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CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (23)
**********************************************
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 - Kenya
[2] Diarrhea - Congo DR (North Kivu)


*****

[1] Cholera - Kenya
Date: Thu 10 Sep 2009
Source: All Africa, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/printable/ ... 00905.html>


"About 13 people are reported to have died of cholera in Turkana [in
the northwest] since 20 Aug [2009]," Shahnaaz Sharif, the director of
public health, told IRIN, adding that 5 of the deaths occurred in
hospital while the rest have been reported by villagers. New cases are
being reported in the Turkana divisions of Kalokol and Kerio, Sharif
said. "The worry is [that] they [Turkana residents] are using water
from the Ferguson Gulf, in Lake Turkana, which is contaminated," he
said. A broken-down water pump has been repaired to provide clean
water. The area also has low latrine cover, contributing to improper
waste disposal.

In the capital Nairobi, 3 cholera cases were reported in the eastern
Dandora area 7 days ago. "This was caused by the use of water from a
well that was sunk close to a latrine," he said. Dysentery cases are
also being reported 250 km [155 miles] from the northeastern Laisamis
area, where a previous cholera outbreak was reported.

So far, more than 600 cholera cases have been reported in the affected
Turkana divisions, the International Rescue Committee (IRC) health
coordinator for Kenya, Vincent Kahi, told IRIN. "Lack of water for
Kalokol, Turkana, is the main driver of the disease," Kahi said. He
said NGO [non-governmental agency] partners, with the Health Ministry,
were distributing chlorine for water treatment and repairing
infrastructure.

The IRC is helping to provide medicine and staff to help in the early
diagnosis of the disease. The Kenya Red Cross Society (KRCS) is
supporting water and sanitation projects in drought-hit northeastern
Ijara and Isiolo in the east to reduce the vulnerability of pastoralist
communities to recurrent droughts. KRCS staff and volunteers are also
training community members in hygiene and are continuing to distribute
relief aid to 573 343 beneficiaries in the region.

--
Communicated by:
ProMED-EAFR
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[Maps of Kenya can be found at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf> and
<http://healthmap.org/r/00O7>.
Lake Turkana is the northern part of the border between the Rift Valley
and Eastern provinces. - Mod.LL]

*****
[2] Diarrhea - Congo DR (North Kivu)
Date: Wed 16 Sep 2009
Source: Radio Okapi [in French, trans. Mod.JW, edited]
<http://www.radiookapi.net/index.php?i=53&a=24717>


A mysterious illness has struck the Walikale territory for the last 3
months. The symptoms of this disease include diarrhea and vomiting. The
tribal chief Lukong Birunga of Waloa Yungu told Radiookapi.net that the
illness first manifested in his group Waloa Yungu before reaching 5
localities of North Kivu province, namely Buhimba, Kimuwa, Nando,
Mikweti, Kahilenge-Mitwa. The same source said that during 3 months, 26
deaths were recorded including the case on [Mon 14 Sep 2009].

Also according to the same source, patients have no access to medical
care, because there is no functional health facility on site. Health
officials in Goma already have the information, says the source, but
cannot go there to intervene because of the bad security situation. The
traditional authority recalls that the Waloa Yungu group in the
territory of Walikale in North Kivu is so far experiencing armed groups
and foreign forces who are the law there.

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

[North (Nord) Kivu can be found in northeastern Congo DR on the maps at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00Pl>. - Mod.LL]

HEPATITIS E VIRUS - UGANDA (05): KITGUM
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Date: Wed 23 Sep 2009
Source: The DailyMonitor, allAfrica.com [edited]
<http://allafrica.com/stories/200909230111.html>


New Hepatitis E Cases in Kitgum
-------------------------------
Authorities in Kitgum District, Uganda, have expressed fears that the
fight against the deadly hepatitis E virus is stagnating and the
disease is showing signs of resurgence. Kitgum chairman John Bosco
Ogwok raised the concern on Monday [21 Sep 2009] after reports that 8
new cases had been reported in the district over the weekend.
Speaking to The Daily Monitor, Mr Ogwok said the 8 new cases were
found by Kitgum Town Council on Saturday. He blamed the outbreak on
residents whom he accused of failing to observe proper hygiene.
Hepatitis E spreads though eating food or drinking fluids that are
contaminated with human [and/or animal] waste.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[At the end of May 2009 it was reported that in the previous 2 weeks
hepatitis E virus infection had killed 2 people and left 60 others
infected in the Kitgum District. That brought the total number of
infections in the district to 1010, and the death toll to 160 since
the disease broke out in the previous year [2008]. The above current
report indicates that hepatitis E virus infection is still prevalent
in the District and improvements in sanitation and provision of clean
water still remain a priority in the district.

A map of Uganda showing the location of Kitgum District in the north
of the country 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/promed?g=443346&v=1.5,36,5>. - Mod.CP]

PLAGUE - CONGO DEMOCRATIC REPUBLIC: (ORIENTALE)
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<http://www.isid.org>

Date: Wed 23 Sep 2009
Source: The Monitor [edited]
<http://www.monitor.co.ug/artman/publish ... 1728.shtml>


The Ministry of Health [of Uganda] has launched a plague control
program in Nebbi and Arua districts as a result of a renewed threat
of the bubonic plague in the Democratic Republic of Congo. The
bubonic plague has been reported in Congo's Orientale province, which
borders the West Nile region. The plague control program is targeting
Vurra and Logiri in Arua district and Kango, Zeu and Jangokoro sub
counties in Nebbi district.

Under the new plague control program ministry of health together with
the 2 district health directorates will engage in massive
sensitization campaigns and spraying of homesteads in 5 subcounties
to prevent a possible outbreak of the disease.

In the West Nile area, the disease outbreaks have been commonly
reported in Logiri and Kango subcounties. In 2008, an outbreak of the
plague in the 2 subcounties left 17 people dead and 90 others
infected.

--
Communicated by:
ProMED Rapporteur Susan Baekeland
<promed@promedmail.org>

[Infections due to _Yersinia pestis_ are endemic in these areas of
the Congo DR. - Mod.LL]

[The Democratic Republic of the Congo can be located using the
HealthMap/ProMEDmail interactive map at:
<http://healthmap.org/r/00S2>.
- CopyEd.EJP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (24)
**********************************************
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 - Uganda (Bugiri)
[2] Cholera - Rwanda (Northwestern Region)
[3] Cholera - Zimbabwe (Masvingo), Mozambique
[4] Cholera - Congo DR (North Kivu, South Kivu)
[5] Cholera - Nigeria (Adamawa)


******
[1] Cholera - Uganda (Bugiri)
Date: 30 Sep 2009
Source: The Monitor [edited]
<http://allafrica.com/stories/200909300259.html>


At least 13 people have died over the past few days and about 60 others
have reportedly been hospitalized with symptoms of cholera in various
health centres in Bugiri District. According to medical workers in the
area, the disease that erupted early last week causes severe vomiting,
bloody diarrhea, dehydration, and general body weakness. It has mostly hit
the areas of Muwayo trading centre in Buluguyi Sub-county.

The district health officer, Dr Stephen Kirya Bulolo, confirmed the deaths
yesterday afternoon [29 Sep 2009]. He said out of the 80 currently under
intense medical monitoring, 71 are adults, while the rest are children
under 7 years. A health worker, only identified as Sr Namukwana, said new
cases were being registered at health centres every hour. She said stool
samples were taken to Kampala for further examination.

[byline: Fredrick Sooma and Asumani Musobya]

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

[Bugiri District is a district in south eastern Uganda. Like most other
Ugandan districts, it is named after its chief town, Bugiri, where the
district headquarters are located. It can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

******
[2] Cholera - Rwanda (Northwestern Region)
Date: Wed 30 Sep 2009
Source: UN Integrated Regional Information Networks (IRIN) [edited]
<http://www.irinnews.org/Report.aspx?ReportId=86369>


At least 50 cases of cholera have been registered in the north western
region of Rwanda, the Health Ministry said on 29 Sep 2009. No deaths were
reported in the affected region, which had been free of the disease for a
decade.

"Basic hygiene and lack of adequate sanitation in the region are described
as the biggest issue, but medical experts and humanitarian staff have been
deployed to outbreak areas," Gamariel Binamungu, director-general of the
National Reference Laboratory, said. "All necessary medication is being
provided to try to prevent the spread of the disease," he told IRIN.

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

[The specific location of the outbreak is not stated in this posting. A map
of Rwanda is shown at
<http://www.un.org/Depts/Cartographic/ma ... rwanda.pdf>. - Mod.LL]

******
[3] Cholera - Zimbabwe (Masvingo, Manicaland), Mozambique
Date: Wed 30 Sep 2009
Source: Zimbabwe Times [edited]
<http://www.thezimbabwetimes.com/?p=23282>


A fresh outbreak of cholera has hit Chiredzi District in Masvingo province,
where 5 new cases of the disease were reported this week, health officials
have said. This brings to 10 the number of cases that have been reported
over the past week, following another 5 new cases which were reported in
Chipinge in Manicaland Province.

Health officials here said the 5 fresh cases were reported in the Sengwe
Communal along the Mozambican border. "We have deployed personnel to the
affected areas, and the situation is under control," said a senior official
within the Ministry of Health.

Masvingo provincial medical director Robert Mudyirandima said: "I have yet
to get official reports, but it would appear cholera has affected parts of
Mozambique; as such, some of our areas along the border risk being affected."

Officials in the ministry yesterday [29 Sep 2009] said that initial tests
had proven that the reported cases were confirmed to be cholera.

In 2008, thousands of lives were lost due to a cholera epidemic which swept
across Zimbabwe.

[byline: Owen Chikari]

--
communicated by:
ProMED-mail and HealthMap
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[A map of Zimbabwe showing the provinces of Masvingo and Manicaland and the
border of Zimbabwe and Mozambique can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

******
[4] Cholera - Congo DR (North Kivu, South Kivu)
Date: Fri 25 Sep 2009
Source: UN Integrated Regional Information Networks (IRIN) [edited]
<http://www.alertnet.org/thenews/newsdes ... 414e64.htm>


At least 100 people have died of cholera in parts of eastern Democratic
Republic of Congo (DRC) since January 2009, say medical sources. South Kivu
Province is the worst affected, with at least 75 people dead and 6392
infected, said Eugene Kabambi, who is in charge of communications at the UN
World Health Organization (WHO) in DRC.

The South Kivu governor, Louis Leonce Muderwa, said the 10 worst-affected
health zones in the province included Fizi in the region of Baraka, Nundu,
Uvira, Kadutu, Ibanda, Bunyakiri, Katana, Minova, Nyantende and Kabare
zones. Two deaths have been reported in Kadutu and one each in Ibanda and
Katana.

Muderwa declared a cholera epidemic there on 14 Sep 2009.

In neighboring North Kivu Province, 48 deaths had been recorded and 4609
people infected by 13 Sep 2009, according to a WHO report.

Five health zones have recorded cases, including the main town of Goma,
Karisimbi, Masisi, Mutwanga, and Rutshuru areas. Other eastern regions have
also recorded cases, with Katanga listing 199 new cases and 2 deaths.

The North Kivu provincial medical inspector, Dominique Bahago, blamed the
cholera outbreaks on poor hygiene. "The majority of the population's supply
of cooking and drinking water is from Lake Kivu, where all kinds of waste
is dumped; cholera is endemic in that zone," said Bahago.

Cramped living conditions in displaced persons camps, as well as the
inconsistent use of latrines, had exacerbated contamination, he said. An
estimated 2 million people are displaced in eastern DRC, some of them
repeatedly since the start of conflict there in 1996.

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

[North and South Kivu can be seen in eastern Congo DR on a map at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.LL]

******
[5] Cholera - Nigeria (Adamawa)
Date: Fri 25 Sep 2009
Source: This Day Online [edited]
<http://www.thisdayonline.com/nview.php?id=155429>


At least 76 persons have been confirmed dead from a suspected outbreak of
an epidemic of cholera in about 7 local government councils of Adamawa state.

The disease, which manifests with symptoms of vomiting, diarrhea, and mild
fever, is ravaging communities in 7 local government areas of Mubi, north
and south, Maiha, Michika, Madagali, Girie, and Hong in the northern part
of the state.

So far, 76 people have died, while 846 are receiving treatment at the
various state health establishments. Commissioner of information, culture
and tourism, Alhaji Musa Bubakari Kamale, who stated this yesterday [24 Sep
2009] after the weekly executive council meeting, said the government had
dispatched adequate drugs and a medical response team to attend to those
already afflicted with the disease in the affected areas.

[byline: Mathew Onah]

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[Nigeria's north eastern Adamawa state can be seen on a map of the country
at <http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

Yellow fever in Cameroon
01.10.2009 - WHO

On 8 September 2009, The Ministry of Health (MoH), Cameroon reported a laboratory-confirmed case of yellow fever, identified through routine yellow fever surveillance. The index case is from Kotto 1 - Bomboko village, Buea Health District, South-West Province. A reactive mass vaccination campaign is planned for October 2009 in two districts, Buea and Mbongue, with a target population of 165,138.

The patient is a 61 year-old man male, without history of yellow fever vaccination, who presented with fever, jaundice and back pain with onset of symptoms on 27 July 2009. The patient consulted a private practitioner in Buea Health District and a clinical diagnosis of yellow fever was made.

Preliminary testing at the Institut Pasteur of Yaoundé suggested the patient may have yellow fever, a finding confirmed by the regional reference laboratory at the Institut Pasteur in Dakar, Senegal, where tests for other haemorrhagic fevers were negative.

During the outbreak investigation, 51 serum samples were collected from additional suspected cases. Laboratory analysis of the specimens is ongoing at the Institut Pasteur in Yaoundé. As yellow fever outbreaks have occurred in different parts of Cameroon, the country carried out a national yellow fever preventive vaccination campaign in May 2009, for the population of 62 districts at high risk. The health district of Buea was not previously known to be a yellow fever endemic area. This outbreak response campaign will therefore extend the area protected against future outbreaks.

The country will use vaccine from the global yellow fever vaccine emergency stockpile, which is managed by the International Coordinating Group for Yellow Fever Vaccine Provision (YF-ICG) and funded by the GAVI Alliance.

Kenia - Darminfektionen
02.10.2009

Risiko für Durchfallerkrankungen landesweit. Mit Cholera-Ausbrüchen ist regional zu rechnen. Zuletzt wurde im September aus Turkana (NW) ein Ausbruch mit mehr als 600 Erkrankten und 13 Todesfällen gemeldet. Hygiene beachten, Impfschutz für Risikoreisende. / Quelle: crm

DENGUE/DHF UPDATE 2009 (40)
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******

Senegal (Kedougou)
Date: Sat 3 Oct 2009
Source: Le Quotidien [in French, trans. & summ. Mod.TY, edited]
<http://www.lequotidien.sn/index.php?opt ... 3&Itemid=9>


The contagious diseases dengue and chikungunya have affected
pastoralists in the Kedougou region. Treatment for these diseases and
vaccines to prevent them are yet to be found. They were detected for
the 1st time in 2008 in the Kedougou region, in the department of
Salemata. Since then, more than a dozen people have been infected [It
is not clear how many of these cases are suspected or laboratory
confirmed as dengue virus infections and how many as chikungunya virus
infections. - Mod.TY]

The 1st case of dengue was registered in that area last year [2008].
Since then, several cases have emerged in the localities Ninefesha,
Banda, Saraya, among other locations. This year, 4 cases have been
reported in adults and 15 in children. It was during the review at the
meeting at the Kedougou medical region that took place on the past 28
Sep [2000] that Dr Sow of the Pasteur Institute of that region
revealed the existence of these "time bombs". To this end, according
to the physician, ''dengue is a viral disease that is transmitted by
an insect. It has the same symptoms as malaria. Moreover, it has
caused epidemics in West Africa during 2008, notably in Cote d'Ivoire,
Mali, etc." Dr Sow indicated. The virus is heterogeneous and a
specific treatment or vaccine have not yet been found.

The treatment of patients is free and is assured by the Institute
Pasteur, which in addition studies the evolution of these diseases in
eastern Senegal and strives to find a cure for these ills. These
diseases are common in West Africa in general and in particular in
Senegal. They emerge every 4 years since the year of their appearance
in 1972 in Asia. As the saying goes "prevention is better than cure."
The state, through the Ministry of Health is called upon to solve
these "time bombs" that can explode at any time.

[Byline: Moussa Seydou Diallo]

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

[An interactive map of Senegal showing the Kedougou area can be accessed at
<http://www.maplandia.com/senegal/tambac ... 12-11-0-w/>.
Additional maps of Senegal can be accessed at
<http://www.lib.utexas.edu/maps/africa/senegal.gif>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00TX>. - Mod.TY]

Südafrika - Masern
05.10.2009

In Südafrika wurde im September ein deutlicher Anstieg der Masern-Erkrankungen registriert. Während es im August 99 Erkrankungen waren, wurden im September 246 Fälle registriert, womit die Zahl der Erkrankungen seit Jahresbeginn auf 414 anstieg. Aus der Provinz Gauteng, insbesondere aus der Hauptstadt Tshwane (296 Erkrankungen) (früher Pretoria) werden die meisten Masern-Erkrankungen gemeldet. Auch Johannesburg meldete im September mit 48 Erkrankungen steigende Fallzahlen. 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
___________________________

Kamerun - Gelbfieber
05.10.2009

Bei einem 61-jährigen Mann aus dem Buea Distrikt in der Südwestprovinz wurde eine Gelbfieber-Infektion nachgewiesen. Von weiteren 51 Verdachtsfällen wurden Serumproben an das Pasteur Institut in Yaoundé gesendet, eine bestätigen steht noch aus. Für Oktober ist eine Impfkampagne in der Region vorgesehen. Impfschutz beachten. Bei Einreise aus endemischen Gebieten ist die Impfung vorgeschrieben, ausgenommen sind Kinder unter 6 Monaten (früher Kinder unter 12 Monaten). / Quelle: crm
____________________________

Nigeria - Darminfektionen
05.10.2009

Risiko für Durchfallerkrankungen landesweit. Cholera ist im Norden endemisch. Der Ausbruch im Norden des Landes hat sich weiter ausgeweitet und betrifft nun die Provinzen Adamawa, Borno und Jigawa. Es wurden mehr als 1.000 Erkrankungen und 88 Todesfälle gemeldet. Mit örtlichen oder regionalen Auftritten ist aber auch in anderen Landesteilen zu rechnen. Hygiene beachten, ggf Impfschutz. / Quelle: crm

Strange disease affecting women breaks out in Zambia
08.10.2009 - xinhuanet

LUSAKA - A strange disease only affecting the joints of women and making them fail to stand on their own has been found in Zambia's Luapula Province, the Times of Zambia reported on Thursday. The strange disease dubbed Dwarf has broken out in the Chembe area of the province and is only affecting women and girls, making them fail to stand on their own, Times said. Teleshi Lwando, an employee at the local Lwela Health Center, told the visiting lawmaker from the area, Mwansa Mbulakulima, that the disease was not "very serious" and that patients were healing after three days. He said the disease first broke out at Kabunda High School where a number of school girls had suffered from the disease. All the affected people were just being given Panadol as a drug, Times said. But the lawmaker said while the disease was not serious, there was need for health specialists to investigate why the disease was only affecting the girls and women. "Yes, we have been told that this disease, Dwarf, is not so serious, but then we should not go to sleep because of the assurance, instead we should work hard to establish the truth about the disease," Mbulakulima told health workers.

Quelle: xinhuanet

Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (25)
************************************************
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 - Uganda (Kampala)
[2] Cholera - Tanzania (Tanga)
[3] Cholera - Mozambique (Cabo Delgado)
[4] Cholera - Cameroon (north)
[5] Cholera - Nigeria (Taraba, Adamawa, Jigawa)
[6] Cholera - Nigeria (Borno)
[7], [8] Cholera - Kenya (Eastern province)
[9] Cholera - Congo DR (South Kivu)

*****
[1] Cholera - Uganda (Kampala)
Date: Wed 7 Oct 2009
Source: The Monitor [edited]
<http://allafrica.com/stories/200910070064.html>


3 people have been confirmed dead and 13 others are hospitalized at
Mulago cholera treatment centre following an outbreak in Kampala last
week. Kampala City Council Health officer, Dr Messach Mubiru, told
the Daily Monitor yesterday [6 Oct 2009] that 1 person died from
Mulago Hospital and the other 2 from Namuwongo. He cautioned people
especially from the slum areas to stop from eating cold food and
drinks vended on the streets.

[Byline: Stephen Otage]

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

[The capital Kampala area can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

*****
[2] Cholera - Tanzania (Tanga)
Date: Wed 7 Oct 2009
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?click_id ... 54&set_id=>


12 people have died in a cholera epidemic in Tanzania over the past
week, with most cases recorded in the north of the country, a health
ministry spokesperson said on Monday [5 Oct 2009].

Around 600 cases were reported in the east African country during the
last 7 days, but Handeni district in the northeastern region of Tanga
was hardest hit with 511 patients, spokesperson Nsachris Mwamaja told
journalists.

"The government is doing all it can to check further spread of the
water-borne disease and treat patients by ensuring adequate supply of
medicines," Mwamaja said.

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

[Tanga is in northeastern Tanzania opposite the semiautonomous
islands of Zanzibar where outbreaks of cholera have occurred
sporadically in the past. The areas can be seen on a map at:
<http://www.un.org/Depts/Cartographic/ma ... nzania.pdf>. - Mod.LL]

*****
[3] Cholera - Mozambique (Cabo Delgado)
Date: Tue 6 Oct 2009
Source: Agencia de Informacao de Mocambique (AIM) [edited]
<http://allafrica.com/stories/200910060984.html>


5 members of the same family died of cholera on 3 consecutive days in
Nazimoja village, Montepuez district, in the northern Mozambican
province of Cabo Delgado, reports Tuesday [6 Oct 2009]'s issue of the
independent daily "O Pais."

According to a resident of that village, many people have been
suffering from the disease, which was initially shrugged off as
simple bouts of diarrhea and vomiting. However, the health
authorities have confirmed that this is cholera. The disease was also
reported in Napai, and Nacate, suburbs of the Montepuez town, where
it has killed at least 4 people.

By 28 Sep 2009, the Montepuez District Hospital had recorded 106
cases of cholera, and 3 of them were still under medical care in a
serious condition. The Cabo Delgado chief doctor Cesario Sauegi
confirmed these facts, adding that the disease has also been reported
in the districts of Mocimboa da Praia, and Ancuabe.

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

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

*****
[4] Cholera - Cameroon (north)
Date: Tue 6 Oct 2009
Source: Reuters [edited]
<http://af.reuters.com/article/topNews/i ... E420091006>


A cholera outbreak in northern Cameroon has killed 15 people, state
media reported on Tuesday [6 Oct 2009]. Cameroonian authorities are
taking measures to contain the epidemic, which was brought in from
neighboring Nigeria, state radio and the official Cameroon Tribune said.

"The disease was imported from neighboring Nigeria by a lady who
visited the country recently," the Tribune said. "She died after
suffering from diarrhea and vomiting and her dresses were washed in a
stream used by local inhabitants, thereby contaminating everybody."

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

[A map of Cameroon showing its extensive western border with Nigeria
can be found at:
<http://www.un.org/Depts/Cartographic/ma ... meroon.pdf>. - Mod.LL]

*****
[5] Cholera - Nigeria (Taraba, Adamawa, Jigawa)
Date: Fri 2 Oct 2009
Source: News24 [edited]
<http://www.news24.com/Content/Africa/Ne ... ll_hits_97>


9 people died and several others were hospitalized this week
following a cholera outbreak in Nigeria's northern Taraba State,
bringing the death toll in the region to 97, an official said on
Thursday [1 Oct 2009].

"We have recorded cases of cholera here in Jalingo (the capital) in
the past 2 days in which 9 people have died and several others
hospitalized at the State Specialist Hospital," the state health
commissioner, Muhammad Bose, said. "I can't give exact figures of
those hospitalized because we are still collating the number of cases
but we have sent health personnel and drugs to the 3 affected
neighborhoods in the metropolis," Bose said by telephone from Jalingo.

On Wednesday [31 Sep 2009] health officials in Jigawa State, also in
the region, announced the death of 11 people following an outbreak of
cholera in Bashuri village where 400 cases emerged in under a
fortnight [less than two weeks]. Health officials were still
investigating the cause of the outbreak, Bose said.

Cholera has claimed 77 lives in recent weeks in Adamawa State,
leaving nearly 1000 people hospitalized. "At the moment we have
recorded 77 deaths and 934 cases in the cholera outbreak," said
Adamawa information commissioner Musa Bubakari by telephone from
Yola, the state capital, which shares border with Taraba state.

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

[The Taraba and Adamawa states as well as Borno (see next posting)
all lie in eastern Nigeria and border with Cameroon. The Jigawa state
is more central. A map of Nigeria showing the mentioned areas can be found at:
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

*****
[6] Cholera - Nigeria (Borno)
Date: Mon 5 Oct 2009
Source: NEXT [edited]
<http://234next.com/csp/cms/sites/Next/H ... /story.csp>


23 of the 600 people who recently contracted cholera in the Biu Local
Government area of Borno State are dead, the director of disease
control in the Borno State ministry of health, Abdullah Sadiq, has
said. Mr. Sadiq, who was at the cholera isolation camp situated in
Biu, last Sunday [4 Oct 2009] when NEXT visited, said some of the
patients were already treated and discharged. About 60 patients are
currently on admission, where oral therapy is being administered on them.

The Borno health official, who blamed the outbreak on the poor
sanitary habits of some residents of the area, also revealed that
specimen analysis at the Maiduguri Teaching hospital confirmed that
the disease is indeed cholera.

A source at the ministry of health said the disease has spread to 6
out of the 9 local government areas of southern Borno. The state has
also recorded a total of 32 death from it.

[Byline: Saadatu Muhammed]

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

*****
[7] Cholera - Kenya (Eastern province)
Date: Fri 2 Oct 2009
Source: The Nation [edited]
<http://www.nation.co.ke/News/-/1056/666776/-/ungkl2/-/>


A team from Medicines Sans Frontiers (MSF) has camped in Marsabit
South district to avert the spread of cholera, which has left 15
people dead. MSF, also known as Doctors without Borders, had
disbanded its 1st camp on 24 Sep 2009 at Moite village in
Loiyangalani division where 11 people died from the disease. The same
disease started to spread in El-Molo Bay location. In 3 days, 3
people had succumbed to cholera. At the same time, a pregnant woman
succumbed to the disease in Moite village.

"Those who have died in El-Molo Bay are children under 15 years. We
also have others who are admitted and the disease is spreading fast
to other areas," local public health officer Lemaiyon Lenamira told
the Nation by telephone. He said a doctor from MSF and a medical
staff from the office of the local Medical Officer of Health (MOH)
have been sent to Moite to assess the situation following the death
of the pregnant woman. He added that their report will determine
whether they will return to the place.

Cholera had been reported in Marsabit South district earlier in 2009
when 18 people died after contracting it.

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

[The areas mentioned are in the Eastern province which can be found
on a map at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

*****
[8] Cholera - Kenya (Eastern province)
Date: Wed 7 Oct 2009
Source: Daily Nation [edited]
<http://www.nation.co.ke/News/-/1056/669538/-/unilv6/-/>


The death toll from a cholera outbreak in Mutomo District has risen
to 7, with more infections being recorded every day. The 7 died at
Mutomo Mission Hospital where they were being treated. The deaths
came as health authorities disclosed that 1134 people had been
diagnosed with the disease in the district.

Since 29 Sep 2009, Medecins Sans Frontieres, working with the
Ministry of Public Health and Sanitation have treated 47 people in El
Molo and 157 in Loyangalani for the disease.

[Byline: Kitavi Mutua, Kibiwott Koross and Cynthia Vukets]

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

[The areas mentioned are in the Eastern province which can be found
on a map at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

*****
[9] Cholera - Congo DR (South Kivu)
Date: Thu 1 Oct 2009
Source: XinHuaNet [edited]
<http://news.runsky.com/2009-10/01/content_3398233.htm>


Congo (DRC) recently (released by the health department) said an
outbreak of cholera in the eastern part of South Kivu has already
7079 people infected, with 82 people dead.

The health sector said cholera outbreak has now spread to 34
districts of the province's 10 districts and the provincial capital
city of Bukavu.

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

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

[The interactive HealthMap/ProMED map of Africa is available at:
<http://healthmap.org/r/0035> - CopyEd.EJP]

HEMORRHAGIC FEVER - ITALY ex SENEGAL: 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: Sun 11 Oct 2009
Source: ANSA.it [in Italian, machine trans., edited]
<http://www.ansa.it/web/notizie/rubriche ... 91378.html>


Patient with unidentified hemorrhagic fever now showing improvement
-------------------------------------------------------------------
A 44 year old Senegalese man, suspected to have contracted a viral
hemorrhagic fever, was hospitalized last night [10 Oct 2009] at the
Spallanzani National Institute in Rome. According to institute sources the
clinical picture is consistent with that of a viral hemorrhagic fever.
However, laboratory analysis has excluded Ebola and Marburg hemorrhagic
fevers, Crimean-Congo hemorrhagic fever, Lassa fever, and Rift Valley
fever. Further analysis is in progress in the high-security laboratories of
the institute. Meanwhile, the condition of the patient is satisfactory and
not considered to be life threatening.

Treatment of the patient and all laboratory procedures have been conducted
under conditions of high biosecurity, first at the hospital Amedeo di
Savoia in Turin and subsequently in the Spallanzani Institute in Rome.

The Spallanzani Institute has stated that the patient is now improving in
terms of clinical tests for blood clotting ability and liver function. The
patient has lived in Italy for 20 years, and returned to Italy on 3 Oct
2009 after a visit to his country of origin. He was admitted initially in
the Amedeo di Savoia hospital in Turin and was later transferred by air
under conditions of high biocontainment arranged by the air force to the
Spallanzani Institute in Rome. Further investigations are in progress
covering a wide spectrum of pathogens. The institute acknowledges extensive
collaboration in case management between the Amedeo di Savoia hospital in
Turin, where the patient was admitted initially, the Sacco hospital in
Milan responsible for land transport of the patient, and the air force in
constant communication with the ministry of health.

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

[Diseases previously imported into Europe from Senegal have included
chikungunya, Crimean-Congo hemorrhagic fever, malaria, and yellow fever.
Further information on the identity of the agent responsible for this case
of presumed hemorrhagic fever is awaited. - Mod.CP]

Mosambik - Darminfektionen
12.10.2009

Risiko für Durchfallerkrankungen landesweit. Mit dem Beginn der Sommerregenzeit kommt es zu lokal begrenzten Cholera-Ausbrüchen. Hygiene beachten, Risikoreisende sollten geimpft werden. / Quelle: crm
_______________________

Nigeria - Darminfektionen
12.10.2009

Risiko für Durchfallerkrankungen landesweit. Cholera ist im Norden endemisch. Der Ausbruch im Norden des Landes hat sich weiter ausgeweitet und betrifft nun die Provinzen Adamawa, Borno und Jigawa. Es wurden mehr als 1.500 Erkrankungen und 97 Todesfälle gemeldet. Mit örtlichen oder regionalen Auftritten ist aber auch in anderen Landesteilen zu rechnen. Hygiene beachten, ggf Impfschutz. / Quelle: crm
_______________________

Uganda - Darminfektionen
12.10.2009

Risiko für Durchfallerkrankungen landesweit. Cholera, gewöhnlich von Flüchtlingslagern ausgehend auf das westliche Grenzgebiet zur DRC beschränkt, breitet sich rezidivierend mit örtlichen Ausbrüchen im Land aus. Aus den Slums der Hauptstadt Kampala wurde Ende September ein Ausbruch gemeldet; bisher gab es 3 Todesfälle. Hygiene beachten. / Quelle: crm

HEMORRHAGIC FEVER - ITALY ex SENEGAL (02): DENGUE
*************************************************
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 15 Oct 2009
From: Vincenzo Puro <puro@inmi.it> [edited]


re: ProMED-mail Hemorrhagic fever - Italy ex Senegal: RFI 20091012.3525
-----------------------------------------------------------------------
Regarding the patient hospitalized at the INMI Spallanzani of Rome
(described in the ProMED-mail post archived as Hemorrhagic fever - Italy ex
Senegal: RFI 20091012.3525), it has now been established that the patient
is suffering from dengue hemorrhagic fever, caused by dengue virus type 3.

The patient arrived in Senegal on 3 Jun 2009, travelling from Milan, and
staying in the village of Keur Souleye, Louga region, until 3 Oct 2009. The
patient returned to Italy from Dakar via Madrid-Turin, arriving in Turin at
20.40 hr on 4 Oct 2009. During the 3 weeks preceding the onset of symptoms
he did not travel outside the village and did not visit health care centres.

The condition of the patient is now good.

--
Vincenzo Puro
Istituto Nazionale per le Malattie Infettive
Lazzaro Spallanzani [INMIS]
Rome
Italy
<puro@inmi.it>

[ProMED-mail thanks Vincenzo Puro for promptly reporting the outcome of
this investigation. Interestingly a correspondent, Prof H Tolou of the
IMTSSA, Marseilles, France, suggested dengue fever, together with malaria,
yellow fever, and leptospirosis in the differential diagnosis of this
patient's illness.

The Louga region in north western Senegal can be located on the
HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/00Wf>. -
Mod.CP]

[see also:
Hemorrhagic fever - Italy ex Senegal: RFI 20091012.3525
Dengue/DHF update 2009 (40) 20091005.3454]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (26)
************************************************
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] Diarrhea, fatal - Angola (Huila)
[2] Cholera - Zimbabwe
[3] Cholera - Nigeria (Borno, Adawama, Jigawa, Taraba)
[4] Cholera - Nigeria (Adawama)
[5] Cholera - Cameroon (North, Extreme North provinces)
[6] Cholera - Uganda (Kampala)

*****
[1] Diarrhea, fatal - Angola (Huila)
Date: 20 Oct 2009
Source: ANGOP (Angola Press Agency) [Trans. by Mod.MPP, edited]


So far in October 2009, 22 people have died in the city of
Quilengues, [located] 140 kilometers [87 miles] north of Lubango, in
Huila province, victims of a diarrheal outbreak, according to
information provided to ANGOP by the Deputy Administrator, Abel Wandi
Andre. The official made it clear that the most recent cases occurred
in commune Dinde of the village Tchituli, where 16 people were
infected with the disease, 9 of whom died. Another 4 cases were
reported at headquarters, with one death.

The municipality of Impul is the most affected part of the district,
where 39 cases with 12 deaths were reported. The administrator
reported that in this constituency, cases occurred in the villages of
Vombo, Kandombe, Kavissaka and in the District headquarters.

At this point, according to the head of the Health Division, Gabriel
Adriano, there are technical staff working in the villages most
affected, in order to provide treatment to the existing cases and
conduct campaigns aimed at awareness and disease prevention.

The causes of the disease are still unknown, according to the deputy
administrator, they only know that it is not cholera. He said that
samples were taken by trained health technicians from Huila and were
sent to laboratories outside the country in order to diagnose [the
disease] and determine the etiology of the disease, a disease
considered "highly dangerous" by rapidly infecting people and causing
death within 24 hours.

Quilengues has an area of 4464 square kilometers and a population
estimated at 134 050 people who live mainly from agriculture and livestock.

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

[Although it is stated that "it is not cholera", a potentially
rapidly fatal diarrheal disease in an area where cholera has been
found in the no so distant past is likely to be cholera. Huila
province is in southwestern Angola and can be found on a map of the
country at:
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]


*****
[2] Cholera - Zimbabwe
Date: Tue 20 Oct 2009
Source: Agence France-Presse [edited]
<http://www.google.com/hostednews/afp/ar ... 80_QSQEwQw>


A total of 5 people have died in a new cholera outbreak in Zimbabwe
where more than 4000 people were killed in the country's worst-ever
outbreak of the disease in 2008, media reported Tuesday [20 Oct 2009].

Health secretary Gerald Gwinji told the Herald newspaper that 117
cholera cases had been confirmed in several parts of Zimbabwe since
infections were reported in September 2009 in the country's east.

"Most of the cases were recorded in Gokwe north among religious
objectors who for a long time have been reluctant to seek medical
attention," Gwinji told the state-controlled newspaper.

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

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

*****
[3] Cholera - Nigeria (Borno, Adawama, Jigawa, Taraba)
Date: Fri 16 Oct 2009
Source: Agence France-Presse [edited]
<http://www.google.com/hostednews/afp/ar ... Nt2J6PZQ5w>


The toll in a cholera outbreak in northern Nigeria rose to 149 Friday
[16 Oct 2009] with 52 more deaths, a provincial health official said.

"We have recorded 52 deaths from cholera outbreak in 4 local
government areas of the state while 1335 have been hospitalized," the
director of disease control in Borno State, Abdallah Sadiq, told AFP.
"The disease was 1st reported on 10 Sep 2009 in Gwoza local
government on the border with Cameroon from where it spread to 6
other districts", he said.

He said Biu local government on the border with Chad was the worst
affected area where 650 were infected, forcing health officials to
open a camp for the victims.

Cholera has claimed 77 lives in recent weeks in Adamawa State,
leaving nearly 1000 people hospitalized.

Late September 2009, officials in Jigawa State announced the death of
11 people in a cholera outbreak which affected 400 others at a
village outside the state capital.

In Taraba state, a neighbor of Adamawa, another cholera outbreak
killed 9 people and infected 120 others.

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

[A map of Nigeria showing the locations of these northern Nigerian
states can be found at:
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - Mod.LL]

*****
[4] Cholera - Nigeria [Adamawa]
Date: Fri 16 Oct 2009
Source: EFE [machine trans. from Portuguese] [edited]

Some 300 people died and many more are hospitalized due to an
outbreak of cholera reported since mid-month in Adamawa State in
northern Nigeria, reported today sources told Efe, the local press.

The situation has worsened due to a strike of workers in the health
sector that happens in this state," said Shehu Dauda, a local
journalist assigned to cover the facts. The areas most affected, the
sources said, are bordering Cameroon in the north which also detected
an outbreak of cholera in recent weeks.

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

[This posting reports a higher number of cholera-associated
fatalities in Adamawa. - Mod.LL]

*****
[5] Cholera - Cameroon (North, Extreme North provinces)
Date: Thu 15 Oct 2009
Source: UN Integrated Regional Information Networks (IRIN) [edited]
<http://www.irinnews.org/Report.aspx?ReportId=86608>


Cholera has killed at least 51 people in the past few weeks in
northern Cameroon, where health experts say safe water and proper
sanitation are sorely lacking. "The fight against cholera here will
be difficult because the hygiene conditions are awful," said a health
official who was not authorized to be quoted. He noted that most
people defecate in open areas.

The regions affected are Cameroon's North and Extreme North, with the
1st infections reported in September 2009, according to the Health
Ministry. As of 14 Oct 2009, 23 people had died in Extreme North, out
of 144 infected, according to a Health Ministry document that is
updated regularly; while in neighboring North region 28 people had
died, out of 152 infected.

This area of Cameroon is on the southern fringe of the Sahel and
water is scarce; existing boreholes and wells are insufficient to
meet the needs of the population, according to UN Children's Fund
(UNICEF) in Cameroon.

Cholera epidemics are frequent in northern Cameroon but the current
outbreak is particularly severe, the health ministry official told
IRIN. The highest number of cholera deaths in recent years was in the
commercial capital Douala in 2004 when cholera killed 100 people.

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

[A map of Cameroon showing the affected provinces can be found at:
<http://www.un.org/Depts/Cartographic/ma ... meroon.pdf>. Both
provinces border on states in Nigeria where cholera is also a
problem. - Mod.LL]

*****
[6] Cholera - Uganda (Kampala)
Date: Wed 14 Oct 2009
Source: UG Pulse [edited]
<http://www.ugpulse.com/articles/daily/n ... a&ID=12784>


17 more people from the suburbs of Kampala have been hospitalized at
Mulago Hospital following an outbreak of cholera in different parts
of the city. This brings the number of people infected with cholera
in Kampala to 35 since the beginning of October 2009.

The district Director of Health Services, Joseph Senzoga, says
cholera infections in Kampala has more than doubled due to heavy
rains. Senzoga says cholera has claimed 4 lives in Kampala.

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

[A map of Uganda showing the area around Kampala can be found at:
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

MELIOIDOSIS - SPAIN ex GAMBIA
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 23 Oct 2009
From: Dr. Juan Antonio Cuadros Gonzalez [edited]
<jcuadros.hupa@salud.madrid.org>


_Burkholderia pseudomallei_ infections are well known and endemic in
South East Asia, India and Australia, however, there have been also
increasing reports of confirmed locally acquired cases and small
outbreaks in the Americas (especially Brazil) and some African
countries. Infections by this bacterium have been related to climatic
phenomena as the 2004 tsunami in Indonesia, and some experts also
suggest that the climatic change could modify the distribution and
prevalence of this disease.

We report here what seems to be the 1st case of imported melioidosis
in Spain. This case illustrates once more as clinical physicians and
microbiology laboratories must work now in a real global perspective.

A young male diabetic immigrant from Gambia living in Spain since
years, presented in the emergency room with fever, bilateral
intramuscular abscess in the calf, cough and hemoptysis. He had
travelled to southern Gambia (Sambaya) from May to October 2009. He
was diagnosed of an autoimmune hepatitis treated previously with
corticosteroids.

The patient was immediately put in isolation for suspected
tuberculosis. CT scans showed bilateral intramuscular calf abscesses,
pleural effusion and a small intrasplenical abscess. Culture from the
pus aspirated from the calf produced a pseudomonal-like microorganism
that was bioquemically identified as _Burkhloderia pseudomallei_. All
mycobacterial stains and cultures continue to be negative. The
diagnosis of melioidiosis was confirmed by subsequent molecular
studies (specific PCR and hybridation techniques) at the National
Reference Laboratory for Spirochaete and Special Pathogens (CNM of
Majadahonda). The patient is receiving now IV ceftazidime.

After a careful risk assessment, health care personal and laboratory
personal who were in contact with the patient or the bacterial strain
are being followed and those with high risk exposures [such] as
intensive manipulation of cultures outside a biological safety
cabinet or preparation of liquid growth culture for antibiograms have
been put on cotrimoxazole [trimethoprim-sulfamethoxazole]
post-exposure prophylaxis.

Diagnosis of melioidosis in patients coming from non-endemic
countries can be very elusive, specially in the tuberculosis-like
pulmonary forms, as _B. pseudomallei_ can be easily discarded as
colonizing upper respiratory tract flora of be misidentified as _B. cepacia_.

--
Dr. Juan Cuadros Gonzalez
Servicio de Microbiologica y Parasitologica
Hospital Principe de Asturias
Madrid, Spain
<jcuadros.hupa@salud.madrid.org>

[ProMED thanks Dr. Gonzalez for this fascinating, 1st-hand report.

Infection due to _Burkholderia pseudomallei_ (melioidosis) is
primarily endemic in focal areas of South East Asia and northern
Australia. _B. pseudomallei_ is deemed to be a category B biowarfare
agent. It is primarily an infection of humans with underlying
diseases such as alcoholism, malnutrition, cirrhosis, and
immunosuppression, but can also affect healthy individuals, as in
this report. In animal models, higher inocula can cause more serious
infection in immunocompetent individuals. Melioidosis is not a
zoonosis per se since although animals can and are infected,
transmission does not occur from animal to human, rather both are
infected similarly.

Dance (1), at a time when the organism had Pseudomonas as its genus,
discussed the epidemiology of melioidosis outside of the classically
endemic areas. The following are the sections regarding Africa and
Europe with the citation numbers removed:

"Africa
-------
The possibility of the existence of melioidosis in Africa was 1st
raised in 1936 by Girard, who isolated a strain of _P. pseudomallei_
from the hemorrhagic submaxillary lymph node of a pig in
Madagascar....In 1969, melioidosis was reported in a goat in Chad.
Then, in 1972, Ferry isolated _P. pseudomallei_ from a number of pigs
in an abattoir in Niamey, Niger. These animals had been brought from
neighboring Upper Volta (Burkina Faso), and Dodin and Ferry were able
to isolate the organism from soil samples taken along the route that
the pigs had followed. They also demonstrated seropositivity in over
10 percent of serum samples from villagers in Upper Volta. At about
this time, Frazier found serological evidence that melioidosis might
exist in Uganda, while Mayer, as cited by Larionov, also reported the
occurrence of human melioidosis in Uganda....Further evidence of
melioidosis in Africa was provided by Bremmelgard, et al., who
reported a case of human melioidosis possibly acquired in Kenya, and
by Wall, et al., in The Gambia, the latter patient originating from
Sierra Leone."

"Europe
-------
The most extraordinary extension of the boundaries of melioidosis
took place in France in the mid-1970s.....an epizootic of melioidosis
among animals in a Paris zoo was revealed. The outbreak subsequently
spread to other zoos in Paris and equestrian clubs throughout France
and beyong, probably by the transport of infected animals and
contaminated manure....Possibly, infected horses from Iran imported
the disease, or perhaps the index case was a panda donated to France
by Mao-Tse Tung in 1973...

"The isolation of _P. pseudomallei_ from horses in Spain has also
been reported, as have several possible cases of human melioidosis in
Berlin in 1947."

Although risk for occupational exposure to _B. pseudomallei_ in
clinical laboratories exists, laboratory-acquired infections are
rare. Laboratory exposures that have resulted in the most recent
cases of infection involved aerosols, alone or in combination with
exposure to nonintact skin (2). In one study, 3 cases of asymptomatic
seroconversion were reported among laboratorians in an area where
melioidosis is endemic, making difficult a determination of whether
infection resulted from occupational or environmental exposure (3).
CDC recommends that clinical specimens suspected of containing _B.
pseudomallei_ be manipulated using biosafety level (BSL)-2
containment practices, equipment, and facilities (4). Sniffing
culture plates is an unsafe laboratory procedure and should be
prohibited. Manipulations of an isolate that might result in aerosol
or droplet exposure or contact with nonintact skin should be
conducted using BSL-3 containment practices, equipment, and
facilities. In addition, improved communication between physicians
and laboratorians might reduce the risks to laboratorians. Laboratory
workers with high-risk exposures can be offered postexposure
prophylaxis with doxycycline (2 mg/kg up to 100 mg orally, twice
daily) or trimethoprim-sulfamethoxazole (8 plus 40 mg/kg, up to 320
plus 1600 mg orally, twice daily) (5), but the optimum duration of
treatment and its efficacy have not been defined clearly by human studies.

The readers are referred to a recent chapter on melioidosis, aimed to
its potential as a biowarfare agent (6).

1. Dance DAB: Melioidosis: the tip of the iceberg? Clin Micriobiol
Rev 1991;4: 52-60.
2. Sewell DL: Laboratory-associated infections and biosafety. Clin
Microbiol Rev 1995;8: 389-405.
3. Ashdown LR. Melioidosis and safety in the clinical laboratory. J
Hosp Infect 1992;21: 301-306
4. CDC: National Institutes of Health: Biosafety in microbiological
and biomedical laboratories, 4th ed. Washington DC: US Government
Printing Office; 1999.
5. CDC: Laboratory exposure to Burkholderia pseudomallei---Los
Angeles, California, 2003. MMWR 2004;53: 988-90.
6. Tolaney P, Lutwick LI: Melioidosis. In Beyond Anthrax: The
Weaponization of Infectious Diseases, Lutwick LI, Lutwick SM
(eds), Humana Press, Totowa, NJ, 2009, pp. 145-158.
- Mod.LL]

[The interactive HealthMap/ProMED map of Spain is available at:
<http://healthmap.org/r/00dK> - CopyEd.EJP]