Wüstenschiff

LUNGENPEST - MADAGASCAR: (TOAMASINA)
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Date: Thu 23 Oct 2008
Source: L'Express de Madagascar (Antananarivo)
[in French, trans. & summ. Mod.JW, edited]
<http://fr.allafrica.com/stories/200810230719.htm>


Morarano village, 40 km east of Moramanga, has been hit by the
plague; 3 persons of the same family have died in recent days and
4 people died one by one of plague in Ambohidray station, a rural
commune of Morarano in the district of Moramanga, according to the
declaration of death made to basic health center (CSB) Level II,
Morarano.

A 20-year-old was the 1st victim on 6 Oct 2008. He caught the disease
while keeping his parents' cattle in the field at Ampasimbe, a village
which is located 15 km from the town. Field rats, common in this
region, are the reservoir of the disease. In ignorance of the cause
of the death, he was buried in the family vault.

The alert was triggered by learning of the death of the father 2 days
later. The mother also soon died. The test strip to confirm that it was
the plague was positive. She presented symptoms of pneumonic plague
-- cough with bloody sputum -- said Dr Mamitiana Raveloarijaona,
medical director of the CSB Morarano.

People panicked when another young man of 16 years died on 15 Oct
2008. He lived in the Ampandrana district near Ambohidray station.
Two more fever patients are still under treatment. Approximately 400
people have received basic treatment with sulfadoxine because they
are in contact with the outbreak of plague, said the chief doctor of
Morarano.

Plague follows an epidemiological cycle in Madagascar. According to
Dr. Rolland Robinson, director of emergencies and the fight against
diseases (DULM), we are in the year of its return, which happens
every 5 years. In such a context, the population must be sensitized
to clean the environment. "We must trap the rats alive and kill them
by throwing them into fire or water to kill their fleas along with
them," he suggests [if they are killed in the trap, their fleas
disperse. - Mod.JW]. In any case, Madagascar is home to several
plague foci; Moramanga, in the region of Alaotra Mangoro, is one of
them.

[Byline: Noro Haingo Rakotoseheno]

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[It is likely that primary pneumonic plague occurred in the parents
of the family. Primary pneumonic plague (one percent of natural
plague presentations) arises as a result of inhalation of plague
bacilli in infectious aerosols, such as would be produced when there
are secondary pneumonic complications in bubonic/septicemic plague.

Primary plague pneumonia has a short incubation period of 1-3 days,
after which there is sudden onset of flu-like symptoms including
fever, chills, headache, generalized body pains, weakness and chest
discomfort. A cough develops with sputum production, which may be
bloody, and increasing chest pain and difficulty in breathing. As the
disease progresses, hypoxia (low oxygen concentration in the blood)
and hemoptysis (coughing up blood) are prominent. The disease is
invariably fatal unless antimicrobial therapy commences within 24
hours of exposure.

Patients with primary pneumonic plague generate large quantities of
infectious aerosols that pose a significant risk to close contacts.
CDC guidelines identify contacts within 2 meters as being at greatest
risk and do not consider the organism likely to be carried through
air ducts or vents. Persons who have been in contact with pneumonic
plague patients or handling potentially infectious body fluids or
tissues without appropriate protection should receive preventive
antimicrobial therapy. The preferred antimicrobial agents for
prophylaxis are tetracyclines, quinolones, or chloramphenicol.

Moramanga is in the Alaotra-Mangoro region of the eastern Toamasina
province of Madagascar. The province can be seen on a map of the
island nation at:
<http://en.wikipedia.org/wiki/Toamasina_Province>.
- Mod.LL

A test using dipsticks for the rapid diagnosis of plague, developed
and evaluated at the Institut Pasteur in Madagascar and Paris, makes
it possible to detect this disease in 15 minutes at a patient's
bedside. This research was published in the 18 Jan 2003 edition of
"The Lancet":
<http://www.pasteur.fr/actu/presse/press ... lett-E.htm>
Re the approx. 5-year cycles of plague in Madagascar, the only
previous reports from there in ProMED's archives below are for
1995-96. - Mod.JW]

Madagaskar - Pest
28.10.2008

In der Nähe von Moramanga im Bundesstaat Tomasina (O) verstarben insgesamt 4 Personen an der Pest. Der Indexfall, ein 20-jähriger Viehhirte verstarb am 6. Oktober. In den folgenden Tagen erkrankten und verstarben insgesamt 3 Personen an den Symptomen der Lungenpest, u.a. Husten und blutiger Auswurf. Ein Schnelltest auf Yersinia pestis war positiv. Die Pest ist endemisch auf Madagaskar. Das Risiko für Reisende ist minimal. Kontakt zu Erkrankten meiden, Chemoprophylaxe (z.B. Doxycyclin) für Hochrisikopersonen. / Quelle: crm

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (10): ARENAVIRUS
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Date: Fri 24 Oct 2008
Source: Communicable Diseases Communique Vol 7, No 10, Oct 2008 [edited]
<http://www.nicd.ac.za/pubs/communique/2 ... l07_10.pdf>


Arena virus outbreak, South Africa -- Update
--------------------------------------------
This updates all previous reports and includes available data as of
24 Oct 2008. An outbreak of infection due to an arenavirus was
identified in South Africa in early October 2008. A total of 5 cases
has been reported for the period 12 Sep to 24 Oct 2008.

The primary case (case 1) had onset of illness on 2 Sep 2008. An
additional 3 secondary cases (case 2, 3 and 4) and 1 tertiary case
(case 5) have been confirmed to have an arenavirus infection by
laboratory testing. The primary case and 3 secondary cases have died.
The tertiary case is currently hospitalized. Ages of cases ranged
from 33 to 47 years. 4 cases were female and 1 male. The source of
infection is, as yet, unknown for the primary case. The other 4 cases
all had potential exposure to blood and/or body fluids of a primary
or secondary case in the health-care setting.

The primary case was a safari booking agent resident in Zambia. The
patient was flown to South Africa for medical care in a critically
ill condition on 12 Sep 2008, and died on 14 Sep 2008. Case 2 was a
paramedic who cared for case 1 during the transfer from Zambia on 12
Sep 2008 and case 3 was a nurse who cared for case 1 in the intensive
care unit from 12-14 Sep 2008. Case 2 was admitted on 27 Sep 2008 and
died on 2 Oct 2008 and case 3 was admitted on 30 Sep 2008 and died on
5 Oct 2008. On 14 Sep 2008, case 4 performed terminal cleaning of the
room in which case 1 was hospitalized. The 5th patient is a nurse who
cared for case 2 from 27 Sep 2008 to 2 Oct 2008. She became ill on 9
Oct 2008 and is currently critical but stable. Ribavirin has been
used for treatment in this case based on good evidence of efficacy in
patients with Lassa fever (an arenavirus infection). The estimated
incubation period (interval from exposure to symptom onset) in
secondary and tertiary cases ranges from 7 to 13 days. In 4 patients
who died, the interval from onset of illness to death ranged from 9
to 12 days (Figure 1).

Only limited clinical data are currently available for case 4, who
presented late in the course of illness with bleeding and confusion
and died soon thereafter. Clinical features of the remaining 4 cases,
for which more clinical data were available, are presented. All
patients presented initially with a non-specific flu-like illness
with symptoms of fever,headache and myalgia. The illness increased in
severity over 7 days with all 4 patients developing diarrhoea and
pharyngitis during the course of illness. A morbiliform rash on the
face and trunk was reported in 4 cases on day 6 - 8 of illness.
Facial swelling occurred in 3 patients. There appeared to be an
initial clinical improvement after hospital admission in 3 patients,
followed by clinical deterioration. Sudden and rapid deterioration
with respiratory distress, neurological signs and circulatory
collapse were terminal features in all patients who died. Bleeding
was not a prominent feature. However, one patient had a petechial
rash and another had oozing of blood from venepuncture sites. Chest
pain was reported in case 1.

At the time of admission all patients had thrombocytopenia (range:
42-104 X109/L). Liver transaminases (AST and ALT) were available for
4 of 5 cases and were variable at the time of admission, however all
4 patients had raised AST and ALT during the course of their illness.
Leucopenia was present on admission in 2 patients and 3 patients had
a normal white blood cell count on admission. 4 patients subsequently
developed leucocytosis during the course of hospitalisation. All
contacts (family members, friends and healthcare staff) are being
monitored with twice daily temperature measurements for a period of
21 days after the last exposure to a known case. In addition, safe
burial of the deceased has been supervised by environmental health
officers. Full personal protective equipment (PPE) and isolation
precautions as per VHF protocols have been instituted.

The causative agent in this outbreak was initially identified as an
Old World arenavirus by immunohistochemical tests performed at the
Infectious Diseases Pathology Branch of the Centers for Disease
Control and Prevention in Atlanta, USA, and on autopsy liver and skin
samples taken with biopsy needles and skin punches in the Special
Pathogens Unit of the National Institute for Communicable Diseases,
National Health Laboratory Service, Sandringham (SPU-NICD/ NHLS),
South Africa, from cases 2 and 3 on 9 Oct 2008 under biosafety level
4 laboratory conditions. Subsequently, infection with an Old World
arenavirus has been confirmed in all 5 cases by positive PCR results
and virus isolation by SPUNICD/ NHLS and CDC. Analysis of sequencing
data generated at SPU-NICD/NHLS, Columbia University, New York, and
CDC, Atlanta appears to indicate that the current outbreak is caused
by a unique Old World arenavirus.

There are currently no additional suspected cases. The outbreak
appears to be contained and has been confined to individuals with
very close contact in a health-care setting. Monitoring of contacts,
active case finding and investigation and management of suspected
cases will continue as needed. Further characterization of the
causative agent is under way and investigation into the source of
infection in the primary case is required. Additional studies to
determine whether mild/asymptomatic infection occurred amongst close
contacts and other exposed individuals would be essential in better
characterizing the extent of this outbreak and clinical spectrum of disease.

Arenaviruses are a family of enveloped negative sense single-stranded
RNA viruses. Members of the family are parasites of rodents, in which
they establish chronic renal infection. High titres of virus are
present in rodent urine, which can contaminate human food or house
dust. Exposed humans may become infected as accidental hosts. The
prototype of the family is lymphocytic choriomeningitis (LCM) virus
and infection of humans with this virus may present as an
influenza-like illness, aseptic meningitis or severe
meningo-encephalomyelitis. Arenaviruses which cause a haemorrhagic
fever syndrome are well documented in South America (New World
arenaviruses, including Junin, Machupo, Sabia and Guanarito viruses).
The so-called Old World arenaviruses include LCM which in fact has a
worldwide distribution, and Lassa fever virus which affects up to 500
000 people annually in West Africa, specifically in Nigeria, Sierra
Leone, Liberia and Guinea, but the virus is suspected to be more
widely distributed in that region.

The clinical spectrum of Lassa fever virus infection ranges from
inapparent, through mild febrile illness to fulminant haemorrhagic
disease, and mortality rates vary from 1-2 percent among cases in the
community at large, through 20 percent among hospitalized patients,
to >40 percent in nosocomial outbreaks. The multimammate mouse
(_Mastomys natalensis_), which is the most important host of Lassa
fever virus, has a distribution extending from West Africa across to
East Africa and from there southwards to the northeasterncorner of
South Africa. Its distribution overlaps with that of other Mastomys
species, and arenaviruses have been found in southern African rodents
in the past, but there has been no previous association of these
viruses with human disease despite sustained monitoring. Preliminary
testing indicates that the virus associated with the present
nosocomial disease outbreak is a distinct new member of the family.

--
Communicated by:
Dr Irene Lai MB BS
Deputy Medical Director
Intl. SOS Online and Corporate Medical R&D
International SOS
Level 5 Challis House 4 Martin Place
Sydney NSW 2000 Australia
<73022@internationalsos.com>

[This update provides a definitive account of the recent outbreak of
arenavirus-associated disease in South Africa. A primary case (case
1) had onset of illness on 2 Sep 2008. An additional 3 secondary
cases (case 2, 3 and 4) and 1 tertiary case (case 5) have been
confirmed to have an arenavirus infection by laboratory testing. Case
5 (not previously reported) is a nurse who cared for case 2 from 27
Sep 2008 to 2 Oct 2008. She became ill on 9 Oct 2008 and is currently
critical but stable. Cases 1, 2, 3 and 4 did not survive infection.

Infection with an Old World arenavirus has been confirmed in all 5
cases by positive PCR results and virus isolation by SPUNICD/ NHLS
and CDC. Analysis of sequencing data generated at SPU-NICD/NHLS,
Columbia University, New York, and CDC, Atlanta, appears to indicate
that the current outbreak is caused by a unique Old World arenavirus.

There are currently no additional suspected cases. The outbreak
appears to be contained and has been confined to individuals with
very close contact in a health-care setting. Monitoring of contacts,
active case finding and investigation and management of suspected
cases are continuing. Further characterization of the causative agent
is under way, as is investigation into the source of infection in the
primary case.
- Mod.CP]

Yellow feverin the Central African Republic
WHO - 30.10.2008

On 22 August the Ministry of Health (MoH) of the Central African Republic reported a laboratory confirmed case of yellow fever. This is the second Yellow fever event reported by the Central African Republic in 2008. The case has been laboratory confirmed for Yellow fever by the Institut Pasteur, Dakar.

The initial case is a 32-year old male from Ngotto village, sub-prefecture of Boda, Prefecture of La Lobaye, who presented with symptoms of fever and jaundice. He is alive and continues to recover from his illness. The case was detected by the national Yellow fever surveillance system.

The outbreak investigation team evaluated 34 contacts in Boda sub-prefecture. Four presented with symptoms of fever or jaundice and the other 30 were asymptomatic.

On the basis of the assessment of the outbreak situation, it was decided to vaccinate 183,992 people against Yellow fever in the four sub-prefectures of the Prefecture of La Lobaye (Mbaiki, Mongoumba, Boda and Bogonda) and part of the neighbouring Prefecture of La Sangha (sub-prefecture of Bambio).

The Prefecture of La Lobaye is not an endemic area for Yellow fever. In March 2008, the Central African Republic reported some Yellow fever cases in the North West of the country and a mass vaccination campaign against Yellow fever was conducted successfully in the region.

In response to the outbreak, the MoH has made a request for yellow fever vaccines and operational costs for the preventative mass vaccination campaign from the GAVI funded Global Emergency Stockpile for Yellow fever vaccine, managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control (YF-ICG).

Yellow fever in Burkina Faso
WHO - 03.11.2008

On 3 October, The Ministry of Health, Burkina Faso reported two laboratory confirmed cases of Yellow fever in the health district of Ouahigouya, in the North of the country, near the border with Mali. Both cases were reported by the Yellow fever surveillance system and presented with symptoms of fever and jaundice.

The initial case was a 7-month old male child who recovered from the disease. The second case was a 6-year old male child who died 2 days later. Both cases were not vaccinated against Yellow fever and were first confirmed at the National Laboratory of Muraz Center and reconfirmed at the WHO regional laboratory for Yellow fever at the Institut Pasteur of Dakar, Senegal.

The routine infant immunization in the health district of Ouahigouya started in 2002 and the reported Expanded Program on Immunization (EPI) coverage at the end of 2007 was 85.3%. This health district was not retained as a high priority epidemic risk during the consensus meeting for the Yellow fever risk assessment in 2007. Thirty seven health districts in Burkina Faso will benefit from a Yellow fever preventative mass vaccination campaign on 13 November 2008.

On the basis of the outbreak investigation, it was decided to carry out a reactive mass vaccination campaign targeting 366,052 people in the health district of Ouahigouya. In response to the outbreak, the MoH has made a request for Yellow fever vaccines for the preventative mass vaccination campaign from the GAVI funded Global Emergency Stockpile for Yellow fever vaccine, managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control (YF-ICG).

Sambia - Arena Virus
03.11.2008

Am 12. September 2008 wurde eine 36 Jahre alte Frau mit einer schweren fieberhaften Allgemeininfektion aus Sambia nach Südafrika ausgeflogen und in Johannesburg stationär versorgt. Sie starb zwei Tage später. In der Folge verstarben 3 weitere Personen die mit der Patientin Kontakt hatten. In den letzten Tagen wurden 121 Kontaktpersonen nachbeobachtet, ohne dass weitere Symptome auftraten. Ein hämorrhagisches Fieber ist mittlerweile ausgeschlossen worden, der Verdacht fokussiert sich auf ein bisher unbekanntes Virus. Von einer weiteren Übertragung wird nicht ausgegangen. / Quelle: crm

BEULENPEST, FATAL - UGANDA: (ARUA, NEBBI)
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Date: Mon 3 Nov 2008
Source: Bloomberg, Africa [edited]
<http://www.bloomberg.com/apps/news?pid= ... fer=africa>


An outbreak of bubonic plague killed 3 out of 9 people infected with the
disease in the north western Ugandan districts of Arua and Nebbi, the Daily
Monitor has reported.

Of those infected, 2 of them in Arua and 3 in Nebbi, are in critical
condition in hospital, the Kampala-based newspaper reported, without saying
when the outbreak started.

Bubonic plague is transmitted to humans through contact with rats infested
with fleas. The disease, common in north western Uganda and neighboring
Democratic Republic of Congo, causes fever, headaches, and fatigue, the
newspaper said.

[byline: Fred Ojambo]

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

[Fatalities in plague, infections due to _Yersinia pestis_ are often due to
spread of the organism outside of the painful bubo into the bloodstream
causing septicemic plague and/or spread to the lung causing pneumonic
disease. It is this latter form that facilitates person-to-person spread
via the respiratory route.

Arua and Nebbi are endemic for plague and are located in north western
Uganda as can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL

The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/promed?g=443328&g= ... 2,31.167,5>. CopyEd.MJ]

UNDIAGNOSED HAEMORRHAGIC FEVER - SOUTH AFRICA ex MALAWI
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Date: Fri 7 Nov 2008
Source: The Times (Johannesburg) [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=879863>


Man shows symptoms of killer virus
----------------------------------
A Malawian man who was admitted to the Life Fourways Clinic with symptoms
of viral haemorrhagic fever is undergoing blood tests, Talk Radio 702 reports.

The move is a precautionary measure at this stage. The hospital has assured
the public the 55-year-old has been properly isolated, according to the report.

When contacted by The Times website this morning, the hospital was not
immediately available for comment.

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

[Insufficient information is provided to evaluate this report precisely,
but it is likely that the patient is suspected to have contracted the novel
arenavirus haemorrhagic fever responsible for a recent outbreak in Zambia
(see ProMED-mail Archive references below). A new type of arenavirus has
been identified by experts at the National Institute for Communicable
Diseases (NICD) in Johannesburg as they studied the virus that caused the
deaths of 4 people in recent weeks. Result of the diagnostic tests are awaited.

Malawi lies to the east of Zambia and can be located using the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed?v=-13.2,34.3,5> - Mod.CP]

UNDIAGNOSED HEMORRHAGIC FEVER - SOUTH AFRICA ex MALAWI (03): NOT
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Date: Mon 10 Nov 2008
Source: The Times (Johannesburg), Sapa report [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=881001>


A 55 year old man isolated in a northern Johannesburg hospital has tested
negative for all haemorrhagic fevers, including the [novel] arenavirus.
Life Fourways hospital spokeswoman Marietjie Shelly said: "We have been
informed by the National Institute for Communicable Diseases that they have
ruled out all the haemorrhagic fevers." She said the man's condition had
improved: "He is doing very well, and he is taking all his meals."

The man, a South African citizen who lives in Malawi, arrived at the
hospital on Thursday [6 Nov 2008] at 7 pm and was taken to the trauma and
emergency unit before being placed in an isolation unit. "He had a high
temperature, severe abdominal and kidney pain, and vomiting. Initial blood
tests gave no indication of internal bleeding," said Shelly.

The man was placed in an isolation unit as a precautionary measure to
ensure the safety of hospital staff, patients and visitors, she said. In
September and October 2008, 4 people died of haemorrhagic fever owing to
[novel] arenavirus infections.

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

[Laboratory investigation has now excluded arenavirus (and other
haemorrhagic fever viruses) infection as the cause of the illness of the
patient recently arrived in Johannesburg from Malawi. The other viruses
responsible for viral haemorrhagic fevers in central and southern Africa
include Crimean-Congo haemorrhagic fever virus and the filoviruses (Ebola
virus and Marburg virus). Although a positive diagnosis remains to be
established, haemorrhage is not prominent among the patient's symptoms, and
the patient is recovering well. A final diagnosis is awaited.

Malawi lies to the east of Zambia and can be located using the
HealthMap/ProMED-mail interactive map at:
<http://healthmap.org/promed?v=-13.2,34.3,5>. - Mod.CP]

MEASLES - EQUATORIAL GUINEA
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Date: Mon 10 Nov 2008
Source: Terra, EFE News Agency report [in Spanish, trans. CopyEd.MJ, edited]
<http://actualidad.terra.es/sociedad/art ... 876425.htm>


At least 10 children have died in various hospitals in Equatorial Guinea as
a result of a measles epidemic declared in the country 2 weeks ago,
according to EFE [News Agency] sources confirmed today [10 Nov 2008] by the
Health Ministry.

Although an official of the Ministry of Health and Welfare declined to give
details, medical sources contacted by EFE said the epidemic is affecting
hundreds of children up to 9 years [of age] in several districts of the
mainland and in Malabo, capital of the country.

Reports of the NGO 'Family Care' claim that one in 6 children born in this
sub-Saharan country, which was a Spanish colony until 1968, dies before
reaching 2 years, because health [services] in rural communities are
limited to small first-aid clinics with minimal material.

The last known outbreak of measles in the country occurred in April 2001,
when more than 100 children lost their lives because in Equatorial Guinea
basic concepts of hygiene and disease prevention are still poorly
understood or misinterpreted by a large portion of the population.

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

[Equatorial Guinea in sub-Saharan Africa can be located using the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed?v=1.7,10.3,6>. - Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (42)
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In this update:
Africa
[1] Cholera, refugees - Congo DR (North Kivu)
[2] Cholera - Mozambique
[3] Cholera - Zimbabwe

******
[1] Cholera, refugees - Congo DR (North Kivu)
Date: Tue 11 Nov 2008
Source: The Guardian (UK) [edited]
<http://www.guardian.co.uk/world/2008/nov/11/congo>


A cholera outbreak in a refugee camp has spread to eastern Congo's
provincial capital of Goma, as humanitarian groups called for more UN
(United Nations) peacekeepers to protect civilians caught up in the
fighting between government forces and rebel troops.

Human Rights Watch said the UN Security Council should bolster the 17
000-strong UN force in Congo, the world's biggest UN peacekeeping
mission, by 3000 soldiers and police. The call for more peacekeepers
came amid fears that cholera will deepen the misery of a quarter of a
million people who have fled their homes since late August 2008 in
the upsurge of fighting between the forces of rebel general Laurent
Nkunda, Congolese army soldiers and their allied militia.

Cholera cases rose slightly yesterday [10 Nov 2008] in the towns of
Goma and Kibati, with at least 90 known cases and 6 new admissions
overnight. Officials with Doctors Without Borders said the cases they
were treating were well contained. Only 4 new ones were reported at
the group's clinic in Kibati camp. But dozens of people have died of
cholera in recent weeks elsewhere in eastern Congo. Doctors also fear
an epidemic behind rebel lines, where access has been limited by
fighting and rebels have driven tens of thousands of people from
camps where outbreaks had been contained.

[Byline: Mark Tran]

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

[Goma is in northeastern Congo DR and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[2] Cholera - Mozambique
Date: Tue 11 Nov 2008
Source: Reuters Foundation AlertNet, UN Integrated Regional
Information Networks (IRIN) News report [edited]
<http://www.alertnet.org/thenews/newsdes ... 0867a7.htm>


Fears that cholera may be spreading throughout central Mozambique has
forced the government to issue the highest state of alert.

"We are dealing with a cholera outbreak and unfortunately it has
already started spreading," Fernanda Teixeira, secretary general of
the Red Cross in Mozambique told IRIN. "In the beginning we were not
sure if it was cholera because of the high mortality rates."

According to Mozambique's National Disaster Management Agency (INGC),
"Samples collected for laboratory examination confirmed a cholera
epidemic on the 5 Nov 2008." Some 250 cases and 48 fatalities have
been registered.

A rapid assessment conducted by Oxfam, the British-based development
NGO, pointed to Guro district in the central Manica Province as the
epicentre, and indicated that the outbreak started on 24 Oct [2008].
New cases have also been registered in Tete and Zambezia provinces.

Mozambique started recording cases of cholera in Zambezia province as
early as October 2007. Before the current spike, 7547 cases with 78
deaths were recorded between October 2007 and October 2008, according
to the health ministry. Only 3 provinces -- Sofala, Cabo Delgado, and
Gaza -- have not registered any cases of cholera in the past 60 days,
the UNICEF (United Nations Children's Fund) report said.

"We have cholera every year, but never with such high mortality
rates. The situation now seems under control," Teixeira commented.
But with the rainy season quickly approaching, "cases could again go up."

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

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

******
[3] Cholera - Zimbabwe
Date: Tue 11 Nov 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Int Fed of Red Cross and Red Crescent Societies
report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


Zimbabwe has reported a severe outbreak of cholera since August 2008.
So far, a total of 1224 cases have been confirmed, with a total of 42
deaths. The worst affected areas are Harare, Nyamapanda, Chinhoyi,
and Kariba. The situation is still unfolding as cholera spread to
other parts of the country.

A cholera outbreak has hit the high density suburbs of Harare, the
capital city of Zimbabwe, border town Nyamapanda in Mashonaland
Central Province and Kariba (Mola) in Mashonaland West and provincial
town Chinhoyi also in Mashonaland West. An unconfirmed case has been
reported in Mutare in Manicaland Province, which is on the border
with Mozambique. The 1st cholera case was reported on 26 Aug 2008,
long before the rainy season, which usually starts at the end of
October. Current reports indicate that cholera continues to spread
across the country due to high mobility and limited capacity to
contain the disease.

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

[A map of Zimbabwe showing the mentioned areas, primarily in the
north of the country can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.

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]

BOTULISM, STUDENTS - UGANDA: (KAMPALA), 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: Wed 12 Nov 2008
Source: The New Vision, Uganda [edited]
<http://www.newvision.co.ug/D/8/13/659208>


The Seeta High School student who died recently was not poisoned, but
died of botulism, medical reports have revealed. The director General
of health services, Dr Sam Zaramba, yesterday [11 Nov 2008] said the
Senior Five student died of botulism, according to reports from the
Centre for Disease Control (CDC) and the health ministry.

On the morning of Mon 20 Oct 2008, the female student was taken to
the school's sickbay, with pain in the throat and breathing
complications. Her parents were called in after the school nurse said
she could not manage her condition. She was taken to International
Hospital Kampala, where she died 5 days later.

The student's friend, who a day before had complained of vision
problems, was admitted at Mulago Hospital's Intensive Care Unit and
remains hospitalized. Another student who was admitted has since been
discharged.

"When the student died, we took samples from all the girls' property
that we could get and sent them to CDC-Atlanta, for investigations.
We also did a post-mortem of the student," Zaramba said. He said
results from the samples are expected in the next 2 weeks. "We tried
to trace all that they had eaten and used."

Zaramba said it was discovered that this was food-borne botulism. "We
have advised the school to limit the amount of food that is brought
for students on visitation days."

This is the 2nd botulism outbreak in Uganda, Zaramba said. The 1st
was in the 1970s.

[Byline: Conan Businge]

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

[ProMED-mail awaits additional information regarding the type of
botulism involved (most likely type A based on the rapidity and
severity of symptoms) and the specific source.

The capital city of Kampala can be found on a map of Uganda at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?g=232422 ... 6,30.566,6>. - Mod.LL]

GNATHOSTOMIASIS - BOTSWANA
****************************
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 13 Nov 2008
From: John Frean <johnf@nicd.ac.za>


Gnathostomiasis acquired in Botswana
-------------------------------------
We have identified 2 separate clusters of gnathostomiasis acquired in
the Okavango Delta, Botswana, with a total of 8 confirmed or probable cases.

Both outbreaks (one in August, one in November 2008) occurred in
groups of people who ate raw, marinated bream (_Tilapia_ species).
After non-specific malaise and/or gastrointestinal discomfort, some
exposed individuals presented with recurrent episodes of painful
migratory skin nodules and transient urticaria. Several small worms
were extracted from localised skin lesions, and we identified 3rd
stage larvae of a _Gnathostoma_ species. These nematode parasites
have a complicated life cycle involving carnivorous mammals as
definitive hosts and a variety of intermediate and paratenic hosts,
including snakes, birds, frogs, eels, crustaceans and freshwater
fish. Humans become infected when they eat raw or undercooked fish,
crabs, or crayfish. The larvae migrate through skin and subcutaneous
tissues (the most common presentation), but also sometimes the
internal organs, including the eye or central nervous system in the
most serious forms of the disease.

Gnathostomiasis is well-known in Southeast Asia and Central and South
America and is regarded as an emerging imported disease resulting
from increasing international travel and adventurous eating. This is
the 1st description of the disease from Botswana; the only other
recognised outbreak in the region occurred on the Zambezi River in
western Zambia. Freshwater fish caught in Botswana and Zambia should
not be eaten raw.

[Reported by: Dr John Frean (Johannesburg, South Africa) and Dr Chris
Carey (Maun, Botswana)]

--
Dr J Frean
National Institute for Communicable Diseases
National Health Laboratory Service
Johannesburg, South Africa
<johnf@nicd.ac.za>

[Humans become infected by eating undercooked fish or poultry
containing 3rd-stage larvae or, reportedly, by drinking water
containing infective 2nd-stage larvae in Cyclops.

Gnathostomiasis occurs worldwide in tropical and subtropical areas
but has especially been reported from Southeast Asia, probably
because eating raw or undercooked fish is common there.

Gnathostomiasis has previously been reported from Zambia; see:

Hale DC, Blumberg L, Frean J. Gnathostomiasis in two travelers to
Zambia. Am J Trop Med Hyg. 2003;68:707-9). - Mod.EP]

[For an excellent diagram of the life cycle of the _gnasthostoma
spp._ see <http://www.dpd.cdc.gov/dpdx/HTML/gnathostomiasis.htm>.

For a map of Botswana, see
<http://www.lib.utexas.edu/maps/africa/b ... _pol95.jpg>.

For the interactive HealthMap/ProMED map of Botswana with links to
other recent ProMED-mail postings on events in Botswana and
neighboring countries, see
<http://healthmap.org/promed/en?v=-22.2,23.8,5>. - Mod.MPP]

DENGUE/DHF UPDATE 2008 (49): MALI, SUSPECTED
***********************************************
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 13 Nov 2008
From: Tim Herrick <leland@orangemali.net>

A warden message from the US Embassy in Mali is being circulated
concerning an outbreak of probable dengue in the region surrounding
Kayes, Mali. About 26 Oct [2008], a physician began seeing clinical
cases consistent with dengue, including headache and substantial
musculoskeletal pain. Since that time, over 70 patients have been
seen, and, apparently, 2 patients have died after manifesting
hemorrhagic symptoms. At present, the number of new cases is greatly
diminished to one or 2 a day. The Ministry of Health has apparently
been involved and relevant samples dispatched to the Pasteur
Institute and CDC-Fort Collins. Preliminary testing has shown some of
the samples to be positive for dengue. No serotype has been mentioned.

--
Tim Herrick, MD, MS;
ONG Nyeta Sabati
Bamako, Mali
<leland@orangemali.net>

[Over the past 4 months, there have been reports of dengue in West
Africa, including countries neighboring Mali (Burkina Faso, Guinea,
Senegal and Cote d'Ivoire). Dengue-3 virus was the serotype isolated
this year (2008). See ProMED archive no. 20080820.2597 for those
reports. ProMED is grateful to Dr. Herrick for sending this report.
Firsthand information about dengue outbreaks in Africa is very
infrequently provided, and the occurrence of these outbreaks is
doubtless under-reported. If the 2 deaths are indeed due to dengue
virus infection (DHF), the total number of dengue cases is
considerably higher than the over 70 patients mentioned in this report.

An interactive map showing the location of Kayes in northwestern Mali
on the banks of the Senegal River can be accessed at
<http://www.maplandia.com/mali/kayes/kayes/>.
The HealthMap/ProMED-mail interactive map of Mali and the other West
African countries mentioned above can be accessed at
<http://healthmap.org/promed?v=7.6,-5,5>.
- Mod.TY]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (43): CONGO DEMOCRATIC REPUBLIC
*************************************************************************
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, Provincial Epidemiological Unit report
[2] Cholera - Congo DR: WHO report

******
[1] Cholera - Congo DR: North Kivu, Provincial Epidemiological Unit report
Date: Thu 13 Nov 2006
From: Prudence Mitangala [edited]
<prudendeb@yahoo.fr>


North Kivu province is actually facing the worst internal population
displacement since the end of the civil war in 2003. Due to fighting
between governmental forces and rebels, more than 800 000 internally
displaced people (IDP) have been forced to leave their homes and
facilities established in the area of Goma. More recently, 33 080
displaced people have escaped around Goma Town from the IDPs camps on
28 Oct 2008, fleeing the fighting area. Some patients suffering from
cholera left health centers with intravenous catheters despite the
ongoing intensive rehydration.

The insecurity and the breakdown of the health structures have led to
the emergence of several cholera and measles outbreaks. By the end of
October 2008, there were approximately 1094 suspected cases of
cholera; 398 of them reported from Rutshuru health zone located 65 km
(40.4 mi) north of Goma. Due to limited access, non-governmental
organizations (NGOs) or other humanitarian missions were not able to
reach this health zone before the last week [from 27 Oct to 2 Nov 2008].

Nevertheless, etiological agents of these high transmissible
infectious diseases have been identified by the Provincial Public
Health Reference laboratory AMI LABO since 4 Oct 2008. Strains
isolated locally were _Vibrio cholerae_ O1, Inaba serotype, sensitive
to the commonly used antibiotics but resistant to
trimethoprim-sulfamethoxazole.

In spite of this extremely difficult situation, the Provincial Health
authority is coordinating health partners, with the logistic support
of the NGO CEMUBAC-Belgium and WHO, in the implementation of specific
control measures in order to monitor infectious diseases outbreaks
and limit their spread to other areas. With limited resources the
health care personnel was able to identify the causative agents of
outbreaks and to manage this critical situation.

These facts highlight the benefit of sustainable epidemiological
surveillance systems and the need of improving laboratory capacities
especially in a conflict region, allowing rapid control measure
implementation. In regard to this situation, authorities should
consider reinforcement of the regional strategic drugs stock to
maintain their reactive response capacity when outbreaks occur.

[Authors: Mitangala P, Baabo D, Mutombo G]

--
Prudence Mitangala MD MPH
Provincial Epidemiological Unit
North Kivu Province, DR Congo
<prudendeb@yahoo.fr>

[ProMED-mail is indebted to Dr Mitangala and colleagues in North Kivu
and to Prof Olivier Vandenberg of the Department of Laboratory
Medicine, Saint-Pierre University Hospital & Jules Bordet Institute
for this first hand report of this awful human tragedy in eastern Congo DR.

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

******
[2] Cholera - Congo DR: WHO report
Date: Fri 14 Nov 2008
Source: ThaiPR, WHO (World Health Organization) press release [edited]
<http://www.thaipr.net/nc/readnews.aspx? ... 669F40C815>


The World Health Organization (WHO) and health partners have launched
an intensive operation to prevent and control the increase in the
number of cholera cases, which have tripled in some areas to 150 a
week, amid the recent escalation of violence in the eastern part of
the Democratic Republic of the Congo. Insecurity, massive population
displacement (at least 250 000 people since early August 2008), weak
health services and a lack of safe water and proper sanitation
facilities have caused a marked increase in the number of people with
cholera in North and South Kivu.

As yet no data is available on the number of deaths linked to the
current outbreak, but generally in complex emergencies the case
fatality rate can surpass 30 percent. In 1994, some 50 000 people
died from a combined epidemic of cholera and dysentery linked to the
Rwandan exodus into Goma, the main town of North Kivu.

There has been a tripling of cholera cases since the start of October
2008 to early November 2008 in the Goma health zone, which includes
the area of Karisimbi. From July-August 2008, there was a weekly
incidence of less than 20 cases in Goma. But in the 1st week of
October 2008, there were 40 cholera cases, which increased to about
150 in early November 2008.

"Such an increase of cases in a region that is already endemic for
cholera is an early warning sign of a potentially larger epidemic,
and all health providers are working together to ensure that we do
not see a repeat of 1994," said Dr Eric Laroche, assistant
director-general for WHO's Health Action in Crises cluster.

In all of North Kivu, there have been at least 997 cholera cases
reported in that time, with most recorded in Rutshuru (466), Goma
(263), and Karisimbi (145). In South Kivu during the same period, 855
cholera cases have been reported, with most in Minova (371).

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

The HealthMap/ProMED-mail interactive map of the Democratic Republic
of the Congo is available at
<http://healthmap.org/promed/en?v=-2,25,5>. - CopyEd.MJ]