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SCHISTOSOMIASIS - ANGOLA: (NZETO)
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 16 Nov 2008
Source: Xinhua Net [edited]
<http://news.xinhuanet.com/english/2008- ... 360566.htm>


Schistosomiasis -- which broke out in Kindeje, Nzeto district,
northern Ziare province, Angola in October 2008 -- has killed at
least 9 people, a local health official said on Friday [14 Nov 2008].

Paulo Seixas Nelembe, head of the Nzeto District Health Bureau, told
reporters that since October 2008, more than 300 cases of the illness
have been diagnosed.

According to him, the cause of the expansion of the disease is the
poor quality of the water consumed by local people from rivers,
lagoons and wells.

He said more medical workers have been dispatched to the Kindeje area
to carry out awareness campaigns on how to treat water before
drinking it and to distribute anti-parasite medicine to the sick.

Schistosomiasis or bilharziosis is a serious and common disease in
Africa caused by several species of flukes of the genus _Schistosoma_
and which affects internal organs.

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

[There are no recent published data on schistosomiasis in Angola, but
the WHO country collaboration report on Angola mentions a
schistosomiasis control program but without any data on prevalence
and geographical distribution
<http://www.who.int/countryfocus/coopera ... ago_en.pdf>.

Schistosomiasis has been described in Cuna soldiers serving in
Angola: Martinez Rodriguez R et al. Schistosomiasis mansoni in Cuban
patients. A clinical study of the first 4 cases imported from the
People's Republic of Angola. Rev Cubana Med Trop. 1986;38:135-9
(Spanish); and in literature from the previous colonial power,
Portugal: Ferreira and Gomes. Bilharziasis. The focus of Malanje
(Angola). (Aid for the study of bilharziasis in Angola). An Inst Med
Trop (Lisb). 1959;16:407-32 (Portugese).

A map of Angola showing the location of Kindeje can be found at:
<http://www.maplandia.com/angola/zaire/nzeto/kindeje/>. - Mod.EP]

Simbabwe - Darminfektionen
17.11.2008

Risiko für Durchfallerkrankungen landesweit. Für den seit August anhaltenden Cholera-Ausbruch, von dem v.a. Harare, Nyamapanda, Chinhoyi und Kariba betroffen sind, gibt es weiterhin keine Entwarnung. Bisher sind 1.224 Personen erkrankt, wovon 42 verstarben. Hygiene beachten. / Quelle: crm
_________________________________________

Mali - Dengue
17.11.2008

Aus Kayes (NW) wird ein Dengue-Ausbruch meldet. Seit Ende Oktober sind mindestens 70 Personen an typischen Dengue-Symptomen erkrankt. Labortechnisch konnten bei einem Teil der Infizierten Dengue-Antikörper nachgewiesen werden. Unbestätigt sind 2 Todesfälle. Zuletzt häuften sich Meldungen über Dengue-Ausbrüche in Westafrika. Schutz vor den vorwiegend tagaktiven Stechmücken beachten. / Quelle: crm

DENGUE/DHF UPDATE 2008 (50)
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Africa, Asia, India, South America
Date: Fri 14 Nov 2008
From: Aravinda de Silva <aravinda_desilva@med.unc.edu>


With respect to the recent dengue cases reported in West Africa, I am
intrigued to learn that it is [dengue virus type 3] DENV-3. We have
demonstrated that DENV-3, genotype III viruses are native to the
Indian subcontinent and East Africa (see Messer, et al. Emerging
Infectious Diseases 9(7): 800-9; available at
<http://www.cdc.gov/NCIDOD/EID/vol9no7/03-0038.htm>).

Others and we have shown that a new clade of DENV-3, genotype III has
moved into Latin America and is currently expanding in the South and
East Asia as well. This new clade is also linked to large epidemics
of dengue fever and DHF in Asia and Latin America.

I am most curious to learn if the cases in West Africa are also
caused by this new clade of DENV-3 that is emerging in many parts of
the world. We are happy to assist any groups interested in comparing
these viruses to other genotypes of DENV-3.

--
Aravinda de Silva, MPH, PhD
University of North Carolina at Chapel Hill
Department of Microbiology and Immunology
C.B. # 7290, M.E. Jones Room 720
Chapel Hill, NC 27599
USA
<aravinda_desilva@med.unc.edu>

[ProMED-mail thanks Dr de Silva for the interesting information about
the distribution of DENV-3 and the appearance and spread of the
genotype III clade. We hope that anyone having isolates of West
African DENV-3 will accept the offer for genetic analysis of these
isolates and contact Dr de Silva. - Mod.TY]

BOTULISM, STUDENTS - UGANDA (02): (KAMPALA), CONFIRMED
******************************************************
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 18 Nov 2008
Source: Afrique en Ligne [edited]
<http://www.afriquenligne.fr/news/africa ... 16231.html>


Botulism has occurred in Uganda, the US-based Centers for Disease
Control (CDC) confirmed after tests done on a high school student who
died in October 2008. The Ministry of Health said that a senior
student at Seeta High School in Mukono district, 20 kilometers (12.4
mi) east of the capital Kampala, died of botulism, a disease, which
last was reported in the landlocked East African country 30 years ago.

"The test results from CDC in Atlanta, USA, on the 2 cases admitted
at Mulago Hospital last month [October 2008] confirmed botulism,"
said Dr Sam Zaramba, the director of general health services, in a
statement on Tuesday [18 Nov 2008].

"Current evidence from the investigation suggests that the foods
consumed by the affected girls a few hours or days before the onset
of the illness was contaminated by the botulism toxin," Dr Zaramba said.

The ministry ruled out earlier speculation that the deceased student
must have been a victim of food contaminated by poison at her Seeta
High School's kitchen. "If it was the case there would have been many
more cases among the student population," the health ministry announced.

Since the confirmed test, epidemiologists and other health
specialists at CDC and World Health Organization (WHO) are carrying
out further investigations to establish the potential source of intoxication.

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

[Confirmation requires neutralization tests to be done, which would
additionally identify the serotype of botulinum toxin involved in
this small outbreak. The rapid deterioration and death of the student
suggests that serotype A was involved. - Mod.LL]

TYPHOID FEVER UPDATE 2008 (07)
******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Uganda (Kasese)
Date: Thu 13 Nov 2008
Source: AllAfrica, New Vision (Kampala) report [edited]
<http://allafrica.com/stories/200811130072.html>


In the last 4 months, 20 people have died and 90 others admitted
following a typhoid outbreak in Kasese district in western Uganda.
The latest deaths were of 4 people, who died last week [week of 3 Nov
2008] in Kyabarungira sub-county. The sub-county chief, Steven Kabau,
said the dead included 2 students of Kuruhe High School, a Primary
Six pupil of Kyabarungira Primary School and a catering graduate.

The district health officer, Dr Peter Mukobi, said: "More people are
believed to have died of typhoid, though their cases have not been reported."

Mukobi said it was difficult to diagnose typhoid. He added, "The
problem with typhoid is that patients show symptoms of malaria at the
beginning. In most cases, by the time one realizes that it is typhoid
it is too late," Mukobi explained.

[Byline: Conan Businge, John Thawite]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Uganda's Kasese district is located in the southwestern part of the
country and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>.
The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/promed/en?g=443342&v=0.167,30,6>.

Both these postings state the difficulty of distinguishing typhoid
fever, a waterborne bacterial disease caused by _Salmonella enterica_
serotype Typhi and malaria, a mosquito-borne protozoan infection
caused a one of several species of _Plasmodium_. Both illnesses, as
well as a number of other infections, present as primarily febrile
episodes without, necessarily, any symptoms suggesting involvement of
a specific organ system.

Typhoid fever is best diagnosed by bacterial culture of the blood or
by serological methods and can be treated with one of a variety of
antibacterial agents. Malaria is best diagnosed by examining a
stained smear of the peripheral blood looking for the
intraerythrocytic protozoa and is treated with one or a combination
of antimalarials. In the absence of laboratory facilities, the
periodic fever of malaria (every 2nd or 3rd day) and the
non-remitting fever of typhoid may help to distinguish the illnesses
although neither may be present early in the illness. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (44)
**********************************************
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 - Uganda (Kanungu) ex Congo DR
[3] Cholera - Zimbabwe (Matabeleland South)
[4] & [5] Cholera - Zimbabwe (Mashonaland East)
[6] Cholera - Mozambique

******
[1] Cholera - Congo DR (North Kivu)
Date: Tue 18 Nov 2008
Source: Easy Bourse [edited]
<http://www.easybourse.com/bourse-actual ... ngo-564040>


Cholera is spreading quickly in eastern Congo where rebels are
fighting government troops, the UN Children's Fund (UNICEF) warned
Tuesday [18 Nov 2008]. Veronique Taveau, a UNICEF spokeswoman, told
journalists that 127 fresh cases had just been discovered in the
village of Ishasha, north of Goma and near the Ugandan border.

She said aid agencies couldn't get to many areas because of the
fighting. "There are numerous places we can't reach, which definitely
makes us fear a sizable rise in the number of cases," she said. "It
is vital that humanitarian access is allowed."

The cases "seem to have spread very quickly due to a lack of hygiene
and water," she said.

The WHO (World health Organisation) warned last week [week of 10 Nov
2008] that cholera poses a "serious risk" in the region where around
1000 cases have been reported since October 2008. Fighting between
Congolese government troops and followers of renegade Tutsi general
Laurent Nkunda has killed at least 100 civilians and displaced more
than 250 000, the UN and humanitarian groups have said.

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

[A map of eastern Congo DR can be found at
<http://www.un.org/Depts/Cartographic/ma ... astdrc.pdf>.
As reported below, the disease is now spreading across the border
into western Uganda. - Mod.LL]

******
[2] Cholera - Uganda (Kanungu) ex Congo DR
Date: Mon 17 Nov 2008
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/18/659961>


At least one person has been reported dead of suspected cholera among
the Congolese refugees who entered Uganda. They are fleeing the
fighting in the DR Congo. Kanungu district director of health
services Dr Stephen Ssebude said cholera and dysentery have been
reported in Congo about 10 km (6.2 mi) from the Uganda-Congo border
where a 14-year-old child was reported dead.

An official with the Red Cross, Charles Cadet, said about 1200
people, who intended to cross to Uganda have been denied entry by the
army on the Congo side. They were reportedly living in unhygienic
conditions, which makes the disease spread quickly. However, they
entered Uganda after the soldiers who were preventing them from
entering the country fled to an unknown place on Wednesday [12 Nov 2008].

Cadet also said the army on the Congo side of the boarder, have on
several occasions tried to forcefully arrest people who have crossed to Uganda.

Some refugees disclosed that they had dodged the army and crossed to
Uganda through river Ishasha, which they said was a risk because the
volume of the water had increased due to the rains.

[Byline: Caleb Bahikaho]

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

[The close proximity of the southwestern Kanungu district of Uganda
to Congo DR can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

******
[3] Cholera - Zimbabwe (Matabeleland South)
Date: Tue 18 Nov 2008
Source: The Chronicle [edited]
<http://www.chronicle.co.zw/inside.aspx?sectid=312&cat=1>


A serious cholera outbreak has hit Beitbridge District in
Matabeleland South, killing 36 people, while 431 have been diagnosed
as having the disease, Chronicle learned yesterday [17 Nov 2008].

Confirming the outbreak, the acting district medical officer for
Beitbridge, Dr Takaitei Kanongora, said the epidemic was detected on
Friday night [14 Nov 2008] following the admission of a Chegutu woman
to Beitbridge District Hospital. The woman involved in cross-border
trade, intended to cross into South Africa when she succumbed to
cholera. It is suspected that the now deceased woman, who was selling
amazhanje, could have eaten them resulting in severe vomiting and diarrhoea.

"There is a serious outbreak of cholera in Beitbridge and we have
since taken biological (stool) samples to our laboratory, which
eventually confirmed that. Initially we had recorded 8 deaths but
however this morning (17 Nov 2008) the number of the casualties has
increased to 36 and we have admitted 431 people at Beitbridge
Hospital," said Dr Kanongora. He said due to inadequate health
personnel and resources they had been forced to close the only
district hospital to other cases except cholera-related ailments.

"We had to clear the hospital wards to create space for the cholera
patients and therefore we had to close the hospital to other cases
except cholera and we are referring them (other cases) to other
health centres largely because of lack of equipment and staff as we
are now prioritising cholera," he said.

Medecins Sans Frontieres (MSF), a non-governmental organization, and
the International Organisation for Migration (IOM) have deployed
their staff to assist in fighting the epidemic. The 2 organisations
also supplied the hospital with medical kits such as gloves, tablets,
and protective garments for the health staff.

Cases of cholera in Beitbridge District were last reported in 2003.
Travelers passing through the border post have also been put on high
alert following the outbreak. Beitbridge border post is reported to
be the busiest point of entry in sub-Saharan Africa with a huge
volume of both human and motor traffic passing through everyday.

[Byline: Mashudu Netsianda]

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

[As can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>, the
areas are in extreme southern Zimbabwe bordering on South Africa.

Much of the recent cholera activity in Zimbabwe has been in the
capital Harare and other northern areas. - Mod.LL]

******
[4] Cholera - Zimbabwe (Mashonaland East)
Date: Tue 18 Nov 2008
Source: Medecins Sans Frontieres [edited]
<http://www.msf.org/msfinternational/inv ... =full_html>


In Zimbabwe's capital, Harare, Medecins Sans Frontieres (MSF) is
responding to a cholera outbreak of cholera, which the local Ministry
of Health has declared "the biggest ever in Harare". MSF has set up
cholera treatment centres (CTC) in Budiriro Polyclinic and Harare
Infectious Diseases Hospital, where 500 patients have been treated to
date and, on average, 38 new patients are admitted every day. About
78 percent of the patients come from 2 densely populated suburbs in
the south west of Harare, Budiriro and Glen View, which have a
combined population of approximately 300 000 people.

The outbreak has also affected people from the neighboring suburbs of
Mbare, Kambuzuma, Kwanzana, and Glen Norah. Up to 1.4 million people
are endangered if the outbreak continues to spread.

"At Budiriro CTC, things are getting out of hand," said MSF Water and
Sanitation officer, Precious Matarutse. "There are so many patients
that the nurses are overwhelmed. In the observation area, a girl died
sitting on a bench. The staff is utilizing each and every available
room and still in the observation area patients are lying on the
floor. A man came to the clinic yesterday [17 Nov 2008] for
treatment. His wife had just died at home and that is what made his
relatives realize this is serious, and they brought the man to the
clinic. They wanted to know what to do with the wife's body. People
are concerned about catching cholera from others. Health education
must be intensified to inform the population."

"It is a constant challenge to keep up with increasing patient
numbers. We are running out of ward space and beds for the patients,"
said Vittorio Varisco, MSF logistician. "Today [18 Nov 2008] patients
at the Infectious Diseases Hospital are lying outside on the grass
and we are setting up tents with additional beds as an overflow for the wards."

"Patients need constant supervision to ensure adequate hydration,
without which they will die," said MSF doctor Bauma Ngoya. "As
patient numbers continue to increase we must continue to recruit and
train nursing staff."

Cholera is no new phenomenon in crisis-shaken Zimbabwe. In some of
the rural areas of the country cholera is endemic and occurs every
year. However, until recent years cholera was relatively rare in
urban areas of the country where treated piped water and flush
toilets exist in most homes. With the ongoing economic crisis and the
constantly deteriorating living conditions these urban areas are more
and more affected.

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

[The capital city of Zimbabwe, Harare, is located in Mashonaland East
province and can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

******
[5] Cholera - Zimbabwe (Mashonaland East)
Date: Mon 17 Nov 2008
Source: Afrique en Ligne, Panafrican News Agency (PANA) report [edited]
<http://www.afriquenligne.fr/news/africa ... 16167.html>


Health authorities in Zimbabwe admitted Monday [17 Nov 2008] they
have failed to bring a cholera outbreak in the capital, Harare, which
has claimed 37 lives, under control amid a rising death toll. The
disease broke out 3 weeks ago in Harare, and health authorities have
been battling to contain it. But city health director Stanley Mungofa
admitted Monday [17 Nov 2008] the cholera outbreak in the city was
getting worse and claiming more lives.

He said at least 37 people had died of the disease, but "there could
have been (more) communal deaths. We have recorded 25 deaths at
Beatrice Road Infectious Diseases Hospital. All the deaths have been
in the 1st 24 hours of admission of which 70 percent were in the 1st
4 hours of being brought to the hospital. A further 12 people have
died at Budiriro Polyclinic since the outbreak of the disease on 25
Oct 2008. There could have been communal deaths and the (Harare City)
Council is still compiling figures."

The outbreak is widely blamed on consumption of unclean water, and
has defied concerted efforts by health authorities in the last 2
weeks to contain it. A breakdown in the provision of clean water and
administration of health services in Harare, like elsewhere in
Zimbabwe because of an economic crisis, is making it difficult to
bring the cholera outbreak under control.

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

******
[6] Cholera - Mozambique
Date: Tue 18 Nov 2008
Source: Bloomberg [edited]
<http://www.bloomberg.com/apps/news?pid= ... fer=africa>


Cholera has killed at least 12 people in central Mozambique, state
broadcaster Televisao de Mozambique reported, citing Armando Tonela,
head of health services in the region.

With about 120 more reported cases, the central districts of Alto
Moloque, Alto Ligonha, and Gurue, north of Maputo, are braced for a
worsening of the outbreak as the rainy season approaches, the broadcaster said.

[Byline: Fred Katere]

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

[A map of the southeastern African country of Mozambique showing the
location of Maputo can be found at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.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]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (45)
**********************************************
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 - South Africa (Northern Province) ex Zimbabwe
[2] Cholera - South Africa (KwaZulu-Natal) ex Zimbabwe
[3] Cholera - Zimbabwe: USA ambassador statement
[4] Cholera - Zimbabwe (Midlands Province)
[5] Cholera - Zimbabwe (Masvingo)
[6] Cholera - Mozambique (Manica)
[7] Cholera - Congo (Pool)
[8] Cholera - Guinea-Bissau
[9] Diarrhea, fatal - Somalia (Galgadud)
[10] Cholera - Sudan (Northern Bahr el Ghazal)

******
[1] Cholera - South Africa (Northern Province) ex Zimbabwe
Date: Thu 20 Nov 2008
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... mRkPTTiD4A>


A health official said Thursday [20 Nov 2008], 3 Zimbabweans have
died of cholera in neighboring South Africa, where dozens of people
have come in search of treatment after an outbreak back home.

So far 3 Zimbabwean patients have died since Saturday [15 Nov 2008].
The latest casualty was recorded Wednesday evening [19 Nov 2008],
said Phuti Selobi, spokesman for the health department in the border
town of Musina.

South Africa has identified a total of 72 cholera cases. All but 2 of
them are Zimbabweans, Selobi said.

Zimbabwe is grappling with a cholera outbreak that has killed 73
people in recent weeks, about half of them in the town of Beitbridge,
just across the border from South Africa, according to state media in Harare.

South African health officials have stepped up their efforts to check
for the disease on the border, amid signs the disease is reaching
deeper into the country, Selobi said.

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

[Musina, in South Africa's Northern Province, is close to the border
with Zimbabwe where there has been a recent flare up of cholera. Its
location can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. - Mod.LL]

******
[2] Cholera - South Africa (KwaZulu-Natal) ex Zimbabwe
Date: Wed 19 Nov 2008
Source: IOL (Independent Online, South Africa) [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 134C746371>


A truck driver who arrived from Zimbabwe has been diagnosed with
cholera, the KwaZulu-Natal health department said on Wednesday [19
Nov 2008]. Spokesperson Leon Mbangwa said that the man had been
placed in an isolation ward in Durban's Addington Hospital. He said
the man had left Zimbabwe last Thursday [13 Nov 2008] with his
brother and arrived in Durban on Saturday morning [15 Nov 2008].

The truck driver and his brother checked into a local Durban lodge on
that morning. By evening the man was vomiting and suffering from
diarrhea. He was first admitted to City Hospital before being
transferred to Addington Hospital.

"He was in a semi-coma condition at that time, so it was hard to get
information from him. It has emerged that where he was in Zimbabwe
where people were suffering from diarrhea," said Mbangwa. He said
that tests had confirmed that the man had cholera. His brother was
under observation.

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

[As can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>,
Durban in KwaZulu-Natal province is separated from Zimbabwe by
hundreds of miles showing that rapid transportation can introduce the
waterborne disease a long way from the border. - Mod.LL]

******
[3] Cholera - Zimbabwe: USA ambassador statement
Date: Thu 20 Nov 2008
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... 8PBVxmRzFA>


The US ambassador to Harare, James McGee, said Thursday [20 Nov 2008]
that a total of 294 people have been confirmed dead from cholera in
Zimbabwe, amid some 1200 cases of the waterborne disease.

"The water situation, sanitation situation has gone through the
ceiling," McGee told reporters in Washington via a satellite hookup
from Harare.

"There are over 1200 confirmed cases of cholera and another 2500
unconfirmed cases of cholera," McGee said, adding that the death toll
had risen to 294, which is higher than the official toll.

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

[A map of Zimbabwe can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.

Cholera had been reported initially in the northern provinces and
then in the southern province of Matabeleland South (which borders
South Africa as noted above). Cases are now reported in more central
provinces as posted below. - Mod.LL]

******
[4] Cholera - Zimbabwe (Midlands Province)
Date: Thu 20 Nov 2008
Source: China View, Xinhua News Agency report [edited]
<http://news.xinhuanet.com/english/2008- ... 388071.htm>


More people have died of cholera outbreak in Zimbabwe, as an
additional 9 deaths were reported on Thursday [20 Nov 2008] in the
country's central province of Midlands, bringing the total death toll
up to 94 in the country.

The cholera outbreak was reported to have spread to Gweru, a city
about 300 km (186 mi) south of Harare where 9 people have died while
28 others have been diagnosed as having the disease, The Chronicle reported.

This brings the cholera death toll in Midlands to 13 after 4 others
died in Zvishavane's Murowa area in the province recently, the newspaper said.

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

[The central province of Midlands can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

******
[5] Cholera - Zimbabwe (Masvingo)
Date: Wed 19 Nov 2008
Source: The Zimbabwean [edited]
<http://thezimbabwean.co.uk/index.php?op ... Itemid=103>


Poor sanitary facilities, intermittent water supplies and poor refuse
management have led to a cholera outbreak in Masvingo. Although no
deaths have been officially recorded to date, sources spoken to by
RadioVOP indicated that about 5 people have already died due to
cholera and related illnesses. More than 450 cases of cholera have
been recorded in health centres in the province since Friday [14 Nov 2008].

The most affected areas are Rujeko suburbs, Mushandike, and
Mpandawana Growth point in Gutu and Chivi district. Health officers
were on Monday [17 Nov 2008] deployed at Mushandike Resettlement area
where they are said to be treating the victims.

Medical staff at Masvingo General Hospital who spoke on condition of
anonymity said a number of people were being ferried to the
Provincial hospital for cholera treatment.

An official at Rujeko clinic said more than 200 cases of cholera were
recorded since Thursday last week [13 Nov 2008].

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

[The southeastern province of Masvingo borders with Midlands to the
north as well as with Mozambique as can be seen at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

******
[6] Cholera - Mozambique (Manica)
Date: Tue 18 Nov 2008
Source: AllAfrica, Agencia de Informacao de Mocambique (Maputo) report [edited]
<http://allafrica.com/stories/200811181021.html>


The cholera outbreak in Guro district, in the central Mozambican
province of Manica, which began in late October 2008, has now spread
to new areas surrounding the villages of Chinda, Thanda, Bunga, and
Nhamassonje, but no new deaths were recorded, reports Tuesday's [18
Nov 2008] issue of the Maputo daily 'Noticias'.

Guro district administrator Deolinda Bengula told reporters that
there were 17 people hospitalised at the Cholera Treatment Centre in
Chinda on Monday [17 Nov 2008], while 8 others had been transferred
from Thanda and Bunga to Changara, in neighbouring Tete province.

Guro chief doctor Albertino Zunza, who is in Chinda with the medical
team working in the treatment centre, said that 13 new patients had
been admitted by Sunday [16 Nov 2008], rising to 17 by the next day.

Since the outbreak of the disease in Guro, which is blamed on the
consumption of untreated water, 200 cases have been diagnosed, with a
total of 53 deaths.

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

[The area, close to eastern Zimbabwe can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>. - Mod.LL]

******
[7] Cholera - Congo (Pool)
Date: Thu 20 Nov 2008
Source: Afrique en Ligne, Panafrican News Agency (PANA) report [edited]
<http://www.afriquenligne.fr/news/africa ... 16325.html>


At least 26 people are suffering from cholera in the Kinkakassa
Village, in the southern Congolese Pool District, a source close to
the World Health Organisation (WHO) Regional Office for Africa told
PANA here on Wednesday [19 Nov 2008]. The outbreak was first reported
about 2 weeks ago, but no deaths from the disease have so far been reported.

Cholera was diagnosed in Kinkakassa following a dramatic surge of
diarrhea cases in the area. Samples taken by NGO Medecins d'Afrique,
which is working under a socioeconomic rehabilitation and development
project funded by the European Union, were forwarded for analysis to
the Brazzaville national public health laboratory, where the
diagnosis of cholera was confirmed.

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

[The Pool region of Congo located west of the country of Congo DR can
be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /congo.pdf>. - Mod.LL]

******
[8] Cholera - Guinea-Bissau
Date: 19 Nov 2008
Source: All Africa, UN Integrated Regional Information Networks
(IRIN) report [edited]
<http://allafrica.com/stories/200811190981.html>


After more than 6 months of battling cholera in Guinea-Bissau the
epidemic is now easing health officials say, though they admit they
have not identified its root causes or put in place measures to
prevent future outbreaks.

Thus far, 221 people have died and 13 921 have been infected,
according to the Ministry of Health.

"All the factors that cause cholera remain unaddressed: poverty,
deficient sanitary services, lack of drinking water," Umaro Ba, head
of the cholera unit at the capital Bissau's Simao Mendes hospital,
told IRIN. "And more importantly in the future we need to put in
place a strong prevention programme."

At the epidemic's peak in the final week of September 2008, 1376 new
cholera cases were registered and 19 people died, according to the
ministry of health, but from 9 to 16 Nov 2008 just 128 new cases and
no deaths were reported.

A decrease in cholera cases is partly due to the end of the rainy
season, according to Ba, as the disease is spread by bacteria in
contaminated water.

The strong mobilization from UN agencies, communities, local and
international NGOs, and donors also helped contain the disease,
according to Johannes Mooij, technical adviser at the Simao Mendes hospital.

Health Ministry officials say cholera broke out in May 2008 in the
southern region of Tombali, but they still do not know how it spread
to the capital, home to the highest number of victims. Nor do
epidemiologists understand why the isolated Bijagos Islands had the
highest per capita caseload.

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

[The West African country of Guinea-Bissau is south of Senegal and
north of Guinea (also called Guinea-Conakry and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... ineabi.pdf>. - Mod.LL]

******
[9] Diarrhea, fatal - Somalia (Galgadud)
Date: Tue 18 Nov 2008
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200811190648.html>


At least 100 people have died in the past 4 weeks after an outbreak
of acute watery diarrhea (AWD) in and around the town of Abudwaaq, in
Galgadud region of central Somalia, medical sources said on 18 Nov 2008.

"Since 3 Oct 2008, 100 people have died in Abudwaaq town; there are
some people who have died in the villages around it but we don't have
numbers for them," said Mohamed Jama, the only doctor in the area.
"This is the highest mortality rate I have witnessed in my career."

Jama said that so far 500 cases of AWD had been registered in the
hospital, where a treatment centre was set up. "These are the ones
who made it here. We are getting reports of people dying in the
outlying villages, but unfortunately we cannot reach them."

He blamed the outbreak on contaminated water drawn from wells and
"barkads" (water catchments).

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

[AWD is an often used term to be used instead of cholera, which is
likely to be the cause of this outbreak. The location of Galgadud
(spelled Galguduud on the map) can be found at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. - Mod.LL]

******
[10] Cholera - Sudan (Northern Bahr el Ghazal)
Date: Wed 19 Nov 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Miraya FM report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


The minister of health in Northern Bahr el Ghazal, Akon Bol Akok,
told Miraya FM that more than 10 people died of cholera and
waterborne diseases following the recent floods, which hit the state
recently. Akon added that the number of patients is on the increase,
especially in Eastern Aweil County, Fariang, Akwem-Nhom, and Piu-Chiok.

The minister referred to more than 240 cases of cholera and watery
diarrhea registered during the last week.

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

[The area mentioned in the semiautonomous region of South Sudan can
be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (46)
**********************************************
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
[2] Cholera - Zimbabwe (Bulawayo)
[3] Cholera - South Africa (Limpopo) ex Zimbabwe

******
[1] Cholera - Zimbabwe
Date: Fri 21 Nov 2008
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... 7Gb3xMWB4w>

Nearly 300 people had died of cholera in Zimbabwe as of 18 Nov 2008,
the United Nations chief humanitarian agency said on Friday [21 Nov
2008].

"The cholera outbreak has taken a national dimension. Newer outbreaks
are reported from all provinces. The total number of suspected
cholera cases in the country stands at 6072 cases and 294 deaths,"
the UN's Office for the Coordination of Humanitarian Affairs (OCHA)
said in a statement.

The latest outbreaks were reported from Beitbridge in the Matabele
South province with 700 cases and 20 deaths. Health facilities in the
area are reporting an admission rate of 200 patients per day, OCHA
said.

"The spatial distribution of outbreaks will most likely continue to
expand as well as the number of people infected," given the worsening
water and sanitation situation in densely populated areas, it warned.

The World Health Organization (WHO) said it has requested emergency
health kits from its warehouse in Dubai to strengthen national and
provincial stocks ahead of the rainy season. The WHO added it has
provided strategic stocks of emergency supplies to various locations
in the country, which is suffering from world record inflation and a
power struggle between President Robert Mugabe and the opposition.

Zimbabwe medical groups have slammed poor basic water and sanitation
facilities and a weakened health system, paralysed by drug shortages,
dilapidated infrastructure, and a brain drain of health professionals.

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

******
[2] Cholera - Zimbabwe (Bulawayo)
Date: Fri 21 Nov 2008
Source: Malaysian National News Agency (Bernama) [edited]
<http://www.bernama.com.my/bernama/v3/ne ... ?id=373519>


The cholera outbreak has spread to Bulawayo, Zimbabwe's 2nd largest
city, with 2 deaths recorded in the city while 9 other people were
diagnosed, China's Xinhua news agency said quoting a local media
report Friday [21 Nov 2008].

Resident minister for Bulawayo Province Cain Mathema told journalists
on Thursday [20 Nov 2008] that 2 men died after traveling to the
southern Zimbabwe border city of Beitbridge where the disease has
claimed at least 51 lives.

"One died on Wednesday [?12 Nov 2008] after a visit to Beitbridge.
The other, a truck driver, died on Saturday [15 Nov 2008] at Mpilo
Central Hospital after he also arrived from Beitbridge," said Mathema.

The other 9 suspected to have cholera include 4 men, 2 women, and a
10-year-old child. They are admitted at Thorngrove Isolation Centre.

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

Bulawayo (<http://en.wikipedia.org/wiki/Bulawayo>) is the 2nd largest
city in Zimbabwe, after the capital Harare. It is located in
Matabeleland, southwest of Harare but is now treated as a separate
provincial area.
A map of Zimbabwe can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]

******
[3] Cholera - South Africa (Limpopo) ex Zimbabwe
Date: Fri 21 Nov 2008
Source: The Times (South Africa), South African Press Association
(SAPA) report [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=889750>


The number of cholera cases has risen to 123 in the Limpopo border
town of Musina, the Department of Health said.

"A total of 22 cases have been reported since last night [20 Nov
2008], bringing the number to 123 since Saturday [15 Nov 2008]," said
department spokesman Phuti Seloba. "Those who are infected are from
Zimbabwe, with the exception of one South African... 18 people have
been hospitalized," he said.

A Zimbabwean man died yesterday [20 Nov 2008], making it the 3rd
fatality from the illness. The other 2 had died earlier.

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

Limpopo (<http://en.wikipedia.org/wiki/Limpopo>) was previously known
as the Northern province. A map of South Africa can be found at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.
The HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/promed/en?g=1085597&v=-24,29.5,5>. Mod.LL]

ANTHRAX, BOVINE, HUMAN - ZIMBABWE (MATABELELAND NORTH)
******************************************************
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: Fri 28 Nov 2008 06:57:34 -0800 (PST)
Source: The Zimbabwean, UN Integrated Regional Information Networks
(IRIN) News report [edited]
<http://www.thezimbabwean.co.uk/index.ph ... Itemid=103>


A surge in anthrax has also hit the south of Zimbabwe, claiming the
lives of villagers and their livestock.

Matabeleland North provincial medical director, Dr Gibson Mhlanga,
confirmed the deaths of 2 people from anthrax, but a report in the
official The Chronicle newspaper said 6 had died and over 200 cattle
had been wiped out in the province's Dongamuzi area near Lupane, 120
km (74.6 mi) north of Bulawayo, Zimbabwe's 2nd city.

The government dispatched its disaster management Civil Protection
Unit (CPU) to Lupane last week [week of 17 Nov 2008] to work with the
Veterinary Services Department to vaccinate affected cattle in a bid
to contain the disease. Anthrax will further strain Zimbabwe's
crumbling health delivery system. Medical officials in Lupane said the
people who had succumbed to anthrax over the past week had eaten meat
from infected cattle; several other villagers in the district have
been hospitalised.

Villagers in the Lupane area who spoke to IRIN said they had lost a
considerable number of livestock to the rapid onset infection, which
is hard to detect in its early stages. "My entire kraal [enclosure
for cattle or other livestock] was almost wiped out and the few
cattle that I have remaining have been vaccinated [but] I am not sure
whether the 7 remaining cattle I have left will not die also,"
said Matthew Ncube, 57, who had already lost 35 of his animals.

Ephraim Moyo pointed out that the risk of human infection was rising
with the approach of the festive season. "People eat a lot of meat,
and the problem is that people in the village do not throw away
cattle that die ... they eat the meat."

The outbreak is causing serious concern in Bulawayo, where most
people buy their meat from unlicensed butcheries that source the
animals from rural areas like Lupane. "Ever since the outbreak of
anthrax I have not been buying meat from the vendors I normally buy
from, as the meat that they bring from rural areas is not inspected,"
said Bulawayo resident Ndabezinhle Sibanda.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[This confirms that the anthrax epizootic in Matabeleland North is
continuing and possibly 2 more have died since the official report in
the Chronicle, date unknown, of 6. It seems that the number of
deaths, 2 to 6, is oscillating between one official source and the
next, (see ProMED-mail no. 20081117.3631). This report also confirms
the deployment of a CPU to the affected area last week. There is an
interesting photograph of protesters with a banner, "We want drugs
for patients."

Hopefully farmers have been obtaining their livestock vaccine from a
reliable source. - Mod.MHJ]

Gambia - Malaria
01.12.2008

In den letzten Wochen kam es gehäuft zu Malariaerkrankungen bei europäischen Reisenden. Seit Ende Oktober wurden mehr als 30 Malaria tropica Fälle registriert. In Dänemark kam es zu einem Todesfall. Viele der Reisenden unternahmen eine Last-Minute Pauschalreise. Fast alle verzichteten auf Malaria-Chemoprophylaxe, in zwei Fällen wurde eine Prophylaxe mit Chloroquin durchgeführt. In Gambia besteht ganzjähriges Malariarisiko. / Quelle: crm
_____________________________

Nigeria - Poliomyelitis
01.12.2008

Nachdem die Fallzahlen im vorigen Jahr zurückgegangen waren, zeichnet sich im Norden des Landes ein erneuter Anstieg ab. 758 Erkrankungen wurden in diesem Jahr bereits gemeldet, davon die meisten durch Wildvirus Typ 1, der in den letzten Jahren für die Reimporte in zahlreiche Länder verantwortlich war. Nach neueren Untersuchungen gibt es in den nördlichen Bundesstaaten noch immer Schlüsselregionen mit hohem Risiko, in denen 20% der Kinder nicht geimpft sind. Nachweislich zwei Fälle wurden von dort bereits in diesem Jahr wieder in die Nachbarländer Benin und Niger importiert. Impfschutz bei Reisen weiterhin beachten. / Quelle: crm

Gambia - Malaria
01.12.2008

In den letzten Wochen kam es gehäuft zu Malariaerkrankungen bei europäischen Reisenden. Seit Ende Oktober wurden mehr als 30 Malaria tropica Fälle registriert. In Dänemark kam es zu einem Todesfall. Viele der Reisenden unternahmen eine Last-Minute Pauschalreise. Fast alle verzichteten auf Malaria-Chemoprophylaxe, in zwei Fällen wurde eine Prophylaxe mit Chloroquin durchgeführt. In Gambia besteht ganzjähriges Malariarisiko. / Quelle: crm

Simbabwe - Darminfektionen
01.12.2008

Risiko für Durchfallerkrankungen landesweit. Der seit August anhaltende Cholera-Ausbruch hat sich weiter ausgebreitet. Betroffen sind vor allem Harare, Nyamapanda, Chinhoyi und Kariba. Bis Ende November erkrankten mehr als 10.000 Personen, wovon 425 verstarben. Tendenz steigend. Hygiene beachten. Risikoreisende sollten geimpft werden. / Quelle: crm
_________________________________

Ghana - Darminfektionen
01.12.2008

Risiko für Durchfallerkrankungen landesweit, Mitte September wurden insgesamt 3 Cholera-Erkrankungen aus der Hauptstadt Accra gemeldet, es wird befürchtet, dass sich der Ausbruch ausweiten könnte. Milzbrand, der zu bösartigen Geschwüren an Haut oder Darm mit schweren Allgemeinerscheinungen führen kann, kommt bei Einheimischen durch Umgang mit oder Verzehr von kranken Tieren vermehrt vor. Polio durch Wildviren wurde dieses Jahr zum ersten Mal seit 2003 aus Nord-Nigeria reimportiert und in 5 Fällen nachgewiesen. Hygiene und Impfschutz (Polio) beachten. / Quelle: crm
_________________________________

Guinea-Bissau - Darminfektionen
01.12.2008

Risiko für Durchfallerkrankungen landesweit. Nach einer Pause von zweieinhalb Jahren gab es im Land wieder Cholera: Der seit Anfang August anhaltenden Ausbruch scheint unter Kontrolle zu sein. Bisher sind mehr als 13.900 Personen erkrankt, wovon 221 verstarben. Die Zahl der täglichen Neuerkrankungen war zuletzt deutlich rückläufig. Die Hauptstadt Bissau war am stärksten betroffen. Guinea-Bissau erlitt mit mehr als 25.000 Erkrankungen und 400 Todesfällen in der zweiten Jahreshälfte 2005 eine der schwersten Cholera-Epidemien in seiner Geschichte. Hygiene beachten.techmücken beachten. / Quelle: crm

ANTHRAX, BOVINE, HUMAN - ZIMBABWE (02): (MATABELELAND NORTH)
************************************************************
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 1 Dec 2008 09:18:28 GMT
Source: The Earth Times [edited]
<http://www.earthtimes.org/articles/show ... oming.html>


Aid agency: worst anthrax outbreak looming
------------------------------------------
An outbreak of the deadly cattle-born disease anthrax is threatening
to turn into Zimbabwe's worst yet, compounding a 7-week national
epidemic of cholera, an international aid agency warned Monday [1 Dec
2008]. The British-based Save the Children Fund said health workers
had reported 32 cases of human infection and 3 deaths of people who
had probably been eating meat from the carcasses of cattle infected
with the disease in remote northwest Zimbabwe.

The disease had already killed 150 livestock, 2 elephants, 70 hippo,
and 50 buffalo. It threatened to wipe out 60 000 cattle in the
region, it said.

Spokeswoman Rachel Pounds said the outbreak could be the worst since
the country's civil war for black majority rule that preceded
independence in 1980, when hundreds of people were reported to have
died. There was a risk that the disease, which is usually fatal if
not treated with heavy antibiotic doses, could spread out of the
Binga district in the Zambezi river valley, into the tourist town of
Victoria Falls and across the border into neighbouring Zambia, she
said.

Traders had been seen trucking potentially infected meat from Binga
to Victoria Falls.

"Many families in the Zambezi Valley are so hungry they are taking
meat from the carcasses of their animals, even if they know it's
diseased, and feeding it to their children," Pounds said. "Families
no longer have choice here. Even if they know they shouldn't sell
their livestock, it's often the only way of making money to feed
themselves."

Zimbabwe is in the grip of a deadly complex of crises, with a
collapsing economy, famine with nearly 4 million people facing
starvation, the shut-down of infrastructure including hospitals and
schools, and the failure of services like water, electricity,
sewerage disposal, and refuse collection. "Quarantines (against the
movement of potentially infected meat) may be in place, but
Zimbabwe's systems have collapsed," Pounds said.

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

[Binga is located on the lower southeastern shore of Lake Kariba; see
<http://www.lib.utexas.edu/maps/africa/z ... l_2002.pdf>.

This report appears to be another take on the outbreak originally
reported in Lupane District, Matabeleland North, on 14 Nov 2008 (see
ProMED-mail 20081116.3621). From what is implied it would now appear
that the epidemic has spread north to the Zambezi Valley -- why else
would meat from Binga be a risk -- reinforced by the reports of hippo
and buffalo deaths.

Up until now the Zambezi press has been holding to only 6 human cases
with wobbles. Now we have 32 human clinical cases with 3 deaths. With
the collapse of the medical services anything unfortunately could be
happening. - Mod.MHJ]

MALARIA - EUROPE, USA, ex GAMBIA
********************************
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 1 Dec 2008
Source: GeoSentinel [edited]
<http://www.geosentinel.org>


GeoSentinel, the global surveillance program of the International
Society of Travel Medicine (ISTM) wishes to report additional
travel-related clusters and cases of _Plasmodium falciparum_ malaria
acquired in the Gambia

A total of 7 cases of _Plasmodium falciparum_ have presented to GeoSentinel:
- 4 cases at our Cambridge, UK (CBG) site located at Addenbrooke's
Hospital, University of Cambridge;
- 2 cases at our Oslo Norway Site (OSL) located at Ulleval Hospital; and
- 1 case at our Bronx, New York site (BXL) located at Bronx Lebanon Hospital.

Dates of presentation have been from 26 Sep to 14 Nov [2008],
suggesting increased transmission since early September [2008]. 4
cases have been in immigrants visiting friends and relatives (VFR
travelers), 2 in tourists, and 1 in a missionary volunteer.

All 7 have recovered. None had taken chemoprophylaxis. One patient
from the UK had been specifically advised against doing so by a trip
organizer, another took no prophylaxis despite a previous episode of
malaria in 2004 after a trip to Tanzania.

Several recent studies have reported on significant decreases in
malaria transmission in the Gambia to the end of 2007 as perhaps
associated with control efforts (Lancet of 1 Nov 2008; 372: 1545-54;
<http://www.malariajournal.com/content/7/1/235.


Indeed, prior to the current cases, the last previous cases of
malaria from the Gambia reported to GeoSentinel were in 2005 from our
Zurich site, though we had no reporting sites in the UK during 2005
and 2006.

These recent travel-related cases once again point to the benefit of
sentinel travelers in the rapid detection of changes in disease
transmission patterns and secondly to the need for chemoprophylaxis
in all travelers to West Africa.

--
Communicated by:
David O Freedman, MD (Birmingham, Alabama, USA)
Effrosyni Gkrania-Klotsas, MD (Cambridge, UK)
Mogens Jensenius, MD (Oslo, Norway)
Stefan Hagmann, MD (Bronx, New York, USA)
For GeoSentinel
<geosentinel@geosentinel.org>

******
[2]
Date: Mon 1 Dec 2008
Source: European Network on Imported Infectious Disease Surveillance
(TropNetEurop) [edited]
<http://www.tropnet.net>


Netherlands
-----------
Report from Dutch national infection surveillance meeting last
Thursday [27 Nov 2008].

In the Netherlands, 8 patients have been reported with _P.
falciparum_ malaria after returning from the Gambia (1st day of
illness between [21 Sep and 14 Nov 2008]. One patient had died, 5
travelers did not use chemoprophylaxis, one traveller was non
compliant, and 2 had used homeopathic medication.

[Leo Visser, Leiden, The Netherlands]

Norway
------
We have had 2 patients with _P. falciparum_ infection from the Gambia
in November [2008].

[Bjorn Myrvang, Oslo, Norway]

United Kingdom
--------------
We too have had this week a P falciparum malaria case in a patient
from the Gambia. No malaria prophylaxis!

[Matthias Schmid, Newcastle General Hospital, Newcastle upon Tyne,
United Kingdom]

Spain
-----
Two _P. falciparum_ patients from Barcelona. The patients where from
the Gambia but living in Spain and took no chemoprophylaxis.

[Joaquim Gascon, Barcelona, Spain]

Denmark
-------
The patient who died of suspected malaria in Denmark has now been
confirmed to have malaria at the autopsy, bringing the total number
of cases to 8.

[Carsten Schade Larsen & Eskild Petersen, Aarhus, Denmark]

--
Communicated by:
Tomas Jelinek
<jelinek@bctropen.de>
TropNetEurop coordinator
Berlin Center for Travel and Tropical Medicine
Jagerstr. 67-69, 10117 Berlin, Germany
<http://www.bctropen.de>

[The total number of cases reported is now 32 from TropNetEurop and 7
from the GeoSentinel network, with 2 fatalities and several patients
in intensive care and on ventilators. It is surprising that so many
travelers have been visiting a highly endemic area without
chemoprophylaxis, which indicates that pre-travel advice has been
insufficient. Some travelers had been advised to use chloroquine as a
single drug prophylaxis, which has been obsolete in the Gambia since
at least 15 years back.

ProMED-mail would be happy to post data on malaria in the indigenous
population in the Gambia if it is available. The surge in imported
cases shows that transmission must be very high in the Gambia and a
surge in malaria in children, pregnant women, and adults with little
clinical immunity would be expected for example seen by an increasing
number of admission at local hospitals.

Maps of the Gambia are available at
<http://www.lib.utexas.edu/maps/africa/gambia.gif>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?v=13.5,-15.5,6>. - Mod.EP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 ( 48 )
***********************************************
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
[2] Cholera - South Africa (Limpopo, Mpumalanga) ex Zimbabwe

******
[1] Cholera - Zimbabwe
Date: Sun 30 Nov 2008
Source: Agence France Presse (AFP) [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Zimbabwe's health minister insisted Sunday [30 Nov 2008] that the
country's crumbling medical system was taking all necessary measures
to combat a cholera epidemic, even as more than 1000 new cases were
reported.

Since the current outbreak began in August 2008, health minister
David Parirenyatwa, said 425 people had died and a total of 11 071
suspected cases had been reported nationwide. The last estimate from
the United Nations on Friday [28 Nov 2008] had put the toll at around
9900 cases.

Parirenyatwa said the health services were trying to contain the
disease's alarming spread but warned that already poor sanitation was
likely to worsen with the onset of the rainy season. "What I am
afraid of is that now that the rainy season has come, all the feces
lying in the bushes will be washed into shallow wells and contaminate
the water," Parirenyatwa told the government mouthpiece Sunday Mail
newspaper.

"Management of water and sanitation is primary to the cholera
problem." He emphasized the need for clean water, a proper sewage
system and refuse collection.

[Byline: Godfrey Marawanyika]

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

[The number of cases of cholera in Zimbabwe continues to rise
dramatically, underscoring the need for rapid intervention.

A map of Zimbabwe can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/promed/en?v=-19,29.9,6>.
- Mod.LL]

******
[2] Cholera - South Africa (Limpopo, Mpumalanga) ex Zimbabwe
Date: Mon 1 Dec 2008
Source: Sowetan [edited]
<http://www.sowetan.co.za/News/Article.aspx?id=895645>


The death toll as a result of cholera infection has risen to 5 in
Limpopo, while in Mpumalanga, 2 people were found to have contracted
the disease over the weekend.

This brings to 6 the total number of people who have died since the
outbreak of the waterborne disease 2 weeks ago. One person died in
KwaZulu-Natal last week after being diagnosed with the infection.

Limpopo department of health and social development spokesman Phuti
Seloba said 2 people died at the weekend after contracting the
disease. One of them died shortly after he was admitted to the
Messina Hospital, while another one died at a rehydration centre in
Madimbo, an area outside Musina that is used by most Zimbabweans to
cross into South Africa.

Of the total number of deaths, 2 were South Africans who had
allegedly visited Zimbabwe, and the rest are Zimbabweans.
Departmental records yesterday [30 Nov 2008] showed that at least 363
patients had been treated in various hospitals in Limpopo. 81 of them
have been admitted to the Musina, Siloam and Donald Fraser hospitals.

[Byline: Frank Maponya]

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

[Limpopo
<http://en.wikipedia.org/wiki/Limpopo>
was previously known as the Northern province.

A map of South Africa showing the mentioned areas can be found at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.
As can be seen on the map, Mpumalanga does not border Zimbabwe.

The HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/promed/en?g=1085597&v=-24,29.5,5>.
- Mod.LL]