Wüstenschiff

Libyen - Pest
06.07.2009

Wie die WHO inzwischen bestätigte kam es in der Stadt Tubruq zu einem Pest-Ausbruch. Bei 5 Personen wurde die Pest nachgewiesen. Eine Erkrankung verlief als Lungenpest und endete tödlich. Es handelt sich um die ersten Pest-Erkrankungen in Libyen seit 25 Jahren. Die Küstenstadt Tubruq liegt im Nordosten des Landes ca. 125 km von der ägyptischen Grenze entfernt. Der Ausbruch ereignete sich bei einem teillweise nomadisch lebenden Volksstamm. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (18 )
***********************************************
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] Cholera, prison - Swaziland (Lubombo)
[2] Cholera - Swaziland (Mbabane)
[3] Cholera - Kenya

******
[1] Cholera, prison - Swaziland (Lubombo)
Date: Tue 7 Jul 2009
Source: The Swazi Observer [edited]
<http://www.observer.org.sz/index.php?news=5583>


Following reports of a cholera outbreak in Big Bend prison, acting
commissioner of correctional services Isaiah Ntshangase has visited
the centre on a health assessment mission. In a brief interview
yesterday [6 Jul 2009], Ntshangase said 10 people at Big Bend prison
have been diagnosed with cholera. Six of these are prison officers,
while the remaining are inmates. The number of people to have
contracted cholera at the prison has just recently shot up. Just
recently, only 4 correctional staffers had been positively identified
as having the disease, while 2 inmates had been diagnosed.

Currently, a tanker is used for water supply at the prison instead of
running water, and this has raised concern that the use of portable
instead of running water may further exacerbate the situation.

[Byline: Hlengiwe Ndlovu]

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

[Big Bend prison is located in the eastern Swaziland province of
Lubombo; see map at:
<http://www.mapsofworld.com/swaziland/ma ... nd-map.jpg>. The
location of land-locked Swaziland can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. - Mod.LL]

******
[2] Cholera - Swaziland (Mbabane)
Date: Thu 2 Jul 2009
Source: The Swazi Observer [edited]
<http://www.observer.org.sz/index.php?news=5493>


A 5-year-old child has died of cholera in an outbreak in Mndobandoba
and Mahlabaneni areas, Minister of Health Bennedict Xaba revealed.
Eight new cases have been reported in the area, bringing to 16 the
number of reported cases.

Addressing Members of Parliament in the House of Assembly, the
Minister said although they were yet to undertake further tests at
Mbabane Government Hospital on the child's issue, preliminary results
from Good Shepherd Hospital were that cholera was the cause of death.

"It was found that residents source their water from the nearby Great
Usuthu River, which is contaminated. We're presently working hard to
provide a clean water supply to Bholi Clinic, being used by the
community and generally the whole of Nkilongo constituency," he said.

[Byline: Njabulo Dlamini]

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

[Mbabane province is in northwestern Swaziland and shares a border
with the above mentioned Lubombo province as seen on a map at:
<http://www.mapsofworld.com/swaziland/ma ... nd-map.jpg>. - Mod.LL]

*****
[3] Cholera - Kenya
Date: Wed 8 Jul 2009
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 633C287951>


The number of Kenyans who have died since the start of 2009 in a
cholera outbreak has risen to 89, the Red Cross Society said on
Wednesday [8 Jul 2009], warning water shortages could spread the
disease to Nairobi.

Kenya Red Cross Society spokesperson Titus Mungou said that since the
1st case was reported in the western Nyanza province in late December
2008, a total of 4000 cases and 89 deaths were confirmed. He added
that water shortages across the country had led many people,
including in the capital, to buy water, often from unreliable sources.

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

[A map of Kenya can be found at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

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

Date: 11 Jul 2009
Source: Nation Online, Window on Malawi [edited]
<http://www.nationmw.net/newsdetail.asp?article_id=3384>


Strange disease hits Neno
-------------------------
An unknown disease has killed 15 people out of 103 patients since May
this year [2009] in 2 bordering villages of Mtemankhawa and Datson in
Malawi and Mozambique, respectively. Mtemankhawa Village, with a
total population of 753, is in the area of TA Dambe in Neno while
Datson Village, in the area of Chief Tsangano in Mozambique, has a
population of 329.

Traditional leaders in the area and Secretary for Health Chris
Kang'ombe have confirmed the occurrence of the unknown disease and
the deaths. "It is true that 15 people out of 103 cases have died so
far. 8 are from the Malawi side while 7 from Mozambique side. 5 are
admitted to Neno District Hospital," said Kang'ombe in an interview
yesterday. He described the disease as "not well known".

The PS said the ministry has already sent laboratory samples to South
Africa for analysis. The symptoms of the disease, according to
Kang'ombe, include stiff neck, dehydration, fever, headache, joint
pain, discomfort in abdomen and loss of voice. He ruled out meningitis.

While waiting for the results of the samples, he said, the ministry
is treating some patients with antibiotics and has supplied the
people with Chlorine because "they use unprotected wells for water."
He said the area is "very cold" and some people are forced not to
bathe for many days. He said some live together with animals in their
round grass-thatched houses which have no windows. "These could be
some contributing factors but it is yet to be seen," said Kang'ombe.
He said the ministry has also set up a treatment camp in the area to
handle minor cases.

Group Village Headman Chakulembera, who oversees Mtemankhawa Village,
said in an interview on Wednesday [8 Jul 2009] in Mwanza that those
affected by the disease develop stiff jaws, neck and have abdominal
pains. "It makes it difficult for them to eat," he said.
Chakulembera, who was flanked by village headman Mtemankhawa and T/A
Dambe's envoy MacDonald Chindimwe, said among those killed include 5
pupils, 3 from Chawe Primary School.

"On average, we have 3 or 4 deaths per week. People are worried about
the development because they cannot work in their wheat and Irish
potato gardens," said Chakulembera, who was supported by Mtemankhawa
who said: "The latest death was on Monday this week, 6 Jul 2009."

The group village headman said the disease has affected almost every
family, with some having more than one patient. Chakulembera said
some patients died at Neno District Hospital but the majority
succumbed at their homes. "We are living in fear. When one is
attacked, we know he or she is going to die," he said.

Chakulembera said health officials from both Malawi and Mozambique
have been visiting the area "frequently" to monitor the situation.
"The Ministry of Health supplied us with Chlorine to add to the water
we use," confirmed Chakulembera. There is no piped water or
boreholes. Most of the houses are old round grass-thatched ones and
have no windows. People sleep together with animals in such houses,"
he said when asked to explain the living conditions of the people in
the affected area.

On another note, Mtemankhawa said he is living in fear for his life
after some of his villagers warned they would "deal with him. They
accuse me of being a wizard and that I am behind the deaths. They
make such allegations because they say I do not provide a solution.
But it is not true," he said.

He said villagers have since agitated for a witchdoctor to come to
the village to find the cause of the mysterious disease. He also said
grave-diggers have threatened to abandon their work, arguing they are
fed up with the frequent deaths. Dambe's advisor said the chief
advised fellow traditional leaders to tell people to stop sleeping in
the same house with animals and ensure that all dwelling units have
windows and pit latrines as preventive measures.

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

[The above newswire describes a clinical picture that is difficult to
come to diagnostic conclusions on. Some of the symptoms might lead
one to think meningitis was the etiology, but the newswire mentions
that meningitis has been ruled out. Other symptoms might be
compatible with the more severe form of leptospirosis, although
arthralgias are described rather than myalgias, and jaundice is not
mentioned where it tends to be a predominant presenting symptom with
severe leptospirosis. According to the article, since the beginning
of May 2009, the overall attack rate has been 9.5 percent (103 cases
out of a total population of 1082) with a case fatality rate of 14.6
percent. Oftentimes when one reads newswires, the presumed risk
factors of disease mentioned helps to narrow down the etiologic
agent. In the above newswire this isn't really the case as it
mentions poor water and sanitation, and close proximity to animals,
risk factors for a large spectrum of microbial agents includi!
ng bacterial and viral agents. Note, that while this moderator is
mentioning microbial agents, the possibility of exposure to
environmental toxins has not been ruled out as yet either.

More information from knowledgeable sources in the region would be
greatly appreciated.

For a map of the Neno district of Malawi, see
<http://www.maplandia.com/malawi/southern/neno/>. For a map of the
Tsangano district of Mozambique, see
<http://www.maplandia.com/mozambique/tete/tsangano/>. If one zooms
out, one sees that the 2 districts are to the south of Lake Nyasa.

For the interactive HealthMap/ProMED map of Neno, Malawi, see
<http://healthmap.org/r/00Aa>, and for Tsangano Mozambique, see
<http://healthmap.org/r/00Ab>. - Mod.MPP]
..............................mpp/ejp/dk

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (19)
**********************************************
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 - Angola
[2] Cholera - Kenya (Eastern Province)

******
[1] Cholera - Angola
Date: Wed 15 Jul 2009
Source: Angola Press Agency (Angop) [edited]
<http://www.portalangop.co.ao/motix/en_u ... e2e1d.html>

Health authorities have reported 1250 cases of cholera that killed 35
across the country during the 1st half of 2009, Angop learned Wed 15
Jul 2009. The data were released by the Epidemiological Data
Processing Centre (CPDE) of the National Health Department.

The source noted that the country recorded a sharp drop of cholera
cases, judging by the number of the cases reported in the same period
of 2008 (5000), which claimed 125 lives.

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

[Maps of Angola can be found at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00BZ>. - Mod.LL]

******
[2] Cholera - Kenya (Eastern Province)
Date: Sun 12 Jul 2009
Source: Kenya Broadcasting Corporation (KBC) [edited]
<http://www.kbc.co.ke/story.asp?ID=58523>

Two people have died from what is suspected to be cholera in Isiolo,
Eastern Province. The men aged 35 and 80 died in their homes in
Quarry Kuu village near the border of Isiolo and Imenti North
districts. Eyewitnesses said the victims had earlier complained of
severe stomachache, vomiting, and diarrhea.

Four children from the same village were rushed to hospital with
similar symptoms where one was admitted, and the others aged between
3 through 7 were treated and discharged.

The villages reported the matter to Isiolo medical officer of health
(MOH) Dr Stephen Kiluva who visited the area with a medical team to
ascertain whether the 2 died from cholera and to sensitize residents
on measures to take to ensure the disease does not spread.

More than 20 people have so far died of cholera in Isiolo district
since March 2009.

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

[A map of Kenya showing the Eastern Province 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/00B_>. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (20)
**********************************************
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 - Somalia (Bay, Lower Shabelle regions)
[2] Cholera - Burundi (Bujumbura)
[3] Diarrhea, fatal - Uganda (Busia)

*****
[1] Cholera - Somalia (Bay, Lower Shabelle regions)
Date: Tue 21 Jul 2009
Source: Horseed Media [edited]
<http://english.horseedmedia.net/news/24121.shtml>


Reports from Bay region, central Somalia, are confirming that at
least 3 people have died so far from cholera, medical officers warn
for lack of medicine. 2 children and an elderly woman were confirmed
to be the latest victims of the cholera outbreak in Bay region.
Regional medical officials say, more people are hospitalized for the
disease, which is spreading in central Somalia.

"...we don't have enough medicine and more people are arriving in the
hospital..." Said Baidoa hospital staff, where more than 8 people
where hospitalized, yesterday [20 Jul 2009].

More cholera outbreak cases are reported from neighboring regions. In
Lower Shabelle region 2 children were confirmed dead, and more than
10 people were put into hospitals. Latest reports indicate that the
cholera outbreak might spread to other regions in south and central
Somalia.

[Byline: Mohamed Osman]

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

[The Bay and Lower Shabelle (Shabelle Hoose on the map) can be found
in southern Somalia on a map at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>.
The HealthMap/ProMED-mail interactive map of Somalia is available at
<http://healthmap.org/r/00aM> - Mod.LL]

*****
[2] Cholera - Burundi (Bujumbura)
Date: Mon 20 Jul 2009
Source: Afrique en Ligne, Panafrican News Agency (PANA) report [edited]
<http://www.afriquejet.com/news/africa-n ... 32042.html>


Some 27 residents of the Burundian capital, Bujumbura, have been
hospitalized for cholera, medical sources told PANA here Mon 20 Jul
2009. According to the doctor of the municipal health centre in
Bujumbura, Pascal Nday ongeje, a new case from Buyenzi, a popular
neighborhood in the city centre, was detected Mon 20 Jul 2009.

Cholera broke out 11 Jul 2009 in 3 neighborhoods in the northern part
of Bujumbura, and has since spread to other areas. No deaths have so
far been recorded. The high prevalence of diarrheal diseases in the
popular neighborhoods in Bujumbura has been blamed on poor sanitation
and lack of potable water, among others.

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

[Bujumbura is located in the western province of the same name and
can be found on the maps at
<http://www.un.org/Depts/Cartographic/ma ... urundi.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00Cs>. - Mod.LL]

******
[3] Diarrhea, fatal - Uganda (Busia)
Date: Wed 22 Jul 2009
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/17/688679>


Strange disease hits Busia, Uganda
----------------------------------
Experts from the health ministry are in Busia town to investigate a
strange disease that has hit the area. The disease, which has
symptoms similar to those of cholera, broke out in Soloa, Arubaine,
Marachi A and B, and Mugungu villages. 7 people, including 2
children, died after suffering from severe diarrhoea and vomiting.
Over 20 others were admitted at Samia-Bugwe North Health Centre IV.

Dr George Oundo Bwire, the district health officer, said some of the
patients had been discharged. "I cannot, therefore, say there is a
cholera outbreak," Oundo said.

The Arubaine and Marachi leaders blamed the disease on the
Busia-Kenya sewage system, which they said had overflowed into the
village wells. They said residents started falling sick when the
sewage started flooding. Oundo said an isolation centre had been
created at the health centre, adding that some patients who were at
the health centre before the outbreak, discharged themselves fearing
that they would contract the disease.

He appealed to residents to report any suspected cases. However, some
of the patients said they had eaten cassava and chapattis from
Arubaine market.

One of the patients, a Marachi B resident, said he developed the
symptoms 8 hours after he drunk water packed in kaveera (polyethylene
bag).

[Byline: Egessa Hajusu]

--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[A disease with fatalities that has symptoms like cholera may well be cholera.

The Busia district, which contains the town of the same name is
located in southeastern Uganda, bordering on Kenya. Its location can
be found on the maps at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00Bf>>. - Mod.LL]

UNDIAGNOSED FATALITIES - MALAWI, MOZAMBIQUE (02): REQUEST FOR INFORMATION
*************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 24 Jul 2009
Source: Daily Times, Malawi
<http://www.dailytimes.bppmw.com/article ... leID=13893>


Neno outbreak affects 133
-----------------
The mysterious epidemic that has plagued Neno continues to cause
casualties. It has now infected 133 people and caused 17 deaths.

A press statement from the United States Government says the disease,
which broke out in May this year [2009], has infected 95 people in
Neno and 38 in neighbouring Tsangano district in Mozambique.

"Affected persons display unusual symptoms with neurological
complications. Patients admitted to the hospital have been treated
with antibiotics and given supportive care including rehydration,"
the statement states.

The development forced the Malawi government to seek help from the US
government which has sent 5 specialists to investigate the outbreak.

"The specialists have expertise in environmental health and
neurology. They arrived in the country on [20 Jul 2009], and are
working with the District Health Officer and his team to conduct a
full investigation on the outbreak," the statement says.

It states that the experts were conducting epidemiological
investigations, diagnosis and laboratory support, treatment and
containment of the outbreak.

"Previous attempts to demystify the disease have proved futile
because the blood samples collected by the ministry for testing in
Malawi, Zimbabwe and South Africa all yielded negative," says part of
the statement.

According to the statement, new samples have been taken and are being
shipped to the Centers for Disease Control and Prevention (CDC) in
the USA for further analysis.

Secretary for Health Chris Kang'ombe confirmed in an interview
yesterday that the specialists have already started their work.

Kang'ombe said the specialists would be in the country for 2 to 3 weeks.

"The results will be available immediately they finish their mission
in the country," the PS said.

The Government of Malawi formally requested Epidemiological Aid
assistance from United States Government on [15 Jul 2009].

[Byline: Theresa Kasawala]

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

[There are now 133 cases and 17 deaths (case fatality rate [CFR] 12.8
percent). In the 1st newswire covered in a prior ProMED-mail posting
on 11 Jul 2009 (see archive number 20090711.2489), there were
reports of 103 cases with 15 deaths (CFR 14.6 percent). The earlier
report mentioned a total population at risk of 1082, so the overall
attack rate has increased from 9.5 percent to 12.3 percent. The
earlier report mentioned a symptom complex of "stiff neck,
dehydration, fever, headache, joint pain, discomfort in abdomen and
loss of voice". The above newswire doesn't provide much more on the
clinical picture other than to mention neurologic complications. The
mention that environmental health specialists and neurologists are on
the investigating team from the CDC in the USA suggests that
environmental etiologies are suspected.

More information on this outbreak from knowledgeable sources would be
greatly appreciated.

For a map of the Neno district of Malawi, see
<http://www.maplandia.com/malawi/southern/neno/>. For a map of the
Tsangano district of Mozambique, see
<http://www.maplandia.com/mozambique/tete/tsangano/>. If one zooms
out, one sees that the 2 districts are to the south of Lake Nyasa.

For the interactive HealthMap/ProMED map of Neno, Malawi, see
<http://healthmap.org/r/00Aa>, and for Tsangano Mozambique, see
<http://healthmap.org/r/00Ab>. - Mod.MPP]

LEPTOSPIROSIS - SOMALIA: SUSPECTED, REQUEST FOR INFORMATION
***********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 29 Jul 2009
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/12/689604>


A strange disease has killed 2 Ugandan peacekeepers in Somalia and
affected 17 others who were flown to a hospital in Nairobi yesterday
[28 Jul 2009], according to the UPDF [Uganda People's Defense Force].

One died in Mogadishu on Tuesday [28 Jul 2009] evening while another
one died on Wednesday [29 Jul 2009] morning in Nairobi, said
spokesperson Col Felix Kulayigye. Another 17 are admitted at the
intensive care unit of Nairobi Hospital.

UPDF has dispatched a medical team to Mogadishu to establish the
cause of the problem.

"The symptoms are chest pain, fever, headache, swelling of the lower
limbs, rapid heart-beat, and difficulties in breathing," said Kulayigye.

"We have no confirmation yet on what disease they are suffering
from." By the end of last week [25 Jul 2009], over 50 Burundians had
been hit by the same mysterious disease, killing 4. Dr Col James
Kiyengo, the force medical officer, on Friday [24 Jul 2009] said they
suspected the disease to be leptospirosis.

"Leptospirosis is a bacterial disease caused by exposure to water
contaminated with the urine of infected animals," Dr Kiyengo
explained. "For example, a rat could have urinated in a water tanker
and spread the disease."

Al Shabaab, the Islamist insurgents fighting the Somali government
and the peacekeepers, claimed responsibility, saying they had
poisoned them. But the claim was dismissed by medical officers of the
African Union peacekeeping force, who said it was a bacterial
infection as a result of poor hygiene and living conditions
associated with the job.

According to the US Centers for Disease Control [and Prevention -
CDC], leptospirosis is a bacterial disease that affects humans and animals.

In humans it causes a wide range of symptoms, such as high fever,
severe headache, chills, muscle aches, and vomiting. It may include
jaundice (yellow skin), red eyes, abdominal pain, diarrhoea, or a
rash. If not treated, the patient could develop kidney damage,
meningitis (inflammation of the membrane around the brain and spinal
cord), liver failure, and respiratory distress. In rare cases death occurs.

Humans become infected through contact with water, food, or soil
containing urine from infected animals, such as dogs or rats,
according to the US Centers for Disease Control. This may happen by
swallowing contaminated food or water, through skin contact, such as
the eyes or nose, or contact with broken skin.

The disease is not known to be spread from person to person. The time
between a person's exposure to a contaminated source and becoming
sick is about 4 weeks.

The illness lasts from a few days to 3 weeks. Without treatment,
recovery may take several months. Leptospirosis is an occupational
hazard for many people who work outdoors or with animals, such as
farmers, veterinarians, fishermen, or the military.

Dr Kiyengo said the disease can be treated with antibiotics and
prevented by boiling water and keeping out rats.

There are 4300 AU [African Union] peacekeepers in Somalia, of whom
2700 are Ugandan. The current Ugandan contingent will be replaced
next month [August 2009]. Col Nathan Mugisha is taking over from Gen
Francis Okello as force commander.

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

[Leptospirosis has a variable clinical picture, and can be
complicated by heart and kidney damage, meningitis, liver failure,
and respiratory distress. The news release above mentions that
patients in the outbreak had chest pain, fever, headache, swelling of
the lower limbs, rapid heartbeat, and difficulties in breathing, but
these findings are too non-specific to lead to a diagnosis. In
addition, no mention is made in the news release of myalgias or
conjunctival suffusion, predominant presenting findings of
leptospirosis; neither is jaundice, a prominent finding of severe
leptospirosis, mentioned. - Mod.ML]

[Leptospirosis is a zoonotic water-related disease caused by
pathogenic _Leptospira_ species. The organisms have been found in
rodents, insectivores, dogs, cattle, pigs, and horses. Hence it is an
occupational hazard for people who work outdoors or with animals,
such as military personnel, farmers, sewer workers, veterinarians,
and dairy workers. Human infection occurs through direct contact with
the urine of infected animals or by contact with a urine-contaminated
environment, such as surface water, soil, and plants. The bacteria
gain entry through cuts and abrasions in the skin and through mucous
membranes of the eyes, nose, and mouth. Disease symptoms include high
fever, severe headache, muscle pain, chills, and redness in the eyes,
abdominal pain, jaundice, hemorrhages in skin and mucous membranes
(including pulmonary bleeding), vomiting, diarrhoea, and a rash (see
<http://www.who.int/water_sanitation_hea ... index.html>).

In a suspected outbreak, attempts to diagnose leptospirosis must be
encouraged to enable prompt treatment with appropriate antibiotics.
When an outbreak of leptospirosis is suspected or identified, and if
it has been possible to identify the serovar concerned, the source
must be identified and appropriate environmental measures
implemented, with public information to people at risk (including
clinicians and health care workers and health authorities; (see
<http://www.who.int/zoonoses/diseases/Le ... llance.pdf>).

The HealthMap/ProMED-mail map of Somalia showing Mogadishu is
available at <http://healthmap.org/r/00Cu>. - Mod.JFW]

Äthiopien - Meningokokken-Meningitis
03.08.2009

Aus dem Norden des Landes wird ein Meningokokken-Ausbruch gemeldet. Äthiopien liegt im afrikanischen Meningokokken-Gürtel. Impfschutz beachten, besonders für Reisende mit engem Kontakt zur einheimischen Bevölkerung. / Quelle: crm

LEPTOSPIROSIS - SOMALIA (02): SUSPECTED, REQUEST FOR INFORMATION
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Thu 30 Jul 2009
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/artman/publish ... 8893.shtml>


By press time, 8 Ugandan soldiers on the Somali peacekeeping mission
were still in intensive care at a Nairobi hospital battling a strange
ailment suspected to be a result of poisoning. The soldiers are
feared to have been poisoned through water sources by the Islamist
fundamentalists, Al Shabaab, who are opposed to the interim
government in Somalia and the peacekeeping mission, sources told
Daily Monitor. But Maj Barigye Ba-Hoku, the African Union Peace
Keeping Mission spokesman, yesterday [29 Jul 2009] dismissed the
poisoning claims. "It's not true because this ailment is general and
it has affected the Somalis outside the camps. It's not only the
peacekeepers," he said.

"[Kenyan and Amisom (African Union Mission in Somalia)] doctors are
studying the cause of the illness and they will soon come up with the
report," Maj Ba-Hoku told Daily Monitor by telephone from Mogadishu.
The infected Ugandan peacekeepers are part of the over 50 who have
contracted the ailment that has in the last 3 weeks hit the Burundian
and Ugandan camps in Mogadishu. Al Shabaab early this month [July
2009] claimed they had poisoned Burundian peacekeepers.

Sources who did not want to be named because of the sensitivity of
the subject said 4 of the Ugandan soldiers were evacuated from the
Somali capital, Mogadishu, and flown to Nairobi on Tuesday [28 Jul
2009] for treatment at Nairobi International Hospital. The Ugandan
and Burundian camps are about 2 kilometres [1.2 mi] apart, each with
its water tanks. Last week [week of 20 Jul 2009], the Deputy Amisom
Commander, Gen Juvinele Niyoyunguriza, told a group of Ugandan
journalists in Mogadishu that Burundian forces had been infected with
a strange disease.

Gen Niyonyunguriza said 50 soldiers had been admitted and 4 died at
Nairobi International hospital. Mr Gaffel Nkolokosa of the African
Union Mission for Somalia [Amisom] in Nairobi yesterday [29 Jul 2009]
said 12 of the 50 were evacuated from Mogadishu 3 weeks ago and
brought to Kenya for treatment after exhibiting symptoms similar to
those of their colleagues who had been admitted. He, however, said
they had recovered and returned to Burundi.

According to sources, the Ugandan soldiers had developed fever and
skin rash, before developing body organ failure. Amisom Medical
Officer James Kiyengo said on Friday [24 Jul 2009] that the strange
ailment is a bacterial infection caused by rat urine. He identified
the infection as leptospirosis. "It is spread by a rat. A rat could
have urinated in the water tank. We need to keep hygiene and keep
rats off," he said last week [week of 20 Jul 2009]. He said the
ailment causes fever and skin rash, but added that its spread can
stopped through isolation of cases and giving them doxycycline injections.

Col Kiyengo said they had received drugs from the Islamic Relief
Association in the United States and Korean International Cooperation
Agency for treatment of the force and the general Somali community.
Amisom, which comprises 4300 Ugandan and Burundian soldiers, has come
under intense attack from Al Shabaab, who consider the peacekeepers
as an occupying force. 12 Ugandan peacekeepers have been killed since 2007.

Al Shabaab, a youthful group that has been terrorising Somalis since
2006, has now turned to using both psychological and combat war to
scare Somalis from supporting Amisom and the Transitional Federal
Government, which has been in place for barely 7 months.

[Byline: Risdel Kasasira, Andrew Bagala]

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

******
[2]
Date: Mon 3 Aug 2009
Source: Daily Nation (Kenya) [edited]
<http://www.nation.co.ke/News/-/1056/634368/-/ulkh44/-/>


The African Union Mission in Somalia (Amisom) has ruled out water
poisoning as the cause of a ''strange'' disease that has struck its
soldiers in Mogadishu. Amisom spokesman Gaffel Nkolokosa said in
Nairobi on Monday [3 Aug 2009] that the organisation was waiting for
an official medical report on what has made Ugandan and Burundian
soldiers to fall sick. The soldiers have been admitted to Aga Khan
Hospital [in Nairobi, Kenya]. "It is not true the water was
poisoned," he said. The AU soldiers are defending the Somali
government from an array of Islamic rebels fighting to topple it.
Al-Shabaab, the biggest of the rebel groups, had claimed that it
poisoned water used by Amisom.

In Kampala, defence and military spokesperson Felix Kulayigye
confirmed that 11 UPDF [Uganda People's Defence Force] soldiers
admitted to hospital had been discharged. 2 of the 6 remaining
soldiers are still in intensive care. The rest of the soldiers have
been released and would not be returning to their camp in Somalia,
sources have said. 17 Ugandan soldiers were flown to Aga Khan
Hospital after exhibiting symptoms similar to those afflicting
Burundian troops.

Doctors have also confirmed that the Ugandans had not been poisoned
as had earlier been claimed by al-Shabaab. Symptoms of the illness
include fever, swelling in the lower limbs, and jaundice (yellowing
of the skin and eyes).

The illness is believed to be leptospirosis, also known as Weil's
syndrome. It is said even the locals around the Amisom bases were
suffering the same ailment, thus ruling out poisoning. The World
Health Organisation has been carrying out investigations but is yet
to release results.

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

******
[3]
Date: Fri 31 Jul 2009
From: Steve Berger <mberger@post.tau.ac.il> [edited]


Re: ProMED-mail Leptospirosis - Somalia: susp, RFI 20090802.2706
----------------------------------------------------------------
I ran this scenario through Gideon [Global Infectious Disease &
Epidemiology Network]. Assuming that these findings represent a
single infectious disease, the most likely diagnosis is anthrax. If,
as claimed, the peacekeepers were intentionally infected, anthrax is
the only relevant disease in Somalia, which has bioterror potential.

--
Dr Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel
<mberger@post.tau.ac.il>

[Although according to the news releases, officials seem sure that
leptospirosis was the diagnosis for the disease affecting the Ugandan
and Burundian peacekeepers in Mogadishu, the clinical picture that
was given in the prior ProMED post (Leptospirosis - Somalia: susp,
RFI 20090802.2706) lacked certain features that are characteristic of
leptospirosis, such as myalgias, conjunctival suffusion, and
jaundice. However, the 2nd news release above now includes jaundice
in the clinical picture. In addition, although the outbreak was
thought to be intentionally perpetrated by Al Shabaab, who consider
these peacekeepers as an occupying force, the news releases above
discount this, mentioning that Somalis in the community were
suffering from the illness as well.

Dr Berger brings up the possibility that the cause of the outbreak in
the Ugandan and Burundian forces is anthrax, having assumed this
event was bioterrorism. I presume he means the inhalation form of
anthrax, which could account for chest pain and difficulty breathing
that has been part of the clinical picture (see ProMED post
Leptospirosis - Somalia: susp, RFI 20090802.2706), and multiorgan
failure mentioned in the news release above.

"Skin rash" that was not further characterized in the news release
above could be cutaneous anthrax that was seen in half of the 22
infected persons exposed to anthrax spores in the 2001 bioterrorism
event in the USA. However, the appearance of cutaneous anthrax is
distinctive and I assume would be identified as such by the
physicians in Nairobi. A detailed description of the skin rash in the
Ugandan and Burundian cases would be helpful.

In addition, many of the patients with the clinical picture that
included respiratory symptoms were said to have recovered, whereas
the mortality rate for inhalation anthrax is very high; even in the
2001 outbreak in the USA the case-fatality rate for inhalation
anthrax was 45 percent. Also, no mention was made in the Ugandan and
Burundian cases of radiologic findings of mediastinal widening
consistent with adenopathy or large pleural effusions, which are
commonly seen in patients with inhalation anthrax, and no one was
said to have meningitis, which was seen as the presenting illness in
the index case in the 2001 outbreak in the USA, and occurred in half
the autopsied cases with inhalation anthrax in the 1979 Russian
outbreak. For these reasons, I doubt anthrax is the cause of illness
in the Ugandan and Burundian peacekeepers.

The HealthMap/ProMED-mail interactive map of Somalia showing
Mogadishu is available at
<http://healthmap.org/r/00Cu>. - Mod.ML]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (21)
**********************************************
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 - Nigeria (Adamawa)
[2] Cholera - Congo DR (North Kivu)
[3] Cholera - Ethiopia (Oromia)
[4] Cholera - Somalia
[5] Cholera - Angola (Benguela)
[6] Cholera, prison - Zimbabwe (Masvingo)


******
[1] Cholera - Nigeria (Adamawa)
Date: Wed 19 Aug 2009
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 864C105075>


A cholera outbreak has claimed 39 lives in northern Nigeria's Adamawa
state in the past week, a senior local official said on Tuesday [18 Aug 2009].

"An outbreak of cholera in our locality in the last week has killed a
family, including a 52-year-old man, his wife and child. 36 other
people have also died," the deputy chairman of Maiha local
government, Yahaya Hamman-Julde, told reporters.

He said "scores of people" had been hospitalized as a result of the
disease, adding that an ongoing strike by medical workers in the
state was hampering efforts to assist the sick. Julde could not
immediately disclose the cause of the disease, but recalled that a
similar outbreak in June 2009 killed 20 people in the area.

Last September 2008, a spate of cholera outbreaks in northern Nigeria
claimed almost 100 lives in 3 states, Katsina, Zamfara and Bauchi.

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

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

******
[2] Cholera - Congo DR (Notth Kivu)
Date: Tue 18 Aug 2009
Source: Radio Okapi [In French, trans. Mod.MPP, edited]
<http://www.radiookapi.net/index.php?i=5 ... r=0&br=qst>


87 cases of acute diarrhea have been reported in less than 2 weeks.
According to the provincial medical inspector, it is cholera,
although laboratory results have not yet confirmed that. The only
good news at the moment is that there have not been any deaths
reported, said radiookapi.net.

At the Provincial hospital, visited this Tuesday [18 Aug 2009]
morning, there were 25 patients hospitalized [with cholera].
According to the provincial medical inspector, this situation is due
to the lack of running water in the city of Goma. Until now, many
households directly consume water taken from the lake. The director
of nursing at this hospital says the hospital has treated over 10 new
patients since the weekend.

"Since Saturday [15 Aug 2009], there have already been more than 40
cases; on Sunday [16 Aug 2009], 12 cases [were seen]; yesterday [17
Aug 2009], there were 18 cases seen, and now we are left with 25
cases. Last week, there were 2 or 3 cases per day. You see, since
Saturday, the number of cases per day has exceeded 10; it's too many.

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

[Goma is a city in northeastern Congo DR located in North Kivu
province, and the city can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... astdrc.pdf>. - Mod.LL]

******
[3] Cholera - Ethiopia (Oromia)
Date: Sat 8 Aug 2009
Source: Gadaa.com [edited]
<http://gadaa.com/oduu/?p=741>


According to information obtained from Oromia, AWD (Acute Watery
Diarrhea, commonly known as cholera) is ravaging West Arsi, East
Shewa, West Hararghe, North Shewa and Arsi zones in the state of
Oromia. Unfortunately, the government's lack of attention to the
control, treatment and intervention of the situation is exacerbating
the problem.

Cholera is expanding and killing hundreds of people in West Arsi
(Shashamane, Kofale, Shalla, Arsi Negele and other districts), East
Shewa (Fantale, Boset and Adami Tulu districts), West Hararghe
(Mieso, Guba Qoricha, Chiro and other neighboring districts) and
North Shewa (Wara Jarso district), and Arsi zones (Merti, Jaju, and
other neighboring districts).

According to experts and informants, on 29 Jul 2009, there were over
1700 cases of cholera and 28 deaths in the West Arsi zone. Out of 220
cases, 5 deaths are reported in Mieso, Chiro and Guba Qoricha
districts. Similar death cases are also reported from all other
affected districts and zones.

Due to lack of access to the remote areas of the zones, the number of
death cases and cholera-affected people has been under-reported; the
problem is much worse than what is being reported. The situation in
West Arsi is the worst; the government has prohibited visits to the area.

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

[The Oromia region of Ethiopia can be seen on a map at
<http://en.wikipedia.org/wiki/Regions_of_Ethiopia>. - Mod.LL]

******
[4] Cholera - Somalia
Date: Wed Aug 12 2009
From: Grainne Moloney <grainne.moloney@fsnau.org>


Cholera is endemic in Somalia, and in 2009, the outbreak is
particularly bad. However, we are not reporting directly in this
update on Mogadishu, given our lack of access, and, in addition, our
target population for assessments are children less than 5 years old.
We are not involved in any assessment of the peace keepers, and I do
not have access to any information on the outbreak affecting them.

--
Communicated by:
Grainne Moloney
Nutrition Technical Manager
Food Security and Nutrition Analysis Unit - Somalia (FSNAU),
Nairobi, Kenya
<grainne.moloney@fsnau.org>

[A map of Somalia can be found at: at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. The
HealthMap/ProMED-mail interactive map of Somalia is available at
<http://healthmap.org/r/00aM>. - Mod.LL]

******
[5] Cholera - Angola (Benguela)
Date: Tue 4 Aug 2009
Source: Angola Press [edited]
<http://www.portalangop.co.ao/motix/en_u ... 51014.html>


At least 5 people, out of 16 patients, died of cholera from July 2009
until the present moment in Bocoio district, central Benguela
province, according to data from the local health authorities.
Speaking to ANGOP this Tuesday [4 Aug 2009], the local health
director, Felix Laureano, reported that 3 of the 5 deaths did not
occur at health posts.

That official explained that the 16 cases of cholera were notified in
the district headquarters and in the villages of Chindur, Kamundo,
Balanca, Cangoia and Fasil.

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

[A map of Angola showing Benguela can be found at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf> and the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00BZ>. - Mod.LL]

******
[6] Cholera, prison - Zimbabwe (Masvingo)
Date: Mon 3 Aug 2009
Source: Radio Voice of the People [edited]
<http://www.radiovop.com/index.php?optio ... Itemid=755>


Six inmates at Masvingo Remand Prison have succumbed to cholera as a
fresh outbreak has been reported, despite claims by the government
that it has contained the disease. Prison officials told Radio VOP on
Monday [3 Aug 2009] that the fresh outbreak had added woes at the
prison, battling to contain hunger-related diseases that have claimed
over 100 lives in all Masvingo's 3 prison centers.

"Six of our inmates at the Remand prison lost their lives after they
contracted cholera last week. We did not anticipate another outbreak
this year [2009] after we had successfully contained the previous
outbreak in 2008," said Zimbabwe Prison Service provincial officer,
Edmore Chatikobo.

He said they were hurriedly taken to Masvingo general hospital but
could not get medical attention due to drug shortages, and only 4
were treated, leading to the deaths of the other 6.

Masvingo Provincial Medical Director, Dr Robert Madyiradima,
confirmed the outbreak. "We received reports about the outbreak, and
I am sure about 10 inmates from the prison were brought to our
hospital for treatment, and we could not attend all due to shortages
of drugs, and this led to the death of others," he said.

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

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]

Äthiopien - Darminfektionen
24.08.2009

Risiko für Durchfallerkrankungen landesweit, auch für Cholera. Aus der Region Oromia (zentrales bis südliches Äthiopien) wird im August ein Ausbruch von akuter wässriger Diarrhö (wahrscheinlich Cholera) gemeldet. Polio-Wildvirus ging nach einer Pause von 4 Jahren durch Reimport aus dem Sudan im Dezember 2004 wieder in Zirkulation. 2006 wurden noch 17 Fälle nachgewiesen, 2007 keine und im vorigen Jahr 2 Fälle. Nahrungs- und Trinkwasserhygiene sowie Impfschutz gegen Polio beachten. / Quelle: crm
___________________________

Uganda - Typhus
24.08.2009

Der Typhus-Ausbruch im Bukwo Distrikt im Osten Ugandas hält weiterhin an. Bisher wurden 22 Todesfälle gemeldet. Hygiene und Impfschutz beachten. / Quelle: crm
___________________________

Uganda - Schlafkrankheit
24.08.2009

Wie in den Nachbarländern hat die gefährliche Krankheit auch in Uganda zugenommen. Mit einem hohen Aufkommen bei Tieren, die dem Erreger als Reservoir dienen, und einer Übertragung auf Menschen ist landesweit zu rechnen. Schutz vor Tsetse-Fliegen (Überträger) beachten. Bei verdächtigen Reaktionen sofort einen Arzt aufsuchen. / Quelle: crm

METHANOL POISONING, FATAL - UGANDA: (KAMPALA)
*********************************************
A ProMED-mail post
http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 23 Aug 2009
Source: Monitor Online [edited]
<http://www.monitor.co.ug/artman/publish ... 0124.shtml>


Residents of Kasana Sanja zone in Kulambiro, a Kampala suburb, are
panic-stricken following the deaths of several people in the area within a
month. The latest victims of a strange disease, who died on Friday [21 Aug
2009], include 3 residents of Kasana Sanja zone.

Nakawa RDC [cannot find definition of this acronym. - Mod.SH], Mr Fred
Bamwine, who has since visited the area, has appealed to the police and
Kampala City Council authorities to investigate the cause of the deaths.

According to an uncle who was staying with one of the recently deceased
residents, the disease 1st killed their mother in July 2009. "She woke up
in the morning, and all seemed okay, but we were surprised to be informed 2
hours later that she had died. And on Friday [21 Aug 2009] at 2 a.m., my
nephew called us from his bed saying he could not see anything, though he
could hear our voices. He also felt a heavy chest. Moments later, he died.
Victims of the disease do not show any signs of illness. They simply go
blind and feel a sudden heaviness in the chest, which stops them from
breathing, and within a matter of hours, they die."

Kira Road Police Station DPC confirmed the deaths. "We have recorded 7
deaths in the last one month in Kasana LC1 Kulambiro village Sanja. We are
still waiting for the medical report."

[byline: Stephen Otage]

--
communicated by:
Michelle Sellors
Nurse Adviser
MASTA Ltd
Leeds LS19 7BN
UK
<michelles@masta.org> and by ProMED-EAFR

[This strange disease has claimed 9 people in 4 weeks, all residents of a
Kampala suburb. The common symptoms prior to death include blindness and
respiratory symptoms. These would suggest methanol poisoning, in which
visual effects and metabolic acidosis are the hallmark. The same symptoms
may, however, manifest in other types of poisoning, including iron,
salicylates, or diseases like diabetic ketoacidosis and uremia.

The probabily of methanol poisoning will be strengthened if the history of
ingestion can be elicited, which, therefore, needs to be established by the
investigations that are currently going on.

There were related reports, 3 months ago, of 5 deaths in the Western Uganda
town of Kasese following consumption of liquor packed locally in the town
<http://www.newvision.co.ug/PA/8/13/680686>. The investigation into those
cases was not conclusive, but it is possible that all these reports point
to unregulated brewing of alcohol products in the country, especially in
the rural areas.

In 2007, 40 people with a presentation similar to the symptoms of the
current deaths died in Kampala and nearby districts after drinking a toxic
local gin. The investigation into those cases by the Ministry of Health
revealed that the cases had been exposed to a local gin that contained too
much methanol <http://www.newvision.co.ug/PA/8/13/680686>.

Methanol toxicity remains a common problem in many parts of the developing
world, where methanol is often a component of bootleg alcohol, which is
made in rural regions. Because of its low cost, it is often consumed by
those in lower socioeconomic classes. Methanol has a relatively low
toxicity, hence the adverse effects are thought to result from the
accumulation of formic acid, a metabolite of methanol metabolism. Formic
acid metabolism is very slow, hence accumulates in the body, leading to
metabolic acidosis.

Initial symptoms occur 12-24 hours after ingestion and in general correlate
with the volume of methanol ingested and the amount of ethanol
concomitantly ingested. The minimal lethal dose is believed to be 1 mg/kg
body weight. Initial symptoms include disinhibition and ataxia followed by
headache, nausea, and vomiting or epigastric pain. These are then followed
by drowsiness, seizures, and eventually coma. Visual symptoms like flashes
of light, blurring, scotomas, and scintillations occur and may progress to
complete visual loss. Prompt medical care is hence vital to avoid
complications secondary to methanol intoxication. Supportive therapy is
aimed at initiating airway management, correcting electrolyte disturbances,
and providing adequate hydration. The metabolic acidosis may necessitate
administration of bicarbonate and assisted ventilation. Bicarbonate
potentially may reverse visual deficits. In addition, bicarbonate may help
to decrease the amount of active formic acid.

Antidote therapy is directed towards delaying methanol metabolism until the
methanol is eliminated from the system, either naturally or via dialysis,
often accomplished in 2 ways: ethanol or fomepizole. Ethanol is also
metabolized by alcohol dehydrogenase (ADH), and the enzyme has 10-20 times
higher affinity for ethanol compared with methanol. Fomepizole is also
metabolized by ADH; however, its use is limited because of high costs and
lack of availability. <http://emedicine.medscape.com/article/1174890-overview>.

The HealthMap/ProMED-mail map showing Kampala in Central Uganda is
available at <http://healthmap.org/r/00v0>. - Mod.TG]

Uganda - Typhus
07.09.2009

Der Typhus-Ausbruch im Bukwo Distrikt im Osten Ugandas hält weiterhin an. Bisher wurden mehr als 600 Erkrankungen und 22 Todesfälle gemeldet. Hygiene und Impfschutz beachten. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (22)
***********************************************
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], [2] Cholera - Ethiopia
[3] Cholera - Kenya
[4] Cholera - Zimbabwe (Manicaland)
[5] Cholera - Nigeria (Adamawa)

*****
[1] Cholera - Ethiopia
Date: Mon 7 Sep 2009
Source: Reuters [edited]
<http://af.reuters.com/article/topNews/i ... 07?sp=true>


Cholera and other diarrheal diseases have infected 18 000 people in
Ethiopia over the last 3 weeks in many parts of the country,
including the capital Addis Ababa, according to a document seen by Reuters.

The document, minutes of a meeting attended by international health
charities and UN agencies last Tuesday [1 Sep 2009], said half of
moderate-to-severe cases of the 18 000 infections were cholera. It
did not say how many were moderate-to-severe. Most of the diarrheal
illnesses that were not cholera were acute watery diarrhea (AWD),
health workers said [often used as a euphemism for cholera - Mod.LL].

"To date, there are approximately 14 000 cases of AWD/Cholera (in the
regions) and an additional 4000 from Addis Ababa," the minutes of the
meeting said.

Addis Ababa usually suffers less from diarrhea epidemics than other
parts of the country, but the city's health authorities are
investigating the hygiene standards of hundreds of hotels and
restaurants, according to local media.

Health workers, who declined to be named, told Reuters the fatality
rate was 2 percent when the outbreak began but that it had been
reduced as local and international agencies stepped up their
response. "The case fatality rate is falling as the response
matures," the minutes of the meeting said. "The epidemic is now in
its 2nd phase, case load taking the form of a series of peaks over a
protracted period."

Ethiopia's Health Ministry said last week that 34 people had died
from AWD but it had not yet confirmed any cholera cases.

Aid agencies now fear a religious festival scheduled for this month
[September 2009] will worsen the outbreak of AWD and cholera. "The
Meskel religious festival (is a) major cause for concern," the
document said. "Up to 500 000 people are expected to gather for 10
days from 15-30 Sep 2009 with poor access to safe drinking water and
sanitation facilities."

Some governments in Africa are often reluctant to admit to the
presence of cholera for fear it could hamper agricultural exports and tourism.

[Byline: Barry Malone]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Addis Ababa and other regions of Ethiopia can be seen on a map at:
<http://en.wikipedia.org/wiki/Regions_of_Ethiopia>. - Mod.LL]

******
[2] Cholera - Ethiopia
Date: Mon 7 Sep 2009
Source: UN Office for Coordination of Humanitarian Affairs (OCHA) [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


Acute Watery Diarrhea (AWD) cases have been reported from all 10
sub-cities in Addis Ababa, with the highest caseload recorded from
Akaki/Kaliti, Addis Ketema, Arada and Kolfe, according to official
reports from the Federal Ministry of Health (FMoH). The outbreak also
continues to spread in other regions of the country, and new woredas
[administrative divisions] are reportedly affected in Amhara,
Oromiya, Dire Dawa and SNNPR. Between 17 and 23 Aug 2009 (34th
epidemiological week), a total of 2330 new cases of AWD and 22 deaths
with 0.9 per cent case fatality rate have been reported from 61
woredas and 10 sub-cities in Addis Ababa, Afar, Amhara, Somali,
Oromiya and SNNPR. The ongoing kiremt rains and the continuous
movement of pilgrims and migrant laborers to and from holy water
sites and private farms are contributing to the spread of the
disease. The re-opening of schools in mid-September 2009 also
requires special attention.

--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland

******
[3] Cholera - Kenya
Date: Mon 7 Sep 2009
Source: Daily Nation [edited]
<http://www.nation.co.ke/News/-/1056/654600/-/umsm3k/-/>


Eight people have died of cholera in Laisamis, Marsabit, while 6
members of a Nairobi family are being treated for the disease at the
Kenyatta National Hospital. The 6 Nairobi family members contracted
the disease in Dandora Estate, Embakasi after drinking contaminated
water from a nearby well, the Public Health director, Dr Shanaaz
Shariff, said on Monday [7 Sep 2009].
Following the outbreak, a team of Public Health officials visited the
area and treated the contaminated water with chlorine tablets.

"As the water rationing continues to bite, I would like to appeal to
residents to observe basic hygiene standards and ensure they boil
drinking water at all times," Dr Shariff said. The rationing program
in the city is forcing some residents to use water from unknown or
contaminated sources.

At the same time, the drought being experienced in most parts of the
country has also led to a severe shortage of water, resulting in a
rise in cases of cholera and other water-borne diseases. According to
experts, more than 50 people have died from the killer disease in
various parts of the country in the past 6 months.

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

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

******
[4] Cholera - Zimbabwe (Manicaland)
Date: Tue 25 Aug 2009
Source: Voice of America [edited]
<http://www.voanews.com/english/Africa/2 ... -voa46.cfm>


Health experts in Zimbabwe are considering the implications of 12
cases of cholera confirmed this week in Chipinge district of eastern
Manicaland province some weeks after the Ministry of Health declared
that the deadly 2008-2009 cholera epidemic had run its course.

Health Minister Henry Madzorera has advised against alarm saying
Zimbabwe is much better prepared to deal with such outbreaks now than
it was at this time in 2008, when an epidemic began which eventually
took 4228 lives from more than 98 000 cases over 10 months.

Executive Director Itayi Rusike of the Community Working Group on
Health said the new cases show that while the epidemic has ended,
cholera is now endemic and a continuous threat, warning that the
onset of the rainy season could bring even more cases. Zimbabwe's
rainy season typically begins in October.

[Byline: Patience Rusere and Sandra Nyaira]

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

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

******
[5] Cholera - Nigeria (Adamawa)
Date: Sat 22 Aug 2009
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... rdVUXc6_fw>


A cholera outbreak in northern Nigeria has killed 13 more people,
taking the death toll to 52, the health commissioner said on Saturday
[22 Aug 2009]. "We recorded more cases of [the] cholera outbreak in
the state in the last 5 days," Zainab Baba Kwanci told AFP of the
outbreak in Adamawa state. "In Demsa, we have recorded 9 deaths,
while 120 people are hospitalized. In Fufure, we recorded 4 deaths
and 18 hospitalized."

39 people were reported killed by the disease in Maiha, according to
local government official Yahaya Hamman-Julde. He said "scores of
people" had been hospitalized as a result of the disease, stressing
that an ongoing strike by medical workers in the state was hampering
efforts to assist the sick.

Last September 2008, a spate of cholera outbreaks in northern Nigeria
claimed almost 100 lives in Katsina, Zamfara and Bauchi states.

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

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

Südafrika - Masern
14.09.2009

Aus der Provinz Gauteng, insbesondere aus der Hauptstadt Tshwane (früher Pretoria) wir eine Zunahme der Masern-Erkrankungen gemeldet. Landesweit wurden 131 Fälle gemeldet, davon 97 aus Tshwane. Nach dem deutschen Impfkalender sind 2 MMR-Impfungen für alle Kinder vorgesehen. Ein fehlender Impfschutz kann auch später jederzeit, z.B. anlässlich einer Reise, nachgeholt werden. / Quelle: crm
__________________________

Nigeria - Poliomyelitis
14.09.2009

Nachdem die Fallzahlen 2007 im Vergleich zu 2006 zurückgegangen waren, stiegen die Neuerkrankungen 2008 auf 798 an. In diesem Jahr wurden bisher 372 Fälle registriert. Damit steht Nigeria weltweit weiterhin an der Spitze. Nach neueren Untersuchungen gibt es in den nördlichen Bundesstaaten noch immer Schlüsselregionen mit hohem Risiko, in denen 20% der Kinder nicht geimpft sind. Impfschutz bei Reisen weiterhin beachten. / Quelle: crm
__________________________

Äthiopien - Darminfektionen
14.09.2009

Risiko für Durchfallerkrankungen landesweit, auch für Cholera. Aus der Hauptstadt Addis Abeba und aus anderen Landesteilen wird seit Mitte August ein Ausbruch von akuter wässriger Diarrhö (wahrscheinlich Cholera) gemeldet. In der Hauptstadt und Umgebung wurden bisher mehr als 18.000 Patienten behandelt, es gab mindestens 34 Todesfällen. Polio-Wildvirus ging nach einer Pause von 4 Jahren durch Reimport aus dem Sudan im Dezember 2004 wieder in Zirkulation. 2006 wurden noch 17 Fälle nachgewiesen, 2007 keine und im vorigen Jahr 2 Fälle. Nahrungs- und Trinkwasserhygiene sowie Impfschutz gegen Polio beachten. / Quelle: crm
__________________________

Burkina Faso - Überschwemmungen
14.09.2009

Durch die schweren Überschwemmungen der letzten Wochen werden Ausbrüche von Infektionskrankheiten befürchtet. Seitens der Behörden wurden Warnungen ausgesprochen bezüglich Cholera und Rift Valley-Fieber. / Quelle: crm