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MELIOIDOSIS - SPAIN ex GAMBIA (02)
*******************************
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: Sat 24 Oct 2009
From: Henry Wilde <wildehenry@yahoo.com>


We encountered 2 cases of meliodosis acquired in Africa in Bangkok
during 1999. The cases were a female US Foreign Service officer and
her daughter on direct transfer from a central African country. The
mother (normal host) developed a right upper lobe pneumonia which was
1st thought to be TB but cultured _B. pseudomallei_. She had a very
high antibody titer to the organism and responded readily to therapy.

Her then asymptomatic daughter had experienced an acute severe
febrile illness in Africa prior to departure, which was treated with
a broad spectrum antibiotic, and had fully recovered. We collected
serum from her and also found a very high antibody titer to _B.
pseudomallei_ [Thummakul T, Wilde H, Tantawichien T. Military Med
1999;164: 658-62]. Our literature review at that time concluded that
melioidosis has been a well documented infection by veterinary
scientists in Africa for decades and was almost certainly
under-reported in humans.

--
Henry Wilde, MD, FACP
Professor of Medicine
Division of Research Affairs
WHO-CC for Research and Training in Emerging Zoonoses
Faculty of Medicine, Chulalongkorn University
Bangkok, Thailand
<wildehenry@yahoo.com>

[ProMED thanks Dr. Wilde for his contribution. - Mod.LL]

DENGUE/DHF UPDATE 2009 (44)
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<http://www.isid.org>

******
Cape Verde (Praia, Maio)
Date: Fri 23 Oct 2009
Source: Panafrican News Agency (PANA) [in Portuguese, trans. Mod.MPP, edited]
<http://www.panapress.com/freenewspor.as ... 23/10/2009>


Cape Verde confirms dengue cases
---------------------------------
The Ministry of Health of Cape Verde received on Thursday [22 Oct
2009], test results of samples sent to the Pasteur Institute in
Dakar, Senegal, that confirmed that type 3 dengue virus is the
etiological agent of the viral disease that has been affecting the
populations of the Praia and Maio municipalities since the end of
September, PANA was told by official sources in the Cape Verdean
capital.

The test results confirmed the suspicions of the health authorities
that the disease transmitter would be one of the mosquitoes that
exist in Cape Verde, namely _Aedes aegypti_.

By confirming the presence of the dengue virus in Cape Verde, the
minister of health, Basilio Ramos, reinforced the conviction that the
fight against mosquitoes is the main way to combat the disease, which
so far has not caused any fatalities. "Therefore it is essential that
the different social players, especially the Government, the
Municipal Councils, the Community Associations, the family, and
finally society, engage vigorously in the elimination of the mosquito
breeding sites," said the minister.

Basilio Ramos assured that the Ministry of Health has met all
conditions to care for the people affected by the disease.

The government created an Inter-Ministerial Committee to Fight
Disease Vectors, with the aim of providing greater consistency and
efficiency of anti-vector action to prevent the spread of dengue
fever and more serious conditions that could result from the spread
of the epidemic to other islands and municipalities in the
archipelago.

The disease caused by dengue viruses can present in different forms,
ranging from an inapparent infection, where a person may be infected
but not have any symptoms, to severe hemorrhaging, which may lead to
death.

Dengue is suspected when a patient has an acute fever lasting up to 7
days, accompanied by headaches, eye, muscles, joints, prostration,
and a rash on the body.

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

A HealthMap/ProMED-mail interactive map of Cape Verde can be accessed at
<http://healthmap.org/r/00Xw>. - Mod.TY]

MELIOIDOSIS - SPAIN ex GAMBIA (03)
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Mon 26 Oct 2009
From: Per Lausund <veterinary.surgeon@gmail.com> [edited]


In a recent ProMED-mail post (Melioidosis - Spain ex Gambia
20091024.3662), melioidosis is referred to as connected to climatic
changes, especially in connection with the 2004 tsunami, which was
followed by an increased number of reported incidents of the disease,
especially in Indonesia. In all probability the increase was not just
caused by increased attention, but also by an absolute increase in
cases. However, assigning this to climatic changes, and indeed
referring to the tsunami as a climatic event is probably somewhat
misleading.

A more likely cause of the probably increased incidence of
melioidosis in humans following the 2004 tsunami are the increased
exposure of large groups to flooding and injury in the weeks and
months following the disaster. Any natural event like the tsunami
will make contamination by _Burkholderia mallei_/_pseudomallei_ more
available at the same time as the number of puncture-wounds and
indeed exposure to contaminated water increases dramatically, thus
putting more people at risk.

--
Lt Col Per Leines Lausund DVM MPH
Defence Research Institute
Norway
<veterinary.surgeon@gmail.com>

*****
[2]
Date: Mon 26 Oct 2009
From: David Dance <david.dance@phnt.swest.nhs.uk> [edited]


I was interested to read about this case, and the follow up posting
from Henry Wilde, both of which support my belief that melioidosis is
commoner in Africa than is currently realized, although not often
diagnosed because of a lack of laboratories capable of identifying
the organism and a lack of awareness of the disease amongst
clinicians.

More recent reviews than the one cited by the moderator (1,2) have
found very few further cases clearly acquired in Africa. This is only
the 2nd case of melioidosis with a link to the Gambia of which I am
aware. As cited by the moderator, the other was reported from the UK
Medical Research Council Unit, which has had a longstanding presence
in the Gambia (3), although the patient herself originated in Sierra
Leone. If human melioidosis were common in the Gambia then one would
expect it to be recognized more frequently by this well equipped and
well resourced unit, which does not appear to have been the case. So
the true incidence of melioidosis on the African continent remains
very unclear.

Detailed molecular epidemiological studies of _B. pseudomallei_ are
shedding interesting light on its epidemiology and evolution (4). It
would be interesting if the isolate from Gonzalez's case could be
made available to one of several groups currently undertaking such
studies so that its relationship to isolates from southeast Asia and
northern Australia could be determined.

The other interesting and difficult issue is when to use prophylaxis
for those exposed to patients with melioidosis or working with the
organism in the laboratory. In reality there have been very few cases
of melioidosis actually acquired in these ways. Since the drugs used
for prophylaxis are not without risks themselves, careful risk
assessment is necessary, as mentioned by Gonzalez. However, there is
very little hard evidence on which to base decisions, so those faced
with this dilemma may be interested to read the combined views of a
group of those working with the organism (5).

References
----------
1. Cheng AC, Currie BJ: Melioidosis: epidemiology, pathophysiology,
and management. Clin Microbiol Rev 2005; 18: 383-416 [available at
<http://cmr.asm.org/cgi/content/full/18/2/383>].
2. Currie BJ, Dance DAB, Cheng AC: The global distribution of
_Burkholderia pseudomallei_ and melioidosis: an update. Trans R Soc
Trop Med Hygiene 2008; 102/S1:S1-S4 [abstract available at
<http://www.tropicalmedandhygienejrnl.ne ... 6/abstract>].
3. Wall RA, Mabey DC, Corrah PT, Peters L: A case of melioidosis in
West Africa. J Infect Dis 1985; 152: 424-5.
4. Tuanyok A, Auerbach RK, Brettin TS, et al: A horizontal gene
transfer event defines two distinct groups within _Burkholderia
pseudomallei_ that have dissimilar geographic distributions. J
Bacteriol. 2007; 189(24): 9044-9 [available at
<http://jb.asm.org/cgi/content/full/189/ ... type=HWFIG>].
5. Peacock SJ, Schweizer HP, Dance DAB, et al: Management of
accidental laboratory exposure to _Burkholderia pseudomallei_ and _B.
mallei_. Emerg Infect Dis 2008; 14(7) [online report]; available at
<http://www.cdc.gov/EID/content/14/7/e2.htm>.

--
Dr David Dance
Regional Microbiologist
Health Protection Agency (South West)
Devon, United Kingdom
<david.dance@phnt.swest.nhs.uk>

[ProMED-mail thanks Drs. Lausund and Dance for their comments.
Indeed, the devastating late 2004 tsunami was not truly a climatic
event but rather a consequence of an earthquake. Not only were there
an increased number of cases of melioidosis, the flooding and
cutaneous injuries caused an upswing of gastrointestinal illness as
well as tetanus. - Mod.LL]

Kap Verde - Dengue
27.10.2009

Auf Kap Verde gibt es seit Ende September einen Dengue-Fieber-Ausbruch. Betroffen sind die Bezirke Praia und Mao. Über die Anzahl der Dengue-Fälle liegen keine Berichte vor. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm
__________________________________

Uganda - Darminfektionen
27.10.2009

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. Der Ausbruch in den Slums der Hauptstadt Kampala hält weiter an. Bis Mitte Oktober stieg die Zahl der Patienten auf 35 an, es gab 3 Todesfälle. Hygiene beachten. / Quelle: crm

RABIES, HUMAN, CANINE - GHANA
*******************************
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: 27 Oct 2009
Source: allAfrica.com [edited]
<http://allafrica.com/stories/200910271144.html>


Residents of the Bongo district and of communities within the
Bolgatanga Municipal area in the Upper East Region are trembling in
fear as rabies infested dogs have bitten and killed 6 people, with 2
others currently in critical condition.

The horrific death of an 11-year-old boy on 19 Oct 2009 in Zorko, a
suburb of the Bongo, brought the total number of deaths related to
rabies to 6 within 5 days. According to an eyewitness, when the boy
was brought to the hospital, he was literarily barking like a dog and
behaving aggressively. He said that because the case had advanced,
the medical personnel could not offer any help except to dose him
with sedatives just to ease the pains. His parents, out of
frustration however, took the child home, where he died later the
same day.

When Public Agenda visited the Bongo District Hospital, a Senior
Nursing Officer confirmed the cases but said all the 6 people died
out of hospital, since "they were brought in too late for admission
and treatment." The official lamented the absence of anti-rabies
vaccines in the hospital. She said that even cases that were reported
in a timely manner could not be treated because of lack of the
anti-rabies vaccine in the hospital.

According to her, 2 people from Namoo, a border community in the
district, reported with cases of rabies on 20 Oct 2009 but were asked
to go and buy the drug [vaccine] at Bolga for treatment. The victims
could not afford the drug [vaccine] and so had to return home to
await their painful death. According to the official, anti-rabies
drug [vaccine] sold in the open market costs around GHS 100.00 [USD
70.00], an amount too costly for most people living in deprived
communities such as Bongo. An official at the hospital who pleaded
anonymity alleged that because the drug [vaccine] is expensive, some
officials are hoarding the drug as a way of making money for
themselves. She wondered why an anti-rabies drug [vaccine] which is
not regularly dispensed can suddenly run short of supply.

Another official, speaking on anonymity, was of the view that as a
matter of urgency, all dogs and cats within the district should be
vaccinated free of charge. Another option, according to the official,
was to kill all dogs, as was done to pigs at the time of the swine
fever, since the situation was reaching an alarming state. "As I
speak to you now, we don't know how many dogs are getting infected
out there and how many people will be bitten by these dogs," she
stated.

When this reporter visited the veterinary offices in the district, no
official was available for comment. When contacted by telephone, the
District Chief Executive of Bongo, Hon. Akugre Clement, said that he
was not aware of the matter. He, however, said that he would liaise
with the Ministry of Health and the Ghana Service to find a solution
to the menace.

The people of Bongo are living in fear now with every passing moment
and demand the immediate supply of anti-rabies vaccines for the
treatment of infected persons. They are also calling on the
veterinary division of the Ministry of Agriculture to, as a matter of
urgency, take steps to vaccinate all dogs and possibly cats to
prevent further spread of the disease.

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

[Rabies causes over 24 000 deaths a year in Africa, mostly children
in poor rural communities. Rabies prevention and treatment are costly
and the necessary resources often scarce or inadequate. Controlling
rabies in dogs, the main agents of rabies spread, is, therefore, an
important part of any rabies eradication programme.

To investigate the evolutionary dynamics of rabies virus in western
and central Africa, 92 isolates sampled from 27 African countries
over 29 years were collected and sequenced. This revealed that rabies
virus currently circulating in dogs in this region fell into a single
lineage designated "Africa 2." A detailed analysis of the
phylo-geographical structure of this Africa 2 lineage revealed strong
population subdivision at the country level, with only limited
movement of virus among localities, including a possible east-to-west
spread across Africa.

In addition, Bayesian coalescent analysis suggested that the Africa 2
lineage was introduced into this region of Africa only recently
(probably less than 200 years ago), in accordance with the timescale
of expanding European colonial influence and urbanization, and then
spread relatively slowly, perhaps occupying the entire region in a
100-year period. (See Evolutionary history and dynamics of dog rabies
virus in western and central Africa. Talbi C, Holmes EC, de
Benedictis P, Faye O, Nakoune E, Gamatie D, Diarra A, Elmamy BO, Sow
A, Adjogoua EV, Sangare O, Dundon WG, Capua I, Sall AA, Bourhy H.
National Reference Centre for Rabies, WHO Collaborating Centre for
Reference and Research on Rabies, 75724 Paris Cedex 15, France. In
The Journal of General Virology, 90 (Pt 4): 783-791, 2009: open
access paper:
<http://vir.sgmjournals.org/cgi/content/full/90/4/783>).

The HealthMap/ProMED-mail interactive map of Ghana is available at:
<http://healthmap.org/r/00IG>. Bolgatanga, colloquially known as
Bolga, is the capital of both the Bolgatanga Municipal District and
the Upper East Region of Ghana and has a population of about 50 000
(2000 census). Bolga is the major town between Tamale, 161 km (about
100 miles) to the south, and the border with Burkina Faso. The
location of Bolga is indicated on the map at:
<http://en.wikipedia.org/wiki/Bolgatanga>. - Mod.CP]

[According to Ghana's information to the OIE, 19 human cases of
rabies were recorded during 2008; a rate of 0.0903 per 100 000
population. This was significantly higher than the records of the
previous 3 years, 2005, 2006 and 2007, when 1, 3 and 1 humans,
respectively, reportedly died of rabies. The background to this
increase is not disclosed but may reflect an increased number of
stray, unvaccinated animals (particularly dogs). The number of animal
rabies outbreaks (each of them including one or multiple cases) were,
for the 4 years 2005-2008, respectively 38, 37, 23 and 57.
Vaccination of domestic animals should be accompanied by immediate
steps to control the size of the virus reservoir, mainly the stray
dog population. - Mod.AS]

Dengue fever in Cape Verde
30.10.2009 - WHO

As of 28 October 2009, the Ministry of Health has reported 3 367 suspected cases of viral diseases of unknown etiology in 4 islands: Brava, Fogo, Maio, and Santiago. This is the first reported epidemic of Dengue fever in Cape Verde. The first samples tested, have been laboratory confirmed as dengue virus serotype 3 by the Institute Pasteur Dakar, the WHO Collaborating Centre for Arbovirus and Viral Haemorrhagic Fevers (VHF) and Global Outbreak Alert and Response Network (GOARN) partner. It is important to highlight that an ongoing outbreak of Pandemic (H1N1) 2009 virus has been circulating in the country since June 2009.

The Government has established a ministerial committee of vector control lead by the Prime Minister including all ministries involved in containing the outbreak. The measures taken include clinical management, vector control, and social mobilization. A rapid surveillance and reporting system through SMS messaging systems has been established by the MoH and the public IT agency with WHO collaboration. On 26 October a team from the WHO Regional Office for Africa, Intercountry Support Team and the Institute Pasteur Dakar arrived to support Cape Verde in investigating the outbreak. The team will provide laboratory, entomology and epidemiology support and set up laboratory diagnostics at the Hospital Agostinho Neto. The team will further initiate vector control activities and the recording and analysis of epidemiological trends. The Global Outbreak Alert and Response Network (GOARN) will provide additional assistance to health authorities in Cape Verde.

DENGUE/DHF UPDATE 2009 (45)
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


******
Cape Verde
Date: Fri 30 Oct 2009
Source: WHO Global Alert and Response (GAR) Disease Outbreak News [edited]
<http://www.who.int/csr/don/2009_10_30a/en/index.html>


As of 28 Oct 2009, the Ministry of Health [MoH] has reported 3367 suspected
cases of viral diseases of unknown etiology in 4 islands: Brava, Fogo,
Maio, and Santiago. This is the 1st reported epidemic of dengue fever in
Cape Verde.

The 1st samples tested have been laboratory confirmed as dengue virus
serotype 3 by the Institute Pasteur Dakar, the WHO Collaborating Centre for
Arbovirus and Viral Haemorrhagic Fevers (VHF) and Global Outbreak Alert and
Response Network (GOARN) partner.

The government has established a ministerial committee of vector control
lead by the prime minister including all ministries involved in containing
the outbreak. The measures taken include clinical management, vector
control, and social mobilization. A rapid surveillance and reporting system
through SMS messaging systems has been established by the MoH and the
public IT agency with WHO collaboration.

On 26 Oct [2009] a team from the WHO Regional Office for Africa,
Intercountry Support Team and the Institute Pasteur Dakar arrived to
support Cape Verde in investigating the outbreak. The team will provide
laboratory, entomology, and epidemiology support and set up laboratory
diagnostics at the Hospital Agostinho Neto. The team will further initiate
vector control activities and the recording and analysis of epidemiological
trends. GOARN will provide additional assistance to health authorities in
Cape Verde.

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

[A HealthMap/ProMED-mail interactive map of Cape Verde can be accessed at
<http://healthmap.org/r/00Xw>. - Mod.TY]

Burundi - Polio
02.11.2009

Nachdem in der nordwestlichen Provinz Cibitoke zwei Fälle von Polio diagnostiziert wurden, ist eine groß angelegte Impfkampagne für 1,5 Millionen Einwohner eingeleitet worden. Burundi war über 10 Jahre poliofrei, die aktuellen Erkrankungen wurden aus der benachbarten DR Kongo importiert. Impfschutz beachten. / crm
_____________________

Ghana - Tollwut
02.11.2009

Aus der Upper East Region wird ein Tollwut-Ausbruch gemeldet. In den letzten Wochen wurden hier 6 Todesfälle registriert, zuletzt verstarb am 19. Oktober ein 11-jähriger Junge. Nach verdächtigen Tierkontakten sollte umgehend eine nachträgliche Impfung (Postexpositionsprophylaxe) eingeleitet werden. Impfstoffe sind im regionalen Krankenhaus jedoch nicht erhältlich. Risikoreisende sollten vorbeugend geimpft werden. / crm
______________________

Kenia - Darminfektionen
02.11.2009

Risiko für Durchfallerkrankungen landesweit. Mit Cholera-Ausbrüchen ist regional zu rechnen. Aus den Slums von Nairobi wurde Ende Oktober ein Ausbruch mit 9 Todesfällen und mindestens 60 Erkrankten gemeldet. Zuletzt wurde im September aus Turkana (NW) ein Ausbruch mit mehr als 600 Erkrankten und 13 Todesfälle gemeldet. Auch aus der Eastern Province wurde kürzlich ein Ausbruch gemeldet. Hygiene beachten, Impfschutz für Risikoreisende. / crm
_______________________

Südafrika - Masern
02.11.2009

Die Zahl der Masern-Erkrankungen stieg auch im Oktober weiter deutlich an. Inzwischen wurden landesweit 1.355 Fälle registriert. Fast alle Erkrankungen (90%) werden aus der Provinz Gauteng, insbesondere aus der Hauptstadt Tshwane (früher Pretoria) gemeldet. Auch Johannesburg meldete steigende Fallzahlen, in einem Gefängnis erkrankten hier zuletzt 20 Insassen. Bisher verstarben 4 Personen (ein Erwachsener und 3 Kinder) an Masernkomplikationen. Nach dem südafrikanischen Impfkalender wird gegen Masern im Alter von 9 Monaten und 18 Monaten geimpft. 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. / crm

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (27)
************************************************
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, diarrhea - Kenya (Coast)
[2] Cholera - Cameroon (North, Extreme North)
[3] Cholera - Uganda (Bugiri)
[4] Cholera - Uganda (Kampala)
[5] Cholera - Tanzania (Tanga)

******

[1] Cholera, diarrhea - Kenya (Coast)
Date: Tue 3 Nov 2009
Source: AllAfrica, The Daily Nation report [edited]
<http://allafrica.com/stories/200911031047.html>


The government has stepped up a fight against an outbreak of waterborne
diseases in several parts of the Coast province in the aftermath of the
floods. Coast provincial medical officer [PMO] Dr Anisa Omar on Tuesday [3
Nov 2009] confirmed that 12 people have been admitted at Lamu district
hospital after contracting cholera. She, however, said the victims were in
stable condition after they received treatment at the public hospital.

At the same time, Dr Anisa said several people at Kanagoni in Magarini were
being treated by a team of medical personnel following an outbreak of diarrhea.

The PMO and a team of medical staff toured Kanagoni among other areas to
assess the situation. She noted that the areas affected by the outbreak of
water-borne diseases included Lamu, Magarini, and Tana Delta district.

[byline: Mathias Ringa]

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

[The southeastern province of Coast can be found on a map 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/00Zl>. - Mod.LL]

******
[2] Cholera - Cameroon (North, Extreme North)
Date: Sat 31 Oct 2009
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... jSPO8GHX1Q>


A cholera outbreak in Cameroon has killed 65 people and infected hundreds
since it started in September 2009, state media said on Friday [30 Oct 2009].

"Up to 27 Oct 2009, 407 cases (of cholera) were recorded (in northern parts
of the country), including 65 deaths," according to a government statement
in the state newspaper, the Cameroon Tribune. More than 60 per cent of
those who died did not go to hospital, the statement said.

Cholera outbreaks are common in northern Cameroon, especially during the
rainy season, the official said, but this year's [2009] has proved
particularly bad.

--
communicated by:
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. The
HealthMap/ProMED-mail interactive map of Cameroon is available at
<http://healthmap.org/r/00Yv>. - Mod.LL]

******
[3] Cholera - Uganda (Bugiri)
Date: Sun 1 Nov 2009
Source: Uganda Pulse [edited]
<http://www.ugpulse.com/articles/daily/n ... +&ID=13216>


The outbreak of cholera has claimed 8 lives in Bugiri district in just 10
days and about 45 others are hospitalized. The endemic broke out in the
area in September 2009. The 10 deaths reported now bring the number of
people who have died because of the outbreak to 23 within 2 months.

The Ministry of Health says cholera has cluttered mostly areas of Muwayo
trading center in Buluguyi Sub County. Dr Kirya Bulolo, the district
medical officer of Bugiri, says about 75 per cent of the people
hospitalized due to cholera outbreak are adults.

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

[A map of Uganda showing the location of the south eastern district of
Bugiri can be found at
<http://www.coetzee-uganda.com/index_fil ... Uganda.htm>. The
HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/00Zo>. - Mod.LL]

******
[4] Cholera - Uganda (Kampala)
Date: Fri 30 Oct 2009
Source: Uganda Pulse [edited]
<http://www.ugpulse.com/articles/daily/n ... a&ID=13194>


3 more people from Kampala have been hospitalized at Mulago Hospital
following an outbreak of cholera in Namuwongo, a suburb of Kampala.

Cholera broke out in Kampala at the beginning of October 2009. It has
killed 5 people since that time and many others are admitted at Mulago
Hospital.

The district director of health services, Joseph Senzoga, says cholera has
broken out in Kampala due to heavy rains.

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

[Maps of Uganda showing Kampala in the south can be found at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf> and
<http://healthmap.org/r/00UL>. - Mod.LL]

******
[5] Cholera - Tanzania (Tanga region)
Date: Sun 1 Nov 2009
Source: Big Medicine [edited]
<http://www.bigmedicine.ca/africa.htm#10 ... ra_spreads_>


An outbreak of cholera in northern Tanzania has continued to spread,
claiming 59 lives over the past 2 months. Health ministry officials
reported 60 new cases last week [week of 26 Oct 2009].

"We have recorded 3454 cases of cholera in Tanga region during the last 8
weeks," Nsachris Mwamaja, a spokesman for the health ministry said. He
added that the most affected area was in Handeni District, where health
officials have attributed the outbreak to ignorance of hygiene practices.

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

[Maps of Tanzania showing the northeastern location of Tanga can be found
at <http://www.un.org/Depts/Cartographic/ma ... nzania.pdf> and
<http://healthmap.org/r/00Zp>. - Mod.LL]

LEISHMANIASIS - SUDAN: (SOUTHERN)
*********************************
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: 6 Nov 2009
Source: Medecins Sans Frontiers press release [edited]
<http://www.msf.org/msfinternational/inv ... =full_html>


MSF responds to serious kala azar outbreak in southern Sudan
------------------------------------------------------------
"We suspect that the number of kala azar patients reaching clinics in some
areas is just the tip of the iceberg," said Dr David Kidinda, MSF medical
coordinator in southern Sudan. "With all the barriers facing people here --
the severe lack of infrastructure, few proper roads, crippling absence of
health care staff and structures and the current increase in violence and
insecurity in the region -- survival becomes a cruel obstacle course for
those in need of life-saving treatment."

Following a serious outbreak of severe parasitic disease, kala azar, in
southern Sudan, medical humanitarian aid agency, Medecins Sans Frontieres
(MSF; aka Doctors withour Borders), is responding to the emergency in
several locations across both Jonglei and Upper Nile States. MSF is
treating patients in its clinics in Pibor and Lankien and using mobile
teams in Rom to actively trace patients.

"Without treatment, those infected with kala azar become skeletal and can
die within weeks if their immune system is already weakened," said Dr
Kidinda. "Yet, in Southern Sudan, where almost 3 quarters of the population
have no access to even the most basic health care, it's a race against time
to reach patients."

Kala azar, or visceral leishmaniasis, is a neglected tropical disease,
endemic in some parts of southern Sudan, and which spreads quickly and
easily during an outbreak. The disease thrives in poor, remote, and
unstable areas, where there is extremely limited access to health care.

It is contracted by the bite of a sandfly carrying the kala azar
[leishmania] parasite, which multiplies inside the body, attacking the
immune system. Symptoms include an enlarged spleen, fever, weakness and
wasting. It demands quick diagnosis and treatment and if left untreated is
fatal in almost 100 per cent of cases within one to 4 months. However, if
patients access treatment on time there is a success rate of up to 95 per cent.

Jonglei State is the most affected area, with reports of 275 kala azar
patients in the Old Fangak clinic in the northwest being treated by a local
non-governmental organisation. In its remote health centre in Pibor, MSF
has admitted 24 kala azar patients, 2 of whom died having accessed health
care too late. MSF has also admitted an additional 46 kala azar patients to
its clinic in Lankien. Further north, in neighbouring Upper Nile State,
following reports that 66 kala azar patients were undergoing treatment in
Malakal hospital, MSF deployed an outbreak response team to screen people
across Rom, where 37 patients are now undergoing treatment.

The patients in Pibor clinic were infected in the cattle camps in the north
of Jonglei State, before moving back to their villages around Lekwongole,
in the north west of Pibor County. Patients make their way to MSF's
outreach health post in Lekwongole, as MSF teams are currently unable to
access these villages due to insecurity and road inaccessibility. MSF then
transports the patients to Pibor by boat, as roads have become rivers.

MSF is not only providing direct treatment for the disease, which involves
one injection per day for 30 days, but is also giving supportive treatment
for dehydration, anaemia, and other diseases affecting some kala azar
patients, such as malaria. In addition, MSF is providing food to patients
and distributing mosquito nets and soap, and is starting health promotion
activities in Jonglei State to raise awareness of the disease and encourage
more people to seek treatment.

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

[Southern Sudan is endemic for both cutaneous and visceral leishmaniasis as
well as HIV and Leishmaniasis co-infection
(<http://www.who.int/leishmaniasis/leishm ... ndex1.html>). WHO
estimates that about 2 per cent of the adult population is infected with
HIV in Sudan
<http://apps.who.int/globalatlas/predefi ... 008_SD.pdf>).
The report of the 5th consultation meeting on HIV and Leishmania, Addis
Ababa, March 2007, can be found here:
<http://www.who.int/leishmaniasis/resour ... ction5.pdf>.
WHO background information on leishmaniasis is available at
<http://www.who.int/leishmaniasis/en/>.

The last major outbreak of leishmaniasis in the Sudan was from 1984 to
1994, when WHO estimated that 100 000 people died out of a population of
300 000 in the Western Upper Nile State
<http://www.who.int/csr/resources/public ... niasis.pdf>.
The present outbreak is most probably due to famine combined with an
unstable security situation, where poor infrastructure further makes
control measures difficult.

The HealthMap/ProMED-mail interactive map of Sudan can be accessed at
<http://healthmap.org/r/00UR>. - Mod.EP]

DENGUE/DHF UPDATE 2009 (46)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


Cape Verde: 1st report, alert
Date: Thu 6 Nov 2009
Source: Jornal Digital [in Portuguese, trans. Mod.TY, edited]
<http://www.jornaldigital.com/noticias.php?noticia=20042>


The Cape Verde Government is considering declaring a state of calamity
in view of the dengue epidemic which gripped the country since
September [2009] and is expanding rapidly and alarmingly. The latest
official data from this outbreak are noted to be approximately 9000
people infected by dengue virus, including 25 suffering from DHF,
which has resulted in 6 [fatal] victims.

Measures are being taken and the Government announced that the country
already has a laboratory in a position to confirm dengue infections.
The Government also announced the import of new drugs and equipment,
with a view to creating conditions for treatment in the country.

To cope with this calamity, the Government of Cape Verde declared a
national work recess on Fri 6 Nov [2009], as a way to involve the
whole society, public and private institutions, military, educational
establishments and all the population in a national campaign against
the mosquito vector of this disease.

Prime Minister Jose Maria Neves has announced the availability of
financial allocation to combating the disease, while soliciting
support from countries such as Portugal, Brazil, Spain and Cuba to
help fight dengue. Also, doctors and health workers already retired
have been recruited while hospitals and health centers are full of
patients. Most of the islands already note that the supply of stock
repellents and paracetamol in pharmacies is exhausted.

The situation has worsened, and the Bishop of the Dioceses of 2 Cape
Verde [islands] -- Santiago and Sao Vicente -- Dom Arlindo Furtado, is
calling for people to join this fight against the pandemic. The
various football championships have been postponed, since most of the
athletes are affected by dengue.

The schools, as well as institutions are working "half-throttle," so
this fight against the disease has been extended to diplomatic
missions in Cape Verde. The ambassador of the United States in Cape
Verde has already established contacts with health facilities in that
country to collaborate with Cape Verde in combating the epidemic.

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

[Dengue virus type 3 is circulating in the Cape Verde islands. The 5
Nov 2008 edition of Afrol News (in Portuguese)
(<http://www.afrol.com/es/articulos/34633>) reported that authorities
have urged citizens to kill mosquitoes, instead of going to work,
while police and the army try to eradicate the disease. The epidemic
has reached the archipelago as a rude awakening, where this tropical
disease has never been recorded before, and it has spread like
wildfire. Registered infections are increasing at a record pace of
1000 infections per day.

The latest figures as published in Praia are 8799 cases of which 851
are in the capital. Yesterday (5 Nov 2009), the Cape Verde government
had no choice but to send a warning to tourists to take extra
precautions due to the epidemic. The Ministry of Foreign Affairs of
Portugal -- which represents one of the most important tourist markets
in Cape Verde -- has already issued a warning to Portuguese citizens
who plan to travel to Cape Verde. For the archipelago, a blow to the
tourism industry could bring significant economic consequences.
Tourism has become the backbone of the economic boom in Cape Verde.
The archipelago has a serious goal of becoming the "new Canary
Islands" off the coast of West Africa. With the emergence of tropical
diseases, mass tourism, however, does not seem very realistic.

A HealthMap/ProMED-mail interactive map of Cape Verde can be accessed at
<http://healthmap.org/r/00Xw>. - Mod.TY]

Tansania - Darminfektionen
10.11.2009

Risiko für Durchfallerkrankungen landesweit. Es treten regelmäßig örtlich begrenzte Cholera-Ausbrüche auf. Seit Anfang September wird ein größerer Cholera-Ausbruch aus der Tanga Provinz im Norden des Landes gemeldet. Bis Ende Oktober wurden mehr als 3.000 Erkrankungen und 59 Todesfälle registriert. Hygiene beachten, Impfschutz für Risikoreisende. / crm

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (28 )
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


******

Cholera - Nigeria (Adamawa)
Date: Wed 4 Nov 2009
Source: Agence France-Presse (AFP) [edited]
<http://uk.news.yahoo.com/18/20091104/th ... 993ab.html>


A fresh cholera outbreak has killed 20 people and left 200 others
infected in northern Nigeria's Adamawa State in the past week, a
senior health official said Wednesday [4 Nov 2009]. The latest deaths
take to 169 the number of those killed by cholera in 4 northern states.

"We have recorded a resurgence of cholera in 4 local government areas
in the northern part of the state in the last week, which has claimed
20 lives with about 200 others infected by the disease," Zainab Baba
Kwanci, Adamawa State health commissioner told AFP.

"We are doing everything that is necessary to contain the situation,
including the provision of drugs and vaccines as well as health
personnel to the affected areas," he added.

The latest deaths take to 169 the number of those killed by the
disease in 4 northern states, Adamawa, Jigawa, Taraba, and Borno, in
the past 3 months.

--
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>.
The HealthMap/ProMED-mail interactive map of Nigeria is available at
<http://healthmap.org/r/007*>. - Mod.LL]

DENGUE/DHF UPDATE 2009 (47)
***************************
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] Cape Verde
[2] Senegal


******
[1] Cape Verde
Date: Wed 11 Nov 2009
Source: Medecins Sans Frontieres [edited]
<http://www.msf.org.uk/articledetail.asp ... e_20091111>


MSF [Medecins Sans Frontieres] emergency teams are responding to the
1st ever dengue fever outbreak in Cape Verde, and the biggest in
Africa. The Cape Verde Ministry of Health has reported 13 187
suspected cases of dengue fever in 4 islands within the archipelago
between 1 Oct - 9 Nov [2009]. The outbreak is the 1st ever in Cape
Verde and is the biggest recorded in Africa. The number of cases has
increased sharply since the beginning of November 2009, reaching 1000
cases per day. 93 cases of DHF have been reported, and 6 people have
already died.

The international response to the dengue fever outbreak has been
positive, with public health experts and international medical teams
now providing medical support, case management, surveillance and diagnostics.

MSF has sent a team to support the hospital in Sao Filipe, the main
town on the island of Fogo, where between 100 and 150 new dengue
cases are being reported every day. Fogo has a population of around
40 000 people. More medical staff from MSF will arrive by the end of
the week [week of 15 Nov 2009] to support health centres in Cape
Verde's capital city Praia on Santiago Island.

"This is the 1st reported epidemic of dengue fever in Cape Verde, and
it is huge," says Dr Iza Ciglenecki, MSF's Emergency Coordinator in
Cape Verde. "With globalisation, dengue fever is appearing in places
where it has previously been unknown; it is the most rapidly
spreading mosquito born disease in the world."

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

[A HealthMap/ProMED-mail interactive map of Cape Verde can be
accessed at <http://healthmap.org/r/00Xw>. - Mod.TY]

******
[2] Senegal
Date: Wed 11 Nov 2009
Source: China View [edited]
<http://news.xinhuanet.com/english/2009- ... 433547.htm>


Up to 10 cases of dengue fever, which is not common in Senegal, were
detected since October [2009] in various localities of the West
African country, newspapers published in the capital Dakar reported
on Tuesday [10 Nov 2009]. The Senegalese health authorities have
found 19 patients suspected of suffering from dengue fever, since the
disease was 1st detected in Louanga, professor Oumar Faye, the
director of the Health Ministry, told the privately-owned Le
Populaire newspaper. Doctor Malang Coly of the office of the World
Health Organization (WHO) in Dakar also confirmed the outbreak,
indicating that the 1st case was detected in a Senegalese residing in
Italy who recently came to Senegal for holiday. No deaths have been
reported, officials said, adding a campaign is in place to eliminate
mosquito breeding grounds.

The outbreak is the 1st in Senegal, which has reported no cases in
the past 2 decades. The dengue fever is spread by the mosquito and
has similar symptoms to malaria: headaches, fever, fatigue and severe
muscle pains.

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

[Reports of dengue outbreaks from sub-Saharan Africa are extremely
rare. It has been suggested that clinical dengue disease seldom
occurs in Africa, perhaps due to the genetic makeup of the
population. Alternatively, dengue surveillance may not be active
enough to detect dengue cases. Both factors may be involved. ProMED
would appreciate receiving reports of dengue cases from Africa.

An interactive map of Senegal can be accessed at
<http://www.maplandia.com/senegal/>. A HealthMap/ProMED-mail
interactive map of Senegal can be accessed at
<http://healthmap.org/promed/en?v=14.4,-14.5,5>. - Mod.TY]

Kap Verde - Dengue
16.11.2009

Auf den Kapverdischen Inseln gibt es seit Ende September einen Ausbruch von Dengue-Fieber. Die Epidemie hat mittlerweile 4 Inseln erfasst (Brava, Fogo, Maio, and Santiago), eine weitere Ausbreitung wird erwartet. Es wurde Dengue Serotyp 3 nachgewiesen. Zuletzt wurden offiziell mehr als 13.000 Verdachtsfälle, inklusive 93 Fälle von Dengue-hämorrhagischem Fieber und 6 Todesfällen bestätigt. Seit Anfang November wurden bis zu 1.000 Fälle pro Tag registriert. Es handelt sich dabei um den ersten Dengue-Ausbruch auf den Kap Verden und um einen der größten jemals in Afrika registrierten Ausbrüche. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm