Wüstenschiff

YELLOW FEVER - AFRICA (15): KENYA (BARINGO), NOT
************************************************
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 25 Apr 2011
From: Dr. David Mutonga [edited]
<dmutonga@ddsr.or.ke>


On 13 Apr [2011], we received a report from the acting Director
Clinical Services at Moi Teaching and Referral Hospital about 2
patients who had been referred to the hospital and later died there
from what the hospital thought was possible yellow fever [YF]. On
receiving the report, the surveillance teams immediately conducted
field investigations and gathered the following information about the
2 patients.

The 1st patient was a 50-year-old male from Kapluk village, Kabut Kei
Division, Baringo North District. Reported date of onset of illness
was on 18 Mar 2011 and died on 29 Mar 2011. Clinical presentation at
various stages of the illness included nose bleeding, headache,
malaise, and fever. There was no history of jaundice. Active case
search by the District Health Management Team [DHMT] in the case
household, neighbouring facilities and communities revealed that no
unusual cases of fever, jaundice, bleeding or any other unusual
illness had been detected.

Laboratory tests - ELISA and PCR tests done at KEMRI [Kenya Medical
Research Institute] were negative for yellow fever [virus] and the
other arboviruses.

The 2nd patient was a 26-year-old male from Seretunin Village, Ewalel
Division, Baringo Central District. The patient had a history of
chemical poisoning before onset of this illness. The reported date of
onset was 3 Apr 2011 and died on 5 Apr 2011. There was no history of
jaundice. A visit to the patient's home, local community and health
facilities by the DHMT did not reveal any other patient having a
similar presentation, nor unusual occurrence of fever cases.

Conclusion: As per the country surveillance guidelines, these
patients are unlikely to have died of yellow fever or the other viral
haemorrhagic fevers. As of now there is no known suspected or
confirmed yellow fever case or outbreak in Baringo County or any other
County in the country at the moment. However, the ministry has alerted
the district health authorities and communities in Baringo county to
be on high alert and to report and investigate any suspected case of
yellow fever or any other epidemic prone disease immediately as per
the surveillance guidelines.

There is adequate laboratory capacity in Kenya to confirm yellow
fever cases when they occur. Health workers are required to collect
specimens and send them to the KEMRI Arbovirus laboratory as soon as
they suspect a case of yellow fever.

The ministry will continue to strengthen the Integrated Disease
Surveillance and Response System to ensure that health authorities
respond immediately and appropriately to any case of epidemic
disease.

Baringo county is a yellow fever high risk county and routine
vaccination is done at 9 months of age through the Expanded Programme
of Immunization (EPI). Catch-up campaigns are done once every 10
years. The last campaign was done in 2002 and the next one is
scheduled for 2012.

--
Dr David M. Mutonga
Head, Division of Disease Surveillance and Response
Department of Disease Prevention and Control
Kenya Ministry of Public Health and Sanitation
<dmutonga@ddsr.or.ke>

[ProMED is grateful to Dr. Mutonga for his rapid response to the
suspected YF cases, in which he provides information that rules out YF
virus infection in these 2 cases. His report provides an excellent
example of field epidemiological surveillance and timely, effective
laboratory support. KEMRI, which provided the laboratory support, is a
WHO Collaborating Center for Arbovirus and Hemorrhagic Fever Reference
and Research.

A HealthMap interactive map of Kenya showing the location of Baringo
district can be accessed at
<http://healthmap.org/r/0JN_> - Mod.TY]

Namibia - Darminfektionen
26.04.2011

Risiko für Durchfallerkrankungen landesweit. Insbesondere im Norden kann es während und nach der Regenzeit (Oktober-März) zu lokalen Cholera-Ausbrüchen kommen. In diesem Jahr ist es aufgrund der Überschwemmungen im Norden zu 123 vermuteten und 4 bestätigten Fällen mit 2 Todesfällen gekommen. Betroffen sind vor allem die Regionen Caprivi, Oshana, Omusati, Ohangwena und Oshikoto. Hygiene und ggf. Impfschutz bei Reisen beachten. / Quelle: crm

MELIOIDOSIS - SPAIN (02): (MADRID) ex AFRICA, BACKGROUND
********************************************************
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 26 Apr 2011
From: David Dance <David.d@tropmedres.ac> [edited]


[Re: ProMED-mail Melioidosis - Spain: (Madrid) ex Africa
20110413.1164]
----------------------------------------------------------------------
I was very interested to read of this case and see yet more
confirmation of the existence of melioidosis in Africa, although
because of this patient's extensive travel history it is obviously
impossible to pinpoint where the infection was acquired. Since the
review I wrote 20 years ago, which was cited in your report, there
have been very few further cases of human melioidosis apparently
acquired in mainland Africa or islands in the Indian Ocean.

Apart from the case from the Gambia reported on ProMED in 2009
[referenced below], 2 cases were reported from Madagascar (1) and an
additional case from Mauritius (2). A further case was reported last
year [2010] in "an African", but again it was impossible to determine
the precise source from the report and my attempts to contact the
authors to obtain further information have been unsuccessful (3).

Over the past year I personally have been contacted about a confirmed
case diagnosed in the UK in a patient who is likely to have acquired
infection in Nigeria, and single indigenous cases in Kenya and Malawi,
although both these isolates await full characterization.

I remain convinced that melioidosis is more common in sub-Saharan
Africa than we realise but is being missed, both because of a lack of
diagnostic laboratories and a lack of awareness. It would be
interesting to hear of further cases via ProMED-mail.

References
----------
1. Borgherini G, Poubeau P, Paganin F, et al: Melioidosis: an
imported case from Madagascar. J Travel Med 2006; 13(5): 318-320
[available at
<http://onlinelibrary.wiley.com/doi/10.1 ... 050.x/full>].
2. Issack MI, Bundhun CD, Gokhool H: Melioidosis in Mauritius. Emerg
Infect Dis 2005; 11(1): 139-140 [available at
<http://www.cdc.gov/ncidod/eid/vol11no01/04-0605.htm>].
3. Amezyane T, Lecoules S, Algayres J-P: Mycotic iliac aneurysm
associated with _Burkholderia pseudomallei_. Int J Infect Dis
2010;14S: e381-e382 [available at
<http://www.ijidonline.com/article/PIIS1 ... 2/fulltext>].

--
Communicated by:
Dr David Dance, MB, ChB, MSc, FRCPath
Clinical Research Microbiologist
Department of Microbiology
Mahosot Hospital
Vientiane, Laos
<david.d@tropmedres.ac>

[ProMED-mail thanks Dr. Dance for his expert comments on this issue.
- Mod.LL]

MALARIA - MOZAMBIQUE (MAPUTO PROVINCE): REQUEST FOR INFORMATION
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Tue 26 Apr 2011
Source: Club of Mozambique [edited]
<http://www.clubofmozambique.com/solutio ... 2&tipo=one>


Malaria increase sharply in Maputo Province
-------------------------------------------
The number of cases of malaria in Maputo province increased sharply
in the 1st quarter of this year, according to the provincial governor,
Maria Jonas.

Speaking on Monday [25 Apr 2011] in Machava, in the southern city of
Matola, on the occasion of World Malaria Day, Jonas said 49 854 cases
of malaria had been diagnosed in the province between January and
March this year, compared with only 19 018 in the same period of
2010.

Jonas regarded this 68 per cent increase in malaria cases as a matter
of serious concern, and stressed the need for all citizens to become
involved in the efforts to halt the spread of malaria.

"Let us all be soldiers in the struggle against malaria," said the
governor. In particular, she urged everyone to support the
government's campaigns to spray insecticide against the mosquitoes
that carry the disease.

The Maputo Provincial Director of Health, Cremilda Anli, announced
that the province is spending about a million US dollars a year on
spraying. Despite this, cases of malaria have risen.

Anli stressed the need to publicise information on how to prevent
malaria -- including home spraying, and the distribution of
insecticide treated mosquito nets, particularly to pregnant women and
children under the age of 5.

World Malaria Day was instituted by the World Health Organisation
(WHO) in 2007, in an attempt to encourage the global struggle against
the disease.

There has been some progress internationally over the past decade.
The number of deaths from malaria fell from 985 000 in 2000 to 781 000
in 2009. About 90 percent of all malaria deaths occurred in Africa,
and 92 percent of them were among children aged under 5.

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

[Malaria is endemic in Mozambique, and a sharp increase as described
most probably is either due to a breakdown in control measures or a
reporting problem. ProMED will be happy to post further information.

The interactive HealthMap/ProMED map is available at:
<http://healthmap.org/r/00Pj>. - Mod.EP]

[ProMED would like to know if Mozambique is using DDT as a persistent
adulticide. - Mod.JW]

MALARIA - ZIMBABWE (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 28 Apr 2011
Source: The Herald (Zimbabwe) [edited]
<http://www.herald.co.zw/index.php?view= ... Itemid=131>


Malaria has so far claimed 125 lives throughout the country since the
beginning of malaria peak season last month [March 2011] amid reports
of serious shortage of drugs in most districts. A further 71 858
people have so far been treated for the disease. Of the cases, 9549
were reported in the week ending 3 Apr 2011 with 2007 of the cases
being children under the age of 5.

According to information from the Cholera Control and Command Centre
(C4) epidemiological update, highest [number of] cases of malaria in
week ending 3 Apr 2011 were recorded in Mashonaland East that saw 3354
people being treated and 2193 in Manicaland province.

To date, 10 districts namely: Mudzi, Kariba, Mutoko, Mutasa, Kadoma,
Mutare city, Rushinga, Makonde, Chimanimani and Mutare rural have
recorded outbreaks. Meanwhile, people seeking treatment from some of
the districts where outbreaks have occurred have complained that some
were being told the malaria drug [co-artemether] was out of stock
while others got it.

Although no official comment could be obtained from the Ministry of
Health and Child Welfare, sources confirmed that malaria drugs were
delivered last week [week ending 24 Apr 2011]. "There were no new
supplies all along. They were only delivered last Friday [22 Apr
2011]," said one source.

He further said because of the delay in procurement of malaria
supplies, health centres that had ran out of rapid test kits were
administering treatment without carrying out any investigation. With
[co-artemether], patients were supposed to be tested 1st for malaria
and only if they are positive can they be given treatment. But in this
case, since there were no kits to test people they ended up treating
people on suspicion that it could be malaria, thereby creating
unnecessary demand on the available treatment. And for the 1st time
since we introduced [co-artemether], we ran out of the drug," he
said.

Malaria is the 2nd largest killer [infectious] disease in Zimbabwe
after HIV and AIDS [but see comment below]. Although some districts
have malaria throughout the year, in most of the districts it is
seasonal. The malaria peak season is between March and May.

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

[Zimbabwe is one of the countries in the African region where,
despite evidence of wide scale implementation of malaria control
activities to more than 50 percent of the population at risk, there is
limited evidence of progress in reducing the number of malaria cases
between 2000 and 2009
(<http://whqlibdoc.who.int/publications/2 ... 06_eng.pdf>).

It is therefore clear from the current report from Zimbabwe that
despite the indications of progress made at the global level in
combating the disease through improved supplies of artemisinin
combination therapy (ACTs), long lasting insecticide treated nets
(LLINs), and rapid diagnostic test kits (RDTs), a lot more investment
need to be put into improving the supply chain bottlenecks to ensure
that the patients actually benefit from these supplies, with reduced
cases and deaths from the disease.

A map showing the administrative regions of Zimbabwe can be accessed
at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe can be accessed
at
<http://healthmap.org/r/017p>. - Mod.JFW]

[Causes of death from infectious diseases among children under 5
years of age (%) (Both sexes) Year 2000 data: Col.1 Zimbabwe Col.2 WHO
African region (basically sub-Saharan)

HIV/AIDS 2000 40.6 6.8
Pneumonia 2000 14.7 21.1
Diarrhoeal diseases 2000 12.1 16.6
Measles 2000 2.9 4.3
Malaria 2000 0.2 17.5
<http://www.afro.who.int/en/zimbabwe/cou ... ofile.html>

Latest data posted (2000). Malaria was 5th cause; since then, the
situation must have worsened for all these diseases. Data for all
ages not shown.
- Mod.JW]

Mosambik - Malaria
02.05.2011

Aus der Provinz Maputo (S) wird ein Anstieg der Malaria-Fälle berichtet. 2011 wurden von Januar bis März bereits 49.854 Erkrankungen gemeldet, im Vorjahr waren es 19.018. Expositionsprophylaxe beachten, die Einnahme einer Chemoprophylaxe wird empfohlen. / Quelle: crm
_______________

Simbabwe - Malaria
02.05.2011

In mehreren Ausbrüchen landesweit wurden in diesem Jahr schon 71.858 Erkrankungen mit 125 Todesfällen berichtet. Es wurden Ausbrüche aus folgenden Distrikten gemeldet: Mudzi, Kariba, Mutoko, Mutasa, Kadoma, Mutare Stadt, Rushinga, Makonde, Chimanimani und Mutare. Besonders betroffen sind die Provinzen Mashonaland East mit 3.354 und die Manicaland mit 2.193 Fällen. Schutz vor den dämmerungs-und nachtaktiven Mücken beachten und Einnahme einer Chemoprophylaxe empfohlen. / Quelle: crm

YELLOW FEVER - AFRICA (16): KENYA (BARINGO)
*******************************************
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 2 May 2011
Source: All Africa [edited]
<http://allafrica.com/stories/201105021423.html>


Medical personnel in Baringo and Elgeyo-Marakwet counties have been
put on high alert after 9 out of 16 of people tested for yellow fever
[YF virus infection] turned out positive. The area had been put on
high alert last week after a 50-year-old man succumbed to a disease
suspected to be yellow fever in Kapluk area of North Baringo district,
bringing to 6 the number of people who have succumbed to the disease
since the beginning of the year. This prompted Kenya Medical Research
Institute (KEMRI) officials from Kisumu and Busia to be deployed to
the area to monitor the situation.

According to Baringo north district Medical Officer of Health (MOH)
Dr Felix Atisa, blood specimens for the victims from Kapluk Dispensary
and Kabarnet District Hospital taken for analysis at KEMRI
headquarters in Nairobi on Tuesday last week [26 Apr 2011] revealed
that they have the viral disease. Dr Atisa said that health personnel
in all health facilities in the area have been directed to be on the
lookout for the symptoms of the disease, which include chills, fever,
headache, backache, joint and muscle pains and yellowness of the eyes
in severe cases, which become noticeable within a period of 3-6 days
after the victim is bitten by the mosquito. The medic, however,
assured the locals that all health facilities in the area have been
stocked with enough drugs in case of any emergency.

He advised the residents to ensure that bushes and empty cans around
their compounds were cleared since they were conducive environments
for the breeding of mosquitoes. "We advise the people to take
precautionary measures to prevent mosquitoes breeding in their
compounds and also spraying insecticides. We also urge those who
develop any symptoms similar to those of yellow fever to seek
medication without delay," said Dr Atisa.

He said that health personnel have also been deployed to the high
risk areas to carry sensitization campaigns to the people. He said
that a mass vaccination of the entire population will soon be rolled
out in the area. The last time the exercise was carried out in Baringo
and Elgeyo Marakwet counties was in 2001. This was after 15 people
died of the disease, prompting the World Health Organization (WHO) to
intervene.

A senior health official who preferred anonymity warned that more
people will succumb to the deadly disease if no urgent measures are
taken by the government to roll out a mass vaccination exercise.
"Yellow fever vaccines provide immunity for a period of 10 years,
which have elapsed since the last vaccination in the area. To make the
matters worse, the area has not been mapped out to determine the
extend of the fatal disease," said the medic.

Local residents who spoke to the Nation claimed that many people from
areas such as Salawa, Kapluk, Barwessa and Seretunin were beginning to
develop the symptoms of the disease. Led by Mr Harold Kipchumba of
Bare Carea local CBO, the residents demanded that results from KEMRI
be made public by the government.

"Even if the economic impact of such a step is big, the life of our
people should come 1st," said Mr Kipchumba. He feared that the
situation will worsen with the expected downpour in the area. Baringo
and Elgeyo Marakwet counties, particularly the lower regions, are
prone to yellow fever.

Yellow fever is an acute viral haemorrhagic disease transmitted by
infected mosquitoes and can be transmitted from one person to another
by the mosquito that bites during the day. The "yellow" in the name
refers to the jaundice that affects some patients. According to the
World Health Organisation (WHO), there is no cure for yellow fever.
Treatment aims at reducing the symptoms for the comfort of the
patient. Vaccination is the most important preventive measure against
the disease.

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

[This situation is confusing in that the case of the 50-year-old man
from the Baringo district who was originally suspected as having YF
was subsequently discarded as a YF case after laboratory tests done at
KEMRI were negative. Is the above case the same one, as seems likely?
In any event, since 9 of 16 suspected YF cases have turned out to be
positive (by tests done at KEMRI?), there is a small YF outbreak going
on in the area and rapid implementation of a vaccination program is
needed urgently. ProMED would appreciate receiving additional field
and laboratory information as it becomes available.

A HealthMap interactive map of Kenya showing the location of Baringo
district can be accessed at <http://healthmap.org/r/0JN_>. - Mod.TY]

YELLOW FEVER - AFRICA (17): KENYA, BACKGROUND
*********************************************
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 4 May 2011
From: Paul Reiter <paul.reiter@pasteur.fr> [edited]


The 1st recorded outbreak of yellow fever [YF] in Kenya occurred from
mid-1992 through March 1993. Nearly all confirmed infections were
acquired between 1500-1800 m [4900-5900 ft] in the Tugen Hills
[Baringo district, Rift Valley province], not far from the present
outbreak area.

Transmission appeared to be entirely sylvatic, that is, all confirmed
cases were independent of other human cases and had acquired their
infection by contact with mosquitoes that had been infected by feeding
on viraemic monkeys. Infected mosquitoes (_Aedes africanus_ and _Ae.
keniensis_) were captured close to a cluster of human cases at ca.
1700m [5577 ft].

A team comprised of Kenya Government/KEMRI/WHO/CDC specialists found
that _Ae. aegypti_ was absent in the villages, hard to find in the
small local town of Kabarnet [Baringo district] (population 10 000)
but abundant in Kakamega [Western province] (population 73 000) and
Kisumu [Nyanza province] (current population estimated at 0.5
million), Kenya's 3rd most populous city. There was an excellent road
from the area to Kisumu; the drive took about 4 hours without
speeding.

The population in the outbreak area was small but included the
ancestral village of the then-president, Arap Moi. We were told that
this had enabled many local people to obtain jobs in Nairobi and other
parts of the country.

All this to emphasize the obvious: the region of transmission was
once quite remote but today there is a real and present danger that
such outbreaks could metastasise to urban areas in other parts of the
country and beyond, with potentially catastrophic consequences.
Pro-active vaccination of the local population would greatly reduce
this danger and thereby evade anxieties over adverse impact on
tourism.

Lastly, although there are virtually no records of yellow fever in
other parts of the country, older men in the local community
remembered a large epidemic of fever, haemorrhage, and jaundice that
had occurred in the area during World War II, perhaps in 1941 or
1942.

References
----------
1. Sanders EJ, Marfin AA, Tukei PM, et al: First recorded outbreak of
yellow fever in Kenya, 1992-1993. I. Epidemiological Investigations.
Am J Trop Med Hyg, 59(4): 644-9 [available at
<http://www.ajtmh.org/cgi/reprint/59/4/644>].
2. Reiter P, Cordellier R, Ouma JO, et al: First recorded outbreak of
yellow fever in Kenya, 1992-1993 II. Entomologic investigations. Am J
Trop Med Hyg, 59(4): 650-6 [available at
<http://www.ajtmh.org/cgi/reprint/59/4/650>].

--
Paul Reiter
<paul.reiter@pasteur.fr>

[ProMED-mail thanks Dr Reiter for his interesting comments on YF in
Kenya. His concern about potential spread of YF virus to other parts
of Kenya is serious and one hopes that a prompt vaccination campaign
in the affected areas will prevent spread to other areas.

Maps of Kenya can be accessed at
<http://www.ogiek.org/photo-gallery/kenya-map-big.jpg> and
<http://healthmap.org/r/0JN_>. - Mod.TY]

Kenia - Gelbfieber
05.05.2011

Anfang Mai wurde ein kleiner Ausbruch im Distrikt Baringo (Provinz Rift Valley, ca. 200 km nördlich von Nairobi) gemeldet. Neun der insgesamt 16 Verdachtsfälle konnten bestätigt werden, bisher gab es sechs Todesfälle. Nun soll eine große Impfaktion einen größeren Ausbruch verhindern. Die Impfung bietet nur für 10 Jahre einen zuverlässigen Schutz, die letzten Massenimmunisierungen sind entsprechend lange her. Bei Einreise nach Kenia wird die Impfung bereits aufgrund des Gelbfieber-Ausbruchs in Uganda stärker kontrolliert. Eine Impfung wird auch aus medizinischer Sicht allen Reisenden empfohlen. / Quelle: crm

YELLOW FEVER - AFRICA (18 ): KENYA (BARINGO) NOT
***********************************************
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: Fri 6 May 2011
From: David Mutonga <dmutonga@ddsr.or.ke>[edited]


KEMRI [Kenya Medical Research Institute] has completed the testing of
the samples collected from Baringo. We have received the following
results from KEMRI Arbovirology/VHF lab, Center for Virus Research --
the central reference laboratory for yellow fever in Kenya.

Summary of results
------------------
1. All samples were negative by IgM ELISA (NO evidence of acute
yellow fever [virus] infection)
2. One sample was weakly positive by IgG ELISA (evidence of previous
exposure or vaccination)
3. All samples were negative by RT-PCR (flavivirus, YF [yellow
fever], DEN [dengue], and WN [West Nile viruses]). NO evidence of
acute infection by any of these viruses.

--
Dr David Mutonga,
for The Director Ministry of Public Health and Sanitation
Kenya
<dmutonga@ddsr.or.ke>

[ProMED-mail thanks Dr Mutonga for this official information. It
dispels the confusion reflected in the earlier reports of YF cases
from this area in Kenya. The suspected YF cases have turned out to be
negative for this virus infection. Apparently, the earlier report of 9
of 16 samples positive for YF virus infection was not accurate.

Maps of Kenya can be accessed at
<http://www.ogiek.org/photo-gallery/kenya-map-big.jpg> and
<http://healthmap.org/r/0JN_>. - Mod.TY]

******
[2]
Date: Wed 4 May 2011
Source: AllAfrica, Daily Nation (Kenya) report [edited]
<http://allafrica.com/stories/201105050280.html>


The government has dispelled fears over the presence of yellow fever
in Baringo and the country in general. Public health minister Beth
Mugo said on Wednesday [4 May 2011] that currently there are no
laboratory-confirmed cases of the disease, allaying fears on the
prevalence of the fever-disease. "I assure the general public that
those intending to visit the country that there are no known cases
that meet the case definition standard or are laboratory confirmed to
be yellow fever," she told journalists at a media briefing at her Afya
House office. However, she cited Baringo, Koibatek, Keiyo, and
Marakwet as yellow fever high-risk areas in the country though
vaccination of the disease was routinely administered at 9 months [of
age] for children in these areas.

On the suspected cases of 16 patients from Baringo county, she said
that initial confirmatory tests had all turned negative for the
disease though a second set of confirmatory tests had been requested.
The results will be released by the end of this week, she said. "We
also conduct catch-up vaccination campaigns every 10 years with the
last one having been done in 2002 and the next one due in 2012," the
minister said adding that the upcoming campaign was not triggered by
the current yellow fever scares in the area.

She urged the public in the high risk areas preventive measures to
keep the disease at bay. "Protect yourselves from mosquito bites by
wearing long sleeved clothing, sleeping under insecticide treated nets
and using mosquito repellents," the minister advised the public.

The minister said that one of the 2 patients suspected to have died
of yellow fever 3 weeks ago at Moi Teaching and Referral Hospital had
their blood sample tested negative for the disease at KEMRI
laboratories. "No specimen was taken from the 2nd patient because it
was established that he had drank poison prior to the onset of
haemorrhage," Mrs Mugo said. However the minister said a team from
KEMRI's centre for Infectious and Parasitic Diseases Control research
in Busia had visited Baringo county last week [week of 25 April] and
randomly collected 14 blood samples from patients presenting with
fever at Kapluk dispensary and Kabarnet district hospital and all
tested negative for the disease.

[byline: Joy Wanja]

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

******
[3]
Date: Thu 5 May 2011
Source: Daily Nation [edited]
<http://www.nation.co.ke/News/Yellow+fev ... index.html>


Public health minister Beth Mugo said on Thursday [5 May 2011] there
were no laboratory-confirmed cases of the disease. "I assure the
general public and those intending to visit the country that there are
no known cases that meet the case definition standard or are
laboratory confirmed to be yellow fever," she told a media briefing at
her Afya House office.

Last week [week of 25 April], Baringo North District medical officer
of health Felix Atisa also dismissed claims that a man had died of
yellow fever in the area although the Kabarnet District Hospital
medical superintendent Robert Pukose had said the man died from
haemorrhagic fever, "which is common among patients with yellow
fever."

Dr Pukose told journalists that a post-mortem examination at Moi
Teaching and Referral Hospital in Eldoret confirmed the cause of death
to be yellow fever. He named Baringo, Koibatek, Keiyo, and Marakwet as
yellow fever high-risk areas, although vaccination was routinely
administered at 9 months [of age] for children in these areas.

On the suspected 16 cases from Baringo County, the minister said,
initial tests had all turned negative for the disease [YF virus
infection], although a 2nd set of confirmatory tests had been
requested. The results will be released by the end of this week, she
said.

"We also conduct catch-up vaccination campaigns every 10 years with
the last one having been done in 2002 and the next one due in 2012,"
the minister said. The upcoming campaign, she said, was not triggered
by the current yellow fever scare in the area.

Mrs Mugo urged the public in the high-risk areas to take preventive
measures to keep the disease at bay. "Protect yourselves from mosquito
bites by wearing long sleeved clothing, sleeping under insecticide
treated nets, and using mosquito repellants," the minister told the
public.

She said that one of the 2 patients suspected to have died of yellow
fever 3 weeks ago at Moi Teaching and Referral Hospital had their
blood sample tested at KEMRI laboratories and the result was negative
for the disease. "No specimen was taken from the 2nd patient because
it was established that he had drank poison prior to the onset of
haemorrhage," Mrs Mugo said.

A team from KEMRI's Centre for Infectious and Parasitic Disease
Control research in Busia had visited Baringo last week [week of 25
Apr 2011] and collected 14 blood samples from patients presenting with
fever at Kapluk Dispensary and Kabarnet District Hospital and all
tested negative for the disease.

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

Kenia - Hämorrhagisches Fieber
09.05.2011

Anfang Mai wurde im Distrikt Baringo (Provinz Rift Valley, ca. 200 km nördlich von Nairobi) ein kleiner Ausbruch von Erkrankungen mit Todesfällen gemeldet, die zunächst als Gelbfieber bestätigt wurden. Nach offizieller Mitteilung des Kenya Medical Research Insitute hat sich jedoch in weiteren Labortests bei keinem der 16 Verdachtsfälle Gelbfieber-Virus nachweisen lassen, so dass es sich also nicht um einen Gelbfieber-Ausbruch handelt. / Quelle: crm

UNDIAGNOSED ILLNESS, FATAL - SOMALIA (BAKOOL): 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: 19 May 2011
Source: AllHeadlineNews [edited]
<http://www.allheadlinenews.com/articles ... z1MvAgFgWa>

Mysterious illness kills 64 in southwestern Somalia
---------------------------------------------------
Location: Hudur, Somalia

An unidentified disease has killed at least 64 people, mainly women
and children, in villages in the southwestern Somali region of Bakool
over the past 3 days, elders confirmed on Thursday [19 May 2011].

The elders said there are no health facilities in the affected
villages of Yoonkoy and Busti around the region's provincial capital
of Hudur, which is about 430 km [267 miles] southwest of Mogadishu.

An elder in the region, Omar Isak Madey, told the media Thursday that
the strange illness emerged at the beginning of the week and people
began dying within 48 hours after becoming infected. "This is a
humanitarian disaster we have never seen before so we are calling for
emergency life saving medical assistance," Madey said during a
telephone press conference. "There is a terrible condition here,
people are dying and we cannot do anything to save them," the elder
lamented.

Most cities and towns in the Bakool region including the provincial
capital are under the control of Al-Shabaab militants who have banned
international aid agencies from the region.

[Byline: Shafi'i Abokar]

--
Communicated by:
Ronan Kelly on behalf of Flutrackers.com
<http://www.flutrackers.com>
<ronankelly@comcast.net>

[It is impossible to discern the cause of this apparent outbreak
without further information. Enteric infections, including cholera,
other bacterial diarrheas or foodborne illness, influenza and a
variety of other respiratory viral infections could be involved.
Further details from anyone with information from this region would be
welcome. - Mod.LM]

[Re the similar outbreak in the same locality in 1999 (see ProMED
ref. below), I commented at that time "Sounds like the usual
unfortunate multiple cause outbreak in an aggravated sanitary
situation."

ProMED/Healthmap location at <http://healthmap.org/r/0RM->
- Mod.JW]

UNDIAGNOSED ILLNESS, FATAL - SOMALIA (02): (BAKOOL), 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: 21 May 2011
Source: OCHA Weekly Humanitarian Bulletin No. 20, 13-20 May 2011 via
Somaliweyn [edited]
<http://www.somaliweyn.org/pages/news/Ma ... May18.html>


In Hudur, Bakool region, there are reports of an unclassified disease
that has affected over 90 people with 53 deaths. Signs and symptoms of
the cases include fever for one to 2 months, a high pulse rate,
occasionally sore throat, and progressive swelling of joints and limbs
including pain. It is observed that patients either recover slowly or
die.

Retrospective data collected indicates that the case fatality rate is
a major concern. WHO has dispatched additional supplies including
antibiotic syrups and tablets to Hudur to support the mobile clinic in
the affected villages for a period of one month.

--
Communicated by:
Ronan Kelly for FluTrackers.com
<http://www.flutrackers.com>

[This may be the same cluster described in an earlier report (archive
number 20110521.1534) reporting 64 deaths in the same region due to an
undefined illness. Those deaths were reported to be mainly in women
and children. It is hard to fit the clinical syndrome into any one
disease entity, and one wonders whether there are multiple
contributing etiologies: respiratory viruses, arboviruses
(chikungunya?), malaria, enteric infections (including typhoid), and
hepatitis, all in the setting of more chronic maladies such as
malnutrition, HIV and tuberculosis. Any additional information would
be welcomed. - Mod.LM]

[ProMED/Healthmap location at <http://healthmap.org/r/0RM->
- Mod.JW]

MENINGITIS, MENINGOCOCCAL - NIGERIA: (YOBE), 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>

Date: Mon 23 May 2011
Source: allafrica.com [edited]
<http://allafrica.com/stories/201105230763.html>


According to a report by the state's Epidemiological Department in
Damaturu yesterday, Yobe State recorded 322 cases of cerebrospinal
meningitis across the 17 local government areas of the state last
year, and 22 persons died from the disease. It added that 4 persons
died out of the 51 cases that were reported between January and May
this year [2011].

Reacting to the report, the Director General of the Yobe State Health
Care Management Board, Alhaji Lawal Ibrahim said the board had
procured preposition drugs on measles, meningitis and other related
diseases and that they had already been distributed to the 6
epidemiological zonal offices in the state.

He said that government has also embarked on a campaign against
overcrowding, personal and environmental hygiene, saying those were
preventive measures against disease outbreak in the state.

[Byline: Kabir Matazu]
--
Communicated by:
HealthMap Alerts via
ProMED-mail <promed@promedmail.org>

[Although the above news release does not specify the microbial cause
of the meningitis outbreak in Nigeria, the sub-Saharan region of
Africa is plagued yearly by large epidemics of meningococcal
meningitis. This region, known as the "Meningitis Belt," stretches
from the east to the west coast of Africa, and includes Nigeria, as
well as Burkina Faso, Benin, Chad, Democratic Republic of the Congo,
Ethiopia, Ghana, Ivory Coast, Kenya, Mali, Niger, Sudan, Togo, and
Uganda
(<http://www.cdc.gov/ncidod/eid/vol9no10/03-0170.htm>). The
meningitis outbreaks occur in the dry season (December to June), and
every 8-12 years large outbreaks occur
(<http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx>). Attack rates
during these cyclic epidemics of meningitis range from 100 to 800 per
100 000 population, but individual communities have reported rates as
high as 1000 per 100 000 (World Health Organization: Meningococcal
meningitis fact sheet:
<http://www.emro.who.int/sudan/pdf/FactS ... ngitis.pdf>).

Epidemic thresholds are used to confirm the emergence of an epidemic
in order to step up control measures, that is, mass vaccination and
appropriate case management. For definitions of epidemic thresholds,
see
<http://www.who.int/disasters/repo/6618.doc>.

To control an outbreak, WHO recommends mass vaccination with the
appropriate meningococcal vaccine in every involved district in an
attempt to induce herd immunity, whereby transmission is blocked when
a critical percentage of the population has been vaccinated (see
<http://www.who.int/mediacentre/factsheets/fs141/en/>). In 2009,
meningococcal serogroups A and W135 were involved in outbreaks in
Nigeria (see ProMED mail post Meningitis, meningococcal - Nigeria (03)
20090509.1731). These serogroups cause meningitis that is potentially
vaccine-preventable. However, in 2010, a new strain (serogroup X) of
meningococcal meningitis emerged in Burkina Faso that led to huge
outbreaks in that country, with 46 percent (6/13) of the regions in
the country being at epidemic level. Serogroup X is one of those for
which no vaccine exists. Niger, which borders the Yobe State of
Nigeria, also experienced cases due to serogroup X in 2010 and
experienced an epidemic of meningitis due to this strain in 2006 (see
ProMED-mail post Meningitis, meningococcal - Africa (02): WHO
meningitis region. 20100426.1343)

In addition, _Streptococcus pneumoniae_ is a pathogen also known to
cause outbreaks of meningitis in the African "meningitis" region (see
ProMED-mail post Meningitis, pneumococcal - Africa: WHO meningitis
region 20100213.0507).

Yobe State is located in northeastern Nigeria that borders on Niger.
Damaturu is the capital of Yobe State, which has a population of
88,014 at the 2006 census (<http://en.wikipedia.org/wiki/Damaturu>).

The HealthMap/ProMED-mail interactive map of Nigeria is available at

<http://healthmap.org/promed/en?v=9.6,6.1,6>. A map of the African
bacterial meningitis belt can be found at
<http://www.medic8.com/images/map4-9.gif>. - Mod.ML]

UNDIAGNOSED ILLNESS, FATAL - SOMALIA (03): (BAKOOL), 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 23 May 2011
From: A. Mark Joffe [edited]
<mjoffe@ualberta.ca>


The fatal illness reported in Somalia has some similarity to
epidemics reported in neighbouring Ethiopia - Epidemic Dropsy. This is
a syndrome caused by tainting of cooking oil with the Mexican poppy,
_Argemone mexicana_, that is now grown in Ethiopia, India, U.S. and
India (and perhaps elsewhere). Epidemics have been reported in South
Africa as well as Ethiopia.

The syndrome is usually associated with G.I. symptoms (diarrhea and
vomiting) but presents with continuous or intermittent fevers and
bilateral symmetrical pitting edema and burning paresthesias of the
legs. The edema is a result of a capillary leak syndrome that can
progress to non-cardiogenic pulmonary edema, cough, dyspnea and
death.

--
A. Mark Joffe
Professor of Medicine, Division of Infectious Diseases, University of
Alberta
Senior Medical Director, Infection Prevention and Control
Alberta Health Services
<mjoffe@ualberta.ca>

[ProMED-mail thanks Dr. Joffe for his contribution on a possible
cause for the outbreak in Somalia. This outbreak has affected more
than 90 people with 53 deaths and has been characterized by "fever for
one to 2 months, a high pulse rate, occasionally sore throat, and
progressive swelling of joints and limbs including pain."

ProMed-mail has previously posted reports on epidemic dropsy: see
Epidemic dropsy - India (UP): mustard oil susp. 20050207.0412.
Epidemic dropsy is an intoxication with benzophenanthridine alkaloids,
sanguinarine and dihydrosanguinarine, present in argemone oil, mainly
derived from the seeds of _Argemone mexicana_ (Mexican prickly poppy),
that has adulterated cooking oil, usually mustard oil
(<http://www.ncbi.nlm.nih.gov/pubmed/10621875>). Several outbreaks of
epidemic dropsy have occurred in the past in India as well as in
Mauritius, Fiji Island, and South Africa
(<http://www.ncbi.nlm.nih.gov/pubmed/9189656>).

More information concerning the clinical picture and epidemiology of
the Somali outbreak would be greatly appreciated.

The HealthMap/ProMED-mail interactive map of Somalia can be accessed
at:
<http://healthmap.org/promed/index.php?n ... 1,42.441,5>.
- Mod.ML]