Wüstenschiff

Kongo, Republik - Chikungunya
04.07.2011

Der seit Anfang Juni aufgetretene Ausbruch mit mittlerweile über 7.000 Fällen in Brazzaville im Süden des Landes breitet sich in die umliegende Pool Region aus. Schutz vor tag- und nachtaktiven Mücken beachten. / Quelle: crm

Kongo, Demokratische Republik - Infektionskrankheiten
04.07.2011

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit. Seit Ende Februar wird ein Cholera-Ausbruch mit etwa 2.800 Erkrankten und 150 Todesfällen aus Kisangani (O) gemeldet. Inzwischen ist auch die Hauptstadt Kinshasa betroffen, hier wurden Ende Juni 13 Fälle gemeldet. Alle Formen der Virushepatitis kommen im Land vor. Angesichts des desolaten Gesundheitswesens ist davon auszugehen, dass der Polio-Erreger in der DRC weiterhin zirkuliert. Insgesamt 101 Fälle wurden 2010 gemeldet. 2011 gab es bis Anfang Juni 54 gemeldete Fälle. Der Erreger wurde wahrscheinlich aus Angola importiert. Schlafkrankheit und Tollwut sind weit verbreitet, Risiko auch für örtliche Auftritte von Pest, vor allem im NO des Landes, für Affenpocken sowie viralen hämorrhagischen Fiebern. / Quelle: crm
_______________________

Kongo, Republik - Chikungunya
04.07.2011

Der seit Anfang Juni aufgetretene Ausbruch mit mittlerweile über 7.000 Fällen in Brazzaville im Süden des Landes breitet sich in die umliegende Pool Region aus. Schutz vor tag- und nachtaktiven Mücken beachten. / Quelle: crm


Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (20)
************************************************
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] Cholera - Zimbabwe (Masvingo, Manicaland)
Date: Thu 7 Jul 2011
Source: Newsday [edited]
<http://www.newsday.co.zw/article/2011-0 ... a-claims-9>


Nine people died recently, while 194 were hospitalized following a
fresh outbreak of cholera in Chiredzi, a senior provincial health
official confirmed on Thu 7 Jul 2011.

Masvingo provincial medical director Robert Mudyiradima told NewsDay
that the most affected areas include Lapache, Umbono and Nyahombe in
Lowveld district. He said the latest outbreak, believed to have
started in neighboring Chisumbanje Tea Estates in Manicaland, had left
194 people hospitalized.

"As you are aware, Chiredzi borders Manicaland, where the disease was
1st detected. We believe farm workers moving in search of jobs brought
the disease to Chiredzi. That is why Chiredzi has been a problem
area."

[byline: Tatenda Chitag]

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

******
[2] Cholera - Zimbabwe (Matabeleland)
Date: Wed 6 Jul 2011
Source: Daily Nation [edited]
<http://www.nation.co.ke/News/africa/Dia ... /dtxv89/-/>


At least 10 children have died from a suspected diarrhoea outbreak
which has affected over 200 children in Zimbabwe's 2nd city of
Bulawayo over the past month, a state daily said on Wed 6 Jul 2011.

"More than 200 children suffering from the disease were admitted
during the month of June 2011," The Herald newspaper quoted an
official at the government-run Mpilo Hospital as saying.

"Ten children have died. Technicians at our laboratories are
analysing stools to determine the cause of the disease."

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

******
[3 Cholera - Ghana (Central Region)
Date: Thu 7 Jul 2011
Source: Joy News/Ghana [edited]
<http://news.myjoyonline.com/health/201107/68816.asp>


Health authorities in the Abura-Asebu-Kwamankese District of the
Central Region have intensified education to minimize the spread of
cholera cases at Moree, a fishing community near Cape Coast.

Reported cases have increased from 45 to 55 in less than 2 days. So
far, 2 people are reported dead. The staff of the hospital has been
beefed up to fight the menace.

The Abura-Asebu-Kwamankese District Director of Health Services,
Gifty Ankrah, says health education in the area has been intensified.

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

******
[4] Cholera - Nigeria (Gombe)
Date: Thu 30 Jun 2011
Source: Nigerian Observer [edited]
<http://nigerianobservernews.com/3006201 ... ews14.html>


Dr Abubakar Joshua, the epidemiologist in charge of the Preventive
Health Service in Gombe State Ministry of Health, told newsmen that
tests had confirmed an outbreak of cholera.

Joshua said that the ministry received reports of the outbreak of
gastro-enteritis from Bajoga town in Funakaye Local Government Area on
15 Jun 2011 and from Nafada town of Nafada Local Government Area on 23
Jun 2011, with a total of 104 recorded cases.

"When we received a report of gastro-enteritis, we had to collect
stool samples and analyse them to see the causative agent, and we
found that it was cholera. Out of the 5 patients that we met in
General Hospital, Nafada, 2 of them tested positive to the organism
that causes cholera."

Joshua said that 3 deaths were recorded in Nafada and 2 in Bajoga.

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

******
[5] Cholera - Nigeria (Niger)
Date: 30 Jun 2011
Source: Nigerian Tribune [edited]
<http://tribune.com.ng/index.php/communi ... 3-in-niger>


No fewer than 13 people have been reported dead following as outbreak
of cholera in Niger State, Dr Usman Mohammed, the state director of
primary health services, has said. He explained that out of the 32
samples of the 457 cases reported to the health ministry, 18 of them
were confirmed to have contacted cholera.

"The state had recorded 13 deaths from the confirmed cases of
cholera, following the outbreak of the disease from 1 Jun 2011 to date
[30 Jun 2011]. All the cases of cholera recorded in the state are
confined to Minna, the state capital, although we have reported cases
of diarrhea in Paikoro and Bosso Local Government areas."

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

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (22): AFRICA
**************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******

Cholera - Ghana (Central)
Date: Mon 11 Jul 2011
Source: Joy News/Ghana [edited]
<http://news.myjoyonline.com/health/201107/68994.asp>


Health officials at the Abura Asebu Kwamankese District [Central
region] are collaborating with sanitation agencies in the Central
Region to check the spread of cholera in Moree. The number of cholera
cases reported at the Moree Health Centre has shot up to 71 in 5 days
while 2 deaths have so far been recorded.

The District Director of Health Services, Gifty Ankrah, says they
have deployed community health nurses to the fishing community to help
contain the disease.

Central Regional Correspondent, Richard Kojo Nyarko, reported some of
the measures to be taken will include disinfecting water bodies and
places of convenience as well as ridding the Moree township of filth.

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

[The HealthMap/ProMED-mail interactive map of Ghana can be seen at
<http://healthmap.org/r/11MF>. - Sr.Tech.Ed.MJ]

UNDIAGNOSED FEBRILE CHILD FATALITIES - CONGO DR: (EQUATEUR), 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: Sat 9 Jul 2011
From: James Wilson <jim.wilson@praecipiointernational.org> [edited]


We have been tracking reports of pediatric fatalities from reliable
ground sources who have been present in DRC for many years in Gemena,
NW Equateur Province, DRC.

The area from which cases have been reported include Gemena and east
towards Karawa (as far as 80 km and 300 km west and east of Gemena,
respectively).

The reporting peaked in April and May 2011, but fatalities and
medical infrastructure strain reportedly continue.

The medical infrastructure reports "grid" level strain, with several
wards "full," with patients to include children in intensive care
(with ICU overload) at Gemena General Hospital.

The clinical presentation includes high fever (38-40.4 C), vomiting,
anemia, occasional diarrhea, dehydration, death within 2-5 days;
sources deny abdominal pain, rash, hemorrhage, or jaundice.

Epidemiological features known so far are beyond the above; reports
on the ground (without formal epi investigation) indicate they are
seeing more pediatric fatalities than they have seen at least in the
last 3 years [and this is the 1st such "alarm" we have seen from this
area from usually calm and reliable sources]. Suspected etiologies
include falciparum malaria and typhoid, among others.

Additional information/direct quote from the source: "In the case of
my friend, he personally had the same blood type as his one-year-old
son, and could give him blood. There are no blood banks here and
basically no refrigeration available. This morning, I saw my friend
who came home from the hospital to wash up then to return. He said
that the ICU is full of little children, so full that there are
children out on the walkways. This morning before 8 AM, he said 4
children died in the ward where his son is. All have similar symptoms.
When he went back, he saw another child die. In addition, I know of 2
other deaths of children from contact with other friends here. Of
course, many people do not take their children in for medical care
because they cannot afford it, or they try using smaller clinics. So
the number of deaths is much higher. At a hospital 80 km east of here
at Karawa, they have higher than normal child death rates right now as
well. In May 2011 in one church in one week, 20 child deaths were
reported, all with the symptoms listed.

Local medical people are making some contacts with the national
health service, but there is some feeling that because of upcoming
national elections in November 2011, either other things take priority
or some problems are downplayed.

Local people are suspicious of a recent polio vaccine program. Two of
the 3 doses have been administered, and many of the children who have
died of course also received the vaccine. There is enough suspicion
that there is a significant risk that people will not let their
children receive the 3rd dose in the series.

Local hospitals have also had a large number of positive tests for
typhoid.

This has been discussed by doctors in the province. Local WHO offices
are aware of these issues, but they have not sponsored a special
study. No national office has done studies. There are no suggested
treatments other than what local staff try.

As far as I know, no extensive tests have been done recently about
water quality or other possible public health risks.

Other people have voiced concerns about: Increases in Chinese
products in local markets; lead or other metal poisoning; viruses
targeting children. However, the ordinary person tends to put the
blame on the oral polio vaccination program.

One missionary reported hearing reports of increased deaths of goats
in the area, perhaps with fever and anemia as well. The goat deaths
are real. The symptoms are unconfirmed and have not been studied as
far as I know."

--
James M. Wilson V, MD
Executive Director
Praecipio International
Washington-Houston-Port au Prince
<jim.wilson@praecipiointernational.org>

[ProMED thanks Dr James M. Wilson for alerting us to this outbreak.

We agree that falciparum malaria would be high up on the list of
suspected infections; however, the NW Equateur province is
hyper-endemic for perennial transmission, and malaria usually does not
cause outbreaks under such conditions. Anemia is an unspecific symptom
in many severe infections but would be particularly severe in
malaria.

ProMED reported an outbreak of hepatitis E from the same area of DRC
in 2006, and even though jaundice is not reported, this is a
possibility, although a contamination of water sources over a large
area at the same time is difficult to explain.

Typhoid is another cause which could be waterborne, but the
geographical distribution over several hundred km makes it less
likely, as each location would have its own water source, and not all
water sources would be contaminated at the same time.

Measles seems to be excluded, as it always is followed by a
characteristic rash in a high proportion of cases, and monkeypox is
also unlikely without the typical vesicles and pustules on the skin.

The lack of bleeding should exclude haemorrhagic fevers with a high
probability, including yellow fever.

Tick-borne infections like the rickettsiae and _Borrelia recurrentis_
usually do not come in large outbreaks.

Dengue fever would be a possibility, although more haemorrhagic cases
would be expected with such a high mortality.

Trypanosomiasis would be expected to give more cases in adults.

It is stated in the report that the local inhabitants blame the polio
immunization campaign. This is highly unlikely and should be
relatively easy to investigate. It is most unfortunate if the polio
vaccine receives the blame, and this needs urgent attention from the
organization which supplied or administered the vaccine.

The other concerns raised are increases in Chinese products in local
markets and lead or other metal poisoning. Indeed, the melamine
scandal caused a lot of concern worldwide over contaminated food. The
main symptom of melamine poisoning was impaired kidney function, and
fever was also reported. We have no information on kidney function in
this report. The symptoms point to an infection, but food poisoning is
difficult to rule out without a detailed epidemiological
investigation.

ProMED will be interested in further information and will follow the
outbreak closely.

For the ProMED-mail HealthMap of the location of this outbreak, see:
<http://healthmap.org/r/12KL>. - Mod.EP]

Cholera outbreaks in the Democratic Republic of Congo (DRC) and the Republic of Congo
22.07.2011 - WHO

Cholera outbreaks are being reported along the Congo River, affecting the Democratic Republic of Congo (DRC) and the Republic of Congo.

In DRC, the outbreak was reported in March 2011 and has intensified in the last 3 to 4 weeks, affecting four provinces (Bandundu, Equateur, Kinshasa and P Orientale). As of 20 July 2011, a total of 3 896 cases, including 265 deaths have been reported, with an overall case fatality of 7%.

In the Republic of Congo, between 14 June and 20 July 2011, a total of 181 suspected cases including 6 deaths have been reported from four provinces (Brazzaville, Cuvette, Likouala and Plateaux) with a case fatality of 3%. Four cases from Brazzaville and Likouala have been laboratory confirmed with cholera.

There is high risk of the epidemic further spreading along the Congo River. The outbreak has been reported to have spread to new locations, particularly in Kinshasa, where there are large population groups with inadequate safe water.

In response to the outbreaks, the governments of DRC and the Republic of Congo, international organizations and non-government organizations have intensified surveillance, case management and health promotion activities in the affected areas, in addition to setting up cholera treatment centres at selected sites.

In DRC, WHO is conducting a rapid risk assessment to identify urgent needs for the coming weeks. Two epidemiologists, a health promotion officer and a logistician have been deployed to Kinshasa to support the response operations.

Kongo, Demokratische Republik - Infektionskrankheiten
25.07.2011

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit. Die seit Ende Februar herrschende Cholera-Epidemie breitet sich weiter aus. Die 4 Provinzen Bandundu, Equateur, Kinshasa und Orientale sind am schwersten betroffen. Insgesamt gibt es bis Ende Juli fast 4000 Fälle und über 260 Todesfälle. Auch das Nachbarland Republik Kongo ist betroffen. Medikamente zur Behandlung der Cholera sind nur begrenzt erhältlich. Internationale Organisationen intensivieren ihre Überwachungsmaßnahmen und errichten neue Behandlungszentren. Alle Formen der Virushepatitis kommen im Land vor. Angesichts des desolaten Gesundheitswesens ist davon auszugehen, dass der Polio-Erreger in der DRC weiterhin zirkuliert. Insgesamt 101 Fälle wurden 2010 gemeldet. 2011 gab es bis Anfang Juni 54 gemeldete Fälle. Der Erreger wurde wahrscheinlich aus Angola importiert. Schlafkrankheit und Tollwut sind weit verbreitet, Risiko auch für örtliche Auftritte von Pest, vor allem im NO des Landes, für Affenpocken sowie viralen hämorrhagischen Fiebern. / Quelle: crm

Gruß
Birgitt

UNDIAGNOSED ILLNESS - UGANDA: CHILD, ex WALES, 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: Sat 6 Aug 2011
Source: Daily Post, North Wales News [edited]
<http://www.dailypost.co.uk/news/north-w ... -29186966/>


The devastated parents of a little boy who died after contracting a
mysterious illness while on holiday in Africa have opened their hearts
about their "perfect" son. The 4-year-old boy died at Gertrude's
Children's Hospital in Nairobi, Kenya last week. The happy and healthy
youngster had been ill for 12 days due to deadly toxins released into
his body by an unidentified bacteria or virus, causing his organs to
shut down. The boy had been on holiday in Uganda with his mother and
father who was near the end of a charity bike ride to raise cash for
the country's Kisiizi Mental Health Hospital when the boy took ill.

His mother, a nursing director at the Cheshire and Wirral Partnership
NHS Trust, said: "My son had not really been himself for a few days,
but we were not really worried. We just put it down to the long flight
and different food. His father set off on his bike ride, and we
travelled to Kisiizi Hospital to meet him at the end. While we were
there, the boy started to suffer stomach pains and diarrhoea, and he
was seen straight away by a doctor. We hoped it was just a 48-hour
bug, but by the 3rd day, we could see it was more serious. By that
time, he had toxins in his body which were starting to affect his
organs and cause internal bleeding."

The boy was flown to Kenya to receive specialist treatment and began
to get better, giving both his family and doctors a shred of hope. "He
was taken off the ventilator and was responding to questions," said
his father, who abandoned his bike ride on the 4th day to be at his
son's bedside. "We hoped he was over the worst, but then we discovered
his other organs were affected. His doctors were devastated when he
died. Nurses were breaking down in tears." His mother added: "There
was nothing anyone could have done. Our son had a team of about 6
consultants, and they were all absolutely brilliant."

No one has been able to pinpoint what caused his illness, which could
have been picked up at home in Halkyn [his Welsh home]. "It could have
been caused by anything," Avril said. "We don't know if it was
something he ate or touched. By the time he was displaying symptoms,
the illness had left him; it was just the toxins that were still
there. Throughout it all, he was so brave. He never complained and had
so much dignity for a little boy of his age. He formed a special
relationship with everyone he met and was so kind. He loved being
outdoors and did everything with us. He even climbed mountains, he
would give anything a go. He loved animals and got to see a lion --
his favourite -- while we were in Uganda, which he absolutely loved."

The boy was due to start school at Ysgol Rhos Helyg, where he had
attended nursery, in September 2011. "It seems such a waste, but we
won't let it be," his father said. "We are planning to set up a
memorial fund in our son's honour and build new hospital facilities in
Uganda with the proceeds. Something good has to come from his death,
as he brought us so much joy. The boy's parents and his 17-year-old
twin sisters were overwhelmed with messages of condolence, which they
say have helped them through. A celebration of the boy's life will be
held at St Mary's Church, Halkyn, on 11 Aug 2011 at 11 AM.

[Byline: Kate Forrester]

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

[This report lacks precise information about the deceased child's
symptoms and medical history, other than generalised statements about
stomach pains, diarrhea and general organ failure. The length of the
family's stay in Uganda is also unclear, and it is suggested even that
the child may have contracted his condition before leaving Wales.

Nonetheless, an apparently untreatable illness in Uganda raises the
specter of Ebola hemorrhagic fever (EHF). In general, outbreaks of EHV
have involved communities. However, recently in Uganda, a single case
of EHF was confirmed on 12 May 2011 after a 12-year-old girl from
Zirobwe Sub County in Luwero district died on 6 May 2011 at Bombo
Military Hospital. No other affected persons were identified other
than the index case, suggesting that perhaps the outbreak virus was
less contagious than previously circulating strains of EHF virus [see
ProMED-mail posts referenced below].

Further information would be welcomed from anyone familiar with the
case of this Welsh child.

Kisiizi Hospital is in southwest Uganda, between Kabale and Rukungiri.
It is in the Kigezi highlands and is about 5300 feet above sea level.
The HealthMap/ProMED-mail interactive map of Uganda can be accessed
at: <http://healthmap.org/r/0089>. - Mod.CP]

UNDIAGNOSED ILLNESS - UGANDA (02): CHILD, ex WALES, HUS
*******************************************************
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 9 Aug 2011
Source: Daily Mail online [summ., edited]
<http://www.dailymail.co.uk/news/article ... -ride.html>


The 4 year old boy who travelled to Africa to support his father in a
charity bike race died after contracting a rare disorder that shut
down all his organs. The boy went with his mother to watch his father
take part in a 330 mile [531 km] ride to raise money for the Kisiizi
Hospital, in Kabale, Uganda. But the energetic infant contracted
haemolytic uraemic syndrome [HUS] and, after initial treatment at the
hospital his father was fundraising for, he was taken to the Kenyan
capital Nairobi -- where he died.

[The boy was transferred by] air ambulance to Gertrude's Children's
Hospital in Nairobi, Kenya. But his condition deteriorated and he died
on Mon 25 Jul 2011.

--
communicated by:
Andrea Jones
<andrea@allaboutresources.co.uk>

[ProMED-mail thanks Andreas Jones for responding to our "request for
information".

Haemolytic uraemic syndrome (HUS) is a triad of microangiopathic
haemolytic anaemia, thrombocytopenia, and acute renal failure. It is
the commonest cause of acute renal failure in children and its
incidence appears to be growing worldwide.

Typical (or infection-induced) HUS is most commonly associated with
_Escherichia coli_ with somatic (O) antigen 157 and flagellar (H)
antigen 7 -- hence the designation O157:H7. It produces a toxin called
Shiga toxin or verotoxin -- hence, alternative names are Shiga
toxin-producing _E. coli_ (STEC) or verotoxin-producing _E. coli_
(VTEC). HUS is a systemic disease caused by damage arising from the
circulating toxin which binds to endothelial receptors, particularly
in the renal, gastrointestinal, and central nervous systems. Thrombin
and fibrin are deposited in the microvasculature. This occurs early in
the disease, prior even to the development of HUS and may be why
antibiotics confer no benefit. Erythrocytes are damaged as they pass
through partially occluded small vessels and subsequent haemolysis
occurs. Platelets are sequestered but without the cascade of clotting
factors as in disseminated intravascular coagulation (DIC).

Other pathogens may induce HUS, including bacteria such as
_Streptococcus pneumoniae_ and _Shigella dysenteriae_ type 13 as well
as some viruses such as human immunodeficiency virus and
coxsackieviruses. Atypical HUS can be caused by exposure to certain
medications (such as ciclosporin, tacrolimus), genetic mutations in
the complement pathway 4 and systemic conditions including lupus,
cancer, and pregnancy.

Haemolytic uraemic syndrome (HUS) is a rare disorder with an annual
incidence of 6.1 cases per 100 000 children aged under 5 years
(compared with an overall incidence of 1 to 2 cases per 100 000). Over
90 per cent of cases in children are secondary to infection. O157:H7
causes haemorrhagic colitis but only about 3-15 per cent of cases
progress to HUS. Cases may be sporadic or occur as part of larger
outbreaks. The largest documented outbreak in England occurred in
Cumbria in 1999, and was associated with pasteurised milk. It affected
114 people.

About 10 per cent of HUS cases are atypical and are not caused by
Shiga toxin-producing bacteria or streptococci. Patients without
evidence of underlying infection should be fully investigated, in
particular looking for complement gene mutations. HUS occurs worldwide
but is less widely reported in countries with less developed medical
services. (Extracted from Patient.co.uk
<http://www.patient.co.uk/doctor/Haemoly ... ndrome.htm>)

This diagnosis leaves open the questions of the causation of the boy's
HUS. - Mod.CP

We have learned from a reliable source that there is no evidence of
Ebola in the region of Uganda where this took place. No other cases of
HUS have been reported from the hospital. - Mod.LM]

Kongo, Demokratische Republik - Infektionskrankheiten
11.08.2011

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit. Die seit Ende Februar herrschende Cholera-Epidemie breitet sich weiter aus. Die 4 Provinzen Bandundu, Equateur, Kinshasa und Orientale sind am schwersten betroffen. Insgesamt gibt es bis Ende Juli fast 4000 Fälle und über 270 Todesfälle. Auch das Nachbarland Republik Kongo ist betroffen. Medikamente zur Behandlung der Cholera sind nur begrenzt erhältlich. Internationale Organisationen intensivieren ihre Überwachungsmaßnahmen und errichten neue Behandlungszentren. Alle Formen der Virushepatitis kommen im Land vor. Angesichts des desolaten Gesundheitswesens ist davon auszugehen, dass der Polio-Erreger in der DRC weiterhin zirkuliert. Insgesamt 101 Fälle wurden 2010 gemeldet. 2011 gab es bis Anfang August 71 gemeldete Fälle. Der Erreger wurde wahrscheinlich aus Angola importiert. Schlafkrankheit und Tollwut sind weit verbreitet, Risiko auch für örtliche Auftritte von Pest, vor allem im NO des Landes, für Affenpocken sowie viralen hämorrhagischen Fiebern. / Quelle: crm

MALARIA - NIGERIA: (GOMBE)
***************************
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: Sun 14 Aug 2011
Source: Champion Newspapers [edited]
<http://www.champion.com.ng/displaycontent.asp?pid=11618>


Malaria has claimed the lives of more than 700 people in Gombe state
in the last 2.5 years according to Mallam Ahmed Audu. Evaluating
Officer of the World Bank Assisted Malaria Control Booster Project in
Gombe.

Mallam Ahmed Audu made this revelation recently in Dukku LGA [Local
Government Area] of the state during an interactive session organized
for working journalists in the state.

He said more than 100 deaths occurred between February and May this
year [2011] alone even as he pointed out that about 170 000 people
were infected by the malaria scourge in the 11 Local Government Areas
of the State from 2009 to May 2011.

According to the project monitoring officer, about 46 000 out of the
malaria prevalence rate were recorded between February and May this
year [2011]. Audu, however, stated that the project had in February
this year distributed over 130 000 doses of malaria drugs to all
government hospitals in the 11 local government areas in the state.

He further said about 2 million doses of malaria preventive drugs for
pregnant women and children were donated to the state Ministry of
Health for use during the Children Health Week in May this year.

Also speaking, the Project Manager, Dr. Arnold Abel stated that
malaria accounted for the loss of over N130 billion [about USD 844
million] annually in Nigeria as well as for 30 percent deaths in
children and 5 percent in pregnant women.

In his speech, the Project Mobilization officer, Mallam Muhammad
Lawal, said there were plans to produce jingles, drama, and programmes
on malaria attacks and treatment on the state radio and television
stations in an effort to reduce its spread, especially among poor
rural communities. He also said the Project collaborated with the
State Environmental Protection Agency (GOSEPA) on refuse disposal
while plans were underway to resurrect sanitary departments in the 11
local government areas of the state.

[Byline: Williams Attah]

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

[Gombe State is located in the eastern part of Nigeria and has
approximately 2 353 000 inhabitants (2006). With 170 000 cases between
February and May 2011, this is roughly equivalent to an annual
incidence rate of 200 cases per 1000 population per year.

2 previous studies found that pregnant women were malaria microscopy
positive in 8 percent and 9.4 percent respectively (VanderJagt TA et
al: Comparison of the OptiMAL rapid test and microscopy for detection
of malaria in pregnant women in Nigeria. Trop Med Int Health. 2005;
10(1): 39-41;
<http://onlinelibrary.wiley.com/doi/10.1 ... 349.x/full>.
VanderJagt DJ et al: Nutritional factors associated with anaemia in
pregnant women in northern Nigeria. J Health Popul Nutr. 2007; 25(1):
75-81; <http://www.jhpn.net/index.php/jhpn/article/view/677>). If
these figure are representative of the prevalence in the general
population the parasite positive rate has increased.

Maps of Nigeria can be seen at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf> and
<http://healthmap.org/r/18pk>. - Mod.EP]

Outbreak of illness in schools in Angola
15.08.2011 - WHO

An outbreak of an unknown illness has been reported among children and students in schools in Angola. In most cases, the illness has occurred suddenly, followed by the resolution of symptoms within a few hours. No deaths have been reported.

The typical symptoms reported include: vomiting, headache, sore throat, eye irritation, coughing, breathing difficulties and fainting in some cases. The outbreaks have been reported in schools of the capital, Luanda, and in a number of other provinces.

Although the cause of these outbreaks still remains unknown, this may be related to exposure to irritant chemicals. WHO has sent a team to Angola to assist the Government in investigating these outbreaks and to suggest measures for preventing further occurrences.

The WHO team includes an epidemiologist, laboratory specialists and a pharmacologist/toxicologist who are providing technical support to the national intersectoral committee created for this purpose.

This is complex work and WHO is consulting with experts and specialized institutions from other countries to explore ideas on appropriate lines of investigation.

Gruß
Birgitt

UNDIAGNOSED OUTBREAK, SCHOOLS - ANGOLA (02): MASS HYSTERIA SUSPECTED
********************************************************************
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[1]
Date: Wed 17 Aug 2011
From: Jahangir Hossain <jhossain@icddrb.org> [edited]


There is a possibility of mass psychogenic illness [MPI]. Only
vomiting is unusual in mass psychogenic illness and all other features
correspond to MPI. Always exclude other causes before diagnosis of
MPI.

--
Dr. Jahangir Hossain
Associate Scientist
Head, Outbreak investigation cluster
Dhaka
Bangladesh
<jhossain@icddrb.org>

******
[2]
Date: Wed 17 Aug 2011
From: Eran Kopel <eran.kopel@mail.huji.ac.il> [edited]


Following the latest ProMED-mail communication (20110816.2486) of the
WHO outbreak report in Angola, suspected currently for exposure to
irritant chemicals, I would like to comment that although it should be
primarily a diagnosis by exclusion only, an outbreak of "mass
hysteria", also known as "epidemic hysteria" or "mass sociogenic
illness", could eventually make another possible etiology for this
kind of outbreak and its unique characteristics, as preliminary
reported.

Sudden onset with rapid (and complete) resolution within a few hours
of several symptoms, all of which could have had a psychogenic origin
(such as, vomiting, breathing difficulties, fainting), and
particularly in school children (no other population, such as school
teachers, was mentioned in the initial WHO report), was also reported
before in numerous outbreaks of epidemic hysteria [1].

A literature review [1] has found that about 50 percent of the
reported past 20th century epidemic hysteria outbreaks were associated
with schools, mostly with schoolchildren and with higher female
prevalence. The trigger of such outbreaks was often reported to be
associated with an environmental event or even a rumor of such an
event (such as, water supply contamination, a gas odor or perception
of such odor).

Reference
---------
1. Boss LP: Epidemic hysteria: a review of the published literature.
Epidemiol Rev 1997; 19(2): 233-43 [available at
<http://epirev.oxfordjournals.org/conten ... 3.full.pdf>].

--
Eran Kopel MD
Tel Aviv, Israel
<eran.kopel@mail.huji.ac.il>

[ProMED-mail thanks Drs Hossain and Kopel for their timely comments.
This moderator also considered MPI in the differential diagnosis in
this situation in Angola but was awaiting more information. A
commission in Angola has also suggested the diagnosis as well as seen
below. - Mod.LL]

******
[3]
Date: Thu 4 Aug 2011
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/News/World/-/6 ... index.html>


A commission set up by the Angolan government to probe mass fainting
in schools in the country has denied that toxic gas was responsible
and instead blamed "mass hysteria" for the phenomenon.

More than 500 pupils have allegedly fainted in 7 provinces including
the capital Luanda since April 2011, allegedly due to intoxication
with an unidentified gas. The fainting wave has affected mainly
females and speculation had earlier centered on criminals supposedly
sighted launching toxic gas in the institutions.

But on Wednesday, 3 Aug 2011, the deputy commander of the National
Police, Paulo de Almeida, dismissed the existence of such a gas.
"Tests do not confirm any toxic substance causing the fainting
registered in several schools in the country," he said at a news
conference. "The tests were done and the results are negative," he
said, adding that the samples had also been sent to foreign
laboratories. The officer however admitted that some gangs were
seeking to capitalize on the public's panic and confirmed the force
had made some arrests

Another member for the commission, Luanda psychiatric hospital
director Dr Rui Pires, said that no syndrome of any sort had been
confirmed and alluded to "psychological" problems instead.

Dr Adelaide de Carvalho the national director of public health, said
none of the teenagers had spent more than 5 days in hospitals, and
some of them were asthmatics.

[Byline: Arnaldo Vieira]

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[Additional references on mass hysteria cited in a previous
ProMED-mail posting:
1. Govender I: Mass hysteria with possible pseudoseizures at a primary
school. S Afr Med J. 2003; 93(1): 10 (available at
<http://www.samj.org.za/index.php/samj/a ... /2025/1283>).
2. Small GW, Feinberg DT, Steinberg D, Collins MT: A sudden outbreak
of illness suggestive of mass hysteria in schoolchildren. Arch Fam
Med. 1994; 3(8): 711-6 (available at
<http://archfami.ama-assn.org/cgi/conten ... ct/3/8/711>).
3. Mkize DL, Ndabeni RT: Mass hysteria with pseudoseizures at a South
African high school. S Afr Med J. 2002; 92(9): 697-9.
4. Roach ES, Langley RL: Episodic neurological dysfunction due to mass
hysteria. Arch Neurol. 2004; 61(8): 1269-72 (available at
<http://archneur.ama-assn.org/cgi/content/full/61/8/1269>).
5. Pastel RH: Collective behaviors: mass panic and outbreaks of
multiple unexplained symptoms. Mil Med. 2001; 166(12 Suppl): 44-6
(available at
<http://findarticles.com/p/articles/mi_q ... _n9008773/>).
6. CDC: Rashes Among Schoolchildren: 14 States, October 4,
2001-February 27, 2002. MMWR 2002: 51(8); 161-4; available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5108a1.htm>.
7. Bartholomew RE: Re: "Epidemic hysteria: a review of the published
literature". Am J Epidemiol. 2000; 151(2): 206-7 (available at
<http://aje.oxfordjournals.org/content/1 ... 6.full.pdf>).
8. Cole TB, Chorba TL, Horan JM: Patterns of transmission of epidemic
hysteria in a school. Epidemiology. 1990; 1(3): 212-8 (available at
<http://www.jstor.org/pss/25759800>).
9. Robinson P, Szewczyk M, Haddy L, Jones P, Harvey W: Outbreak of
itching and rash. Epidemic hysteria in an elementary school. Arch
Intern Med. 1984; 144(10): 1959-62 (abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/6486980>).
10. Dhadphale M, Shaikh SP: Epidemic hysteria in a Zambian school:
"the mysterious madness of Mwinilunga". Br J Psychiatry. 1983; 142:
85-8 (abstract available at
<http://bjp.rcpsych.org/content/142/1/85.abstract>).
11. Jones TF, Craig AS, Hoy D, et al: Mass psychogenic illness
attributed to toxic exposure at a high school. N Engl J Med. 2000;
342(2): 96-100 (available at
<http://www.nejm.org/doi/full/10.1056/NE ... 1133420206>. - Mod.LL]

[The curiosity here is the occurrence of these events in multiple
schools located in 7 different provinces. We have not seen
information on the time line (epidemic curves) of each of these
outbreaks, but one wonders if there has been media coverage of each
outbreak and that subsequent outbreaks occurred following the media
coverage. A review of the literature revealed reports of illnesses
labeled as "mass hysteria" were overwhelmingly from a single
geographic location (a school, a single town, a single village). Of
interest, there was an incident associated with vaccine administration
in Jordan where day one, there was a mass hysteria event leading to 80
students from one school being hospitalized that day, with the
following day up to 122 students country-wide were hospitalized. A
contributing factor seemed to be the media coverage of the initial
mass hysteria event. (see Kharabsheh S, Al-Otoum H, Clements J, Abbas
A, Khuri-Bulos N, Belbesi A, Gaafar T, Dellepiane N. Mass psychogenic
illness following tetanus-diphtheria toxoid vaccination in Jordan.
Bull World Health Organ. 2001;79(8):764-70. Epub 2001 Oct 24.
available at
<http://www.ncbi.nlm.nih.gov/pmc/article ... 545334.pdf>).
Given the unusual geographic distribution of these events, we await
further information on the results of the investigation underway as
mentioned in the WHO report in the earlier post on this outbreak
(Undiagnosed outbreak, schools - Angola: WHO, RFI 20110816.2486). -
Mod.MPP]


[The HealthMap/ProMED-mail interactive map of Angola can be seen at
<http://healthmap.org/r/18AP>. - Sr.Tech.Ed.MJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (27): AFRICA
********************************************************
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In this update:
[1] Cholera - Nigeria (Osun)
[2] Cholera - Nigeria (Oyo)
[3] Cholera - Somalia (Benadir region)
[4] Cholera - Somalia, internally displaced persons
[5] Cholera - Burundi
[6] Cholera - Ghana (northern regions)
[7] Cholera - Ghana (Brong Ahafo Region)
[8] Cholera - Ghana (Western Region)
[9] Cholera - Cameroon (Far North region)
[10] Cholera - Congo DR
[11] Cholera - Mali

******
[1] Cholera - Nigeria (Osun)
Date: Wed 24 Aug 2011
Source: Nigerian Tribune [edited]
<http://www.tribune.com.ng/index.php/new ... -8-in-osun>


The people of Osun State now live in fear over the outbreak of cholera
that has claimed 8 lives in the state. Nigerian Tribune investigations
revealed that the epidemic, which has affected some parts of the state
in the past few days, has sent dangerous signals to the people, as
there are no medical officials that could come to their rescue due to
the ongoing strike by medical practitioners in the state.

It was gathered that the epidemic claimed 4 lives in Ede North, 2 in
Sogbedere village, Ede South Local Government and 2 in the ancient
town of Ede.

[byline: Adeolu Adeyemo]

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******
[2] Cholera - Nigeria (Oyo)
Date: Sun 21 Aug 2011
Source: Business Day Online [edited]
<http://www.businessdayonline.com/NG/ind ... pitalised->


Cases of cholera have been reported in Ibadan North West Local
Government Area of Oyo State, which have left 4 dead and 16
hospitalized. Areas affected by the disease are: Ayeye community,
Opo-Yeosa, Idi Ikan, Alawo, Abebi, and Ekotedo communities.

Director of environmental services in the council, Olalekan
Olatunbosun, who confirmed the incident, added that the worst hit by
the epidemic was Ayeye community. Giving the breakdown, Olatunbosun
said 3 adults (gender not indicated) and a child were, so far,
reported dead.

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******
[3] Cholera - Somalia (Benadir region)
Date: Thu 18 Aug 2011
Source: Al Jazeera [edited]
<http://english.aljazeera.net//news/afri ... 75929.html>


The United Nations has warned that a cholera outbreak linked to dirty
water threatens Somali children already weak and on the brink of
starvation. At Banadir hospital in Mogadishu, medical staff are
struggling to cope with the influx of patients, the Associated Press
reported.

Dr Abdalla Abukar said the cholera outbreak began in July 2011, and
the hospital admits between 50 and 80 people with the disease per day.
One hospital in Mogadishu has had 181 patients die from the disease
since January 2011. Half of those were children younger than 2 years
old.

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******
[4] Cholera - Somalia, internally displaced persons
Date: Mon 15 Aug 2011
Source: UN IRIN News [edited]
<http://www.irinnews.org/report.aspx?reportid=3D93506>


Fears are mounting that a cholera epidemic could spread rapidly among
the hundreds of thousands of people living in often unsanitary
conditions in Mogadishu after fleeing drought, famine and insecurity.

"The number of cases is 2 or even 3 times what was there in 2010, so
we can say that we have an epidemic of cholera going on," said Michel
Yao, public health adviser at WHO.

In Mogadishu's largest health facility, Banadir Hospital, 4272 cases
of acute watery diarrhea, a symptom of cholera, have been recorded so
far in 2011, causing 181 deaths. Children under 5, weakened by
malnutrition, make up 3/4ths of the cases. Of the total cases, 1633
were reported in June and July 2011.

WHO spokesman Tarek Jasarevic said: "This sudden increase had various
reasons. 1st, the numerous informal settlements of internally
displaced persons with makeshift shelters, poor sanitation and limited
access to safe water; 2nd, the limited capacity of existing health
partners to access those informal settlements and provide essential
health services; and 3rd, the high number of malnourished children due
to the ongoing famine has increased the susceptibility to waterborne
diseases such as acute watery diarrhea."

An estimated 100 000 people, fleeing drought, famine and conflict,
have made their way to Mogadishu over the past 2 months, according to
Adrian Edwards, a spokesman for the UN Refugee Agency, UNHCR. They
joined another 370 000 people who had fled to the capital earlier.

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******
[5] Cholera - Burundi
Date: Sun 21 Aug 2011
Source: Africa News [edited]
<http://www.afriquejet.com/chholera-buru ... 20925.html>


The cholera outbreak in Burundi has claimed 3 lives, out of 100
patients admitted since the end of July 2011 in different health
facilities across the country, minister of public health, Sabine
Ntakarutimana, announced on Fri 19 Aug 2011.

The minister mentioned Bujumbura city, the nation's capital, as one of
the areas worse hit by the disease. The other areas are in the west of
the country and along the shores of Lake Tanganyika.

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******
[6] Cholera - Ghana (northern regions)
Date: Fri 26 Aug 2011
Source: Modern Ghana [edited]
<http://www.modernghana.com/news/347333/ ... gions.html>


The Ghana Health Service (GHS) is raising cholera alerts in some parts
of the country, especially the 3 northern regions, as the rains
continue to fall.

There are already reports of an outbreak of cholera in some parts of
the Brong Ahafo region which has claimed one life.

Meanwhile, 25 new cholera cases have been reported at the Kwesimintsim
Polyclinic in the Sekondi/Takoradi Metropolis.

Dr Jonathan Mensah, acting medical superintendent of the hospital,
told the Ghana News Agency that 2 deaths had so far been recorded.

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******
[7] Cholera - Ghana (Brong Ahafo Region)
Date: Sun 14 Aug 2011
Source: Ghana News Agency [edited]
<http://www.ghananewsagency.org/details/ ... 1&ai=32379>


The Atebubu-Amantin District Directorate of Ghana Health Service says
it suspects an outbreak of cholera in the district following
increasing diarrhea cases reported at health facilities. A man
believed to be in his 50s recently died of the disease in the area.

Mr Ramseyer Ahmed, Atebubu-Amantin District disease control officer,
announced that from January to August 2011, a total number of 814
diarrhea cases had been recorded by the health directorate. The
majority of the cases were reported from Atebubu-Zongo and
Atebubu-Konkomba Line communities, he added.

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******
[8] Cholera - Ghana (Western Region)
Date: Fri 12 Aug 2011
Source: Modern Ghana [edited]
<http://www.modernghana.com/news/344571/ ... lives.html>


Two people have been reported dead in new cases from a cholera
outbreak in the Western region. The dead included a 6 year old child,
deputy western regional director of health services Dr Kweku Karikari
confirmed to Joy News, adding that 50 other cases have been detected,
with the patients receiving treatment.

Dr Karikari said the cholera outbreak started in June 2011 in the
Ahanta West District and has been sporadic ever since.

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******
[9] Cholera - Cameroon (Far North region)
Date: Tue 16 Aug 2011
Source: Bloomberg News [edited]
<http://www.sfgate.com/cgi-bin/article.c ... NBSCAN.DTL>


A cholera outbreak in Cameroon's Far North region killed 59 people
from 1 Jun to 12 Aug 2011, Rebecca Djao, the regional delegate for
public health, said. More than 1300 new cases of the disease have been
found during that period, Djao said in a telephone interview today [16
Aug 2011] from Maroua, the capital of the Far North region. The
disease worsened after heavy rains disrupted power supplies and water
systems, she said.

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******
[10] Cholera - Congo DR
Date: Thu 11 Aug 2011
Source: Agence France-Presse [edited]
<http://mmail.com.my/content/80038-chole ... o-top-5000>


A cholera outbreak in the Democratic Republic of Congo has infected
more than 5000 people and caused nearly 300 deaths since March 2011,
the United Nations said Wed 10 Aug 2011. Bandundu, Equateur, and
Province Orientale are the worst-hit regions.

"The 5000 mark was reached this week, with 5088 reported cases of
cholera, including 296 deaths," the UN Office for the Coordination of
Humanitarian Affairs stated.

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******
[11] Cholera - Mali
Date: Sat 6 Aug 2011
Source: Bloomberg News [edited]
<http://www.businessweek.com/news/2011-0 ... -says.html>


Mali's death toll from a cholera epidemic has reached 23, with 419
cases recorded so far, the National Directorate of Health announced
today [6 Aug 2011] on public radio.

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Ghana - Darminfektionen
28.08.2011

Risiko für Durchfallerkrankungen landesweit. Bei Cholera-Ausbrüchen in der 1. Jahreshälfte soll es mindestens 5.600 Erkrankungen und 69 Todesfälle gegeben haben. Vorkommen landesweit, besonders betroffen ist die Region um Accra (S). Hygiene und bei Risikoreisenden Impfung beachten. / Quelle: crm
____________________________

Kongo, Demokratische Republik - Infektionskrankheiten
28.08.2011

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit. Die seit Ende Februar herrschende Cholera-Epidemie breitet sich weiter aus. Die 4 Provinzen Bandundu, Equateur, Kinshasa und Orientale sind am schwersten betroffen. Insgesamt gibt es bis Ende August über 5.000 Erkrankte und etwa 300 Todesfälle. Auch das Nachbarland Republik Kongo ist betroffen. Medikamente zur Behandlung der Cholera sind nur begrenzt erhältlich. Internationale Organisationen intensivieren ihre Überwachungsmaßnahmen und errichten neue Behandlungszentren. Alle Formen der Virushepatitis kommen im Land vor. Angesichts des desolaten Gesundheitswesens ist davon auszugehen, dass der Polio-Erreger in der DRC weiterhin zirkuliert. Insgesamt 101 Fälle wurden 2010 gemeldet. 2011 gab es bis Ende August 75 gemeldete Fälle. Der Erreger wurde wahrscheinlich aus Angola importiert. Schlafkrankheit und Tollwut sind weit verbreitet, Risiko auch für örtliche Auftritte von Pest, vor allem im NO des Landes, für Affenpocken sowie viralen hämorrhagischen Fiebern. / Quelle: crm
____________________________

Tansania - Masern
28.08.2011

Ein Ausbruch hat bislang zu über 1.500 Erkrankten (überwiegend nicht geimpfte Kinder unter 5 Jahren) und 18 Todesfällen geführt. 6 Regionen des Landes sind betroffen: Arusha, Dar es Salaam, Iringa, Pwani, Morogoro und Tanga. Seit Mitte August gibt es einen Ausbruch auf Sansibar mit über 70 Erkrankten, die Insel war 5 Jahre lang frei von Masern. Impfschutz beachten. Fehlende Impfungen sollten gemäß den aktuellen STIKO-Empfehlungen nachgeholt werden. / Quelle: crm

Gruß
Birgitt