Wüstenschiff

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (25)
***********************************************
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 - Zimbabwe (Mashonaland Central)
[2] Cholera - Tanzania (Dar es Salaam)
[3] Cholera - Namibia (Kunene)
[4] Cholera - Angola (Huila)

******
[1] Cholera - Zimbabwe (Mashonaland Central)
Date: Thu 8 May 2008
Source: Afriquenligne [edited]
<http://www.afriquenligne.fr/news/africa ... 83280.html>


Health authorities in Zimbabwe said on Thu 8 May 2008 that cholera
had killed 5 people, including a small child, in the northern resort
town of Kariba in recent weeks.

District medical officer for the area, William Mhundwa, said the
disease was concentrated in 2 settlements around the town and is
thought to be a result of people eating contaminated fish from a
nearby lake. He said this was the 2nd cholera outbreak in the area in
2008. "We suspect that these people consumed fish which was
contaminated by cholera bacteria after the fish had also consumed
contaminated raw crocodile affluent," he said.

Several cholera deaths have been reported in a number of areas in
Zimbabwe in 2008, a problem compounded by lack of medicines.

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

[Kariba is located in Mashonaland Central and can be seen, on the
Zambia border, at:
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

******
[2] Cholera - Tanzania (Dar es Salaam)
Date: Tue 6 May 2008
Source: AllAfrica & The Citizen (Dar es Salaam) [edited]
<http://allafrica.com/stories/200805060597.html>


Dar es Salaam, a city of nearly 4 million residents served with poor
water and sanitation networks, has been hard hit by a cholera
outbreak, the government announced yesterday, 5 May 2008. In her
report, Dar es Salaam regional chief medical officer Judith Kahama
said Temeke and Ilala municipalities have been highly affected by the
disease. But, so far, no one has died of it.

Dr Kahama warned city residents to keep the environment clean,
especially during the rainy season. As of 5 May 2008, 8 patients from
Chang'ombe, Yombo Vituka and Miburani surburbs in Temeke district
have been admitted to hospital for treatment.

[Byline: Consesa John]

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

[Dar es Salaam, located on the eastern Indian Ocean coast of
Tanzania, can be found on a map of the country at:
<http://www.un.org/Depts/Cartographic/ma ... nzania.pdf>. - Mod.LL]

******
[3] Cholera - Namibia (Kunene)
Date: Wed 30 Apr 2008
Source: AllAfrica & New Era (Windhoek) [edited]
<http://allafrica.com/stories/200804300380.html>


A record 2168 suspected cholera cases have been reported in the
Kunene Region since the beginning of 2008, with the 1st case reported
at Okangwati in Epupa constituency, some 120 km north of Opuwo. 51
patients have been admitted with only 5 cases confirmed through
laboratory tests.

About 13 residents died from suspected cholera, while an additional 2
are suspected to have succumbed to the disease without reporting the
symptoms to a nearby health center. "There were people dying, and we
were only informed that he/she died of diarrhea," said Jogbeth
Karutjaiva, the primary health care supervisor for Opuwo district
during her joint presentation on national immunization days and
disease surveillance with fellow staffer Puyo Mbaumba, the regional
health primary administrator for family health. According to them,
most of the suspected cholera cases came from Epupa.

[Byline: Michael Liswaniso]

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

The Kunene region is in extreme northwestern Namibia, west of
Ohangwena, and can be seen on a map at:
<http://en.wikipedia.org/wiki/Kunene_Region>. - Mod.LL]

******
[4] Cholera - Angola (Huila)
Date: Mon 28 Apr 2008
Source: Angola Press [edited]
<http://www.angolapress-angop.ao/noticia-e.asp?ID=613408>


At least 12 cases of cholera were registered at the weekend in the
districts of Chibia and Lubango by the provincial department of
public health and diseases control in southern Huila province.
Speaking to Angop on Monday [28 Apr 2008] in Lubango city, the head
of Great Diseases and Emergency Section of Public Health department,
Felix Januario, said that 9 cases had occurred in Lubango district
and 3 in Chibia.

In the same period, 11 patients had been discharged, and 26 others
are still receiving medical aid in treatment centers in Lubango and Chibia.

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

[The location of the southern province of Huila can be found on a map
at <http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

HEPATITIS E VIRUS - UGANDA (02): (WEST NILE)
********************************************
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 12 May 2008
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/artman/publish ... Nile.shtml>


Hepatitis E spreads to West Nile
--------------------------------
Hepatitis E, a deadly disease that is causing havoc in the northern
district of Kitgum [see ProMED-mail Hepatitis E virus - Uganda
20080304.0894] has now spread to the West Nile region. Health minister
Stephen Mallinga told journalists that hepatitis E, which was reported in
the 4 parishes of Madi, Opei Sub-county in Kitgum late last year [2007],
has now spread to Yumbe District in West Nile and 4 other sub-counties in
Kitgum District.

Dr Mallinga was on Friday [9 May 2008] giving an update of the action taken
by the Ministry of Health to control hepatitis E. "During the last 2
months, Adravu Sub-county in Yumbe District has also reported cases among
the Sudanese refugees, but fortunately, no more cases have been reported in
the district," Dr Mallinga said.

Yumbe District health officer Alfred Yayi told Daily Monitor on Friday [10
May 2008] that so far 23 cases have been reported in Yumbe out of which 4
died. Dr Yayi said all the cases were from a refugee camp where about 10
000 refugees from South Sudan are living. He said the United Nations high
commissioner for refugees in collaboration with the International Committee
of the Red Cross have started repatriating the refugees. Dr Yayi said so
far about 3000 refugees have been repatriated and that the district, the
Ministry of Health, and other partners are sensitising the residents on
good sanitation practices to contain the disease.

Since last October [2007], a viral disease that WHO says has no cure, has
been killing people in near the frontier with Sudan. Dr Mallinga said the
number of hepatitis E cases has increased from 1109 last month [April 2008]
to 1262 and that 25 people have died. About 81 per cent of the deaths have
occurred among pregnant women. Pregnant women are at a higher risk of dying
than other people because during pregnancy, the blood volume in the body
increases by over 40 per cent and weakens the immune system, which makes
mothers susceptible to any illnesses including minor diseases.

Dr Mallinga said the weekly trends indicate that the number of cases
continues to go up due to increased contamination of water during the rainy
season. He said during the past week, 156 new cases have been reported, and
one person died.

Hepatitis E is a viral disease transmitted through eating or drinking water
or food contaminated with faeces. Some of its symptoms include fever, dark
yellow urine, and yellow eyes. The transmission is similar to that of other
diarrhoeal diseases such as cholera and dysentery. It is very common in
areas with low latrine coverage, inadequate safe water, and poor personal
hygiene. Dr Mallinga said water testing in the affected areas has revealed
that 32 per cent of wells are contaminated with human waste. At the
household level, 75 per cent of the household clay pots used to store and
collect water are contaminated. He said communities are being mobilised
through public education meetings, home visits, and radio talk shows among
others. More pit latrines and safe water sources have been constructed so
that people can stop using contaminated water.

Dr Mallinga also said the Health Ministry has remitted an additional
funding of UGX 25 million (about USD 15 000) to Kitgum to help the district
cope with the limited number of staff in health facilities. The Ministry is
providing families with jerricans, which cannot easily be contaminated.
Investigations done by the Ministry of Health have revealed that
communities using pots to store drinking water are at a higher risk of
getting infection.

[byline: Jane Nafula]

--
communicated by:
ProMED-mail rapporteur Brent Barrett

[Hepatitis E is a liver disease caused by hepatitis E virus (HEV), which is
transmitted in much the same way as other enteric viruses. Hepatitis E
outbreaks have occurred worldwide in recent years. The signs and symptoms
of HEV infection are loss of appetite, nausea, vomiting, discoloured urine,
jaundice, and abdominal pain. There is, however, no chronic (long term)
infection. Hepatitis E is more severe among pregnant women, especially in
the 3rd trimester. HEV is found in the faeces of people and animals with
hepatitis E. HEV is spread by eating or drinking contaminated food or
water. Transmission from person to person may occur.

It seems likely in view of the deficiencies in basic sanitation pertaining
in rural Uganda that other enteric agents in addition to HEV are
contributing to the epidemic situation described above.

A map of Uganda showing the location of Kitgum and Yumbo in the north and
north west of the country respectively can be accessed at
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg>. - Mod.CP]

Uganda - Hepatitis E
13.05.2008

Eine Krankheitswelle dieser oral übertragenen Form der Virushepatitis breitet sich, ausgehend von sudanesischen Flüchtlingslagern, in den letzten Monaten im Norden aus. Im Kitgum-Distrikt wurden 1.384 Erkrankungen aus 5 Sub-Distrikten registriert, darunter 29 Todesfälle, vorwiegend bei Schwangeren. Inzwischen wurden 23 Erkrankungen mit 4 Todesfällen aus dem Yumbe-Distrikt in der West-Nile Region bekannt. Als Infektionsquelle gilt unsauberes Trinkwasser. Hygiene beachten, Schwangere sollten die Region meiden. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (26)
**********************************************
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
[3] Cholera - Kenya (Nyanza)
[4] Cholera - Namibia (Ohangwena)
[5] Cholera - Zambia (Luapula)
[6] Cholera - Angola (Uige)
[7] Cholera - Angola (Luanda)

******
[1] Cholera - Kenya (Nyanza)
Date: Wed 14 May 2008
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Int Fed of Red Cross and Red Crescent Societies (IFRC) report
[edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Nyanza Province has had cholera outbreaks since late 2007, where the 1st
case was confirmed in Suba District on 2 Dec 2007. The outbreaks have so
far been reported in 10 districts: Suba, Migori, Rongo, Bondo, Kisumu East
and West, South Kisii, Homa Bay, Nyando, and Siaya. According to the
statistics from the provincial medical officer of Nyanza Province, 708
cases of cholera have been recorded in the health facilities in the region
and 42 deaths from the disease have been registered.

In some districts like Rongo, Migori, Suba, and Kisumu West the outbreaks
are sporadic. The common features about these outbreaks are that they are
occurring in households whose main water sources are rivers and lakes. In
addition, the sanitation component (latrine coverage) in the affected
divisions of the above-mentioned districts is as low as one per cent.

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

[Nyanza is located in the southwestern corner of Kenya and can be found on
a map at <http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. -
Mod.LL]

******
[2] Cholera - Namibia (Ohangwena)
Date: Tue 13 May 2008
Source: AllAfrica, New Era (Windhoek) report [edited]
<http://allafrica.com/stories/200805130641.html>


Lack of pit latrines and general toilet facilities in the northern regions
of the country is likely to compromise health officials' efforts in curbing
cholera, a disease that has since early in 2008 claimed more than 37 lives.
Regional health director for the Ohangwena Region, Dr Naftali Hamata, has
said if no drastic measures are taken to address the situation, the
affected areas should be prepared to have cholera cases every rainy season.

Since Friday [9 May 2008], 1406 suspected cholera cases were recorded in
the Ohangwena Region with 17 confirmed laboratory cases and 19 deaths, Dr
Hamata said. "Sanitation and clean water remain some of the challenges in
the regions. The majority of people do not have access to latrines, a good
place for cholera to spread," the doctor said.

[byline: Petronella Sibeene]

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

[A map of Namibia showing the province of Ohangwena in the north can be
found at <http://en.wikipedia.org/wiki/Ohangwena>. - Mod.LL]

******
[3] Cholera - Zambia (Luapula)
Date: Tue 13 May 2008
Source: Zambia National Broadcasting Corporation [edited]
<http://www.znbc.co.zm/media/news/viewne ... 1210694902>


A total of 9 cases of cholera have been reported in Mansa, Luapula
Province. A woman from Nchelenge was also admitted to Butungwa clinic in
Mansa with suspected cholera. The 9 cholera patients are all from Sebe
Village, but are admitted to a cholera center in Samfya as it is nearest to
the village.

Mansa district commissioner, Moddy Chola, said no deaths have been recorded
so far. Ms Chola is appealing to the Ministry of Health to urgently send
medicine and other requirements to help curb the spread of the disease.

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

[Luapula province can be found in the north central part of Zambia on a map
at <http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. - Mod.LL]

******
[4] Cholera - Angola (Uige)
Date: Tue 13 May 2008
Source: AllAfrica, Angola Press Agency (Luanda) report [edited]
<http://allafrica.com/stories/200805130439.html>


Angop (Angola Press Agency) learnt on Monday [12 May 2008] from the
provincial health director, Quiala Godi, that 29 cases of cholera, from
which 2 resulted in deaths, were registered last week [5-11 May 2008] in
the northern Uige province by the local health authorities.

According to the official, one of the deaths was registered at the Negage
Municipal Hospital coming from Dambi village, due to the late arrival at
the hospital, while the other was not registered at a hospital in Caquiuia
ward, next to Uige city. He revealed that the 1st case of the
epidemiological outbreak was detected on the 2nd part of April 2008 and
samples were sent to the country's capital, Luanda, registering negative
results, but the cases of diarrhea continue emerging, a situation that
intensified in the beginning of May 2008.

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

[Uige province is in northwest Angola bordering on Congo DR and can be
found on a map at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

******
[5] Cholera - Angola (Luanda)
Date: Tue 13 May 2008
Source: AllAfrica, Angola Press Agency (Luanda) [edited]
<http://allafrica.com/stories/200805130912.html>


Health authorities of Luanda Province have recorded 5 deaths out of the 875
cases of cholera [registered between] 11 Jan 2008 and May 2008, ANGOP has
learned.

This was said during a meeting held by the local government and the
National Commission for Prevention Against Cholera, meant to outline
strategies to improve water supply distribution to the population, and
assessing the appearance of new cases. One of the deaths was recorded at a
hospital and the others in homes.

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

[Luanda province is in north west Angola bordering the Atlantic Ocean and
can be found 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]

Gelbfieber in der Zentralafrikanischen Republik
WHO - 20.05.2008

As of 15 May, the Ministry of Health (MoH) of the Central African Republic has reported 2 laboratory confirmed cases of Yellow fever from the Bozoum sub-prefecture, Ouham-Pendé Prefecture. The MoH has conducted an epidemiological investigation.

In response to the outbreak the MoH has made a request for 64,391 doses of Yellow fever vaccine from the GAVI funded Global Emergency Stockpile for Yellow fever vaccine, managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control (YF-ICG). The target population was estimated to be 55,035 people. The MoH plans to vaccinate the sub prefecture of Bozoum starting on 26 May 2008 for three days.

Namibia - Cholerafälle gehen zurück
21.05.2008

Windhoek – „Es gibt inzwischen Tage an denen keine neuen Fälle von Cholera in den Tageskliniken oder Krankenhäusern angemeldet werden. Die Krankheit ist auf dem Rückzug“, sagte Dr, Naftali Hamata gestern auf Nachfrage. Der Koordinator des Gesundheitsministeriums für die zentralen nördlichen Regionen Omusati, Oshana, Ohangwena und Oshikoto sagte, dass bis zum vergangenen Freitag 1415 Cholerafälle registriert worden seien, die alle aus dem Engela- und Eenhana-Bezirken in der Ohangwena-Region stammen ... mehr

SCHISTOSOMIASIS- MADAGASCAR: (D'AMARON'I MANIA)
***********************************************
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: Sun 25 May 2008
Source: AllAfrica (Antananarivo) [in French, trans. Mod.EP, abridged, edited]
<http://fr.allafrica.com/stories/printab ... 10621.html>


Schistosomiasis is hyper-endemic in the d'Amoron'i Mania region, with
12 469 patients treated last year [2007] out of a population of about
25 000. The report indicates that neurological problems were common
and responded to treatment. In all, 1/3rd of the villages in the
region were considered hyper-endemic and received mass treatment.

The 2nd most affected district is Manandriana, with 3930 treated
cases, followed by Fandriana with 3892, Ambositra and
Ambatofinandrahana with 3758 and 1069 cases, but the numbers of
patients seeking treatment are increasing.

Local health authorities have intensified surveillance using
serological testing in the hyper-endemic area, followed by mass
treatment. Health authorities had a plan to reduce the number of
cases by 25 percent in 2006, but the target was not achieved, and the
prevalence of infection is again increasing.

[Byline: Par Anastase]

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

[Infection with _Schistosoma_ is endemic in Madagascar. The present
increase in prevalence seems to be related to a failure of the
control program for the area, with the infection moving towards
pre-control levels. _Schistosoma mansoni_ and _S. haemoatorbium_ have
a complex life cycle involving a fresh water snail as intermediate
host but no animal reservoir. Eggs are excreted in the urine by
humans infected with _S. haematobium_ and in feces if infected by _S.
mansoni_. Lack of proper sanitary conditions and sewage handling,
lack of snail control, and insufficient diagnosis and treatment of
infected cases may all contribute to the emergence of the infection
following a failed control program. - Mod.EP]

Madagaskar - Schistosomiasis (Bilharziose)
26.05.2008

Die durch Saugwürmer verursachte Erkrankung von Darm und/oder Blase mit Komplikationen an Inneren Organen und Nervensystem ist auf der gesamten Insel verbreitet, vor allem im westlichen Tiefland mit den Provinzen Toliara und Mahajanga. In einzelnen Distrikten sind über 50% der ländlichen Bevölkerung befallen, die Zahl der behandlungsbedürftigen Infizierten ist in letzter Zeit deutlich angestiegen. Die Übertragung erfolgt durch Larven, die im Süßwasser leben und durch die gesunde Haut eindringen können. Kontakt mit Binnengewässern meiden. / Quelle: crm

SCHISTOSOMIASIS- MADAGASCAR (02): (AMORON'I MANIA), COMMENT
************************************************************
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: Tue 27 May 2008
From: A Lee Willingham <awi@life.ku.dk>


The posting on schistosomiasis in the d'Amoron'i Mania region
[Schistosomiasis - Madagascar: d'Amoron'i Mania 20080525.1717]
states: "The report indicates that neurological problems were common
and responded to treatment," but I did not see any comment from
ProMED about this. Neurological problems have been associated with
_Schistosoma japonicum_ infections, but, to my knowledge, not with
_S. haematobium_ or _S. mansoni_ infections.

Was there any indication for attribution of the "neurological
problems?" We know that _Taenia solium_
cysticercosis/neurocysticercosis is hyperendemic in Madagascar, so
perhaps this could be a cause of the neurological problems mentioned.
There is currently discussion between WHO's Department of Control of
Neglected Tropical Diseases and Madagascar's Ministry of Health [MoH]
about treatment measures in areas co-endemic for both schistosomiasis
and cysticercosis.

The Pasteur Institute in Madagascar conducted national serological
surveys for human cysticercosis in the late 1990s (sites included
Mahasolo, Mahajanga, Ambositra, Ihosy, and Tamatave/Antananarivo)
based on detection of antibodies in more than 4000 persons, finding
prevalence of cysticercosis between 7-17 percent in the general
population and 21 percent in a group of epileptics in Ambositra.

Madagascar was the only endemic country to reveal at the World Health
Assembly in 2003, when control of neurocysticercosis was discussed,
that it had a serious problem with cysticercosis and needed
assistance for surveillance, prevention, and control activities.

In addition, US Peace Corps volunteers who have served in Madagascar
have been found to be infected with cysticercosis (see Leutscher P
and Andriantsimahavandy A (2004): Cysticercosis in Peace Corps
Volunteers in Madagascar. New England Journal of Medicine, 350:
311-2), further providing evidence about the risk of infection in the
country.

--
A Lee Willingham III, DVM, PhD
WHO/FAO Collaborating Center for Parasitic Zoonoses
Department of Veterinary Pathobiology
Faculty of Life Sciences
University of Copenhagen
Dyrlaegevej 100
1870 Frederiksberg, Denmark
<awi@life.ku.dk>

******
[2]
Date: Tue 27 May 2008
From: Albis Francesco Gabrielli <gabriellia@who.int>


Madagascar will implement a large-scale distribution of praziquantel
in 21 districts endemic for schistosomiasis in June 2008. The MoH is
aware of the risks associated with co-endemicity with
taeniosis/cysticercosis, and, as a consequence, will implement
surveillance and pharmacovigilance activities aimed at detecting
possible adverse events following treatment.

Please also see the paper by Andriantsimahavandy A et al: "Situation
epidemiologique actuelle de la cysticercose a Madagascar." Arch Inst
Pasteur de Madagascar 2003; 69: 46-51. Data from this paper and from
other sources were used to make a decision on where the routine
surveillance and pharmacovigilance measures had to be intensified
because of the risks associated with co-endemicity.

--
Dr Albis Francesco Gabrielli
Medical Officer
Preventive Chemotherapy and Transmission Control (PCT)
Department of Control of Neglected Tropical Diseases (NTD)
World Health Organization/Organisation Mondiale de la Sante
20, Avenue Appia
CH-1211 Geneva 27, Switzerland
<gabriellia@who.int>

******
[3]
Date: Thu 29 May 2008
From: Pascal Magnussen <pma@life.ku.dk>


_S. haematobium_ has been associated with neurological symptoms in
Malawi. The [schistosomiasis] group in Leiden [University,
Netherlands] (Lissette van Lieshout) worked on this. These were
medullary symptoms due to egg granulomas in the lower spinal cord.
The term "neurological problems" stated from Madagascar is vague and
non-defined so we should be careful to immediately associate such
"symptoms" with cysticercosis. We need to get a specification from
Madagascar that the symptoms were cerebral (such as, epilepsy
equivalents.)

--
Dr Pascal Magnussen MD, DTM&H
Specialist in Tropical Medicine and Infectious Diseases
DBL - Centre for Health Research and Development
Faculty of Life Sciences
University of Copenhagen
Thorvaldsensvej 57, DK1871 Frederiksberg C, Denmark
<pma@life.ku.dk>

[ProMED-mail thanks Drs Willingham and Gabrielli for alerting us to
the problem with cysticercosis in Madagascar as an explanation for
the high prevalence of neurological symptoms.

In neurocysticercosis symptoms can be aggravated during treatment
because the dying cysts cause a local inflammation in the brain with
local edema leading to focal neurological symptoms. This is usually
treated with steroids, but during mass treatment campaigns people
receive treatment without previous investigation for
neurocysticercosis. Therefore the neurological symptoms mentioned in
the posting may be due to the effect of praziquantel on
neurocysticercosis.

ProMED-mail will be interested in further information if available. - Mod.EP]

[Amoron'i Mania, in central Madagascar, is one of the regions of
Fianarantsoa province. It can be located on the map of Madagascar at
<http://en.wikipedia.org/wiki/Amoron%27i_Mania>. - CopyEd.MJ]

HEPATITIS E VIRUS- UGANDA (03): (KITGUM)
*****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 28 May 2008
Source: The New Vision [edited]
<http://www.newvision.co.ug/D/8/16/630359>


Hepatitis kills 4 more
----------------------
The number of people killed by hepatitis E in Kitgum district has
increased to 35 from 31 in the past one week, reports Chris Ocowun.
The dead are mainly pregnant women, while the total number of those
infected is 1797.

"The virus, thought to have been brought from South Sudan, was first
detected in Lamwo County. It spread to Agoro, Mucwini, Paloga,
Potika, Padibe, and Lukung sub-counties and is now threatening Kitgum
town council," the deputy resident district commissioner, Sylvester
Opira, said on Tuesday [27 May 2008]. "We are urging people to visit
health centres if they feel feverish. We are also advising couples to
delay conception."

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The number of cases of hepatitis E reported in the initial account
of the outbreak in the region of Uganda bordering Sudan (see
reference below) has increased now from 314 cases and 11 deaths to
the current 1797 cases and 35 deaths.

Hepatitis E is a liver disease caused by hepatitis E virus (HEV),
which is transmitted in much the same way as other enteric viruses.
HEV is found in the faeces of people and animals with hepatitis E.
HEV is spread by eating or drinking contaminated food or water.
Transmission from person to person may occur.

Hepatitis E outbreaks have occurred worldwide in recent years and may
be increasing in frequency. The signs and symptoms of HEV infection
are loss of appetite, nausea, vomiting, discoloured urine, jaundice,
and abdominal pain. There is, however, no chronic (long term)
infection. Hepatitis E is more severe among pregnant women,
especially in the 3rd trimester.

A map of Uganda showing the location of Kitgum in the north of the
country can be accessed at
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg>. - Mod.CP]

Guinea-Bissau - Darminfektionen
29.05.2008

Risiko für Durchfallerkrankungen landesweit. Nach einer Pause von zweieinhalb Jahren gibt es im Land wieder Cholera: Bei einem örtlichen Ausbruch in einem Fischerdorf an der Südostküste wurden bisher 53 Erkrankungen und 2 Todesfälle gemeldet. Die Mobilität der Fischer entlang der Küste lässt eine weitere Ausbreitung befürchten. So sollen im benachbarten Grenzgebiet von Guinea 40 Menschen erkrankt sein, was offiziell noch nicht bestätigt ist. Guinea-Bissau erlitt mit mehr als 25.000 Erkrankungen und 400 Todesfällen in der zweiten Jahreshälfte 2005 eine der schwersten Cholera-Epidemien in der Geschichte des Landes. Hygiene beachten. / Quelle: crm

Uganda - Hepatitis E
02.06.2008

Eine Krankheitswelle dieser oral übertragenen Form der Virushepatitis breitet sich, ausgehend von sudanesischen Flüchtlingslagern, in den letzten Monaten im Norden aus. Am meisten betroffen ist der Kitgum-Distrikt, aber auch aus den Distrikten Yumbe und Pader werden Erkrankungen gemeldet. Besonders gefährdet für schwere Verläufe und Todesfälle sind Schwangere. Als Infektionsquelle gilt unsauberes Trinkwasser. Hygiene beachten, Schwangere sollten die Region meiden. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (27)
**********************************************
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 (Nyanza)
[2] Cholera - Zambia (Northern Province)
[3] Cholera - Guinea Bissau, Guinea Conakry
[4] Diarrhea, cholera - Sudan (south)
[5] Cholera - Congo DR (North Kivu)
[6] Cholera - Uganda (Kibaale)

******
[1] Cholera - Kenya (Nyanza)
Date: Wed 28 May 2008
Source: The Times (South Africa), Agence France-Presse (AFP) report [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=774620>


A cholera outbreak has killed 3 people and infected several others in
western Kenya over the past 2 weeks, a newspaper said today [28 May
2008].

The fatalities occurred in Nyanza Province's Ranchuonyo district near
the shores of Lake Victoria, local public health officer Heron Obaye
told the Standard newspaper. Several people were being treated in the
area and the authorities have shut roadside eateries and distributed
water treatment kits, he said.

A previous outbreak in the same region killed at least 64 people and
infected thousands in the recent months.

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

[Nyanza province is located in the southwestern corner of Kenya and
can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

******
[2] Cholera - Zambia (Northern Province)
Date: Wed 28 May 2008
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2008- ... 270000.htm>


The Zambian health authority has recorded 98 cholera cases in
Mpulungu District, Northern Province, Times of Zambia reported on
Wednesday [28 May 2008]. No deaths, however, have been reported since
the disease broke out early April 2008, Times of Zambia said.

The Health Ministry, together with all stakeholders in Zambia,
resolved to start sensitization programs in the affected areas and
disinfect the water wells in an effort to prevent the disease.

[Editor: Jiang Yuxia]

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

[Northern Province can be found on a map of Zambia at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. - Mod.LL]

******
[3] Cholera - Guinea Bissau, Guinea Conakry
Date: Mon 26 May 2008
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200805261233.html>


An outbreak of cholera in a remote fishing village in southeastern
Guinea Bissau has killed 2 people and infected 53, the WHO (World
Health Organisation) reported.

"The outbreak is very localized at the moment. It seems to be
restricted to villages in one sector and we have not received reports
of cases in any other region in Bissau," said Daniel Kertesz, head of
the WHO in Bissau, which provided the figures.

Some 40 cases of cholera have also been reported across the border in
Guinea Conakry and are also being dealt with by local authorities
there. "People in these areas fish all up and down the coast, so it
could potentially spread to other countries, but we have not seen
evidence of that happening yet," Kertesz added.

Guinea Bissau has some of the worst coverage of modern water and
sanitation infrastructure in the world according to the UN (United
Nations). In rural areas less than half of people have access to
clean water and less than 25 percent to modern toilets.

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

[Guinea Conakry (sometimes referred to just as Guinea) and Guinea
Bissau are located in West Africa with a common border, which can be
seen on a map of the area at
<http://www.un.org/Depts/Cartographic/ma ... africa.pdf>. - Mod.LL]

******
[4] Diarrhea, cholera - Sudan (south)
Date: Fri 23 May 2008
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200805230971.html>


The tankers that roar down the streets of the Southern Sudanese
capital of Juba carry precious water, but health experts suspect much
of what they deliver is contaminated. "The sources of the water are
often contaminated, the containers used to ferry it are contaminated,
and the people [do not know] the best way to avoid diseases," an aid
worker in the town said.

Juba has neither a functioning water nor sewage system. Whatever
existed in the 1950s and 1960s was destroyed during more than 2
decades of conflict between the South and North. The situation has
been compounded by generally poor hygiene. Recently there have been
reports of diarrheal disease outbreaks, including suspected cholera
cases.

In May 2008, a diarrheal disease outbreak was reported in the Juba
military barracks, a unit that houses about 6000 people, including a
joint integrated force made up of both northern and southern troops.

There have also been suspected cases in Eastern Equatoria. Alfred
Alunyo of the WHO office for Southern Sudan said samples had been
sent to Nairobi for analysis after rapid tests found cholera in 3 out
of 53 suspected cases.

"That is a cumulative number for 4 weeks," Alunyo said. "When we add
on the [suspected] cases from this week [19-25 May 2008], we expect
it to increase to more than 80."

Millions of people across Southern Sudan, especially women and
children, lack access to adequate safe drinking water. While more
than 20 million people lack access to sanitation, 17 million have no
source of safe drinking water, according to UNICEF (United Nations
Children's Fund).

Cases of cholera have been rising, stemming from sharp increases in
the population as people return from being displaced and find few
essential services such as safe drinking water or proper sanitation

As a result, disease outbreaks are rampant. In April 2008, an
outbreak was reported in Yei. According to the NGO (non-governmental
organisation) Medair, diarrheal diseases have become an endemic
problem in Yei town in 2008, with cases rising with the onset of
rains.

Between 12 Mar 2008 and 5 Apr 2008, 118 cases of acute watery
diarrhea were seen in Yei hospital. "Across Southern Sudan, cases of
cholera have been rising in the last 2 years, stemming from sharp
increases in the population, as people return from being displaced
and find few essential services such as safe drinking water or proper
sanitation," the NGO said.

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

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

******
[5] Cholera - Congo DR (North Kivu)
Date: Wed 21 May 2008
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200805210759.html>


An outbreak of cholera in North Kivu province, in eastern Democratic
Republic of Congo (DRC), has claimed more sufferers in the past 2
weeks, medical and humanitarian officials said. The most severely
affected areas are the health zones of Pinga and Mweso in the upper
and forested Masisi North area.

"The cholera epidemic has fluctuated in this zone but over the past
couple of weeks we have seen a dramatic rise in [the number of]
cases," said Gaby Lumangamenga of the UN World Health Organization
(WHO) in the North Kivu capital, Goma.

According to the UN Office for the Coordination of Humanitarian
Affairs (OCHA) in Goma, 12 deaths were reported in Pinga over just
one week in late April 2008, while 159 cases were recorded between 5
and 11 May 2008.

Lumangamenga said Medecins Sans Frontieres (MSF) and Solidarites had
built water chlorination facilities and latrines but the problem
persisted because the residents did not like to drink chlorinated
water.

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

[North (or Nord) Kivu can be found in northeastern Congo DR and can
be located on a map at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[6] Cholera - Uganda (Kibaale)
Date: Wed 21 May 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Uganda Red Cross report [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Cholera has killed 4 people and infected 43 in Kibaale district.
According to the Uganda Red Cross Society (URCS) branch field
coordinator for Kibaale District, Mr Abel Muwonge, the disease that
broke out in the district on 17 May 2008, left 25 people admitted at
Kasojo Health Centre II in Mpefu Sub County, 3 admitted at Kagadi
Health Centre IV, while 11 are still at home unattended to.

Mr Muwonge said the most affected areas are fish landing sites. These
include Kitebere, Kabukanga, Kamina, Kamulebe, and Nguse landing
sites. He attributed the big number of infections at the landing
sites to poor sanitation.

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

[Kibaale district is in western Uganda and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.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]

Yellow fever hits Congo deportees
06.06.2008 - 17:00

Yellow fever is sweeping through the thousands of Congolese expelled from Angola, a local official says. At least 10 people have already died, says the mayor of Lutembo in south-west Democratic Republic of Congo. The town's hospital, which is chronically short of medicines, is struggling to cope ... mehr

LASSA FEVER - NIGERIA (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>

Date: Mon 9 Jun 2008
Source: Leadership Nigeria [edited]
<http://www.leadershipnigeria.com/produc ... 1&osCsid=b>


Within the last 8-12 weeks, cases of Lassa fever in the endemic states of
Edo, Plateau, Lagos, Ogun, Nasarawa, Taraba, Borno, and Anambra have
reoccurred, with 8 fatalities.

Minister of health, Professor Adenike Grange, who disclosed the cases
yesterday [8 Jun 2008] in Abuja, said the World Health Organization (WHO)
and a team of health supervisors from the ministry confirmed these
outbreaks. Grange disclosed that an on-the-spot assessment of Zaria, Kaduna
State, which is one of the most affected areas, confirmed that the
situation needed the urgent intervention of the federal government.

According to her, a team of experts had already been dispatched to the
endemic areas to determine the extent of the outbreaks, as well as to
initiate preventive and containment measures in affected communities, and
to report to the ministry.

--
communicated by:
ProMED-mail rapporteur A-Lan Banks

[It appears that there have been Lassa fever cases in several localities in
Nigeria recently. The article does not indicate whether these cases have
been laboratory confirmed. ProMED-mail would appreciate learning of the
results of follow-up efforts being made in the affected regions.

Lassa fever virus, in the arenavirus family, is endemic in West Africa in
the rodent _Mastomys_ spp. A description of Lassa fever and its
epidemiology, with an image of _Mastomys_, can be accessed at
<http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... lassaf.htm>.

Lassa fever, a hemorrhagic disease, is a common infection in West Africa,
with estimates that range from 100 000 to 300 000 cases annually, with 5000
deaths. Prevention of transmission from rodents to people requires
continuous rodent control. This is extraordinarily difficult to get
ordinary people to do in the absence of human cases in their immediate
vicinity. Many cases occur in hospital settings where barrier nursing is
not practiced and staff are exposed to blood, exudates, and excreta from
infected patients. Infection of health care staff is common.

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