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CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (10)
**********************************************
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: WHO
[2] Cholera - Zimbabwe
[3] Gastroenteritis, fatal - Nigeria (Ebonyi)
[4] Dysentery - Sudan (Lakes State)

******
[1] Cholera - Zimbabwe: WHO
Date: Sun 25 Jan 2009
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Government of Zimbabwe; WHO report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Zimbabwe: daily cholera update and alerts, 25 Jan 2009
------------------------------------------------------
Highlights of the day:
- 655 cases and 26 deaths added today (in comparison 1906 cases and
21 deaths yesterday [24 Jan 2009)
- 36.2 percent of the districts affected have reported today (21 out
of 58 affected districts)
- 88.7 percent of districts reported to be affected (55 districts/62)
- Revised figures for Bindura deaths from 19 to 21
- Cumulative institutional case fatality rate 2.2 percent
- Daily institutional case fatality rate 1.9 percent

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

[The total number of cases reported in the full report at
<http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf>
is now 53 306, and the total fatality count has risen to 2872. In the
4 days since ProMED-mail's last posting, the cases have risen by 4683
and the fatalities by 117. The outbreak continues to spread to new
areas and the overall case fatality rate, reflecting the overall poor
conditions in the country, remains very high at 5.4 percent.

A map of Zimbabwe with provinces 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 - Zimbabwe
Date: Thu 22 Jan 2009
Source: BBC News [edited]
<http://news.bbc.co.uk/2/hi/africa/7844417.stm>


The main impact of Zimbabwe's cholera epidemic has shifted from urban
areas to rural areas, making its containment much harder, a medical
charity says. Medecins Sans Frontieres [MSF] told the BBC that the
disease was spreading to remote areas, while cases in some urban
areas, like Harare, were decreasing.

The rainy season could lead to even more infections, as water sources
become contaminated, aid workers warn. MSF Zimbabwe representative
Manuel Lopez said that small villages off the main roads were now
being affected following the Christmas holidays [2008], when urban
residents went home.

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

******
[3] Gastroenteritis, fatal - Nigeria (Ebonyi)
Date: Thu 22 Jan 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009- ... 703449.htm>


An outbreak of a disease suspected to be gastroenteritis has claimed
an unofficial figure of 15 lives in Ndiagu-Amagu village in Ikwo
Local Government Area of Ebonyi this month [January 2009], the News
Agency of Nigeria reported on Thursday [22 Jan 2009].

Sunday Nwangele, state commissioner for health announced in Abakaliki
that 6 of the dead were male and 9 female including 5 children. He
attributed the outbreak, which infected some 120 persons, to intake
of contaminated water following the breakdown of the three boreholes
in the area.

Local media last week [week of 12 Jan 2009] reported that at least 41
children died of gastroenteritis in another community in southeastern
Nigeria's Ebonyi State [which was referred to as cholera in one
report - Mod.LL]. The disease was said to have started some weeks ago
and to have gradually grown into epidemic with children between one
to 10 being the mostly affected, with some in critical condition.

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

[Ebonyi State is an inland south eastern state of Nigeria and is one
of the 6 new states in Nigeria created in 1996; Ebonyi was created
from the of old Abakaliki division of Enugu State and old Afikpo
division of Abia State.

The area of Nigeria mentioned can be found on a map at
<http://en.wikipedia.org/wiki/Ebonyi_State>.
The HealthMap/ProMED-mail interactive map of Nigeria is available at
<http://healthmap.org/promed/en?g=259534 ... 5,10.083,5>. - Mod.LL]

******
[4] Dysentery - Sudan (Lakes State)
Date: Fri 16 Jan 2009 15:21:16 +0100 (CET)
From: Ruth Jonathan <ruthjonathan@xs4all.nl>


We have seen quite a few cases with dysentery in Rumbek, Rumbek State
Hospital, South Sudan recently. Patients were sick with fever and
abdominal pain.

With antibiotic treatment they seem to recover well after some days,
however it has caused quite a few premature deliveries in pregnant
women, with their babies dying from prematurity. Unfortunately there
is no possibility to do culture or sensitivity analysis.

--
Dr Ruth Ay-Lian Jonathan
Medical officer
Rumbek Lake State Hospital
<ruthjonathan@xs4all.nl>

[This moderator apologizes for the delay in posting this report.
ProMED-mail thanks Dr Jonathan for this first-hand report of
gastrointestinal illness in Rumbek, the capital of the Lakes State,
which can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>.
The HealthMap/ProMED-mail interactive map of Sudan is available at
<http://healthmap.org/promed/en?g=367927&v=11.8,29.683,5>.

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

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (11)
**********************************************
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: WHO
[2] Cholera - South Africa (Limpopo)
[3] Cholera - Sudan (Warrab)

******
[1] Cholera - Zimbabwe: WHO
Date: Tue 27 Jan 2009
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Government of Zimbabwe; WHO report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


Zimbabwe: daily cholera update and alerts, 27 Jan 2009
------------------------------------------------------
Highlights of the day:

- 1579 cases and 57 deaths added today (in comparison 2817 cases and
102 deaths yesterday [26 Jan 2009])
- 68.9 percent of the districts affected have reported today (40 out
of 58 affected districts)
- 88.7 percent of districts reported to be affected (55 districts/62)
- institutional case fatality rate 2.1 percent
- Daily institutional case fatality rate 1.2 percent

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

[The total number of cases reported in the full report is now 57 702,
and the total fatality count has broken the 3000 barrier at 3028. In
the 2 days since ProMED-mail's last posting the cases, which
obscenely show no signs of abatement, have risen by 4396 and the
fatalities by 156. The outbreak continues to spread to new areas and
the overall case fatality rate, reflecting the overall poor
conditions in the country, remains very high at 5.2 percent.

A map of Zimbabwe with provinces 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)
Date: Tue 27 Jan 2009
Source: The Times, South African Press Association (SAPA) report [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=926574>


The number of cholera patients in Limpopo has passed the 3000 mark
since an outbreak hit the province almost 3 months ago, the
provincial health department said today [27 Jan 2009]. Spokesman
Phuti Seloba said a total of 3114 people affected by cholera had been
through the province's health facilities since November 2008.

These cases included 82 people reported over the last day. A total of
11 lives had been lost to the disease in the province.

Vhembe, together with Sekhukhune and Capricorn districts, was
identified by Limpopo health MEC Seoparo Charles Sekoati as having
the highest number of cholera patients with 68 new cases treated in
the areas over the last day.

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

The HealthMap/ProMED-mail map of South Africa is available at
<http://healthmap.org/promed/en?v=-29,25.1,5>. - Mod.LL]

******
[3] Cholera - Sudan (Warrab)
Date: Tue 27 Jan 2009
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 State minister of Health in Warap [also spelled Warrab - Mod.LL]
and the Deputy Governor Achuil Akuch Mager-Dit has assured Miraya FM
of a cholera outbreak in Akon area, North Gogrial District. He added
that the latest statistics of the disease until last week are 17
infections and 8 deaths.

Deputy Governor Achuil Akuch Mager-Dit told Miraya FM that a medical
team from the Federal Ministry of Health arrived in the area to
diagnose those affected and to identify the type of cholera in
addition to providing them with medication.

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

[The case fatality rate, whether 8/17 or 8/17+8 (it is not clear
which) is abnormally high, suggesting that either many non-fatal cases
are going unreported, or something other than cholera is causing the
outbreak. - Mod.JW

A map of Sudan showing Warap (Warrab) state in the south can be found at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>.
The HealthMap/ProMED-mail interactive map of Sudan is available at
<http://healthmap.org/promed/en?g=449225 ... 3,27.617,5>.

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

LASSA FEVER - UNITED KINGDOM ex NIGERIA (03): FATAL
***************************************************
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 29 Jan 2009
Source: BBC News [edited]
<http://news.bbc.co.uk/2/hi/health/7859655.stm>


A 66-year-old man being treated in hospital for Lassa fever has died
--------------------------------------------------------------------
The patient, from east London, died following a sudden deterioration
in his condition, said a spokesman from Hampstead's Royal Free
Hospital. The man, who has not been identified, had been travelling
in Nigeria and was admitted to hospital soon after returning to the
UK on 6 Jan 2009. Lassa fever was diagnosed on 22 Jan 2009 at the
Hospital for Tropical Diseases. Next of kin have been informed. A
spokeswoman from the Health Protection Agency (HPA) said there was no
risk of contamination to the public.

Lassa fever is caused by the Lassa virus and is endemic in Nigeria,
Sierra Leone, Liberia, Guinea, and the Central African Republic.
Hundreds of thousands of people are infected in these countries each
year and isolated cases have been seen in Europe and the USA. Around 8
in 10 people infected with Lassa virus develop mild or no symptoms,
but in 20 percent of cases people will have severe illness. Symptoms
include fever, headache, sore throat, a cough, nausea, vomiting,
diarrhoea, and muscle pain. A common complication is deafness, but
only about 2 percent of all patients die from the illness.

Dr Dilys Morgan, a Lassa fever expert at the HPA, said: "This is an
isolated case. It is important to stress that there is no risk to the
general public from this patient. "Lassa fever is an infection that is
found in West Africa and is seen rarely in this country in those who
have travelled to parts of the world where it is common. The virus is
spread by infected rats through their urine and droppings. The
infection is not easily spread to others and then only by direct
contact with bodily fluids."

There have been 10 confirmed cases of Lassa fever in the UK since 1970.

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

[Detailed information concerning Lassa fever can be obtained from the
World Health Organisation (WHO) website at
<http://www.who.int/mediacentre/factshee ... index.html>.

A photograph of the multimammate rat, the vector of the disease in
West Africa, can be accessed at
<http://farm3.static.flickr.com/2277/151 ... c9.jpg?v=0>. - Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (12)
**********************************************
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: WHO
[2] Cholera - South Africa (Mpumalanga, Limpopo)
[3] Cholera - Malawi (Central region)
[4] Cholera - Nigeria, Niger
[5] Cholera - Zambia (Northwestern, Southern provinces)
[6] Cholera - Togo (Maritime)

******
[1] Cholera - Zimbabwe: WHO
Date: Sun 1 Feb 2009
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Government of Zimbabwe; WHO report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... c=1&cc=zwe>


Zimbabwe: daily cholera update and alerts, 1 Feb 2009
-----------------------------------------------------
Highlights of the day:
- 1672 cases and 53 deaths added today (in comparison 555 cases and 3
deaths yesterday [31 Jan 2009])
- 36.2 percent of the districts affected have reported today (21 out
of 58 affected districts)
- 88.7 percent of districts reported to be affected (55 districts/62)
- 1 death occurred on 31 Jan 2009 in new area in Binga (Sinakoma)
- Mutare cases reduced by 73 and Ruwa deaths reduced by 6 after data cleaning
- Mazowe district reported 3 cases and 1 death for 1 Feb 2009, 7
cases and 1 death for 31 Jan 2009 and 5 cases and 0 deaths for 30 Jan 2009
- Midlands province did not report
- Chipinge district reported after 12 days
- Chiredzi district reported after 3 days with one reporting after 10
days, another reporting after 6 days and 2 others reporting after 19 days
- cumulative institutional case fatality rate 2.1 percent
- daily institutional case fatality rate 2.3 percent

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

[The total number of cases reported in the full report is well over
the 60 000 barrier, now at 62 909, and the total fatality count is
3229. In the 5 days since ProMED-mail's last posting the cases, which
obscenely show no signs of abatement, have risen by 5207 and the
fatalities by 201. This is an average of about 1040 cases with 40
deaths each day. The outbreak continues to spread to new areas and
the overall case fatality rate, reflecting the overall poor
conditions in the country, remains very high at 5.1 percent.

The full report can be found at
<http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf>.

A map of Zimbabwe with provinces 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 (Mpumalanga, Limpopo)
Date: Mon 2 Feb 2009
Source: The Times, South African Press Association (SAPA) report [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=930714>


11 more people have died of cholera in Mpumalanga and Limpopo, the
provinces' health departments said. Mpumalanga spokesman Mpho
Gabashane said 7 more people had died of cholera related illness in
the province, bringing the death toll to 26 in the region. Limpopo
health spokesman Phuti Seloba said 4 deaths had been confirmed. This
brought the province's cholera death toll to 20. Seloba added the 4
deaths were not recent, but that the department had received test
results only on Monday [2 Feb 2009] confirming the 4 victims had had cholera.

A total of 4165 people with cholera symptoms had been treated in
Mpumalanga alone by Monday afternoon [2 Feb 2009] since the outbreak,
blamed on the Zimbabwean collapse as well as government's lack of
delivery in SA [South Africa], began during November 2008. Limpopo
officials said 3600 people in the province were suffering from
cholera symptoms.

Dr Lucille Blumberg from the National Institute for Communicable
Diseases said that, even though the outbreak originated outside South
Africa, it was spreading to more SA communities. This was especially
so in Limpopo and Mpumalanga due to the unavailability of purified
water and proper sanitation in most of the rural areas in the provinces.

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

The HealthMap/ProMED-mail map of South Africa is available at
<http://healthmap.org/promed/en?v=-29,25.1,5>. - Mod.LL]

******
[3] Cholera - Malawi (Central region)
Date: Mon 2 Feb 2009
Source: Nyasa Times [edited]
<http://www.nyasatimes.com/national/2599.html>


Cholera has broken out at Lilongwe police station and health
authorities have since turned the police station into a cholera
treatment center. Central region police spokesman John Namalenga
confirmed about the cholera outbreak but said there have been no
deaths recorded so far.

So far about 39 people have died across the country due to cholera.
Lilongwe alone has had over 30 deaths.

In a related development, at least one person out of the 3 cholera
suspects who died recently in Kasungu has been confirmed to have died
of the disease according to Kasungu district deputy health officer,
Josam Banda.

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

[The areas mentioned are in Malawi's Central region and can be found
on a map at <http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>.
The HealthMap/ProMED-mail interactive map of Malawi is available at
<http://healthmap.org/promed/en?v=-13.2,34.3,6>. - Mod.LL]

******
[4] Cholera - Nigeria, Niger
Date: Fri 30 Jan 2009
Source: AllAfrica, The Daily Trust report [edited]
<http://allafrica.com/stories/200901300312.html>


The Federal Ministry of Health has alerted the National Emergency
Management Agency (NEMA) on the possible outbreak of cholera in some
states. The delegation from the ministry led by the director public
health professor Abdulsalam Nasidi, informed NEMA that the disease
may have broken out in parts of Ebonyi, Niger, Nassarawa, and Benue
states, following reports of the epidemics in the neighboring countries.

"The alert was issued based on information available to the ministry
about the outbreak of the disease in Zinder Region of Niger Republic
where reported cases of infection and death were reported," he said.

[Byline: Abdulkadir Badsha Mukhtar]

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

The Zinder region in southern Niger can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /niger.pdf> and
The states in Nigeria mentioned can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. None
border on Niger. - Mod.LL

Both countries can be located on the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/promed/en?v=17.4,9.4,5>. - CopyEd.MJ]

******
[5] Cholera - Zambia (Northwestern, Southern provinces)
Date: Thu 29 Jan 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009- ... 734697.htm>


Cholera has broken out in Choma, in Southern Province of Zambia, with
2 cases recorded in the district so far, Zambia News and Information
Services (ZANIS) reported on Thursday [29 Jan 2009]. District
commissioner Laiven Apuleni confirmed this to ZANIS in Choma on that
day. He said there have been no deaths recorded so far.

In Solwezi, in Northwestern Province, the cholera outbreak, which
claimed 2 lives at Chiljingejinge 2 weeks ago, has been contained.
Solwezi district medical doctor Harrison Ng'uni disclosed that 20
cases of suspected cholera were reported at the Kimasala cholera
isolation center, 18 were admitted and 14 were treated and
discharged. He said 6 clients tested positive of cholera and were
under treatment and in stable condition.

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

[The Northwestern and Southern provinces can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>.
The HealthMap/ProMED-mail interactive map of Zambia is available at
<http://healthmap.org/promed/en?v=-14.417,26,6>.

******
[6] Cholera - Togo (Maritime)
Date: Sun 1 Feb 2009
Source: Xinhua News Agency [in Chinese, trans. submitter AH, edited]
<http://news.hsw.cn/2009-02/01/content_10576302.htm>


According to media reports on 31 Jan 2009, Togo has experienced a
cholera epidemic during which about 620 people have contracted
cholera, of which 7 people died.

In December 2008 the Government of Togo in Lome had announced an
outbreak of cholera. Since then, the World Health Organization (WHO)
provided to Togo a number of cholera prevention measures and drugs.
Togo broadcast media also published a notice, so that people
understand the epidemic situation and preventive measures.

--
Communicated by:
HealthMap Alerts via ProMED-mail Rapporteur Dr Angela Huang

[A map of Togo showing the affected area in the south of the country
can be found at
<http://reliefweb.int/rw/fullMaps_Af.nsf ... penElement>.
The HealthMap/ProMED-mail interactive map of Togo is available at
<http://healthmap.org/promed/en?v=8.166,1.255,7>. - Mod.LL]

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

HEPATITIS A - EUROPE ex EGYPT
*****************************
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:
[1] Eurosurveillance Editorial
[2] France ex Egypt
[3] Belgium ex Egypt
[4] Germany ex Egypt

******
[1] Eurosurveillance Editorial
Date: Thu 22 Jan 2009
Source: Eurosurveillance edition 2009; 14(3) [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19101>


Hepatitis A in the European Union: responding to challenges related
to new epidemiological patterns
----------------------------------------------------------------------
[Authors: L Payne, D Coulombier
European Centre for Disease Prevention and Control, Stockholm, Sweden]

Hepatitis A is a vaccine-preventable acute, usually self-limiting
disease caused by infection with hepatitis A virus (HAV).
Transmission is usually by the faecal-oral route, including via
person-to-person spread, contaminated water or food products. It has
also been associated with injecting drug use and outbreaks among men
having sex with men.

In the European Union (EU), though figures may vary among countries,
the overall incidence of hepatitis A has decreased over the last 10
years from 15.1 per 100 000 population in 1996 to 3.9 per 100 000 in
2006 (1). This decreasing trend has been attributed to continued
improved sanitary and living conditions, with reduced exposure to
infection, especially in early childhood. However, reduction in
circulation of HAV leads to decreased acquisition of immunity and, in
the absence of universal vaccination, an accumulation of susceptible
individuals.

The impact of increasing susceptibility of the general population on
the risk for outbreaks is clearly illustrated in independent
outbreaks in Czech Republic, Latvia, and Slovakia in 2008, described
in 3 of the articles published in this week's issue of
Eurosurveillance (2-4). In these papers, the authors describe the
extent to which hepatitis A can spread within at-risk susceptible
populations and in the cases of Czech Republic and Latvia within the
general population. In these reports, a significant proportion of
cases are young adults, resulting in potentially more severe clinical
presentation and posing a challenge to the health authorities in the
area of safety of blood and tissue donation.

Experiences from the response to these outbreaks were the focus of a
technical meeting organised by the European Centre for Disease
Prevention and Control (ECDC) in collaboration with the Latvian
Public Health Agency in Riga in November 2008, where the
epidemiological pattern of hepatitis A outbreaks was reviewed, as
well as the role of vaccination in outbreak settings. Discussions
highlighted the fact that emergence of outbreaks in the EU generally
follows the introduction of the virus from endemic countries through
"seeding events." Non-immunised travellers to endemic areas are often
at the origin of seeding events, as shown in this week's issue of
Eurosurveillance in the three articles from France, Belgium, and
Germany (5-7), which describe clusters of travel-related cases
following visits to Egypt.

To prevent the introduction of HAV in the EU travellers to endemic
countries need to be vaccinated, and indeed vaccination for
travellers is recommended by the national guidelines of these 3
countries. However, as the authors point out, none of the cases
reported in their articles had been vaccinated. These clusters
therefore highlight the importance of effective travel medicine
advice reaching EU travellers of all age groups.

Seeding events can be self-contained. However, when occurring in
at-risk settings or communities, HAV transmission may be "amplified"
and result in a wide spread of the disease, as described among
injecting drug users in the reports by Czech Republic and Latvia, as
well as among Roma populations as reported by Slovakia. Similarly,
infected food-handlers may contribute to transmission amplification.
Introduction of HAV by children attending day care centres or primary
schools represents another type of situations at risk of increased
transmission. The Slovak experience shows that immunisation targeting
at-risk communities following such introduction may prevent the
spread to the general community. However, the Czech example shows
that such a strategy for control may not be effective with
hard-to-reach communities such as injecting drug users.

Once the outbreak spreads to the general population, vaccination of
contacts, as carried out in Czech Republic, represents an option to
complement isolation of cases and health education measures, if done
within a few days from exposure. Currently, there is no
evidence-based guidance available regarding the use of HAV vaccine in
outbreak control.

Though the total number of cases may be decreasing yearly in the EU,
the articles published in this edition of Eurosurveillance indicate
that hepatitis A is still an important public health issue, and
highlight the need for increased awareness of both the risk of
infection to the individual and the possibility of community
outbreaks within a changing EU epidemiology. As HAV vaccination is
not included in universal immunisation schedules, the EU is likely to
experience similar outbreaks in the future. This stresses the need to
promote immunisation of all travellers to endemic areas to prevent
return introduction and to develop evidence-based guidance for
outbreak control strategies.

References
----------
1. European Centre for Disease Prevention and Control: Annual
Epidemiological Report on Communicable Diseases in Europe 2008.
Stockholm, European Centre for Disease Prevention and Control, 2008.
Available from
<http://ecdc.europa.eu/en/files/pdf/Publ ... g_2008.pdf>.
2. Castkova J, Benes C: Increase in hepatitis A cases in the Czech
Republic in 2008 -- update. Euro Surveill. 2009; 14(3): pii=19091.
Available online at
<http://www.eurosurveillance.org/ViewArt ... leId=19091>>.
3. Perevoscikovs J, Lucenko I, Magone S, Brila A, Curikova J, Vennema
H: Community-wide outbreak of hepatitis A in Latvia in 2008 -- an
update. Euro Surveill. 2009; 14(3): pii=19092. Available online at
<http://www.eurosurveillance.org/ViewArt ... leId=19092>.
4. Hrivniakova L, Slacikova M, Kolcunova S: Hepatitis A outbreak in a
Roma village in eastern Slovakia, August-November 2008. Euro
Surveill. 2009; 14(3): pii=19093. Available online at
<http://www.eurosurveillance.org/ViewArt ... leId=19093>.
5. Couturier E, Roque-Afonso AM, Letort MJ, Dussaix E, Vaillant V, de
Valk H: Cluster of cases of hepatitis A with a travel history to
Egypt, September-November 2008, France. Euro Surveill. 2009; 14(3):
pii=19094. Available online at
<http://www.eurosurveillance.org/ViewArt ... leId=19094>.
6. Robesyn E, Micalessi MI, Quoilin S, Naranjo M, Thomas I: Cluster
of hepatitis A cases among travellers returning from Egypt, Belgium,
September through November 2008. Euro Surveill. 2009; 14(3):
pii=19095. Available online at
<http://www.eurosurveillance.org/ViewArt ... leId=19095>.
7. Bernard H, Frank C: Cluster of hepatitis A cases among travellers
returning from Egypt, Germany, September through November 2008. Euro
Surveill. 2009; 14(3): pii=19096. Available online at
<http://www.eurosurveillance.org/ViewArt ... leId=19096>.

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

******
[2] France ex Egypt
Date: Thu 22 Jan 2009
Source: Eurosurveillance edition 2009; 14(3) [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19094>


Cluster of cases of hepatitis A with a travel history to Egypt,
September-November 2008, France
----------------------------------------------------------------------
[Authors: E Couturier1, AM Roque-Afonso2, MJ Letort1, E Dussaix2, V
Vaillant1, H de Valk1
1. French Institute for Public Health Surveillance (Institut de
veille sanitaire, InVS), Department of infectious diseases
(Departement des maladies infectieuses), Saint-Maurice cedex, France
2. National reference centre for hepatitis A virus (Centre national
de reference du virus de l'hepatite A), Hopital Paul Brousse AP-HP,
Villejuif, France]

Summary
-------
Since September 2008, 26 cases of hepatitis A with a history of
travel to Egypt have been reported in France. Investigations indicate
that a common source of contamination linked to Nile river cruises is
the most likely explanation of the increase in the number of cases
reported in France as well as in several other European Union countries.

Full text available at
<http://www.eurosurveillance.org/ViewArt ... leId=19094>.

--
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<promed@promedmail.org>

******
[3] Belgium ex Egypt
Date: Thu 22 Jan 2009
Source: Eurosurveillance edition 2009; 14(3) [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19095>


Cluster of hepatitis A cases among travellers returning from Egypt,
Belgium, September through November 2008
----------------------------------------------------------------------
[Authors: E Robesyn1, MI Micalessi2, S Quoilin2, M Naranjo2, I Thomas2
1. Flemish Agency for Care and Health, Department of Public Health
Surveillance, Infectious Disease Control Unit, Brussels, Belgium
2. Scientific Institute of Public Health, Brussels, Belgium]

Summary
-------
Following a European alert by France, we detected a hepatitis A
cluster in Belgian travellers returning from Egypt. Our investigation
supports the hypothesis of a common source outbreak, linked to Nile
river cruises. The outbreak also suggests the need to consider an
intensification of the vaccination policy for travellers to hepatitis
A endemic countries.

Full text available at
<http://www.eurosurveillance.org/ViewArt ... leId=19095>.

--
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ProMED-mail
<promed@promedmail.org>

******
[4] Germany ex Egypt
Date: Thu 22 Jan 2009
Source: Eurosurveillance edition 2009; 14(3) [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19096>


Cluster of hepatitis A cases among travellers returning from Egypt,
Germany, September through November 2008
----------------------------------------------------------------------
[Authors: H Bernard, C Frank
Robert Koch Institute, Department for Infectious Disease
Epidemiology, Berlin, Germany]

Summary
-------
From September to November 2008, 34 cases of hepatitis A imported
from Egypt were reported to the German public health authorities.
Investigations point to a continuing common source of infection, most
likely linked to Nile river cruises. The patients affected had not
been vaccinated, which emphasises the need for more effective travel
advice before trips to hepatitis A endemic countries.


Full text available at
<http://www.eurosurveillance.org/ViewArt ... leId=19096>.

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

[While hepatitis A virus vaccination is not included in universal
immunisation schedules in Europe, the EU is likely to experience
similar outbreaks in the future. Consequently there is a need to
promote immunisation of all travellers to endemic areas to prevent
reintroduction of hepatitis A virus into a largely susceptible
population, and to develop outbreak control strategies. - Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (13)
**********************************************
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: WHO
[2] Cholera - Malawi
[3] Cholera - Mozambique (Cabo Delgado)
[4] Cholera - South Africa (Limpopo)


******
[1] Cholera - Zimbabwe: WHO
Date: Tue 3 Feb 2009
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Government of Zimbabwe; WHO report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Zimbabwe: daily cholera update and alerts, 3 Feb 2009
-----------------------------------------------------
Highlights of the day:
- 1038 cases and 28 deaths added today (in comparison 1792 cases and
69 deaths yesterday [2 Feb 2009])
- 57.6 percent of the districts affected have reported today (34 out
of 59 affected districts)
- 90.3 percent of districts reported to be affected (56 districts/62)
- no report received from Mashonaland Central
- cholera spreads to Nkayi District in Matabeleland North
- cumulative institutional case fatality rate 2.08 percent
- daily institutional case fatality rate 1.3 percent

--
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[The total number of cases reported in the full report is now closer
to 70 000 than 60 000, at 65 739, and the total fatality count is
3323. The horrendous outbreak continues to spread to new areas and
the overall case fatality rate, reflecting the overall poor
conditions in the country, remains very high at 5.1 percent.

The full report can be found at
<http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf>.

A map of Zimbabwe with provinces 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 - Malawi
Date: Wed 4 Feb 2009
Source: Medecins Sans Frontieres [edited]
<http://www.msf.org/msfinternational/inv ... =full_html>


As the cholera outbreak in Malawi escalates, the number of cases more
than doubled in January 2009 with 1142 cumulative cases recorded and
39 deaths, and the number continues to rise.

Exacerbated by poor sanitation and rainy season floods, the outbreak
started in the capital, Lilongwe, on 17 Nov 2008, quickly spreading
to 2 of the capital's densely populated slums where there is no
running water. The disease has now spread to more than 30 percent of
the districts in the country, with the highest concentration
remaining in and around Lilongwe.

"39 people have died from cholera with more than 1000 cases
recorded," said Dr Moses Massaquoi, medical coordinator in Malawi for
Medecins Sans Frontieres (MSF). "It's extremely worrying as the
disease continues to spread and numbers mount. Every day the rain
pounds down and people with no access to safe water resort to
drinking untreated water from swamps or from unprotected wells in
slums. As one of the poorest countries in the world, water and
sanitation levels are extremely low. On top of this, the floods cause
latrines to overflow and sewage then mixes with drinking water."

While cholera is endemic in Malawi, it has been 8 years since the
country's worst outbreak, which killed almost 1000 people, so that
much of the "memory" of how to respond to cholera is lost. As a
result, MSF medical staff are carrying out intensive bedside training
and mentoring for national Malawian nurses and assisting them in
handling cases to increase their capacity to respond to and contain
this outbreak.

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

[Lilongwe in Malawi's Central region and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>.
The HealthMap/ProMED-mail interactive map of Malawi is available at
<http://healthmap.org/promed/en?v=-13.2,34.3,6>. - Mod.LL]

******
[3] Cholera - Mozambique (Cabo Delgado)
Date: Tue 3 Feb 2009
Source: AllAfrica [edited]
<http://allafrica.com/stories/200902030673.html>


The health authorities in the northern Mozambican province of Cabo
Delgado have warned that the cholera outbreak in this part of the
country could worsen if attacks against health workers and sabotage
of cholera treatment centres continue. Cabo Delgado has seen a wave
of disinformation, according to which the very people trying to treat
the disease are accused of spreading it.

"If this situation is not corrected urgently, we could have negative
results in our program to prevent and fight against cholera
throughout the province," he warned.

In the provincial capital, Pemba, and in the town of Montepuez tents
used as cholera treatment centres have been burnt down, by angry mobs
who have swallowed the rumour that the treatment centres cause the disease.

Cholera has claimed 4 lives in Montepuez since the start of the
outbreak in late December 2008. Over the past weekend, 30 new cases
of the disease were reported in this district.

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

[Cabo Delgado province in northeastern Mozambique can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>.
The HealthMap/ProMED-mail interactive map of Mozambique is available
at <http://healthmap.org/promed/en?g=105182 ... 6,33.587,5>. - Mod.LL]

******
[4] Cholera - South Africa (Limpopo)
Date: Wed 4 Feb 2009
Source: Sowetan [edited]
<http://www.sowetan.co.za/News/Article.aspx?id=931725>


80 new cholera cases have emerged in Limpopo as the disease continues
to spread like wild fire in the province. The official death toll
remained unchanged at 20 yesterday [3 Feb 2009]. Provincial spokesman
for the department of health and social development, Phuti Seloba,
said new cases of infections were increasing and putting the lives of
ordinary people in danger.

The latest developments bring to 3680 the total number of cases that
had been dealt with since the outbreak of the disease on 15 Nov 2008.
Seloba said the Vhembe district had 16 new cases, Capricorn 37,
Sekhukhune 9, Mopani 2, and Waterberg 16.

The disease was first believed to have been brought about as a result
of the high influx of Zimbabweans who crossed into South Africa to
seek treatment. This was after they were found to have been exposed
to contaminated sewerage water in their country, resulting in the
outbreak. But now the majority of those contracting the disease or
dying from it are South African citizens.

[Byline: Frank Maponya]

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

[Limpopo can be found on a map of the country at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.
Limpopo is called the Northern Province on this map.
The HealthMap/ProMED-mail map of South Africa is available at
<http://healthmap.org/promed/en?v=-29,25.1,5>. - Mod.LL]

RABIES, CANINE, HUMAN - ANGOLA (02): (HUAMBO)
***********************************************
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 3 Feb 2009
Source: Agencia AngolaPress [Portugese, trans. Mod.MPP, edited]
<http://www.portalangop.co.ao/motix/pt_p ... ca041.html>


The Health Department of the Caala municipality, which is located 23
km from the provincial capital, reported 5 cases of people being
bitten by rabid dogs that were roaming in the main streets of the
city during the month of January [2009].

This fact was given to the Angop [Angola Press] today [3 Feb 2009] by
the head of the Health Division in the municipality of Caala, Ernesto
Albino Ndumbo, and thanks to prompt intervention of hospital
services, they [the people bitten by the rabid dogs] are out of
danger [presumably as a consequence of post-exposure vaccination].

Furthermore, the head of the municipal Health department in Caala
said the municipal health technicians have increased actions to raise
the awareness of residents on preventive measures against rabies. He
stressed that in addition to conducting talks in health centers, the
health technicians have also conducted door to door sensitization
activities to encourage the population to take their animals to the
vaccination centers.

The Angop knows that in the entire township of Caala, since January
2009, the veterinary services have immunized approximately 500
animals with rabies vaccine including dogs, cats and monkeys.

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

[Unfortunately, such incidents have not been rare in Angola, and the
efforts of the authorities have been reactive rather than preemptive.
In January 2007 (see archive reference below), a similar outbreak
occurred in another township (Ukuma), also close to the provincial
capital, in which 21 people were bitten by dogs, one of whom died.

The location of Caala, a community of approximately 7000 persons in
the province of Huambo, can be found at:
<http://www.fallingrain.com/world/AO/8/Caala2.html>.

A map of the provinces of Angola can be accessed at:
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>
showing Huambo in the centre of the country. - Mod.CP]

PLAGUE, FATAL - ALGERIA (04): NOT
*********************************
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 5 Feb 2009
Source: The Mercury, South African Press Association (SAPA)/Agence
France-Presse (AFP) report [edited]
<http://www.themercury.co.za/index.php?f ... Id=4826359>


Plague outbreak denied
----------------------
Algeria has dismissed reports that about 40 Al-Qaeda militants were
killed by an outbreak of bubonic plague at a secret training camp in
the country.

"No case of plague of any type has been recorded in any region of
Algeria since 2003," the health ministry said.

Reports had suggested that an Al-Qaeda offshoot had been
experimenting with the plague to create a biological weapon.

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

[Without confirmation, this thread is cut. - Mod.LL]

IRIN hat geschrieben:NIGERIA: Northern states on high alert for meningitis

KANO, 6 February 2009 (IRIN) - Nigerian health authorities have placed northern states on high alert following a meningitis outbreak in neighbouring Niger, which according to the World Health Organization (WHO) killed 17 people and infected 382 in January.

"In view of the fact that there are certain states sharing boundaries with Niger Republic, we have adopted a stitch-in-time strategy of putting these states on a state of high alert," said Nigerian Health Minister Babatunde Osotimehin in a 4 February statement.

The Nigerian states identified as highest-risk are Katsina, Sokoto, Kano, Kebbi and Jigawa.

Since 1 February Nigerian health officials reported 15 deaths from meningitis and more than 200 hospitalisations in Katsina state, Nigeria's closest state to Zinder, an infected region in Niger.

"[We decided] to intensify efforts to ensure that we curb its spread so that it [meningitis] does not explode into an epidemic, given the highly contagious nature of the disease," said a Katsina state health official who requested anonymity.

Bacteria that cause meningitis attack the spinal cord or brain lining, leading to possible paralysis, deafness, nervous disorders and death, according to WHO.

Nigeria's national government has announced it is heightening surveillance and improving laboratories in all 44 states, improving public awareness of the disease and distributing the chloramphenicol antibiotic used to treat meningitis.

Kano, which borders Katsina and is Nigeria's most populous state, has started running radio jingles on ways to prevent infection, according to state health commissioner Aisha Kiru.

The commissioner told IRIN health officials are reminding people to keep bedroom windows open and to "ensure ventilation" wherever they are. The disease is spread from person to person through droplets of respiratory or throat secretions, according to WHO.

The health agency estimates that up to 25 percent of the population, more in epidemic areas, may carry the bacteria at any given time without being infected.

"We have mobilised local chiefs, public health personnel and local government authorities for [education] campaigns in all the nooks and corners of the state," commissioner Kiru told IRIN.

Kiru predicted "disastrous" consequences in the case of a spillover of the epidemic from Niger.

In 1996 Africa experienced the largest recorded meningitis epidemic in history with more than 250,000 recorded cases and 25,000 deaths, including more than 1,000 in Nigeria.

During the dry season in West Africa, typically October to June, dust winds and cold nights lead to more respiratory infections, according to WHO. The infection spreads most rapidly in overcrowded living quarters.

http://m.irinnews.org

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (14)
**********************************************
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: WHO
[2] Cholera - Zimbabwe
[3] Cholera - Southern Africa
[4] Cholera - South Africa (Limpopo)
[5] Cholera - Ghana (Eastern region)
[6] Cholera - Malawi
[7] Cholera - Botswana ex Zimbabwe
[8] Bloody diarrhea - Liberia (Bong)

******
[1] Cholera - Zimbabwe: WHO
Date: Mon 9 Feb 2009
Source: Government of Zimbabwe; World Health Organization (WHO) [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Zimbabwe: Daily cholera update and alerts, 9 Feb 2009
-----------------------------------------------------
Highlights of the day:
- 1950 cases and 67 deaths added today (compared with 362 cases and 9
deaths yesterday)
- 49 per cent of the districts affected have reported today (29 out of 59
affected districts)
- 90 per cent of districts reported to be affected (56 districts/62)
- cumulative institutional case fatality rate 1.96 per cent
- daily institutional case fatality rate 1.2 per cent
- Chimanimani revised the cumulative cases from 2035 to 1135 and deaths
were reclassified (42 to 47 Institutional and 25 to 30 community)
- No reports from Mashonaland East, Masvingo, Matabeleland North.

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

[In the 6 reporting days since the last ProMED-mail posting, the total
number of cases reported in the full report has increased from 65 739 to 70
643 and the total fatality count has increased from 3323 to 3467. This
corresponds to a daily increase in cases of 817 and in deaths of 24. The
horrendous outbreak continues to spread to new areas and the overall case
fatality rate, reflecting the overall poor conditions in the country,
remains very high at 4.9 per cent. The full report can be found at
<http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf>.

A map of Zimbabwe with provinces 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 - Zimbabwe
Date: Sun 8 Feb 2009
Source: The Telegraph [edited]
<http://www.telegraph.co.uk/news/worldne ... 00000.html>


Zimbabwe's cholera epidemic has broken all African records and WHO predicts
100 000 people may be infected before it is contained. When cholera 1st
started spreading last year [2008] the worst-case projections were that 60
000 people could fall ill. That total has already been surpassed, with well
over 3000 dead.

While the cholera epidemic in Harare, the capital, has stabilized, in other
more rural locations, cholera is raging. The International Federation of
the Red Cross has deployed a large number of emergency response units in
Zimbabwe, but neither it nor other humanitarian agencies can cope with the
spread of cholera. WHO recently found that in a 2 week period in Midlands
province infections quadrupled from 1000 to 4000, while deaths rose from
100 to 400.

Matthew Cochrane, the IFRC's spokesman, travelled across Zimbabwe last week
[2-6 Feb 2009] and said that in Kwekwe, a mining town 100 miles west of
Harare, the Imbizo clinic, which had no resources, was overrun with
patients after admitting 130 in 3 days.

[byline: Peta Thornycroft]

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

******
[3] Cholera - Southern Africa
Date: Sat 7 Feb 2009
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 173C621458>


A total of 51 people have died from cholera in South Africa over the past 3
months, MPs heard on Wednesday [4 Feb 2009]. Presenting the latest figures
on the cholera epidemic, health department communicable diseases manager
Frew Benson told Parliament's water affairs portfolio committee there have
been a total of 8100 cases in the country since October-November 2008.

Most of these, 4165 cases, had been in Mpumalanga, the province with the
most deaths, 30. Second was Limpopo, with 3680 cases and 20 deaths. There
had also been 234 cases in Gauteng, with 3 deaths. Less affected provinces
were Western Cape (9 cases, 1 death), North West (7 cases), KwaZulu-Natal
(2 cases, 1 death), Eastern Cape (1 case), Free State (1 case) and Northern
Cape (1 case).

The figures for some other countries in the region cover the period from
October or November 2008 up to mid-January 2009. While South Africa has
been the worst affected, Mozambique, which has reported 3333 cases and 46
deaths, is not far behind. Zimbabwe's northern neighbour, Zambia, has 2267
reported cases of the disease, with 28 deaths; Angola has reported 643
cases and 8 deaths; and Namibia 58 cases and 5 deaths. Botswana has
reported only 6 cases, and no deaths.

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

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

******
[4] Cholera - South Africa (Limpopo)
Date: Mon 9 Feb 2009
Source: Sowetan [edited]
<http://www.sowetan.co.za/News/Article.aspx?id=935086>


Another death has been recorded in Limpopo, bringing to 21 the total number
of deaths as a result of cholera in the province. The latest victim was a
26 year old man who died while receiving treatment at the Siloam Hospital
outside Thohoyandou.

Spokesman for the provincial department of health and social development,
Phuti Seloba, said yesterday [8 Feb 2009] 63 new cholera cases were
recorded at the weekend. This, he said, indicated a decline in new cases
recorded on a daily basis. But the total number of cases that had been seen
has exceeded the 4000 mark since the outbreak of the disease on 15 Nov 2008.

Seloba said there were 11 new cases in Vhembe, 28 in Capricorn, 11 in
Sekhukhune, 4 in Mopani and 9 in the Waterberg districts.

[byline: Frank Maponya]

--
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[Limpopo can be found on a map of the country at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. Limpopo is
called the Northern Province on this map. The HealthMap/ProMED-mail map of
South Africa is available at <http://healthmap.org/promed/en?v=-29,25.1,5>.
- Mod.LL]

******
[5] Cholera - Ghana (Eastern region)
Date: Thu 5 Feb 2009
Source: Ghana Broadcasting Corporation [edited]
<http://gbcghana.com/news/24479detail.html>


The Eastern Regional Health Directorate recorded about 88 cholera cases
from 10 Dec 2008 to 4 Jan 2009. The affected communities include Mamfe,
Amonokrom, Akropong Akwapim North District. Mamfe recorded the highest
number with 70 cases. The deputy eastern regional director in charge of
public health, Dr George Bonsu attributed the problem to lack of good
drinking water and poor environmental sanitation.

Dr Bonsu advised the public to cook food thoroughly in treated water and
eat while it is hot. They should also wash their hands thoroughly with soap
after defecation and before preparing or eating food. Dr Bonsu also
entreated the public to wash vegetables and fruits in treated water before
consumption. According to him anybody who suffers from severe watery
diarrhoea should quickly report to the nearest health center for medical
treatment.

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

[The Eastern region of Ghana can be found on a map of the country at
<http://www.un.org/Depts/Cartographic/ma ... /ghana.pdf>. - Mod.LL]

******
[6] Cholera - Malawi
Date: Thu 5 Feb 2009
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... fRrye2VAzw>


More than 50 have been killed by an outbreak of cholera in Malawi which has
affected more than 1800 people, the health ministry said on Thursday [5 Feb
2009].

The death toll has moved from 14 in Jan 2009 to 52 now, Chris Kango'mbe, a
senior official in the health ministry said in a report. He said that 39 of
the deaths occured in 2 shantytowns of the administrative capital Lilongwe
due to "perennial water shortages and poor sanitation in city townships."

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

[Lilongwe in Malawi's Central region and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>. The
HealthMap/ProMED-mail interactive map of Malawi is available at
<http://healthmap.org/promed/en?v=-13.2,34.3,6>. - Mod.LL]

******
[7] Cholera - Botswana ex Zimbabwe
Date: Thu 5 Feb 2009
Source: Botswana Press Agency (BOPA) [edited]
<http://www.gov.bw/cgi-bin/news.cgi?d=20 ... s_recorded>


Since the outbreak of cholera in Zimbabwe, Botswana has so far recorded 10
cases. A 41 year old man recently died at Tsolamosese Clinic in
Mogoditshane after showing cholera symptoms. According to the Director of
Public Health, Ms Shenaaz El Halabi, investigations are ongoing to
determine if the actual cause of death was cholera.

Ms Halabi said all the victims in the recorded cases are from Zimbabwe and
because they were reported in different places, chances are that the
disease could be all over the country. She advised people to follow strict
hygienic measures to prevent the disease at all costs.

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

[Botswana can be seen on a map at
<http://www.mapsofworld.com/botswana/map ... na-map.jpg>. - Mod.LL]

******
[8] Bloody diarrhea - Liberia (Bong)
Date: Wed 4 Feb 2009
Source: Liberian Observer [edited]
<http://www.liberianobserver.com/news/fu ... _Zota.html>

The officer-in-charge of Shankpallah Clinic in Zota district (where the
outbreak of the caterpillars was 1st observed) in Bong County, Benson Kaba,
has disclosed that many people living in the area are suffering from
'bloody' diarrhea.

[byline: Marcus N Malayea]

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

[Bloody diarrhea is more often attributed to shigellosis but may occur as a
symptoms of a variety of gastrointestinal infections. Bong county can be
found on a map of Liberia at
<http://www.un.org/Depts/Cartographic/ma ... iberia.pdf>. To learn
more about this caterpillar which was identified as _Achaea catocaloides
rena_, a species that only rarely appears in such great numbers, the reader
is referred to
<http://www.nytimes.com/2009/02/06/world ... ref=africa>.
Mod. LL]

MOZAMBIQUE: Cholera still remains a risk

IRIN hat geschrieben:MAPUTO, 10 February 2009 (IRIN) - Cholera has spread to all but two of Mozambique's 10 provinces, but that does not deter hundreds of vendors and buyers from crowding the waterlogged, garbage strewn Xiquelene market on the eastern outskirts of the capital, Maputo.

Outbreaks of cholera are common during the rainy season and there are still two months to go, so health authorities remain on high alert.

"When it rains there is mud and water everywhere, but if I stay at home I will have nothing to eat with my family," said Rosina Nhone, a single mother of three, as she spread her tomatoes, onions and other vegetables on plastic sheets on the ground next to the other traders.

Three major roads meet at Xiquelene, making it the main shopping area for more than a dozen impoverished districts in Maputo, whether it rains or not.

The World Health Organisation (WHO) has noted that cholera "remains a challenge to countries where access to safe drinking water and adequate sanitation cannot be guaranteed ... typical at-risk areas include peri-urban slums."

Cholera is a waterborne intestinal infection that causes severe diarrhoea and vomiting, leading to rapid dehydration. Left untreated, it can bring death within 24 hours but the WHO describes it as "an easily treatable disease", cured with rehydration salts to replace lost fluids.

Real risk

The numbers show the risk is real: according to the Ministry of Health, 2,655 cases and 21 deaths were recorded in Mozambique during the month of January alone. Since the outbreak began in October 2008, there have been 4,132 cholera cases and 52 cholera-related deaths.

The good news is that the mortality rate has dropped significantly. "The number of cholera infection cases normally increases during the rainy season but for this period [January] we are happy to say the mortality rate as a percentage of the cases treated is less than one percent," the secretary-general of the Mozambican Red Cross, Fernanda Teixeira, told IRIN.

The latest cholera update by the UN Office for the Coordination of Humanitarian Affairs noted that the case fatality rate since the outbreak began was 1.3 percent but had dropped to 0.56 percent in January.

Only the two southern provinces of Gaza and Inhambane have not record cholera-related fatalities; the highest fatality rates were recorded in Mozambique's northern and central provinces of Nampula, Cabo Del Gado, Manica and Tete.

"More than 50 percent of the population does not have access to safe and clean drinking water, and that is a major cause for the spread of the disease," Teixeira said.

"Our prevention strategy is aimed at teaching people about improved hygienic standards, such as washing hands after eating, and properly washing vegetables to reduce chances of their contamination during irrigation [before being harvested]."

gn/tdm/he

© IRIN. All rights reserved. More humanitarian news and analysis

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (15)
**********************************************
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: WHO
[2] Cholera, Somali refugees - Kenya (North Eastern province)
[3] Cholera - Malawi
[4] Cholera - South Africa (Mpumalanga)
[5] Cholera - Mozambique

******
[1] Cholera - Zimbabwe: WHO
Date: Wed 11 Feb 2009
Source: UN Office for Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Government of Zimbabwe; WHO report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... c=1&cc=zwe>


Zimbabwe: daily cholera update and alerts, 11 Feb 2009
------------------------------------------------------
Highlights of the day:
- 1698 cases and 12 deaths added today (compared with 767 cases and 40
deaths yesterday [10 Feb 2009])
- 49 per cent of the districts affected have reported today (29 out of 59
affected districts)
- 90 per cent of districts reported to be affected (56 districts/62)
- cumulative institutional case fatality rate 1.91 per cent
- daily institutional case fatality rate 0.35 per cent
- Harare's deaths revised downwards by 1 (from 110 to 109 community
deaths), Binga number of cases reduced by 3 (from 1077 to 1074)
- Binga's deaths now fully categorized into community and institutional
- no reports from Mashonaland East (Except Hwedza).

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

[In the 2 reporting days since the last ProMED-mail posting, the total
number of cases reported in the full report has increased from 70 643 to 73
105 and the total fatality count has increased from 3467 to 3513. This
corresponds to a daily increase in cases of 1231 and in deaths of 23. The
horrendous outbreak continues to spread to new areas and the overall case
fatality rate, reflecting the overall poor conditions in the country,
although decreasing slightly remains very high at 4.8 per cent. The full
report can be found at
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... report.pdf>.

A map of Zimbabwe with provinces 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, Somali refugees - Kenya (North Eastern province)
Date: Thu 12 Feb 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009- ... 808300.htm>


On Thursday [12 Feb 2009], 2 relief agencies said that one case of cholera
and 14 suspected cases have been reported in the Hagadera refugee camp in
Dadaab, [north east] Kenya, numbers that have the potential to spike as
Somali refugees inundate already overstretched camps. The International
Rescue Committee (IRC) and the Norwegian Refugee Council (NRC) said in a
joint statement issued in Nairobi that they are working tirelessly to
contain the outbreak.

An average of 5000 Somalis are streaming into Dadaab every month, fleeing
ongoing violence in the Horn of Africa nation. Hagadera, one of 3 camps in
Dadaab, was originally designed for 50 000 people, but is now home to 90
000 refugees, making the pressure on existing resources intense.

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

[Hagadera can be seen in the North Eastern province on a map of Kenya at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. The
HealthMap/ProMED-mail interactive map of Kenya is available at
<http://healthmap.org/promed/en?g=196919&v=0.5,37.9,6>. - Mod.LL]

******
[3] Cholera - Malawi
Date: Wed 11 Feb 2009
Source: AfricaNews [edited]
<http://www.africanews.com/site/Malawi_C ... ages/23132>


The cholera outbreak in Malawi is reported to have killed over 60 people.
Media reports in the southern African country say about 67 people have died
across the 17 affected districts. Malawi's capital Lilongwe is the hardest
hit as recently its death toll stood at 39. The country's local daily of
The Nation quoted minister of health Khumbo Kachali as saying over 2000
cases have been recorded since the start of the rainy season with 67 people
reported dead.

According to the report, this year's cholera cases are higher. Malawi has
since established cholera camps in Lilongwe to fight the spread of the
disease, which according to principal secretary for health has been caused
by poor hygiene and drinking of unsafe water. "Lilongwe has registered 1478
cases and 40 people have died," said Kachali.

The other districts affected by the disease are Balaka in the southern
region, which has registered 203 cases with one death, Mangochi also in the
southern region with 143 cases and 3 deaths; and Nkhata Bay in the northern
region, which has registered 5 deaths.

The minister then appealed to people to improve their hygiene to fight the
disease.

Several countries in Africa are experiencing the rainy season, which has
further prolonged the cholera disease.

[byline: Sam Banda]

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

[Lilongwe in Malawi's Central region and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>. The
HealthMap/ProMED-mail interactive map of Malawi is available at
<http://healthmap.org/promed/en?v=-13.2,34.3,6>. - Mod.LL]

******
[4] Cholera - South Africa (Mpumalanga)
Date: Mon 2 Feb 2009
Source: South African Government Information [edited]
<http://www.info.gov.za/speeches/2009/09020310451004.htm>


Since the outbreak of cholera in the Mpumalanga province, we have as of 1
Feb 2009, 4165 cases that have been seen in various health facilities in
the province. We have also reported 26 confirmed deaths thus far. The
deaths were reported in the following areas; Mbombela North 3, Thabachweu
1, and Bushbuckridge 22.

The areas that are most affected are Mbombela North with 2206 cases;
Bushbuckridge with 1443; Mbombela south with 184; Nkomazi with 166,
Thabachweu with 161, and Umjindi with 6 cases.

--
communicated by:
Rabelani Daswa
<tangwu@webmail.co.za>

[Although this is data from more than one week ago, it breaks down areas in
the province. ProMED-mail thanks Rabelani Daswa for the posting. Mpumalanga
province in north east South Africa can be seen on a map of the country at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. The
HealthMap/ProMED-mail map of South Africa is available at
<http://healthmap.org/promed/en?g=1085595&v=-29,25.1,5>. - Mod.LL]

******
[5] Cholera - Mozambique
Date: Tue 10 Feb 2009
Source: UN Office for Coordination of Humanitarian Affairs (OCHA),
Integrated Regional Information Networks (IRIN) News [edited]
<http://www.irinnews.org/Report.aspx?ReportId=82856>


Cholera has spread to all but 2 of Mozambique's 10 provinces, but that does
not deter hundreds of vendors and buyers from crowding the waterlogged,
garbage strewn Xiquelene market on the eastern outskirts of the capital,
Maputo.

Outbreaks of cholera are common during the rainy season and there are still
2 months to go, so health authorities remain on high alert.

The World Health Organization (WHO) has noted that cholera "remains a
challenge to countries where access to safe drinking water and adequate
sanitation cannot be guaranteed ... typical at-risk areas include
peri-urban slums." The numbers show the risk is real: according to the
Ministry of Health, 2655 cases and 21 deaths were recorded in Mozambique
during the month of January 2009 alone. Since the outbreak began in October
2008, there have been 4132 cholera cases and 52 cholera-related deaths.

The latest cholera update by the UN Office for the Coordination of
Humanitarian Affairs noted that the case fatality rate since the outbreak
began was 1.3 per cent but had dropped to 0.56 per cent in January 2009.
Only the 2 southern provinces of Gaza and Inhambane have not record
cholera-related fatalities; the highest fatality rates were recorded in
Mozambique's northern and central provinces of Nampula, Cabo Del Gado,
Manica, and Tete.

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

[The provinces of Mozambique can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>. The
HealthMap/ProMED-mail interactive map of Mozambique is available at
<http://healthmap.org/promed/en?g=105182 ... 6,33.587,5>. - Mod.LL]

LASSA FEVER - NIGERIA
*********************
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 16 Feb 2009
Source: AllAfrica, This Day report [edited]
<http://allafrica.com/stories/200902160188.html>


Nigeria: Lassa fever -- specialist expresses concern over spread
----------------------------------------------------------------
The chief medical director of Irrua Specialist Hospital, Prof George
Akpede, has expressed concern over the wide spread of Lassa fever in
recent times, disclosing that out of 229 suspected cases reported
between January and December 2008, 30 people died.

Prof Akpede, who spoke at National Lassa Fever Stakeholders Forum at
Ekpoma [at the] weekend [14-15 Feb 2009] noted that there had been a
marked rise in the number of suspected and confirmed cases between
December 2008 and January 2009 representing about 60 percent and 80
percent increases respectively. He, however, disclosed that some
drastic measures were under way as the Irrua Specialist Teaching
Hospital had entered into partnerships with Behard-Notch Institute of
Tropical Medicine, Hamburg, Germany, and Harvard University, USA for
collaboration in Lassa fever research and control efforts. Part of
the collaboration, according to him, had resulted in the donation of
diagnostic facilities for the confirmation of the disease in the
hospital without samples having to be sent out of the country any longer.

In his contribution, [the] member representing Esan Central/Esan
West/Igueben Federal Constituency in the House of Representatives,
Mr. Patrick Ikhariale, also expressed concern over the spread of the
Lassa fever epidemic nation-wide and called for urgent control
measures at the national level. Ikhariale assured that he would draw
the attention of the National Assembly to the menace posed by the
disease to millions of Nigerians.

[Byline: Adibe Emenyonu]

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

[Lassa fever is a zoonotic disease, whereby humans become infected
from contact with infected animals. The animal reservoirs of Lassa
virus are rodents of the genus _Mastomys_, the "multimammate rat."
Lassa virus-infected animals do not become ill, but they can shed the
virus in their urine and faeces. (A photograph of a multimammate rat
can be accessed at
<http://i127.photobucket.com/albums/p145 ... CF4892.jpg>).

In humans Lassa viral haemorrhagic fever is an acute illness of 1-4
weeks duration that occurs in West Africa. The virus is a
single-stranded RNA virus belonging to the virus family
_Arenaviridae_. Lassa fever is known to be endemic in Guinea
(Conakry), Liberia, Sierra Leone, and parts of Nigeria, but probably
exists in other West African countries as well.

About 80 percent of human infections are asymptomatic; the remaining
cases have severe multi-system disease, where the virus affects
several organs in the body, such as the liver, spleen, and kidneys.
The incubation period of Lassa fever ranges from 6-21 days. It has
been estimated that about 300 000 to 500 000 cases of Lassa fever and
5000 deaths occur yearly across West Africa. The overall
case-fatality rate is 1 percent, and up to 15 percent among
hospitalized patients.

The disease is especially severe late in pregnancy, with maternal
death and/or fetal loss occurring in greater than 80 percent of cases
during the 3rd trimester.

Humans usually become infected with Lassa virus from exposure to
excreta of infected _Mastomys_. Lassa virus may also be spread
between humans through direct contact with the blood, urine, faeces,
or other bodily secretions of a person with Lassa fever. There is no
epidemiological evidence supporting airborne spread between humans.
Person-to-person transmission occurs in both community and health
care settings, where the virus may be spread by contaminated medical
equipment, such as re-used needles.

The current increase in cases of Lassa fever in some parts of Nigeria
may by a consequence of increased abundance of the vector or some
other factor resulting in increased contact between humans and
rodents promoting the spread of the disease in the human population. - Mod.CP

The HealthMap/ProMED-mail interactive map of Nigeria is available at
<http://healthmap.org/promed/en?v=9.6,6.1,6>. - CopyEd.MJ]

Meningococcal disease in Nigeria
19.02.2009 - WHO

As of 8 February 2009, the Ministry of Health of the Federal Republic of Nigeria has reported 1364 suspected cases of meningococcal disease including 108 deaths (case-fatality rate: 7.9%) in 19 out of 35 states and Abuja. So far 30 Local Government Areas (LGA) in 8 states have crossed the alert or the epidemic threshold. In the last week, 11 LGAs crossed the epidemic threshold, and 600 suspected cases including 40 deaths were reported across the country.

Cerebrospinal fluid specimens collected from Jigawa state have tested positive for Neisseria meningitidis serogroup A by latex test. The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has approved the release of 268 750 doses of polysaccharide vaccine for a mass vaccination campaign in two affected LGAs in Jigawa state.

WHO is supporting the Federal and National Ministry of Health in the submission of additional requests to the ICG to secure vaccine for the remaining affected areas. WHO is supporting the Ministry of Health to strengthen epidemiological and laboratory surveillance and data management.

LASSA FEVER - UNITED KINGDOM ex MALI: FATAL
*******************************************
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 19 Feb 2009
Source: BBC News [edited]
<http://news.bbc.co.uk/1/hi/england/london/7898756.stm>


'No risk' after Lassa fever death
---------------------------------
Health officials have said the public are not at risk after a patient
at a London hospital died of Lassa fever. The Health Protection
Agency (HPA) said the death at University College Hospital was an
isolated case and the patient had been working in Africa. The Agency
is trying to identify members of staff or healthcare workers who
might have had contact with the patient who had been to Mali.
Patients and visitors to the hospital are not at risk, the HPA said.

Last month, a 66-year-old east London man, who had been travelling in
Nigeria, died of Lassa fever at London's Royal Free Hospital.

The fever is caused by a virus and is endemic in Nigeria, Sierra
Leone, Liberia, Guinea, and the Central African Republic. Dr Dilys
Morgan, a Lassa fever expert at the Health Protection Agency, said:
"These people will be provided with information about Lassa fever and
asked to get in contact with us should they develop any symptoms."

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

[Lassa fever is a zoonotic disease, whereby humans become infected
from contact with infected animals. The animal reservoirs of Lassa
virus are rodents of the genus _Mastomys_, the "multimammate rat." (A
photograph of a multimammate rat can be accessed at
<http://i127.photobucket.com/albums/p145 ... CF4892.jpg>.)
Lassa virus-infected animals do not become ill, but they can shed the
virus in their urine and faeces. It can be transmitted also between humans.

Lassa fever is endemic in many countries in West Africa, but is only
rarely imported into Europe. Remarkably this is the 2nd death this
month [February 2009] of a patient in a London hospital as a result
of Lassa fever virus infection contracted in Africa. (See the ProMED
references below for more detail). A recent statement from Nigeria
suggests that currently Lassa fever virus infection appears to be on
the increase (see the ProMED-mail report: Lassa fever - Nigeria,
archived as 20090218.0669).

The HealthMap/ProMED-mail interactive map of the West-African country
of Mali can be accessed at
<http://healthmap.org/promed/en?v=17.4,-3.5,5>.