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FOODBORNE ILLNESS - EGYPT: (SHARM EL-SHEIKH), HOTEL
***********************************************
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 15 Sep 2008
Source: RIA Novosti News Agency [edited]
<http://en.rian.ru/russia/20080915/116797717.html>


More than 80 Russian tourists vacationing at the Sheraton Sharm
Resort in Egypt are believed to be suffering from food poisoning, a
Moscow radio station said on Monday [15 Sep 2008], citing one of the
victims. The Ekho Moskvy radio station said it is not clear what
caused the poisoning, but the tourists believe they fell ill after
consuming contaminated food.

"The tourists are suffering from the same symptoms: diarrhea,
stomachaches, nausea, vomiting," Gleb Borisov told Ekho Moskvy. "Some
of them have been unable to leave their hotel rooms for a 3rd day
already, although some are feeling a little better now." Borisov said
that no major medical assistance had been given to the tourists, with
hotel management reluctant to address the problem, advising the
victims to contact their insurance companies.

Russia's honorary consul to the Egyptian Red Sea resort of Sharm
el-Sheikh, Akhmed Semari, told RIA Novosti that the hotel management
had denied there were any health issues at the resort. Semari said,
citing the hotel, that 6 Russian tourists had been taken to an
international medical clinic on Sunday [14 Sep 2008], adding that the
results of tests would be available later on Monday.

The 4-star Sheraton Sharm Hotel currently has around 600 tourists
staying, he said. Russian operators have meanwhile suspended sales to
the hotel until Egyptian health officials clear up the cause of the
poisoning, a spokesperson for the Russian Tourist Industry
Association said. "Some 100 tourists lodged complaints with their
insurance companies over the weekend," Irina Tyurina said. "Sales of
tours to the hotel have been suspended, and tourists who bought
holidays at the hotel will be accommodated in other hotels." She said
Russian tourists are being relocated to other hotels.

The Russian Tourist Industry Association said earlier that 2 million
Russians were expected to visit Egypt this year [2008] compared with
1.5 million in 2007. The country is a popular travel destination
during the fall and winter months with Russians due to the country's
simplified visa regime, warm climate, good diving and archaeological sites.

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

[The features of this outbreak, such as the mildness of the
condition, the absence of fever and the predominance of
gastrointestinal symptoms, are consistent with norovirus infection.

The duration of illness is probably too long for staphylococcal or
clostridial food poisoning. Further information is awaited.

The HealthMap/ProMED-mail interactive map of Egypt is available at
<http://healthmap.org/promed?v=26.5,29.9,5>
showing the location of Sharm el-Sheikh, which is on the southern tip
of the Sinai Peninsula. - Mod.CP]

TOLLWUT, BOVINE, CANINE, HUMAN - SÜDAFRIKA: (EASTERN CAPE)
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 17 Sep 2008
Source: IOL online, SAPA News Agency [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 766C667336>


Pets in the Eastern Cape will receive free 6-month rabies
vaccinations following the deaths of 2 people and 7 cattle in Mount
Ayliff, the department of agriculture said on Wednesday [17 Sep 2008].

"We have decided to launch a rabies awareness campaign at Cabanza
Village, where 2 villagers were confirmed to be killed by rabies
infection," said Veterinary services head Luba Mrwebi. "The 7 cattle
which died in the area were also confirmed to have been infected with
rabies [virus]."

He said veterinary services would, from 15 to 21 Sep 2008, target
schools where children and the community would be educated on the
dangers of rabies. "The rabies awareness launch would be followed by
free mass vaccination of animals throughout the province. ...
Domestic animals acquired rabies from wild animals, and humans
contract rabies through dog bites," Mrwebi said.

He also warned communities in the area to take precautionary measures
and protect themselves against rabies infection because "rabies is a
deadly disease. Those who have sustained dog bites should immediately
seek treatment at the nearest clinic and follow the full treatment course."

Communities in the province were urged to take their pet animals for
the free vaccinations, which would be performed by the department.
Veterinary technicians would be dispatched to the various localities
where they would man designated spots, said Mrwebi.

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

[Rabies is endemic in South Africa, and reports in ProMED-mail have
originated most frequently from Eastern Cape province. It is presumed
that the 2 most recent deaths were a consequence of bites by rabid
dogs, in view of the emphasis on vaccination of pet animals.

A map of the Eastern Cape province of South Africa can be found at
<http://www.saexplorer.co.za/maps/ecape/province.asp>,
and the location of Mount Ayliff can be found at
<http://www.fallingrain.com/world/SF/1/Mount_Ayliff.html>.
- Mod.CP]

BURULI ULCER - WEST AFRICA: IVORY COAST, GHANA, BENIN
*****************************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 18 Sep 2008
Source: Reuters AlertNet [edited]
<http://www.alertnet.org/thenews/newsdes ... bf4f37.htm>


A tropical flesh-eating disease, Buruli ulcer, is spreading across
West Africa and has infected at least 40 000 people, leaving them
with bloody infected wounds and swollen skin ulcers, which at their
worst, require surgery or amputation, according to the World Health
Organization (WHO).

The disease has been reported in 30 countries around the world,
mostly in poor, rural, tropical communities that live near water. In
West Africa, according to WHO 2006 statistics, Ivory Coast has
reported 24 000 cases, Ghana reported 11 000, and Benin has 7000
confirmed cases [these are the number of cases recorded in Cote
d'Ivoire between 1978 and 2006, in Benin between 1989 and 2006 and in
Ghana since 1993, according to the WHO -- see
<http://www.who.int/mediacentre/factsheets/fs199/en/> and below].
Despite a 10-year global WHO-backed Buruli ulcer research initiative,
researchers still do not know how the disease is spread, and whether
water-born insects are to blame, as suggested by early research.

Even though the same bacteria family causes both Buruli ulcers and
tuberculosis, Buruli ulcer disease receives far less international
attention and remains one of the world's most overlooked diseases,
according to the WHO.

A woman, who gives her name as Agnes, says it has been 5 years since
she was diagnosed with Buruli ulcer disease. She lives in Agbanou, a
rural town 60 km [37.3 miles] from Benin's economic hub, Cotonou. She
told the IRIN before her infection, she spent most her time working
in marshlands. "At the beginning, I felt pain everywhere, and then
the skin on my feet hurt even more and started to change colours.
Then I saw open wounds. I thought it was witchcraft, which is why I
did not think to go to the hospital. Instead, I turned to a
traditional healer," said Agnes. When her condition worsened, and the
healer could not treat her deepening wounds, Agnes says she went to
the hospital where doctors told her she had Buruli ulcer disease.

Roch Christian Johnson, director of Benin's Program to Control Buruli
ulcer disease, says unreported cases in Benin outnumber reported ones
because lack of knowledge about the disease, illiteracy, poverty and
traditional healing often prevent people from going to medical
facilities. Also, the disease has few noticeable symptoms at the
beginning -- painless swelling, no fever -- according to the WHO.
Yet, without treatment, massive, bloody ulcers start tearing away the
patient's flesh.

Johnson says when it reaches this stage it can cost up to USD 2000 to
cure the disease. Depending on how bad the ulcers are, the patient
may need 8 weeks of medicine, surgery, or in a worst-case scenario,
amputation to fight the infection. Hospital stays often last longer
than 3 months; complications can lead to even costlier long-term
disability, according to the WHO.

Patient care is subsidised in part by the government and private
foundations in Benin. But nevertheless, Johnson says the cost is
still too much for many ulcer patients. The average annual salary in
Benin is USD 570, based on 2008 World Bank figures.

Faced with a rapidly spreading and largely unknown disease, and
mounting health care costs, Benin's government set up 5 testing
centres throughout the country starting in 1998 to try and catch the
disease early. On average, about 80 people seek treatment or testing
in these centres for Buruli ulcer every month, according to program
director Johnson.

From 2003 to 2006, Johnson says health officials tested and treated
3793 people. Out of the country's 12 regions, 8, including the south
with its 125 km [77.6 miles] of open coastline, have reported
infections. The arid north has been spared.

Despite the fact that little is known about how the infection is
spread, Johnson says he is still hopeful the disease can be
controlled. "The prospects are good to progressively contain this
disease in Benin. We are working with a large team of [local]
researchers to learn all we can about this disease, which means, in
the near future, the situation will improve." Johnson says even if
health officials do not know how the disease is spread, they can
encourage people to get tested at government health centres, and to
get treatment quickly to prevent the disease from consuming their
flesh -- and finances.

The WHO reports a vaccine, available in Benin, can offer some
short-term protection against _Mycobacterium ulcerans_, the bacterium
that causes the ulcers.

--
Communicated by:
ProMED Rapporteur Mary Marshall

[Most of the following information has been extracted from
<http://www.who.int/mediacentre/factsheets/fs199/en/>:

Buruli ulcer is an infection caused by _Mycobacterium ulcerans_,
which leads to extensive destruction of skin and soft tissue with the
formation of large ulcers on the limbs, predominantly the legs. The
disease progresses without pain or fever. When previously neglected
lesions heal, scarring may cause restricted movement of limbs and
other permanent disabilities. Almost all patients are children under 15 years.

Although slow growing, _M. ulcerans_ can be cultured from human
lesions on media used for mycobacteria, provided the incubation
temperature is kept between 29-33 DEG C [84.2-91.4 DEG F]. _M.
ulcerans_ DNA can by amplified by polymerase chain reaction (PCR)
from swabs of ulcers or tissue biopsies with sensitivity is around 98 percent.

Buruli ulcer has been reported in more than 30 countries mainly with
tropical and subtropical climates, and is endemic in many foci in
sub-Saharan tropical Africa, as well as in south-east Asia and in
Australia, near Melbourne, where it is referred to as the Bairnsdale
ulcer. The incidence of the disease has increased markedly for
unknown reasons in the last decade in several West African countries,
notably Benin, Cote d'Ivoire, and Ghana, as the above report documents.

_M. ulcerans_ is an environmental mycobacterium and has been
recovered from water and soil in swampy areas. Cases seem to occur in
association with an aquatic environment. Near Melbourne, Australia,
an outbreak of Buruli ulcer occurred in both golfers and non-golfing
local residents and visitors in small area, in the center of which
was a golf course where sewage was treated and the effluent used to
irrigate the course (see ProMED post: Buruli ulcer - Australia 19951211.1230).

Natural reservoirs and the exact mode of transmission of _M.
ulcerans_ are still unknown, though abrasions after contact with
contaminated water, soil, or vegetation have been thought to be
likely routes of entry. Also, insects have been thought to be
possible vectors (see ProMED: Mycobacterium ulcerans - Australia
(VIC): mosquito-borne, susp 20050311.0713). There is no evidence
that the disease can be transmitted from person to person.

Current recommendations for treatment are as follows:
1. A combination of rifampin and streptomycin/amikacin for 8 weeks
as a 1st-line treatment for all forms of the active disease. Nodules
or uncomplicated cases can be treated without hospitalization.
2. Surgery to remove necrotic tissue, cover skin defects and correct
deformities.
3. Interventions to minimize or prevent disabilities.

A map of West Africa can be found at
<http://www.cpj.org/Briefings/2000/Bekoutou/map.html>. - Mod.ML]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (37)
***********************************************
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 East)
[2] Cholera - Guinea-Bissau

******
[1] Cholera - Zimbabwe (Mashonaland East)
Date: Sat 20 Sep 2008
Source: African Press Agency [edited]
<http://www.apanews.net/apa.php?page=sho ... icle=75868>


The Zimbabwe health authorities have recorded 17 new cases of
diarrhea and cholera in a suburb in Harare, as a water crisis
continues to wreak havoc in the Zimbabwean capital, a residents'
association said on Saturday [20 Sep 2008].

The Combined Harare Residents Association (CHRA) blamed the outbreaks
in Mabvuku and Tafara suburbs on uncollected refuse, unavailability
of clean water and sewer line blockages. The reports of the new
outbreaks come days after the UN announced it had established 2
emergency treatment centres in Chitungwiza, a town located about 30
km east of Harare, where a cholera outbreak has claimed 11 lives.

UN agencies and other non-governmental organisations were currently
treating more than 80 Chitungwiza residents who have been infected
with the disease, which can be fatal if not treated on time. Similar
outbreaks are feared in other Zimbabwean towns and cities where water
delivery has been poor during the past year due to shortages of
treatment chemicals and constant power cuts, which affect the
government's capacity to pump water.

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

[Harare and Chitungwiza are in Mashonaland East province and can be
found on a map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

******
[2] Cholera - Guinea-Bissau
Date: Wed 17 Sep 2008
Source: Reuters [edited]
<http://africa.reuters.com/wire/news/usnLH686081.html>


A cholera outbreak in Guinea-Bissau has spread, and the death toll
doubled in a month to 122, because many people resist a ban on
funeral customs that propagate the disease, health officials said on
Wednesday [17 Sep 2008]. The outbreak has overwhelmed the weak public
health system in the poor former Portuguese colony in West Africa,
where the risk of water-borne diseases like cholera rises sharply
during the annual rainy season when floods are common.

The Ministry of Health in Bissau said that up to Tuesday [16 Sep
2008], 6461 people had contracted cholera since May 2008, out of whom
122 had died, compared to 59 deaths reported up to 21 Aug 2008.

In a bid to halt the spread of the disease, which had now affected
all of Guinea-Bissau's 11 regions, the government had banned large
traditional funeral and mourning ceremonies because of the risk of
infection involved.

"People gather in large numbers, they greet one another, all these
are factors of propagation," UNICEF spokeswoman in Bissau, Karyna
Silva Gomes, said. "These ceremonies have been prohibited, but there
is resistance to stopping them," she added. Other health experts said
this reluctance to halt traditional burial customs was being
encountered, for example, in the Pepel ethnic communities on the
cashew nut growing Biombo peninsula just north of Bissau.

[Byline: Alberto Dabo]

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

[A map of Guinea-Bissau can be found at:
<http://www.un.org/Depts/Cartographic/ma ... ineabi.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]

Ägypten - Darminfektionen
22.09.2008

Risiko für Durchfallerkrankungen einschließlich Ruhr sowie Typhus landesweit. Behörden melden den Ausbruch einer akuten Gastroenteritis russischen Touristen in einem Hotel in Scharm-el-Sheik im Sinai. Mindestens 80 der insgesamt knapp 400 Hotelgäste seien mit akuten Brechdurchfällen erkrankt. Hygiene und ggf. Impfschutz beachten. / Quelle: crm

Cholera in Guinea Bissau
WHO - 24.09.2008

Since the beginning of May 2008, Guinea-Bissau has been facing a large cholera outbreak. As of 21 September, 7 166 cases had been reported throughout the country, among whom 133 people had died. The overall case-fatality rate stands at 1.9%, and decreases below 1% for hospitalized cases. However, the case-fatality rate reaches 9% in remote areas, indicating that rural populations affected by cholera do not have access to treatment rapidly enough to save lives. The fact that Bissau, the capital, accounts for more than 70% of all cases but only 31% of deaths also illustrates this issue. The areas with the highest attack rates are Bissau, Biombo, Bijagos and Oio. Cholera epidemics regularly resurge in Guinea-Bissau. In 2005-2006, cholera affected 25 111 people and killed 399.

Numerous national and international partners are supporting the Ministry of Health. Médecins sans Frontières (MSF-Spain) took charge of cholera treatment centres by building local capacity, and improving early detection and treatment of cases through systematic patient home visits. UNICEF is providing technical expertise and material in the area of water and sanitation; WHO is deploying an epidemiologist. A team from The US Centers for Disease Control (CDC) - Brazil team - have also arrived in the country to support the outbreak investigation. In addition, efforts are being made to strengthen community mobilization, health and hygiene education, and to de-stigmatize cholera among potentially-affected populations.

Cholera is mainly transmitted through contaminated water and food and is closely linked to inadequate environmental management. In many areas of Guinea-Bissau, basic infrastructures appear to be largely inefficient. The overall quality of water and sanitation remains very poor, therefore facilitating cholera transmission. Long-term prevention of cholera depends on access to safe water and adequate sanitation to prevent exposure and interrupt transmission. In addition, corpses of deceased cholera patients should be handled with extreme caution and correctly disinfected before proceeding with the burial ceremony to avoid further contamination.

WHO does not recommend any restrictions to travel or trade to or from affected areas as a means to control the spread of cholera.

MILZBRAND, HUMAN, BOVINE - ZIMBABWE (MASHONALAND WEST)
****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Fri 26 Sep 2008
Source: The Herald, Harare [edited]
<http://www.herald.co.zw/inside.aspx?sectid=1205&cat=1>


Anthrax outbreak hits Mhondoro
------------------------------
An anthrax outbreak has hit parts of Mhondoro once again, prompting
the Ministry of Health and Child Welfare to suspend the sale of meat,
particularly beef, in the area. There have been moves to raise
awareness on preventive measures and also calls to avoid slaughtering
beasts until the situation is brought under control. So far, only one
human case has been detected and authorities are still monitoring the
situation to establish if there are more cases.

Mashonaland West provincial medical director Dr. Wenceslas Nyamayaro
urged people in the affected areas to exercise caution. "We have one
confirmed case of anthrax in Chegutu district and our teams are still
carrying out investigations to make sure that the disease does not
spread. The situation is under control," he said.

Dr. Nyamayaro said anthrax was endemic in the area but warned people
to avoid slaughtering cattle -- even those which looked healthy --
until they had been given the green light by health officials. "We
are not really surprised because temperatures are picking up now as
we enter into the summer season. People are now burning grass and
animals tend to eat grass to the root, bringing them into contact
with anthrax spores," he said.

Anthrax spores can lie dormant for up to 10 years until they get into
contact with a host. Anthrax is endemic in the belt just to the west
of the central watershed following spore seeding by Rhodesian
intelligence agents in the last years of the liberation war.

On Tuesday [23 Sep 2008] most people had taken heed of the warning by
health officials not to slaughter beasts and consume the meat.
Butcheries at Mubaira Growth Point had stopped selling meat while
restaurants were offering alternative dishes in compliance with the
order. "I have just got meat from the Nyamweda area because there is
none here," said a woman, who did not want to be identified. The
situation was the same at Rwizi Business Centre. At Kadhani Service
Centre, butcheries and other retail outlets were selling poultry only.

A wide cross-section of people interviewed demonstrated awareness
about the outbreak and precautionary measures they were required to take.

[Byline: Chinhoyi Bureau]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[It is clear from what is not said in this report that in the
Zimbabwean severe financial stress and hyperinflation the veterinary
service is inactive in Mashonaland West and livestock in a known
enzootic region are not being vaccinated. This will continue until
the economy can begin to recover and the veterinary service gets
their act together. If there is no money for transport, vaccines,
fuel, personnel, there is very little one can do.

The claims of Rhodesian BW [biowarfare] activities in the late '70s
are often made but with little evidence to support them. What is
clear is that until the civil war anthrax was very well controlled
throughout the country with minimal livestock and human cases. Then
the insurgents began shooting the rural Veterinary Assistants, who
became understandably reluctant to go out and vaccinate village
livestock. With the onset of heavier than normal rains in 1978
anthrax reached epidemic proportions. Because of rural malnutrition
sick animals were slaughtered and butchered with all the usual results.

In its day their veterinary service was one of the most effective in Africa.

Map of Zimbabwe:
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>
Chegutu is 20 miles (33 kms) NW of Kadoma and some 100 miles WSW of
Harare. - Mod.MHJ]

TOLLWUT, HUMAN, BEEF CONSUMPTION - MALAWI: REQUEST FOR INFORMATION
*****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Tue 23 Sep 2008
Source: The Daily Times (Malawi) [edited]
<http://www.dailytimes.bppmw.com/article ... leID=10834>


More than 1000 people from Traditional Authority Chikumbu in Mulanje
[District] are feared to have contracted rabies after eating beef
from an infected cow. [Malawi's administrative divisions include
districts, traditional authorities (TA), and local government wards. - Mod.AS]

The cow, according to veterinary officials, died early this month
[September 2008] after showing rabies symptoms and members of the
community were told to dispose of the animal but they instead started
selling it.

Mulanje District health officer John Chipolombwe said since last week
[week of 15 Sep 2008], about 800 people have received anti rabies
vaccine but there are more who have not yet received the vaccine.

"We have treated about 800 people and it is possible for the figures
to go up. We are here to sensitise the people that those who took the
meat should receive the vaccine," he said.

Chipolombwe further said the hospital was expected to spend about
Malawian Kwachas [MWK] 8 million [approx. USD 56 560] to treat the
affected persons, although it would be challenging to complete the exercise.

"Vaccine for people costs about MWK 9000 [approx. USD 64] and to
treat these is going to cost millions. The main challenge is that
most of these people are old while others are young and cannot manage
to come to the hospital so we have to travel to nearest points where
we can administer the vaccine," explained Chipolombwe.

District animal health and livestock officer Stanford Muyira said
after observing the symptoms they concluded that it was rabies and
warned the people against eating meat from the cow.

"However, we were surprised that some few guys decided to sell the
animal," he said.

Muyira said they suspect that the cattle was either bitten by a rabid
dog or cat or had eaten something that was affected by rabies [the
latter is unlikely. - Mod.AS]

According to Muyira, after inspecting the [dead] animal, veterinary
officials took a sample to a laboratory for a postmortem where it was
discovered that the animal died of rabies.

[A woman] said her son ate the meat from her neighbours while some
bought it at MWK 10 [approx. USD 0.07] a piece and others exchanged
[for it] pegion peas, dried cassava (makaka), and maize. "My son has
now a sore leg and I could not take [him] to hospital because it is
far. Apart from that, my husband and mother also ate the meat and I
have to take care of them as well," she said.

[Byline: Caroline Kandiero]

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

[Rabies could only be contracted by penetration of the epidermis via
a wound or similar lesion. Rabies virus can replicate to a limited
extent in muscle tissue, but to do damage it must access neural
tissue via the acetylcholine neurotransmitter. Rabies virus only
propagates to high titres in neural tissue and salivary gland tissue.
Rabies virus is heat and acid sensitive, so the risk of infection via
cooked or uncooked meat would be negligible, although it could not be
excluded. - Mod.CP

Similar situations, in Bolivia and Belarus, have been reported in
earlier ProMED-mail postings (see references below). The case in
Bolivia, in 1999, was thoroughly discussed by Mod.TG and by a
correspondent. Subscribers are encouraged to visit the said posting,
Rabies, bovine, eaten - Bolivia 19990820.1445.

According to internationally prevailing meat-inspection guidelines,
rabid food animals are to be totally condemned. The main risk related
to such animals is the exposure of those involved in their
transportation and handling, particularly butchers, to the infected
tissues and saliva. Veterinarians may be exposed to infection while
approaching a bovine for diagnostic mouth and throat palpation, since
rabid cows are sometimes suspected by owners to suffer from throat
obstruction (such as by potatoes and similar objects).

The view of international public health authorities on the need to
apply rabies post-exposure prophylaxis (PEP) in consumers of such
meat will be useful. - Mod.AS

Mulanje District, in the Southern region of Malawi, can be located on
the map at
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>.
The HealthMap/ProMED-mail interactive map of Malawi can be accessed at
<http://healthmap.org/promed?g=925788&v=-16,35.583,5>. - CopyEd.MJ]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (38 )
**********************************************
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] Cholera - Benin (Bourgou)
[3] Cholera - Ghana (Greater Accra)
[4] Cholera - Guinea-Bissau
[5] Diarrhea - Kenya (Coast Province)
[6] Cholera - Nigeria (north)
[7] Cholera - Congo DR (North Kivu)

******
[1] Cholera - Uganda (Kampala)
Date: Mon 29 Sep 2008
Source: The New Vision [edited]
<http://www.newvision.co.ug/D/8/13/652203>


Mulago Hospital has set up a cholera isolation unit after confirming
an outbreak of the disease in some parts of Kampala. 2 cholera
victims from Kinawataka-Katogo zone in Nakawa division were treated
at the unit yesterday [28 Sep 2008].

Dr Joseph Senzoga said 29 cases had been reported from the area.
Since the outbreak 2 weeks ago, 3 people have been reported dead.
Senzoga attributed the outbreak to poor water supply and poor
sanitation in the slum, located in a swampy area.

"Residents draw water from a shallow well. There is only one communal
toilet which serves a big population in the area," Senzoga said. He
said they had contacted the National Water and Sewage Corporation to
reconnect the area, whose water supply was cut off.

Cholera usually hits the city during the rainy season. The most
affected areas are Kawempe, Kisenyi, Kamwokya, and Kalerwa.

[Byline: Florence Nakaayi]

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

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

******
[2] Cholera - Benin (Bourgou)
Date: Sun 28 Sep 2008
Source: Afrique en Ligne [edited]
<http://www.afriquenligne.fr/40-cholera- ... 13023.html>


Sources close to Benin's Public Health ministry told PANA [Panafrican
News Agency] Sunday [28 Sep 2008], 40 cholera cases have been
reported in Malanville, northeastern Benin, close to Niger. All the
reported cases are already being treated free of charge.

The World Health Organization (WHO) recently presented treatment kits
worth CFAF 17 million [USD 36 442] to Benin, which has set aside CFAF
211 million [USD 452 184] to efficiently control the pandemic. Under
the budget, clean drinking water would be provided in the affected
areas, solid waste dumps destroyed and the environment cleaned up.

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

[Malanville is in the Bourgou province of Benin in extreme northern
Benin bordering Niger. It can be found on a map at
<http://www.mapsofworld.com/benin/maps/benin-map.jpg>. - Mod.LL]

******
[3] Cholera - Ghana (Greater Accra)
Date: Thu 25 Sep 2008
Source: My Joy Online, Ghana News Service report [edited]
<http://news.myjoyonline.com/health/200809/20990.asp>


Ghana Health Service (GHS) on Thursday [25 Sep 2008] cautioned the
general public of a cholera outbreak in the Accra metropolis. In a
statement issued in Accra by Dr Irene Agyepong, regional director of
health service, the GHS advised the public not to panic when struck
by the disease but rather quickly attend the nearest health centre
for free treatment, take in plenty of water or oral rehydration
solution to control it.

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

[Accra in the Greater Accra is in southern Ghana and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /ghana.pdf>. - Mod.LL]

*****
[4] Cholera - Guinea-Bissau
Date: Sun 24 Sep 2008
Source: World Health Organization (WHO) Epidemic and Pandemic Alert
and Response (EPR) disease outbreak news [edited]
<http://www.who.int/csr/don/2008_09_24/en/index.html>


Guinea-Bussau: cholera
----------------------
Since the beginning of May 2008, Guinea-Bissau has been facing a
large cholera outbreak. As of 21 Sep 2008, 7166 cases had been
reported throughout the country, among whom 133 people had died. The
overall case-fatality rate stands at 1.9 percent, and decreases below
1 percent for hospitalized cases. However, the case-fatality rate
reaches 9 percent in remote areas, indicating that rural populations
affected by cholera do not have access to treatment rapidly enough to
save lives. The fact that Bissau, the capital, accounts for more than
70 percent of all cases but only 31 percent of deaths also
illustrates this issue.

The areas with the highest attack rates are Bissau, Biombo, Bijagos,
and Oio. Cholera epidemics regularly resurge in Guinea-Bissau. In
2005-2006, cholera affected 25 111 people and killed 399.

WHO does not recommend any restrictions to travel or trade to or from
affected areas as a means to control the spread of cholera.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[A map of Guinea-Bissau showing the mentioned areas can be found at
<http://www.un.org/Depts/Cartographic/ma ... ineabi.pdf>. - Mod.LL]

******
[5] Diarrhea - Kenya (Coast Province)
Date: Thu 25 Sep 2008
Source: All Africa, The Nation (Nairobi) report [edited]
<http://allafrica.com/stories/200809250172.html>


Health officials said residents relied on contaminated water from a
local pan near Malomani primary school in Malomani sub-location,
which they shared with their livestock.

An official at Ganze Health Centre, who requested anonymity, told
Kilifi district commissioner John Elungata that there had been an
upsurge in the number of cases of diarrhoea.

"At least 30 cases have been reported at the health centre after
residents of Malomani, Mitsenzini, Ganze, Migodomani, and Dungicha
villages came to seek treatment," he said. "People are coming from
different villages for treatment complaining of diarrhea and stomach
pains."

"A majority of affected youths have been passing urine mixed with
blood, indicating they are suffering from bilharzia
[schistosomiasis]," the officer said.

The DC urged the Ministry of Health to dispatch a medical team to
investigate the cases before the situation worsens. He also advised
residents to boil water before drinking it.

"I am asking the ministry of Public Health to supply purification
tablets as well as chlorine powder to treat drinking water in the
affected areas," Mr Elungata said.

The DC [district commissioner] said the Department of Arid and
Semi-Arid Lands would dig separate water pans for the residents and
their livestock in various parts of the constituency.

Ganze constituency is a semi-arid area in Kilifi District, and has
been experiencing perennial water shortages. Residents mostly depend
of water pans and ponds that collect water during the rainy season.

[Byline: Walker Mwandoto]

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

[Kilifi District is an administrative district in the Coast Province
of Kenya. Its capital is the coastal town of Kilifi. The district is
located north and northwest of Mombasa. It can be found in
southeastern Kenya on a map at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

******
[6] Cholera - Nigeria (north)
Date: Fri 22 Sep 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), Integrated Regional Information Networks (IRIN) News [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Local government officials say cholera outbreaks across Katsina,
Zamfara, Bauchi, and Kano states in northern Nigeria have killed 97
people in the past 2 weeks, making it the worst outbreak in the north
for several years, according to an official from National Primary
Healthcare Agency (NPHA) in Abuja.

More than 60 people have died in Zamfara state in the past 2 weeks,
according to Tukur Sani Jangebe, Zamfara's state commissioner for
religious affairs.

"It is quite alarming and it is quite unusual for northern Nigeria.
If up to 100 people have died from cholera in just 2 weeks, you can
only imagine how many more are affected by the disease," an official
from the government-run NPHA who requested anonymity, told IRIN.

Jangebe said the death toll may be higher as reports of new
infections are still coming in.

In Katsina state in the villages of Makadawa and Kagadama, 20 people,
mostly women and children, have died while 30 others have been
hospitalized according to local government chairman Masur Usman
Murnai. Another 9 people have died in Nabardo village in Bauchi state
since 13 Sep [2008], with 40 more affected, according to Garba Sale,
a primary health care coordinator. Kano State's health commissioner
Aisha Isyaku Kiru told IRIN 5 people have died of cholera in the
state within the past week.

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

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

******
[7] Cholera - Congo DR (North Kivu)
Date: 30 Sep 2008
Source: Caritas [in French, trans. & summ. JW, edited]

17 dead out of 116 cases of cholera among displaced
---------------------------------------------------
Due to limited access due to insecurity, no humanitarian mission could
go to Ngungu during last week [of 22 Sep 2008], where 116 cases of
cholera have been reported, with 17 dead, among 25,000 displaced
people in the camp located about 60 km west of 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. -- see ProMED archive 20080602.1764 Cholera,
diarrhea & dysentery update 2008 (27) below. - Mod.JW

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

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

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

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION
************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 5 Oct 2008
Source: News24, South Africa
<http://www.news24.com/News24/South_Afri ... 06,00.html>


Health scare in Gauteng
-----------------------
3 people have died following cases of an infectious disease in
Johannesburg, the Health Department said on Sunday [5 Oct 2008].

"We are on high alert following the confirmation of 3 cases of an
unknown highly infectious disease which has since led to 3 deaths,"
said the department in a statement.

According to the department the 1st patient was a female from Zambia
who was critically ill when she arrived on [12 Sep 2008] in South
Africa. She was treated for tick-bite fever and other potential
infections at Morningside Medi-Clinic. "2 days later she died. Blood
samples were taken and the results
were not conclusive of any particular disease including the viral
haemorrhagic fevers."

Flu-like symptoms
-----------------
The 2nd patient was a Zambian male paramedic who had accompanied the
1st patient. He was admitted on [27 Sep 2008] at the same facility
with flu-like
symptoms and treated for a variety of infections. "His condition
initially improved, but later deteriorated on Wednesday, [1 Oct 2008]
and he died the following day [2 Oct 2008]."

Investigations for viral haemorrhagic fever and other formidable
infectious diseases were conducted and the results came out negative.

A nurse at Morningside Medi-Clinic who came into contact with the 1st
patient became ill with flu-like symptoms and was subsequently
admitted to Sir Albert Robinson hospital in the West-Rand on Wednesday
[1 Oct 2008]. "Her condition deteriorated on Saturday [4 Oct 2008]
and she passed away today (on Sunday [5 Oct 2008]). Viral haemorrhagic
fever and other formidable infectious diseases were negative."

Healthcare workers monitored
----------------------------
According to the department, systems were in place to follow up on
everyone with whom the deceased had had contact.

Healthcare workers and family members were being monitored for raised
temperatures and flu-like symptoms for a period of 21 days.

"Steve Biko Academic and Charlotte Maxeke Academic hospitals are on
high alert and ready to handle any cases related to this situation."

Members of the community with travel history to Zambia during the
last month and who suffer from raised temperatures or flu-like
symptoms are requested to report to the nearest health facility for a
medical examination or contact Dr Chika Asomugha on 082 330 1490.

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

[From the above description of the illness, it is difficult to develop
a narrow differential diagnosis -- a disease that is a febrile disease
with flu-like symptoms that is apparently highly fatal, occurring in
Africa has one immediately thinking about the possibility of a viral
hemorrhagic fever (even though hemorrhagic symptoms were not
specifically mentioned in the newswire). As one of the world's top
reference laboratories for viral hemorrhagic fevers is located in
South Africa, the information that testing for the known hemorrhagic
fevers gave negative results means one can comfortably remove the
known hemorrhagic fevers from the differential diagnosis list.

From the above description of the dates of onset, it appears the
disease has an incubation period of between 2 and 4 weeks. The mode
of transmission is not clear (respiratory vs contact with bodily
fluids).

One might suspect that it is contact with bodily fluids, [because if
respiratory] one might have expected to see more cases by now (with 3
generations of cases most likely described in the above newswire).
However, on reviewing ProMED-mail archives, in November 2007 there was
an outbreak of presumed pneumonic plague in Southern Zambia. Borrowing
from ProMED-mail Mod.LL's comment at that time, "Patients with primary
pneumonic plague generate large quantities of infectious aerosols that
pose a significant risk to close contacts. CDC (US Centers for Disease
Control and Prevention) guidelines identify contacts within 2 meters
(6.5 feet) as being at greatest risk and do not consider the organism
likely to be carried through air ducts or vents." (see ProMED-mail
posting Undiagnosed deaths - Zambia (02): pneumonic plague susp.
20071130.3862). Of note is that the incubation period for plague is 1
to 14 days, possibly shorter than noted in the above given dates of
onset of the 3 cases.

A review of all ProMED-mail prior postings on events in Zambia
revealed the overwhelming number of reports were related to
veterinary outbreaks (such as foot & mouth disease, contagious bovine
pleurpneumonia and swine fever), the next most common reports were of
zoonotic diseases affecting both human and animal health (anthrax,
rabies, plague), and next, person to person or food and waterborne
transmitted diseases (measles, cholera, diarrhea). There was one
scare of a possible hemorrhagic fever outbreak but it was ruled out as
attributable to 3 different diseases -- schistosomiasis, gum disease
and pneumonia. (see prior ProMED-mail posting Re: Ebola - Zambia?
19950626.0458).

ProMED-mail would greatly appreciate receiving more information on
these cases from knowledgeable sources in the region.

For a map of Zambia, see
<http://www.lib.utexas.edu/maps/africa/zambia_pol01.jpg>.
For a map of South Africa, see
<http://www.lib.utexas.edu/maps/africa/s ... l_2005.jpg>.

For the interactive HealthMap/ProMED map of Zambia with links to
recent ProMED-mail postings on events in Zambia and surrounding
areas, see <http://healthmap.org/promed?v=-14,27.8,5>. Of note,
recent ProMED-mail reports on events in Zambia have been about
outbreaks of anthrax, cholera and diarrhea.]

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (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>

[1]
Date: Mon 6 Oct 2008
Source: South African Broadcasting Corporation News online [edited]
<http://www.sabcnews.com/south_africa/he ... 844,00.htm>


A 4th person with viral haemorragic fever (VHF) symptoms has died.
The virus has already claimed the lives of a Zambian national and 2
other people at the Morningside Clinic in Johannesburg. The woman was
a cleaner at the clinic.

The National Health Department has issued an alert in Gauteng
following these deaths. Unconfirmed tests indicate they may have died
of [a] fatal viral haemorragic fever. An Outbreak Response and
Tracking Team has been set up to contain any further spread. The
department's Zanele Mngadi says investigations are still underway
into the cause of the deaths.

Mngadi confirmed the death of the 4th person, who was admitted at the
Leratong hospital last night [5 Oct 2008]. The patient, who showed
symptoms of VHF, was transferred to the Charlotte Maxeke Johannesburg
Academic Hospital, where she died. The health department says there
is no need for South Africans to panic. The department's Frew Denson
says the fever is highly contagious but is only transmitted through
body fluids.

It is reported that the virus can kill a person within 72 hours. VHF
is an extremely infectious and life-threatening disease caused by
[several different] viruses, including Ebola virus. The death rate
[in the case of Ebola virus] can be as high as 90 percent. Symptoms
vary but include fever, vomiting, diarrhea and bleeding.

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

******
[2]
Date: Mon 6 Oct 2008
From: Amy Cantlay <inka@iwayafrica.com>


I have just read the posting (Undiagnosed fatalities - South Africa
ex Zambia: RFI 20081005.3139) on your site, and it appears to be
rather misleading. The chronological order of events (as I can
gather) is as follows (None of this information has yet been confirmed.):

4 Sep 2008 - Index Case - female South African, (living in Zambia for
many years) begins to suffer from flu-like symptoms.

9 Sep 2008 - She is slowly deteriorating. She sees multiple doctors in Lusaka.

11 Sep 2008 - She is admitted to hospital and deteriorates over night.

12 Sep 2008 - Paramedic is called in to evacuate her to South Africa.
He does the transfer, along with another Dr assisting.

13 Sep 2008 - Index Case dies.

14 Sep 2008 Paramedic starts to develop flu-like symptoms.

14-27 Sep 2008 - Paramedic slowly deteriorates.

27 Sep 2008 - Paramedic is diagnosed as very sick and medivaced to
South Africa. Nurse who treated Index case begins to get flu-like symptoms.

30 Sep 2008 - Paramedic dies.

1 Oct 2008 - Nurse who treated Index Case is admitted to hospital.

5 Oct 2008 - Nurse who treated Index Case dies.

The information that I can gather is the following:

1. Incubation period is as little as 2 days (paramedic), but as long
as 14 days (nurse).

2. Disease course is generally 4-7 days of flu-like illness with
patient only becoming critically ill in 2nd week of disease.

3. Further information is that Index Case reportedly had an eschar on
one of her feet, thought to be from a tick-bite. She had also been in
contact with horses from Congo in the weeks preceding her illness.
Transmission is hypothesized to be by 2 means: tick-borne 1st (which
may have brought the disease into the human population from the
animal population) followed by direct contact with bodily fluids
(resulting in human to human transmission).

4. It appears further hospital staff are now critically ill in
Zambia, though this has not been confirmed.

5. If the incubation period is as long as 2 weeks, then we should
still be closely watching all "contact-cases" for any signs of the
disease. Those in contact with the Index case should be in the clear
by now, while those in contact with the paramedic and the nurse (as
well as any hospital staff who are currently sick) are still at high
risk. One should probably work on a 21-day incubation
period/quarantine period to be safe.

6. Chances are this is a new virus (or new subtype of virus) in the
[family _Filoviridae_]. The only 2 known viruses in this group are
Ebola and Marburg. It looks as though [the infection] may have
entered Zambia from the Democratic Republic of the Congo (DRC)
through a tick (carried on a horse), but again this cannot be confirmed.

This comment assumes that labs in South Africa have already tested
all known VHFs. It is unlikely to be pneumonic plague, as this would
have been discovered in South Africa; however, it is still a
possibility that this [putative] viral disease has been in the
Southern Province of Zambia (and that the 4 reported cases seen there
were not diagnosed or wrongly called pneumonic plague).

7. The important steps in control are 1. effective quarantine of sick
patients, and 2. monitoring of all "in-contact" cases, with
quarantine as soon as any signs of flu or fever are noted. The
government should also ideally make a statement to calm the panic and
prevent people from fleeing the capital (potentially carrying the
disease countrywide). This disease only spreads to people who are in
very close contact with sick individuals. Those family members who
are potentially incubating the disease should be encouraged to stay
around Lusaka, so that signs can be picked up quickly and treatment
issued rapidly. Early treatment of most "viral hemorrhagic fevers"
with ribavirin has been proven to reduce the fatality rate
significantly. The country needs to import ribavirin if there is not
enough in stock.

--
Communicated by:
Dr Amy Cantlay BVSc.MRCVS <inka@iwayafrica.com>
Veterinarian
Mkushi, Zambia

[ProMED-mail thanks Dr. Cantlay for her commentary, which contributes
some interesting detail. At this point, it would not be useful to
speculate further on the identity of the infectious agent responsible
for the deaths of the 4 Zambian patients. No doubt a firm diagnosis
will be available shortly from a South African reference laboratory.
Several different viruses cause viral hemorrhagic fever. Of these,
Ebola, Marburg, Lassa or Crimean-Congo hemorrhagic fever viruses have
not been recorded in Zambia up to the present. A comprehensive
account of these and other viruses responsible for hemorrhagic fevers
can be found at the US CDC website:
<http://www.cdc.gov/ncidod/diseases/virlfvr/virlfvr.htm>.

A map of Zambia can be accessed at
<http://www.lib.utexas.edu/maps/africa/zambia_pol01.jpg>,
and a map of South Africa at
<http://www.lib.utexas.edu/maps/africa/s ... l_2005.jpg>.
- Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (39 )
**********************************************
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 (North Kivu)
[2] Cholera - Nigeria (Kaduna)
[3] Cholera - Nigeria (Sokoto)
[4] Cholera - Senegal (Kaolack)

******
[1] Cholera - Congo DR (North Kivu)
Date: Fri 3 Oct 2008
Source: International Herald Tribune (IHT), Associated Press (AP)
report [edited]
<http://www.iht.com/articles/ap/2008/10/ ... holera.php>


Medical officials say 37 people have died in 2 weeks from a cholera
outbreak in camps for those fleeing fighting in eastern Congo.

Regional medical inspector Dominique Bahago says at least 300 people
have been infected by the outbreak around the village of Ngungu,
about 100 kilometers (60 miles) northwest of the regional capital of Goma.

Bahago says at least 25 000 people are living in 2 makeshift camps in
the area, which is near UN peacekeeping positions.

Bahago says there has not been enough water for the surge of people
and that continuing fighting in the region has kept the government
from getting to the camps.

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

[The area is in the North Kivu district and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[2] Cholera - Nigeria (Kaduna)
Date: Tue 7 Oct 2008
Source: Leadership Nigeria [edited]
<http://www.leadershipnigeria.com/produc ... 2eef556b64>


Following an outbreak of cholera in Zonkwa, headquarters of Zangon
Kataf local government area of Kaduna State, about 9 persons have
reportedly lost their lives within one week.

Leadership source, Kabiru Hassan, said the number might have
increased, saying "We have been receiving reports about deaths [from]
cholera and we are calling on the authorities to expedite action, so
that it will come to an end."

[Byline: Samuel Peter Aruwan]

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

[The north central state of Kaduna can be found on a map of Nigeria at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

******
[3] Cholera - Nigeria (Sokoto)
Date: Fri 3 Oct 2008
Source: AllAfrica, Daily Trust (Abuja) report [edited]
<http://allafrica.com/stories/200810030134.html>


No fewer than 21 people have been reported dead in some villages in
Kware and Wamakko local government areas of Sokoto State. The
breakdown from health officials in the affected local government
areas shows that 14 people died in Kware while 7 died in Wamakko
local government area.

Briefing newsmen in Maruda village of Kware local government, the
health official in charge of a camp created for victims in the area,
Malam Aliyu Amadu, said 13 children and an adult died from the
disease while the director of health in Wamakko local government,
Malam Abubakar Mohammed Kaura, confirmed the death of 7 people in the area.

Meanwhile, the state commissioner of information Malam Dahiru
Maishanu has confirmed that only 2 people lost their lives at the
hospital "and that is the only figure we have officially but I am not
overruling a number of deaths outside the hospital."

The commissioner said the outbreak was reported in 12 local
government areas of the state "but only 3 are now having reported
cases." The 3 local governments are, Kware, Dange Shuni, and Wamakko.

[Byline: Aminu Mohammed]

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

[Sokoto is in extreme northwestern Nigeria bordering with Niger and
can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

******
[4] Cholera - Senegal (Kaolack)
Date: Sat 4 Oct 2008
Source: Walf Fadjri [in French, trans. & summ. Mod.LL, edited]
<http://www.walf.sn/societe/suite.php?rub=4&id_art=49896>


A cholera outbreak has been newly declared in villages of Ndoffane
and Kaffrine, which have respectively recorded in recent days 14 and 2 cases.

The last figures noted within the 2 villages, add to the overall
number of now 481 since July 2008. The persons affected are in the
health region of Kasnack in Kaolack.

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

[The area is in the Kaolack region as can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... enegal.pdf>. - Mod.LL]

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

Guinea - Gelbfieber
06.10.2008

Aus der Stadt N’zerekore wird ein Ausbruch von urbanen Gelbfieber gemeldet. Seit Ende August wurden 2 Fälle bestätigt, bei weiteren 14 Patienten besteht die Verdachtsdiagnose. Im Oktober ist eine großangelegte Impfkampagne für ca. 140.000 Einwohner geplant Die Gelbfieberimpfung ist bei Einreise gesetzlich vorgeschrieben. / Quelle: crm

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (03)
****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Tue 7 Oct 2008
Source: IOL, Health [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 304C470799>


Cleaner's supervisor isolated
-----------------------------
At least 9 people have been isolated or put under observation after
the deaths of 4 people from a mystery disease. On Monday [6 Oct
2008], health authorities finally traced the families of [patient A],
37, from Slovoville, who died on Sunday night at Charlotte Maxeke
Johannesburg Academic Hospital, and nursing sister [patient B], 34,
of Westonaria, who died on Saturday. [Patient A] was a cleaner and
[patient B] a nurse, and both had contact with the 1st victim. In a
dramatic development on Monday afternoon [patient A]'s supervisor
went to Chris Hani Baragwanath hospital and was put in an isolation ward.

Zanele Mngadi, spokesperson of the Department of Health, said the
woman checked herself in at the hospital yesterday after hearing
about [patient A]'s death. The woman told the hospital staff that she
had been feeling ill for a few days, had flu-like symptoms as well as
fever. "Her blood samples have been taken and we are waiting for the
results," Mngadi said. At the moment, the only people who have
access to her are medical staff in protective gear.

Morningside Medi-Clinic spokesperson Melinda Pelser said the disease
had been identified as a viral haemorrhagic fever, the exact strain
had not been identified as tests for Ebola, [Crimean-]Congo fever and
other likely possibilities had all returned [out] negative. "Congo
fever is most likely the suspect, and a viral haemorrhagic fever is
high on the list," said Dr. Lucille Blumberg, of the National
Institute for Communicable Diseases (NICD). Blumberg said tests on
samples from victims were continuing, but the fact that the 1st
person to be infected came from Zambia meant that of all the
haemorrhagic fevers, [Crimean-]Congo was the most likely. The Congo
fever virus is carried by a species of tick and is found throughout
Southern Africa.

"They haven't had Ebola or Marberg outbreaks in Zambia, and you even
get Congo fever here in South Africa," explained Blumberg. She said
that so far there were no other known cases of the mystery illness in
Zambia. "What we are doing is following the trail of possible
exposure, looking for contacts that person had, trying to find the
pieces of the puzzle."

National Health Department spokesperson Fidel Hadebe said the
department could not confirm speculation linking the deaths to
haemorrhagic fevers. The NICD is conducting a battery of tests, some
of which could take days to complete. The priority, explained
Blumberg, was to isolate the patient. Samples might be sent to the US
for further tests.

Symptoms have included flu-like illness, fever, diarrhoea, rash and
bleeding. Health authorities urged people not to panic and warned
those who developed such symptoms who had been in Zambia, or had
contact with the deceased, to get help.

The 1st victim was tourism operator [patient C], 36, who was flown to
the Morningside clinic on 12 Sep 2008 from Zambia in a critical
condition after being ill for 3 weeks. She died 2 days later. On 27
Sep 2008, the paramedic who had flown with her from Zambia, [patient
D], 33, of Speciality Emergency Services in Lusaka, returned to South
Africa and was admitted to the Morningside clinic with similar
symptoms, said Morningside manager Jaco Erasmus. [Patient D] died on
2 Oct 2008. Dr. Nivesh Sewlal, who was treating [patient D] at the
Morningside clinic, said he had diarrhoea, high fever and a rash.
Blood samples were taken from [patient D] and [patient C], 36. "The
results have been negative for viral haemorrhagic fever. However,
they have died of what of what seems to be a viral illness," Sewlal said.

The NICD was alerted last Monday night and began investigating a
possible outbreak of West Nile haemorrhagic fever. By then, 2 people
who worked at the Morningside clinic had fallen ill -- but they ended
up in hospitals that did not know they had been in contact with
someone who had died from an unknown infectious disease. [Patient B]
fell ill on October 1 and was admitted to a general ward with 4 other
patients at Sir Albert Robinson Hospital on the West Rand. She had
not told the Sir Albert Robinson Hospital she was ill, but it was
only the following day before Morningside alerted the hospital to the
problem and [patient B] was put in isolation. She died on Saturday.
Sir Albert Robinson spokesperson Marion van der Walt said 8 people,
including staff who had contact with [patient B], were put in
isolation for observation. "We're confident that none of those
patients were affected," Van der Walt said.

By then, Morningside clinic was trying to trace all staff who had
contact with [patient C] or [patient D]. The clinic and Health
Department emphasised [patient A] had been ill for months before she
had ever been in contact with [patient C]. Pelser said there was "a
very low possibility", that her case was linked to the others.

[Byline: Louise Flanagan, Solly Maphumulo, Shaun Smillie, Botho
Molosankwe, Gill Gifford]

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

******
[2]
Date: Tue 7 Oct 2008
From: Janusz Paweska, Lucille Blumberg, Jackie Weyer, Robert Swanepoel
National Institute for Communicable Diseases, South Africa
<lucilleb@nicd.ac.za>


Outbreak of an acute disease in South Africa, ex-Zambia
-------------------------------------------------------
An outbreak of an, as yet, unknown disease has been identified in
South Africa. To date there have been 4 probable cases, all of whom
have died. The index case was a Zambian national, resident in Lusaka
who had close contact with horses and a history of possible tick
exposure. The subsequent 2 patients had close contact with the index
case patient in a healthcare setting: a paramedic involved in her
medical evacuation to South Africa and an intensive care nurse in
Johannesburg. These 2 patients became ill approximately 7 days after
exposure to the index case. Clinical and laboratory features common
to all 3 patients include a prodromal illness of approximately 7 days
with (38oC), a morbilliform rash in 2 patients, thrombocytopaenia and
mild hepatic dysfunction in 2 patients. An initial improvement was
reported in the 2 latter patients, and all 3 patients had a sudden
and marked deterioration in mental state, rhabdomyolysis in one case,
and evidence of acute and severe hepatic necrosis. Bleeding was not a
marked clinical feature although oozing from venepuncture sites was
noted as well as a petechial rash in one patient. Blood cultures to
date have been negative. Tests for viral haemorrhagic fevers (VHFs)
including Ebola, Marburg, Crimean-Congo haemorraghic fever (CCHF),
Hantaviruses, Rift Valley fever virus and Lassa fever virus, are
negative to date. No further secondary cases have been identified and
there is no indication of similar cases occurring in Zambia. It seems
likely that this is an isolated case with secondary transmission in
the nosocomial setting. Given the high mortality, nosocomial
transmission and clinical presentation, a viral haemorrrhagic fever
remains possible.

Laboratory testing for VHFs has been conducted by the Special
Pathogens Unit at the National Institute for Communicable Diseases
(NICD). Multiple nucleic acid and antigen detection assays as well as
serological tests have been negative for CCHF, Ebola, Marburg, Lassa
fever, Hantaviruses and Rift Valley fever virus. The final results
for viral culture in animal and cell cultures are pending. Only
specimens from Cases 2, 3 and 4 were available for testing. The index
case has been given a diagnosis of "tick-bite fever" and no specimens
were available for testing (she died shortly after arrival in SA).
Negative results to date may be explained by several factors. These
could include; the timing of collection (taken late - day 10 of
illness), virus variants not detected by current molecular and
serological assays. All contacts of cases, including healthcare
workers and laboratory staff are under surveillance and are all currently well.

--
Janusz Paweska, Lucille Blumberg, Jackie Weyer, Robert Swanepoel
National Institute for Communicable Diseases
Private Bag X4
Sandringham 2131
South Africa

[The 1st report tends to the view that that one or more of the 4
fatalities may be a consequence of infection by Crimean-Congo
haemorrhagic fever virus, although this preliminary diagnosis has not
been supported by laboratory tests. There are now 9 people under
observation, but not all may be suffering from the same illness. Also
it is not yet clear that the 4 fatalities have been caused by the
same agent. No more cases have been reported in Zambia.

The 2nd authoritative report from the South African National
Institute for Communicable Diseases reviews in detail the current
status of laboratory diagnosis, which has yet to confirm the identity
of the agent involved. It is concluded that Crimean-Congo
haemorrhagic fever virus, or another uncharacterised haemorrhagic
fever virus may be responsible. It seems likely that this incident
can be interpreted as is an isolated case with secondary transmission
in a nosocomial setting. Unfortunately no clinical sample from the
index case is available, which complicates the task of identifying
the causative agent.

A map of Zambia can be accessed at
<http://www.lib.utexas.edu/maps/africa/zambia_pol01.jpg>,
and a map of South Africa at
<http://www.lib.utexas.edu/maps/africa/s ... l_2005.jpg>. - Mod.CP]

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (04)
****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 7 Oct 2008
Source: The Star, South African Press Association (SAPA) report [edited]
<http://www.thestar.co.za/?fSectionId=49 ... 216C145841>


About 121 people who came into contact with 3 people who died of an
unknown kind of viral haemorrhagic fever remain under observation
although all appear fine, Joburg [Johannesburg] doctors said on
Tuesday [7 Oct 2008].

Doctor Lucille Blumberg of the National Institute of Communicable
Diseases said while the illness was currently "controlled," doctors
would have to wait for 21 days before they could possibly declare it
contained. Twenty-one days is the period doctors believe the illness
could still move from exposure to incubation to manifestation.

A list of 121 people who came into contact with the deceased has been
compiled and those people were having their temperatures taken every
6 hours for the 3-week period. "If we are not sure of their symptoms
we will put them in isolation to evaluate," said treating doctor
Nivesh Sewlall.

On 12 Sep 2008, a 36-year-old woman was airlifted from Zambia to the
Morningside Medi Clinic in Sandton. She was treated for tick bite
fever and other potential infections, but died 2 days later. A
Zambian paramedic who accompanied her into the country died last
week, and a nurse at the clinic died on Sunday [5 Oct 2008]. On
Tuesday, Sewlall said of those being observed, 6 people had been
taken to hospital but 4 had already been discharged. A 51-year-old
cleaning supervisor who was admitted to Chris Hani Baragwanath
hospital with symptoms of the illness was also ready to be discharged
on Tuesday. Blumberg said her blood tests had come back clear and she was fine.

The 11-year-old son of a nurse that passed away, and his 23-year-old
nanny, were still being kept in hospital although neither displayed
any symptoms. "He is fine, but it is a traumatic time and it's more
for trauma counselling," said Sewlall. His nanny had initially
displayed a marginally high fever, but was now fine, with her blood
test normal.

Doctors said while the recent death of a cleaning staff member at the
Morningside Medic-Clinic was probably not related to the other deaths
at the hospital, they could not disregard anything at this stage.
"Scientifically we can not exclude anything until we get to 21 days,"
said Sewlall.

Sewlall and other medical officials held a news conference at the
Morningside Medi-Clinic on Tuesday [7 Oct 2008], because they said
they wanted to dispel misconceptions and panic around the illness.
Intensive care specialist professor Guy Richards said: "The public at
large are not at risk, only those with direct exposure to the 3
cases." Morningside Medi-Clinic Gauteng marketing manager Melinda
Pelser said: "This hospital is at no risk, this is where there is a
huge misunderstanding. You cannot contract the illness through air,
[you cannot contract it] unless you have had direct contact with a
patient mostly though blood, stool, and urine. We don't want panic out there."

Blumberg said there was also no outbreak of the illness in Zambia
itself and there was no risk of contracting the disease through
travel to Zambia. Sewlall said the idea that it was a disease that
doctors had never heard of and knew nothing about was incorrect.
Blumberg said: "We don't have a diagnosis as yet. It is a viral
haemorrhagic fever but we don't know what caused it." Not knowing the
cause made no difference to how patients were managed, said Richards.
"Treatment is not harmed by the fact it has not been identified."
Blumberg said various tests were being done but these could take some
time. Her institute was also collaborating with the US Centres for
Disease Control (CDC).

On Tuesday [7 Oct 2008] the World Health Organisation (WHO) said it
had flown in a laboratory expert and a disease surveillance expert to
help the South African health authorities determine the illness.
Blumberg said the 1st victim, a tourism operator, probably contracted
the illness in Lusaka [Zambia]. She lived on the outskirts of the
city in a place where there were horses and exposure to ticks.
Sewlall said she was ill for about 10 days before coming to [South
Africa] and did have a tick bite but had not identified a specific
incident of when she got ill. Sewlall said all precautions had been
in place such as masks and gowns for the nurse who contracted the illness.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This report reinforces the interpretation that this is an isolated
incident stemming from a single case of an as yet unidentified 'tick
fever virus' infection contracted in Zambia and spread by nosocomial
infection in South Africa. No further cases have been recorded in
Zambia and the nosocomial spread in South Africa has been contained.
Precise identification of the tick fever virus is pending.

The HealthMap/ProMED-mail interactive map of Zambia, showing the
location of Lusaka, can be accessed at
<http://healthmap.org/promed?v=-14,27.8,5>. - Mod.CP]