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CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (05)
**********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Congo DR: (Katanga)
[2] Cholera - Mozambique
[3] Bloody diarrhea - Sudan: (Darfur)
[4] Cholera - Malawi: (Southern Province)

******
[1] Cholera - Congo DR: (Katanga)
Date: Fri 18 Jan 2008
Source: Reuters India [edited]
<http://in.reuters.com/article/health/id ... 6820080118>


More than 550 people have fallen victim to a cholera epidemic so far
in 2008 in Lubumbashi, capital of Congo's mineral-rich Katanga
province, medical charity Medecins Sans Frontieres (MSF) said on
Friday [18 Jan 2008]. At least 8 people have died from the waterborne
illness in the city of around one million, and 104 are receiving
medical care at a treatment center set up by MSF's Belgian chapter.

"We are seeing that the worst hit people are those who live in the
poorest neighborhoods. That is where the people have no access to
drinking water and the hygiene conditions are poor," said Bertrand
Perrochet, MSF's emergency pool coordinator.

Cholera is endemic in many parts of Congo, which is still recovering
from a 1998-2003 war that killed an estimated 4 million people,
mainly through hunger and disease, and left infrastructure in ruins.
Health officials have recorded 150 new cases, including 5 deaths, in
the town of Bukama, about 300 km (192 miles) north of Lubumbashi
since 1 Jan 2008. Another cholera outbreak has been reported in
Likasi, 90 km (58 miles) northwest of Lubumbashi. However,
large-scale epidemics in Lubumbashi, the heavily populated capital of
Katanga, are relatively rare.

"The last major epidemic (in Lubumbashi) was in 2003. In Katanga,
there are of course outbreaks every year, but this year [2208] it
started very early during the dry season," Perrochet said.

[Byline: Joe Bavier]

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

[Katanga Province, in the southeast region of the Democratic Republic
of Congo, borders 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]

******
[2] Cholera - Mozambique
Date: Tue 15 Jan 2008
Source: AllAfrica, Agencia de Informacao de Mocambique (Maputo) report [edited]
<http://allafrica.com/stories/200801150738.html>


The vast majority of cholera cases diagnosed in the current outbreak
are in Maputo and the adjoining city of Matola, according to
Mozambican Health Minister Ivo Garrido. Since the outbreak began in
November 2007, over 1000 cases have been diagnosed, and over 80
percent of these are in Maputo and Matola.

The cholera treatment center for the 2 cities has been set up in
Maputo's Mavalane hospital, which is seeing between 5 and 10 new
patients a day, said Garrido, cited in the Tuesday [15 Jan 2008]
issue of the Maputo daily "Noticias."

However, the situation in the southern province of Gaza is also
becoming alarming. The disease has been reported from the provincial
capital Xai-Xai, and the districts of Chokwe and Guija. Garrido said
that between 10 and 20 new cases are being reported every day.

The central city of Beira has also been struck by cholera, but here
there are only 2 or 3 new cases a day. In the northern province of
Cabo Delgado, the disease has been reported from the provincial
capital, Pemba, and from the district of Pemba-Metuge. Garrido said 4
to 6 cases were being diagnosed per day.

Cholera has also been reported from Guro district in the central
province of Manica, but the total number of cases diagnosed here is only 3.

No cases of cholera have been reported from the accommodation centers
established for almost 60 000 people evacuated from flood stricken
areas, particularly in the Zambezi valley.

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

[Maputo and Matola are located in the extreme south of the country in
Maputo province, Manica in the central part of the country and Capo
Delgado in the extreme north. The areas can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>. - Mod.LL]

******
[3] Bloody diarrhea - Sudan: (Darfur)
Date: Tue 15 Jan 2008
Source: World Health Organization [edited]
<http://reliefweb.int/rw/RWB.NSF/db900SI ... Report.pdf>


Sudan: Morbidity and Mortality Weekly Bulletin -- 22-28 Dec 2007
----------------------------------------------------------------
The attack rate of bloody diarrhea, observed during the current week
[22-28 Dec 2007], was 5.51 cases per 10 000 which is lower than the
mean attack rate (8 cases per 10 000) for 2007. West and South Darfur
have been reporting higher rates as compared to North Darfur. The
mean attack rate for 2005 and 2006 was respectively 13.73 and 9.37 per 10 000.

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

[The weekly attack rates of bloody diarrhea for Greater Darfur, Sudan
for the years 2005-2007 can be found in a chart at the source URL.

A map of Sudan showing mentioned areas can be found at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>. - Mod.LL]

******
[4] Cholera - Malawi: (Southern Province)
Date: Tue 15 Jan 2008
Source: Reuters Africa [edited]
<http://africa.reuters.com/top/news/usnBAN540674.html>


The health minister said on Tuesday [15 Jan 2008] 8 people have died
from an outbreak of cholera in southern Malawi, where flooding has
increased the risk of contracting the disease,

"Floods are worsening the situation because in rural areas people are
unable to satisfy the most basic human needs like hygiene, proper
sanitation, and safe drinking water," health minister Marjorie
Ngaunje told Reuters in an interview. "But we are trying to teach
people to wash their hands, boil water, and other important
information to help prevent the disease."

Ngaunje said there were 291 reported cases of cholera in the past 3
weeks in the southern part of Malawi, one of the poorest nations in
Africa. "In (the) 2001/02 rainy season we recorded 33 546 cases with
953 deaths, in the 2003/04 season we had 959 cases but only 13 people
died and in 2006/07 only 6 people died out of 309 reported cases," she said.

[Byline: Mabvuto Banda]

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

[The Southern Province can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>. - Mod.LL]

Kenia: Malaria
21.01.2008

Während und nach der Winterregenzeit ist in Kenia wie in anderen ostafrikanischen Ländern in jedem Jahr mit einem erhöhten Übertragungsrisiko zu rechnen. Daran erinnert erneut ein tragischer Todesfall aus München: Eine 63-jährige Frau wurde am 9. Januar tot in ihrer Wohnung aufgefunden. Die Diagnose Malaria tropica wurde bei der Sektion gestellt. Die Frau war am 19. Dezember von einer dreiwöchigen Keniareise zurückgekehrt. Obwohl sie sich krank fühlte, hatte sie offenbar keinen Arzt aufgesucht. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (06)
**********************************************
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: (Luanda)
[2] Cholera - Angola: (Cunene)
[3] Cholera, diarrhea - Liberia: (Maryland, Grand Kru)
[4] Bloody diarrhea - Sudan: (Darfur)
[5] Acute watery diarrhea - Sudan: (South)
[6] Cholera - Mozambique: (Tete)

******
[1] Cholera - Angola: (Luanda)
Date: Mon 21 Jan 2008
Source: Angola Press [edited]
<http://www.angolapress-angop.ao/noticia-e.asp?ID=590207>


Luanda's Health Department has recorded 191 cases of cholera, including 174
recorded in the localities of Quilunda lagoon, Cacuaco district, since 1
Jan 2008.

Speaking to ANGOP on Monday [21 Jan 2008], the Health Department's
provincial director, Vita Vemba, said that last week there were registered
88 new cases of the disease in localities close to Quilunda lagoon.

Every week the Department reports cases of acute diarrhea, including
cholera, affecting residents of Quilunda lagoon's localities due to
consumption of untreated water and fish caught in that lagoon, said the
health official, who also quoted 4 cases in Samba district, in Mussulo
commune, and Camuxiba ward with 2 each, and 2 cases at Sao Pedro da Barra
ward (Sambizanga district).

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

[The area of the capital city and province of Luanda were where the large
2007 outbreak of cholera began spreading throughout the country of Angola.
Luanda can be found on a map of Angola at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. Mod.LL]

******
[2] Cholera - Angola: (Cunene)
Date: Tue 22 Jan 2008
Source: Angola Press [edited]
<http://www.angolapress-angop.ao/noticia-f.asp?ID=590612>


The outbreak of new cases of cholera in rural zones will require from the
health officials a detailed study of conducting methods, with a view to
prevent the disease from hitting the southern Cunene province, said the
local health director, Eduardo Haiumba. The official said this at the end
of a working visit of Health Ministry delegation, led by minister Ruben
Sicato, as part of the programme of combat to cholera.

Since the record of new cases on 23 Dec 2007, the Health Department has
already notified 608 cases of cholera (33 fatal) in localities of Evale,
Ondjiva, Nehone, and Kalonga.

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

[The southern province of Cunene, bordering on Namibia, can be seen on a
map of Angola at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

******
[3] Cholera, diarrhea - Liberia: (Maryland, Grand Kru)
Date: Mon 21 Jan 2008
Source: United Nations Mission in Liberia (UNML) [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Liberia: UNMIL humanitarian situation report No. 134 14-20 Jan 2008
-------------------------------------------------------------------
The latest assessment of the outbreak of acute watery diarrhea/cholera in
Maryland and Grand Kru Counties indicate that the situation has stabilized
and is under control. There is an improvement in information collection and
dissemination. Improved collaboration between health authorities, NGOs
(non-governmental organizations) and the UN has increased the effectiveness
of response.

According to the Ministry of Health and Social Welfare, improving treatment
facilities in the 2 counties is a challenge that will determine the
effectiveness of response to future outbreaks. Unconfirmed reports that
some cases of acute watery diarrhea may have been registered in River Gee
County (which borders Maryland County) have led to intensification of
contingency planning in neighboring Grand Gedeh County. The health
facilities in River Gee County lack adequate drugs and supplies to respond
to outbreaks.

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

[The areas discussed are all in south eastern Liberia and can be found on a
map at <http://www.un.org/Depts/Cartographic/ma ... iberia.pdf>. -
Mod.LL]

******
[4] Bloody diarrhea - Sudan: (Darfur)
Date: Tue 22 Jan 2008
Source: WHO [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... Report.pdf>


Sudan: Morbidity and Mortality Weekly Bulletin - 29 Dec 2007 - 4 Jan 2008
-------------------------------------------------------------------------
Darfur:
Cases of bloody diarrhea (Epidemiologic week 52, 21-28 Dec 2007)
North Darfur 3
West Darfur 168
South Darfur 54

The attack rate of bloody diarrhea, observed during the current week
[unclear if week 52 of 2007 or week 1 of 2008 - Mod. LL], was 3 cases per
10 000, which is lower than the mean attack rate (8/10 000) for 2007. West
and South Darfur have been reporting higher rates as compare to West
Darfur. The mean attack rate for 2005 and 2006 was respectively 14 and 9
per 10 000.

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

[The weekly attack rates of bloody diarrhea for Greater Darfur, Sudan for
the years 2005-2007 can be found in a chart at the source URL. A map of
Sudan showing mentioned areas can be found at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>. - Mod.LL]

******
[5] Acute watery diarrhea - Sudan: (South)
Date: Tue 22 Jan 2008
Source: WHO [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... Report.pdf>


Sudan: Morbidity and Mortality Weekly Bulletin - 29 Dec 2007 - 4 Jan 2008
-------------------------------------------------------------------------
There has been an increase in the number of acute watery diarrhea (AWD)
cases especially among children under 5 years of age in Yei, Tambura, Juba,
and Wau counties. A total of 250 cases have been reported in this week,
mostly from the latter 3 counties. Samples are being collected for culture.
Cumulative total from 31 Dec 2007 to 6 Jan 2008 is 250 cases and 2 deaths
with an overall case fatality rate of 0.8 per cent.

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

[Juba and Yei are located in the state of Central Equatoria, Wau is in
Western Bahr El Ghazal, and Tambura is in Western Equatoria. Acute watery
diarrhea is a term sometimes used instead of cholera. Cholera has occurred
in these South Sudan areas before, including a large outbreak in 2006. The
states can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>. - Mod.LL]

******
[6] Cholera - Mozambique: (Tete)
Date: Tue 22 Jan 2008
Source: Medecins Sans Frontieres [edited]
<http://www.msf.org/msfinternational/inv ... =full_html>


Since the end of 2007, heavy rainfalls have caused floods in different
countries across southern Africa. Although floods are expected this time of
year in Mozambique, the river levels are alarming and much higher than this
time in 2007. MSF teams are intervening to mitigate the health impact of
the floods.

In Mozambique, it is estimated that since December 2007, 65 000 people
living in the Zambezi basin have had to leave their home and resettle in
camps in safer areas. In addition to those, many who had fled last year's
floods have never returned to their home and need support as well.

"Healthwise, the main risks after floods are usually measles, and diarrheal
diseases," says Dr Biot. "We will make sure that most children are
vaccinated against measles, and that there is access to clean water in
camps to avoid the propagation of waterborne diseases."

A total of 4 confirmed cases of cholera have been spotted in Mutarara, and
cholera treatment centers are being put in place to treat these patients
and avoid further spread of the disease. As for clean water, MSF teams have
been using trucks to deliver water to camps, which also meant delivering
tanks in some cases, and are distributing chlorination kits to the
community, so that people can purify river water.

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

[Mutarara is in Tete province in north western Mozambique. The state can be
found on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf> - Mod.LL]

MENINGITIS, MENINGOCOCCAL - AFRICA: WEST AFRICA (BURKINA FASO,
NIGERIA, NIGER), CONGO DR
*********************************************************
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 17 Jan 2008
From: AllAfrica, IRIN (UN Integrated Regional Information Networks)
report [edited]
<http://allafrica.com/stories/200801170957.html>


The World Health Organization (WHO) has confirmed outbreaks of the
deadly meningitis bacterium [_Neisseria meningitidis_] in 3 West
African countries, marking the start of what experts have warned
might be the worst meningitis epidemic to hit Africa in a decade.
"One district is on alert in Burkina Faso, an epidemic has been
reported in a region of Nigeria, and there are 2 cases in Niger, as
well as cases in the Democratic Republic of Congo," Professor Kader
Konde, director of WHO's Ouagadougou [the capital of Burkina
Faso]-based Multi-Disease Surveillance Centre (MDSC) told IRIN
[Integrated Regional Information Networks, commonly known as IRIN, is
a project of the United Nations Office for the Coordination of
Humanitarian Affairs].

The WHO warned in October [2007] that 80 million people out of
roughly 350 million who live in 21 African countries stretching from
Ethiopia in the east to Mauritania in the west might need to be
vaccinated against the bacterium [_Neisseria meningitidis] this year
[2008]. Meningococcal meningitis, which usually reaches epidemic
levels in the region often referred to as Africa's "meningitis belt"
between December and May, could be especially severe this year [2008]
as the region is heading toward the peak of a 10- to 12-year cycle of
meningitis crises, health forecasters say.

Between 1995 and 1997, the last time there was a major epidemic in
the region, at least 25 000 people died and 250 000 people were
infected. From December 2006 to May 2007, 53 000 cases of meningitis
were reported and an estimated 4000 people died across the region.

Semi-arid Sahelian countries are hit each year by outbreaks during
the dry seasons between December and June when strong, dust-laden
winds and cold nights make people more prone to respiratory
infections. The meningitis bacterium is transmitted by sneezing or
coughing. According to Konde, the situation could be worse this year
[2008] because of high dust levels in the region and the low level of
immunity among populations. He said new research by WHO and national
research centres also appears to have shown a new strain of the
bacterium. "If you take into account all these factors we find
ourselves in a situation where the risk [of epidemics] is high," Konde said.

Preparedness for meningitis epidemics is notoriously difficult
because vaccines cannot be administered until it is known which of
the many different forms of the bacterium are spreading. In
2006-2007, the humanitarian response was further hindered by a
shortfall of the cheaper vaccines usually used in the region as
European producers focused on producing newer, longer-lasting but
more expensive vaccines. Just 7 million doses were available. In
2008, between 25 million and 30 million doses could be available,
according to WHO. "We do find ourselves in a more favourable
situation than last year [2007]," Konde said.

Emergency health officials are due to meet in Dakar next week [21-27
Jan 2008] to coordinate responses to the expected epidemic. Hans
Hebbing, regional health coordinator of the International Federation
of the Red Cross, told IRIN the Federation has already started
training 25 000 volunteers across the region, and is educating people
about how to recognise meningitis and the dangers. "We know this is
not really going to prevent a major outbreak. But we're hoping that
early activity can prevent some spread of the disease and we do know
that training and preparedness can make the response faster," he said.

Meningitis is an infection of the thin lining around the brain and
spinal cord. Even when meningitis is diagnosed early and adequate
therapy is available, between 5 and 10 percent of patients die,
typically within 24 and 48 hours of experiencing the 1st symptoms.
Many thousands of survivors are left with brain damage, hearing loss,
or learning disabilities.

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

[Meningitis due to the _Neisseria meningitidis_ occurs both
sporadically and as epidemics. There are at least 13 serogroups,
based on the antigenic specificity of their capsular polysaccharides;
disease due serogroups A, B, C, Y, and W135 are most common. All
serogroup polysaccharides but B, are immunogenic in humans.

From a prior ProMED-mail post (20071207.3954): To control an
outbreak, WHO recommends mass vaccination with the appropriate
vaccine, depending availability, in every involved district in an
attempt to induce herd immunity (whereby transmission is blocked when
a critical percentage of the population have been vaccinated
(<http://www.who.int/mediacentre/factsheets/fs141/en/>).

There are several different types of meningococcal vaccines.
Polysaccharide vaccines, which have been available for more than 30
years, exist against serogroups A, C, Y, and W-135 in various
combinations (such as, a bivalent AC, trivalent ACW-135, and a
tetravalent ACYW-135 polysaccharide vaccine). There is a monovalent
conjugate vaccine against serogroup C and a tetravalent against
serogroups A, C, Y, and W-135. The conjugate vaccines are immunogenic
for children under 2 years of age whereas polysaccharide vaccines are
not. All these vaccines have been proven safe and effective with
infrequent and mild side effects. For both the meningococcal
conjugate and the polysaccharide vaccines, approximately 7-10 days
are required following vaccination for development of protective
levels of anti-meningococcal antibodies.

During the 1st 10 weeks of the 2006 meningitis season, outbreaks in
eastern Africa were mainly caused by _Neisseria meningitidis_
serogroup W-135, whereas in West Africa the outbreak was due to
mainly serogroup A. The serogroups currently spreading in sub-Saharan
Africa are not stated in the news release above.

For a map of the African meningitis belt, see
(<http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx>). - Mod.ML]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (07)
**********************************************
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: (Benguela)
[2] Cholera - Congo DR: (Katanga)

******
[1] Cholera - Angola: (Benguela)
Date: Mon 28 Jan 2008
Source: AllAfrica, Angola Press Agency (Luanda) report [edited]
<http://allafrica.com/stories/200801281256.html>


At least 2 people out of 20 patients suffering from cholera died from the
disease in Bocoio district, south western Benguela province.

Speaking to Angop [Angola Press Agency] on Monday [28 Jan 2008], the head
of fight against cholera program, at the local hospital, Antonio Avelino,
said that the disease started early in January 2008. The source blamed the
spread of the disease on lack of treated drinking water and hygiene within
the community.

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

[The location of Benguela in the south western part of Angola can be found
at <http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

******
[2] Cholera - Congo DR: (Katanga)
Date: Fri 25 Jan 2008
Source: Medecins Sans Frontieres (MSF) [edited]
<http://www.msf.org/msfinternational/inv ... =full_html>


A team of 15 from MSF's Congo Emergency Pool (PUC; Pool d'Urgence Congo) is
currently working to fight a cholera epidemic that has been raging since
the start of 2008 in the heart of Lubumbashi, the capital of Katanga
province in the Democratic Republic of Congo (DRC). Lubumbashi, a mining
city in the south east of the Democratic Republic of the Congo (DRC) with a
population of 1.3 million, is the 2nd largest city in the country (next to
the capital, Kinshasa).

To date, 767 cholera patients have been treated in the MSF supported
cholera treatment center (CTC) and the number of patients is rising
slightly. There were 278 new patients admitted over the course of last week
-- an average of 30 to 40 new patients every day.

On 10 Jan 2008, while the PUC team was working in the city's only CTC,
located in one of the general referral hospitals in the Kenya district, the
number of patients rose so rapidly that hospital staff were completely
unable to cope.

The MSF team first reorganized patient care by placing the entry and exit
disinfection areas outside of the hospital, which also increased the
center's capacity. The severely ill, those suffering from severe
dehydration due to vomiting and diarrhea caused by cholera, are placed in
an isolated room and put on an intravenous drip. They then go through
various phases of treatment until the convalescence area.

It was necessary to open a 2nd treatment center. On Sat 19 Jan 2008, MSF
opened a CTC in the Katuba district, 8 km (5 mi) from the Kenya district
where 24 patients have already been admitted. Over several days, community
awareness raisers informed the population about the imminent opening of the
centre. "We were able to reduce the overload on the Kenya center and
provide closer care to a greater number of patients," explained Elke Frans,
an MSF nurse. The Katuba district is one of the largest focus areas of
cholera in the city. Until now, due to the lack of a centre, patients had
been crossing Lubumbashi before receiving treatment.

MSF is now focusing its efforts in order to limit the spread of the
epidemic, while aware that it could not be contained in time due to the
lack of adequate resources deployed for the poorest population of this rich
mining city.

A serious epidemic previously hit Lubumbashi in 2003 and MSF provided
assistance on that occasion. Once again, it is the people living in
difficult hygiene conditions and without access to drinking water that are
affected.

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

[Lubumbashi can be found in the south of the southern province of Katanga,
close to the border with Zambia, on a map at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

Burkina Faso: Meningokokken-Krankheit
29.01.2008

Nach dem Einsetzen der Trockenzeit hat in den Ländern Afrikas, in denen diese sog. "epidemische Hirnhautentzündung" verbreitet ist, die diesjährige Erkrankungssaison begonnen. Die WHO hat für dieses Jahr vor größeren Ausbrüchen gewarnt. Erste Auftritte wurden aus Burkina Faso, Nigeria und der Demokratischen Republik Kongo bekannt. Reisende sollten sich vor einer Reise in die betreffenden Länder durch einen erfahrenen Arzt beraten lassen und mit einem sog. "Vierfachimpfstoff" geimpft sein, vor allem bei Kontakten zur einheimischen Bevölkerung. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 ( 08 )
**********************************************
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 - Uganda: (Kampala)
[2,3] Cholera - Congo DR: (Katanga)
[4] Acute watery diarrhea - Somalia: (Banadir)

******
[1] Cholera - Uganda: (Kampala)
Date: Thu 31 Jan 2008
Source: The New Vision [edited]
<http://www.newvision.co.ug/D/8/13/609451>


Cholera has once again struck Kampala. A total of 6 patients have been
admitted at the cholera isolation camp in Mulago Hospital; 4 of the
patients belong to the same family in Kifumbira zone in Kamwokya, a Kampala
suburb. Dr Mohammed Kirumira, the Kampala chief health inspector, said 4
cholera cases had been confirmed.

A man, his pregnant wife, plus their sons aged 10 and 8 were first admitted
at Maria Asumpta Clinic in Kamwokya on Sunday [27 Jan 2008] before being
referred to Mulago. "They first brought the elder boy, who complained of
stomach pains, diarrhea, and vomiting. The next day, the younger one
reported with similar complications," said Irene Migere, a midwife at the
clinic. Subsequently, the boys' parents came with similar symptoms before
they were referred to Mulago. The other 2 unidentified cholera patients
were admitted in the isolation unit.

Reports that suspected cholera cases had also been registered in Kawempe
were not verified by the health authorities. However, the division
chairperson, Nasser Takuba, said 2 suspected cases had been reported at the
border between the central and Kawempe divisions.

[byline: Anthony Bugembe, Patrick Jaramogi]

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

[Kampala is in southern Uganda and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

******
[2] Cholera - Congo DR: (Katanga)
Date: Tue 29 Jan 2008
Source: Medecins Sans Frontieres (MSF) [edited]
<http://www.msf.org/msfinternational/inv ... =full_html>


Since the beginning of January 2008, MSF has recorded more than 1700 people
with cholera in the cities of Lubumbashi, Bukama, and Likasi. All these
people came from the poorer areas where bad hygiene conditions, combined
with high population density, contribute to the flaring up of this
contagious disease.

"What we have seen in Lubumbashi was repeated in Likasi," said Bertrand
Perrochet, MSF emergency team coordinator. "Adequate measures to avoid the
outbreak have not been taken by the health authorities. In the space of a
few days the main referral hospitals in the district of Kenya in
Lubumbashi, and in the city of Likasi, were overloaded. There were not
enough beds, no continuous disinfection of the building. An alarming
situation for a contagious disease that kills up to 50 per cent of
patients, if left untreated."

MSF logisticians simultaneously improved the treatment center in Lubumbashi
and built a new one in another neighborhood of this 1.3 million people
city. "Thanks to the opening of this 2nd treatment center, the number of
patients has become manageable on both sides" said Perrochet. "These last
days, 25 patients on average have come to be treated in each health center."

In Likasi, a city of more than 300 000 people, a 2nd emergency team has
faced a similar situation: large numbers of patients treated in bad
conditions and a hospital deprived of the necessary infrastructure to treat
people correctly. "In the last 3 weeks, more than 400 patients have
solicited care in the only functioning treatment center in Likasi," added
Perrochet. "When we arrived, more than 60 new patients were coming every
single day in a center which has a normal capacity of 35. There was not
enough space or beds. Water and rehydration solutions were missing as well.
Hygiene conditions were catastrophic."

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

******
[3] Cholera - Congo DR: (Katanga)
Date: Thu 31 Jan 2008
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5h_m ... TYDhhnw7Dw>


More than 2000 cholera cases, including 59 deaths, have been recorded in
January 2008 in the Democratic Republic of Congo's south eastern Katanga
province, an aid organization said Wednesday [30 Jan 2008]. Three different
sites in the province have registered 2083 cholera cases, said Bertrand
Perrochet, an official with Medecins Sans Frontieres (MSF; Doctors Without
Borders). A week ago, MSF had reported 1463 cases and 30 deaths, mostly in
the provincial capital of Lubumbashi, the mining city of Likasi, and the
rural area of Bukama.

In Bukama, the outbreak appears to have been brought under control and the
organization's emergency teams have been sent to Likasi, with a population
of more than 300 000. "When we arrived in Likasi (last week), more than 60
new patients were arriving each day for a center with a capacity of 35
people," MSF said. "Hygienic conditions were catastrophic."

MSF has recorded 30 deaths and 687 cases in Likasi over the course of a month.

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

[Likasi, Bukama, and Lubumbashi are located in the southern Congo DR
province of Katanga and can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[4] Acute watery diarrhea - Somalia: (Banadir)
Date: Thu 31 Jan 2008
Source: Medecins Sans Frontieres (MSF) [edited]
<http://www.msf.org/msfinternational/inv ... &mode=view>


MSF has been operating a primary health care clinic in the Yaqshid area of
Mogadishu since 1994. In Balcad and Kaaran areas, a relatively more stable
security situation has allowed some limited access to 4 MSF outpatient clinics.

In November 2007, MSF teams performed 12 061 consultations, the majority
related to maternal and child health. In the same month, MSF teams saw a
worrying increase of watery diarrhea cases, from 50 to 78. In December, MSF
opened a new 50-bed inpatient pediatric clinic in the Abdul-Aziz district.

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

[Mogadishu is in Banadir as can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. Areas
around Banadir in the south of Somalia reported cholera in 2007. - Mod.LL]

Kongo, Demokratische Republik: Infektionskrankheiten
05.02.2008

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit, besonders unter Einwohnern und Flüchtlingen der Grenzgebiete in den Provinzen Nord Kivu und Orientale im NO des Landes, die nach wie vor unter Rebellenkämpfen leiden. Seit Anfang Januar gibt es Cholera-Ausbrüche in der Provinz Katanga (S), die Anfang Januar in der Provinzhauptstadt Lubumbashi, mit 1,3 Mio Einwohnern zweitgrößte Stadt im Land, begannen und sich auf die Städte Bukama und Likasi ausgedehnt haben. Alle Formen der Virushepatitis kommen im Land vor. Polio durch reimportiertes Wildvirus Typ 1 wurde 2006 wieder bei 13 Erkrankten nachgewiesen, im letzten Jahr wurden bisher 36 Fälle aus verschiedenen Provinzen gemeldet. Es ist davon auszugehen, dass das Virus in der DRC weiterhin zirkuliert. Schlafkrankheit und Tollwut sind weit verbreitet, Risiko auch für örtliche Auftritte von Pest, Affenpocken sowie viralen hämorrhagischen Fiebern. / Quelle: crm

Nigeria: Darminfektionen
05.02.2008

Risiko für Durchfallerkrankungen landesweit. Cholera ist im Norden endemisch, mit örtlichen oder regionalen Auftritten ist aber auch in anderen Landesteilen zu rechnen. Die letzten Ausbrüche wurden Ende vorigen Jahres aus Ajakajak im Rivers State (S), Guma im Benue State sowie aus dem Bokkos-Distrikt im Plateau State (zentral) gemeldet. Aktuell wurden Anfang Februar d.J. 54 Erkrankungen aus Slums von Arusha registriert. Hygiene beachten. / Quelle: crm

Nigeria: Aerogen übertragene Krankheiten
05.02.2008

Angesichts der gegenwärtigen Krankheitswelle von Masern und Röteln hat das Gesundheitsministerium generell vor der erhöhten Gefahr tröpfchenübertragener Krankheiten während der Trockenzeit gewarnt, die noch bis April/Mai anhält. Am meisten von der Masernwelle betroffen ist der mittlere Norden des Landes mit den Bundesstaaten Sokoto, Kano, Jigawa, Kaduna und Katsina. Ein weiteres Risiko liegt im saisonalen Anstieg der Meningokokken-Krankheit; hiervon sind ebenfalls die nördlichen Landesteile betroffen, die zum sog. afrikanischen Meningitisgürtel gehören. 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

Sambia: Darminfektionen
05.02.2008

Risiko für Durchfallerkrankungen landesweit; eine Zunahme cholera-verdächtiger Diarroen wird nach starken Regenfällen aus der Stadt Kitwe im Copperbelt gemeldet. Hygiene beachten. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 ( 09 )
**********************************************
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] Acute watery diarrhea, fatal - Somalia: (Middle Shabelle)
[2] Cholera - Nigeria: (Delta)
[3] Cholera - Zambia: (Copperbelt)
[4] Cholera - Congo DR: (Katanga)
[5] Cholera - Kenya: (Rift Valley)
[6] Cholera - Tanzania: (Arusha)
[7] Cholera - Angola: (Kwanza Sul)

******
[1] Acute watery diarrhea, fatal - Somalia: (Middle Shabelle)
Date: Mon 4 Feb 2008
Source: Garowe Online [edited]
<http://www.garoweonline.com/artman2/pub ... rhea.shtml>


At least 8 children have died in southern Somalia's Middle Shabelle
region after drinking contaminated water, relatives said Monday [4
Feb 2008]. The children died in Bal'ano village, east of the
provincial capital Jowhar. Several relatives told Garowe Online that
the village has been experiencing severe water shortage in recent
weeks. The children are believed to have died from a form of watery diarrhea.

Tens of families began leaving the village in search of clean water
sources in nearby towns, locals said. Somalia has lacked an effective
central government since 1991, a development that has impacted the
livelihoods of thousands of ordinary civilians who face the daily
challenges of conflict, drought and poverty.

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

[Acute watery diarrhea is often used as a more "politically correct,"
if you may, term for cholera which is reported in this country. The
location of Middle Shabelle can be found in southern Somalia as
Shabelle Dhexe on a map at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. - Mod.LL]

******
[2] Cholera - Nigeria: (Delta)
Date: Tue 5 Feb 2008
Source: Vanguard Online [edited]
<http://www.vanguardngr.com/content/view/5857/>


Scores of children have been hospitalized in various hospitals in
Asaba, Delta State and neighboring towns following an outbreak of
cholera especially in riverine communities of the state.

A similar cholera epidemic occurred in 2007 in the state, claiming no
fewer than 10 lives.

The state director of Information, Mr Austin Mowah, confirmed the
epidemic yesterday [4 Feb 2008], saying: "The Ministry of Health has
reported an outbreak of gastrointestinal infection popularly known as
cholera in some parts of Oshimili South local government area."

[Byline: Austin Ogwuda]

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

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

******
[3] Cholera - Zambia: (Copperbelt)
Date: Tue 5 Feb 2008
Source: AllAfrica.com, The Times of Zambia (Ndola) report [edited]
<http://allafrica.com/stories/200802050028.html>


Suspected cholera has broken out in Kitwe's Ipusukilo Township where
residents have been drinking water from shallow wells following the
closure of water kiosks by Nkana Water and Sewerage Company (NWSC)
for non-payment.

District director of health, Chikafuna Banda, said 3 people were
currently admitted and were under observation at the District Health
Management (DHM) cholera center while 3 others had been discharged.
Dr Banda said during a district disaster management meeting, chaired
by district commissioner, McDonald Mtine and attended by Town Clerk,
Ali Simwinga that the report on the outcome of the tests to determine
whether it is actual cholera or not was still being awaited.

"People in Ipusukilo are drinking contaminated water after NWSC
closed down water kiosks and the water table level has risen. We are
currently treating 3 people from the same township for suspected
cholera," he said.

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

[Kitwe is in the Copperbelt province in northeast Zambia, which
borders on the Katanga province of Congo DR where cholera has been a
major problem (see next posting). The area can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. - Mod.LL]

******
[4] Cholera - Congo DR: (Katanga)
Date: Wed 6 Feb 2008
Source: Reuters [edited]
<http://www.reuters.com/article/africaCr ... SL06306132>


A cholera epidemic has killed at least 76 people and infected nearly
3000 in Democratic Republic of Congo's southeastern province of
Katanga since the start of the year [2008], health officials said on
Wednesday [6 Feb 2008].

"This year [2008] is worse (than most)," Katanga's provincial health
minister, Augustin Ilunga, said. "There has been a major demographic
explosion with the arrival of mining companies. Population has grown.
And there are neighbourhoods without drinking water or proper
sanitation," he told Reuters.

Lubumbashi, the heavily populated capital of Katanga, and the mining
city of Likasi, 90 km (58 mi) to the northwest, have been among the
worst hit by the epidemic.

Cholera is endemic in many parts of Congo. However, large-scale
epidemics in Lubumbashi, which alone has registered 1284 cases of the
disease including 18 deaths since the beginning of January 2008, are
relatively rare.

[Byline: Joe Bavier]

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

[Likasi and Lubumbashi are located in the southern Congo DR province
of Katanga and can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[5] Cholera - Kenya: (Rift Valley)
Date: Sat 2 Feb 2008
Source: Kenya Broadcasting Corporation [edited]
<http://www.kbc.co.ke/story.asp?ID=47963>


A cholera outbreak alert has been sounded in an (internally displaced
persons) IDP camp in Narok. The more than 1000 IDPs camping at Narok
North district headquarters do not have proper sanitation and the 3
pit latrines they have been using are full.

District Public Health officer John Towett told a district executive
meeting chaired by area DC Andrew Rukaria that the victims are also
in dire need of food, clothing and shelter. The most affected are the
elderly, children, and pregnant mothers, he said.

Meanwhile at least one person has reportedly died and 70 others are
admitted to Mandera District Hospital following an outbreak of
cholera in the town.

Speaking to the Kenya News Agency, the Area Medical Superintendent Dr
Muktar Omar said samples sent to the National Public Health
Laboratory confirmed the outbreak of the disease. He said they are
recording more cholera cases at the institution by the day.

[Byline: Judy Maina]

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

[Narok is in the southern part of the Rift Valley province in
southwestern Kenya and can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>.
Mandera is in the North Eastern province. - Mod.LL]

******
[6] Cholera - Tanzania: (Arusha)
Date: Fri 1 Feb 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, The Arusha Times report [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Municipal authorities have issued an alert message to residents of
Arusha calling them to be aware of an outbreak of cholera, which
until last week [21-27 Jan 2008] has affected 54 residents. They
called on residents to observe the highest standards of hygiene in
order to curb the water born disease, which broke out on 5 Jan 2008.

The Arusha municipal health officer Dr EH Mamuya told reporters in
his office that the problem was looming larger in the slum areas of
Sokoni I, Sombetini, Unga Limited, Themi, Ngarenaro, Sekei, Ilboru,
Losunyai, Sanawari, and Sakina. He said unless residents took
concerted efforts to fight the disease it will continue as a health
hazard and nagging problem for a long time.

Cholera outbreak has been an on- and-off problem in Arusha and many
other parts of Tanzania for many years now. This time around the
epicentre is Sokon One south of the municipality, a ward that harbors
most of the rain and wastewater flowing from the town center.

[Byline: Jamal Hashim]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The province and city of Arusha are in north-central Tanzania and
can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... nzania.pdf>. - Mod.LL]

******
[7] Cholera - Angola: (Kwanza Sul)
Date: Sat 2 Feb 2008
Source: Angola Press (ANGOP) [edited]
<http://www.angolapress-angop.ao/noticia-e.asp?ID=593341>


The Red Cross of Angola (CVA) in coastal Kwanza Sul province
intensified in the past days the awareness campaign against cholera
to enable the population to acquire knowledge on the cares with the
disease. Speaking to ANGOP, the coordinator of CVA's programme of
combat to cholera, Agostinho Kaquinda considered necessary that the
population learns about the 1st symptoms of the disease and head
urgently to health centers or hospitals nearest to the community.

ANGOP learnt from a source of the region's public health sector that
during the month of January 2008 the province registered 7 cases of
cholera without deaths.

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

[Kwanza Sul (spelled Cuanza Sul on the map) can be found in
west-central Angola on a map at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>.

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

Tansania: Darminfektionen
07.02.2008

Risiko für Durchfallerkrankungen landesweit. Ein aktueller Ausbruch von Cholera ist seit Anfang des Jahres aus Arusha bekannt. Bis Ende Januar wurden 54 Erkrankungen gemeldet. Hygiene beachten. / Quelle: crm

Malawi, Mosambik, Sambia, Simbabwe - Klima/Wetter:
11.02.2008

Anhaltend schwere Regenfälle haben in den südostafrikanischen Staaten Mosambik, Sambia, Malawi und Simbabwe regional zu ausgedehnten Überschwemmungen geführt. Zahlreiche Flüsse, vor allem der Sambesi und seine Nebenflüsse, sind streckenweise über die Ufer getreten. Dörfer sind eingeschlossen, Verkehrswege unpassierbar, zahlreiche Menschen sind obdachlos. Es besteht eine erhöhte Gefahr für oral- und mückenübertragene Erkrankungen wie Durchfälle und Malaria. Mit einer nachhaltigen Entspannung der Situation wird nicht vor Ende der Regenzeit im April gerechnet. Zu weiteren Einzelheiten wird auf die aktuellen Berichte in den Medien und die Angaben der Reiseveranstalter verwiesen. Katastrophengebiete sollten touristisch nicht bereist werden. / Quelle: crm

Zentralafrikanische Republik - Meningokokken-Krankheit
12.02.2008

Wie in anderen Ländern des sog. "afrikanischen Meningitis-Gürtels" sind die saisonalen Fallzahlen auch in der Zentralafrikanischen Republik angestiegen. Besonders betroffen ist der Nordwesten mit den Provinzen Ouham, Ouham Pendé und Nana-Grebezi. Reisende sollten geimpft sein, vor allem bei Kontakten zur einheimischen Bevölkerung. / Quelle: crm