Wüstenschiff

DENGUE/DHF UPDATE 2010 (23)
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******
Tanzania (Dar es Salaam)
Date: Sat 15 May 2010
From: Belia Klaassen <bklaassen@istclinic.com> [edited]


This is to report about at least 17 suspect dengue fever cases seen
at our clinic in Dar es Salaam Tanzania since April 2010. In 2 Jan
[2010], cases of proven dengue in Japanese travelers were already reported.

Since the 1st half of April 2010, we have seen at least 17 patients
suspected with dengue fever symptoms and typical lab results with low
WBC, low platelet counts and sometimes raised liver enzymes. All
patients were tested negative for malaria and were followed up for
1-2 weeks. Since 10 May 2010, a rapid dengue test was obtained, and
out of the 17 cases, 8 were tested positive on the rapid test (some
IgG and IgM both positive). All patients were (expatriate) residents
in Dar es Salaam, and some had been in Zanzibar the week(s) before
the infection: 8 male, 9 female, 2 children (2 and 7 years old).
Dengue serology was sent for virological serotyping of the virus, but
no results are known yet. No cases of DHF were seen so far.

The cases have been reported to the Tanzanian Ministry of Health.

Up till now, dengue was not recorded (except for possible chikungunya
up-country) in Dar es Salaam or elsewhere in Tanzania.

--
Dr Belia Klaassen, MD IST
Medical Scheme Clinic
Dar es Salaam Tanzania
<http://www.istclinic.com>
<bklaassen@istclinic.com>


[ProMED thanks Dr Belia Klaassen for this report. We receive few
dengue reports from Africa, and these firsthand reports from local
health providers are especially valuable.

A HealthMap/ProMED-mail interactive map of Tanzania showing the
location of Dar es Salaam on the coast can be accessed at
<http://healthmap.org/promed/en?v=-6,35,5>. - Mod.TY]

RABIES, ANIMALS, HUMAN - ANGOLA (02)
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<http://www.isid.org>

Date: Tue 18 May 2010
Source: Angop Saude [trans. Mod.MPP, edited]
<http://www.portalangop.co.ao/motix/pt_p ... 0352c.html>


Eleven people died of rabies last week (11-17 May 2010) in the
country, bringing the number of deaths reported since January 2010 up to 78.

Speaking at the regular review session on the influenza and rabies
epidemiological situation, the deputy health minister, Carlos Alberto
Masseca, said the cases occurred in the provinces of Kwanza Sul, (4),
Benguela (2), Kwanza Norte (2), Cunene (2) and Uige (1).

"This picture shows a large movement of rabies virus [infection] in
the country and need to continue to strengthen measures to combat the
disease," warned the leader.

Due to the high number of bites recorded (669), Carlos Alberto
Masseca asked the provincial governments to strengthen the procedures
for the collection of stray animals from streets and public awareness
about the importance of vaccination as the primary means of
prevention against this disease.

According to the official, most provinces have already established
kennels/catteries in operation or are nearing completion of works.

In this period, he said, 3585 animals were vaccinated (dogs, cats and
monkeys), a total of 160 519 since the start of the campaign.

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

[As yet, the government's attempts to interrupt the transmission of
rabies virus infection in Angola are showing few signs of progress.

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]

LASSA FEVER - NIGERIA: (KEBBI)
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Date: Tue 18 May 2010
Source: Independent online, SAPA/AFP report [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 379C877858>


A fresh outbreak of Lassa fever has killed 17 people and left dozens
infected in northern Nigeria's Kebbi State in the past month, a
health official said on Tuesday [18 May 2010]. "We have so far lost
17 people to the Lassa fever outbreak, which started about 4 weeks
ago," state chief epidemiologist Shehu Mohammed told AFP [Agence France-Press].

Lassa fever is an endemic acute viral haemorrhagic illness common in
west Africa, which is usually contracted through contact with
rodents' excreta. "Scores of people have been confirmed to have been
infected with the disease," said Mohammed in a phone interview. He
said the outbreak was recorded in 3 local districts, including the
state capital Birnin-Kebbi, the worst hit with 9 recorded deaths.

Mohammed said the World Health Organisation has roped in medical
experts from South Africa, Netherlands and Nigeria's commercial
centre Lagos to help tackle the outbreak. The disease, which causes
fever, headache, difficulty in swallowing and can lead to infection
of vital organs and death, is named after the town of Lassa in
northern Nigeria's Borno State where it was 1st identified in 1969.

It occurs mainly in Guinea, Liberia, Nigeria and in Sierra Leone,
where it claims roughly 200 lives each year.

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

[Lassa viral haemorrhagic fever is an acute illness of 1-4 weeks
duration that occurs in West Africa. Though 1st described in the
1950s, the virus causing the disease was not identified until 1969.
The virus is a single-stranded RNA virus belonging to the virus
family _Arenaviridae_. Lassa fever is known to be endemic in Guinea,
Liberia, Sierra Leone and parts of Nigeria but probably exists in
other West African countries as well.

About 80 percent of human infections are asymptomatic; the remaining
cases have severe multi-system disease, where the virus affects
several organs in the body, such as the liver, spleen and kidneys.
The incubation period of Lassa fever ranges from 6-21 days. The onset
of the disease is usually gradual, starting with fever, general
weakness, and malaise. After a few days, headache, sore throat,
muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and
abdominal may follow. Severe cases may progress to show facial
swelling, fluid in the lung cavity, bleeding from mouth, nose, vagina
or gastrointestinal tract, and low blood pressure. Protein may be
noted in the urine. Shock, seizures, tremor, disorientation, and coma
may be seen in the late stages. Deafness occurs in 25 percent of
patients of whom half recover some function after 1-3 months.
Transient hair loss and gait disturbance may occur during recovery.

Lassa fever is a zoonotic disease. The animal reservoir of Lassa
virus is a rodent of the genus _Mastomys_, commonly known as the
"multimammate rat." _Mastomys_ infected with Lassa virus do not
become ill, but they can shed the virus in their urine and faeces.
(An image of a multimammate rat can be viewed at:
<http://www15.bni-hamburg.de/bni/bni2/ne ... &pid=21232>).

Lassa fever occurs in all age groups. Persons at greatest risk are
those living in rural areas where _Mastomys_ are usually found,
especially in areas of poor sanitation or crowded living conditions.
There is no epidemiological evidence supporting airborne spread
between humans. Person-to-person transmission occurs in both
community and health care settings.

The virology of Lassa fever infections has recently been reviewed by
Charrel RN, de Lamballerie X; Vet Microbiol. 2010 Jan
27;140(3-4):213-20. Epub 2009 Aug 28 ). "To date, the International
Committee for Taxonomy of Viruses recognizes that the family
_Arenaviridae_ contains a unique genus _Arenavirus_ that includes 22
viral species. (There are 9 additional arenaviruses that either have
been discovered recently, or which taxonomic status remains pending).
Arenaviruses have been classified according to their antigenic
properties into 2 groups, the Lassa-Lymphocytic choriomeningitis
(LCM) serocomplex and the Tacaribe serocomplex, which has been
further divided into 4 evolutionary lineages. Each arenavirus is more
or less tightly associated with a mammal host. The distribution of
the host dictates the distribution of the virus. Humans may become
infected by arenaviruses through direct contact with infected
rodents, including bites, or through inhalation of infectious rodent
excreta and secreta. Lassa, Junin, Machupo, Guanarito, and Sabia
viruses are known to cause a severe hemorrhagic fever, in western
Africa, Argentina, Bolivia, Venezuela, and Brazil, respectively.
Infection by LCM virus can result in acute central nervous system
disease, congenital malformations, and infection in organ
transplantation recipients. Detection of arenaviruses in their animal
host can be achieved by virus isolation, and has recently taken
advantage of PCR-based techniques."

The HealthMap/ProMED-mail interactive map of Nigeria can be accessed
at: <http://healthmap.org/r/007*>. - Mod.CP]

METHANOL POISONING, FATAL - UGANDA
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<http://www.isid.org>

Date: Wed 19 May 2010
Source: Time.com [edited]
<http://www.time.com/time/world/article/ ... 42,00.html>


A patient is slouched in a chair at the Victory Rehabilitation Center
on the outskirts of Kampala, recalling his time as a maker of
homemade banana gin. "I knew it could be dangerous, but I didn't know
it could kill so many people," says the 34-year-old former primary
school teacher.

This patient is referring to the more than 100 people who have died
in western Uganda since early April [2010] after ingesting a
methanol-laced version of a homemade gin known as waragi. The popular
drink, easy to make and cheap to buy, has been blamed for causing
blindness and death before, but never so many in such a short span of
time. Illegal production of hard liquor is a problem across much of
Africa, but it may be worst in Uganda.

Unregulated waragi accounts for nearly 80 percent of the liquor
produced in the country, according to the Uganda National Bureau of
Standards (UNBS), which oversees production of legal products in the
country. It doesn't help that the alcohol is inexpensive and that the
penalties for producing or selling it are ineffective. A tall glass
of homemade waragi "usually made from bananas or cassava, millet or
sugarcane" goes for about 25 cents, one-sixth the cost of the leading
regulated brand. Illegal production carries a fine of only about
[USD] 1.50 and a jail term not to exceed 6 months, while offenders'
cases are often dropped before they reach a courtroom.

The drink is packaged in cheap sachets sometimes as small as 100 ml
and costing as little as 10 cents, making them accessible to the
destitute and children. Another outpatient at Victory Rehabilitation
Center, recalls being initiated to alcohol through the sachets, which
some students snuck into his secondary school to sell. "In Uganda
it's as if drinking has no restrictions," he says.

Which, in many ways, is true. Uganda still has no national alcohol
policy nor an effective regulatory body, while the tax on
domestically produced alcohol was lowered 2 years ago, boosting both
production and consumption. Alcohol was the country's 6th-highest
revenue earner in 2008, accounting for 10 percent of national
revenue, according to Uganda Youth Development Link (UYDEL), one of
the country's leading voices against alcohol abuse. "Drinking has
been made way too easy," says Mutaawe Rogers, UYDEL's Program
Officer. "Business interests are winning out over national interests."

[Byline: Ioannis Gatsioun]

--
Communicated by:
Gary Greenberg, MD MPH
Sysop / Moderator Occ-Env-Med-L MailList
Univ N Carolina School Public Health
Medical Director
Urban Ministries of Wake County Open Door Clinic
<GNGreenberg@gmail.com>

[Methanol toxicity remains a common problem in many parts of the
developing world, where methanol is often a component of bootleg
alcohol, which is made in rural regions. Because of its low cost, it
is often consumed by those in lower socioeconomic classes. Methanol
has a relatively low toxicity, hence the adverse effects are thought
to result from the accumulation of formic acid, a metabolite of
methanol metabolism. Formic acid metabolism is very slow, therefore
it accumulates in the body, leading to metabolic acidosis.

Initial symptoms occur 12-24 hours after ingestion and in general
correlate with the volume of methanol ingested and the amount of
ethanol concomitantly ingested. The minimal lethal dose is believed
to be 1 mg/kg body weight. Initial symptoms include disinhibition and
ataxia followed by headache, nausea, and vomiting or epigastric pain.
These are then followed by drowsiness, seizures, and eventually coma.
Visual symptoms like flashes of light, blurring, scotomas, and
scintillations occur and may progress to complete visual loss. Prompt
medical care is vital to avoid complications secondary to methanol
intoxication. Supportive therapy is aimed at initiating airway
management, correcting electrolyte disturbances, and providing
adequate hydration. The metabolic acidosis may necessitate
administration of bicarbonate and assisted ventilation. Bicarbonate
potentially may reverse visual deficits. In addition, bicarbonate may
help to decrease the amount of active formic acid.

Antidote therapy is directed towards delaying methanol metabolism
until the methanol is eliminated from the system, either naturally or
via dialysis, often accomplished in 2 ways: ethanol or fomepizole.
Ethanol is also metabolized by alcohol dehydrogenase (ADH), and the
enzyme has 10-20 times higher affinity for ethanol compared with
methanol. Fomepizole is also metabolized by ADH; however, its use is
limited because of high costs and lack of availability.
<http://emedicine.medscape.com/article/1174890-overview>. - Mod.TG]

[The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/01ht> and an administrative map of the
country can be seen at
<http://www.coetzee-uganda.com/index_fil ... Uganda.htm>.
- Sr.Tech.Ed.MJ]

UNDIAGNOSED FATALITIES, INFANTS - SUDAN: (SOUTH DARFUR) REQUEST FOR INFORMATION
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<http://www.isid.org>

Date: Sun 23 May 2010
Source: UN ReliefWeb, Miraya FM report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


107 babies die from mysterious fever in Nyala, South Darfur
-----------------------------------------------------------
The death toll from a yet identified fever has risen to 107 infants
in Nyala, South Darfur State. Between March and May [2010], 988
babies have been infected with the raging fever which can inflict
death within 48 hours of delivery. Miraya's correspondent in Nyala
toured the town's main hospital and described the situation as
catastrophic, observing that 2 to 3 newborn babies share a bed.

Lack of air-conditioning coupled by Nyala's scorching temperatures
have aggravated the overcrowded hospital, causing a stench to pervade
the wards.

Speaking to Radio Miraya, Head of Nyala hospital, Dr Mubarak
Abdelrahman, said that pollution in the area surrounding the birth
centres or homes, polluted water, or temperature rises could be some
probable causes of the yet unidentified fever.

According to Miraya correspondent in Nyala, the State health
authorities have requested the Federal Minister of Health, United
Nations Children's Fund (UNICEF), and the World Health Organization
(WHO) to assist in identifying the disease.

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

[ProMED-mail would like to thank Sharon Sanders at FluTrackers for
alerting us to this ongoing outbreak.

The differential diagnosis of febrile fatal illnesses in neonates
includes overwhelming viral or bacterial sepsis. In the absence of
laboratory studies, a precise diagnosis is difficult to make or
speculate at this time.

More information on this outbreak from knowledgeable sources in the
region would be greatly appreciated.

For a map of Sudan with provinces, see
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>.
Nyala, Darfur, can be located via the interactive
HealthMap/ProMED-mail map of Sudan at
<http://healthmap.org/r/01kS>. - Mod.MPP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (10): AFRICA
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Cholera - Nigeria (Federal Capital Territory)
[2] Cholera - Uganda (Tororo)
[3] Cholera - Uganda (Moroto)
[4] Diarrhea - Angola (Luanda)
[5] Cholera - Sudan (Northern Bahr el Ghazal)
[6] Cholera - Kenya (Rift Valley, Coast)

******
[1] Cholera - Nigeria (Federal Capital Territory)
Date: Mon 24 May 2010
Source: AllAfrica, Daily Trust report [edited]
<http://allafrica.com/stories/201005240982.html>


Last Wednesday, 19 May 2010, 4 persons lost their lives following an
outbreak of cholera at Ibwa community in Gwagwalada Area Council of
the Federal Capital Territory. Council Chairman, Alhaji Zakari Angulu
Dobi, said 2 persons died on the 1st day of the outbreak of the
epidemic last week, while another 2 died the following day at the
community's health centre.

According to him, on receiving information on the outbreak, the
council authority immediately sent additional drugs to the affected
community in order to control the epidemic. He said the report he
received indicated that 118 people were affected by the epidemic,
including children, who were treated.

The council boss urged residents of the community to report cases of
such diseases on time rather than engage in self medication, adding
that the council will refurbish the community's bore-hole in order to
support the existing water sources.

[Byline: Abubakar Sadiq Isah]

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

[The HealthMap/ProMED-mail interactive map of Nigeria is available at
<http://healthmap.org/r/01l4>.
An administrative map of the country can be seen at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf> - Sr.Tech.Ed.MJ]

******
[2] Cholera - Uganda (Tororo)
Date: Sun 23 May 2010
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english2010/h ... 310549.htm>


An outbreak of cholera following frequent floods in eastern Uganda
has left 6 people dead and dozens more admitted in hospital, local
authorities said on [Sat 22 May 2010].

"Since the outbreak of the deadly disease early this week, cholera
has now killed 6 people in 2 sub counties of Mulanda and Kirewa,"
Emmanuel Osuna, the district local council chairman told Xinhua on
the phone.

The outbreak in Tororo district, eastern Uganda, was a result of
recent flash floods that ravaged parts of the mountainous area
following torrential rains, local officials said.

"We have so far received about 50 cases in the main hospital. It has
forced the district authorities to set up reception centers that will
handle emergencies as the medics struggle to treat them amidst
scarcity of the drugs in the hospital," said Osuna.

The floods destroyed the latrine facilities, contaminating drinking
water and posing a grave health threat to the local communities.

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

******
[3] Cholera - Uganda (Moroto)
Date: Sat 22 May 2010
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/News/National/ ... /x06191/-/>


The cholera epidemic in Moroto District has spread out to 40
villages, authorities have said. About 220 cases and 5 deaths have
reported since the outbreak was detected on 16 Apr 2010.

According to the World Health Organization's 'health action in
crisis' officer in charge, Mr Innocent Komakech, 20 to 25 cases of
cholera are diagnosed each day at the treatment unit in Moroto
District.

"About 48 patients are admitted in the wards. The treatment units are
congested and we are preparing to create new units across the
district," Mr Komakech told Saturday Monitor on [Thu 20 May 2010].

He said the sub-counties of Nadunget, Rupa, and North, East and South
divisions in Moroto municipality have been hit the hardest by the
outbreak.

"There a risk of the epidemic spreading out to other parts of
Karamoja region if not checked properly," he said.

Martin Eyura, the district health officer said, "Latrine coverage in
Moroto is still very low at 10 per cent with most of the latrines not
utilized.

[Byline: Richard Otim]

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

[The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/00bX>
and an administrative map of the country can be seen at
<http://www.coetzee-uganda.com/index_fil ... Uganda.htm>.
- Sr.Tech.Ed.MJ]

******
[4] Diarrhea - Angola (Luanda)
Date: Tue 18 May 22010
Source: Angola Press Agency (Angop) [in Portuguese, machine trans., edited]
<http://www.portalangop.co.ao/motix/pt_p ... 29e21.html>


During the 1st 4 months of the year [2010], 1101 cases of acute
diarrhea were treated at the Rangel Health Center, in the
municipality of the same name, in Luanda province, 100 more than
during the same period of 2009. According to Adelaide Auguste Paulo,
nurse supervisor of the Rangel Health Center, in January [2010], 268
people consulted the center, 400 in February, 184 in March, and 250
in April. In her opinion the picture is preoccupying, since 9 cases
are taken care of daily, but she hopes to see a reduction in the
number of cases because of the dry period, when there are no floods
or stagnant water accumulating on the streets.

She emphasized that the lack of the sanitation of the environment and
the lack of attention of some parents to the medical advice are the
base of the frequent epidemic. The municipality of Rangel has an
estimated population of 700 000 inhabitants distributed in the
communes of the Marcal, Nelito Soares, and Rangel.

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

[The HealthMap/ProMED-mail interactive map of Angola is available at
<http://healthmap.org/r/00ay>.
An administrative map of the country can be seen at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Sr.Tech.Ed.MJ]

*****
[5] Cholera - Sudan (Northern Bahr el Ghazal)
Date: Sun 16 May 2010
Source: Sudan Tribune [edited]
<http://www.sudantribune.com/spip.php?article35087>


Peth Lou, one of the local administrative units situated east of
Wanyjok, headquarters of Aweil East County, Northern Bahr el Ghazal
State, may be again on the verge of a severe cholera outbreak. Peth
is to the south of Malual Baai Payam where there is a health center
reportedly run by International Rescue Committee, it is also to the
East of Madhol and west of Tokyep village from where 10 people mostly
children are reportedly caught by watery diarrhea.

The outbreak is entering its 2nd week and shows little sign of
slowing down. It has quickly spread into surrounding villages of
Mabil, Dhok, Rumrit, and Baai chok, Wunyiik, Maluil, Majak, Warkou,
Halkou, and Riangkou, Marial Ngap, killing 2 people and infecting the
entire village.

The village, located 20 miles [32 km] from the main Aweil Civil
Hospital, is home to over 10 000 residents. Health authorities say
the disease first struck towards the end of April 2009, killing 3
people before its confirmation by the local ministry of health.

It is believed another 21 villages surrounding Ameth Lou, east of
Malual Baai Payam, have also registered cholera cases in the last
week with records showing that 12 suspected patients were admitted at
Malual health center before being discharged.

Some of the villages that are worst hit in Ameth include; Wunyor,
Warapac, Mayom, Akong, Akuac, and Majak Paluiel. Mathiangdit and
Areng have also been reported to have the highest number of
infections.

[Byline: Ngor Arol Garang]

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

[The HealthMap/ProMED-mail interactive map of Sudan is available at
<http://healthmap.org/r/01l7>.
An administrative map of the country can be seen at
<http://www.unhcr.org/publ/PUBL/409224744.pdf>. - Sr.Tech.Ed.MJ]

******
[6] Cholera - Kenya (Rift Valley, Coast)
Date: Mon 10 May 2010
Source: Eat Drink and Be [edited]
<http://eatdrinkandbe.org/article/index. ... ca_cholera>


A fast-spreading outbreak of cholera has killed at least 10 people in
West Pokot [Rift Valley province] and Kilifi [Coast province]
districts, in what the government said on 10 May 2010 was the worst
epidemic since the onset of the current rains.

Public Health Minister Beth Mugo confirmed that 8 people had died in
West Pokot and that her ministry had dispatched officers to
flood-prone regions to sensitize residents on ways to prevent the
scourge.

Elsewhere, 2 children from Matsangoni village, Kilifi are feared to
have died of the water-borne disease while 4 people had been admitted
to health centers there.

"For almost a year, we have not had any cholera outbreak in Kisumu,
Nyanza which is the traditional area of cholera. That shows that we
are really controlling the disease," Mrs Mugo observed.

In 2009, Kenya faced one of the worst cholera outbreaks in a decade
and at least 122 people died as a result of the epidemic sweeping
across the country. A total of 10 940 cases were reported from the
outbreak, which began in December 2008.

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

[The HealthMap/ProMED-mail interactive map of Kenya is available at
<http://healthmap.org/r/019e>
and an administrative map of the country can be seen at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Sr.Tech.Ed.MJ]

Yellow feverin Cameroon
27.05.2010 - WHO

On 25 January 2010, the Ministry of Health (MoH), Cameroon reported one case of yellow fever in Kumba district in the country's south-western region, close to the border with Nigeria's Cross River State.

The index case was identified as a 16 year-old female student in Kake high school. She presented with a clinical picture of fever and jaundice. Onset of symptoms started on 11 January with fever. She had no history of yellow fever vaccination and survived. The index case was identified through routine yellow fever surveillance system.

Laboratory specimens from this case were found to be IgM positive by ELISA method at the National Laboratory in the Institut Pasteur, Yaoundé, Cameroon and confirmed positive by plaque reduction neutralization test (PRNT)- a more specific test for yellow fever- at the regional reference laboratory for yellow fever at the Institut Pasteur in Dakar, Senegal.

Following identification of the index case, an outbreak investigation was conducted in the area. The investigation identified one person as symptomatic (fever). Laboratory tests by ELISA method of serum samples for this and 50 other contact were found to be negative.

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 Kumba and Muyuka were however, not part of the campaign as they had no history of yellow fever cases in the past 50 years.

The Ministry of Health plans to vaccinate 345,592 people in Kumba and Muyuka 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 funded by the GAVI Alliance through the World Health Organization. This support is part of the global Yellow Fever Initiative which aims to prevent devastating yellow fever epidemics and secure adequate yellow fever vaccine supply for Africa.

CHIKUNGUNYA - AFRICA: (GABON)
*****************************
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<http://www.isid.org>

Date: Fri 28 May 2010
Source: Romandie [in French, trans. Corr.SB, edited]
<http://www.romandie.com/infos/news2/100 ... zuy665.asp>


An outbreak of chikungunya [virus] was reported in April [2010] in
south-eastern Gabon, which has also recorded cases of dengue fever,
which caused no deaths, officials said Friday [28 May 2010], at the
Centre International de Recherches Medical (CIRMF).

The 1st cases of chikungunya emerged early April [2010] in the region
of Ogooue-Lolo and late April in the Haut-Ogooue, Franceville, which
is the county seat, said Dr. Eric Leroy, a researcher at CIRFM where
samples were analyzed at the request of health authorities.

He said out of 608 total samples studied in 3 weeks (3-23 May[2010])
for the area of Franceville only, the researchers found 298 cases of
chikungunya and 82 cases of dengue fever, 2 diseases of viruses are
transmitted by mosquitoes.

In a report on the situation of both diseases in Franceville, CIRMF
believes that "the epidemic of chikungunya is coming to an end, in 3-4
weeks."

Among the positive cases 15 were "doubly infected with both viruses
which is exceptional. Their lives were not endangered but their
condition required hospitalization," Dr Leroy said.

"Only 7 cases were found in 2007 when the epidemic hit Libreville." In
Franceville the epidemic of chikungunya affects other localities of
Upper Ogooue (Moanda, Mounana, Okondja) and Ogooue-Lolo (Koulamoutou
Lastourville) but no statistics will be released until Friday [29 May
2010] to determine the magnitude (of the epidemics) in the absence of
"systematic sampling."

"As of today, there have been no deaths. [...] The trend is
stabilizing or even declining," assured his [Dr Eric Leroy's] aide
Norbert Mouyabi, Head of Communication CIRMF.

A person with chikungunya [virus infection] has the same symptoms as
the flu: fever over 38 degrees, muscle aches, joint pain, haemorrhage
or headache.

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

[This is an interesting mixed chikungunya/dengue virus outbreak. Both
viruses are likely transmitted by the same _Aedes_ mosquito, but it
would be of interest to have the identity of the mosquito vector(s)
confirmed.

In the 19 May 2010 ProMED post (archive no. 20070523.1654) Dr. Andreas
Krueger reported that the potential chikungunya virus vector is _Aedes
albopictus_ in Libreville (together with _Ae. aegypti ssp. formosus_).
This was the 1st report of the detection of _Ae. albopictus_ in Gabon.

A map showing the political divisions of Gabon mentioned in this
report can be accessed at
<http://www.lib.utexas.edu/maps/africa/g ... l_2002.jpg>.
A HealthMap/ProMED-mail interactive map of Gabon can be accessed at
<http://healthmap.org/promed/en?v=-0.6,11.8,5>. - Mod.TY]

[ _Aedes albopictus_:
<http://www.fehd.gov.hk/english/safefood ... _adult.jpg>
- Mod.JW]

DENGUE/DHF UPDATE 2010 (25)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


******
Gabon
Date: Fri 28 May 2010
Source: Romandie [in French, trans. Corr.SB, edited]
<http://www.romandie.com/infos/news2/100 ... zuy665.asp>


An outbreak of chikungunya was reported in April [2010] in
south-eastern Gabon, which has also recorded cases of dengue fever
that caused no deaths, officials said on Friday [28 May 2010], at the
Centre International de Recherches Medicales of Franceville (CIRMF).

Dr Eric Leroy of CIRMF said that out of 608 total samples studied in 3
weeks (3-23 May[2010]) only for the area of Franceville, the
researchers found 82 cases of dengue fever. Among the positive cases,
15 were "doubly infected with [chikungunya and dengue] viruses which
is exceptional. Their life is not endangered but their condition
required hospitalization," Dr Leroy said.

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

[This is an interesting mixed chikungunya-dengue virus outbreak. Both
viruses are likely transmitted by the same _Aedes_ mosquito, but it
would be of interest to have the species of the mosquito vector(s)
confirmed.

In the 19 May 2010 ProMED-mail post (archive no. 20070523.1654) Dr
Andreas Krueger reported that the potential chikungunya virus vector
is _Aedes albopictus_ in Libreville (together with _Ae. aegypti_ ssp.
_formosus_). Both species can transmit dengue virus. This was the 1st
report of the detection of _Ae. albopictus_ in Gabon.

A map showing the political divisions of Gabon mentioned in this
report can be accessed at
<http://www.lib.utexas.edu/maps/africa/g ... l_2002.jpg>
A HealthMap/ProMED-mail interactive map of Gabon can be accessed at
<http://healthmap.org/r/0082>. - Mod.TY]

Burkina Faso - Meningokokken-Meningitis
01.06.2010

Meningokokken-Erkrankungen treten saisonal in der Trockenzeit auf. In diesem Jahr wurde das Land besonders hart getroffen. Besorgniserregend waren die hohe Sterblichkeitsrate mit 14 %, sowie das Auftauchen eines neuen Erreger-Typs, gegen den es noch keinen Impfstoff gibt. In der Trockenzeit (Dezember-April) kommt es in den Ländern des Afrikanischen Meningitisgürtels regelmäßig zu Meningokokken-Epidemien. Während der letzten Meningokokken-Saison wurden laut WHO aus vierzehn afrikanischen Ländern 78.416 Verdachts- und 4.053 Todesfälle gemeldet. Impfschutz (ACWY) beachten. / Quelle: crm

CHIKUNGUNYA - AFRICA: (GABON) (02)
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 3 Jun 2010
Source: Generation Nouvelle [in French, Trans. Corr.SB, edited]
<http://generation-nouvelle.org/index.ph ... 8&Itemid=1>


Cases of chikungunya and dengue are being registered in the provinces
of Upper Gabonese Ogooue and Ogooue lolo. According to the Director
General of Health of Gabon, Mr. Khouilla. "Out of 616 samples
analyzed by the International Centre for Medical Research (CIRMF),
303 cases were positive for chikungunya virus and 15 cases of
co-infection with both diseases [viruses]. So far, no deaths have
been reported since the declaration of these epidemics in April
[2010]."

To provide a response to these 2 outbreaks, health experts have been
dispatched to the country to strengthen the management of patients
through an allocation of medicines and emergency training for health
care staff working in those areas where the epidemics exist.

Dr. Khouilla has also said that awareness campaigns are carried out
actively on the risks people face by these epidemics and how to fix
them. He also recommended spraying houses with insecticide in order
to fight against mosquitoes, the main vectors of these 2 diseases
[viruses].

Chikungunya is manifested by fever, severe joint pain and rashes.

In 2008, an outbreak of chikungunya was reported in the estuary,
particularly in Libreville and in the provinces of Woleu-Ntem,
Ogooue-Maritime. According to figures from the Ministry of Health,
more than 16 000 cases were registered during the epidemic which had
appeared for the 1st time in the country.

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

[The number of chikungunya virus infections has increased by 5 since
the 28 May 2010 ProMED report, indicating that the outbreak is
ongoing. Spraying houses with insecticides in the absence of
elimination of water catchments in which the vector mosquitoes breed
will provide only temporary reduction of the mosquitoes.

A map showing the political divisions of Gabon mentioned in this
report can be accessed at
<http://www.lib.utexas.edu/maps/africa/g ... l_2002.jpg>.
A HealthMap/ProMED-mail interactive map of Gabon can be accessed at
<http://healthmap.org/promed/en?v=-0.6,11.8,5>. - Mod.TY]

UNDIAGNOSED DISEASE - UGANDA: (BUGIRI), 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: Fri 4 Jun 2010
Source: Uganda Health News [edited]
<http://www.ugpulse.com/articles/daily/n ... e&ID=14692>


Ugandans flee Island on Lake Victoria over an outbreak of strange disease
-------------------------------------------------------------------------
Hundreds of people on Sigulu Island on Lake Victoria have fled their
homes this week [week ending 4 Jun 2010] due to an outbreak of a
strange disease. Field reports indicate that at least 2 people have
been killed by the strange disease and more than 20 have been
admitted to Uganda and Kenyan hospitals.

Dr. Stephen Kirya, the Bugiri district health officer, says some of
the people who have fled from their homes are displaced within Bugiri
town council. The strange disease broke out on the Island last week.
The victims complain of stomach pains, headache and diarrhea. The
doctors say the outbreak of this strange disease is not cholera.

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

[The description of the symptoms of the illness alarming the
inhabitants of Sigulu Island on Lake Victoria is not sufficiently
specific to suggest a diagnosis. A haemorrhagic fever seems unlikely
and none of the diseases featuring in previous ProMED-mail posts
originating from Uganda in 2010 seem appropriate (see below).

Rift Valley fever has been reported in animals in neighboring Kenya,
but so far not in humans (see: Rift Valley fever - Kenya: alert,
prevention 20100520.1675). ProMED-mail would welcome specific
information about this outbreak of illness from an informed source in
the region.

Bugiri District is a district in eastern Uganda. named after its
'chief town,' Bugiri, where the district headquarters are located.
The map of Uganda at
<http://en.wikipedia.org/wiki/File:Bugir ... Uganda.png> shows
its location on the northern shore of Lake Victoria. The
HealthMap/ProMED-mail interactive map of Uganda can be accessed at:
<http://healthmap.org/r/0089>. - Mod.CP]

Somalia - Darminfektionen
07.06.2010

Risiko für Durchfallerkrankungen einschließlich Cholera landesweit, auch in der Hauptstadt Mogadishu. Die WHO meldet Anfang Juni einen Cholera-Ausbruch, bei dem 132 Menschen stationär behandelt werden mussten, 3 sind bisher verstorben. Eine nachhaltige Besserung der Situation ist angesichts des anhaltenden Bürgerkrieges und der desolaten medizinischen Versorgung nicht in Sicht. Hygiene beachten. / Quelle: crm

DENGUE/DHF UPDATE 2010 (26)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Italy ex Egypt
[2] Gabon


******
[1] Italy ex Egypt
Date: Thu 3 Jun 2010
From: Guido Calleri <calleri@asl3.to.it> [edited]


We were recently called in on consultation for 2 cases of suspected
dengue fever in travelers to the Red Sea resorts in Egypt, where the
disease was not reported in recent years. The 2 patients were
travelling together in early May 2010, and visited Marsa Alam,
Berenice, and Bir Shalatayn.

Case 1
------
A 72-year-old female, presented with fever, arthralgia, vomiting, and
diarrhea. Leucopenia and thrombocytopenia were present. Subsequently a
moderate impairment of consciousness appeared. Dengue serology was
negative at presentation. 10 days later dengue EIA IgG index was 21
(positive greater than 11), and IgM was 29 (positive greater than 11).
Dengue IFA IgG was 1/3200. Also West Nile fever [virus] serology was
positive (IgG 1/320, IgM negative: non-specific?). A slow improvement
of symptoms was seen and after 10 days the patient was discharged.

Case 2
------
A 71-year-old female, presented with fever, arthralgia, vomiting, and
diarrhea. Symptoms improved within 3 days and the patient was
discharged. Dengue serology was negative at presentation, and 10 days
later dengue EIA IgG index was 19 (positive greater than 11), and IgM
was 15 (positive greater than 11). Dengue IFA IgG was 1/3200. Also in
this case West Nile fever serology was positive (IgG 1/320, IgM
negative).

Investigation within TropNetEurop, a network for imported tropical
diseases, specifically reporting dengue cases, did not show dengue
reporting from Egypt in the last few years.

Is this another consequence of the broadening of _Aedes_ area, and
consequently of dengue area? The observation is significant because of
the large number of tourists [going] from Europe to the Red Sea resorts.

--
Guido Calleri
Filippo Lipani
Pietro Caramello
Amedeo di Savoia Hospital
Torino
--
Roberto Raso
Regional Epidemiology Unit for infectious Diseases
Alessandria
Italy
<calleri@asl3.to.it>

[ProMED-mail is grateful to Dr Calleri and colleagues for this report.
The number of dengue reports from North Africa and the Middle East are
very few, so one does not know if the virus is truly absent there, or
if transmission is occurring but is undiagnosed and unreported. It
would also be of interest to know if there are _Aedes albopictus_
present in the area where these patients live and hence, a risk of
ongoing transmission in Italy.

A map of Italy can be accessed at
<http://www.lib.utexas.edu/maps/europe/i ... l_2004.jpg>.
A HealthMap/ProMED-mail interactive map of Italy can be accessed at
<http://healthmap.org/r/00uE>. - Mod.TY]

******
[2] Gabon
Date: Thu 3 Jun 2010
Source: Generation Nouvelle [in French, trans. Corr.SB, edited]
<http://generation-nouvelle.org/index.ph ... 8&Itemid=1>

Cases of chikungunya and dengue are being registered in the Gabonese
provinces of Haut-Ogooue and Ogooue-Lolo. According to the director
general of Health of Gabon, Mr Khouilla, "Out of 616 samples analyzed
by the International Centre for Medical Research (CIRMF), [there were]
84 cases of dengue virus and 15 cases of co-infection with both
diseases [viruses]. So far, no deaths have been reported since the
declaration of these epidemics in April [2010].

To provide a response to these 2 outbreaks, health experts have been
dispatched to the country to strengthen the management of patients
through an allocation of medicines and emergency training for
healthcare staff working in those areas where the epidemics exist.

Dr Khouilla has also said that awareness campaigns are carried out
actively on the risks people face by these epidemics and how to remedy
them. He also recommended spraying houses with insecticide in order
to fight mosquitoes, the main vectors of these 2 diseases [viruses].

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

[The number of dengue virus infections has increased by 2 since the 28
May 2010 ProMED-mail report, indicating that the outbreak is ongoing.
Spraying houses with insecticides in the absence of elimination of
water catchments in which the vector mosquitoes breed will provide
only temporary reduction of the mosquitoes.

A map showing the political divisions of Gabon mentioned in this
report can be accessed at
<http://www.lib.utexas.edu/maps/africa/g ... l_2002.jpg>.
A HealthMap/ProMED-mail interactive map of Gabon can be accessed at
<http://healthmap.org/r/01tn>. - Mod.TY]

Ägypten - Dengue
08.06.2010

Wie TropNetEurope (Europäisches Netzwerk zur Surveillance) berichtet, sind zwei italienische Touristinnen im Alter von 71 und 72 Jahren, die sich Anfang Mai in Marsa Alam, Berenice und Bir Shalatayn am Roten Meer aufgehalten hatten, nach Rückkehr an Dengue-Fieber erkrankt. Beide Patientinnen konnten inzwischen aus der stationären Behandlung entlassen werden. In den vergangenen Jahren wurden keine Dengue-Fälle aus Ägypten gemeldet. Die aktuellen Importe resultieren aus einer Veränderung der epidemiologischen Situation, die schon seit einiger Zeit am Roten Meer zu beobachten ist und auch bereits in Jordanien zu Dengue-Erkrankungen geführt hat. Es ist davon auszugehen, dass das Infektionsrisiko für Reisende in dieser Region zunimmt. Sorgfältiger Schutz vor den überwiegend tagaktiven Überträgermücken ist anzuraten. / Quelle: crm