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CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (29)
************************************************
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 - Zambia (Southern province)
[2] Cholera - Kenya (Eastern province)
[3] Cholera - Kenya (Coast province)


******
[1] Cholera - Zambia (Southern province)
Date: Fri 13 Nov 2009
Source: Lusaka Times [edited]
<http://www.lusakatimes.com/?p=20437>


Cholera cases have persisted in Sinazongwe district in Southern
province since the disease broke out in September 2009.

Sinazongwe District Public Health officer Elias Chilwana disclosed
that the number of cumulative cases has reached 30 and 1 person has
since died. Mr. Chilwana said the cases were being treated at
Sinazeze clinic as most people that were being affected were coming
within the same area.

Mr Chilwana stated that most cholera cases were from Nkandabbwe
Collum Coal Mine's (CCM) shaft 2 because of the poor environmental
hygiene within their mining area. The District Public Health officer
noted that the scenario was disturbing as the company has contributed
to the spread of cholera cases resulting from the supply untreated
water and their sanitary facilities were of poor design.

In January 2009, more than 139 people were affected by the cholera
cases in Sinazongwe district resulting in the closure of several
schools as some were turned into cholera centers.

[Byline: Tovin Ngombe]

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

[A map of Zambia showing the location of the Southern province as
well as the affected district can be found at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>.
The HealthMap/ProMED-mail interactive map of Zambia is available at
<http://healthmap.org/r/00-f>. - Mod.LL]

******
[2] Cholera - Kenya (Eastern province)
Date: Thu 12 Nov 2009
Source: The Standard [edited]
<http://www.eastandard.net/InsidePage.ph ... 8260&cid=4>


A total of 4 people have died at a dispensary following a cholera
outbreak in Marsabit North District. The patients had been brought to
Ilaret Dispensary on Sunday [8 Nov 2009], but by Wednesday morning
[11 Nov 2009] 2 adults and 2 young children had succumbed to the
disease. Kenya Red Cross Society Regional Health Officer Abdi Mohamed
said more than 40 cholera patients had been admitted since 8 Nov
2009. He attributes the outbreak to recent floods and poor hygiene.

The disease has so far killed more than 26 people in a month in the
expansive Upper Eastern region.

According to Garbatulla District medical officer Nelson Muriu,
cholera cases have doubled compared to other diseases. "We are trying
to contain spread of the disease but the hospital has been
overwhelmed for lack of enough drugs," said Dr Muriu.

[Byline: Josephat Siror]

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

[The location of the mentioned area in the Eastern province of Kenya
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/00-g>. - Mod.LL]

******
[3] Cholera - Kenya (Coast province)
Date: Wed 11 Nov 2009
Source: Daily Nation [edited]
<http://www.nation.co.ke/News/regional/- ... /7o6or2/-/>


To date, 8 people have been confirmed dead after a cholera outbreak
in several parts of Lamu island. Kenya Red Cross Society and health
officials on Wednesday [11 Nov 2009] said 3 children, 2 women, and 3
men had died of the disease caused by water contamination. 28 people
are being treated King Fahad district hospital.

The disease has affected mostly wananchi [citizens] in Mkomani,
Langoni, Kandahar, and Kijitoni suburbs. Since the outbreak was
reported last week [week of 20 Nov 2009], social gatherings such as
weddings and funerals have been banned.

[Byline: Mike Mwaniki, Galgalo Bocha]

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

[Lamu Island is a part of the Lamu Archipelago of Kenya. The island
is linked by ferry to Mokowe on the mainland and to Manda Island. It
is part of the southeastern Coast province and can be found on the maps at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf> and
<http://healthmap.org/r/00-h>. - Mod.LL]

YELLOW FEVER - AFRICA (03): COTE D'IVOIRE (DENGUELE)
****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 16 Nov 2009
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200911162030.html>


Health officials have confirmed 3 cases of yellow fever [YF] in Cote
d'Ivoire's northwest Denguele region. "We have 10 suspected cases,
with 3 confirmed," Simeon N'da, Health Ministry head of
communications, told IRIN on 16 Nov [2009]. Health workers vaccinated
people in and around affected villages at the weekend [14-15 Nov
2009], according to N'da. He did not specify how many people were
vaccinated and in what localities.

N'da said there had been no deaths from the mosquito-borne viral
infection. Local taxi drivers told IRIN they transported the bodies
of 4 teenagers from the village of Tron Touba to the region's main
city Odienne in a period of a few days the week of 9 Nov [2009].
Villagers said they had died of an unknown illness. Local health
officials in Odienne would not comment.

Some 30 000 people worldwide die of yellow fever each year, of about
200 000 cases, according to the World Health Organization (WHO). No
cure exists and 50 percent of infected people who cannot access
treatment will die, according to WHO, which says vaccination is "the
single most important preventive measure".

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

[Abidjan, the capital of the Cote d'Ivoire, located in the south of
the country, experienced an outbreak of urban YF last year (2008),
which triggered a rapid vaccination campaign that reached 2.2 million
people in the city.

The current political situation in the Cote d'Ivoire is in a state of
flux that may hamper the government's response to what has been so
far, a small YF outbreak. The northern part of the country is
controlled by the New Forces, and recent information indicates that
both New Forces and government forces are re-arming, with the
possibility of increased violence in the run-up to the 29 Nov 2009
elections. This situation would further complicate attempts to mount
an extensive vaccination campaign to control the outbreak. ProMED
watches this situation with considerable concern.

A map showing the location of Cote d'Ivoire in West Africa can be accessed at
<http://www.nationsonline.org/map_small/ ... ll_map.jpg>.
A map showing the Denguele region can be accessed at
<http://en.wikipedia.org/wiki/File:Coted ... nguele.png>
The HealthMap/ProMED-mail interactive map of Cote d'Ivoire can be accessed at
<http://healthmap.org/r/00-v>. - Mod.TY]

Dengue fever in Cape Verde - update 1
18.11.2009 - WHO

As of 16 November 2009, the Ministry of Health has reported 16 744 suspected cases of dengue in five islands: Brava, Fogo, Maio, Sal and Santiago.

The World Health Organization (WHO) is working closely with the government of Cape Verde to support technical response to the outbreak, as well as to support coordination with other United Nations agencies, bilateral partners and non-governmental organizations for the operational response. WHO has deployed more than 20 experts - many through the Global Alert and Response Network (GOARN) mechanism - to support Cape Verde on epidemiological and entomological surveillance and laboratory investigation, vector-control, clinical case management, social mobilization, logistics and information and technology. The experts come from Senegal, Thailand, Brazil, Italy, Martinique, Guadeloupe, French-Guyana and from within WHO. WHO has also deployed personal protection equipment (PPE), larvicide, fog machines and laboratory diagnostics supplies to support the government operations for source reduction, vector control and sustaining the onsite laboratory diagnosis of dengue. Dengue technical guidelines in Portuguese have also been provided by WHO. The Ministry of Health of Cape Verde, the Operational Nucleus of Information Society (NOSi) and WHO have launched a nationwide internet and text messaging (SMS) reporting and alert system for dengue, providing real time information to public health experts and alerting individuals at risk when and how to seek care.

This is the first dengue outbreak in the country and people did not have immunity against the disease. During epidemics of dengue, infection rates among those who have not been previously exposed to the virus are often between 40% and 50%, but could reach 80% to 90% in worse case scenario. Dengue is present in sub-Saharan Africa but often unrecognized. Although many arboviruses – such as dengue, chikungunya, Crimean–Congo haemorrhagic fever, Rift Valley fever, yellow fever and West Nile virus – affect human health in west Africa, surveillance programmes are not consistently available except for yellow fever. In the recent years, dengue has been documented in travellers returning from several countries in West Africa, and particularly dengue type-3 virus. Dengue type-3 virus has first isolated in travellers returning to Japan and France from Abidjan Cote d’Ivoire in 2008 and from Senegal to Italy in October 2009.

Nigeria: Cholera Kills Twenty in Borno, 2000 Infected
19.11.2009 - AllAfrica.com

Kaduna — About 20 people have lost their lives and over 2,000 hospitalised following a cholera outbreak in Borno State. According to a BBC Hausa report monitored in Kaduna yesterday, the outbreak started in Madube village of Gwoza Local Government Area of the state, and has spread to other villages in Biu, Jere, Mafa, Konduga, Marte, Dikwa, Ngala, and Maiduguri Local Government Areas ... mehr
__________________

Mozambique: Typhoid Outbreak in Tete
20.11.2009 - AllAfrica.com

Maputo — The supposedly mysterious disease that has been claiming victims in Tsangano district, in the western Mozambican province of Tete, has been identified as typhoid fever, reports Friday's issue of the Maputo daily "Noticias". The disease has struck an area near the Malawian border. 111 people are known to have contracted it, 17 of whom have died ... mehr


Gruß
Birgitt

DENGUE/DHF UPDATE 2009 ( 48 )
***************************
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 18 Nov 2009
Source: WHO Global Alert and Response (GAR) Disease Outbreak News [edited]
<http://www.who.int/csr/don/2009_11_18/en/index.html>


As of 16 Nov 2009, the Ministry of Health has reported 16 744
suspected cases of dengue in 5 islands: Brava, Fogo, Maio, Sal, and
Santiago.

The World Health Organization (WHO) is working closely with the
government of Cape Verde to support technical response to the
outbreak, as well as to support coordination with other United
Nations agencies, bilateral partners, and non-governmental
organizations for the operational response.

WHO has deployed more than 20 experts -- many through the Global
Alert and Response Network (GOARN) mechanism -- to support Cape Verde
on epidemiological and entomological surveillance and laboratory
investigation, vector-control, clinical case management, social
mobilization, logistics, and information and technology. The experts
come from Senegal, Thailand, Brazil, Italy, Martinique, Guadeloupe,
French-Guyana, and from within WHO.

WHO has also deployed personal protection equipment (PPE), larvicide,
fog machines, and laboratory diagnostics supplies to support the
government operations for source reduction, vector control, and
sustaining the onsite laboratory diagnosis of dengue. Dengue
technical guidelines in Portuguese have also been provided by WHO.

The Ministry of Health of Cape Verde, the Operational Nucleus of
Information Society (NOSi), and WHO have launched a nationwide
internet and text messaging (SMS) reporting and alert system for
dengue, providing real time information to public health experts and
alerting individuals at risk when and how to seek care.

This is the 1st dengue outbreak in the country and people did not
have immunity against the disease. During epidemics of dengue,
infection rates among those who have not been previously exposed to
the virus are often between 40 and 50 percent, but could reach 80-90
percent in a worse case scenario.

Dengue is present in sub-Saharan Africa but often unrecognized.
Although many arboviruses -- such as dengue, chikungunya,
Crimean-Congo haemorrhagic fever, Rift Valley fever, yellow fever,
and West Nile virus -- affect human health in west Africa,
surveillance programmes are not consistently available except for
yellow fever.

In the recent years, dengue has been documented in travellers
returning from several countries in West Africa, and particularly
dengue type-3 virus. Dengue type-3 virus has first isolated in
travellers returning to Japan and France from Abidjan Cote d'Ivoire
in 2008 and from Senegal to Italy in October 2009.

--
Communicated by:
ProMED-mail Rapporteurs Marianne Hopp and Brent Barrett

[Since this is the 1st outbreak of dengue on the islands and
presumably vector mosquitoes are abundant, it is likely to continue
for some time.

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

******
[2] Senegal
Date: Sat 14 Nov 2009
Source: Sud Quotidien [in French, trans. Mod.TY, edited]
<http://www.sudonline.sn/spip.php?article21282>


The epidemic of dengue type 3 is well established in Senegal. In
fact, 55 cases have been registered in the country. According to
authorities of the Ministry of Health who met last Friday [13 Nov
2009] in a symposium to explain its mode of transmission and its
prevention, they have established a strategy to halt the progression
of this disease.

The epidemic of dengue disease continues spread in the country.
Indeed, there appeared a few weeks ago [dengue virus] type 3, and
Senegal has already registered 55 declared cases. According to
professor Bernard Diop of the Infectious Disease Service of the Fann
Hospital, speaking last Friday [13 Nov 2009] in Dakar during a
symposium about the disease, "dengue is manifested by high fever (39
to 40 deg C/102.2-104 deg F), headache, muscle pain fatigue, bloody
diarrhea, etc. The disease [virus], he said, is transmitted by the
bite of a mosquito called _Aedes aegypti_. The characteristic of this
insect is that its area of development is in "flower vases, old
tires, cans with water, troughs, waste containers with water, and
abandoned containers. The danger that this mosquito presents is its
ability to bite both day and night; [_Ae. aegypti_ bites during
daylight hours, including dawn and dusk. - Mod.TY] It occurs mainly
in urban and periurban areas.

Professor Diop indicated that "the treatment is mainly symptomatic,
not curative." It consists mainly of treatment of the patients to
reduce their pain. However, said professor Diop, this disease has a
significant economic impact because "convalescence requires 6-7
weeks". For the authorities in charge of individual and collective
[dengue] prevention in Senegal, the only means of coping with the
illness is to eliminate places where the mosquito can breed.

From this same viewpoint, Seyni Thiam of the National Health Service
indicated that in addition to this, the Ministry of Health will
proceed under "emergency measures to fight against the vector-borne
diseases including dengue, [to carry out] a spraying campaign with
insecticides within and outside homes within the territory of the
Dakar region." He indicated that this campaign started yesterday,
Friday [13 Nov 2009] afternoon. Senegal has already experienced
several times in the past dengue [virus] type 2. For the 1st time in
history, it is [dengue virus] type 3 disease, which broke out in the
country.

[Byline: Mamadou Amadou Diop]

--
Communicated by:
ProMED-FRA
<promed-fra@promedmail.com>

[After Cote d'Ivoire and Cape Verde, Senegal, in turn, is facing the
epidemic of dengue type 3. This confirms the emergence and the spread
of the disease in West Africa. - Mod.SC]

[ProMED-mail appreciates receiving this dengue report, as we get so
few from Africa. It would be of interest to know in which areas
dengue virus transmission is occurring. Is it focal in Dakar or
widespread?

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

Côte d’Ivoire - Gelbfieber
23.11.2009

Aus der Region Denguélé (NW) wurden 3 labortechnisch bestätigte Gelbfieber-Erkrankungen gemeldet. Bei weiteren 7 Patienten besteht die Verdachtsdiagnose, in dem betroffenen Dorf sind zuletzt mehrere Einwohner an einer undiagnostizierten fieberhaften Erkrankung verstorben. Eine Impfkampagne wurde in der Region initiiert. Letztes Jahr kam es in der Hauptstadt Abidjan zu einem Gelbfieber-Ausbruch. Impfschutz beachten. / crm
___________________________

Kenia - Darminfektionen
23.11.2009

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. Landesweit wurden im November mehrere örtliche Ausbrüche gemeldet. Hygiene beachten, Impfschutz für Risikoreisende. / crm

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (30)
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Zimbabwe (Mashonaland East)
[2] Cholera - Uganda (Kasese)
[3] Cholera - Uganda (Bugiri)
[4] Cholera - Tanzania (Dar es Salaam)
[5] Cholera, prisoners - Kenya (Nairobi)
[6] Cholera - Kenya (Central province)
[7] Cholera - Nigeria (Borno, Taraba)


*****
[1] Cholera - Zimbabwe (Mashonaland East)
Date: Tue 24 Nov 2009
Source: AllAfrica, The Herald (Zimbabwe) report [summ., edited]
<http://allafrica.com/stories/200911240030.html>


A total of 6 suspected cholera cases have been recorded in Mabvuku,
Harare, as the municipality battles to provide sufficient water to
residents in the eastern and western parts of the city. Speaking at a
press conference in Harare yesterday, 23 Nov 2009, Health and Child
Welfare minister Dr Henry Madzorera said no deaths had been recorded.

Countrywide, authorities had recorded 143 suspected cholera cases by
the afternoon of 23 Nov 2009 which 21 were confirmed after laboratory
tests.

Since the 1st cases were reported in September 2009, 5 people have
died from cholera. Dr Madzorera said the case-fatality rate stood at
4.3 percent.

According to international norms, a controlled cholera outbreak
usually leads to a fatality rate of not more than 1 percent. The 5
deaths were recorded in Chegutu (2), Gokwe North (2), and Makonde (1).

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

[The location of Harare in Mashonaland East can be found on the
HealthMap/ProMED-mail interactive map of Zimbabwe at
<http://healthmap.org/r/00*d>. - Mod.LL]

******
[2] Cholera - Uganda (Kasese)
Date: Fri 20 Nov 2009
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/13/701828>


Cholera has broken out in Kasese district with 2 cases reported in
Hamukungu fishing village in Lake Katwe sub-county on Tue 17 Nov 2009.

The district health officer, Dr Peter Mukobi, said 584 cases with 10
deaths have been registered in the district since the beginning of
2009. He added that most of the cases were from the sub-counties
neighboring the Democratic Republic of Congo.

[Byline: Bernard Masereka]

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

[Uganda's Kasese district in the southwestern part of the country can
be seen on the district map at
<http://www.coetzee-uganda.com/index_fil ... Uganda.htm>.
- Mod.LL]

******
[3] Cholera - Uganda (Bugiri)
Date: Mon 16 Nov 2009
Source: Uganda Pulse [edited]
<http://www.ugpulse.com/articles/daily/n ... +&ID=13554>


The outbreak of cholera has claimed 2 people in Bugiri district in 1
week and about 10 others are bedridden in hospitals. The endemic
broke out in the area in September 2009 and it has so far killed more
than 18 people.

Dr Kirya Bulolo, the district medical officer of Bugiri says cholera
has hit mostly Muwayo trading centre in Buluguyi Sub County. He says
the cholera outbreak has been caused by too much rain in the district.

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

[Uganda's Bugiri district is in the eastern part of the country as
seen on the map at
<http://www.coetzee-uganda.com/index_fil ... Uganda.htm>.
- Mod.LL]

******
[4] Cholera - Tanzania (Dar es Salaam)
Date: Fri 20 Nov 2009
Source: This Day [edited]
<http://www.thisday.co.tz/?l=10187>


Cholera continues to spread in Dar es Salaam Region as a total of 211
cases have been reported so far. The statistics show the highest
number of reported cholera cases in Temeke District, where 73 cases
have been recorded, while Kinondoni District has 68 cases, according
to records available on Wed 18 Nov 2009.

The acting Dar es Salaam regional commissioner, Evans Balama,
confirmed that Temeke is leading in the number of recorded cases and
that 4 new cases were recorded in Ilala District raising the total
number of cases recorded in that district so far to 70.

[Byline: Sayuni Kimaro]

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

[Dar es Salaam is located in northeastern Tanzania bordering the
Indian Ocean and can be seen on a maps at
<http://www.un.org/Depts/Cartographic/ma ... nzania.pdf>
and
<http://healthmap.org/r/00*f>. - Mod.LL]

******
[5] Cholera, prisoners - Kenya (Nairobi)
Date: Mon 23 Nov 2009
Source: Kenya Broadcasting Corporation (KBC) [summ, edited]
<http://www.kbc.co.ke/story.asp?ID=61117>


The government has contained the outbreak of cholera at the Kamiti
Maximum Prison, which left 10 inmates dead and scores hospitalized,
vice president Kalonzo Musyoka has said.

The VP said tests have ruled out the prisons water system or food as
the cause of the epidemic, adding that it was suspected the disease
was introduced into the facility by a new inmate, who had contracted
it from one of the affected estates in Nairobi.

[Byline: Margaret Kalekye]

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

[The prison is located in Nairobi, which can be seen on the maps of Kenya at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf> and
<http://healthmap.org/r/00*g>. - Mod.LL]

******
[6] Cholera - Kenya (Central province)
Date: Thu 19 Nov 2009
Source: Kenya Broadcasting Corporation (KBC) [edited]
<http://www.kbc.co.ke/story.asp?ID=61047>


So far 2 people have been confirmed dead and 9 others admitted in
serious condition following cases suspected to be a cholera bout in
Ruiru. Ruiru district public health officer Francis Mwangi said the 2
succumbed while on their way to hospital. 14 cases have so far been
confirmed.

The PHO said the victims, who hail from Murera, Gatong'ora, and
Gitambaya villages, had consumed contaminated water from the Ruiru
river. He said samples of the water have been taken for testing and
advised residents to boil river water before drinking it.

In October 2009, 2 other people died of suspected cholera in
Gatuanyaga area of Thika East district. At least 250 others were
treated for symptoms of the disease after they drank dirty water from
Athi River.

[Byline: Judy Maina]

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

[Ruiru (<http://en.wikipedia.org/wiki/Ruiru>) is a town in the Thika
District of Kenya's Central Province. Located within 3 kilometers (2
mi) of Nairobi's city boundary. Ruiru is a dormitory town for the
nation's capital, and is connected by both rail and road. - Mod.LL]

******
[7] Cholera - Nigeria (Borno, Taraba)
Date: Wed 18 Nov 2009
Source: AllAfrica, Daily Trust report [summ., edited]
<http://allafrica.com/stories/200911180459.html>


A fresh outbreak of cholera in parts of Maiduguri and Jere Local
Government Area of Borno State claimed 6 more persons between 16 and
17 Nov 2009, bringing to 78, the number of persons who died in one
month as a result of the disease. This is besides an earlier outbreak
in Biu Local Government Area of the state in October 2009 which
killed nearly 100 people.

Records at a treatment and isolation camp established for victims at
Ngaranm-bulabulin ward in Maiduguri showed that 795 cases were
recorded between 16 Oct 2009 and 17 Nov 2009 out of which 78 persons
have died, bringing the average death toll to 2 persons per day.
Following the fresh outbreak at the weekend [14-15 Nov 2009], over 20
people reported to the camp out of whom 3 died on 16 Nov 2009 and
another 3 died on 17 Nov 2009.

In a related development, 3 persons have been confirmed dead while 11
others are in critical condition as a result of a cholera outbreak in
Karim-Lamido Local Government Area of Taraba State. The 11 victims of
the epidemic are currently receiving treatment at Karim-Lamido
Comprehensive Health Centre.

[Byline: Isa Umar Gusau, Yahaya Ibrahim]

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

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

Mosambik - Typhus
25.11.2009

Aus der Tete Provinz, in der Nähe der Grenze zu Malawi, wurde Mitte November ein Typhus-Ausbruch mit 111 Erkrankten und 17 Todesfällen gemeldet. Hygiene beachten, Risikoreisende sollten geimpft werden. / Quelle: crm

UNDIAGNOSED DISEASE, FATAL - REPUBLIC OF THE CONGO: (NIARI) REQUEST
FOR INFORMATION
***********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 25 Nov 2009
Source: IOL (Independent Online, South Africa) [edited]
<http://www.iol.co.za/index.php?from=rss ... 684C420568>


Unidentified disease kills 3 in Congo
-------------------------------------
An unidentified disease has killed 3 people and spread to more than
100 others in the south west of the Republic of the Congo, according
to medical sources who suspect swine flu, the pandemic (H1N1) 2009
virus. "3 people have lost their lives since the epidemic broke out a
few days ago," said a local medical source. "A little more than 100
others are being monitored in the hospital" at Londela Kayes [Niari
department], more than 350 km [220 mi] south west of Brazzaville. The
symptoms are acute diarrhoea, high fever, and vomiting.

"We haven't yet received samples that we can analyse to determine the
origins of the illness," a doctor at the National Laboratory of
Public Health, Jean-Vivien Mombouli, said, adding that swine flu was
nevertheless suspected. "We are at the stage of suspicions. Since
[pandemic] H1N1 flu has already affected Brazzaville and Pointe-Noire
(home to more than half the population of the country), it's probable
that the movements of traders and agents of the state in small places
have contaminated people," Dr Mombouli said. The Congo registered its
1st cases of the [pandemic] A (H1N1) virus at the end of October
[2009] in a private school in Brazzaville [see ProMED-mail archived
reference below].

The Congolese authorities state that they have set up an alert
system, with the help of the World Health Organisation, making it
possible to detect all kinds of flu and to react rapidly.

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

[Insufficient information is provided in this report to identify the
disease. An outbreak of pandemic (H1N1) 2009 influenza is suspected,
but the symptoms described are not sufficiently specific to confirm
this, or even to indicate that the etiologic agent is a virus.

Influenza pandemic (H1N1) 2009 virus infection is a possibility since
this infection has been reported in school children in Brazzaville,
but the mortality rate in this outbreak is high. Additional
information concerning this outbreak would be appreciated.

The HealthMap/ProMED-mail interactive map of the Republic of Congo
(Congo-Brazzaville) can be accessed at
<http://healthmap.org/r/00*q>.
An administrative map of the country is available at
<http://www.un.org/Depts/Cartographic/ma ... /congo.pdf>. - Mod.CP]

Kap Verde - Dengue
30.11.2009

Auf den Kapverdischen Inseln gibt es seit Ende September einen Ausbruch von Dengue-Fieber. Die Epidemie hat mittlerweile 5 Inseln erfasst (Brava, Fogo, Maio, Sal and Santiago), eine weitere Ausbreitung wird erwartet. Es wurde Dengue Serotyp 3 nachgewiesen. Zuletzt wurden offiziell mehr als 16.000 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. Die WHO hat Experten zur Bekämpfung des Ausbruches eingeflogen. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm

Yellow Fever in the Central African Republic
01.12.2009 - WHO

On 14 November 2009, The Ministry of Health (MoH) in the Central African Republic reported four suspected cases of yellow fever, including 3 deaths. The cases were found through regular yellow fever surveillance in the Sub-Prefecture of Yaloké-Bossembelle, Prefecture of Ombella Mpoko and in the Sub-Prefecture of Bagamongone, Prefecture of La Lobaye.

The index case was reported in the Sub-Prefecture of Yaloké-Bossembelle. He was an 18-year-old man, a cattle breeder. On 6 September, he presented with fever, headache, jaundice and haemorrhagic signs. The patient was hospitalized in the health centre of Yaloke, where he died on 14 September. In the following days, 2 additional cases were reported with the same severe clinical presentation, and both died. In Bagamongone, a small town 20 km from Yaloke, another case was reported during the same period.

Three cases were positive for yellow fever IgM at the National Laboratory in the Institute Pasteur of Bangui. The regional reference laboratory at Institut Pasteur in Dakar, Senegal, also confirmed that neutralization tests found specific antibodies against yellow fever, thus confirming the cases to be yellow fever. Other haemorrhagic fevers were excluded by specific tests. During the outbreak investigation conducted by the Ministry of Health, serum samples were collected from 80 of "contacts" of the cases. All these serum samples were sent to the Institute Pasteur of Bangui for investigation, and were IgM negative by ELISA test. Entomological studies showed a limited presence of mosquito vectors of sylvatic yellow fever.

These cases follow two yellow fever outbreaks in Basse Kotto and Ombella Mpoko Prefectures earlier in 2009. In 2008, 4 reported events resulted in reactive mass vaccination campaigns. Cases had occurred in the sub-prefectures of Bozoum in April 2008, Boda in August 2008, Bimbo and Briac in October 2008. An assessment of yellow fever virus circulation in human, non human primates and vectors was carried out in 2009 by a group of experts of the Yellow Fever Partnership. Laboratory testing for the study is underway.

Emergency mass vaccination against yellow fever is planned for a population of 327,877 in affected regions for early December 2009. Vaccines have been provided from the global emergency vaccine stockpile, managed by the International Coordinating Group for Yellow Fever Vaccine Provision (YF-ICG) with funding from the GAVI Alliance. The Central African Republic is not part of a group of 12 endemic countries in Africa where preventive mass vaccination campaigns are ongoing since 2007. However, with these events since 2008, the Central African Republic is now considered to be at high risk of further outbreaks.

MENINGITIS, MENINGOCOCCAL - CONGO DR: (ORIENTALE)
***********************************************
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: Wed 12 Dec 2009
Source: China View [edited]
<http://news.xinhuanet.com/english/2009- ... 574856.htm>


Ten students at Maikazo Institute in Tshopo district in Kisangani,
the main town in Orientale province of the Democratic Republic of
Congo (DRC), died in one week from an unknown disease, with
meningitis-like symptoms, the Congolese radio reported on Tuesday [1
Dec 2009?]. The last case of death came on Tuesday morning at the
Mangobo general hospital, where 3 of these students had been admitted
since Saturday [28 Nov 2009?], when 9 others died a few hours after
they had been taken to the hospital, Dr. Cecile Edambulu, chief
medical doctor in Tshopo zone, told the radio.

"The children had symptoms of headache, fever and convulsions. Upon
arrival at the health center, they died. The symptoms that they
showed made us think they were suffering from meningitis," Edambulu
explained. According to hospital sources, similar cases were
identified in Makiso and Mangobo districts in the neighborhood of
Tshopo. The children had been taken to Mangobo and Kisangani
hospitals, they reported.

The provincial education minister, Polydore Latigo, has decided to
momentarily close down Maikazo Institute. "This is a preventive
measure to allow the administrative and medical authorities to carry
out investigation on the situation," he said. The mayor of Kisangani
has brought together all education and health partners in the town to
find a way to curb the spread of the disease while awaiting the
results of tests on the samples taken to the capital Kinshasa and
South Africa to determine the type of the virus.

[Byline: Xiong Tong]

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

******
[2]
Date: Tue 8 Dec 2009
Source: Irin (UN Integrated Regional Information Ne2rks) Africa [edited]
<http://www.irinnews.org/report.aspx?ReportID=87364>


An outbreak of meningitis that killed more than a dozen students from
the same school last week has spread throughout the city of
Kisangani, in central Democratic Republic of Congo, officials said
Monday [30 Nov 2009?]. The strain of the meningococcal [serogroup] C,
which was confirmed last week, had infected at least 100 people
throughout the port city on the Congo River, said the Minister of
Health, August Mopipi, on 7 Dec 2009. He visited the city to assess
what local leaders have called an "epidemic". By 6 Dec 2009,
according to hospital officials and the UN radio service in
Kisangani, 17 had died from the bacterial infection, all students at
the local Maikazo Technical Institute.

"It's a source of hope that this deadly disease remains curable,"
Mopipi said, adding that more than 40 of the cases had been cured.
The minister said the government was working on distributing
vaccinations but warned they could be "prohibitively" expensive.
According to Kisangani mayor Guy Shilton, crisis meetings between
hospitals, local government authorities and religious leaders had
been organized and an "emergency protocol" had been put in place,
providing for the distribution of drugs. "Once the epidemic is
declared, we will attack it in every way possible," Shilton said.

The 1st fatalities took place at the Maikazo Technical Institute,
when 9 students from the school died at end-November 2009 after being
checked into the local hospital. According to the UN, doctors said
the patients all had signs of meningitis, but it could not be
confirmed. A 10th student died a week ago, and the school was closed
down by the state minister of education. "It's a preventative and
temporary measure," said Minister Polydor Latigo, "but we need to
investigate the problem safely." Andre Kitenge, a press officer for
the UN in Kisangani, said that while all deaths related to the
outbreak were from the school, cases in other parts of Kisangani were
"prevalent".

Kisangani, one of the largest cities in the Congo, lies in the middle
of Africa's "meningitis belt". During the dry season, it infects
hundreds more people than the global average of 3 per 100 000.
According to the World Health Organization, an affordable vaccine is
supposed to be on the way, but for poor and densely populated areas
such as Kisangani, it still poses a serious threat. An outbreak of
meningitis at the beginning of 2009 across the "belt" infected nearly
25 000, according to the UN, and killed more than 1500.

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

[Orientale is a province in the northeastern corner of the Democratic
Republic of Congo (DRC). The 2005 Constitution divided Orientale
Province into 4 new provinces: Ituri, Haut-Uele, Tshopo, and Bas-Uele
(<http://en.wikipedia.org/wiki/Democratic ... _the_Congo>).
The provincial capital of Tshopo is Kisangani.

Eastern DRC has been the site of ongoing civil unrest. From an USAID
report: "regional armed conflict across the Democratic Republic of
the Congo (DRC) has resulted in an estimated 5.4 million deaths since
1998. Most deaths occurred due to indirect consequences of fighting,
such as disease, malnutrition, and neonatal- and pregnancy-related
complications. Overall, the decade of fighting displaced more than 3
million Congolese across eastern and southern DRC and hindered access
to agricultural land and traditional markets. Poverty continues to be
widespread, and the Congolese health care system has eroded due to a
lack of resources and looting of medical assets"
(<http://www.usaid.gov/our_work/humanitar ... 6-2009.pdf>).

Numerous cases of meningococcal meningitis are reported in the
African region known as the "Meningitis Belt" each year during the
dry season, between December and June, and every 8-12 years large
outbreaks occur
(<http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx>). The
"Meningitis Belt" extends from Senegal in the west to Ethiopia and
Eritrea in the east (<http://www.cdc.gov/ncidod/eid/vol9no10/03-0170.htm>).

During the 1st 11 weeks of 2009 (1 Jan-15 Mar 2009), a total of 24
868 suspected cases, including 1513 deaths were reported to WHO by
countries of the meningitis belt. The current epidemic has been the
deadliest outbreak since 1996, and 1/3rd of the world's emergency
vaccine stockpile for meningococcal vaccine has been consumed
(<http://en.wikipedia.org/wiki/2009_West_ ... e-reuter-1>).
More than 85 percent of the cases occurred in one epidemic focus that
encompasses Northern Nigeria and Niger and is due primarily to
_Neisseria meningitides_ serogroup A
(<http://www.who.int/csr/don/2009_03_25/en/index.html>).

Although, the DRC is not considered a part of the usual African
meningitis belt
(<20090124.0310,Y">http://www.promedmail.org/pls/otn/f?p=2 ... 124.0310,Y>),
outbreaks of meningococcal meningitis, some of which have been
confirmed to be due to meningococcus serogroup A, have occurred in
the past (see ProMED posts listed below).

A map of the DRC is available at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. Maps
of the African bacterial meningitis belt can be found at
<http://www.medic8.com/images/map4-9.gif> and
<http://upload.wikimedia.org/wikipedia/c ... ld-Map.png>.
- Mod.ML]

ANTHRAX, HUMAN, LIVESTOCK - KENYA: (RIFT VALLEY) SUSPECTED
***********************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 23 Dec 2009
Source: Daily Nation, Kenya [edited]
<http://www.nation.co.ke/News/regional/- ... /8o60wo/-/>


A person has died and several others have been admitted to hospital
over what is suspected to be anthrax in Trans Mara District. There
was congestion at the district hospital as more than 40 people
reported to have eaten the infected meat were brought in for treatment.

An ambulance from the hospital and taxis had a difficult time
accessing the remote area where the incident occurred. With no other
means of transport for the victims, the ambulance made several trips
to the area.

District public health officer Anthony Mwanthi said a person had
died, 3 had been admitted to hospital, while 39 others with mild
symptoms were treated and discharged.

Mr Mwanthi said the affected area was prone to anthrax outbreaks,
noting that in October 2009, one person died and 33 others were
admitted to hospital after eating the carcass of an infected animal.

The health officer said that despite efforts to curb anthrax
outbreaks, the residents were still ignoring the dangers of eating
un-inspected meat. He cautioned the residents against relying on
herbs, which they believe to have the power to sterilise meat, and
instead engage the services of the public health officers to inspect
the meat. "It's time the locals changed their attitudes towards some
cultural beliefs, especially those which expose them to dangers," he said.

However, according to one of the residents, Mr Peter Sankale, it was
hard for many locals to dispose of carcasses by burning or burying
them, as this is a cultural taboo.

There are fears that more infections might occur as hundreds of
animals continue to be slaughtered for the end of year festivities
without being inspected.

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

[In the past 4 years, livestock anthrax has been reported in the
following Kenyan provinces: Central, Coast, Eastern, Nairobi, and the
Rift Valley. These have been mainly in cattle but also in sheep and
goats. The higher numbers in the Nairobi area probably reflect a
reporting bias and proximity to better diagnostic facilities. The
human loses are significant, with 136 cases in 2005-2008. There is an
unfortunate high probability that infected meat is sold in local
markets. Depending on herbs to quell the infection only increases the
probability of death. - Mod.MHJ]

[Anthrax spores survive for years in the environment, but the
herbivores are particularly susceptible to being exposed to the
spores, especially when grazing close to the ground during the dry
season. Human beings may develop cutaneous anthrax through a skin
lesion, gastrointestinal anthrax following ingestion of meat from an
animal that died of the disease, or pulmonary (inhalation) anthrax
from breathing in airborne anthrax spores. The public should be
educated in avoiding meat from diseased or dead animals and on the
burying of carcasses to prevent outbreaks. Special messages should be
designed to counter dangerous taboos so as to prevent recurrence of
the outbreaks.

The Rift Valley Province is found at number 7 on the map of Kenya
located at <http://en.wikipedia.org/wiki/Provinces_of_Kenya>, and the
HealthMap/ProMED-mail interactive map of Kenya can be accessed at
<http://healthmap.org/r/006h>. - Mod.JFW]

YELLOW FEVER - AFRICA (05): COTE D'IVOIRE (DENGUELE)
***********************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 24 Dec 2009
Source: Angola Press [in Portuguese, trans. Mod.TY, edited]

An epidemic of yellow fever rages in the north of Cote D'Ivoire, with
12 cases confirmed today [Thu 24 Dec 2009], causing the government
and the World Health Organization (WHO) to launch a vaccination
campaign, it was learned today from an official source.

An unexpected epidemic in the Denguele region, declared by the WHO
and the Ivorian authorities in mid-November 2009, was extended in
this area and old savanna region (in the far north, bordering on
Mali), stated the Ivorian Minister of Health and WHO in a joint
statement. "Right now, 36 suspected cases, of which 12 are confirmed
by Institute Pasteur of Cote D'Ivoire, were reported, with 19
deaths," he stated.

"With the technical and financial support from WHO, the Ministry will
vaccinate about 300 000 people in the region of Denguele from 26-31
Dec 2009 to prevent the spread of the epidemic and to protect persons
not [yet] affected."

The major proportion of cases are fatal. Yellow fever is a disease
caused by a virus transmitted by mosquitoes.

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

[Epidemics of yellow fever are often unexpected. A few weeks ago,
ProMED-PORT reported on cases of yellow fever in Senegal. This was an
error; the cases were in Sierra Leone. - Mod.JLS]

[This is a further report of the continuing yellow fever outbreak
that emerged in the Denguele region in November 2009. One hopes that
the rapid response of the Ministry of Health will halt transmission
and the outbreak.

A map showing the location of Cote d'Ivoire in West Africa can be
accessed at
<http://www.nationsonline.org/map_small/ ... ll_map.jpg>.
A map showing the Denguele region can be accessed at
<http://en.wikipedia.org/wiki/File:Coted ... nguele.png>. The
HealthMap/ProMED-mail interactive map of Cote d'Ivoire can be
accessed at <http://healthmap.org/r/00-v>. - Mod.TY]

YELLOW FEVER - AFRICA (06): COTE D'IVOIRE (DENGUELLE)
***********************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 29 Dec 2009
Source: Baiita-Dot-Ph [edited]
<http://balita.ph/2009/12/29/yellow-feve ... te-divore/>


A total of 21 people have died in an outbreak of yellow fever [YF]
since the disease was detected in November [2009] in Cote d'Ivoire's
northern province of Ordienne, local media reported Monday [28 Dec
2009]. A total of 37 suspected cases were also reported in the
province, media reports said.

Health authorities said the disease is transmitted by the mosquito
and vaccination is the most effective way to prevent it. The
government has already allocated USD one million for vaccines for
some 290 000 people. Medical teams have been sent to the affected
regions to help with the vaccination.

There are an estimated 200 000 cases of yellow fever worldwide each
year, causing 30 000 deaths, according to the World Health
Organization.

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

[This same report was also issued by UB!Alert
(<http://www.ubalert.com/a/13467>). Assuming that it is accurate,
there have been 2 additional YF deaths in the past 2 days in this
region. Application of the vaccine to people in the affected area
is urgent. Odienne is one of the 58 departments of Cote d'Ivoire,
lying in the northwestern part of the country. It is within the
Denguele region, one of the 19 regions of the country.

A map showing the location of Cote d'Ivoire in West Africa can be
accessed at
<http://lib.utexas.edu/maps/africa/ivory_coast_pol88.jpg>. A map
showing the Denguele region can be accessed at
<http://en.wikipedia.org/wiki/File:Coted ... nguele.png>. The
HealthMap/ProMED-mail interactive map of Cote d'Ivoire can be
accessed at <http://healthmap.org/r/00-v>. - Mod.TY]