Wüstenschiff

Kenia - Leishmaniase, viszerale
12.06.2008

Nach Angaben örtlicher Behörden aus Isiolo und Wajir in der Ost- bzw. Nordostprovinz gab es in beiden Regionen seit April d.J. eine Krankheitswelle, vorwiegend bei Kleinkindern. Die durch Einzeller verursachte Erkrankung der inneren Organe ist im NO des Landes verbreitet. Die Übertragung erfolgt durch kleine, nachtaktive Stechmücken (Phlebotomen). Mückenschutz beachten. / Quelle: crm

Nigeria - Lassa-Fieber
12.06.2008

Nach Angaben des Gesundheitsministeriums wurden innerhalb der letzten 12 Wochen Erkrankungen und Todesfälle an dieser mit Blutungen einhergehenden Viruskrankheit aus folgenden Staaten gemeldet: Edo, Plateau, Lagos, Ogun, Nasarava, Taraba, Borno und Anambra. Es ist davon auszugehen, dass der 1969 in dem Dorf Lassa in Nordnigeria entdeckte Erreger landesweit verbreitet ist. Als Hauptreservoir dient die Vielzitzenratte (Mastomys natalensis), die Übertragung erfolgt vorwiegend durch Tröpfcheninfektion im Bereich der Ratten(biotope) oder von Mensch zu Mensch im Haushalt bzw. Krankenhaus. Entsprechende Kontakte sind zu meiden. Das gilt auch für andere westafrikanische Länder, in denen es Lassa-Fieber gibt. Personen, die in diesen Ländern unkonventionell reisen, wird zuvor dringend eine Beratung durch einen reisemedizinisch erfahrenen Arzt empfohlen. / Quelle: crm

Uganda - Darminfektionen
12.06.2008

Risiko für Durchfallerkrankungen landesweit. Örtliche Cholera-Ausbrüche gehen im westlichen Grenzgebiet zur DRC immer wieder von den überfüllten und völlig unzureichend versorgten Flüchtlingslagern aus. Zahlreiche Erkrkankungen wurden kürzlich aus einer Reihe von Fischerdörfern im Kibale-Distrikt am Südufer des Albert-Sees gemeldet. Seit Anfang Juni gibt es nach stärkeren Regenfällen auch wieder Cholera im Osten des Landes: Erkrankungen werden aus den Distrikten Butaleja und Mbale gemeldet. Die Infektionsgebiete liegen nördlich des Viktoria-Sees im Grenzgebiet zu Kenia. Hygiene beachten. / Quelle: crm

LEISHMANIASIS, VISCERAL - KENYA: (NORTH EAST)
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Date: Wed 11 Jun 2008
Source: UN Integrated Regional Information Networks (IRIN), Early Warning
[edited]
<http://www.irinnews.org/Report.aspx?ReportId=78687>


An outbreak of visceral leishmaniasis -- also known as kala azar or black
fever -- has been reported in Isiolo and Wajir in north eastern Kenya.
According to a senior health official 4 people have died.

Shahnaaz Sharif, the senior deputy director of medical services in Kenya's
health ministry, said 66 people had been infected in the outbreak that was
first reported in Wajir in April 2008. Sharif said the most affected age
group was children between the age of one and 5 "This is due to lowered
immunity and the prevailing malnutrition problem in the northern region,"
he said.

The most affected areas in Wajir are the districts of Wajir West with 50
per cent of the total cases (in the localities of Arbijahan, Eldas,
Giristu, Wara, and Malale), Wajir East, and Wajir North. In Isiolo, the
Merta Alba area was the most affected.

Sharif said the health ministry and other stakeholders were carrying out
case management and distributing drugs to the sick in treatment centres in
Wajir and Isiolo. The affected communities are also being provided with
health education on disease prevention and control, while therapeutic
feeding of malnourished children is also taking place.

Control measures for kala azar include the use of insecticide treated bed
nets and skin repellents as well as early diagnosis, complete treatment,
and effective surveillance. Sharif said it had not been possible to reach
all of those potentially affected by the outbreak as some had travelled in
search of water and pasture for their livestock. Isiolo and Wajir are
located in Kenya's pastoral-nomadic region.

Kala azar is endemic in northern Kenya and outbreaks are common in times of
drought. Once it enters the body, the leishmaniasis parasite, which is
carried by sand flies, migrates to internal organs and bone marrow. If an
infection progresses to disease and is left untreated, it almost always
results in death.

Sand flies thrive in the cracks of mud-covered dwellings, in cow dung, rat
burrows, anthills, dry riverbeds, and vegetation. In Wajir, the flies often
bite people as they dig for water in the bed of the Ewaso Nyiro River or
graze their livestock on nearby bushes. The most effective methods of
diagnosing kala azar can only be conducted in large hospitals located far
from the worst-affected areas.

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

[Please see the extensive moderator's comment from the ProMED-mail posting
on VL (visceral leishmaniasis) in northern Kenya date 21 Jul 2006 (archive
no. 20060721.2007). The comment concluded that, "The present increase in
cases is most probably part of a larger outbreak of the entire region
including eastern Ethiopia, Somalia, and north eastern Kenya." The comment
posted 23 Jul 2006 (archive no. 20060723.2030) from Ellicott McConnell
emphasized the connection between outbreaks of VL and malnutrition. It
seems that malnutrition is still part of the problem and the situation has
not changed since 2006. - Mod.EP

A map of Kenya is available at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - CopyEd.MJ]

POLIOMYELITIS(02): AFRICA
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******
West Africa
Date: 13 Jun 2008
Source: All Africa / UN Integrated Regional Information Networks [edited]
<http://allafrica.com/stories/200806131003.html>


Outbreak of polio prompts mass vaccination campaign in West Africa
------------------------------------------------------------------
The World Health Organization (WHO) and the governments of Niger, Burkina
Faso, and Mali are launching a cross-border polio vaccination campaign
today [13 Jun 2008] following an April 2008 report of a polio case at
Tillabery in south west Niger, 100 km [62 miles] from the borders of Mali
and Burkina Faso. The campaign will target the Gao region in Mali, north
eastern Burkina Faso, and southern Niger, including Maradi, Tahoua and the
capital, Niamey.

"Hundreds of thousands of children will be vaccinated, the majority of them
in Niger, to avoid the virus spreading into neighbouring countries,"
Mathieu Kamwa, coordinator of the WHO West Africa office told IRIN. "We
will pay particular attention to populations that frequently move across
the borders of these three countries," said Kamwa.

The campaign aims to create a polio barrier to prevent the spread of the
virus in polio-free areas of the 3 countries. WHO officials fear the
re-emergence of polio in Tillabery, which has been free of the virus for 3
years, because of its proximity to the borders Burkina Faso and Mali.

Burkina Faso and Mali have had no reported polio cases since 2004 and both
are on their way to receiving certification as polio-free countries in
October 2008. Niger meanwhile reported 9 cases in 2008.

Tillabery is 180km [112 miles] from Nigeria, where 21 percent of the
world's polio cases were reported in 2007. That made it one of 4 countries
in the world alongside India, Pakistan and Afghanistan, where polio is
still endemic.

According to WHO's Kamwa, 247 cases of polio have been reported in Nigeria
since January 2008.

Polio mainly affects children under 5 years old, with one in 200 infections
leading to irreversible paralysis, according to WHO.

[This report does not necessarily reflect the views of the United Nations]

--
communicated by:
ProMED-mail rapporteur Brent Barrett

Kamerun - Schistosomiasis (Bilharziose)
16.06.2008

Die durch Saugwürmer verursachte Erkrankung von Darm und/oder Blase mit Komplikationen an Inneren Organen und Nervensystem ist in Kamerun weit verbreitet. Das gilt nicht nur für ländliche Gebiete. In den letzten Jahren wird ein Anstieg der Fallzahlen auch aus Yaounde gemeldet. In einzelnen Stadtteilen sind bis zu einem Drittel der Einwohner infiziert. Das betrifft nicht nur Armenviertel sondern auch Wohngebiete mit höherem Standard. Die Übertragung erfolgt durch Larven, die im Süßwasser leben und durch die gesunde Haut eindringen können. Kontakt mit Binnengewässern ist überall meiden. / Quelle: crm

NIGERIA - FG Declares State Of Emergency In Health Sector
16.06.2008

[...] Within the last 8-12 weeks, cases of lassa fever outbreak in endemic states of Edo, Plateau, Lagos, Ogun, Nasarawa, Taraba, Borno and Anambra have been re-occurrent with 8 fatalities. Minister of health, Prof. Adenike Grange, who disclosed this yesterday in Abuja, said the World Health Organisation (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 outbreaks as well as initiate preventive and containment measures in affected communities, and to report to the ministry ... mehr

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (28 )
**********************************************
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<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 (Butaleja)
[2] Cholera - Uganda (Mbale)
[3] Cholera - Sudan (south)
[4] Cholera - South Africa (Mpumalanga)

******
[1] Cholera - Uganda (Butaleja)
Date: Mon 16 Jun 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>


State minister for Primary Health Care Dr Emmanuel Otaala has
confirmed a cholera outbreak in Butaleja district. The 1st suspect
case was reported on 29 May 2008 and later confirmed on 30 May 2008.
This was after samples of stools were examined at Busolwe hospitals.
By 9 Jun 2008, 36 cases had been reported with 4 deaths registered.

A baseline survey on the impact assessment of the cholera outbreak in
Butaleja was carried out by the Uganda Red Cross Society, Tororo
branch. This was followed by different efforts coming together to
contain the outbreak, which included social mobilization that was
carried out by the surveillance teams as well as community education
of cholera prevention and control.

The areas affected include Kachonga Sub County, Doho-Hibira,
Nabiganda C, Hamuseru village, Mazimasa, Magugu-Doho, and Hanjehe all
found in Butaleja Sub County.

[Byline: Tina Shiela Namubiru]

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

[Butaleja is a district of Uganda created on 1 Jul 2005. Formerly
part of Tororo District, it was created out of the former Bunyole
county (source: <http://en.wikipedia.org/wiki/Butaleja>). Tororo
district can be found on a map of Uganda in eastern part of the country at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

******
[2] Cholera - Uganda (Mbale)
Date: Thu 5 Jun 2008
Source: AllAfrica, The Monitor (Kampala) report [edited]
<http://allafrica.com/stories/200806051243.html>


An outbreak of cholera has been reported in a remote village of Mbale
District; it has already claimed 3 lives and leaves many others at
risk. Bubulo west MP George William Wopuwa says the epidemic is
blamed on the dry season that has forced people to consume polluted
water from rivers, specifically from the Manafwa River, which flows
through this affected area.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Mbale District can be found in eastern Uganda on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>.
The district is close to the Butaleja district noted above. - Mod.LL]

******
[3] Cholera - Sudan (south)
Date: Wed 11 Jun 2008
Source: Reuters [edited]
<http://uk.reuters.com/article/worldNews ... 8120080611>


Cholera has infected almost 6000 south Sudanese and killed at least
44 in 2008, with more than half dying within the past 4 weeks,
officials from the South Sudanese Health Ministry said on Wednesday
[11 Jun 2008].

"From previous experience it always starts (in the south) and goes
north," South Sudan's director for preventable medicine John Rumunu
said. The epidemic has now reached Bor town, in the center of South
Sudan, he said.

A 2005 peace deal ended more than 2 decades of north-south civil war
and established a semi-autonomous southern government, but the
conflict left the region's health infrastructure desperately undeveloped.

Some 700 people died from the waterborne disease in 2006 and around
25 000 were affected. In 2008, outbreaks have occurred in several
southern towns, Rumunu said, including the southern capital Juba
where cases in nearby army barracks first raised the alarm in May 2008.

[Byline: Skye Wheeler]

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

[Bor can be found on a map of Sudan in the Lakes Province at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>.
Central and Eastern Equatoria provinces have been previously noted
with cases of cholera. - Mod.LL]

******
[4] Cholera - South Africa (Mpumalanga)
Date: Tue 10 Jun 2008
Source: AllAfrica, Bua News (Tshwane) report [edited]
<http://allafrica.com/stories/200806101084.html>


On Tuesday [10 Jun 2008], 2 more cases of cholera were confirmed in
Barberton bringing the total number of reported cholera cases to 13
in the past 2 weeks. All the victims, including the 2 men who died,
are believed to be illegal gold miners who drank contaminated
underground water while digging for gold in abandoned mineshafts at
the Sheba mine.

"We currently have 4 patients at the Barberton hospital and the
others have since been discharged," said spokesperson for the
Mpumalanga Department of Health Mpho Gabashane, who added that the
town's water supply has tested clear of cholera and remains safe to
drink. He said the department was monitoring the situation.

The miners live in a nearby informal settlement called Sharlock,
where the department has distributed sachets of clean water in case
the miners return to the mines. They were reported missing by their
families and the police found them after searching the abandoned
mines on 29 May 2008.

Gold has been mined in Barberton for the past 200 years and illegal
miners continue to search for the valuable mineral. They are thought
to sneak into the networks of abandoned tunnels in small groups of 6
or 7 and live and sleep underground for days and even weeks at a time
while searching for gold ore. Some of the tunnels are almost 100
years old, but connect to modern gold mines still being used by
commercial companies, resulting in clashes with mine security.

[Byline: Sydney Masinga]

--
Communicated by:
Rabelani Daswa
<rabedaswa@gmail.com>

[ProMED-mail thanks Rabelani Daswa for this report.

Mpumalanga province is located in northeastern South Africa and can
be found at a map at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. - Mod.LL]

Poliomyelitisin Nigeria and West/Central Africa
WHO - 18.06.2008

Northern Nigeria is currently affected by a new outbreak of wild poliovirus type 1 (WPV1), which has begun to spread internationally. In 2008, a nine-fold increase in new cases caused by this serotype has been reported compared with the same period in 2007. This outbreak in northern Nigeria has the potential to cause major international outbreaks, as occurred in 2003-2006. This year, Nigeria accounts for 86% of WPV1 cases in the world.

This new outbreak in Nigeria has occurred because upwards of 20% of children remain unimmunized in key high-risk areas for polio in the north of the country. From 2003 to 2006, an outbreak in northern Nigeria led to national and international spread of the disease, eventually re-infecting 20 previously polio-free countries, causing outbreaks in places as far away as Indonesia and Yemen, and resulting in 1,475 cases in these 20 countries.

New WPV1 genetically linked to viruses from northern Nigeria has now been confirmed in Benin (one case, onset 17 April 2008) and the western part of Niger (1 case, in Tillaberry province, close to the borders with Burkina Faso and Mali; onset 11 April 2008). It is from these areas that WPV1 originating from Nigeria spread across west, central and the Horn of Africa in 2003-2004, re-infecting – among others – Côte d'Ivoire, Ghana, Guinea and Togo. In addition to international spread of WPV1 from northern Nigeria, wild poliovirus type 3 (WPV3) originating from northern Nigeria has been reported from Chad (onset of most recent case 13 April 2008).

The risk of renewed international spread of polio from Nigeria is increasing due to the intensity of the outbreak in northern Nigeria, the upcoming rainy season which is associated with increased transmission of poliovirus, and the anticipated large-scale population movements for the Hajj (pilgrimage to Mecca, Saudi Arabia) in the second half of 2008. Saudi Arabia has been notified of the increased risk of polio infection to Hajj pilgrims.

Nigeria has planned two large-scale rounds of emergency polio immunization in the northern states in July and August 2008. Large-scale emergency polio immunization campaigns were conducted on 13-16 June in high-risk and border areas of Benin, Burkina Faso, Mali and Niger, followed by additional campaigns in July. Disease surveillance is being heightened in 'at-risk' countries, including in those re-infected in 2003-2006.

For more information: Global Polio Eradication Initiative

HEPATITIS E VIRUS - UGANDA (04): (KITGUM)
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Date: Fri 20 Jun 2008
Source: IRIN, via Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdes ... db6bb7.htm>


Hepatitis E virus on the rise in Kitgum
---------------------------------------
Uganda's Ministry of Health has sent a team of experts to the
northern district of Kitgum to investigate an outbreak of hepatitis E
virus (HEV) infection in camps for internally displaced persons
(IDPs) which has killed 64 people over the past 8 months. The team
will assess the extent of the epidemic, the level of intervention
against the disease and identify response gaps, Kitgum District
Chairman Komakech John Ogwok told IRIN.

"The biggest challenge we have is the attitude of the population," he
said, explaining that many people preferred to visit traditional
healers first and only go to health centres as a last resort. No
treatment is available for patients who have reached an acute stage
of infection, "but HEV infections are usually self-limited and
hospitalisation is generally not required", according to the World
Health Organization. "Unless people change their attitude, it will be
difficult to get rid of the disease and more people will continue
dying," said Ogwok.

Community mobilisers in affected areas said sanitation and hygiene
conditions were very poor in IDP camps and the villages to which
people were returning in the wake of a rebel insurgency in the north.

Hepatitis E is a viral disease spread via the faecal-oral route.
Outbreaks tend to be linked to contaminated water or food supplies.
Mortality rates are generally low, ranging from 0.5 to 4.0 percent.
But among pregnant women in their 3rd trimester this rate can rise to
20 percent.

"The number of hepatitis E cases is continuing to increase in the
district... Over 3082 cases have been registered in the district
since October 2007, with 64 deaths," Kitgum District Health Officer
Alex Olwedo told IRIN. "The majority of those getting the infection
and dying are women who are pregnant and it's really disturbing," he said.

A report by the Kitgum health directorate said the worst affected
areas of the district were Madi Opei sub-county, which is the
epicentre of the disease with 1114 cases, followed by Agoro with 685
cases, Paloga with 607 cases, Padibe 304 cases, Mucwini 277 cases and
Lokung with 25 cases. Others are Layamo with 16, Orom 12 cases,
Kitgum town with 12 cases, Akwnag with 3 and Palabek Gem with 2 cases.

At Padibe health centre, an 82-year-old, had recently been diagnosed
with the viral disease. "He is the 4th person to suffer from
hepatitis E in our family. Two of his sons and his elder brother died
of hepatitis E last month," said the patient's son. Gustave Opoka,
the doctor in charge of Padibe emergency health unit, said 60 cases
were reported there within a period of 3 weeks. A near-term pregnant
woman who had been brought to the health centre critically ill had
recently succumbed to the disease, said Opoka.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The hepatitis E outbreak in the Kitgum region of northern Uganda
which began in October 2007 has not yet been contained. Since 28 May
2008 the number of cases has risen from 1797 to 3082, and the number
of deaths from 35 to 64. It is likely that control of the outbreak
will require provision of improved sanitation and adequate supplies
of clean water.

A comprehensive account of all aspects of hepatitis E disease and its
control can be accessed at:
<http://www.who.int/mediacentre/factsheets/fs280/en/>.

A map of Uganda showing the location of Kitgum in the north of the
country can be accessed at:
<http://www.kitgum.go.ug/overview/dist_map.htm>.
- Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 ( 29 )
**********************************************
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<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 - South Africa (KwaZulu-Natal)
[2] Cholera - Uganda (southeast)
[3] Cholera - Kenya (Nyanza)
[4] Cholera - Kenya (Nyanza, Western provinces)

*****
[1] Cholera - South Africa (KwaZulu-Natal)
Date: Thu 26 Jun 2008
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 905C271736>


Precautionary measures have been put in place after a suspected
cholera outbreak on the KwaZulu-Natal South Coast, the provincial
health department said on Thursday [26 Jun 2008]. Spokesperson Chris
Maxon said cases of suspected cholera were reported in a hall where
victims of last week's floods were being sheltered.

Maxon said 1 of the cases was of an 1-month-old baby boy with
diarrhea. "A team of environmental officers are on site, and all
persons reporting with diarrhea will be treated," he said. "The
department will be distributing pre-treated water to all persons in
the hall and surrounding communities as part of the department's
response."

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

A map of South Africa showing KwaZulu-Natal (or often KZN) on its
eastern coast can be found at:
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. The
South Coast area is the coastal area south of the city of Durban. -
Mod.LL]

*****
[2] Cholera - Uganda (southeast)
Date: Wed 25 Jun 2008
Source: New Vision [edited]
<http://www.newvision.co.ug/D/8/13/635578>


At least 31 people have died of cholera and over 290 infected in the
eastern districts of Butaleja, Mbale, Pallisa and Manafwa. The health
minister, Dr. Stephen Mallinga, attributed the infections to River
Manafwa, which he said was contaminated from Bugobero. The river
moves through the 4 districts and empties its waters in the swamps in
the low-lying rice-growing areas of Butaleja.

He added that the outbreak reported in the past 6 weeks followed the
April 2008 heavy rains. "Kachonga, Maizimasa and Butaleja
sub-counties have recorded 65 cases and 4 deaths," he said in a
statement to Parliament yesterday [24 Jun 2008]. Mallinga said they
had reactivated the district cholera task forces, provided supplies
and set up treatment centers. The Government, he explained, was
distributing jerrycans to the people to use instead of water pots.

Pallisa has reported 110 cases and 8 deaths and the most affected
sub-counties were Kasodo, Buseta.

[Byline: A. Mugisa, Joyce Namutebi and John Odyek]

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

[A map of Uganda can be found at:
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. Mbale
and Pallisa are easily found and Butaleja and Manafwa were carved out
of Tororo district. All are close to the border with Kenya. - Mod.LL]

******
[3] Cholera - Kenya (Nyanza)
Date: Wed 25 Jun 2008
Source: AllAfrica & UN Integrated Regional Information Networks (IRIN) [edited]
<http://allafrica.com/stories/200806250918.html>


An outbreak of cholera has been confirmed in the Kisumu municipality
in the western region, a senior health official has said.

"At least 13 out of 38 cases sampled for cholera have tested
positive," Shahnaaz Sharif, the senior deputy director of medical
services in Kenya's health ministry, said. Sharif said 34 people had
also been admitted to the Kisumu district hospital, with a total of
134 cases reported since the outbreak began on 6 Jun 2008. So far, he
said, no deaths had been registered.

The most affected areas included the slums of Manyatta, Nyalenda and
Obunga in the municipality, which lies in the district of Kisumu
East. "The new outbreak is attributable to the onset of recent rains
in the region that have resulted in the contamination of water wells
-- the main sources of water for the residents," he said.

At least 376 cases and 12 deaths have been reported in the Kisumu
East district since January 2008 when an outbreak of the disease was
reported in the rural areas. The outbreak, which also affected the
districts of Bondo, Homa Bay, Kisii South, Kisumu West, Migori,
Nyando, Rongo, Siayathe and Suba in the western region, led to the
deaths of 46 people with 832 cases being reported, according to a UN
World Health Organization (WHO) report on 19 Apr 2008.

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

[Kisumu is the capital of the Nyanza province in western Kenya. As
can be seen on a map at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>, the
area is close to the eastern area of Uganda where cholera is also
occurring. - Mod.LL]

*****
[4] Cholera - Kenya (Nyanza, Western provinces)
Date: 18 Jun 2008
Source: Kenya Red Cross [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Cholera was brought under control in Nyanza at the end of April 2008.
No cases were recorded in May 2008. However, new cases have been
reported in Rachuonyo, Migori and Kisumu East districts of Nyanza
Province and Busia and Samia districts in Western Province in the
month of June 2008.

There were 4 cases reported in Rachuonyo District, while another 13
cases reported in Kisumu East District between 7 and 11 Jun 2008. The
areas affected within Kisumu Municipality were Kajulu, Obunga,
Bandani, Manyata and Nyalenda informal settlement. On 7 Jun 2008, 4
suspected cholera cases were reported in Migori, but laboratory tests
turned out to be negative.

In Western Province, 8 cholera cases were reported and admitted in
Nangina Mission Hospital in Samia District and 1 case admitted in
Butula A. Health Centre in Busia District. The affected villages
include Serikesi and Mudoma in Samia District and Isongo in Butula
Division, Busia District.

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

[The 2 provinces can be found on a map of Kenya at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

Tansania - Darminfektionen
30.06.2008

Risiko für Durchfallerkrankungen landesweit. Cholera gab es zuletzt als örtliche Ausbrüche in der Rukwa-Provinz (SW), im Moshi-Distrikt am Fuß des Kilimanjaro sowie erneut in hygienisch mangelhaft versorgten Vierteln von Dar es Salaam. Seit Juni liegen keine neuen Daten vor, größere Ausbrüche wurden nicht bekannt. Hygiene beachten. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (30)
**********************************************
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 - South Africa (Mpumalanga)

******
[1] Cholera - Kenya (Nyanza)
Date: Wed 2 Jul 2008
Source: Kenya Broadcasting Corporation [edited]
<http://www.kbc.co.ke/story.asp?ID=50961>


Public Health and Sanitation's Dr James Nyikal says inadequate
treatment of water in the area is to blame for the regular cholera
outbreaks. Speaking after holding a consultative meeting with
stakeholders at the New Nyanza General Hospital in Kisumu, Nyikal
said over 219 cases of cholera have been reported so far in Kisumu
with 3 fatalities.

He noted that the cross-contamination of shallow water wells in the
informal settlements where pit latrines are common have put the
residents at a greater risk. Increased pollution of Lake Victoria by
rivers that drain effluent from the changaa [illegal alcoholic drink
popular in Kenya, distilled from grains like maize and sorghum] dens
and fish cooking points into the lake are also factors that have
contributed to the increased outbreaks of the disease, Nyikal said.

"Another worrying issue is the fact that the sewerage treatment
system in Nyalenda has collapsed, leading to the draining of raw
sewage into the lake," he said.

[Byline: Simon Acholla]

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

[Kisumu is the capital of the Nyanza province in western Kenya. As
can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>, the
area is close to the eastern area of Uganda where cholera is also
occurring. - Mod.LL]

******
[2] Cholera - South Africa (Mpumalanga)
Date: Tue 1 Jul 2008
Source: Daily Dispatch [edited]
<http://www.dispatch.co.za/article.aspx?id=219519>


4 people have died following a cholera outbreak in Barberton. A
Mpumalanga Health Department spokesperson said yesterday [30 Jun
2008], "We discovered the outbreak of cholera on 29 May 2008. Since
then the confirmed number of cholera patients who received medical
treatment has risen to 27. The number of deaths is at 4."

Spokesperson Mpho Gabashane said currently there were 10 patients at
Barberton Hospital and one had been confirmed with cholera. "We are
awaiting test results for the other 9."

Gabashane said the department had instructed its teams to heighten
their surveillance and health promotion. "We are also on a daily
basis testing all sources of water in the area and, up to this point,
all tap water is considered safe for human consumption."

The department had not identified cholera in local streams. "We urge
all the people to use safe tap water and, in cases where they may not
have access, to boil their water at least for 3 minutes or add a
teaspoon of bleach."

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

[Mpumalanga province is located in northeastern South Africa and can
be found on the map at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. - Mod.LL]

MARBURG HEMORRHAGIC FEVER - THE NETHERLANDS ex UGANDA
***********************************************
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 Jul 2008
Source: European Centre for Disease Prevention and Control (ECDC) [edited]
<http://ecdc.europa.eu/index.html>


On Thu 10 Jul 2008, the authorities in The Netherlands notified their
European Union partners and the World Health Organisation of one
confirmed case of Marburg fever diagnosed in the Leiden University
Medical Centre. The case involves a 40-year-old woman who had
recently returned from a holiday in Uganda. The travel included a
visit to 2 caves in the Maramagambo forest (between Queen Elizabeth
Park and Kebale), where she was exposed to fruit bats.

ECDC's initial assessment is that the threat to public health is
limited and mainly focused on the people who have been in close
contact with the patient after the onset of her symptoms. People
intending to travel to Uganda should be aware that there may be a
risk related to visiting caves in the Maramagambo forest.

ECDC is in contact with the authorities in The Netherlands and is
monitoring the situation closely.

--
Communicated by:
Erik Huisman, M.D. <erik.huisman@xs4all.nl>.

[The following information has been abstracted from the ECDC Fact
sheet on Ebola and Marburg haemorrhagic fever.

Ebola and Marburg viruses are members of the family _Filoviridae_.
Ebola virus includes 4 distinct subtypes: Zaire, Sudan, Cote d'Ivoire
and Reston. Three subtypes, Zaire, Sudan and Cote d'Ivoire cause
serious illness in humans. Ebola Reston subtype, found in the Western
Pacific, only causes asymptomatic illness.

The natural reservoir for both diseases is unknown, although it is
presumed there is an animal reservoir. Ebola virus has been isolated
from cynomolgus monkeys and Marburg from green monkeys and bats.

Ebola and Marburg viruses are highly transmissible by direct contact
with blood, secretions, organs or other body fluids of dead or living
infected persons. Sexual contact transmission can occur up to 7 weeks
after clinical recovery. Transmission can also occur by contact with
dead or living infected animals (e.g., monkeys, chimpanzees, forest
antelopes, and bats). Nosocomial transmission can occur. Health care
workers can be infected through close contact with infected patients.
The risk for infection can be significantly reduced through the
appropriate use of infection control precautions and adequate barrier
procedures. This is especially important when performing invasive procedures.

In 1967, isolated cases of hemorrhagic fever occurred among
laboratory workers handling tissues from African green monkeys
(_Cercopithecus aethiops_) from Uganda and in medical personnel who
attended the laboratory workers. This was a new virus named Marburg
virus after the city in Germany where it was 1st characterized. In
1976, epidemics of severe haemorrhagic fever occurred simultaneously
in Zaire and Sudan, and a new filovirus was identified, serologically
different from the Marburg virus. This new virus, Ebola, was named
after a small river in Democratic Republic of Congo. Later studies
clarified the specific nature of these viruses and defined a separate
family, the Filoviridae.

Multiple outbreaks of both Ebola and Marburg have been identified
since their initial discovery. The most recent outbreaks of Ebola
virus were in 2007 in the Democratic Republic of Congo, with 372
cases, of which 166 (45 percent) were fatal, and in 2008 in Uganda,
where there were 3 cases detected among mine workers from Kakasi
Forest Reserve in Kamwenge District. The most recent outbreaks of
Marburg virus were in 2004-2005 in Angola, when there were 252 cases,
of which 227 (90 percent) were fatal and in Uganda in 2007, when 2
mine co-workers were infected; one died.

The typical incubation period for these viruses is from 2 to 21 days.
In most cases, an infected patient experiences sudden onset of fever,
malaise (weakness), muscle and joint pains and headache followed by
progressive weakness, anorexia (lack of appetite), diarrhea (watery
stools sometimes containing blood and mucus), nausea and vomiting.
Some patients progress to develop impaired kidney and liver function
and haemorrhagic symptoms. These manifest by bleeding from the nose,
gums and skin (like bruising), bloody vomiting and stools, and
prolonged bleeding from needle puncture sites. Other symptoms include
skin rash, conjunctival injection, inflamed throat and difficulty
swallowing. Depending on the filovirus and subtypes, risk of death
ranges from 30 to 90 percent.

Laboratory tests on blood specimens detect viral material (including
genetic material) or the patient's antibodies to the virus. These
tests are not commercially available. Samples from infected patients
and viral material present an extreme biohazard and have to be
handled (including for testing) under maximum biological containment
conditions in level 4 biosafety laboratories.

No curative treatment is available for Ebola or Marburg infections.
Treatment is supportive, and severe cases require intensive care. - Mod.CP]

AFFENPOCKEN- CONGO DR (BOKUNGU)
******************************
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: Sat 12 Jul 2008
Source: allAfrica.com, Le Potentiel (Kinshasa) (translated by ProMED-FRA
Mod.SC) [edited]
<http://fr.allafrica.com/stories/200807111055.html>


Congo-Kinshasa: Bokungu - 39 cases of monkeypox recorded since March
--------------------------------------------------------------------
The cases include 19 children from 0 to 5 years, including 3 deaths, in
Bokungu in the Democratic Republic of the Congo (Congo-Kinshasa).

Radiookapi.net has reported that according to Dr Didier Lolobi, the interim
medical officer of the health zone, since the epidemic was declared, the
health area office of Bokungu has received no outside assistance and the
value of treatment available is problematic.

Dr Didier Lolobi indicated that a doctor who was treating the patients has
also contracted infection. He stated that: "Our chief of staff, Dr Robert
Trabongo Bongo, who was in contact with a sick child, has contracted
infection. He is in isolation and is under treatment but we have no
effective means of treatment, such as protective clothing, disinfectants,
and pharmaceuticals products to address this epidemic. We have not
benefited from external assistance. The Diocesan Office for Medical Affair
(BDOM) have given us some drugs but these are insufficient. The area health
organisation does not have enough resources to supervise remote localities
in order to detect still unknown cases in the community."

According to the WHO/Equateur medical epidemiologist, 250 kg of drugs
should reach Bokungu by Wednesday [16 Jul 2008].

--
communicated by:
Pro-MED-FRA <promed@promedmail.org>

[According to the United States Centers for Disease Control and Prevention
(CDC) website monkeypox is a rare viral disease that occurs mostly in
central and western Africa. It is called "monkeypox" because it was first
found in 1958 in laboratory monkeys. Blood tests of animals in Africa later
found that other types of animals probably had monkeypox. Scientists also
recovered the virus that causes monkeypox from an African squirrel. These
types of squirrels might be the common host for the disease. Rats, mice,
and rabbits can get monkeypox, too. Monkeypox was reported in humans for
the first time in 1970.

In humans, the signs and symptoms of monkeypox are like those of smallpox,
but usually they are milder. Another difference is that monkeypox causes
the lymph nodes to swell. About 12 days after people are infected with the
virus, they will get a fever, headache, muscle aches, and backache; their
lymph nodes will swell; and they will feel tired. One to 3 days (or longer)
after the fever starts, they will get a rash. This rash develops into
raised bumps filled with fluid and often starts on the face and spreads,
but it can start on other parts of the body too. The bumps go through
several stages before they get crusty, scab over, and fall off. The illness
usually lasts for 2 to 4 weeks. In Africa, monkeypox has killed between 1
per cent and 10 per cent of people who get it. There is no specific
treatment for monkeypox. Physicians caring for monkeypox patients are
advised to receive smallpox vaccination.

A map of the Democratic Republic of the Congo can be accessed at
<http://www.lib.utexas.edu/maps/africa/c ... _pol98.jpg>. The
location of Bokungu can be found at <http://www.fallingrain.com/
world/CG/0/Bokungu4.html>. - Mod.CP]