Wüstenschiff

UNDIAGNOSED ILLNESS - UGANDA: (BUKUDA) CHICKENPOX SUSPECTED
***********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
[1]
Date: Thu 25 Mar 2010
Source: The New York Times [edited]
<http://www.nytimes.com/reuters/2010/03/ ... x-who.html>


Reported Ugandan Smallpox Is Likely Chickenpox
----------------------------------------------
The World Health Organisation WHO) said on Thursday [25 Mar 2010] it
was investigating reports of suspected cases of the previously
eradicated disease smallpox in eastern Uganda. Smallpox is an acute
contagious disease and was one of the world's most feared sicknesses
until it was officially declared eradicated worldwide in 1979.

"WHO takes any report of smallpox seriously," Gregory Hartl, a
spokesman for the Geneva-based United Nations health agency, told
Reuters via email. "WHO is aware of the reports coming out of Uganda
and is taking all the necessary measures to investigate and verify."
He added that the WHO had received reports before of smallpox cases,
but they had turned out to be false alarms. "In the past, these cases
have always turned out not to be smallpox and were, usually, either
chickenpox or monkeypox cases," he said, stressing that these reports
were of suspected cases of the disease.

Smallpox was eradicated by a collaborative global vaccination
programme led by the World Health Organisation. The last known
natural case was in Somalia in 1977. Since then, the only known cases
were caused by a laboratory accident in 1978 in Birmingham, England,
which killed one person and caused a limited outbreak.

[Byline: Kate Kelland]

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

******
[2]
Date: Thu 25 Mar 2010
Source: Reuters, Africa [edited]
<http://af.reuters.com/article/topNews/i ... 6320100325>


Reported Ugandan smallpox is likely chickenpox
----------------------------------------------
Suspected cases of the previously eradicated disease smallpox in
eastern Uganda appear to be chickenpox and not the acute contagious
disease, the World Health Organisation said on Thursday [25 Mar 2010].

"It appears that the supposed cases of smallpox are actually cases of
chickenpox, and that they have occurred over the past 3 weeks -- this
is not an acute event," WHO spokesman Gregory Hartl said in a
statement. "WHO has communicated this latest information to its member states."

The WHO said earlier on Thursday [25 Mar 2010] it was investigating
reports of suspected cases of smallpox in eastern Uganda. Smallpox
can sometimes be confused with chickenpox, a worldwide infection of
children that is very rarely dangerous.

Smallpox kills around 30 percent of its victims and was one of the
world's most feared sicknesses until it was officially declared
eradicated worldwide in 1979. Chickenpox produces much more
superficial lesions which tend to appear more on the trunk than the
face or hands.

--
Communicated by:
Patricia A. Doyle DVM PhD
Tropical Agricultural Economics
Univ of West Indies
<dr_p_doyle@hotmail.com>

[Chickenpox is a highly contagious infectious disease caused by
varicella-zoster virus (human herpesvirus 3). It usually affects
children, is spread by direct contact or respiratory route via
droplet nuclei, and is characterized by the appearance on the skin
and mucous membranes of successive crops of typical pruritic
vesicular lesions that are easily broken and become scabbed.
Chickenpox is relatively benign in children, but may be complicated
by pneumonia and encephalitis in adults. - Mod.CP]

Madagaskar - Chikungunya
29.03.2010

Aufgrund von Überschwemmungen durch den Wirbelsturm „Hubert“ kam es insbesondere in der Gegend um die Kleinstadt Mananjary zu einer Zunahme der Chikungunya-Fälle. 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

Meningococcal disease in Chad
01.04.2010 - WHO

From 4 January to 28 March the Ministry of Health of Chad reported 1531 suspected cases of meningococcal disease including 151 deaths (case-fatality rate:10%). So far, seven districts have crossed the epidemic threshold (Bébidja, Bédjondo, Béré, Doba, Dono-Manga, Goundi and Laï) while five others crossed the alert threshold (Bénoye, Laokassi and Sarh).

Sixty seven specimens of cerebral spinal fluid have been found positive for Neisseria meningitidis serogroup A by latex test while 14 specimens were found positive for Neisseria meningitidis serogroup W135, by latex, and culture. This indicates that some areas are experiencing mixed epidemics (Dono-Manga), while others are being predominantly affected by either serogroup A (Doba, Bébidja district ) or serogroup W135 (Goundi district).

The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has provided 157,000 doses of trivalent ACW vaccine for a mass vaccination campaign in affected areas of Dono-Manga and Goundi as well as 282,000 doses of bivalent vaccine for mass vaccination in Doba and Bebidja. Vaccines are being provided with the support of the Global Alliance for Vaccines and Immunization (GAVI). Vaccination campaigns have been completed or are being conducted in Bébidja and Doba district, while others will take place shortly in Dono-Manga and Goundi districts.

WHO, UNICEF, Médecins sans Frontières and the International Federation of Red Cross (IFRC) are working with the Ministry of Health, Chad to implement the vaccination campaigns as well as other emergency control measures, including case management and surveillance in neighbouring districts.

KONZO, FOOD-BORNE PARALYSIS - DEMOCRATIC REPUBLIC OF CONGO
**********************************************************
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: 29 Mar 2010
Source: Balita.ph [edited]
<http://balita.ph/2010/03/29/over-15000- ... -official/>


More than 15 000 people suffer from cassava disease "konzo" in DR
Congo: official
-----------------------------------------------------------------------
More than 15 000 cases of people suffering from the cassava[-caused]
disease "konzo" have been reported [this year] against 11 000 cases in
2008, according to the governor of Bandundu province in the Democratic
Republic of Congo (DR Congo).

The disease is characterized by spastic paralysis and is caused by the
cyanide contained in the cassava, unlike paralysis of the joints which
can be avoided by vaccination against polio, Governor Richard Ndambu
Wollang said here on Sunday [28 Mar 2010]. The spastic paralysis
hardens the muscles and slows movement.

The problem was attributed to lack of water in Bandundu province that
can be used to eliminate this cyanide from cassava within an
appropriate time. The population ends up placing this cassava in water
that cannot totally eliminate the toxic substance.

The Bandundu governor was in Kinshasa to seek the central government's
support. The financial needs stand at 600 000 U.S. dollars, including
200 000 dollars already allocated for the drilling for water for
villages situated far away from the natural sources of water.

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

[Konzo is characterized by an acute isolated and symmetrical
hypertonic paraparesis, which is permanent but non-progressive. To
date, 2 large epidemics have been reported, each of more than 1000
cases. The 1st was in the Bandundu region in Congo (1936-37) and the
2nd in the Nampulla province of Mozambique (1981). Small outbreaks
have been reported from Congo, Mozambique, Tanzania, and the Central
African Republic. Sporadic cases of konzo also occur. The majority of
cases occur in the dry season, chiefly during a long drought. Familial
clustering is common.

Cassava (_Manihot esculenta_, Crantz) is a root crop widely consumed
in Africa and South America. Although it originated in Brazil (where
it is called manioc), it was brought to Africa by Portuguese
colonists, and it is now an important crop there and in Indonesia and
Southeast Asia. It is the principal source of nutrition for about 500
million people. Its leaves are edible, but the prize is its starchy
root, rich in protein, minerals, and vitamins A, B, and C.

Cassava is used in a vast variety of cakes, snacks, and desserts and
grows wild in many places, being tough and drought-resistant. In
countries where hunger is an overt reality for many poor households,
cassava is among those food crops that can make the crucial difference
between starvation and survival. The cassava plant is the world's 3rd
most important crop. Cassava enters the North American diet also, as
it is made into tapioca.

Surprisingly for an important edible plant, cassava is quite poisonous
without proper preparation. The toxin in cassava is called linamarin.
When eaten raw or inadequately prepared, the human digestive system
will convert this to cyanide. Even 2 cassava roots contain a fatal
dose of poison. While the bitter variety (white cassava) of the plant
has larger concentrations of cyanide than the sweet variety (yellow
cassava), the sweet cassava is not without risk.

To prepare cassava, it should be peeled, grated, and soaked in warm
water for several days. This allows the cassava's own natural enzyme
(linamarase) to convert the cyanogen linamarin to sugar and cyanide
gas, and the volatile gas disperses usually harmlessly. However, women
-- who are usually charged with processing the plant -- can be
sickened by inhaling cyanide gas. What remains after processing can be
boiled and eaten, or more usually, dried and ground.

The shelf life of a cassava root is quite short once it is removed
from the stem, so there is an urgency to get the food to market. Roots
can turn to mush in less than a week. The rush to get cassava to the
market may keep some batches of cassava from being processed properly.

Cyanide is normally converted in humans to the less toxic thiocyanate
by the enzyme rhodanase, a mitochondrial enzyme which is widely
present throughout the human body, with the highest concentrations in
the liver and kidneys. Thiocyanate is the chief metabolite of cyanide.
Thiocyanate itself has a goitrogenic effect [produces goitre] if there
is a shortage of iodine in the diet. The body uses sulphur-containing
amino acids to render cyanide harmless. If the diet is deficient in
protein, cyanide will be converted to cyanate, which induces
neurodegenerative disease in both animals and humans. The cells which
are most affected are Betz cells in the motor cortex. Tropical ataxic
neuropathy can also be produced.

Konzo begins abruptly, without prodromal signs. In 90 percent of cases
the onset of symptoms takes less than a day. The initial symptoms are
described as tremor, cramps, a heavy feeling, and/or weakness in the
legs, a tendency to fall down, and difficulty remaining upright. There
is a visible hypertonic gait when walking or running. Occasionally
there will be lower back pain, blurred vision, speech difficulties,
and/or paresthesia of the legs, but these symptoms disappear within a
month. During the 1st 2 days the majority of patients have general
muscular weakness and are confined to bed. Hypertonicity is present
from day one. Flaccid paralysis of the limbs does not occur. Later
there is a slight partial improvement. Finally the affected person
develops a stable hypertonic paraparesis, which persists for the
remainder of life, or might improve a little. After onset the
neurological signs remain constant or improve minimally if no further
cyanide is ingested.

Prevention of konzo therefore involves avoiding a farming system
dominated by bitter cassava (which contains higher cyanide levels),
insufficient cassava processing, and a protein deficient diet.

In an effort to avoid this toxicity, it has been reported by Siritunga
and Sayre (1) that transgenic cassava free of cyanogens can be
produced. The investigators generated transgenic plants in which
cytochrome oxidase enzymes that catalyze the 1st step in linamarin
synthesis are inhibited. The plants showed a 94 percent reduction in
leaf linamarin content and a 99 percent decrease in root linamarin
levels. Additionally, the same group (2) has reported that transgenic
cassava plants can be produced that overexpress the gene for
hydroxynitrile lyase, facilitating cyanogenesis during processing and
producing a final product with less risk. The tubers of cassava do not
have this enzyme, and processing relies on spontaneous conversion.
Combining these methods could further decrease the risk of cyanide
poisoning from cassava.

References:
-----------
1. Siritunga D, Sayre RT: Generation of cyanogen-free transgenic
cassava. Planta 2003; 217:367-73.
2. Siritunga D, Arias-Garzon D, White W, Sayre RT: Over-expression of
hydroxynitrile lyase in transgenic cassava roots accelerates
cyanogenesis and food detoxification. Plant Biotechnol 2004; 2: 37-43.

These comments have been borrowed from my colleague Mod.LL. - Mod.TG]

[Cassava plant image:
<http://thekebun.files.wordpress.com/2008/10/cassava.jpg>
- Mod.JW]

RABIES, CANINE, HUMAN - GHANA: (BONGO)
***************************************
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 5 Apr 2010
Source: Ghana web [edited]
<http://www.ghanaweb.com/GhanaHomePage/N ... ?ID=179833>


The increase in consumption of dog heads in the Bongo District is
said to be hampering research efforts into rabies cases reported at
the district hospital in the area. Dogs suspected to carry rabies,
popularly known as "mad dogs" among the people, are killed and eaten,
including the heads that are usually the part that is examined to
determine the presence of rabies.

The consumption of the dog meat has gone up in recent times in the
district, with residents now desiring it during their leisure times.
Dog meat is usually not used in preparing meals at home because of
the belief that not everyone takes the meat.

This was made known on Monday [5 Apr 2010], when Dr Vivian Brusset
Cisneros, a Cuban doctor, presented a paper on the epidemiology of
rabies in the Bongo Hospital at the 11th Regional Scientific Workshop
between Ghanaian doctors and their Cuban counterparts in the Upper East Region.

She said the practice hindered effective research into arriving at
conclusive decisions on suspected rabies-related deaths. She said so
far the hospital has recorded about 101 suspected rabies cases, of
which 47 have been treated and discharged with 5 people losing their lives.

Dr Cisneros indicated that in December last year [2009], 19 dog bites
were recorded and said that the majority of the reported cases came
from Namoo, a frontier with Burkina Faso and Bongo central. She said
that a dog census conducted put the number in the Bongo District at
8217, with only 1843 of them vaccinated against rabies. Dr Cisneros
said that if the rabies scare in the area is to be contained, then
dog owners should vaccinate their dogs.

The Regional Director of Health Service, Dr John Koku Awoonor
Williams, called for a strong surveillance system at the district
level to check outbreaks of all kinds of diseases. He said the idea
about sending data to the Regional Directorate from the district
level, without analyzing them, slowed down the alarm system [for]
disease outbreaks.

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

[Previously in 2009, it was reported (see ProMED-mail reference
below) that: "The people of Bongo are living in fear now with every
passing moment and demand the immediate supply of anti-rabies
vaccines for the treatment of infected persons. They are also calling
on the veterinary division of the Ministry of Agriculture to, as a
matter of urgency, take steps to vaccinate all dogs and possibly cats
to prevent further spread of the disease."

It is difficult from the present report to estimate the extent of the
problem, but there appears to have been human cases (5 fatalities out
of a possible 47 cases presenting for post-exposure prophylaxis). It
is similarly difficult to estimate the extent of the diagnostic
problem. Perhaps the dearth of canine heads is no more than an
original bureaucratic excuse for inactivity.

A map showing the location of Bongo in the upper east district of
Ghana, bordering with Burkina Faso to the north, can be accessed at:
<http://en.wikipedia.org/wiki/File:Upper ... tricts.png>.
The HealthMap/ProMED-mail interactive map of Ghana is available at:
<http://healthmap.org/r/00IG>. - Mod.CP]

RABIES, ANIMALS, HUMAN - ANGOLA
*********************************
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 7 Apr 2010
Source: Angola Press [trans. Mod.MPP, edited]


The Angolan health authorities reported 4 deaths caused by rabies and
a total of 580 bites last week across the country. This was revealed
to the press today [7 Apr 2010] by Deputy Health Minister Carlos
Alberto Masseca at the end of the meeting of the inter-ministerial
committee for Influenza and Rabies.

Carlos Masseca said that the deaths occurred in the provinces of
Malanje (2 cases), Kwanza Norte (1 case) and Moxico (1 case), noting
that Luanda and Bie are the regions most affected by rabies.

"We still continue to report a large number of bites," stated a
spokesman at the meeting, stating that there is enough vaccine for
the national campaign that has been running since February this year [2010].

According to Carlos Alberto Masseca, rabies is fatal, so if bitten by
animals suspected of having the disease, victims should seek
attention at medical units quickly and be vaccinated with the human
rabies vaccine.

For this reason, there are calls for animal owners (of dogs, cats and
monkeys) to assume their responsibilities in the immunization of
these animals [against rabies] as well as greater compliance with the
campaign and intervention of community leaders and provincial
governments in raising public awareness so that together we can
address this public health problem.

Data from provincial departments of the Veterinary Institute indicate
that from [30 Mar 2010 to 6 Apr 2010], 124 692 animals were
vaccinated in the country. During the same period, Luanda had 362
bites, 148 of which were in the Cacuaco municipality.

Huambo, Moxico, Namibe, Uige and Zaire are the regions with
kennels/catteries in operation.

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

[It is too early to judge whether the animal vaccination campaign
initiated on 30 Mar 2010 will have any effect on the incidence of human cases.

A map showing the boundaries of the provinces of Angola can be
accessed at:
<http://www.mapsofworld.com/angola/angol ... l-map.html>. The
HealthMap/ProMED-mail interactive map of Angola can be accessed at:
<http://healthmap.org/promed/en?v=-12.3,17.5,5>. - Mod.CP]

VIRAL HEMORRHAGIC FEVER - SOUTH AFRICA: (EASTERN CAPE) 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: Mon 12 Apr 2010
Source: Dispatch Online (South Africa) [edited]
<http://www.dispatch.co.za/article.aspx?id=393247>


VHF patient isolated: South Africa (Eastern Cape)
-------------------------------------------------
A patient suspected of having a viral haemorrhagic fever was admitted
to East London's Life St Dominic's Hospital last night [12 Apr 2010].
Hospital manager Kurt Wylie said when the patient was admitted 3
patients were moved to Life East London Hospital because they were
occupying an area designated for isolating suspected highly
infectious cases.

Wylie allayed fears over the danger of the disease and said Life St
Dominic's was fully equipped to handle suspected and confirmed cases.
"There is no cause for alarm," he said. "The National Institute of
Communicable Diseases (NICD) and the Department of Health have been
notified of the suspected case. Until such time as the case is
confirmed (and thereafter if it is confirmed), the patient will be
nursed in accordance with the NICD protocols."

The identity of the patient or where he is from could not be
confirmed last night. Viral haemorrhagic fevers are a diverse group
of illnesses caused by 5 different families of viruses. All are
characterised by fever and bleeding disorders and all can progress to
high fever, shock and, in extreme cases, death. Some cause relatively
mild illnesses, while others, such as the African Ebola virus, can
cause severe, life-threatening disease.

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

[This report indicates a suspect viral hemorrhagic fever (VHF) case
has been isolated in East London's Life St Dominic's Hospital.
Additional information on the case presentation, epidemiological and
laboratory findings will be appreciated.

A map of South Africa showing the provinces can be seen at
<http://en.wikipedia.org/wiki/Provinces_of_South_Africa>, and the
HealthMap/ProMED interactive map of the country is available at
<http://healthmap.org/r/01aP>. - Mod.JFW]

[Previously outbreaks of Crimean-Congo haemorrhagic fever [CCHF] have
been recorded in Eastern Cape province (see: Crimean-Congo hem. fever
- South Africa (02): (EAS) 20080726.2282, and Crimean-Congo hem.
fever - South Africa: (Eastern Cape) 20080716.2162). Indeed CCHF is
endemic in many countries in Africa, Although CCHF virus is
transmitted by ticks, humans who become infected with CCHF usually
acquire the virus from direct contact with blood or other infected
tissues from livestock during this time, and only rarely from a tick
bite. When patients with CCHF are admitted to hospital, there is a
risk of nosocomial spread of infection. In the past, serious
outbreaks have occurred in this way and it is imperative that
adequate infection control measures be observed to prevent this
disastrous outcome. - Mod.CP]

UNDIAGNOSED DISEASE - UGANDA: (MBARARA) 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: Tue 13 Apr 2010
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/21/716089>


There is an outbreak of a mysterious disease similar to malaria in
Rwampara [Mbarara district], particularly in Bushwere parish. On
Sunday [11 Apr 2010], my uncle rang me up and told me that most of
his family members were down with a mysterious disease. He also told
me that almost every home in Kisirira village was suffering from the
disease.

[Byline: Jonan Natamba]

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

[It should not be a problem to diagnose malaria in Uganda. The fact
that an entire village was infected simultaneously suggests that it
is not malaria, but more likely an infection transmitted through food
or water. In a malaria endemic area adults would have clinical
immunity and clinical malaria cases would dominate in young infants
and children. ProMED-mail will be interested in further information.
- Mod.EP]

[Mbarara district is located in Western Uganda and can be seen on the map at
<http://en.wikipedia.org/wiki/Districts_of_Uganda>.
The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/01cT>. - Sr.Tech.Ed.MJ]

Guinea - Gelbfieber
19.04.2010

Anfang Januar wurde ein Gelbfieber-Fall bei einer 35-jährigen Frau aus dem Grenzgebiet zur Elfenbeinküste bekannt. Nach Bestätigung des Falles wurde die gesamte Bevölkerung der Mandiana Präfektur gegen Gelbfieber geimpft. Rechtzeitigen Impfschutz (10 Tage vor Abreise) beachten. / Quelle: crm
____________________

Südafrika - Rift Valley-Fieber
19.04.2010

Das Rift Valley-Fieber breitet sich seit Februar bei Farmtieren in den Provinzen Eastern Cape, Northern Cape, North-West and Gauteng aus. Es wurden auch mehr als 100 Erkrankungen beim Menschen bestätigt. Die Übertragung auf den Menschen erfolgt in der Regel durch direkten oder indirekten Kontakt mit erkrankten Tieren (z.B. beim Schlachten), Verzehr von deren ungegartem Fleisch oder unpasteurisierter Milch, aber auch durch Stiche infizierter Mücken. Reisende sollten sich vor tag- und nachtaktiven Mücken schützen und direkten Kontakt mit Schlachtvieh bzw. dessen rohen Produkten meiden. / Quelle: crm

MENINGITIS, MENINGOCOCCAL - AFRICA (02): 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]
Date: Sat 24 Apr 2010
Commercial Times Corporation, Xinhua News Agency report [in Chinese,
machine trans., edited]
<http://www.sdshang.com/MMM/P_Show.asp?id=48095>


The Burkina Faso Ministry of Health released a public statement
reporting that the meningitis epidemic is currently spreading in the
country. The statement said that between 1 Jan-18 Apr 2010, national
health agencies have reported 5118 suspected cases of meningitis,
including 718 deaths.

According to the Ministry of Health statistics, during the same
period in 2009, there were 4000 suspected cases of meningitis,
including 600 deaths.

In February 2010 the government of Burkina Faso adopted a plan to
combat meningitis. The program aims to increase public awareness,
educate the population, carry out vaccination campaigns, and reduce
the mortality rate of meningitis.

Burkina Faso, Mali, Nigeria, Chad, and Ghana have been greatly
affected by meningitis. Several major outbreaks of meningitis have
occurred in Burkina Faso since 1996.

The main symptoms of meningitis are fever, severe headache, and stiff
neck; if not promptly treated, patients may lose consciousness or even die.

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

******
[2]
Date: Fri 23 Apr 2010
Source: UN Integrated Regional Information Networks (IRIN) [edited]
<http://www.irinnews.org/Report.aspx?ReportId=88915>


A new strain of meningitis, strain NMX, also known simply as strain
X, has broken out in Burkina Faso, where it caused just over half the
new cases reported in the past week [week ending 18 Apr 2010]. Of
Burkina Faso's 13 regions 6 are at epidemic level. Since the
beginning of 2010, 5118 cases of meningitis have been reported, and
718 people have died according to the health ministry. Health
Minister Seydou Bouda told reporters at a press conference on 22 Apr
[2010] that strain X was not "well-known in Burkina." Meningitis --
transmitted by nose and throat secretions -- usually spreads across
sub-Saharan West Africa in the dry months from December to June.

Ten cases of the strain have been reported in Niger according to Dr
Mamadou Djingarey, a World Health Organization (WHO) official in the
capital, Ouagadougou. Niger experienced an epidemic of strain X in
2006. Strain X is "no more worrying than other meningitis strains,"
the official told IRIN; strain A is the most lethal of the 12
meningitis strains, according to WHO.

Strain X has been reported in 14 of Burkina Faso's 65 districts.
Bouda said the symptoms of the new strain were the same as other
strains -- sudden fever, headache, and vomiting -- while children
less than one year old might experience swelling in their head
[bulging of the anterior frontanelle].

Across West Africa, some 14 700 meningitis cases and 1650 deaths were
reported between 1 Jan and 11 Apr 2010, according to the most recent
WHO statistics available. This is not as critical as the same period
in 2009, when 49 209 people were infected in an outbreak that killed
2767. Affected countries this year [2010] include Benin, Burkina
Faso, Cameroon, Central African Republic, Chad, Cote d'Ivoire, Ghana,
Guinea, Mali, Niger, Nigeria, Togo, and the Democratic Republic of Congo.

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

[The emergence of a new strain (serogroup X) of meningococcal
meningitis in Burkina Faso this year [2010] has led to huge outbreaks
in the country, with 46 percent (6/13) of the regions in the country
being at epidemic level. The associated case fatality since the year
started is equally high, that is, 14 percent (781/5118), yet it
shouldn't exceed 10 percent for a well-managed epidemic. Serogroup X
is reported to have caused outbreaks in Niger in 2006 and has now
moved to Burkina Faso as indicated in the current report. Serogroup X
is one of those for which no vaccine exists, hence outbreak control
relies solely on enhanced surveillance for early case detection and
referral, appropriate case management using single dose oily
chloramphenicol, and social mobilization and health education. - Mod.JFW]

[The number of suspected cases of meningococcal meningitis in Burkina
Faso has quadrupled, as has the number of deaths since the last
report in Feb 2010 (see ProMED-mail post, Meningitis, meningococcal -
Africa: WHO meningitis region 20100225.0627).

To control an outbreak, WHO recommends mass vaccination with the
appropriate meningococcal 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 (see
<http://www.who.int/mediacentre/factsheets/fs141/en/>).

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 these
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. There is no vaccine for serogroup X.

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 (see
<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 (see
<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.

A prior ProMED-mail post this year (2010) said that health
authorities believe that meningococcus serogroup A, which has been
responsible for almost all outbreaks in the Burkina Faso in the past,
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, that was presumed to be due to
serogroup A meningococci. They discounted loss of vaccine potency at
the time. 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, the vaccines will not prevent
meningococcal infection caused by meningococcal serogroups not
represented in the vaccines, such as serogroup X, and will not
prevent bacterial 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). The
development of meningococcal meningitis in some patients who were
previously vaccinated can now be apparently explained by these
patients being infected with a non-vaccine meningococcal serogroup,
specifically serogroup X.

A map showing the regions in Burkina Faso can be seen at
<http://en.wikipedia.org/wiki/Regions_of_Burkina_Faso>. The
HealthMap/ProMED-mail interactive map of the country is available at
<http://healthmap.org/r/0188>. A map of the African bacterial
meningitis belt can be found at
<http://wwwnc.cdc.gov/travel/images/380.ashx>. - Mod.ML]

Burkina Faso - Meningokokken-Meningitis
27.04.2010

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. Seit Anfang des Jahres sind mehr als 700 Menschen an Meningitis gestorben und ca. 5.000 erkrankt. In 14 Distrikten des Landes ist ein neuer Erreger-Typ aufgetreten, gegen den es noch keinen Impfstoff gibt. 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

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

Date: Wed 28 Apr 2010
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/News/National/ ... /wy0vx1/-/>


Health authorities in Bugiri District have dispatched a medical team
to investigate a disease that has killed at least 72 people in the
last month. Officials took the decision after the disease, suspected
to be meningitis, killed half of its victims at [Hamma] Island on
Lake Victoria and Buwongo Village, Buhemba Sub-county on the mainland
within the last week alone.

The district health officer, Isaac Malinga, said the team is expected
to report its findings within 2 days in order to help them plan how
to stem the outbreak. He, however, added that the district is
ill-equipped to fight the disease on its own. "The outbreak has
caught us unprepared but there is hope that the government will
intervene to save the lives of the people once the cause of deaths is
established," he said.

The Buhemba Sub-county Secretary for Health, Mr John Mbiro, said 32
people, most of whom are children, have so far died in his area. He
blamed the deaths on the geographical location of the affected areas,
which are both difficult to reach due to distance from the mainland
and bad roads.

The LC1 [Local Council 1] Chairman of Hamma Island, Mr Amuza Nagheje,
said some of the sick have been transported to Lake Victoria and
Bondo hospitals in western Kenya to receive treatment. He said all
the medical personnel at the only health centre on the island had
deserted the facility.

[Byline: Fred Siminyu]

--
Communicated by:
Sharon Sanders
FluTrackers
<sharonsanders@flutrackers.com>

[The lack of more specifics concerning this outbreak of suspected
meningitis with a 50 percent case fatality rate, where the deaths
have involved mainly children, in a remote region, makes a specific
diagnosis difficult. ProMED-mail awaits further information with interest.

A map of Uganda showing the affected district in the southeastern
portion of the country, on the coast of Lake Victoria, can be found at
<http://www.reliefweb.int/rw/fullmaps_af ... penElement>.
A map of the African bacterial meningitis belt can be found at
<http://wwwnc.cdc.gov/travel/images/380.ashx>.
The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/01ex>. - Mod.ML]

PERTUSSIS - CONGO DEMOCRATIC REPUBLIC OF THE CONGO: (KASAI ORIENTAL)
********************************************************************
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 22 Apr 2010
Source: Radio Okapi [in French, trans. Corr.SB, edited]
<http://radiookapi.net/actualite/2010/04 ... e-sankuru/>


The health zones of Onema Ototo and Vangakete [in Sankuru] are
affected by pertussis. In total, 74 cases have already been
registered. Among the victims, many are children of 1 to 3 years. The
lack of vaccination or the use of expired vaccines are the cause of
the disease, according to the provincial Minister of Health.

The resurgence of these cases are causing concern at the highest
level of the health authorities in the province of Kasai Oriental
because whooping cough [pertussis] is a disease eradicated from the DRC.

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

[Since it seems clear that the eradication of pertussis even from the
industrialized world is quite difficult, it is not likely that _B.
pertussis_ had been eradicated from DRC. - Mod.LL]

A map showing the provinces of the Democratic Republic of Congo can be seen at
<http://en.wikipedia.org/wiki/Provinces_ ... _the_Congo>.
The HealthMap/ProMED-mail interactive map of the country is available
at <http://healthmap.org/r/01eu>. - Sr.Tech.Ed.MJ]

MENINGITIS, MENINGOCOCCAL - AFRICA (03): BURKINA FASO
*****************************************************
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 5 May 2010
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Plan report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


[Burkina Faso] is being hit especially hard by the disease, with a new
strain of the virus, known as strain X, already claiming half of all the
718 meningitis-related deaths since the beginning of the year [2010]. In 5
districts the disease is at epidemic level, and 9 more districts are on
high alert.

The mortality rate is particularly high at 14 per cent. Worryingly,
children and young people are the most affected group, with 80 per cent of
patients aged between 2 and 30. There is no vaccine for strain X.

Plan Burkina Faso has stepped up efforts to deal with the outbreak. Funding
is planned for antibiotics, other treatments, laboratory use, and equipment
and vaccines against the other strains of meningitis, which are still
killing many. So far 5118 people nationally have been treated for the disease.

The country has never seen so many cases of this new type of meningitis,
strain X. As there is no vaccine for it, the focus for the moment must
remain on antibiotic treatment.

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

[The number of deaths, the number of people nationally who have been
treated for meningitis, and the case fatality rate in Burkina Faso since
the start of 2010 reported in the news release above is about the same as
that reported in a prior ProMED-mail post, Meningitis, meningococcal -
Africa (02): WHO meningitis region 20100426.1343. However, what is new is
the fact that _Neisseria meningitidis_ serogroup X is responsible for half
of all the 718 meningitis-related deaths since the beginning of the year
(2010).

Mass immunization with the appropriate polysaccharide vaccine is a useful
control measure during an epidemic. However, there is no vaccine for
serogroup X. Chemoprophylaxis is recommended to eliminate nasopharyngeal
carriage of _N. meningitidis_ as soon as possible in close contacts of
persons with invasive meningococcal disease (such as, household members,
day-care center contacts, and persons directly exposed to the patient's
oral secretions), whose risk for acquiring meningococcal disease is 500-800
times greater than among the general population (see
<http://www.cdc.gov/mmwr/preview/mmwrhtml/00046237.htm>). The rate of
secondary disease for close contacts is highest immediately after onset of
disease in the index patient.

However, chemoprophylaxis has not generally been recommended during
epidemics (see <http://www.ncbi.nlm.nih.gov/pubmed/8625860>), because
multiple sources of exposure, prolonged risk of exposure, logistic
problems, and high cost make this an impractical alternative. When used,
the antimicrobials commonly used for chemoprophylaxis are rifampicin,
ciprofloxacin, azithromycin, and ceftriaxone, although rifampicin- and
ciprofloxacin-resistant meningococcal disease in close contacts has been
reported following had chemoprophylaxis with these antibiotics (see
<http://www.cdc.gov/ncidod/eid/vol11no06/05-0143.htm> and
<http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5707a2.htm>).

A map showing the regions in Burkina Faso can be seen at
<http://en.wikipedia.org/wiki/Regions_of_Burkina_Faso>. The
HealthMap/ProMED-mail interactive map of the country is available at
<http://healthmap.org/r/0188>. A map of the African bacterial meningitis
belt can be found at <http://wwwnc.cdc.gov/travel/images/380.ashx>. - Mod.ML]

VIRAL CONJUNCTIVITIS - UGANDA: (KAMPALA) 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: Thu 13 May 2010
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/Magazines/Heal ... 2x0r0yz/-/>


For [a woman] who works at a maize mill outlet in Kisenyi [a deprived
district in Kampala, the capital of Uganda], it started as itchy eyes
on Wednesday [5 May 2010] and by Friday 7 May 2010], she was having
the full blown effects of red eyes -- pus flowing out of one reddened
eye, headache, and a bit of fever. That's when she was told that a
number of people in the area were suffering a similar illness. "I
hadn't heard of any outbreak of the disease till then. And much as
this place is very dusty, I thought I had just had a lot of dust in
my eyes during the day. The following day, one eye was a little red
but still itchy and then pus started forming in the corner on the 3rd day."

[She] is one of the people who have been affected by the outbreak of
red eyes, also called conjunctivitis, that has hit Kisenyi I and II
sub-parishes. But the disease has spread very fast and Dr Livingstone
Makanga, the principal medical officer with Kampala City Council, who
has been spearheading the medical team dealing with the outbreak
says, some cases have now been reported in Makindye division [of Kampala].

Conjunctivitis is of 2 kinds: viral and bacterial, with the former
being more contagious. "We are waiting for the Ministry of Health to
come out and tell us which one of these it is. But from the way it's
spreading, it must be viral," Dr Makanga said on Monday [10 May
2010]. At the moment, he says 397 people have received treatment but
that there are still people out there in the community who haven't
come. "This is because the disease is self-limiting, meaning it can
heal naturally without treatment."

After contracting the disease, a person can stay 3 or 4 days without
any symptoms but while spreading the disease and after that, Dr
Makanga says (there may be) symptoms like a headache, fever in some
cases, a burning sensation of the eyes, which may lead to tearing,
swelling of the eyes, reddening, and then pus will begin forming in
the corner of the affected eye(s).

Francis Dudu, one of the KCC [Kampala city council] personnel in
charge of disease surveillance says the chances of re-infection are
very high because Kisenyi is very unhygienic with so many flies which
are the main carriers of the disease. "A fly can pick it from the
eyes of an infected person and if it drops on the hands or any body
part of another person and he touches his eyes too, then he gets
infected," Mr Dudu explains.

"The disease is spreading very fast because waste management is poor,
drainage is poor, and there's overcrowding meaning that people are
always in contact, a situation that largely contributes to the spread
of the disease. People can't observe 100 per cent personal hygiene
because there is a shortage of wholesome water for washing so the
chances of re-infection are very high. This is dangerous because
continuous re-infection can lead to other eye diseases like trachoma
and blindness in some cases." He says the disease has [mainly]
affected [employees] of maize mills and animal feed [producers]. And
because some of these people come from far-off districts to purchase
produce, it is likely they are carrying back the disease.

Well, if you pass by Kisenyi right now, a number of people are
wearing sun glasses which Mr Dudu says help to minimise sunlight
because sufferers are very sensitive to light and get a lot of pain
from exposure to the sun. Though he says other people just don't want
to be identified as suffering from the disease. KCC has set up a
mobile clinic in Kiganda zone, the most affected area and is treating
sufferers for free. The treatment [chloramphenicol] eye drops, amoxyl
capsules, metronidazole tablets, and painkillers.

[Byline: Agnes K Namaganda]

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

[Infective conjunctivitis occurs when the conjunctiva (the thin layer
of cells covering the white of the eye and the inner surface of the
eyelids) becomes inflamed as a result of an infection. The 3 most
common causes of an infection in the eye are bacteria, for example
those strains of bacteria that more commonly cause lung and ear
infections, and viruses. There are no particular signs or symptoms
that differentiate the bacterial agents or viruses that cause of
infective conjunctivitis. Most cases of infective conjunctivitis do
not require medical treatment and will heal without treatment in one
to 2 weeks.

Most frequently, viral conjunctivitis is due to adenovirus infection.
Many serotypes may be involved. Types 3, and sometimes, 4 and 7, are
responsible for pharyngoconjunctival fever -- conjunctivitis
associated with upper respiratory tract infection. Adenovirus types 8
and 19 are frequently associated with keratoconjunctivitis.
Coxsackievirus A24, enterovirus 70, herpes simplex virus, and
varicella-zoster virus may also cause acute haemorrhagic
conjunctivitis. Less commonly viruses such as molluscum contagiosum,
vaccinia, and human immunodeficiency virus may be responsible for
conjunctivitis. Systemic infection with influenza virus, Epstein-Barr
virus, Newcastle disease virus, measles, rubella, and mumps, may also
cause conjunctivitis in association with upper respiratory tract infections.

Viral conjunctivitis often occurs in the aftermath of extreme and
stressful climatic events such as hurricanes, sandstorms and the
like, or as a consequence of exposure to irritants in the work-place.
The virus responsible for the current outbreak in Kampala is likely
to be an adenovirus or an enterovirus. Information on the precise
diagnosis would be welcomed.

The HealthMap/ProMED-mail interactive map of Uganda, showing the
location of Kampala, can be accessed at
<http://healthmap.org/r/00UL>. - Mod.CP]