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MENINGITIS, MENINGOCOCCAL - CHAD
********************************
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International Society for Infectious Diseases
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Date: Tue 14 Apr 2009
Source: News24.com [edited]
<http://www.news24.com/News24/Africa/New ... 18,00.html>


Meningitis has claimed 102 lives in Chad since the beginning of the
year, Health Minister Ngombaye Djaibe said on Tuesday [14 Apr 2009],
warning that the outbreak had reached epidemic proportions. "We're
declaring a meningitis outbreak in Chad," he told a press conference.
"At present, the cumulative number of cases is 871 (since 1 Jan
2009), of whom 102 have died, giving a mortality rate of 11.7
percent."

The health minister of the poor, mainly arid central African nation
said that medical workers had managed to identify different strains
of meningitis, including "W 135, a strain held to be very virulent".

The infectious disease causes inflammation of the tissues surrounding
the brain or spinal cord, with symptoms including fever, nausea,
strong headaches and a stiff neck. In its most severe bacterial form,
it can lead to a coma and death.

Meningitis is widespread in west and central Africa, though it can be
prevented by vaccination campaigns. In 2005-2006, more than 100
people died in an epidemic in Chad, but had been relatively spared
until this latest outbreak.

--
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[Meningitis due to the _Neisseria meningitidis_ occurs sporadically
or as epidemics in sub-Saharan Africa, which is known as the
"Meningitis Belt," an area that stretches from Senegal in the west to
Ethiopia and Eritrea in the east and that includes Chad
(<http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx>). Numerous
cases of meningococcal meningitis are reported in this region of
Africa each year during the dry season, between December and June,
and every 6-12 years a large outbreak occurs
(<http://www.cdc.gov/ncidod/eid/vol9no10/03-0170.htm>).

There are at least 13 serogroups of _Neisseria meningitidis_ based on
the antigenic specificity of their capsular polysaccharides; disease
due serogroups A, B, C, Y, and W135 are most common. All serogroup
polysaccharides but B, are immunogenic in humans.

From a prior ProMED-mail post (archive number 20071207.3954): To
control an outbreak, WHO recommends mass vaccination with the
appropriate vaccine, depending availability, in every involved
district in an attempt to induce herd immunity (whereby transmission
is blocked when a critical percentage of the population have been
vaccinated
(<http://www.who.int/mediacentre/factsheets/fs141/en/>).

There are several different types of meningococcal vaccines.
Polysaccharide vaccines, which have been available for more than 30
years, exist against serogroups A, C, Y, and W-135 in various
combinations (such as, a bivalent AC, trivalent ACW-135, and a
tetravalent ACYW-135 polysaccharide vaccine). There is a monovalent
conjugate vaccine against serogroup C and a tetravalent against
serogroups A, C, Y, and W-135. The conjugate vaccines are immunogenic
for children under 2 years of age, whereas polysaccharide vaccines
are not. All these vaccines have been proven safe and effective with
infrequent and mild side effects. For both the meningococcal
conjugate and the polysaccharide vaccines, approximately 7-10 days
are required following vaccination for development of protective
levels of anti-meningococcal antibodies.

During the 1st 10 weeks of the 2006 meningitis season, outbreaks in
eastern Africa were mainly caused by _Neisseria meningitidis_
serogroup W-135, whereas in West Africa the outbreak was due to
mainly serogroup A.

See prior ProMED-mail posts listed below for more information. A map
of the African bacterial meningitis belt can be found at
<http://www.medic8.com/images/map4-9.gif>. - Mod.ML]

Tschad - Meningokokken-Meningitis
20.04.2009

Bis Mitte April erkrankten 871 Personen, es gab 102 Todesfälle. Während der Trockenzeit (Dezember-April) kommt es in den Ländern des „Afrikanischen Meningitisgürtel“ regelmäßig zu Meningokokken-Epidemien. Impfschutz beachten. / Quelle: crm

Meningococcal disease in Chad
23.04.2009 - WHO

From 29 December 2008 to 5 April, the Ministry of Health of Chad reported 922 suspected cases of meningococcal disease including 105 deaths (case-fatality rate: 11.4%). So far, three districts have crossed the epidemic threshold, including a district in the capital, N'Djamena, while five districts are on alert. Thirty three specimens of cerebral spinal fluid have been found positive for Neisseria meningitidis serogroup W135 and 30 specimens for Neisseria meningitidis serogroup A, by latex, culture and PCR, suggesting that both serogroups are responsible for the epidemic. The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has provided 164,000 doses of trivalent ACW vaccine for a mass vaccination campaign in affected areas of Dourbali, Goundi and Pala district. Additionally, 704 300 doses of trivalent vaccine have been released this week, which will be used for an immunization campaign in the capital, planned to start next week. WHO, UNICEF, Médecins sans Frontières and the International Federation of Red Cross (IFRC) are working with the Ministry of Health, Chad to implement vaccination campaigns as well as other emergency control measures, including case management and surveillance in neighbouring districts.

MENINGITIS, MENINGOCOCCAL - CHAD (02)
*************************************
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Date: Thu 23 Apr 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) Disease Outbreak
News [edited]
<http://www.who.int/csr/don/2009_04_23/en/index.html>


Meningococcal disease in Chad
-----------------------------
From 29 Dec 2008 to 5 Apr [2009], the Ministry of Health of Chad reported
922 suspected cases of meningococcal disease, including 105 deaths (case
fatality rate: 11.4 per cent). So far, 3 districts have crossed the
epidemic threshold, including a district in the capital, N'Djamena, while 5
districts are on alert.

So far, 33 specimens of cerebrospinal fluid have been found positive for
_Neisseria meningitidis_ serogroup W135 and 30 specimens for _N.
meningitidis_ serogroup A, by latex, culture, and PCR, suggesting that both
serogroups are responsible for the epidemic.

The International Coordinating Group (ICG) on Vaccine Provision for
Epidemic Meningitis Control has provided 164 000 doses of trivalent ACW
vaccine for a mass vaccination campaign in affected areas of Dourbali,
Goundi, and Pala district. In addition, 704 300 doses of trivalent vaccine
have been released this week [week of 20 Apr 2009], which will be used for
an immunization campaign in the capital, planned to start next week. WHO,
UNICEF, Medecins sans Frontieres, and the International Federation of Red
Cross (IFRC) are working with the Ministry of Health, Chad to implement
vaccination campaigns as well as other emergency control measures,
including case management and surveillance in neighbouring districts.

--
communicated by:
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[Since the last ProMED-mail post on the meningococcal outbreak in Chad
(archive number 20090416.1439), there have been 51 more cases of
meningococcal meningitis cases and 3 more deaths. The news release confirms
that this outbreak in Chad involves both serogroups A and W135.

See prior ProMED-mail posts listed below for more information on
meningococcal meningitis in Africa.

The HealthMap/ProMED-mail interactive map of Chad is available at
<http://healthmap.org/r/009u>. A map of the African bacterial meningitis
belt can be found at <http://www.medic8.com/images/map4-9.gif>. - Mod.ML]

RABIES - UGANDA: REQUEST FOR INFORMATION
****************************************
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Date: Thu 23 Apr 2008
Source: The New vision [edited]
<http://www.newvision.co.ug/D/8/19/679055>


Rabies on the rise in Kampala and Wakiso
----------------------------------------
There has been an increase in the number of animal bites in Kampala and
Wakiso districts. According to a report by the health ministry, 23 cases of
suspected rabies were registered in Kampala and 35 in Wakiso in the 2nd
week of this month [April 2009]. A total of 290 cases of animal bites were
recorded countrywide, the report said.

Dogs and cats are the most renowned carriers of rabies and transmit the
virus to humans through saliva by biting them. Although there are no deaths
recorded yet, the number of animal bites in the 2 districts has increased,
indicating a rise in unimmunised animals in the 2 districts.

Kampala City Council (KCC) spokesperson Simon Muhumuza blamed the increase
in animal bites on overcrowding. "Kampala district is 195 square kilometers
[75.3 square miles] with 2 million people, most of them living in a crammed
environment. So, this puts them at a high risk of animal bites," he
explained. Muhumuza called upon the public to keep their animals indoors,
adding that stray animals would be killed.

Attempts to get a comment from the KCC health inspector, Dr Mesach Mubiru,
and Wakiso district health director, Dr Emmanuel Mukisa, were futile as
their phones were switched off.

[byline: Chris Kiwawulo]

--
communicated by:
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[The 58 cases of suspected rabies recorded in Kampala and Wakiso in
mid-April 2009 is a very high number. No fatalities have occurred. It is
not clear to what extent this is due to post-exposure vaccination and to
incorrect diagnosis. The statements are confusing. Exposure to dog bites is
obviously a serious problem but difficult to evaluate the situation in the
absence on information on the prevalence of rabies virus infection in the
canine population. Further information would be welcomed regarding the
prevalence of canine and human rabies in Uganda. - Mod.CP]

.....................cp/ejp/sh

Nigeria - Meningokokken-Meningitis
24.04.2009

Bis Mitte April wurden landesweit mehr als 39.000 Erkrankungen und 1.886 Todesfälle registriert. Während der Trockenzeit (Dezember-April) kommt es in den Ländern des „Afrikanischen Meningitisgürtel“ regelmäßig zu Meningokokken-Epidemien. Impfschutz beachten. / Quelle: crm

Angola - Tollwut
27.04.2009

Der Tollwut-Ausbruch in der Hauptstadt Luanda hält weiter an. Bis Mitte Februar sind bisher 93 Personen an der Tollwut verstorben. Bei der Mehrzahl handelt es sich um Jungen die von streunenden Hunden gebissen worden sind. Die Regierung hat im Rahmen einer großangelegten Impfaktion-Aktion 111.000 Tiere (Hunde, Katzen und Affen) immunisiert. Bei entsprechenden Kontakten sofort einen Arzt aufsuchen, bei vorhersehbarem Risiko und längerem Aufenthalt wird eine vorbeugende Impfung empfohlen. / Quelle: crm

Tschad - Meningokokken-Meningitis
27.04.2009

Bis Mitte April erkrankten 922 Personen, es gab 105 Todesfälle. Während der Trockenzeit (Dezember-April) kommt es in den Ländern des „Afrikanischen Meningitisgürtel“ regelmäßig zu Meningokokken-Epidemien. Impfschutz beachten. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (17)
**********************************************
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<http://www.isid.org>

In this update:

Africa
[1] Cholera - Zimbabwe: WHO
[2] Cholera - Southern Africa
[3] Cholera - Somalia (Puntland)
[4] Cholera - Somalia (Southern regions)
[5] Cholera - Kenya

******
[1] Cholera - Zimbabwe: WHO
Date: Sun 26 Apr 2009
Source: N Office for 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, 26 Apr 2009
------------------------------------------------------
Highlights of the day:
- 11 cases and 0 deaths added today (in comparison with 18 cases and
0 deaths yesterday [25 Apr 2009])
- cumulative cases: 97 198
- cumulative deaths: 4 244 of which 2 606 are community deaths
- 68.3. percent of the reporting centres affected have reported today
[26 Apr 2009] (41 out of 60 affected reporting centres)
- cumulative institutional case fatality rate: 1.7 percent
- daily institutional CFR: 0 percent.

--
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[After a very prolonged interval, over the past 6 weeks the outbreak
of cholera in Zimbabwe has slowed to a trickle for now with almost
100 000 reported cases and a very high case fatality rate of almost
4.4 percent. The 26 Apr 2009 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/r/00aK>. - Mod.LL]

******
[2] Cholera - Southern Africa
Date: Thu 23 Apr 2009
Source: CRIENGLISH.com, Xinhua News Agency report [edited]
<http://english.cri.cn/6966/2009/04/23/2041s477667.htm>


The cholera epidemic in southern Africa continues to abate, but
international and local health authorities stress the need to remain
vigilant, the United Nations reported on Wednesday [22 Apr 2009].

"Overall, the duration and magnitude of the epidemic underscores the
need for strengthening surveillance, preparedness and underscores
plans in all countries," according to the UN Office for the
Coordination of Humanitarian Affairs (OCHA). There were a total of
4579 new cases on 3-17 Apr 2009 in the 9 countries, Angola, Botswana,
Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and
Zimbabwe, affected by the often fatal disease since August 2008.
During the 2 weeks preceding 3 Apr 2009, 6460 new cases were
reported, OCHA said.

Authorities warn, however, that cholera could re-appear in the coming
1 to 3 weeks, when waters from flooding in the region, which has
affected more than 1.2 million people, subside and become stagnant.
Those displaced by the deluge lack access to shelter, water, and
sanitation facilities and are at higher risk of contracting the
disease, OCHA said. To prevent that from happening, UN Country Teams
and humanitarian partners plan to expedite their aid to flood
victims. In a number of countries, national cholera policies and
contingency planning is also taking place, in partnership with the UN
World Health Organization (WHO), the UN Children's Fund (UNICEF), and
other organizations.

The cumulative total of cholera cases reported in southern Africa
stands at 155 692, including 96 718 cases in Zimbabwe, the worst
affected country.

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

******
[3] Cholera - Somalia (Puntland)
Date: Mon 20 Apr 2009
Source: Horseed Media [edited]
<http://english.horseedmedia.net/news/17321.shtml>


On Monday [20 Apr 2009], authorities in Bander Bayla town (east
region, Puntland) confirm the death of 5 people in the latest cholera
outbreak. Farah Hoshle, the mayor of Bayla town, told Horseed Media
that the victims were 2 elderly women. More medical staff were sent
to help the local health care centers, said the Mayor.

The latest outbreak comes as the UN is warning about the possibility
of major cholera outbreaks in southern and central Somalia.

--
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[Puntland is a region in northeastern Somalia, centered on Garowe
(Nugaal region), whose leaders declared it an autonomous state in
1998. A third of the Somali people live in the province. It is
location can be found at
<http://en.wikipedia.org/wiki/Puntland>.
The HealthMap/ProMED-mail interactive map of Somalia is available at
<http://healthmap.org/r/00aM>. - Mod.LL]

******
[4] Cholera - Somalia (Southern regions)
Date: Tue 14 Apr 2009
Source: Press TV [edited]
<http://www.presstv.ir/detail.aspx?id=91 ... =351020501>


At least 20 people died of cholera on Tuesday [14 Apr 2009] with
minors accounting for a major part of the toll. More than 11 children
died in the Bakool region while another 8 fell victim to the virulent
disease in Middle Shabelle and one in Lower Shabelle, a Press TV
correspondent reported.

According to medics, a total of around 111 women and children have
been sent to regional hospitals in southern Somalia. The cases mainly
have occurred in areas such as Bay and Bakool, and Lower and Middle
Shabelle regions, where aid workers have stopped operating amid
ceaseless hostilities and ongoing tussles between rival factions.

--
Communicated by:
ProMED-mail
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[The regions mentioned can be found on a map of the country of Somalia at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. - Mod.LL]

******
[5] Cholera - Kenya
Date: Mon 13 Apr 2009
Source: The Standard [edited]
<http://www.eastandard.net/InsidePage.ph ... 1440&cid=4>


Health experts are warning of a cholera outbreak in Nairobi and
Mombasa, as city dwellers return from the Easter break upcountry. It
is feared that the epidemic, that has claimed 55 lives of the nearly
2000 cases reported countrywide, could also spread to Central
Province that has been free of the disease so far, according to the
Kenya Red Cross. The outbreak is traced to a few cases reported in
Nyanza Province last December 2008. It has spread to 8 other
districts in the region and spilled over to other provinces.

So far, Nairobi and Mombasa appear safe although the Easter
festivities, for which thousands of city residents travelled to their
rural homes, will almost certainly bring cholera to the cities'
doorstep.

Latest statistics from the Ministry of Health, as contained in the
Kenya Red Cross Bulletin Number 3, indicate that there have been 1931
cases reported so far, with 55 casualties:
- in Western Province, the outbreak has been reported in 4 districts:
Bungoma East, Kakamega Central, Busia, and Butere, with 173 reported
cases.
- the most recent outbreak was in Bungoma East where 10 people have
died and a couple of other cases treated at Bungoma District
Hospital, Bokoli Sub-District Hospital, Lugulu Mission Hospital, and
Webuye District Hospital.
- in Rift Valley province, the 1st outbreak was reported in March
2009 in Nandi South at Chemase, Kaptumo, and Nandi Hills Town. The
2nd outbreak was at the Nakuru Prison where 10 cases were reported
and 1 casualty.

[Byline: Peter Orengo]

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

[A map of Kenya showing the areas mentioned can be found at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>.
The HealthMap/ProMED-mail interactive map of Kenya is available at
<http://healthmap.org/r/00aN>. - Mod.LL]

Yellow fever in the Republic of the Congo
30.04.2009 - WHO

As of 1 April 2009 the Ministry of Health of the Republic of the Congo reported one case of yellow Fever detected on 28 January 2009 by the epidemiological surveillance system for yellow fever. The case was initially laboratory tested at the Institut National de Recherche Biomedical (INRB) in the Democratic Republic of Congo and subsequently laboratory-confirmed at the Institut Pasteur of Dakar, the regional WHO collaborating centre for yellow fever.

The index case was a 55 year-old male farmer living in Mbama district, Cuvette West Department. He initially presented with acute abdominal pain and subsequently developed fever and jaundice. He was first evaluated in health facilities in Mbama district and was then referred to the district hospital in Ewo district.

From the 23 to 25 March 2009, a yellow fever outbreak investigation team composed of specialists from the MoH and WHO visited Mbama district. No further cases were detected. The samples were sent for laboratory analysis at the Institut Pasteur, Dakar and confirmed by YF seroneutralization, a highly specific test for yellow fever.

The Republic of the Congo had previously benefited from mass vaccination during the years 1930 to 1960. The last outbreak reported was in 1981, and no cases have been confirmed since. The outbreak response vaccination campaign will cover a target population of 73,011 people and has been planned for 6 May 2009.

UNDIAGNOSED FATALITIES - KENYA: (BUNGOMA), REQUEST FOR INFORMATION
******************************************************************
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International Society for Infectious Diseases
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Date: 3 May 2009
Source: Kenya KTN TV / The Standard [edited]
<http://www.eastandard.net/videos/?id=1144013251>


'Mysterious disease', 16 dead in Kenya
--------------------------------------
A total of 16 people have died of "mysterious" disease in western
district. Text of report by Kenyan privately-owned TV station KTN on
[3 May 2009] (video report available at Kenya News Paper The Standard
website):

[Presenter] We have received reports this evening from Bungoma
regarding the deaths of about 10 people in Kabula sub-location, in
Bungoma South District in a week, from a disease which has not been
established. According to area residents, the dead victims suffered
from diarrhoea, vomiting and bleeding from their noses and eyes
before dying.

The residents of the area have accused health officials of failing to
take action to stop the deaths and the spreading of the disease. In
one homestead, a man his wife and son died one after the other,
spreading panic among people. The disease has so far not been
established. Our reporter Zubeida Kananu has the details:

[Kananu] This is Remwa village, and soon after our arrival, we met
sad and terrified people following the death of a whole family over
the mysterious disease. It is said, a boy from this village died on
Thursday [30 Apr 2009] this week from the disease and day later, his
father died. His mother died shortly afterwards.

[Unidentified man in Swahili] Since he was taken ill, the boy did not
speak and uttered no word even to the people attending to him when he
was taken to hospital; he just died.

[Kananu] Before their deaths, the victims had diarrhoea, vomiting,
shedding tears and blood from their eyes and noses. This disease is
mysterious to the villagers. About 16 people from Remwa, Ashioya and
Kabula villages in Bungoma district had the same symptoms and died
from the disease.

[Second unidentified man in Swahili] People who have attended funeral
ceremonies, having washed the bodies of their relatives for burial
have died.

[Kananu] Following the eruption and spread of the disease, all pigs
in the areas have been confined and some locked in their sheds over
fears of the swine flu which erupted in Mexico some weeks ago.

Meanwhile, health officers from the area have been blamed for failing
to take appropriate action to tackle the disease.

--
Communicated by:
ProMED-mail
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[The description of the disease along with the perceived association
with preparation of bodies of deceased cases for burial is highly
reminiscent of descriptions that have accompanied outbreaks of viral
hemorrhagic fever outbreaks in Africa. The symptom complex of
diarrhea and vomiting along with epistaxis (nose bleed) and bleeding
from eyes has also been described in outbreaks of viral hemorrhagic
fevers.

Johnson et al demonstrated antibodies against Ebola virus, Marburg
virus and Rift Valley Fever Virus in residents of Lodwar, Laisamis,
Malindi/Kilifi (see ref 1 below). CCHF has also been described in
Kenya (see ref. 2 below). While there have not been reports of yellow
fever in humans in Kenya in more than 10 years, Kenya is still in the
yellow fever risk zone.

More information on this outbreak would be greatly appreciated.

For a map of Kenya, see
<http://www.lib.utexas.edu/maps/africa/kenya_pol88.jpg>. The Western
Division borders with Uganda where outbreaks of viral hemorrhagic
fevers have been reported in recent times (see prior references
below).

For the interactive HealthMap/ProMED map of Bungoma District, Western
Division Kenya, see
<http://healthmap.org/r/00b3>.

References:
-----------
1. Johnson BK, Ocheng D, Gichogo A, Okiro M, Libondo D, Tukei PM, Ho
M, Mugambi M, Timms GL, French M. Antibodies against haemorrhagic
fever viruses in Kenya populations. Trans R Soc Trop Med Hyg.
1983;77(5):731-3.
2. Dunster L, Dunster M, Ofula V, Beti D, Kazooba-Voskamp F, Burt F,
et al. First documentation of human Crimean-Congo hemorrhagic fever,
Kenya. Emerg Infect Dis [serial online] 2002 Sep;8. Available at
<http://www.cdc.gov/ncidod/EID/vol8no9/01-0510.htm>

- Mod.MPP]

Burkina Faso - Meningokokken-Meningitis
04.05.2009

West- und Zentralafrika erleben aktuell die schwerste Meningokokken-Epidemie seit 5 Jahren. Seit Anfang des Jahres wurden bisher 3.529 Erkrankungen gemeldet, wovon 449 tödlich endeten. Während der Trockenzeit (Dezember-April) kommt es in den Ländern des „Afrikanischen Meningitisgürtel“ regelmäßig zu Meningokokken-Epidemien. Die Meningokokken sind die Erreger der eitrigen Hirnhautentzündung und werden durch Tröpfcheninfektion übertragen. Ein Risiko besteht insbesondere bei engem Kontakt zur einheimischen Bevölkerung. Impfschutz beachten. / Quelle: crm

Tödliche Meningitis in Westafrika - Epidemie ohne Aufmerksamkeit

Während der Westen seine Blicke auf die Schweinegrippe konzentriert, wütet in Westafrika die schlimmste Epidemie seit 1996. Tausende sind bereits gestorben. mehr...

Grüsse
Alexander

Yellow fever in Liberia
06.05.2009 - WHO

On 15 April 2009, The Ministry of Health (MoH), Liberia reported one laboratory-confirmed case of yellow fever in Luyeama town, Zorzor District. The case was identified through regular yellow fever surveillance in Lofa County. The index case was a 32 year-old man who presented with fever and jaundice which began on 28 February 2009. On 28 March, the patient went to the Tellewoyan Hospital in Voinjama City, Lofa County where the clinical diagnosis of yellow fever was made. The case was laboratory-confirmed by the Pasteur Institute in Dakar, Senegal. During the outbreak investigation, 9 serum samples of suspected cases and “contacts” were collected. No additional yellow fever cases have been identified. The MoH has planned to vaccinate the districts of Zorzor and Voinjama, with a target population of 96,169. The country has requested yellow fever vaccines from the GAVI funded Global Emergency Stockpile for Yellow Fever Vaccine, managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control (YF-ICG).

HEPATITIS E VIRUS - UGANDA (02): (KITGUM)
*****************************************
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Date: Wed 6 May 2009
Source: Thomson Reuters Foundation AlertNet, UN Integrated Regional
Information Networks (IRIN) report [edited]
<http://www.alertnet.org/thenews/newsdes ... a4661c.htm>


Hepatitis E still spreading in Kitgum
-------------------------------------
At least 53 new cases of hepatitis E have been recorded among
internally displaced persons (IDPs) in the northern district of
Kitgum at the start of the current rainy season, officials said. Most
were reported in the village health centres of Lukung, Amida, Padibe,
Layamu, and Kitgum town, according to Sylvester Opira, chairman of
the hepatitis E control taskforce in Kitgum.

"New cases of infection are being received at health centres, with
women and children ranking high," Opira told IRIN in Kitgum. Poor
sanitation in areas of return for IDPs and the rains had contributed
to the spread of the disease. Few people, Opira said, had latrines in
their homes while some were drinking water from unprotected sources,
which could be contaminated. "People with no latrines in their homes
will be arrested and forced to sink latrines," he added.

Up to 156 people have so far died of hepatitis E in Kitgum since 2007
when the disease was first reported. Another 9912 people have been
infected. Tony Toolit, the Kitgum district secretary for health, told
IRIN the main problem was lack of clean water for people returning to
villages. "In some places, people are drinking water from ponds and
streams, [thus] spreading the infection," he said. Toolit said safe
water and latrine coverage in Kitgum was only about 40 percent. There
was, therefore, a need to scale up prevention messages, provide clean
water and assist IDPs with latrine construction materials.

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

See also: Hepatitis E outbreak on the rise in Kitgum at
<http://www.irinnews.org/Report.aspx?ReportId=78844>.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Hepatitis E was not recognized as a distinct human disease until
1980. Hepatitis E is caused by infection with hepatitis E virus, a
non-enveloped, positive-sense, single-stranded RNA virus. Although
man is considered the natural host for HEV, antibodies to HEV or
closely related viruses have been detected in primates and several
other animal species. Hepatitis E virus is transmitted via the
faecal-oral route. Hepatitis E is a waterborne disease, and
contaminated water or food supplies have been implicated in major
outbreaks. There is a possibility also of zoonotic spread of the
virus, since several non-human primates, pigs, cows, sheep, goats,
and rodents are susceptible to infection. The risk factors for
hepatitis E virus infection are related to poor sanitation in large
areas of the world, and shedding of the virus in faeces.
Person-to-person transmission is uncommon. There is no evidence for
sexual transmission or for transmission by transfusion. The highest
rates of infection occur in regions where low standards of sanitation
promote the transmission of the virus. However, sporadic cases of
hepatitis E have also been reported elsewhere and serological surveys
suggest a global distribution of strains of hepatitis E of low
pathogenicity. Further information can be accessed at
<http://www.who.int/mediacentre/factshee ... index.html>.

A map showing the location of Kitgum district in the north of Uganda
can be accessed at
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg>.
The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/009_>. - Mod.CP]