressive. To
date, 2 large epidemics have been reported, each of more than 1000
cases. The 1st was in the Bandundu region in Congo (1936-37) and the
2nd in the Nampulla province of Mozambique (1981). Small outbreaks
have been reported from Congo, Mozambique, Tanzania, and the Central
African Republic. Sporadic cases of konzo also occur. The majority of
cases of konzo occur in the dry season, chiefly during a long
drought. Familial clustering is common.

Cassava (_Manihot esculenta_, Crantz) is a root crop widely consumed
in Africa and South America. Although it originated in Brazil (where
it is called manioc), it was brought to Africa by Portuguese
colonists, and it is now an important crop there and in Indonesia and
Southeast Asia. It is the principal source of nutrition for about 500
million people. Its leaves are edible, but the prize is its starchy
root, rich in protein, minerals, and vitamins A, B, and C.

Cassava is used in a vast variety of cakes, snacks, and desserts and
grows wild in many places, being tough and drought-resistant. In
countries where hunger is an overt reality for many poor households,
cassava is among those food crops that can make the crucial
difference between starvation and survival. The cassava plant is the
world's 3rd most important crop. Cassava enters the North American
diet also, as it is made into tapioca.

Surprising for an important edible plant, cassava is quite poisonous
without proper preparation. The toxin in cassava is called linamarin.
When eaten raw or inadequately prepared, the human digestive system
will convert this to cyanide. Even 2 cassava roots contain a fatal
dose of poison. While the bitter variety (white cassava) of the plant
has larger concentrations of cyanide than the sweet variety (yellow
cassava), the sweet cassava is not without risk.

To prepare cassava, it should be peeled, grated, and soaked in warm
water for several days. This allows the cassava's own natural enzyme
(linamarase) to convert the cyanogen linamarin to sugar and cyanide
gas, and the volatile gas disperses usually harmlessly. However,
women -- who are usually charged with processing the plant -- can be
sickened by inhaling cyanide gas. What remains after processing can
be boiled and eaten, or more usually, dried and ground.

The shelf life of a cassava root is quite short once it is removed
from the stem, so there is an urgency to get the food to market.
Roots can turn to mush in less than a week. The rush to get cassava
to the market may keep some batches of cassava from being processed properly.

Cyanide is normally converted in humans to the less toxic thiocyanate
by the enzyme rhodanase, a mitochondrial enzyme which is widely
present throughout the human body, with the highest concentrations in
the liver and kidneys. Thiocyanate is the chief metabolite of
cyanide. Thiocyanate itself has a goitrogenic effect if there is a
shortage of iodine in the diet. The body uses sulphur-containing
amino acids to render cyanide harmless. If the diet is deficient in
protein, cyanide will be converted to cyanate, which induces
neurodegenerative disease in both animals and humans. The cells which
are most affected are Betz cells in the motor cortex. Tropical ataxic
neuropathy can also be produced.

Konzo begins abruptly, without prodromal signs. In 90 percent of
cases the onset of symptoms takes less than a day. The initial
symptoms are described as tremor, cramps, a heavy feeling, and/or
weakness in the legs, a tendency to fall down, and difficulty
remaining upright. There is a visible hypertonic gait when walking or
running. Occasionally there will be lower back pain, blurred vision,
speech difficulties, and/or paresthesia of the legs, but they
disappear within a month. During the 1st 2 days the majority of
patients have general muscular weakness and are confined to bed.
Hypertonicity is present from day one. Flaccid paralysis of the limbs
does not occur. Later there is a slight partial improvement. Finally
the affected person develops a stable hypertonic paraparesis, which
persists for the remainder of life, or might improve a little. After
onset the neurological signs remain constant or improve minimally if
no further cyanide is ingested.

Prevention of konzo therefore involves avoiding a farming system
dominated by bitter cassava (which contains higher cyanide levels),
insufficient cassava processing, and a protein deficient diet.

In an effort to avoid this toxicity, it has been reported by
Siritunga and Sayre (1) that transgenic cassava free of cyanogens can
be produced. The investigators generated transgenic plants in which
cytochrome oxidase enzymes that catalyze the 1st step in linamarin
synthesis are inhibited. The plants showed a 94 percent reduction in
leaf linamarin content and a 99-percent decrease in root linamarin
levels. Additionally, the same group (2) has reported that transgenic
cassava plants can be produced that overexpress the gene for
hydroxynitrile lyase, facilitating cyanogenesis during processing and
producing a final product with less risk. The tubers of cassava do
not have this enzyme, and processing relies on spontaneous
conversion. Combining these methods could further decrease the risk
of cyanide poisoning from cassava.

References:
1. Siritunga D, Sayre RT: Generation of cyanogen-free transgenic
cassava. Planta 2003; 217:367-73.

2. Siritunga D, Arias-Garzon D, White W, Sayre RT: Over-expression of
hydroxynitrile lyase in transgenic cassava roots accelerates
cyanogenesis and food detoxification. Plant Biotechnol 2004; 2: 37-43. - Mod.LL

The HealthMap/ProMED-mail interactive map of Cameroon can be accessed
at <http://healthmap.org/promed?v=5.7,12.7,5>. - CopyEd.MJ]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (62)
**********************************************
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 - Malawi: (Southern Region)
[2] Cholera - Nigeria: (Rivers)
[3] Cholera - Nigeria: (Plateau)

******

[1] Cholera - Malawi: (Southern Region)
Date: Tue 4 Dec 2007
Source: Reuters Africa [edited]
<http://africa.reuters.com/top/news/usnBAN447926.html>


At least one person has died from cholera and 16 others have
contracted the water-borne disease in Blantyre, Malawi's main
commercial city, health authorities said on Tue 4 Dec 2007. All 17
cases were registered over the past week in Bangwe, one of Blantyre's
crowded townships.

Chimota Phiri, the deputy district health officer, said the disease
risked spreading further due to persistent water shortages that have
hit the city as a result of breakdowns at the state-run water
utility. With no safe supply of water, many Malawians may resort to
drinking water from unpurified wells.

"We did not expect to record so many cholera cases now as the rainy
season has not yet reached its peak and we fear the current water
problems could worsen the situation," Phiri said.

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

[A map of the Southern African country of Malawi can be found at
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>.
Blantyre can be found in the Southern Region. - Mod.LL]

******
[2] Cholera - Nigeria: (Rivers)
Date: Sat 1 Dec 2007
Source: Nigerian Tribune [edited]
<http://www.tribune.com.ng/01122007/news/news11.html>


The people of Ajakajak community in Andoni Local Government Area of
Rivers State have cried out to the state government to rescue them
from a cholera outbreak, which has claimed the lives of more than 11
children as at press time on Thu 29 Nov 2007. A source in the
community told Saturday Tribune that the outbreak, which has
reportedly spread to some other communities in the area, was fast
assuming the form of an epidemic, threatening to wipe communities out.

Other sources from Ajakajak informed that records at the community's
health centre confirmed that the figure given was for last week alone
and that more cases had come in this week. It was gathered that the
epidemic was spreading very fast and that about 30 persons had died so far.

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

[A map of Nigeria showing the state of Rivers in the extreme southern
part of the country can be found at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

******
[3] Cholera - Nigeria: (Plateau)
Date: Thu 29 Nov 2007
Source: Reuters Africa [edited]
<http://africa.reuters.com/wire/news/usnL29632230.html>


At least 14 people have died and scores of others are hospitalized
following an outbreak of cholera in the central Nigerian state of
Plateau, a government official said on Thu 29 Nov 2007.

Commissioner for Health Angela Miri said the waterborne disease broke
out in the remote district of Bokkos last week [19-25 Nov 2007] but
was reported late to the authorities. "When it started the people
thought it was a strange ailment so they refused to go to hospital.
By the time we got there 14 people had already died," Miri said.

[Byline: Shuaibu Mohammed, Tume Ahemba]

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

A map of Nigeria showing the state of Plateau in the central part of
the country can be found at
<http://www.un.org/Depts/Cartographic/ma ... igeria.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]

LASSA FEVER - NIGERIA
**********************
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: Tue 4 Dec 2007
Source: AllAfrica.com, This Dat (Lagos) [edited]
<http://allafrica.com/stories/200712040242.html>


The Federal government has expressed concern over the poor attention
paid to the Lassa fever epidemic that has been ravaging the country,
saying that the acute viral illness with bleeding and death in severe
cases has been claiming an average of 5000 lives annually since the
epidemic 1st hit Nigeria in the 1980s. Minister of State for Health,
Mr. Gabriel Aduku, said the spread and impact of the sickness needed
to be checked to forestall a situation in which it would overwhelm
the population in the near future.

Aduku, who spoke at a media sensitization workshop to herald the
Regional Conference on Lassa Fever due to be held this week, said
although the Federal Ministry of Health has made some efforts and
signed a Memorandum of Understanding (MoU) with the Chinese
government in 2004, there was an urgent need to step up efforts in
the area. This, he said, would ensure a steady supply of drugs for
treatment of the ailment, provision of functional laboratory
services, as well as the development of an effective and affordable
vaccine for Lassa fever.

He recalled that some years ago, the Federal Ministry of Health
designated 3 federal tertiary health institutions as centres of
excellence for the control and management of the disease. According
to Aduku, the 3 centres -- namely the Irrua Specialist Teaching
Hospital, Edo State, University of Maiduguri Teaching Hospital, Borno
State, and the Federal Medical Centre, Owerri, Imo State -- needed to
be strengthened through an update of their facilities to contain the
disease. He, however, assured the Lassa Fever Stakeholders Forum, the
conveners of the regional conference, of the government's continued
support in the task of combating Lassa fever in the country.

Chief Medical Director of the Irrua Specialist Teaching Hospital,
Professor Godwin Akpede, disclosed that the conference is aimed at
developing capacity towards containing the challenge of the epidemic
in the West African sub-region; delineating the constraints against
success in the efforts to reduce the prevalence, incidence and
mortality arising from the disease; and developing strategies for the
control and eradication of the disease.

Lassa fever was 1st encountered in the 1950s, and the virus was
identified in 1969. The virus is named after Lassa, the town in Borno
State, North Eastern Nigeria, where the 1st case of the disease
occurred. Since then, some states in Nigeria, such as Edo, Borno,
Nasarawa, Plateau, Ebonyi and Imo, have suffered ravages of the epidemic.

It is endemic to Nigeria, Sierra Leone, Guinea and Liberia. The
disease is said to be spread by rats, which are, however, found
throughout West Africa. Therefore, the actual geographic range of the
disease may be more extensive. Evidence of the infection has also
been found in the Central African Republic, Congo, Mali and Senegal.

[Byline: Onwuka Nzeshi]

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

[Lassa fever was 1st described in the 1950s, although the virus
(_Lassa virus_, family _ Arenaviridae_, genus _Arenavirus_) was not
isolated until 1969. The disease occurs in West Africa and is
transmitted to humans from wild rodents through direct or indirect
contact with the excreta of infected animals. Person-to-person and
laboratory infections occur, particularly in the hospital
environment, by direct contact with blood or other body fluids of patients.

The onset of disease is gradual, with fever, vomiting and
retrosternal pain. Signs may include conjunctival infection,
periorbital edema and swelling of the neck. Deafness occurs in 25
percent of all patients. In severe cases, patients suffer shock,
fluid in the lung cavity, haemorrhage and cerebral edema.
Approximately 15 percent of hospitalized patients die, but the
outcome can be improved by simple supportive care if provided early
in the course of the disease. Specific treatment with the antiviral
drug ribavirin may also be effective.

The signs and symptoms of Lassa fever may be difficult to distinguish
from severe malaria, typhoid fever, yellow fever and other viral
haemorrhagic fevers, but definitive diagnosis requires confirmation
by laboratory testing. Health education strategies for preventing
infections in people living in endemic areas focus on rodent control
and minimizing contact with rodent excreta. Measures to control virus
transmission from cases include routine use of standard precautions,
isolation of suspected cases and surveillance of contacts.

Lassa fever is endemic in several West African countries. According
to the WHO as well as Nigeria, the most severely affected countries
are Guinea, Liberia, Sierra Leone, Cote d'Ivoire, and Ghana. The
incidence of Lassa fever has been increasing in all areas,
particularly in regions of social and political strife.

A map of the provinces of Nigeria can be accessed at
<http://www.ngex.com/nigeria/places/default.htm>. - Mod.CP]

[For the interactive HealthMap/ProMED-mail map providing links to
ProMED-mail postings on events occurring in surrounding countries as
well as within Nigeria, see
<http://healthmap.org/promed?v=9.6,8.1,5>. - Mod.MPP]

PLAGUE, FATAL - UGANDA: (ARUA, NEBBI), 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: Thu 6 Dec 2007
Source: AllAfrica, New Vision (Kampala) [edited]
<http://allafrica.com/stories/200712060049.html>


Plague is occurring in Uganda, killing 10 out of 121 infected people
in Arua, and 9 out of 39 in Nebbi, according to the Ministry of Health.

The disease broke out in Logiri and Vurra sub-counties of Arua. In
Nebbi, the affected area was Nyapea. No new cases have been reported
in either area in the past week, partly because of massive indoor
residual spraying against fleas.

The Minister of Primary Health, Dr Emmanuel Otaala, said women were
most affected due to the local custom that women sleep on the ground.
They are only allowed in bed when the husband invites them for sex,
he explained.

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

[Arua and Nebbi are located in northwestern Uganda as can be seen on
a map at <http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>.

As can also be seen below, this area is not uncommonly affected by
_Yersinia pestis_. - Mod.LL]

[Information on the type of plague (bubonic, pneumonic) involved in
this present outbreak would be appreciated. For the interactive
HealthMap/ProMED map of the region with links to other recent
ProMED-mail postings on events in Uganda and neighboring countries,
see <http://healthmap.org/promed?v=1.3,32.4,6>. - Mod.MPP]

Wegen Rattenplage - Pestausbruch in Madagaskar

In Europa sieht man die Pest als Krankheit des Mittelalters. In Madagaskar ist die Seuche nun wieder ausgebrochen. 18 Menschen sind bereits daran gestorben, Auslöser ist eine Rattenplage. mehr....

Grüsse
Alexander

Rift Valley Fever in Sudan - update 4
WHO - 21.12.2007

Human cases of Rift Valley fever (RVF) continue to occur in Sudan. As of 19 December 2007, a total of 601 human RVF cases, including 211 deaths, have been reported from White Nile, Sennar, Gazeera and River Nile States. In addition 31 cases including 7 deaths were reported in Khartoum State, but they are believed to have acquired the infection in the other affected areas. Gazeera State continues to report the most human cases, and now accounts for 406 cases and 148 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.

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 2008 (01)
**********************************************
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 - Angola (Cunene)
[2] Cholera - Nigeria (Benue)
[3] Cholera - Burundi (Cibitoke)

******
[1] Cholera - Angola (Cunene)
Date: Wed 2 Jan 2008
Source: Angola Press (ANGOP) [edited]
<http://www.angolapress-angop.ao/noticia-e.asp?ID=585699>


At least 34 new cases of cholera were notified in Central Hospital of
Ondjiva, between 23 and 30 Dec 2007, in Angola's southern Cunene
province.

The health official, in charge of cholera division, Anatercia
Ndahambelela, told ANGOP that there had been no fatalities so far.
The reported cases were mostly associated with residents of Kashila
ward, in the surroundings of Ondjiva city, due to lack of hygienic
conditions, added the official.

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

[Angola's province of Cunene borders to its south with Namibia. The
provincial capital and the province itself can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

******
[2] Cholera - Nigeria (Benue)
Date: Wed 2 Jan 2008
Source: Nigerian Tribune [edited]
<http://www.tribune.com.ng/02012008/news/news14.html>


As a result of an outbreak of cholera in Gbajimba, Guma Local
Government Area of Benue State, 10 persons have been confirmed dead.
The state Ministry of Health on Tuesday [1 Jan 2008] confirmed the
outbreak of the epidemic and the number of lives lost to it.

According to an official of the ministry, who asked for anonymity,
steps were being taken to get the situation under control. The source
disclosed that the ministry had drafted personnel to the affected
area to tackle the disease. According to him, the ministry had
contacted the World Health Organization (WHO) and the Federal
Ministry of Health, Abuja, on the outbreak.

[Byline: John Akpodovhan]

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

[The Benue State in Nigeria is located in the southern part of the
country with a small eastern border with Cameroon. The area can be
seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

******
[3] Cholera - Burundi (Cibitoke)
Date: Mon 31 Dec 2007
Source: AllAfrica, Burundi Realites (Bujumbura) report [edited]
<http://allafrica.com/stories/200712310308.html>


A total of 17 people from Rugombo commune in Cibitoke province have
been quarantined in the hospital due to cholera. These patients are
getting treatment free of charge.

There is a lack of clean water in Rugombo. In some areas, the
population has to walk long distances to get clean water. The
state-owned water and electricity company, REGIDESO, has closed
public fountains. The population draws its water from dirty rivers
that flow through this commune.

Other outbreaks of cholera were recently announced in Nyanza Lac in
the south of Burundi, but they have been brought under control.

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

[ProMED-mail thanks Sidi Coulibaly for this posting.

Cibitoke province is in the extreme northwestern part of Burundi,
bordering with Rwanda and Congo DR. It can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... urundi.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]

CHEMICAL CONTAMINATION, WATER - ZAMBIA: (COPPERBELT) 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: Fri 4 Jan 2008 [ProMED regrets the delay in posting. ? Mod.JW]
Source: AllAfrica, The Times of Zambia (Ndola) report [edited]
<http://allafrica.com/stories/200801040294.html>


About 800 people in Mufulira were treated at 2 hospitals for stomach
and other complications after they consumed water supplied from
Mopani Copper Mines (MCM) underground source.

Copperbelt Minister, Mwansa Mbulakulima, said yesterday [3 Jan 2008]
in an interview that 500 people were treated at Ronald Ross Hospital
while close to 300 were attended to at Malcolm Watson Mine Hospital on
Wednesday [2 Jan 2008] as the Government constituted a team to
establish the cause of the pollution.

But in a statement released yesterday [3 Jan 2008], MCM chief services
officer, Passmore Hamukoma, said "We received a number of complaints
from people living in Kantanshi Township -- abdominal pains -- after
drinking tap water. Over 350
people were attended to, 25 had genuine stomach complaints, and 5 were
hospitalized. So far, 4 have been discharged and the remaining one is
in a stable condition," he said. Mr Hamukoma said the pollution was
caused by a pump failure in the
leach section of the mine on the 520-metre (1706 ft) level.

"Irrigation from the surface was immediately reduced to restrict the
volume of raffinate entering the underground workings. As a result of
this and other emergency measurers only minor contamination of water
being pumped to surface occurred and supply to the treatment plant was
halted," he explained.

Mr Mbulakulima said, on the other hand, that he and other officials
who included provincial Permanent Secretary, Jennifer Musonda,
conducted an on-the-spot check at the 2 hospitals from late afternoon
on Wednesday [2 Jan 2008] up to 19:30 hours. The minister said at
Malcolm Watson Mine Hospital, initially 397 people were attended to
but the number rose to 500 in the evening.

At Ronald Ross Hospital, 212 people were treated up to early
afternoon but the number increased to about 300 after people who had
initially thought they had 'minor' stomach complications realised
that the problem was as a result of water pollution from the mines.

Mr Mbulakulima said sensitisation and an effective water testing and
monitoring process should be put in place now because the problem was
a serious one.

Employees interviewed yesterday [3 Jan 2008] said the acid which was
used in the InSitu Leach section spilled over after the pump failure,
and when the dewatering process started, traces of acid were also
pumped out and eventually got into the Mulonga water system.

The polluted water was pumped to the Kantanshi, Kankoyo, Butondo, and
Fairview areas of the town centre from the Mine Site water treatment
plant supplied from MCM.

Mr Mutale, who was in the company of engineers and National Water and
Sanitation Council (NWASCO) director, Oswald Chanda, indicated that
the acid had been cleared in the system and hoped that by the end of
the day yesterday [3 Jan 2008], supply could be restored.

Mr Mwandila said he had arranged a council fire tender, while MCM had
also released its machine, to distribute water to the affected areas as
an interim measure. He said he was part of the team constituted to
look into the cause of the pollution. Others were Mr Mutale, MSD
officials, Environmental Council of Zambia representatives, Mufulira
District Commissioner, Dyford Muulwa, and a representative from the
provincial administration.

On Wednesday [2 Jan 2008], residents almost rioted after some people
who had consumed polluted water were rushed to the hospital, prompting
authorities to deploy police officers in the 3 affected townships, the
town centre and other strategic areas. Police sealed off the hospital
premises as residents in panic thronged the area to check the
condition of the patients.

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

[According to the IUPAC Compendium of Chemical Terminology 2nd Edition
(1997) raffinate is the phase remaining after extraction of some
specified solute(s). When necessary it should be further specified,
such as, scrub raffinate. The original meaning of raffinate as a
'refined product' has become extended and changed by common usage.
The term should normally be applied only to waste streams but the
latter may form the feed to a further extraction process for another
solute. [Extracted from: <http://www.iupac.org/goldbook/R05122.pdf>.]
The article seems to indicate it is part of the waste product. It
would be nice to know the exact content of the raffinate and the
concentration.

There are 2 distinct types of copper ore, the sulfide ore and the
oxide ore. The oxide ores are generally leached. First the copper ore from
an open pit mine is blasted, loaded, and transported to the primary
crushers. Then the ore is crushed and screened, with the fine sulfide
ore (about 0.5 mm) going to froth flotation cells for recovery of
copper. The coarser ore goes to the heap leach, where the copper is
subjected to a dilute sulfuric acid solution to dissolve the copper.
Then the leach solution containing the dissolved copper is subjected
to a process called solvent extraction. The concentrated copper solution
is dissolved in sulfuric acid and sent to the electrolytic cells for
recovery as copper plates (cathodes). [Extracted from:
<http://www.mine-engineer.com/mining/copperm.htm>]

If it is sulfuric acid, it could cause acute stomach upset. Other
clinical signs associated with ingestion of sulfuric acid include
breathing difficulty due to throat swelling, burns in the mouth and
throat, drooling, fever, rapid development of low blood pressure,
severe pain in the mouth and throat, speech problems, vomiting, with
blood and likely vision loss. However, we still don't know the level
of sulfuric acid in the water or how much water the patients consumed
to demonstrate clinical signs. - Mod.TG.

ProMED does not usually post reports of chemical poisoning, unless the
outbreak was initially suspected to be due to an infectious agent or
toxin. But this was a large outbreak. Fortunately, the source
appears to have been quickly found and dealt with. ? Mod.JW.

The Mopani Copper Mine, located in Mufulira, in the Copperbelt
Province of Zambia, is one of the largest in Zambia's copper belt, as
well as one of the world's largest mines. It can be seen on the
interactive map at
<http://wikimapia.org/27973/>.

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

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (02)
****************************************************
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 - Kenya: (Rift Valley province)
[2] Cholera - Uganda: (Arua, Nebbi)
[3] Cholera - Angola: (Cunene)
[4] Cholera - Zimbabwe: (Harare)

*****
[1] Cholera - Kenya: (Rift Valley province)
Date: Mon 7 Jan 2008
Source: Daily Nation [edited]
<http://www.nationmedia.com/dailynation/ ... sid=114167>


Cholera has broken out at a center hosting victims of post-election
violence in Nandi. A total of 3 doctors were tackling the disease at
Kapsabet police station, Nandi North district commissioner Mabeya
Mogaka said. Mr. Mogaka added that the outbreak was occasioned by
congestion, leading to poor sanitation at the station.

He said the Government had evacuated more than 1000 people who had
been displaced. They were among the 2100 who had been camping at the
police station. They were evacuated under tight military security to
safer places in Nakuru and Kisii.

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

[Nandi is located in the Rift Valley province of Kenya which can be
seen on a map at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

*****
[2] Cholera - Uganda: (Arua, Nebbi)
Date: Mon 7 Jan 2008
Source: AllAfrica.com and The Monitor (Kampala) [edited]
<http://allafrica.com/stories/200801071669.html>


Fresh cholera cases have been registered in the West Nile districts
of Arua and Nebbi, despite efforts to contain the disease in late
2007. Arua District Health Officer Patrick Anguzu confirmed that
cases of cholera had been reported in the districts. He said it was
impossible to confirm the total number of deaths as the health team
had not delivered reports from the affected areas.

"It is true that the disease is again there and we have cases
reported already in some health centers," Mr Anguzu said. But some
sources say 3 people have so far died in Madi Okollo and Offaka
sub-counties. According to health reports from Offaka HC III, 2 of the
cholera victims died at home while the 3rd died at the center. 2
people have also reportedly died of cholera in Nebbi town.

[Byline: Warom Felix Okello]

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

[Arua and Nebbi are located adjacent to each other in northwestern
Uganda as can be seen on a map at:
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

*****
[3] Cholera - Angola: (Cunene)
Date: Mon 7 Jan 2008
Source: AllAfrica.com and Angola Press Agency (ANGOP Luanda) [edited]
<http://allafrica.com/stories/200801070572.html>


A total of 38 new cases of cholera have been reported from the
central hospital of Ondjiva, southern Cunene Province, from 1 to 5
Jan 2008, ANGOP has learnt. According to the official in charge of
the cholera assistance sector, Anatercia Ndahambelela, with the
notification of these cases in Ondjiva hospital, the current total
rises to 68.

Ndahambelela also revealed that these new cases are due to
poor hygienic conditions and the nonobservation of the preventive
measures published by the health authorities.

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

[Angola's province of Cunene borders to its south with Namibia. The
provincial capital and the province itself can be seen on a map at:
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

*****
[4] Cholera - Zimbabwe: (Harare)
Date: Fri 4 Jan 2008
Source: The Zimbabwean [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


With a cholera death toll in Zimbabwe's capital [Harare] rising to 9,
the UN Children's Fund (UNICEF) has provided US 210 000 dollars to the
Ministry of Health for urgent measures to control the spread of the
epidemic, sparked by drinking tap water left untreated by the Zimbabwe
National Water Authority (Zinwa). Since December 2007, 500 people have
been affected in the populous suburbs of Mabvuku and Tafara by the
waterborne disease, which is spread by poor sanitation.

The death toll for the epidemic, which is centered in the 2 ghettos,
home to more than 50 000 people, rose from 3 to 9 in a week after 6
people died last weekend [5-6 Jan 2008].

A statement from UNICEF said the funds would be used to bring in
epidemiologists within the Ministry of Health and Child Welfare to
strengthen cholera control activities, including awareness programs.
UNICEF would also provide 5 water bowsers [a bowser is a tanker truck
- Mod.LL] and environmental disinfectants to improve access to safe
water.

"These efforts will go a long way towards controlling the epidemic
and ensuring that the epidemic does not spread to neighboring areas,"
said the UNICEF representative in Zimbabwe.

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

[Mabvuku (<http://en.wikipedia.org/wiki/Mabvuku>) is a high density
suburb some 17 km [10.5 miles] east of Harare, the capital city of
Zimbabwe. It is classified as a suburb or township of Harare, with
the Harare City Council constituting local government. It encompasses
in particular the townships that include Old Mabvuku and New Mabvuku,
and more generally Old Tafara, and New Tafara (the latter 2
constituting Tafara, properly speaking).

A map of Zimbabwe showing the location of Harare can be found at:
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.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]

BEULENPEST, FATAL - MADAGASCAR: (ANTANANARIVO), 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>

[1]
Date: Fri 11 Jan 2008
Source: L'Express de Madagascar (transl. - Mod.LM) [edited]
<http://www.lexpressmada.com/display.php>


The district of Manjakandriana has been confronted with the bubonic
plague. With the last information communicated by the service of the
transmissible disease, the disease has killed, up to now, 3 people.

In addition to a 38-year-old man, an inhabitant of Manankasikely and
dead on 5 Jan 2008, a 12-year-old is also dead in Ambohitseheno. The 3rd
victim lived in the rural district of Ambatolaona, and his death
occurred in December 2007.

Moreover, as of 10 Jan 2008, 4 men and a woman are under treatment in
the hospital complex of the district.

"The rats haven't been beaten down. We have rushed a medical team to
Manjakandriana to address the situation," said Dr. Rolland Robinson,
chief of the service of the Emergenies and Transmissible Diseases within
the Ministry of Health, Family Planning and Social Protection.

In all the cases, the killing of rats are not done, because "that
supports the profusion of the fleas and, so the recrudescence of the
malady," said Dr. Robinson. He encourages the cleansing of the places
and the insecticide use.

[Byline: Fanja Saholiarisoa]

--
Communicated by:
ProMED Rapporteur Dan Silver

[3 deaths are reported in this press posting but 18 deaths are noted in
the web posting below. ProMED would appreciate learning more
information regarding this outbreak.

Madagascar was the location of the isolation of multi-antimicrobial
resistant _Y. pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al:
Multidrug resistance in _Yersinia pestis_ mediated by a transferable
plasmid. N Engl J Med 1997;337: 677-81). The strain was resistant to
chloramphenicol, streptomycin and tetracycline but sensitive to
fluoroquinolones and trimethoprim as well as other aminoglycosides. This
was an ominous observation, however, it is not clear if this naturally
occurring strain has persisted or spread.

Manjakandriana is an administrative region in the central Madagascar
province of Antananarivo. The area can be found on a map of the island
at:
<http://en.wikipedia.org/wiki/Antananarivo_Province>. - Mod.LL]

******
[2]
Date: Wed 9 Jan 2008
Source: Les dessous d'information mondiale [edited]
<http://eldib.wordpress.com/2008/01/10/2175/>


At least 18 people have died of bubonic plague on the East African
island of Madagascar in the past 10 days, and at least 5 patients are
still in hospital. Bubonic plague is caused by the _Yersinia pestis_
bacillus carried by rat fleas.

At the start of the rainy season, currently, rats flee the sewers of
Madagascar in massive numbers and take refuge in people's cottages.

[The following paragraph of this posting is from 1998 (Chanteau S,
Ratsifasoamanana L, Rasoamanana B, et al: Plague, a Reemerging Disease
in Madagascar. Emerg Infect Dis 1998;4: 101-104:

"Between 1930 and 1990, bubonic plague had "virtually disappeared" on
the island due to efficient pest-control and good health-management.
However since 1990, an annual 200 cases are being reported and bubonic
plague takes on epidemic form especially in the port of Mahajanga each
year. In the capital city of Antananarivo more cases are also being
notified each year since 1990. Madagascar (pop. 13 million) has
accounted for 45 percent of all the cases of plague in Africa."
- Mod.LL]

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

DUVENHAGE VIRUS, BAT, HUMAN - NETHERLANDS EX KENYA
*************************************************
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: Thu 10 Jan 2008
Source: Eurosurveillance monthly releases 2008 Volume 13 / Issue 2 [edited]
<http://www.eurosurveillance.org/edition ... 110_01.asp>


Fatal case of human rabies (Duvenhage virus) from a bat in Kenya
-----------------------------------------------------------------------
On 19 Nov 2007, a 34-year-old woman was admitted to the Academic
Medical Center of the University of Amsterdam in the Netherlands with
dysarthria, hypesthesia of both cheeks and unsteady gait, all of
which started the day before. She had also experienced dizziness,
nausea and general malaise since 16 Nov 2007.

On 24 Oct 2007, at the start of a 2-week holiday trip through Kenya,
a small bat had flown against her face. While she was hitting away
the animal, it made 2 bleeding scratches on the right side of her
nose. The incident took place in a camping site between Nairobi and
Mombasa, at dusk, while she was brushing her teeth. The wound was
washed with soap and cleaned with an alcohol solution. The warden of
the campsite and medical personnel of the neighbouring health centre
were not aware of the existence of rabies in bats in the area and no
further action was recommended. The woman and her husband then
continued the holiday trip.

Treatment
-------------
On admission, passive and active post-exposure prophylaxis (PEP) for
rabies was initiated. The patient's neurological clinical picture
deteriorated quickly. As rabies was very likely, on day 7 of
admission, the "Wisconsin rabies treatment protocol" was initiated,
an experimental treatment protocol that has resulted in the survival
of the only patient who recovered from rabies infection without prior
vaccination [1]. As this treatment is experimental, clinical evidence
is still lacking, and patients subsequently treated in a similar or
modified way in Thailand [2], United States [3], and Germany [4] did
not survive. The treatment was only started after consultation of the
family and with their agreement. The diagnosis of infection with
lyssavirus, genotype 4 - Duvenhage virus (DUVV) was confirmed in a
nuchal biopsy taken on the 2 day of admission. This confirmation by
cloning and sequencing of the PCR products was obtained 3 days after
the treatment had begun, when the patient was still alive. Despite
all efforts, the patient died on 8 Dec 2007, 23 days after the onset
of illness.

Preventive measures for contacts
------------------------------------------
There are no laboratory-confirmed cases documenting the transmission
of rabies from rabies-infected patients to healthcare providers or
household contacts, either by direct contact or by fomites or
environmental surfaces, possibly due to extensive prophylactic
treatment of these contacts [5,6,7]. In the case described here, the
patient had been in close contact with several family members during
the 1st days of illness. On admission, protective measures were taken
but it was regarded as prudent to advise all close family contacts (n
= 11) and attending hospital employees (n = 30) to receive passive
and active post-exposure prophylaxis (PEP). Five days before the
onset of illness, the patient had spent a weekend with friends, with
possible exposure to saliva. Chances of infection at that stage were
practically nil, but for various reasons it was decided to offer this
group of 6 people the vaccine series of 5 injections without HRIG
(human anti-rabies immunoglobulin). Literature shows that
approximately 50 contacts per case required PEP, and in one case the
number exceeded 200 [8].

Conclusion
--------------
Rabies is a fatal zoonotic disease in humans, preventable if adequate
measures are applied shortly after a suspected infection. The main
reservoir of rabies (lyssavirus, genotype 1) are dogs and other
animals belonging to the Canidae family, but all mammalian animals in
endemic areas are capable of contracting and transmitting the disease
[9]. The Duvenhage virus is associated with insectivorous bats and
has so far been isolated from 2 human cases bitten by bats in South
Africa
(in 1970 and 2006), and 2 insectivorous bats in South Africa (1981)
and Zimbabwe (1986) [10]. To date, no cases of rabies infection from
a bat have been described in Kenya. This fatal incident shows that in
a rabies endemic area PEP has to be applied in case of every, however
minor, bite or scratch exposure to a mammalian animal, including bats
[10].

A clinical case report and a report on the virological, immunological
and histopathological results will be presented as soon as ongoing
investigations are finished.

[Byline: PPAM van Thiel (p.p.vanthiel@amc.uva.nl)1, JAR van den
Hoek1,2, F Eftimov3, R Tepaske4, HJ Zaaijer5, L Spanjaard6, HEL de
Boer7, GJJ van Doornum8, M Schutten8, ADME Osterhaus8, PA Kager1
1. Division of Infectious Diseases, Tropical Medicine and Aids,
Academic Medical Center, University of Amsterdam, the Netherlands
2. Cluster of Infectious Diseases, Public Health Service, Amsterdam,
the Netherlands
3. Department of Neurology, Academic Medical Center, University of
Amsterdam, the Netherlands
4. Intensive Care Unit, Academic Medical Center, University of
Amsterdam, the Netherlands
5. Department of Medical Microbiology, Unit Clinical Virology,
Academic Medical Center, University of Amsterdam, the Netherlands
6. Department of Medical Microbiology, Unit Hospital Epidemiology,
Academic Medical Center, University of Amsterdam, the Netherlands
7. Occupational Health Services, Academic Medical Center, University
of Amsterdam, the Netherlands
8. Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands]


References
--------------
1. Willoughby RE Jr, Tieves KS, Hoffman GM, Ghanayem NS, Amlie-
Lefond CM, Schwabe MJ, et al. Survival after treatment of rabies with
induction of coma. N Engl J Med 2005 Jun 16;352(24):2508-14.

2. Hemachudha T, Sunsaneewitayakul B, Desudchit T, Suankratay C,
Sittipunt C, Wacharapluesadee S, et al. Failure of therapeutic coma
and ketamine for therapy of human rabies. J. Neurovirol 2006 Oct;12
(5):407-9.

3. Centers for Disease Control and Prevention. Human rabies- Indiana
and California, 2006. MMWR. April 20, 2007 / 56(15);361-365.
Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/
mm5615a1.htm; and JAMA 2007;297:2340-3. Available from:
<http://jama.ama-assn.org/cgi/content/ full/297/21/2340>

4. Schmiedel S, Panning M, Lohse A, Kreymann KG, Gerloff C, Burchard
G, Drosten C. Case report on fatal human rabies infection in Hamburg,
Germany, March 2007. Euro Surveill 2007;12(5):E070531,5. Available
from: <http://www.eurosurveillance.org/ew/2007/070531.asp#5>

5. World Health Organization. WHO expert consultation on rabies. WHO
Tech Rep Ser 2005; Abstract 931, pg. 88.

6. Human rabies prevention -- United States, 1999. Recommendations
of the Advisory Committee on Immunization PracticesACIP). MMWR Recomm
Rep 1999;48:1. Available from:
<http://www.cdc.gov/MMWR/preview/mmwrhtml/00056176.htm>

7. Helmick CG, Tauxe RV, Vernon AA. Is there a risk to contacts of
patients with rabies? Rev Infect Dis 1987; 9:511.

8. M. Stantic-Pavlinic. Rabies treatment of healthcare staff. Swiss
Med Weekly, 2002. Available from:
<http://www.smw.ch>

9. Rupprecht CE, Hanlon CA, Hemachuda T. Rabies re-examined. Lancet
Infect Dis 2002 ;2 :327-43.

10. Paweska JT, Blumberg LH, Liebenberg C, Hewlett RH, Grobbelaar
AA, Leman PA, et al. Fatal Human Infection with Rabies-related
Duvenhage Virus, South Africa. Emerg Inf Dis 2006 Dec;12(12):1965-7.
Available from: <http://www.cdc.gov/ncidod/eid/vol12no12/06-0764.htm>

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

[_Duvenhage virus_ is classified in the "8th Report of the
International Committee on Taxonomy of Viruses" as one of 7 virus
species in the genus _Lyssavirus_ of the _Rhabdoviridae_ family of
negative-stranded RNA viruses. Rabies virus is the type species of
the genus _Lyssavirus_. Chiroptera (bats) are known to be vectors for
6 of the 7 species of _Lyssavirus_, and bats are the exclusive
vectors for 5 of these 6 species. Rabies virus is perhaps exceptional
in that it has in addition many terrestrial vectors, principally
carnivores.

Duvenhage virus was discovered initially in 1970 in South Africa when
a man developed fatal rabies-like disease after being bitten indoors
at night by an unidentified insectivorous bat. A 2nd human case was
reported in February 2006 as a result of another encounter with a
bat some 60 km from the previous case [see ProMED- mail post:
Duvenhage virus, bat, human - South Africa (NW) 20060419.1153].
Subsequently Duvengage virus was isolated from insectivorous bats in
southern Atica, but only infrequently. The case described in the
present reort extends the known range of Duvenhage virus and suggests
that the virus may be prevalent in bats throughout Africa. - Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (03)
**********************************************
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 - Mozambique
[2] Diarrhea, cholera - Liberia: (Maryland, Grand Kru)
[3] Cholera - Nigeria: (Benue)

*****
[1] Cholera - Mozambique
Date: Fri 11 Jan 2008
Source: AllAfrica.com & Agencia de Informacao de Mocambique (Maputo) [edited]
<http://allafrica.com/stories/200801110765.html>


Since the start of the current cholera outbreak in Mozambique in
October 2007, 12 people have died from the disease, according to
Health Ministry statistics cited in the Friday [11 Jan 2008] issue of
the independent newssheet "Mediafax."

The 1st cholera case was diagnosed in Maputo on 8 Oct 2007. By
Thursday [10 Jan 2008] morning, the number of diagnosed cases stood
at 1396. Almost half of these cases, 673, occurred in Maputo city; 7
of these patients died. Maputo province reported 346 cases and 3
deaths. The other areas affected were Cabo Delgado in the far north
(138 cases and 1 death), and the central province of Sofala (133
cases and 1 death).

Cholera is endemic in Mozambique, and there are outbreaks,
particularly in urban areas, almost every rainy season. The number of
cases, however, does seem to be declining. Thus in 2006, 5431 cases
were diagnosed, of whom 24 died. This compares with 20 000 cases and
117 deaths in 2004 (and 15 000 cases and 113 deaths in 2003).

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

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

*****
[2] Diarrhea, cholera - Liberia: (Maryland, Grand Kru)
Date: Thu 10 Jan 2008
Source: AllAfrica.com & The Analyst (Monrovia) [edited]
<http://allafrica.com/stories/200801100761.html>


Health authority in Monrovia has confirmed 163 diarrhea cases and 2
deaths in the southeastern region of Maryland County. Acting Chief
Medical Officer of Liberia, Dr. Moses Pewu, told a news conference at
the headquarters of UNMIL Wednesday [9 Jan 2008] that the health
situation in Maryland and Grand Kru Counties has worsened in recent
time with the epidemic spread of diarrhea.

Dr. Pewo said in December 2007, several communities in Harper
including Up Cape, New Kru Town, Old Kru Town, Barrobo Community,
Bishop Ferguson Hill, Nekanbo, Bassa Community, Karloken and Hence
Street were hard hit by diarrhea. According to him, 163 diarrhea
patients were treated at the only Referral Hospital, J.J. Dossen
Hospital while the total of 49 patients with severe diarrhea were
admitted.

Dr. Pewu told the news conference that the County health team of
Maryland has reported 2 deaths including females ages of 27 and 15.

Apart from the conditions in Harper, he said a local agency has
reported 88 cases of diarrhea in Pleebo. Pleebo, which is about 45
minutes drive from Harper, is the second largest city. Though their
cases were severe, he said they were discharged having been treated
with IV infusion.

Also in Garaway in Grand Kru County, Dr. Pewu said, there were 3
suspected cases of cholera with 2 deaths. Commenting on laboratory
test, he said tests were conducted on 7 specimens collected from
Maryland County. He said analysis proved that 1 of the 7 cases proved
to be positive for _Vibro cholerae_ type O1.

[Byline: Sallu Swaray]

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

[How many of the cases of diarrhea are due to cholera is not clear.
The affected areas of Grand Kru and Maryland are in the extreme south
part of Liberia. Maryland County's eastern border is with Cote
d'Ivoire. The area can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... iberia.pdf>. - Mod.LL]

*****
[3] Cholera - Nigeria: (Benue)
Date: Fri 11 Jan 2008
Source: The Tide [edited]
<http://www.thetidenews.com/article.aspx ... umn=HEALTH>


Another person has lost his life to the recent outbreak of cholera in
Gbajimba village of Guma Local Government Area of Benue. The
confirmation of the death of the victim, brings the total number of
persons that have lost their lives to the epidemic to 41.

The Benue Commissioner for Health, Dr. Jarius Erube, advised the
residents of Gbajimba and its environs to stop drinking water from
their streams or boil it before drinking or using it for other
domestic purposes.

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

[Benue can be found in the south on a map of the country at:
<http://www.un.org/Depts/Cartographic/ma ... igeria.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]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (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>

In this update:
Africa
[1] Cholera, diarrhea - Liberia: (Maryland, Grand Kru, River Gee)
[2] Cholera - Malawi
[3] Cholera - Congo DR: (Katanga)
[4] Diarrhea, dysentery - Zimbabwe: (Harare)
[5] Cholera, diarrhea - Zimbabwe: (Harare)

******
[1] Cholera, diarrhea - Liberia: (Maryland, Grand Kru, River Gee)
Date: 14 Jan 2008
Source: United Nations Mission in Liberia (UNMIL) [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


UNMIL Humanitarian Situation Report No. 133 7-13 Jan 2008; Government
confirms outbreak of cholera in southeast Liberia
-----------------------------------------------
Last week, the Ministry of Health and Social Welfare confirmed that
the suspected outbreak of acute watery diarrhea in the southeastern
counties of Maryland and Grand Kru is a cholera outbreak. Test
results have confirmed one case of cholera, and 4 fatalities were
reported in Maryland and Grand Kru Counties.

Between 5 Dec 2007 and 11 Jan 2008, the total number of cases
reported at the 2 major health facilities in Maryland County (J. J.
Dossen Hospital and Pleebo Health Centre) was 299 patients. There are
no confirmed figures on the number of cases in Grand Kru County. ICRC
confirmed that the cases of acute watery diarrhea/suspected cholera
have so far been reported in Garraway and surrounding areas.

In addition to these officially confirmed cases, there were
unconfirmed reports of an estimated 54 cases of acute watery diarrhea
in Karluway District in Maryland County. In River Gee County, it is
also being reported that there is an apparent outbreak of diarrhea.
According to Dr. Moses Pewu, Acting Chief Medical Officer of Liberia,
most of the figures reported are for people who can reach the 2 major
facilities in Maryland County, and the situation in other parts of
Maryland and Grand Kru Counties is unknown.

A comprehensive response is in place, and it includes case
management, improvement of water and sanitation facilities, hygiene
promotion and awareness/sensitization. UNICEF has dispatched an
assessment mission, including a consignment of drugs, water
testing/purification materials and awareness/sensitization materials
to be used in Grand Kru and Maryland Counties.

WHO dispatched a cholera kit containing materials and medication for
the treatment of 500 people. MERLIN, Solidarites, the Liberia
National Red Cross Society, ICRC, UNMIL and other organizations are
working with the County Health Team to respond to the outbreak. So
far, the response to the outbreak in Maryland County has stabilized
the situation, while the situation in Grand Kru and River Gee
Counties is being monitored.

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

[This posting now mentions diarrhea in River Gee county, which is
just north of both Maryland and Grand Kru. All 3 are located in the
southeastern part of the country of Liberia and can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... iberia.pdf>.
- Mod.LL]

******
[2] Cholera - Malawi
Date: Mon 14 Jan 2008
Source: United Nations Children's Fund [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Cholera remains a major threat in rural and peri-urban areas in
Malawi, with recurrent outbreaks during the rainy season from
November to April, and is particularly a major risk factor in flood
situations because of the possible and immediate breakdown of water
and sanitation facilities. Food shortages and malnutrition have a
direct effect on individual susceptibility to diseases, and thus the
level of a possible epidemic will be directly related to people's
access to food and safe water. So far, 434 cholera cases and 5 deaths
have been reported in Mulanje, Blantyre, Chikwawa, Thyolo,
Chiradzulu, Nsanje and Nkhotakota districts since the current
outbreak that started on the 5 Nov 2007.

The last cholera season 2006/2007 ended on the week of 17 Jun 2007,
with a total of 309 cases, 6 deaths in 12 districts countrywide and
within a period of 11 months (August 2006 to June 2007). This season
seems to be of major concern, as more cases have already been
reported within a period of 2 months only.

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

[A map of Malawi, a southeastern African nation, can be found at:
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>.
- Mod.LL]

******
[3] Cholera - Congo DR: (Katanga)
Date: Sun 13 Jan 2008
Source: Journal Chretien [edited]
<http://www.spcm.org/Journal/spip.php?breve7077>


In 3 days, a cholera epidemic has killed 6 patients recently admitted
in the general referral hospital of Daco in the city of Likasi,
Democratic Republic of Congo, medical sources told APA here. The
death of a patient following epidemic diarrhea and vomiting led to
fear in the dwellers of Likasi city, estimated at over 600 000 inhabitants.

According to Dr Jacques Mpoyo, director of the referral hospital, 91
people suffering from cholera were taken into care last week, whereas
30 others received treatment, he said, appealing for more appropriate
means to eradicate the disease.

Dr Kashindji Numbi, inspector of the health district of Likasi, urged
people through a local radio broadcast to observe preventive measures
to contain the epidemic. The shortage of drinkable water in Likasi
city could be behind this epidemic, sources said.

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

[Likasi, formerly known as Jadotville or Jadotstad, is a town in
Katanga Province, in the southeast region of the Democratic Republic
of Congo close to the border with Zambia. The area can be found on a
map of the country at:
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>.
- Mod.LL]

******
[4] Diarrhea, dysentery - Zimbabwe: (Harare)
Date: Mon 14 Jan 2008
Source: AllAfrica.com & Zimbabwe Standard (Harare) [edited]
<http://allafrica.com/stories/200801140512.html>


The Combined Harare Residents Association (CHRA) has accused the
government of playing down the outbreak of diarrhea in many city
suburbs. According to the Ministry of Health and Child Welfare, more
than 400 cases have been recorded in Mabvuku and Tafara, hit by an
acute water shortage over the past year. CHRA disputed this,
insisting at least 15 000 may have been affected.

CHRA argues Mabvuku and Tafara, being big suburbs with large
populations, could have more victims of the outbreak. The association
says its research showed the government and the council were
understating the number of victims, having counted the households
affected. Some areas in Mabvuku have had no water since last March 2007.

CHRA information officer Mfundo Mlilo says the situation in the twin
suburbs was "very disturbing" because both the Zimbabwe National
Water Authority (Zinwa) and the council had shown a lack of
commitment to solve the crisis.

Mlilo said the diarrhea outbreak was not confined to the 2 suburbs
but to others as well, where cholera and dysentery had been reported.
These include Hatcliffe and Hatcliffe Extension, Epworth,
Marlborough, Msasa, Mufakose, Budiriro, Glen View, Chitungwiza, Mbare
and Hatfield, said the association.

The outbreak has been attributed to erratic water supplies by Zinwa
and the failure by the council to collect garbage and repair burst
sewer pipes on time.

The Standard established during a survey that Hatcliffe has had no
tap water for the past 2 months, and residents say they have been
using unprotected wells. As a result, many people had succumbed to
waterborne diseases.

An Epworth clinic nurse who spoke on condition of anonymity said they
are attending to cases of dysentery and stomach problems "everyday."
She said "I would say that we attend to at least 10 to 15 cases of
some sort of diarrhoea or stomach problems."

At Mbare clinic, a nurse put the figure at 20 a day with diarrhea
complaints. Mbare has raw sewage flowing in the streets and piles of
garbage in different parts of the suburb, especially near the vast
bus terminus.

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

******
[5] Cholera, diarrhea - Zimbabwe: (Harare)
Date: Sun 13 Jan 2008
Source: Monsters and Critics [edited]
<http://news.monstersandcritics.com/afri ... ays_report>


Zimbabwe's capital Harare will go without water for a week, the
state-run water authority announced Sunday [13 Jan 2008] in the
latest set-back for struggling residents. Zimbabwe National Water
Authority (ZINWA) general manager Lisben Chipfunde blamed the cut,
which starts Monday [14 Jan 2008], on major power outages at the main
Morton Jaffray treatment plant. Parts of Harare's sprawling dormitory
town of Chitungwiza will also be affected.

"Harare and parts of Chitungwiza will this whole week experience a
loss of water supplies due to problems beyond our control," Chipfunde
told the state-controlled Sunday Mail newspaper. "We are really
concerned about the frequency of power cuts, which are affecting our
plant." News of the cuts come after record rains in December 2007.
Zimbabwe's dams are now 87 percent full, reports said earlier this
month [January 2008]. Lake Chivero, Harare's main water supply, is
already overflowing.

Despite the rains, Harare's more than 1.5 million residents struggle
with long water cuts exacerbated by power shortages, burst sewage
pipes and mounting piles of uncollected refuse.

The Sunday Mail also reported that more than 400 cases of diarrheal
diseases, including cholera, had been diagnosed in recent weeks in
the twin eastern suburbs of Tafara and Mabvuku. There have been a
number of deaths.

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

[A map of Zimbabwe showing the location of Harare can be found at:
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.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]

Kenia: Tollwut
15.01.2008

Am 8. Dezember verstarb in Holland eine 34-jährige Frau, die am 24. Oktober auf einer Reise durch Kenia zwischen Nairobi und Mombassa auf einem Campingplatz in der Abenddämmerung von einer Fledermaus ins Gesicht gebissen worden war. Sie reinigte die Wunde mit Seife und desinfizierte sie mit Alkohol, erhielt aber keine Impfung. Sie erkrankte am 16. November. Drei Tage später wurde sie im Universitätskrankenhaus von Amsterdam aufgenommen. Dort erhielt sie sofort eine passiv-aktive Impfung und wurde intensivmedizinisch versorgt - wie bei einmal ausgebrochener Tollwut üblich leider ohne Erfolg. Dieser tragische Fall ist erneut eine dringende Warnung, nach jedem verdächtigen Tierkontakt oder -biss, speziell auch durch Fledermäuse, an die Möglichkeit einer Tollwutübertragung zu denken und sofort einen Arzt aufzusuchen. Bei einem vorhersehbaren Risiko sollte eine vorbeugende Impfung erfolgen. / Quelle: crm
___________________________

Kenia: Darminfektionen
15.01.2008

Das Risiko für Durchfallerkrankungen hat im Rahmen der politischen Unruhen und der damit verbundenen Flüchtlingsbewegungen und Versorgungsengpässe landesweit zugenommen. Ein aktueller Ausbruch von Cholera wird aus einem Auffanglager mit über 2.000 Personen in Kabsabet im Westen der Rift Valley-Provinz (W) gemeldet. Zu den seit Anfang Dezember bekannten Ausbrüchen im Seegebiet der Western- und Nyanza-Provinz (SW) gibt es keine neuen Daten. / Quelle: crm
___________________________

Nigeria: Masern
15.01.2008

Ein aktueller Ausbruch hat in Zaria, einer grösseren Stadt im Norden des Bundesstaates Kaduna, seit Anfang Dezember zu mehr als 200 Todesfällen bei Kindern geführt. Inzwischen wurden bei mehreren örtlichen Ausbrüchen aus dem benachbarten Bundesstaat Kano mehr als 100 Erkrankungen mit 10 Todesfällen gemeldet. Impfschutz beachten. Nach dem deutschen Impfkalender sind 2 MMR-Impfungen für alle Kinder vorgesehen. Ein fehlender Impfschutz kann auch später jederzeit, z.B. anlässlich einer Reise, nachgeholt werden. / Quelle: crm