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UNDIAGNOSED HEMORRHAGIC DISEASE - NAMIBIA (02): WINDHOEK, COMMENT
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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 3 Oct 2011
From: Michel Van Herp <michel.van.herp@brussels.msf.org> [edited]


In this context (Namibia), we need to consider in the differential
diagnosis a mycotoxin present in food, resulting in the Onyalai
disease. In the past, we have been confronted by this disease in
Kuito, Angola.

--
Dr Michel Van Herp
Epidemiologist
Medical Departement
Medecins Sans Frontieres
Brussels
<michel.van.herp@brussels.msf.org>

[ProMED-mail thanks Dr Van Herp for drawing attention to this
possibility.

The following description of Onyalai disease is reproduced from the
web-site of the Institute of Tropical Medicine Antwerp
<http://www.itg.be/itg/DistanceLearning/ ... logyp6.htm>:

"General: Onyalai (syn. akembe and afindo) is a rather mysterious
disease which only seems to occur in central southern Africa (southern
Angola and northern Namibia; Kavango and Ovambo territories). Onyalai
means "blood blister" in the language of the Kimbundu, an Angolan
tribe. Onyalai is a disease of unknown etiology. Defective nutrition
may be the cause. One hypothesis is that a toxin, possibly acting as a
hapten, is responsible for this form of thrombocytopenia. The possible
aetiological role of mycotoxins from contaminated millet, sorghum
and/or maize requires further investigation.

Clinical aspects: The disease differs clinically, epidemiologically
and immunologically from idiopathic thrombocytopenic purpura (ITP).
The age of onset varies from 6 months to 70 years with a peak
incidence between 11 and 20 years. It is an acute disease,
characterised by the formation of haemorrhagic vesicles and blisters
on the palatal and buccal mucous membranes, together with severe
thrombocytopenia. Sometimes, haemorrhagic blebs do appear on the skin,
including on the soles of the feet. The general condition tends to be
good, and there are no signs of a constitutional disorder. This
acquired form of thrombocytopenic purpura can lead to haematuria and
melena. Epistaxis, petechiae and ecchymoses are common, as are
subconjunctival bleeding and menorrhagia. The median duration of
bleeding is about 8 days, but recurrent bleeding episodes are common.
About 80 percent of cases will have chronic thrombocytopenia with a
risk of intermittent attacks of acute haemorrhage. Haemorrhage from
ruptured bullae, epistaxis or gastrointestinal bleeding can be severe
and may cause shock and even death.

Diagnosis: The diagnosis is a clinical one, supported by lab tests.
There will be thrombocytopenia and anaemia. The platelets are
morphologically normal. The bone marrow shows changes which are to be
expected: hyperplasia of the red cell precursors and megakaryocytes.
Many patients have IgG and IgM platelet antibodies and glycoprotein
IIb/IIIa autoantibodies in their serum. Complement levels are normal.
Infants of mothers with onyalai, unlike infants of mothers with
idiopathic thrombocytopenic purpura, are not at risk of
thrombocytopenia and haemorrhage. Their mothers however, have a risk
of post-partum haemorrhage.

Differential diagnosis: Differential diagnosis includes other
conditions which are characterized by severe thrombocytopenia, such as
ITP, HIV-associated thrombocytopenia, immune thrombocytopenia
secondary to SLE or lymphoproliferative disease, drug-related
thrombocytopenia (e.g. quinine, heparin), TTP-HUS, hypersplenism and
diffuse intravascular coagulation (DIC). Several infections are
accompanied by low platelet counts (e.g. malaria, leptospirosis,
septicaemias, trypanosomiasis, Marburg virus and arboviral infections
such as Crimean-Congo haemorrhagic fever and dengue). DIC is common in
certain obstetric disorders (eclampsia, abruptio placentae, amniotic
fluid embolus, septic abortion, hydatidiform mole), envenomation
(several snakes), heat stroke and traumata. Suicide attempts with
coumarines is common and leads to bleeding tendency, but is not
accompanied by low platelet counts or haemorrhagic bullae on the
mucosa.

Treatment: Treatment is directed at the prevention of haemorrhagic
shock, and management consists of the correction of blood loss.
Transfusion of blood and of platelets can be life saving. Oral hygiene
is important. The use of aspirin is of course prohibited.
Corticosteroids do not increase the platelet count, although high-dose
methylprednisolone reduced the morbidity of onyalai in children. High
dose intravenous gammaglobulin (Sandoglobulin) may be followed by a
rise in the platelet count and cessation of haemorrhage, but in
general, this treatment is disappointing (and expensive). Vincristine
sulphate (1.5 mg/m2) can be used, as it benefits some patients.
Splenectomy can be considered for patients with severe uncontrollable
bleeding, although splenectomy does not always control the disease.
Splenectomy is followed by a rise in platelet count. If possible,
vaccination against pneumococci should be performed before
splenectomy."

Further information from Namibia is awaited. The HealthMap/ProMED-mail
interactive map of Namibia can be accessed at:
<http://healthmap.org/r/1i9l>, and that of Angola at:
<http://healthmap.org/r/1iGj. - Mod.CP]

Kenia - Darminfektionen
04.10.2011

Risiko für Durchfallerkrankungen landesweit. Mit Cholera-Ausbrüchen ist regional zu rechnen. Auch Polio kommt seit 2009 wieder vor. In diesem Jahr gab es einen bestätigten Fall Ende Juli. Hygiene beachten, Impfschutz für Risikoreisende. / Quelle: crm
_____________________________________

Kenia - Dengue
04.10.2011

Aus der Ortschaft Mandera im Nordosten des Landes (Grenzgebiet zu Äthiopien und Somalia) werden mehr als 1.000 Erkrankungsfälle an Dengue-Fieber gemeldet. Vermutlich handelt es sich hier um die ersten Anzeichen eines größeren Ausbruches in der Region. Schutz vor den überwiegend tagaktiven Überträgermücken beachten. / Quelle: crm
_____________________________________

Mali - Darminfektionen
04.10.2011

Risiko für Durchfallerkrankungen landesweit. In den ersten 8 Monaten des Jahres gab es bereits über 880 Cholera-Erkrankungen mit 36 Todesfällen. Sowohl 2009 als auch 2010 wurden je drei Polio-Fälle gemeldet. In diesem Jahr gab es bis Ende September 7 Fälle. Hygiene und Impfschutz (Polio) weiterhin beachten. / Quelle: crm
_____________________________________

Nigeria - Darminfektionen
04.10.2011

Risiko für Durchfallerkrankungen landesweit. Cholera-Ausbrüche gab es in diesem Jahr bereits aus mehreren Regionen des Landes, Mitte August waren v.a. die Regionen Osun und Oyo (W), Sokoto (NW), Nassarawa (zentral) und Yobe (NO) betroffen. In den ersten 8 Monaten sind landesweit über 13.500 Fälle aufgetreten, 353 Erkrankte sind gestorben. Bis Ende September wurden 33 Polio-Fälle gemeldet. 2010 waren es 21 registrierte Erkrankungen, 2009 388. Hygiene beachten, Impfung ist zu empfehlen. / Quelle: crm
_____________________________________

Uganda - Gelbfieber
04.10.2011

Im Norden des Landes kam es zwischen Oktober 2010 und Februar 2011 zu mindestens 272 Erkrankungs- und 58 Todesfällen. Betroffen waren die Distrikte Abim, Agago, Kitgum, Kaabong, Kotido, Lamwo, Arua,Lira, Pader, Gulu, Nebbi, Napak, Dokolo und Yumbe. Presseberichten zufolge wurde Ende September ein Gelbfieber-Fall aus dem Süd-Sudan nach Kitgum importiert. Gelbfieber ist in Uganda seit 40 Jahren nicht mehr aufgetreten, die Immunität der Bevölkerung ist dementsprechend schlecht. Ende Januar begann die erste Impfphase in Kitgum, Pader, Lamwo, Agago und Abim. Aufgrund des Gelbfieber-Ausbruchs haben die Länder der East African Community (Burundi, Kenia, Tansania, Ruanda und Uganda) beschlossen, den Nachweis einer Gelbfieber-Impfung stärker zu kontrollieren. Genauere Angaben zur Umsetzung sind nicht bekannt. Um Schwierigkeiten bei der Einreise zu vermeiden sollten alle Reisenden, auch bei der Einreise aus Europa, einen gültigen Impfnachweis vorweisen können. / Quelle: crm

Gruß
Birgitt

UNDIAGNOSED HEMORRHAGIC FEVER - NAMIBIA (03): (WINDHOEK) 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: Tue 4 Oct 2011
Source: The Namibian [edited]
<http://www.namibian.com.na/news-article ... t-to-rest/>


The 27-year-old woman who died in the Katutura State Hospital on 24
Sep 2011 had liver failure and not a communicable disease. Similarly,
the 41-year-old man who died in the Roman Catholic Hospital on 27 Sep
2011 had no contagious disease and died of heart failure.

This was confirmed at a meeting at the Ministry of Health and Social
Services head office in Windhoek yesterday [3 Oct 2011]. The ministry,
the World Health Organisation (WHO) and the Centers for Disease
Control and Prevention launched an investigation last week [week of 26
Sep 2011] after it was reported that people were allegedly dying of a
mysterious bleeding disease in the Hakahana area of Katutura.

Yesterday [3 Oct 2011], it was also revealed that only 2 patients died
and not 4 as had been reported earlier. It was further established
that the 2 deaths were unrelated. When the female patient was admitted
to hospital, she complained of headache and a body rash. She was also
found to be bleeding. After admission, her condition deteriorated and
she later died.

The 2nd patient collapsed on arrival at hospital and later died.
According to his death certificate, he died because of heart failure.

Dr Jack Vries of the health ministry said the probe showed that there
is no public health concern. On Friday [30 Sep 2011] already, Vries
had said the patients did not die of poisoning. This came after he
ruled out haemorrhagic fever -- like Crimean-Congo haemorrhagic fever,
Ebola fever, or Rift Valley fever -- as the cause of the deaths on
Thursday [29 Sep 2011].

[Byline: Denver Kisting]

--
Communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

******
[2]
Date: Tue 4 Oct 2011
Source: The Namibian Sun [edited]
<http://mobi.namibiansun.com/content/glo ... e%E2%80%99>


Reports of a 'mysterious disease' causing the deaths of several people
in Windhoek's Hakahana residential area were yesterday [3 Oct 2011]
nipped in the bud. A local daily last week [week of 26 Sep 2011]
reported that 4 people died from a mysterious illness that caused a
strange rash and haemorrhaging through the nose, eyes, and other
openings of their bodies.

"There is no reason for any panic," announced Dr Jack Vries, the
chairperson of the National Health Emergency Management Committee,
after investigations showed that there were only 2 cases, instead of
the reported 4, and that the causes of deaths were completely
natural.

The Ministry of Health and Social Services, along with the World
Health Organisation and the Centers for Disease Control and
Prevention, launched an investigation. A 27-year-old woman died of
liver failure, and a 41-year-old man died of heart failure. Vries
labeled the media reports as very irresponsible "and this is also
coming from the minister's mouth".

Neither the reporting journalist nor the family of the alleged victims
could indicate who the other 2 people were, or the hospital or
mortuary where the other 2 cases came from. "How can you write a front
page story stating 'mysterious disease kills 4 people', causing panic
and scaring people in that way? This is sensationalism and poor
reporting."

In both cases the investigation revealed that the causes of death were
not likely due to communicable disease of public health concern. The
deceased did not even have contact with or links to each other. "These
cases do not represent a presentation of a contagious disease as
speculated in the media," said Vries. He also stressed that in both
cases the family members are also fine and there are no complaints of
anyone being ill. "It is nothing infectious and is not spreading."

According to the investigation team rumors will not always be accurate
and therefore should be investigated to determine if it is of public
health concern. The woman was admitted to the Katatura Hospital on 24
Sep 2011 after she was found unresponsive by her family. Earlier that
day she also visited the hospital complaining about headache and a
body rash. After the clinic visit she stayed home from work until her
family found her and brought her to the hospital. She was bleeding
from the nose and mouth, while her health quickly deteriorated. The
investigation revealed that the cause of death was liver failure.

The man died of heart failure. He was admitted to the Roman Catholic
Hospital on 27 Sep 2011 after complaining that he was suffocating. The
family indicated that they saw mucous secretions from his mouth but no
sign of red blood in secretions or eyes. There were also no reports of
fever as is the case with viral infections. The patient died of
cardiac arrest while a further review by the investigation team
indicates a possible acute respiratory event such as pulmonary
embolism leading to cardiac arrest.

[Byline: Ellanie Smit]

--
Communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[ProMED-mail thanks Ronan Kelly for forwarding these 2 reports which
clarify the situation in Namibia. Clearly there has been no outbreak
of a transmissible haemorrhagic fever in Namibia, nor any other
communicable disease in Windhoek associated with these 2 cases.

The HealthMap/ProMED-mail interactive map of Namibia can be accessed
at <http://healthmap.org/r/1i9l>. - Mod.CP]

Kenia - Dengue
06.10.2011

Aus der Ortschaft Mandera im Nordosten des Landes (Grenzgebiet zu Äthiopien und Somalia) werden mehr als 5.000 Erkrankungsfälle an Dengue-Fieber gemeldet. Vermutlich handelt es sich hier um die ersten Anzeichen eines größeren Ausbruches in der Region. Schutz vor den überwiegend tagaktiven Überträgermücken beachten. / Quelle: crm

Gruß
Birgitt

RABIES - ANGOLA: (HUAMBO) ANIMALS, HUMAN
****************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 7 Oct 2011
Source: Angop Health [edited]
http://www.portalangop.co.ao/motix/en_u ... 84bab.html


Rabies kills 9 children in Huambo
---------------------------------
At least 9 children aged between 5 and 7 years died in the province of
Huambo, in the past 9 months as a result of bites from suspected rabid
dogs, compared with only 15 cases recorded previously the region.

Speaking on Friday [7 Oct 2011] to the press, the Provincial Director
of the Department of Veterinary Services in Huambo, Teresa Berta,
revealed that the process of vaccination campaign against rabies
continues in order to immunize more than 30 000 animals including
dogs, cats and monkeys. The official expressed concern over the
increase in deaths from bites by suspected rabid dogs, mainly in the
municipalities of Huambo, Tchicala-Tcholohanga, Caala and
Londuimbali.

--
Communicated by:
ProMED-mail


[It is unclear from the statement by the Director of Veterinary
Services how the vaccination of dogs, cats and monkeys is being
managed. Is oral recombinant rabies vaccine in bait being employed, or
does the campaign depend on capture and immunisation of domestic
animals?

The number of human fatalities is alarming and suggests that
post-exposure prophylaxis is not readily available for children in
Huambo province, and that free-ranging dogs are the main source of the
virus in the province.

The location of Huambo province can be found in the map of the
provinces of Angola at:
http://en.wikipedia.org/wiki/Provinces_of_Angola. - Mod.CP]

Nigeria - Masern
10.10.2011

Der diesjährige Erkrankungsausbruch hat landesweit bis Mitte September zu über 17.400 Fällen geführt. Über die Anzahl der Todesfälle gibt es keine genauen Angaben. Fehlende Impfungen sollten gemäß den aktuellen STIKO-Empfehlungen nachgeholt werden. / Quelle: crm
_________________________

Zentralafrikanische Republik - Darminfektionen
10.10.2011

Risiko für Durchfallerkrankungen landesweit. Seit Anfang Oktober wird ein Cholera-Ausbruch aus dem Süden des Landes sowie aus der Hauptstadt Bangui gemeldet. Bei den oral übertragenen Formen der Hepatitis (infektiösen Gelbsucht) ist neben A auch vermehrt mit E zu rechnen, vor allem in Bangui und Umgebung. Letztere ist besonders für Schwangere gefährlich. Polio, 2000 schon einmal ausgerottet, wurde 2003 aus Nigeria reimportiert. Einzelne Fälle gab es 2008 und 2009, seither wurden keine Erkrankungen berichtet. Hygiene und Impfschutz (Polio) weiterhin beachten. / Quelle: crm

Gruß
Birgitt

Cholera
http://www.trust.org/alertnet/news/chol ... africa-un/

Gruß

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2011 (36): AFRICA
********************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


In this update:
[1] Cholera - West and Central Africa
[2] Cholera - Somalia (Mogadishu)
[3] Cholera - Congo DR, Congo

******
[1] Cholera - West and Central Africa
Date: Tue 11 Oct 2011
Source: UNICEF [edited]
http://www.unicef.org/media/media_60032.html


UNICEF is calling for a redoubling of efforts to combat cholera
outbreaks that are claiming lives and affecting large numbers of
people across West and Central Africa.

2011 has seen more than 85 000 reported cases of cholera, resulting in
2466 deaths. The size and scale of the outbreaks mean the region is
facing one of the biggest epidemics in its history. In addition, case
fatality rates (CFR) are unacceptably high, ranging from 2.3 percent
to 4.7 percent and can reach much higher levels at district level in
many countries (ranging from 1 percent to 22 percent in Cameroon for
example). Children are more vulnerable to cholera, as they dehydrate
faster, and malnourished children are especially at risk.

The most significant increases in 2011 are in Chad, Cameroon, and in
western Democratic Republic of Congo (DRC). In addition there are
still challenges with getting access, ensuring staff presence in
medical facilities, and establishing surveillance systems to monitor
cases and numbers in parts of Northeastern DRC.

There are 3 major cross border cholera epidemic outbreaks in West and
Central Africa: the Lake Chad Basin (Chad, Cameroon, Nigeria, and
Niger), the West Congo Basin (DRC, Congo, and the Central African
Republic), and Lake Tanganyika (DRC and Burundi). Smaller cholera
epidemics in Benin, Cote d'Ivoire, Ghana, Guinea, Liberia, and Togo
are under control.

UNICEF calls upon governments to coordinate the preparation and
response not only within their borders, but to ensure close
collaboration with neighbouring countries. Cross-border coordination
has to be encouraged at all levels, from the district to the national
level.

A cross-border epidemiological study covering the Lake Chad Basin
(Cameroon, Chad, Nigeria, and Niger) was initiated by UNICEF in 2010,
and is now in its 2nd phase. The study provides critical evidence for
informing cholera prevention and response interventions, which have to
be coordinated across borders. Cross-border coordination between teams
in Kinshasa and Brazzaville has also been initiated for the more
recent cholera outbreak in the West Congo Basin.

Access rates to water and sanitation in West and Central Africa are
among the lowest in the world. Out of 24 countries in the region, not
a single one is on track to meet the MDG [UN Millennium Development
Goal] target for sanitation. This is the underlying cause for cholera
outbreaks in West and Central Africa. Although measures for cholera
response can help contain the spread of the disease and reduce the
number of fatalities, it would be much more effective if the
underlying cause of this 'poor man's disease' is tackled.

--
Communicated by:
ProMED-mail from HealthMap Alerts


[The countries in West and Central Africa can be seen on the map at
http://www.unicef.org/hac2011/images/HA ... _WCARO.jpg. -
Sr.Tech.Ed.MJ]

******
[2] Cholera - Somalia (Mogadishu)
Date: Mon 10 Oct 2011
Source: Press TV [edited]
http://www.presstv.ir/detail/203816.html


Cholera and severe malnutrition have killed 32 more children in
Somalia as the conflict-plagued nation struggles against drought and
famine, Press TV reported. The victims died on Monday morning [10 Oct
2011] in Mogadishu's northern district of Karan. More than 117
children, suffering from cholera and waterborne diseases, were also
taken to hospitals, especially Banadir hospital in southern Mogadishu,
for medical treatment.

The International Committee of the Red Cross (ICRC) warned in a
statement in late September 2011 that, "The situation in Somalia
remains highly critical. Hundreds of thousands of Somalis are still
displaced from their homes in search of security and food."

The Geneva-based humanitarian institution added, "Although
humanitarian aid has started to reach the drought- and
conflict-affected people, many are still struggling to survive."

"Much of the livestock has been decimated and there is no hope for an
improvement in the situation until the next harvest in December," it
added.

Meanwhile, the UN Office for the Coordination of Humanitarian Affairs
(OCHA) has said that 4 million Somalis are in crisis, with some 750
000 at risk of dying in the next 4 months.

The UN body added it is also feared that the rains will also raise the
risk of diseases. "The onset of rains anticipated in October could
fuel the spread of cholera, measles, and malaria, thereby leading to
more deaths in a population already weakened by conflict and famine,"
OCHA noted.

--
Communicated by:
ProMED-mail from HealthMap alerts


[A HealthMap/ProMED-mail interactive map of Somalia can be seen at
http://healthmap.org/r/1gIF.- Sr.Tech.Ed.MJ]

******
[3] Cholera - Congo DR, Congo
Date: Fri 7 Oct 2011
Source: gantdaily.com, UN Integrated Regional Information Networks
(IRIN) report [edited]
http://gantdaily.com/2011/10/07/cholera ... ases-soar/


There has been an increase in the number of cholera cases and deaths
in parts of the Democratic Republic of Congo where an outbreak has
been ongoing since March 2011, say humanitarian agencies. At least
6910 cases and 384 deaths had been reported as of 3 Oct 2011,
according to a report by the UN Office for the Coordination of
Humanitarian Affairs (OCHA), compared with a total of 3896 cases and
some 265 deaths by 20 Jul 2011.

"We cannot know the exact cause of the disease but we know that it has
spread from one person to the other due to poor hygiene," said
Laurence Sailly, the Medecins Sans Frontieres (MSF) assistant medical
coordinator.

The cholera outbreak was first reported in March 2011 in the
northeastern province of Orientale before spreading along the River
Congo to the capital Kinshasa.

Neighboring Republic of Congo has also recorded cholera deaths in an
outbreak that began in June 2011, according to officials. The
outbreak, which had led to about 20 deaths as of late August 2011, is
thought to have spread from the DRC, with most cases reported along
the Congo River, which forms the border between the countries.

--
Communicated by:
ProMED-mail from HealthMap Alerts


The Democratic Republic of Congo (Kinshasa) and the Republic of Congo
(Brazzaville) can be seen on the HealthMap/ProMED-mail interactive map
at http://healthmap.org/r/1koi. - Sr.Tech.Ed.MJ]

[The continent of Africa continues to be a prime location for cholera.
Although the disease has been referred to as "Asiatic cholera" in
deference to the disease's continent of origin, as many as 95 percent
of the yearly burden of cases now occurs in Africa. - Mod.LL]

UNDIAGNOSED ILLNESS - ETHIOPIA: (AFAR), REQUEST FOR INFORMATION
***************************************************************

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ProMED-mail is a program of the
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http://www.isid.org


Date: Mon 10 Oct 2011
Source: All Africa.com, Addis Fortune (Addis Ababa) report [edited]
http://allafrica.com/stories/201110110433.html


Inexplicable Disease Afflicts 3000 in Afar
------------------------------------------
A mysterious disease, which has infected approximately 3000 people in
Afar Regional State in the past 3 months, has medical professionals
puzzled. Blood samples were sent to Senegal after an investigation at
the Ethiopian Health and Nutrition Research Institution (EHNRI) failed
to identify cultures grown here, according to sources in Afar.

People who are infected show symptoms including high fever, shivering,
hallucinations, vomiting, and back pain, according to Hussein Ali, an
official in the Regional Health Bureau. "At 1st we thought it was
malaria because of the symptoms, but blood tests done for it came back
negative," he told Fortune.

People living in 3 Weredas in the region -- Asa'iyta, Dubti and Afambo
-- have been infected, residents and health professionals Fortune
talked to over the phone confirmed. The population of the 3 Weredas is
140 998 out of 1.1 million in the whole region, according to the 2007
census done by the Central Statistics Agency (CSA).

So far patients with the symptoms are being treated with Doxycycline,
an antibiotic, and Diclophenac, an anti-inflammatory, according to a
nurse possessing his Bachelors of Science (BSc), who requested
anonymity due to the sensitivity nature of the issue. "Although there
is suspicion that the cause might be viral, there has not been a
definitive diagnosis," he told Fortune. "However, there has not been a
single death reported so far."

After blood samples tested negative for malaria, health professionals,
the Regional Health Bureau and WHO had suspected that it might be
dengue fever, a tropical disease that is transmitted by mosquitoes,
according to Hussein. "However, that notion has been abandoned as the
symptoms do not include body rash, which is characteristics of dengue
fever," he told Fortune.

Health professionals at the Ministry of Health (MoH), WHO, and EHNRI
declined comment on the issue.

However, the WHO and the Regional Disease Prevention and Control
Office are working collaboratively to identify and control the new
unidentified disease, according to Hussein.

[Byline: Lisa Schlein]

--
Communicated by:
ProMED-EAFR from HealthMap Alerts


[An undiagnosed illness has been reported in Afar region in Ethiopia
with patients presenting with fever, backache and hallucinations
suggestive of viral encephalitis given that bacterial cultures have
been negative to date. The differentials here would include: dengue
fever, West Nile fever, Japanese encephalitis, influenza virus,
enteroviruses (picornavirus) and other causes of viral encephalitis.
ProMED will appreciate additional information on the definitive
diagnosis.

A map showing the 9 provinces in Ethiopia can be seen at
http://en.wikipedia.org/wiki/Regions_of_Ethiopia. The
HealthMap/ProMED-mail interactive map of the country is available at
http://healthmap.org/r/01bp. - Mod.JFW]

[Lack of a reported rash tends to rule out Zika and dengue virus
infections, and no reports of severe arthralgias tends to eliminate
chikungunya virus infection, although the above report of symptoms
may not be complete, so these viruses cannot be eliminated completely
as possible pathogens in these cases. There were cases of an
undiagnosed illness in a neighboring area of Kenya in 2005, but unlike
the current report in Ethiopia, there were deaths (see ProMED-mail
archive number 20050823.2486). - Mod.TY]

PLAGUE, PNEUMONIC - MADAGASCAR (05): (ANTANANARIVO)
***************************************************

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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Tue 12 Oct 2011
Source: Afriquinfos [machine transl.] [edited]
http://www.afriquinfos.com/articles/201 ... 188649.asp


A pneumonic plague epidemic has been declared in the district of
Miarinarivo located in the province of Antananarivo, the Malagasy
capital has reported to the local press Tuesday, 11 Oct 2011. One
person has died of this disease and 5 other persons are being treated
at the hospital.

The district of Miarinarivo and its environs are included among the 12
regions known as endemic for the disease on the island, but it was
also noted that the regions of the central highlands are the most
favorable to their development because of a higher altitude to 800
meters and a cooler temperature.

Plague reappeared in December 2010 with 5 cases including 1 death in a
village 15 km [9.3 miles] from the capital as well as 16 deaths in
Ambilobe, in the northern region of Madagascar in February 2011.

--
Communicated by:
ProMED-mail from HealthMap Alerts


[Primary pneumonic plague (1 percent of natural plague presentations)
arises as a result of inhalation of plague bacilli in infectious
aerosols, such as would be produced when there are secondary pneumonic
complications in bubonic/septicemic plague.

Primary plague pneumonia has a short incubation period of 1-3 days,
after which there is sudden onset of flu-like symptoms including
fever, chills, headache, generalized body pains, weakness and chest
discomfort. A cough develops with sputum production, which may be
bloody, and increasing chest pain and difficulty in breathing. As the
disease progresses, hypoxia (low oxygen concentration in the blood)
and hemoptysis (coughing up blood) are prominent. The disease is
invariably fatal unless antimicrobial therapy commences within 24
hours of exposure.

Patients with primary pneumonic plague generate large quantities of
infectious aerosols that pose a significant risk to close contacts.
CDC guidelines identify contacts within 2 meters [6 feet] as being at
greatest risk and do not consider the organism likely to be carried
through air ducts or vents. Persons who have been in contact with
pneumonic plague patients or handling potentially infectious body
fluids or tissues without appropriate protection should receive
preventive antimicrobial therapy. The preferred antimicrobial agents
for prophylaxis are tetracyclines, quinolones, or chloramphenicol.

Madagascar was the location of the isolation of multi-antimicrobial
resistant _Y. pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et
al: Multidrug resistance in _Yersinia pestis_ mediated by a
transferable plasmid. N Engl J Med 1997;337: 677-81). The strain was
resistant to chloramphenicol, streptomycin and tetracycline but
sensitive to fluoroquinolones and trimethoprim as well as other
aminoglycosides. This was an ominous observation, however, it is not
clear if this naturally occurring strain has persisted or spread. -
Mod.LL]

[The interactive HealthMap/ProMED map for Madagascar is available at:
http://healthmap.org/r/1kSe - CopyEd.EJP]

YELLOW FEVER - AFRICA (20): UGANDA ex SOUTHERN SUDAN, CORRECTION,
HEPATITIS E VIRUS
***********************************************************************************

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: 28 Sep 2011
From: Dr. Joseph F. Walmala [edited]



The lady from Torit turned out to be positive for HEV [hepatitis E
virus] IgM and IgG but negative for yellow fever markers, based on
laboratory results from the CDC Uganda Viral laboratory.

--
Joseph F. Walmala

Senior Epidemiologist
Ministry of Health, Uganda

[The original report was of an imported yellow fever (YF) case from
the city of Torit, the capital of the state of Eastern Equatoria,
Republic of Southern Sudan, discovered in Palabek, Kitgum district,
Uganda (see ProMED-mail archive number 20110926.2922). The original
report indicated that the affected individual had YF. As noted above,
laboratory tests ruled out YF virus infection and diagnosed hepatitis
E virus infection, which can produce symptoms similar to YF virus
infection.

The US CDC states (http://www.cdc.gov/hepatitis/HEV/index.htm,
edited) "Hepatitis E is a serious liver disease caused by the
hepatitis E virus (HEV) that usually results in an acute infection. It
does not lead to a chronic infection. Hepatitis E is common in many
parts of the world. Transmission occurs through ingestion of fecal
matter, even in microscopic amounts. Outbreaks are usually associated
with contaminated water supply in countries with poor sanitation.
There is currently no FDA-approved vaccine for Hepatitis E."

A HealthMap/ProMED-mail interactive map showing the location of
Eastern Equatoria in Southern Sudan can be accessed at
http://southernsudan.prm.ox.ac.uk/sudan_map.php. - Mod.TY]

TOXIC FISH, HUMAN - SUEZ
************************

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: 12 Oct 2011
Source: Masrawy.com (In Arabic, transl. Corr SB; edited)
http://www.masrawy.com/News/Cases/Gener ... OISON.aspx


Family members are poisoned after eating a meal of toxic fish
--------------------------------------------------------------
A total of 5 members of one family from Suez have (been diagnosed
with) acute food poisoning, from eating a meal of a toxic fish which
is banned from hunting or eating. These fish are highly toxic and kill
within hours unless the antidote is given in a timely manner.

Major General Adel Rifaat, Security Director of Suez had received a
communication from the Suez General Hospital stating the arrival of 5
members of one family, who showed symptoms of acute poisoning as a
result of eating a meal of fish.

On a related matter, there are currently warnings in the governorates
of Suez and the Red Sea to refrain from eating the [Alakrbeh] fish.
The General Union of Fishermen has said to refrain from fishing of
many species of poisonous fish in the waters of the Red Sea and Gulf
of Suez and the Lakes region, which cause poisonings. This fish is
also known as "sea-chicken" or "sea cat."

--
Communicated by:
ProMED-mail from HealthMap alerts


[This fish is in the same family as the rock fish, the lion fish and
the scorpion fish. These fish are very toxic and while similar to the
Alakrbeh fish, the Alakrbeh fish is extremely toxic. Natives to the
area never eat the fish. Therefore, the fish became mixed up with
others in some type of stew or mixed dish, or these folks were not
native to the area. - Mod.TG]

[ProMED-mail would greatly appreciate more information on the toxin
associated with the Alakrbeh fish. Extensive internet searching in
English and Arabic (using machine translation) did not identify the
toxin. It should be noted that the rock fish, the lion fish and the
scorpion fish are all fish that have toxins in spiney protrusions and
human intoxication occurs when there is physical contact with these
poisonous spines. From the above description, it appears as though
this fish may have toxin in the actual flesh or in organs if the
individuals were poisoned through eating fish cooked in a stew.
Clarification and identification of the actual toxin would be greatly
appreciated. - Mod.MPP]

[The interactive HealthMap/ProMED map for the Suez Governorate in
Egypt is available at: http://healthmap.org/r/1kJp - CopyEd.EJP]

RABIES - ZAMBIA: (MANSA), CANINE, HUMAN
***************************************

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 15 Oct 2011
Source: allAfrica.com, ex Times of Zambia [edited]
http://allafrica.com/stories/201110170140.html


Rabies has broken out in Mansa district, which has recorded 14 cases
[canine or human?] and one [human] death in the recent past. District
livestock officer Beatwell Mbewe said yesterday [14 Oct 2011] in Mansa
[district] that the 14 cases [canine or human?] were recorded in
Chembe area, while one person died in Mwang'uni after being bitten by
an infected dog.

Mr Mbewe said that, despite there being no cure, the disease could be
prevented if a person bitten by a rabid dog received treatment before
the symptoms manifested themselves. He said one of the commonest
symptoms of rabies in human beings is failure to swallow food or
having a condition known as hydrophobia, or fear to drink water.

As a way to prevent the spread of the disease, the department of
livestock embarked on a mass rabies vaccination campaign in which more
than 500 dogs in Mansa district were expected to be covered. Mr Mbewe
said rabies vaccine centres had been opened in the Senama, Kapesha,
Namandwe and Suburbs areas.

He called on members of the public to report to the department of
livestock, the police and hospital or clinic immediately after being
bitten by any dog as a way of preventing the deadly disease.

Rabies is a disease of dogs and other animals that causes madness and
death. But infected animals could pass the disease to humans if they
are bitten.

--
communicated by:
ProMED-mail from HealthMap alerts


[Dog rabies potentially threatens over 3.3 billion people in Asia and
Africa. People most at risk live in rural areas where human vaccines
and immunoglobulin are not readily available or accessible. Wound
cleansing and immunization within a few hours after contact with a
suspect rabid animal can prevent the onset of rabies and death. The
local authorities in Mansa appear to be well aware of the problem and
the remedy.

Post-exposure prevention consists of local treatment of the wound,
administration of rabies immunoglobulin (if indicated), and immediate
vaccination. In developing countries, the vaccination status of the
suspected animal alone should not be considered when deciding whether
to initiate prophylaxis or not. It must be presumed that the single
fatal human case in Mwang'uni had been bitten by a rabid dog and did
not receive appropriate treatment.

Mansa is the capital of Luapula province of Zambia and headquarters of
Mansa district. It takes its name from the Mansa River, which flows
west to the Luapula River. Mansa district can be located in the
HealthMap/ProMED-mail interactive map of Zambia at
http://healthmap.org/r/1lfW. - Mod.CP]

LEISHMANIASIS, VISCERAL - SOUTH SUDAN (JONGLEI, UPPER NILE)
***********************************************************

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 10 Nov 2011
Source: NaTHNaC [edited]
http://www.nathnac.org/pro/clinical_upd ... 041111.htm


Visceral leishmaniasis in the Republic of South Sudan
-----------------------------------------------------
In September 2009, an outbreak of visceral leishmaniasis was reported
in the states of Upper Nile and Jonglei which are now part of the
newly formed country of the Republic of South Sudan. Since this time
the outbreak has continued with increased numbers of cases and has
spread to the states of Eastern Equatoria and Unity [1].

As of 28 October 2011, more than 18 000 cases and 720 deaths have been
reported since the outbreak began. A total of 7827 cases have been
reported in 2011 which is an increase over 2010 case numbers [1,2].

The World Health Organization (WHO) estimates that the number of
deaths is likely to be under-reported due to the lack of a cohesive
infrastructure and the prevalence of remote communities [2]. This is
further complicated by thousands of people returning from northern
Sudan to settle in endemic areas of the Republic of South Sudan.
Insecurity in the affected states restricts access to health care and
treatment, and malnutrition, poor housing, mosquito net shortages, and
environmental changes escalate the problem [1]. There is concern that
thousands of lives will be at risk during the peak transmission season
through December [1].

WHO is supporting the Republic of South Sudan's health authorities
through provision of drugs, laboratory diagnosis, training of health
staff, and by developing an integrated management strategy to guide
vector control [1].

In order to ensure that treatment sites receive essential supplies
during the rainy season, when roads are impassable, boats are being
made available to facilitate movement of medical supplies [1].

Visceral leishmaniasis
----------------------
Visceral leishmaniasis is caused by parasitic protozoa of the genus
Leishmania. The parasite is transmitted via the bite of infected
sandflies. In advanced infection, symptoms include: fever, weight
loss, enlargement of the liver and spleen, anaemia if not treated.
Visceral leishmaniasis has a mortality rate of 95 percent [1].

Advice for travelers
---------------------
Travelers to and persons returning to live in the Republic of South
Sudan should follow good insect bite avoidance, particularly between
dusk and dawn. Sandflies are small enough to pass through standard
mosquito nets. However, mosquito nets impregnated with permethrin are
usually effective. There is no vaccine against any type of
leishmaniasis.

References
----------
1. World Health Organization Republic of South Sudan. Thousands of
South Sudan people suffer from kala azar epidemic as cases rise. World
Health Organization 28 October 2011. [Accessed 4 November 2011].
Available at:
http://www.who.int/hac/crises/sdn/relea ... er2011/en/
2. United Nations News Centre. Deadly outbreak of kala-azar continues
in South Sudan, UN agency says. 28 October 2010, [Accessed 4 November
2011]. Available at:
http://www.un.org/apps/news/story.asp?N ... +Sudan&Cr1

--
Communicated by:
ProMED-mail from HealthMap alerts


[Sudan, including Southern Sudan, is endemic of leishmaniasis.
Leishmaniasis is spread by sandflies. The main reservoir is dogs and
the main vectors are _Phlebotomus papatasi_ and _P. orientalis_
(Dereure J et al. Visceral leishmaniasis in eastern Sudan: parasite
identification in humans and dogs; host-parasite relationships.
Microbes Infect. 2003;5:1103-8).

Leishmaniasis is a chronic infection with a high mortality in
untreated cases. Malnutrition is a main contributing factor to
clinical disease. Leishmaniasis is also a HIV related disease, but HIV
infection rates are low in South Sudan (Rai RK et al. Prioritizing
Maternal and Child Health in Independent South Sudan. Matern Child
Health J. 2011 Sep 30. [Epub ahead of print]). HealthMap location:
http://healthmap.org/r/1qzq - Mod.EP]

YELLOW FEVER - AFRICA (21): GHANA
*********************************

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 12 Nov 2011
Source: GNA [edited]
http://www.ghananewsagency.org/details/ ... 1&ai=35535


The Upper West Region has recorded 3 yellow fever [YF] cases this year
[2011] with one each in Wa Municipality, Jirapa and Wa East Districts,
Dr Richard Wodah, Medical Director of Saint Joseph's Hospital at
Jirapa has announced. Consequently, a district mass immunisation
programme has been drawn especially for children above one year.

Dr Wodah made this known at Duori, when the Rotary Club of Windsor in
Canada presented delivery packs valued at GHS 900 Ghana [Cedi; 556
USD] to the local health post. He said the region has for the past 6
years recorded no cases of yellow fever and expressed worry about the
development. Dr Wodah said recording as many 3 cases of the disease
was disturbing news to the Regional Health Directorate.

He called on the people to sleep under mosquito nets and also mobilise
all children, especially those above one year to be immunised.

--
Communicated by:
ProMED-mail from HealthMap Alerts


[There was a YF outbreak in the Jirapa district in 2005, with one
confirmed and 10 suspected cases at that time (see ProMED-mail
archives cited below). Sporadic YF cases and outbreaks occur in West
Africa where it is endemic, with the attendant risk of the sylvan
(forest) cycle becoming an urban or suburban epidemic if continuous
vaccination programs are not carried out to maintain immunity in the
population. One hopes that the vaccination campaign mentioned in the
above report is implemented quickly.

A HealthMap/ProMED-mail interactive map showing the location of Jirapa
can be accessed at
http://healthmap.org/r/1qG-. Wa East and Wa West are located in the
district of the Upper West Region of Ghana and a map can be accessed
at
http://en.wikipedia.org/wiki/Wa_East_(G ... stituency).
- Mod.TY]