Wüstenschiff

Yellow fever in Cameroon
24.02.2010 - WHO

On 17 February 2010, the Ministry of Health (MoH) in Cameroon reported three cases of Yellow Fever in Banjoun and Fantun districts of the country's Western Region.

The index case was identified in a 28 year-old man from Bandrrefan village in Bandjoun district, who presented with a clinical picture of fever, jaundice and abdominal pain at the end of December 2009. He had no history of Yellow Fever vaccination and died on 7 January 2010, 3 days after his medical consultation. During the same period, a second case was reported in a 19 year-old male from the same village, who died on 23 January 2010, three days after he consulted the district hospital.

The two cases were identified through routine Yellow Fever surveillance. Specimens from both cases were confirmed by laboratory tests from the Pasteur Centre of Cameroun and the Regional reference laboratory for Yellow Fever at Institut Pasteur in Dakar, Senegal.

Following identification of the two cases, an outbreak investigation was conducted in December 2009 in Fombat district, neighbouring Banjoun district. The investigation identified a third case in a 40 year-old man who died in October 2009. The case was later laboratory confirmed with Yellow Fever. Serum samples were taken from 77 ''contact persons'' of this case, all of which tested negative for Yellow Fever.

Cameroon conducted a Yellow Fever mass vaccination campaign in 62 at-risk-districts covering a population of 7.4 million in May 2009. The two districts of Banjoun and Fantun were however, not part of the campaign earlier because they did not have any cases of Yellow Fever when the vaccination campaign took place in May 2009.

The Ministry of Health plans to vaccinate 254,355 people in Banjoun and Fantun districts. The country has requested support from the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG), which manages the global emergency stockpile of yellow fever vaccine. The ICG has approved support for the vaccination campaign, which will be financed by the GAVI Alliance through the World Health Organization.

MENINGITIS, MENINGOCOCCAL - AFRICA: WHO MENINGITIS REGION
*********************************************************
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] Meningitis belt
[2] Ghana (Upper West)
[3] Burkina Faso

******
[1] Meningitis belt
Date: Tue 22 Feb 2010
Source: Thomson Reuters Foundation AlertNet, UN-OCHA IRIN (Integrated
Regional Information Networks) [edited]
<http://www.alertnet.org/thenews/newsdes ... 74f193.htm>


A meningitis epidemic has struck earlier than usual and is spreading across
sub-Saharan Africa's "meningitis belt" from Senegal to Ethiopia, according
to health ministries in the region. The disease occurs during the dry
season, with most cases reported in mid-April.

As of 7 Feb [2010], health ministries in high-risk countries reported 2298
cases, with a 13 per cent fatality rate. Burkina Faso has reported the
highest number of cases, but Togo has experienced the highest fatality
rate, where 25 of 108 infected people died [23 percent fatality rate]. The
World Health Organization (WHO) described the situation as "alarming."

Mamoudou Harouna Djingarey, a WHO epidemiologist and meningitis expert,
told IRIN it was still not clear why infections were spreading earlier than
expected. "This [timing] is a sign of a major epidemic risk if no action is
taken," he warned. Extensive meningitis outbreaks tended to occur every 8
to 10 years, he said, but were now occurring about every 4 years. In the
2009 meningitis season, 14 African countries reported a total of 78 416
suspected cases, including 4053 deaths, the largest number of infections
since the 1996 epidemic.

Studies are being carried out to determine whether climatic and
environmental factors might be influencing the extent of the current
epidemic. Djingarey told IRIN that infections had also been reported
further south than usual, including in Uganda, Kenya, and Democratic
Republic of Congo.

Burkina Faso: on 17 Feb 2010 the Health Ministry in Burkina Faso reported
1251 meningitis cases, with a 15.4 per cent fatality rate. This time last
year [2009] there were 25 per cent less infections, but a similar
percentage of deaths. The disease has reached epidemic proportions in Pama
in the east, Titao in the north, Sapouy in the centre west, and Batie in
the south east, defined by WHO as areas where at least 10 out of 100 000
people are infected. 3 other districts with half as many reported
infections are on alert, according to Burkina Faso's Ministry of Health.

Vaccinations have been carried out in Pama and Titao, and more are
scheduled to take place in the centre west on 20 Feb 2010. "If we can react
quickly the numbers will drop," Health Ministry epidemiologist Jean Ludovic
Kambou told IRIN.

WHO recommends vaccinating everyone aged from 2 to 29 years and living in
an epidemic zone, as well as people in neighbouring areas that are on
"alert". If the country does not have enough vaccine, it can request
no-cost or minimal-cost vaccines from a meningitis vaccine stock managed by
WHO. Alejandro Costa, a WHO vaccine scientist, told IRIN no countries have
requested vaccines as of 19 Feb 2010.

Costa told IRIN 100 000 doses of vaccine from the stockpile had been sent
to Chad, which did not have vaccines on hand but was facing an epidemic in
the southern regions of Mandoul and Logone Orientale [see ProMED-mail post
Meningitis - Chad: (LR,MA) RFI 20100223.0600]. Chad's Ministry of Health
said 42 000 people in the southern town of Doba needed vaccination.

On 19 Feb 2010 the government reported 507 meningitis infections that have
led to 56 deaths, an 11 per cent fatality rate.

--
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[ProMED-mail posted a report of an outbreak of meningitis in Chad last year
(2009) that involved _Neisseria meningitidis_ serogroups A and W135 (see
Meningitis, meningococcal - Chad (02) 20090424.1544); meningitis due to
these serogroups is potentially vaccine-preventable. In a recent
ProMED-mail post, the news release did not specify the microbial etiology
of the current meningitis outbreak in Chad or the serogroup specificity of
the meningococcal vaccine that is being used (see Meningitis - Chad:
(LR,MA) RFI 20100223.0600). The news release above also fails to identify
which serogroups are involved in the current outbreaks in Burkina Faso or
Chad or the serogroup specificities of the meningococcal vaccines that are
being used.

Maps of the African bacterial meningitis belt can be found at
<http://wwwnc.cdc.gov/travel/images/380.ashx> and
<http://upload.wikimedia.org/wikipedia/c ... ld-Map.png>.
- Mod.ML]

******
[2] Ghana (Upper West)
Date: Tue 23 Feb 2010
Source: Ghana News Agency (GNA) [edited]
<http://www.ghananewsagency.org/s_health/r_12822/>


Dr Alexis Nang-beifubah, regional director of health services, told GNA
[Ghana News Agency] on Tuesday [23 Feb 2010] that 17 people have died from
an outbreak of a new strain of cerebrospinal meningitis in the Upper West
Region since January 2010. He said 15 out of the 96 cases reported have
been confirmed to be [_Neisseria] meningitidis_ [serogroup] W135, which is
being seen for the 1st [time] in Ghana.

Jirapa District has recorded 53 cases of the disease with 8 deaths; Wa
Municipality, 17 cases with 5 deaths; Nadowli District 14 cases with 4
deaths while Lawra and Wa East Districts have registered 11 cases and a
case, respectively, with no deaths.

Dr Nang-beifubah, who updated the GNA on the disease situation in an
interview, said the W135 type is common in neighbouring Burkina Faso and
different from the _Neisseria [meningitidis]_ type, [serogroup] "A," which
is known in the Region. He said the health directorate had no vaccines for
the W135 type [?] A, which was emerging in the area for the first time. Dr
Nang-beifubah said 8 cases were initially reported in Jirapa but the number
rose to 13 the following week.

The Health Directorate has mobilized personnel, vaccines and other
logistics to the Districts to vaccinate the people against type A, while
monitoring the trend in all the 9 districts of the Region. Dr Nang-beifubah
said the situation was under control as all Epidemic Management Committees
in the Districts had been reactivated to help to strengthen local
surveillance on the disease. He said Sissala West; Sissala East; Wa West
and Lambussie/Karni Districts have not yet recorded cases of the disease.
He advised people in the Region to avoid overcrowding and to sleep in
ventilated rooms, as well as drink sufficient water and fluids.

--
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[Although the news release above says that the meningococcal serogroup
involved in the Ghana meningitis outbreak is W135, for which no specific
vaccine is currently available in Ghana, they are, nevertheless,
vaccinating the population at risk with meningococcal serogroup A vaccine,
which, of course, will be ineffective for preventing infection due to
serogroup W135. - Mod.ML

Maps showing the regions and districts of Ghana can be seen at
<http://en.wikipedia.org/wiki/Ghana#Regi ... _districts>. The
HealthMap/ProMED-mail interactive map of the country is available at
<http://healthmap.org/r/0182>. - Sr.Tech.Ed.MJ]

******
[3] Burkina Faso
Date: Fri 19 Feb 2010
Source: AllAfrica, Sidwaya Quotidien report [in French, trans.
Sr.Tech.Ed.MJ, edited]
<http://fr.allafrica.com/stories/201002190145.html>


Since the beginning of the year [2010], meningitis has already killed over
100 people. The Ministry of Health provided an update and announced new
measures.

Meningitis is still present, with its grisly statistics: 4 health districts
are experiencing an epidemic and 193 people of the 1252 suspected cases
reported from 1 Jan to 14 Feb 2010 have died, according to data from the
National Committee on the Management of Epidemics, which met Wednesday [17
Feb 2010] evening with minister Seydou Bouda. The victims include people
who have been vaccinated. 7 health districts have reached the alert
threshold for meningitis. Among them 4 are facing an epidemic situation.

Of note are the health districts of Titao with an attack rate of 20.2 per
1000 inhabitants, Pama (13.3 per 1000), Batie (11.5 per 1000), and Sapouy
(11 per 1000). The health districts of Kongoussi, Nanoro, and Leo have
crossed the alert threshold. The causative agent of this epidemic is
meningococcus serogroup A.

The Ministry of Health claims to have already taken action to contain the
epidemic. Vaccination campaigns have been effective in some localities. "We
have already begun reactive vaccination campaigns in the health districts
of Pama and Titao," said the director of control of the disease, Sylvester
R Tiendrebeogo. [The Ministry] is also making available drugs and
consumables in the 13 health regions, university hospitals, and regional
hospitals, at no cost, as well as disseminating awareness messages in the
local languages.

In the presence of certain technical and financial partners, the minister
asked the regional directors of health and executives involved in the
management of epidemics to examine "what went wrong" in order to control
the disease in the future, especially since the situation has slightly
worsened this year [2010] as compared to the same period in 2009. For 948
deaths, the fatality rate of meningitis was 14.56 per cent from the 1st to
the 6th week [29 Dec 2009 - 11 Feb 2010] of 2009, against 15.43 per cent
this year [28 Dec 2009-14 Feb 2010]. Minister Seydou Bouda considers these
numbers "still too high" for the expectations and everyone should share
responsibility and include in their plans the epidemics and in particular
meningitis epidemics. Technicians should seek to reduce as much as possible
the processing of samples and to remove all obstacles to the prompt access
to vaccines in areas of need as well as review the chain of coordination of
reactive control.

The current system is such that persons in a district facing an epidemic
must travel to Ouagadougou to obtain the necessary vaccines. In addition
there are formalities that at certain levels must be fulfilled during a
working day, the vehicles are not necessarily available in the provinces,
and neither are the financial resources to pay the persons in charge of
vaccination. Some have proposed that the alert team at the central level
work day and night, transport the vaccines to epidemic areas, and at the
same time deal with the formalities.

The idea to place a sufficient amount of vaccine in the districts is not
currently feasible. The existing amount of vaccines will allow for a
"dusting" in small quantities and unable to cope with a large-scale
vaccination where necessary. In other words, it will be difficult to
collect these vaccines once they have been distributed across 63 districts,
if there is an emergency in a given region. Earlier this season, the
Ministry of Health had about 850 000 doses of vaccine in stock. To date,
"there is a stock of about 730 000 (728 370) doses," says Dr Tiendrebeogo.
A new order has been placed," he said.

The quality of the meningococcal vaccine is not in question at the moment.
The new concern for this "epidemic season" of meningitis is that people who
were vaccinated in 2009 still contracted the disease. This is the case in
Titao in the Nord Region. "People vaccinated in 2009 as well as those who
weren't have contracted the disease," says a report of the epidemiological
surveillance service. The report states that of 54 patients, more than half
(51.9 per cent) reported having been vaccinated.

For the director of disease control, it is possible that the bodies of
vaccinated people were debilitated by other reasons, which would prevent
the development of the necessary immunity to counteract the infection. He
added, "We are in a context where there is malnutrition, which might
explain why persons vaccinated do not develop satisfactory immunity.

He emphasized that the vaccine available against serogroup A meningococcus
has a success rate of 95 per cent. In his view, the effectiveness of the
vaccine "may arise" as a question of scientific rigor. But he wants the
Burkinabe to understand that people can miss a vaccination campaign given
the population movements, and that they may still contract the disease upon
returning to an already vaccinated area.

For her part, Professor Ramata Ouedraogo, microbiologist, said that the
current vaccine against meningococcus A does not protect from other types
of meningitis and pointed out that "people can acquire another type of
meningitis next year even when they say they have been vaccinated." Health
authorities have given priority to meningococcus A, which according to
experts is responsible for almost all outbreaks in the country.
Nonetheless, treatment for other types of meningitis is also available.
Thus, 20 000 doses of [ACW135Y vaccine against 4 strains of meningococcus]
are ready. For financial reasons, the government lacks sufficient doses of
vaccines against all strains of the bacterium.

The technicians commented on the case of Titao. Of a total of 62 reported
cases, 42 cases (68 per cent) were in people from villages neighboring
Mali, and others directly from Malian villages.

Minister Seydou Bouda issued an order for everyone to be vaccinated, no
matter how transient, or whether they come from neighboring Mali. "Anyone
who comes to you must be vaccinated in order to break the chain of the
epidemic," he said.

The Committee on the Management of Epidemics has recommended the
organization of a cross-border meeting with health authorities in Mali and
that samples of cerebrospinal fluid continue to be taken for monitoring the
bacteria.

WHO, in partnership with the European Union, is considering the possibility
of a vaccination campaign at a regional level (Economic Community Of West
African States - ECOWAS). "We are in the process of discussing the issue,"
says Henriette Nikiema, representing the EU on this occasion. UNICEF has
pledged some 63 million francs CFA [approx. USD 130 000] to facilitate the
acquisition of doses of vaccine, but also to strengthen the capacity of
laboratory technicians, the laboratory technical platform, and the
transport of samples.

Though not the most deadly, meningitis is the disease most feared by the
people of Burkina Faso, by the authorities, and even by the technical
partners. Despite monitoring and response systems repeatedly corrected, the
disease always manages to strike. The new announced conjugate vaccine
provides great hope.

[byline: Aime Mouor Kambire]

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

There are several different types of meningococcal vaccines that use
meningococcal polysaccharides as the immunogen: the vaccines may contain
one or more of the polysaccharide serogroups alone or conjugated to
protein. Meningococcal vaccines will only protect against meningitis due to
the meningococcal polysaccharide serogroups that the vaccine contains.
Polysaccharide vaccines, which have been available for more than 30 years,
exist for serogroups A, C, Y, and W-135 in various combinations (such as, a
bivalent AC, trivalent ACW-135, and a tetravalent ACYW-135 polysaccharide
vaccine). There is a monovalent protein conjugate vaccine against serogroup
C and a tetravalent against serogroups A, C, Y, and W-135.

Although children as young as 3 months of age may have an immunologic
response to the serogroup A antigen contained in the meningococcal
polysaccharide vaccines, response to the other serogroup antigens is poor
in children younger than 2 years of age. These vaccines also only provide
protection for up to 3 years. In contrast, the meningococcal conjugate
vaccines induce a T-cell-dependent response, resulting in an improved
immune response in infants, provide long-lasting immunity, and prevent
nasopharyngeal carriage of _N. meningitidis_, thus reducing transmission of
this microorganism person-to-person
(<http://www.nfid.org/pdf/publications/me ... alepid.pdf>).

A preventive strategy based on conjugate vaccines could have a
significantly larger and more enduring impact on attempts to control the
yearly recurrences of this disease that causes considerable morbidity and
mortality, especially among children
(<http://www.jidc.org/index.php/journal/a ... 745499/102>).

All these vaccines have been proven safe and effective with infrequent and
mild side effects. For both the meningococcal conjugate and the
polysaccharide vaccines, approximately 7-10 days are required following
vaccination for development of protective levels of anti-meningococcal
antibodies.

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

The news release above says that health authorities believe that
meningococcus serogroup A, which has been responsible for almost all
outbreaks in the Burkina Faso, is also responsible for the current
outbreak, but that people who were vaccinated in 2009, presumably with
meningococcal serogroup A vaccine, still contracted the disease, presumably
due to serogroup A meningococci. They discount loss of vaccine potency.
However, both the polysaccharide and the conjugate vaccines require proper
refrigeration; improper storage or handling of vaccines may result in loss
of vaccine potency and reduced immune response in vaccinees. Also, they
will not prevent meningococcal infection caused by meningococcal serogroups
not represented in the vaccines and will not prevent meningitis caused by
other pathogens, such as _Streptococcus pneumoniae_, a pathogen also known
to cause outbreaks in the African "meningitis" region (see ProMED-mail post
Meningitis, pneumococcal - Africa: WHO meningitis region 20100213.0507). -
Mod.ML

The HealthMap/ProMED-mail interactive map of Burkina Faso is available at
<http://healthmap.org/r/0188>. The departments mentioned can be located via
the maps at <http://en.wikipedia.org/wiki/Communes_of_Burkina_Faso>. -
Sr.Tech.Ed.MJ]

CHIKUNGUNYA (04): MADAGASCAR (FIANARANTSOA)
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 25 Feb 2010
Source: M&C, Deutsche Presse-Agentur report [edited]
<http://www.monstersandcritics.com/news/ ... 36573.php/>


A district in the south east of the impoverished Indian Ocean island of
Madagascar is battling a outbreak of the mosquitoborne chikungunya or
"stooped walk" virus, a local newspaper reported on Thursday [25 Feb 2010].

Chikungunya virus, which is transmitted by a bite from an infected
mosquito, causes high fever, headaches, and severe joint pain that can last
several weeks.

Around 44 000 families in and around Mananjary, a small port town on the
Mananjary River [Fianarantsoa Province], have been affected by the
outbreak, the Malaza daily reported.

The virus gets its name from the Swahili for "stooped walk", after the
appearance of a person affected by the disease, according to the World
Health Organization (WHO).

The latest outbreak in Madagascar has spread rapidly since the 1st case was
diagnosed in the capital Antananarivo on 11 Feb [2010]. Over 60 per cent of
the population in 8 Mananjary neighbourhoods were receiving medical
attention after displaying symptoms, the report said.

Checkpoints had been set up on access roads leading to the town and all
incoming vehicles were being sprayed with insecticide.

There are no specific treatments nor a vaccine for chikungunya [virus],
which occurs during the rainy season in parts of Africa, Southeast Asia,
southern India, and Pakistan, according to the WHO. The virus is rarely
deadly, but a number of fatalities were reported during a severe outbreak
in La Reunion Island near Madagascar in 2005-2006.

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

[One hopes that this is not a harbinger of anther massive chikungunya
outbreak in Indian Ocean Islands. Madagascar experienced a large
chikungunya virus outbreak in 2006, with sporadic cases since, the last 2
having occurred on 1 Jun 2009 (see ProMED-mail archive no. 20090611.2156).

A HealthMap/ProMED-mail interactive map showing the location of Madagascar
Island in the Indian Ocean and its capital Antananarivo can be accessed at
<http://healthmap.org/r/018m>. - Mod.TY]

HEPATITIS E VIRUS - UGANDA: (MOROTO)
************************************
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Date: Thu 25 Feb 2010
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/Magazines/Heal ... index.html>


Hepatitis E spreading fast
--------------------------
At least 28 people have been admitted to Moroto Government Hospital
following an outbreak of hepatitis E, a contagious viral disease. The
district health inspector, Mr Martin Eyura, said investigations carried out
by the district health workers in Moroto Municipality confirmed that the
disease has broke out in the 4 suburbs of Police Barracks, Singila,
Nakapelimon, Junior Quarters, and in Matany Trading Centre outside the
municipality a month ago before spreading to other areas.

"We heard it had broken out in Kaabong District [Moroto District lies to
the south east of Kaabong District. - Mod.CP] but you know people here are
careless. They defecate anywhere, leaving the human waste to become a
breeding place for the disease."

There are 9 cases from Singila, 7 from Nakapelimon, 5 from Junior Quarters,
and another 7 from Matany Trading Centre admitted at Moroto Government
Hospital and the disease seems to be spreading fast," the district health
inspector, Martin Eyura, said. Reports at the hospital confirm that 28
people who have been admitted to the health unit, have been tested and
discovered to have hepatitis E.

The nurses at the hospital, who preferred anonymity, said that 8 cases had
first been registered but the numbers have since increased to 28. District
leaders and health workers in Kaabong managed to fight diseases with good
hygiene and sanitation unlike in Moroto where people are not using
pit-latrines, including market vendors who use a seasonal river, Nangololo
in Moroto Municipality to ease themselves. Mr Eyura also attributed the
surge in hepatitis E cases to poor sanitation. "The district health team is
moving door to door, surveilling and sensitising locals about the disease
to help bring down the number of victims.

"Hepatitis E is a viral disease that affects the liver and if it is not
treated well, it kills very fast," he said, adding that most patients are
complaining of headache, fever, nausea, vomiting, loss of appetite,
abdominal pain, diarrhoea, jaundice, heartburn, dark urine, and pain, which
are all symptoms of the disease. Hepatitis E is a limiting disease that may
occur after natural disasters because of consumption of faecally
contaminated water or food. It is caused by infection with the hepatitis E
virus, a non-enveloped, positive-sense, single-stranded RNA virus. Although
man is considered the natural host for hepatitis E virus, antibodies to
hepatitis E virus or closely related viruses have been detected in primates
and several other animal species. Drinking faecally contaminated water has
given rise to epidemics, and consumption of raw or half-cooked shellfish
has been the source of sporadic cases in endemic areas.

Mr Eyuru maintains that people most at risk of the disease are 15-40 year
olds, including pregnant women and people living with HIV/AIDS. He adds
that the disease can be prevented if everyone disposes of their waste
properly, and appeals to local district leaders to play their role in
helping the health teams ensure that people are sensitised about the
disease to avoid further spread.

The deputy resident district commissioner, Mr Bob Opio, also urged the
residents to make use of pit latrines and observe hygiene and sanitation to
save their lives. "The government is committed to making sure that people
are protected from diseases. but we must also do our part."

[byline: David Mafabi]

--
communicated by:
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[Moroto District is a district in north eastern Uganda. Like other Ugandan
districts, it is named after its "chief town", Moroto, where the district
headquarters are located. A map of Uganda showing the location of Moroto
District can be accessed at <http://en.wikipedia.org/wiki/Moroto_District>
The HeathMap/ProMED-mail interactive map if the country is available at
<http://healthmap.org/r/017y>.

Hepatitis E virus is transmitted via the faecal-oral route. Hepatitis E is
a waterborne disease, and contaminated water or food supplies have been
implicated in major outbreaks. Consumption of faecally contaminated
drinking water has given rise to epidemics, and the ingestion of raw or
uncooked shellfish has been another source of sporadic cases in endemic
areas. There is a possibility of zoonotic spread of the virus, since
several non-human primates, pigs, cows, sheep, goats, and rodents are
susceptible to infection.

The risk factors for hepatitis E virus infection are related to poor
sanitation in large areas of the world. In Uganda past outbreaks have often
occurred in camps for IDPs (internally displaced persons) or refugees from
elsewhere. Person-to-person transmission is uncommon. There is no evidence
for sexual transmission.

In general, hepatitis E is a self-limiting viral infection followed by
recovery. Prolonged viraemia or faecal shedding are unusual and chronic
infection does not occur. At present, no commercially available vaccines
are available for the prevention of hepatitis E. - Mod.CP]

CHIKUNGUNYA (06): MADAGASCAR (FIANARANTSOA)
****************************************************
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ProMED-mail is a program of the
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******
Madagascar (Fianarantsoa)
Date: Sun 28 Feb 2010
From: Jean-Michel Heraud <jmheraud@pasteur.mg> [edited]


On 10 Feb [2010], after observing an increase in the number of
dengue-like syndromes at the primary health care in Mananjary
(Vatovavy-Fitovinany) [Fianarantsoa province], the health district
medical officer shipped 11 specimens to the National Reference
Laboratory (NRL) at the Institut Pasteur from Madagascar for
arboviruses analysis.

On 11 Feb 2010, by RT-PCR and after isolation on AP61 cell line,
viral RNA from chikungunya virus (CHIKV) was detected in all
specimens. NRL sent an alert to the Ministry of Health (MoH).

A team composed of staff from MoH, WHO, and Institut Pasteur from
Madagascar (epidemiologist and entomologist) went to Mananjary for
investigation. Specimens from 91 outpatients with dengue-like
syndromes were collected as well as larvae of mosquitoes.

As of 24 Feb [2010], NRL detected CHIKV in 95 out of 102 sera. Health
authorities said that the total number of suspected cases is 1507
representing 58 percent of total consultant [patients]. 4 other
cities close to Mananjary had confirmed and suspected cases. Health
authorities and technical partners are following closely the
situation in affected district but also in neighboring districts.

--
Dr Jean-Michel Heraud
Head of Virology Unit (NRL)
Institut Pasteur from Madagascar
<jmheraud@pasteur.mg>

[Dr Heraud's information concerning the chikungunya outbreak directly
from the field in Madagascar and providing laboratory confirmations
of chikungunya virus infection is most welcome. One hopes that the
case and vector surveillance and mosquito control can slow this outbreak.

Vatovavy-Fitovinany, in Fianarantsoa province, is the Southeast
region of Madagascar. A map showing its location can be accessed at
<http://mapsof.net/madagascar/static-map ... any-region>.
A HealthMap/ProMED-mail interactive map of Madagascar can be accessed
at <http://healthmap.org/r/018m>. - Mod.TY]

Burkina Faso - Meningokokken-Meningitis
02.03.2010

Während der Trockenzeit (Dezember-April) kommt es in den Ländern des Afrikanischen Meningitisgürtels regelmäßig zu Meningokokken-Epidemien. Die diesjährige Epidemie trifft das Land früher und härter als erwartet; im Februar wurden bereits 1.251 Fälle mit ca. 200 Todesfällen registriert. Während der letzten Meningokokken-Saison infizierten sich in Afrika fast 25.000 Personen, von denen mehr als 1.500 verstarben. Impfschutz (ACWY) beachten. / Quelle: crm
____________________

Togo - Meningokokken-Meningitis
02.03.2010

Die diesjährige Meningitis-Epidemie trifft Togo früher und härter als erwartet mit 25 Toten bei bislang 108 Erkrankungsfällen. Es ist noch unklar, ob dies Anzeichen einer weiteren großen Epidemie sind, nachdem bereits 2009 nahezu 80.000 Menschen mit über 4.000 Toten durch Meningitis in Afrika zu beklagen waren. Impfschutz beachten. / Quelle: crm

Burkina Faso - Meningokokken-Meningitis
02.03.2010

Während der Trockenzeit (Dezember-April) kommt es in den Ländern des Afrikanischen Meningitisgürtels regelmäßig zu Meningokokken-Epidemien. Die diesjährige Epidemie trifft das Land früher und härter als erwartet; im Februar wurden bereits 1.251 Fälle mit ca. 200 Todesfällen registriert. Während der letzten Meningokokken-Saison infizierten sich in Afrika fast 25.000 Personen, von denen mehr als 1.500 verstarben. Impfschutz (ACWY) beachten. / Quelle: crm
_____________________________

Kamerun - Gelbfieber
02.03.2010

Im Bandjoun und Fantun Distrikt im Westen Kameruns sind erneut 3 Todesfälle nach einer Gelbfiebererkrankung bekannt geworden. Kamerun hat 2009 eine Massenimpfung in mehr als 60 Distrikten mit annähernd 7.4 Millionen Menschen durchgeführt, von der die genannten Distrikte bewusst ausgeschlossen wurden, da dort zuvor noch keine Gelbfiebererkrankungen aufgetreten waren. Impfschutz dringend empfohlen und ohnedies für alle Reisenden bei Einreise vorgeschrieben. / Quelle: crm
_____________________________

Madagaskar - Chikungunya
02.03.2010

In der an der Ostküste der Insel gelegenen Stadt Mananjary und ihrer Umgebung (Provinz Fianarantsoa), sind mehr als 44.000 Familien von einem Chikungunya-Ausbruch betroffen. Ausgangspunkt der Epidemie, die sich rasch ausgebreitet hat, war die Hauptstadt Antananarivo, wo Mitte Februar erste Fälle gemeldet wurden. Das Virus wird durch infizierte Mücken übertragen. Es führt zu Fieberattacken, Kopf- und Gliederschmerzen, die oft wochenlang anhalten. Zwar verläuft die Infektion selten tödlich, es gibt aber auch keine spezifische Behandlung oder Immunprophylaxe. Der letzte Ausbruch von Chikungunya in Madagaskar ereignete sich im Jahr 2006. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm
_____________________________

Togo - Meningokokken-Meningitis
02.03.2010

Die diesjährige Meningitis-Epidemie trifft Togo früher und härter als erwartet mit 25 Toten bei bislang 108 Erkrankungsfällen. Es ist noch unklar, ob dies Anzeichen einer weiteren großen Epidemie sind, nachdem bereits 2009 nahezu 80.000 Menschen mit über 4.000 Toten durch Meningitis in Afrika zu beklagen waren. Impfschutz beachten. / Quelle: crm

Madagaskar - Chikungunya
02.03.2010

In der an der Ostküste der Insel gelegenen Stadt Mananjary und ihrer Umgebung (Provinz Fianarantsoa), sind mehr als 44.000 Familien von einem Chikungunya-Ausbruch betroffen. Ausgangspunkt der Epidemie, die sich rasch ausgebreitet hat, war die Hauptstadt Antananarivo, wo Mitte Februar erste Fälle gemeldet wurden. Das Virus wird durch infizierte Mücken übertragen. Es führt zu Fieberattacken, Kopf- und Gliederschmerzen, die oft wochenlang anhalten. Zwar verläuft die Infektion selten tödlich, es gibt aber auch keine spezifische Behandlung oder Immunprophylaxe. Der letzte Ausbruch von Chikungunya in Madagaskar ereignete sich im Jahr 2006. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm

Madagaskar - Chikungunya
08.03.2010

In der an der Ostküste der Insel gelegenen Stadt Mananjary und ihrer Umgebung (Provinz Fianarantsoa) wurden 1.507 Chikungunya-Infektionen bestätigt. Insgesamt sind in der Region mehr als 44.000 Familien durch einen Ausbruch der durch Mücken übertragenen Viruskrankheit gefährdet. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (06): AFRICA
********************************************************
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], [3] Cholera - Mozambique
[4] Cholera - Zambia
[5] Cholera - Uganda (Manafwa)
[6] Cholera - Angola

*****
[1] Cholera - Kenya
Date: Fri 19 Mar 2010
Source: UN Integrated Regional Information Networks (IRIN) [edited]
<http://www.irinnews.org/Report.aspx?ReportId=88487>


As of 15 Mar 2010, 15 districts nationwide were affected with
cholera, with 663 cases confirmed since January 2010, according to a
Ministry of Public Health and Sanitation update. At least 15 deaths
have been recorded. Worst affected are parts of Coast, Eastern and
Rift Valley provinces. Kajiado District, in Rift Valley, has 177 cases.

In 2009, at least 781 cholera cases were laboratory confirmed with
274 deaths, in an outbreak attributed to widespread water shortages
because of drought, contaminated dry river beds and poor hygiene.

At present, more cholera deaths and cases are being reported in
remote areas. Suspected cholera deaths have been reported in the
northwestern Turkana Central District, the medical officer, Kilkrist
Lokoyer, told IRIN.

"We have sent a medical team from Lodwar [the main town] to Mugur
area where 5 people have reportedly died after vomiting and
diarrhoea. We will conduct an audit to ascertain if it is indeed
cholera that killed them," said Lokoyer. Mugur is an island in the
crocodile-infested Lake Turkana making it difficult to access, he said.

Some 127 cases of cholera have been recorded in the eastern district
of Tharaka since 7 Mar 2010, Justus Kitili, Tharaka medical officer,
told IRIN. A temporary outpatient treatment camp has been set up at
the worst-hit Makutano Police Post, with medical personnel from
surrounding areas mobilized to assist the sick. Other areas affected
include the villages of Ura Gate, Mauthuni, Gakauni and Gatithini.

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

[The areas mentioned can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. The
HealthMap/ProMED-mail interactive map of Kenya can be accessed at
<http://healthmap.org/r/017j> - Mod.LL]

*****
[2] Cholera - Mozambique
Date: Fri 19 Mar 2010
Source: Agencia de Informacao de Mocambique [edited]
<http://allafrica.com/stories/201003190426.html>


The Mozambican Health Ministry regards the cholera situation as
"stationary" in the 5 northern and central provinces hit by the
disease in 2010. The Ministry's spokesperson, Leonardo Chavana, told
reporters on Thu 18 Mar 2010 that in the previous 24 hours several
new cases of the disease had been notified, but no deaths were reported.

In the central province of Zambezia there had been 12 new cases, in
Cabo Delgado 9 cases were reported, in Nampula 6 and in Sofala 5. In
the 6th province affected, Niassa, there were no new cases at all.

The worst hit province is Zambezia. Since 1 Jan 2010, there have been
1188 cases notified in Zambezia and 19 deaths. The figures for Cabo
Delgado are 679 cases and 7 deaths, and for Niassa 543 cases and 13
deaths. Sofala has reported 241 cases and 1 death, and Nampula 167
cases and 1 death.

So far no cases of cholera have been reported from the southern
provinces. But Chavana said that, because of the heavy rains in the
south over the past few days, the authorities are on the alert for
possible outbreaks.

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

[The areas of Mozambique mentioned can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>.
The HealthMap/ProMED-mail interactive map of Mozambique can be seen at
<http://healthmap.org/r/00V3>. - Mod.LL]

*****
[3] Cholera - Mozambique
Date: Sat 13 Mar 2010
Source: Targana.com [edited]
<http://blog.taragana.com/health/2010/03 ... ted-20409/>

Mozambique's health ministry spokesman says the country's cholera
outbreak has now killed 42 people in the northern and central parts
of the southern African country. Leonardo Chavane says the disease is
spreading, with more than 2600 cases of people who have contracted
the contagious yet easily preventable infection in 2010.

He said that the situation remains worrying as some provinces hit by
cholera are now also affected by flooding, which is likely to spread
the disease further.

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


*****
[4] Cholera - Zambia
Date: Fri 19 Mar 2010
Source: Africa News [edited]
<http://www.africanews.com/site/Zambia_1 ... ages/30714>


A total of 11 people have died of cholera in Zambia since the
outbreak of the disease at the onset of rainy season in late 2009.
The waterborne disease is endemic in the southern African state
during the wet and rainy season of October to March.

According to the Ministry of Health spokesperson Reuben Kamoto Mbewe,
there has also been an increase in cholera cases from 241 in February
2010 to 564 in March 2010. He said, however, that the Ministry of
Health has continued to monitor the situation from escalating and
that basic water and sanitation measures are being provided to
vulnerable communities nationwide.

[Byline: Sanday Chongo Kabange]

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

[A map of Zambia can be found at:
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>.
The HealthMap/ProMED-mail interactive map of Zambia can be seen at
<http://healthmap.org/r/017q>. - Mod.LL]

*****
[5] Cholera - Uganda (Manafwa)
Date: Sat 6 Mar 2010
Source: The Monitor [edited]
<http://www.monitor.co.ug/News/National/ ... /wj65dk/-/>


The landslide affected area of Bududa District is on high alert for a
cholera outbreak, as the infection has already been confirmed in the
neighboring district of Manafwa, with further suspected infections in Butaleja.

"Several cases of cholera have been confirmed in Manafwa," said
Ministry of Health spokesman Paul Kagwa. "The Ministry of Health has
sent a team to assess the situation and determine an effective response."

Mr. John Bosco Isunju, a lecturer at the School of Public Health,
Makerere University, said the concentration of displaced people in
nearby villages and relief camps would increase the risk of cholera.

"Effort needs to be put on providing clean and treated water for
people to drink," Mr Kagwa said.

[Byline: Katherine Haywood]

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

[Manafwa District is in the Eastern Region of Uganda. The district
was created in 1999 and was part of Mbale district, together with
Sironko district, before 1999. In 2006, the northern part of Manafwa
District was carved off to form Bududa district. The districts can be
seen on the map 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/016Z>. - Mod.LL]

*****
[6] Cholera - Angola
Date: 3 Mar 2010
Source: Angola Press [edited]
<http://www.portalangop.co.ao/motix/en_u ... 301a3.html>


A total of 6 cases of cholera disease were reported in the last 48
hours in the municipal hospital of Tombwa, southern Namibe province,
Dr. Tomas Dias told Angola Press.

According to the doctor, the districts of Rocha Magalhaes and Pinda
are the hardest hit by the disease due to shortages of potable water.
He added that the Namibe province health authority on Monday [1 Mar
2010] started a training action of emergency teams. Those teams were
to be sent to different places in the province to diffuse an
awareness campaign to prevent the disease. He added that following
the cholera outbreak the province is now under epidemiological surveillance.

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

[The HealthMap/ProMED-mail interactive map of Angola is available at
<http://healthmap.org/r/017M>. - Mod.LL]

CHIKUNGUNYA (10): MADAGASCAR
****************************
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 18 Mar 2010
Source: Clicanoo.com [in French, trans. Mod.TY, edited]
<http://www.clicanoo.com/index.php?id_ar ... ge=article>


Swept by a storm a week ago, southeast Madagascar is at the same time
hit by a chikungunya [virus infection] epidemic. At least 2000 cases
were recorded in Mananjary.

Double trouble for Malagasies. After the storm "Hubert" that has
battered part of the Big Island (54 dead, 97 589 victims, and 38 188
homeless), the disease is just now the challenge. And the events
unfold exactly the same area, southeast, in the region
Vatovavy-Fitovinany, located in the province of Fianarantsoa. "We had
an epidemic signal the end of last week [week of 8 Mar 2010]," said
Dr Jean-Louis Solet, a physician epidemiologist at the interregional
cell for epidemiology (CIRE), Reunion-Mayotte.

There is an epidemic of chikungunya [virus infection] in the town of
Mananjary, with over 2000 suspected cases identified. "The laboratory
of the Pasteur Institute, based in Antananarivo has laboratory
confirmed 100 [chikungunya] cases. Yet in the Malagasy press, it is
reported that there are "37 cases". The daily newspaper "L'Express de
Madagascar" describes the situation there: "This disease has a
peculiar character. It causes a sort of paralysis of the lower limbs,
paralysis that also affects the hip. Which is why local people have
called it "Kilalaka 2010", referring to the "dahalo" dance which is
very popular at the moment."

Madagascan health officials have pressed ahead on Friday [12 Mar
2010] to see the extent of the epidemic. Furthermore, anti-mosquito
actions have been conducted with support from the Malagasy Red Cross
(MRC). "They have strengthened disease surveillance for the entire
territory," said Dr Solet. It must be said that other outbreaks of
chikungunya [disease] have been reported across the country. The
chikungunya epidemic that struck the Indian Ocean between 2005 and
2006 "had not affected all regions of Madagascar, said Jean-Louis
Solet. This can lead to small localized epidemics in [previously]
unaffected populations. "In the region affected by this new epidemic
wave, the "Hubert" storm has killed 42 people. And the natural
disaster could lead to a health disaster: "At first, the storm killed
many mosquitoes. But afterward, this will create many breeding
sites," fears the epidemiologist. And an outbreak of chikungunya,
which extends to Madagascar, can only worry Reunion [as well].

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

[The number of chikungunya cases has increased from 1507 cases
reported on 28 Feb 2010 to over 2000 in this report. The previous
report was kindly provided by Dr Jean-Michel Heraud, Head of Virology
Unit (NRL) Institut Pasteur from Madagascar. ProMED-mail would
appreciate receiving additional reports as the information on this
growing outbreak becomes available.

Vatovavy-Fitovinany, in Fianarantsoa province, is the Southeast
region of Madagascar. A map showing its location can be accessed at
<http://mapsof.net/madagascar/static-map ... any-region>.
A HealthMap/ProMED-mail interactive map of Madagascar can be accessed at
<http://healthmap.org/r/018m>. - Mod.TY]

DENGUE/DHF UPDATE 2010 (15)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


******

Japan ex Tanzania
Date: Fri 19 Mar 2010
From: Tomohiko Takasaki <takasaki@nih.go.jp> [edited]


On 9 Feb 2010 and 10 Mar 2010, 2 imported dengue cases from Tanzania
were confirmed in Japan. The 1st case was a 55-year-old male who
stayed in Tanzania from 20-27 Jan [2010] and returned to Japan on 29
Jan [2010]. On 31 Jan [2010], he developed high fever (39 deg C [102
deg F], rash, arthralgia, and thrombocytopenia (platelet count of 98
000/microL). Dengue virus type 3 (DENV-3) genome was detected in the
serum sample by real-time PCR and the virus was isolated. The
isolated DENV-3 demonstrated 99 percent homology with that previously
(GenBank No. AB447989) isolated from the patient who returned from
Cote d'Ivoire in 2008 (ProMED-mail archive no. 20080818.2573).

The 2nd case was a 23-year-old female who stayed in Dar Es Salaam,
Tanzania from 3-25 Feb [2010]. She returned to Japan on 28 Feb [2010]
via London. On 4 Mar [2010], she developed high fever (39 deg C [102
deg F]) with thrombocytopenia (platelet count of 40 000/microL),
leucopenia (WBC 1800/microL), and slight transaminase elevation (AST
154U/L, ALT 73 U/L). DENV-3 genome was detected in the serum sample
by real-time PCR. Anti-dengue IgG and IgM antibodies were positive.
Isolation of DENV is in progress.

Both cases were negative for chikungunya virus by RT-PCR.

We believe that there are the 1st 2 confirmed dengue fever cases
caused by DENV-3 among travelers to Tanzania. It is possible that
DENV-3 is being actively transmitted in Tanzania, although no dengue
outbreaks have been reported.

--
Tomohiko Takasaki <takasaki@nih.go.jp>
Moi Meng Ling <sherry@nih.go.jp>
Akira Kotaki <ak@nih.go.jp>
Ichiro Kurane <kurane@nih.go.jp>
Researcher (Virologist)
National Institute of Infectious Diseases, Japan

Mitsuo Sakamoto <infection.kawasaki@arrow.ocn.ne.jp>
Clinical medical doctor
Kawasaki Municipal Kawasaki Hospital, Japan

Kenichiro Kobayashi <simr355@yahoo.co.jp>
Clinical medical doctor
Tokyo Metropolitan Bokutoh Hospital, Japan

[ProMED-mail is grateful to the health professionals above for this
timely information. ProMED receives very few dengue outbreak reports
from Africa, so this report indicating dengue virus transmission in
Tanzania is most welcome, and we urge other health professionals with
1st-hand information of dengue virus transmission in Africa to submit
reports to ProMED as well.

A map of Tanzania can be accessed at
<http://www.lib.utexas.edu/maps/africa/t ... l_2003.jpg>.
A HealthMap/ProMED-mail interactive map of Tanzania can be accessed at
<http://healthmap.org/r/00aU>. - Mod.TY]

Kenia - Darminfektionen
23.03.2010

Risiko für Durchfallerkrankungen landesweit. Mit Cholera-Ausbrüchen ist regional zu rechnen. Seit Januar 2010 wurden 663 Erkrankungen, einschließlich 15 Todesfällen gemeldet. Insbesondere Teile der Küstenprovinz, die Ost-Provinz und die Rift Valley Provinz (177 Fälle) sind betroffen (überwiegend abgelegene Gebiete). / Quelle: crm

CHIKUNGUNYA (11): MADAGASCAR
****************************
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 24 Mar 2010
From: Jean-Michel Heraud
<jmheraud@pasteur.mg>


Regarding epidemiology situation for Chikungunya in Madagascar, the
National Reference Laboratory (NRL) would like to comment on last
post [ProMED archive number 20100323.0918].

As of 23 Mar 2010, the official situation in the region of Vatovavy
Fitovinany regarding chikungunya is as follows:
Number of specimen analyzed (since 9 Feb 2010): 126
Number of suspected cases (since 4 Jan 2010): 2680
Number of confirmed cases (since 9 Feb 2010): 111 (viral detection)
Average rate of suspected cases over total [medical] consultations: 45 percent

Since 15 Feb [2010], the number of suspected cases is decreasing to
reach 35 suspected cases over 326 consultations from 15 - 19 Feb 2010.

The 2 regions affected are on the East coast (Vatovavy Fitovinany and
Atsinana). Among these region, 5 health districts had confirmed cases
(Mananjary, Ifanadiana, Manakara, Nosy Varika and Toamasina).

--
Dr. Jean-Michel Heraud
Virology Unit (National Reference Laboratory)
Institut Pasteur de Madagascar
Antananarivo
Madagascar

[ProMED is very appreciative of this update from Dr. Heraud on the
chikungunya outbreak on Madagascar. It is good to learn that the
trend in incidence is declining.

Vatovavy-Fitovinany, in Fianarantsoa province, is the Southeast
region of Madagascar. A map showing its location can be accessed at
<http://mapsof.net/madagascar/static-map ... any-region>.
A HealthMap/ProMED-mail interactive map of Madagascar can be accessed at
<http://healthmap.org/r/018m>. - Mod.TY]

UNDIAGNOSED ILLNESS, POX VIRUS SUSPECTED - UGANDA (BUDUDA): 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: Thurs 25 Mar 2010
From: Daily Monitor (Uganda) online [edited]
<http://www.monitor.co.ug/News/National/ ... index.html>


Small pox reported in Bududa camps
--------------------------------
Four children in Internally Displaced People's camps in Bududa
District, reportedly suffering from small pox, have been taken to
Bukigai and Bulucheke Health Centres III and II, respectively.

Ms Kevin Nabutuwa, Uganda Red Cross' regional programme officer for
eastern Uganda, said last evening that the infections were registered
on Monday and Tuesday.

Spread contained
"These are cases in the IDP camps but the spread has been contained,"
she said by phone.

In Kampala, Dr Richard Nduhuura, the state minister for Health
(general duties), said he is "unaware" of the outbreak of the disease
that scientists say can kill three out of every 10 infected persons.

He referred this newspaper to the acting Director General of Health
Services, Dr Kenya Mugisha, who was unavailable for comment

Information posted on the World Health Organisation website indicates
that small pox, an ancient communicable disease infamous for killing
Queen Mary II of England, is transmitted mainly through infected
aerosols and air droplets.

"The frequency of infection is highest after face-to-face contact
with a patient," says WHO. Symptoms include fever, headache, and
back/abdominal pangs. Survivors usually remain with deep-pitted scars
(pockmarks), most prominently on the face.
--
Communicated by:
Sharon Sanders for Flutrackers.com
<ftcom@embarqmail.com>


[Natural infection with smallpox (Variola major) having been
eliminated, our past experience with these types of reports usually
reveals an outbreak of chickenpox, molluscum, or rarely true pox
virus infections such as monkeypox Of course, the possibility of
intentional or accidental release of variola is always of extreme
concern. More information is urgently requested from those with
firsthand knowledge of the situation.

A map of the Bududa district, near the Kenyan border, can be found at:
<http://www.geonames.org/7056280/bududa-district.html> - Mod.LM]