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CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (12): AFRICA
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In this update:
Africa
[1] Cholera - Ghana (Greater Accra Region)
[2] Cholera - Ghana (Eastern Region)
[3] Cholera - Uganda (Nebbi District), Congo Democratic Republic

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[1] Cholera - Ghana (Greater Accra Region)

Date: Wed 18 Apr 2012
Source: Peace FM Online, Radio XYZ report [edited]
http://news.peacefmonline.com/health/201204/108851.php


The death toll in the Greater Accra region from the cholera outbreak has risen to 21 out of 1570 reported cases.

Dr Ato Eshun, the Greater Accra disease control officer in an interview with XYZ News said all hospitals are well equipped to handle cholera cases for now. He also urged the public to quickly report such cases at the nearest hospital.

"So far a lot of cases are being reported because of the awareness situation. For now we have a little over 1570 cases and 21 deaths." He explained that "these deaths are due to the fact people come in the worst conditions. We want to entreat the general public to adhere strictly to personal and environmental hygiene."

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[Maps of Ghana can be seen at http://www.lib.utexas.edu/maps/africa/ghana_pol96.jpg and http://healthmap.org/r/1oA-. - Sr.Tech.Ed.MJ]

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[2] Cholera - Ghana (Eastern Region)
Date: Wed 18 Apr 2012
Source: GBC (Ghana Broadcasting Corporation) News [edited]
http://www.gbcghana.com/index.php?id=1.864404


Statistics from the 9 districts of the Eastern Region show an outbreak of cholera in the area.

About 164 cases have been recorded in the affected areas with the Birim Central Municipality leading with 57 followed by the Suhum-Kraboa-Coaltar, which has recorded 53. Akuapem South Municipality followed with 18 cases.

The Deputy Eastern Regional Director of Health Services, Dr George Bonsu, who disclosed this in an interview with GBC's Radio Ghana said the remaining districts affected by the epidemics are Lower Manya, West Akyem, Kwaebibirem as well as Kwahu East and South Districts.

According to Dr Bonsu, Lower Manya Krobo and West Akyem districts have recorded 14 and 5 cholera cases [respectively], while Kwahu South and Kwaebibirem had 2 cases each with Kwahu East recording only 1.

As at last Fri 13 Apr 2012, he said only 5 districts had reported [a total] of 93 cases while the figure has risen to 164 with new areas such as Kwaebibirem, Kwahu East, West Akyem, and Kwahu South Districts.

Dr Bonsu said the Regional Health Directorate has been intensifying its efforts to control the situation especially in the affected districts.

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[The districts mentioned can be seen on the map at http://www.maplibrary.org/stacks/Africa ... /index.php. - Sr.Tech.Ed.MJ]

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[3] Cholera - Uganda (Nebbi District), Congo Democratic Republic
Date: Sat 14 Apr 2012
Source: Daily Monitor (Uganda) [edited]
http://www.monitor.co.ug/News/National/ ... aw3qmiz/-/


Persistent poor hygiene in Nebbi District has aided further spread of cholera, bringing the number of deaths to 11 and 550 infections in 2 weeks.

Despite increased sensitization about improving sanitation by health workers, communities have been slow in adapting to messages. The communities still take unboiled water, defecate in lakes because families are still reluctant to construct pit-latrines, and there is poor waste disposal in congested markets.

The district health officer, Mr Kits Obima, told the Monitor that the new infections pose a great challenge with the meager resources and manpower at established treatment centres.

"The village health teams moving door-door meet stiff resistance from some family heads who blatantly reject idea of constructing pit-latrines," Mr Obima said.

Already, there are plans to close Panyimur and Dei markets that attract huge numbers of traders from DR Congo. Some of the cases are from DR Congo.

[Byline: Felix Warom Okello, Patrick Okaba]

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[Maps of Uganda can be seen at http://en.wikipedia.org/wiki/Districts_of_Uganda and http://healthmap.org/r/26No. - Sr.Tech.Ed.MJ]

TYPHOID FEVER UPDATE 2012 (09)
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In this update:
[1] Zambia (Central Province)
[2] Zimbabwe (Harare)

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[1] Zambia (Central Province)

Date: Mon 16 Apr 2012
Source: Times of Zambia [edited]
http://allafrica.com/stories/201204161422.html


Typhoid cases in Kabwe have increased to 204 since the disease broke out 2 weeks ago. Kabwe Health District Management (KHDM) medical officer Abel Kabalo said in an interview that 2 more cases were recorded yesterday, 15 Apr 2012.

The department of water affairs has started mounting 11 water tanks in affected townships. Dr Kabalo said most of the patients had continued to receive treatment from their homes. He said yesterday, 15 Apr 2012, that only 2 cases were recorded, as compared to Saturday, 14 Apr 2012, when 11 new patients were treated in the Central Province capital.

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[2] Zimbabwe (Harare)
Date: Sun 8 Apr 2012
Source: The Standard [edited]
http://allafrica.com/stories/printable/ ... 80222.html


Cases of typhoid are still being reported in Harare's high-density suburbs every day since the outbreak of the disease in October 2011. Head of Harare's 2 infectious disease hospitals, Beatrice and Wilkins, Clemence Duri said most of the cases were emanating from Dzivarasekwa and Kuwadzana high-density suburbs, areas which always experience frequent water cuts.

"As of [1 Jan 2012], we were receiving 90 cases per day in Dzivarasekwa and Kuwadzana which were the highest number of cases but now we are getting less than 20," Duri said. "Admissions are now very few compared to January [2012]. We have since adopted a preventive strategy because of the risk that it can spread to other areas."

More than 4000 cases of typhoid have been recorded in Harare since October 2011 while nearly 1000 people have been treated for dysentery in the past 2 months.

[Byline: Jennifer Dube]

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[The interactive HealthMap/ProMED map for Harare is available at:
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VISCERAL LEISHMANIASIS – SOUTH SUDAN
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Date: Fri, Apr 20, 2012
Source: Voa News [edited]
http://www.voanews.com/english/news/hea ... 01465.html


Viseral Leishmaniasis is raging again in the Republic of South Sudan
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The clinic in Old Fangak has treated 1800 cases this year. In newly independent South Sudan, deadly Kala Azar disease is still raging in some of the most remote areas lacking basic health services.

Standing next to the single tent she now calls home in the scorching sunshine, Alaskan-born Dr. Jill Seaman explained how after coming to the southern Sudan in 1989 and visiting villages where only 5 out of 1,000 people had survived a Kala Azar outbreak, she could not tear herself away from this swampland.

"We walked through villages where there was still the ash left from fires, there were still sticks left to tie your cattle up, but there were no people left, you were walking through ghost villages," said Seaman. "And that, plus watching all the skeletal people walking into the clinic every night to get treated and asking them 'How many people in your family have died?' and hearing the answer 12, 14, 8, 13 - it kind of bonds you to a community, and I suppose that's why I'm still here."

That Kala Azar outbreak killed around half the population in the area, and around half the 11 000 cases reported last year were treated at the clinic in Old Fangak.

Dr. Jill Seaman has dedicated years to fighting Kala Azar disease in Sudan, an infectious disease [caused] by a parasite and transmitted by the bite of a sand fly, Kala Azar causes a fever that does not subside. If left untreated, Dr. Seaman said around 95 percent of Kala Azar patients simply waste away or die after catching other infectious diseases. 3 percent of patients died in Old Fangak last year, and the clinic has already treated 1800 people with Kala Azar this year.

In a stuffy ward packed with patients laid head to toe on narrow beds, Nyadak Mouk cuddles her 5-year-old son, who is suffering from Kala Azar-induced fever. She walked 8 hours from Keew village to reach the clinic. Having lost 4 of her 6 children to disease, she said she is not leaving until the boy is cured.

Mouk said she did not bring the other children to the clinic so she does not know why they died. She has been in Old Fangak for 6 months and fears if she moves away from the treatment center, she will lose her young son as well. "I don't know what they died of as I didn't bring them to the clinic – they died in the village. I now live near the clinic. I left home 6 months ago, and I can't be away from it as without treatment he will die," Mouk said.

Dr. Abdi Nasir, a communicable disease specialist for the United Nations World Health Organization, said Kala Azar usually comes in cycles about every 10 years.

But residents of South Sudan are particularly vulnerable to infection because of attacks from rebel groups which displace thousands of people at a time, compounded by generally poor living conditions and malnutrition.

Dr. Nasir said an outbreak that began in 2009 has now affected 25 000 people and is still raging. It is the worst in 30 years. "We very much hope the outbreak will die down and the number goes down, but looking at the different factors and the situation, it doesn't look that way," said Nasir.

Dr. Nasir expects another 11 000 people will be treated this year, but the treatment doesn't come cheaply. Even at the reduced prices available to WHO, the cure costs around $600 per person, not counting the expense of transporting it to remote places such as Old Fangak. Dr. Seaman said if the medicines keep coming, the clinic can try and deal with Kala Azar.

But she said lack of food in the area is her primary concern. Last year, the surrounding areas had almost no harvest after heavy rains flooded crops. While more than 350,000 people have come to South Sudan since it gained independence from Sudan in July, further stretching resources, the border has practically been closed, doubling the prices of staple foods.

Health workers in the clinic said malnourished people are more likely to contract the disease as their immune systems are already low, and they are less likely to recover or will relapse.

Back in the ward, patients almost skeletal from the effects of Kala Azar try to regain their strength with plain bean mash that is the only food on offer. How many lives the disease will claim this year depends on how much food and medicine aid agencies can deliver to this neglected area before next month's rains cut the region off from the world.

[Byline:
Hannah McNeish
Juba, South Sudan]

[Communicated by:
Susan Baekeland
]

[Visceral leishmaniasis, VL, is endemic in Sudan including newly independent South Sudan. Treatment and control of leishmaniasis is discussed in: Control of the leishmaniases. WHO Technical Report Series no. 949. Report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, 22–26 March 2010. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf.

The predominant species coursing VL in Sudan is Leishmania donovani, and the infection is anthroponotic (ie. the reservoir host is humans). Malnutrition and immune suppression, notably HIV infection, predispose to clinical disease.

Health Map location: http://healthmap.org/r/2eyz - Mod. EP]

[Map of infected provinces of South Sudan:
http://wwwnc.cdc.gov/eid/images/07-1099-F1.jpg

Photo of Dr Jill Seaman:
http://www.voafanti.com/gate/big5/media ... +-+230.jpg

Photo of kala azar patients waiting for treatment at Old Fangak clinic:
http://www.sudanmedicalrelief.org/news/ ... tr-p1f.jpg
- Mod.JW]

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (06): NODDING DISEASE
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[1]

Date: Sun, Apr 22, 2012
Source: Friedrich MJ. Targeting Nodding Disease. Journal of the American Medical Association, JAMA 2012;307(15):1573.doi: 10.1001/jama.2012.477 < http://jama.ama-assn.org/content/307/15/1573.1.extract>


Task force to address nodding disease in Uganda
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The Ugandan Ministry of Health is setting up a task force to raise awareness about a mysterious illness called nodding disease or nodding syndrome — characterized by repetitive head nodding and seizures—that is affecting thousands of children in East Africa (http://tinyurl.com/73zj53r).
The plan is to establish screening and treatment centers and mobile clinics in the affected districts, enhance surveillance, and continue efforts to determine the etiology of the disease.

In the last several years, an increase in nodding syndrome has been reported in children between the ages of 5 and 15 years in northern Uganda, as well as South Sudan and southern Tanzania, but the cause and natural history of the disease remain unclear.

Earlier in the year, findings from a case-control study of 2 clusters of nodding syndrome assessed in 38 matched case-control pairs in South Sudan indicated a positive association between the disease and infection with a nematode that causes … [onchocerciasis].

(Full text only available to registered users or after purchase).

[Communicated by
Terry S. Singeltary Sr.
flounder9@verizon.net]

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[2]
Date: Fri, 13 Apr, 2012
Source: Science 2012;336(6078) :144-146. DOI: 10.1126/science.336.6078.144
http://www.sciencemag.org/content/336/6078/144


Mystery Disease Haunts Region
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In Mahenge, a town in a mountainous and isol
ated area of southern Tanzania, a great number of people suffer from epilepsy. Some of the most severe cases are found in people who were normal until they were around 4 or 5 years old, when they began to have seizures characterized by repeated downward
movements of their heads. For many years, Western colleagues doubted or dismissed reports of the nodding seizures, first described in a 1964 paper.

Now an apparent outbreak of a similar nodding syndrome in Uganda and southern South Sudan over the past few years has attracted many more researchers to look for possible causes. They are chasing several suspects, including a parasitic worm, but so far there's no proven culprit. Without a clear explanation of the condition's cause or effective treatments, defeating the disease will be no easy task.

(Full text only available to registered users or after purchase).

[Communicated by
Terry S. Singeltary Sr.
flounder9@verizon.net]

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[3]
Date: Thu, 12 Apr, 2012
Source: United Against Infectious Diseases [edited]
http://uaidintl.org/2012/04/12/um-uaid- ... n-mystery/


Nodding Disease: A Ugandan Mystery
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In the northern plains of Uganda, thousands of children convulse, writhe, and wander uncontrollably. They aimlessly crawl across the grounds of their villages, serving only to scare their worrisome mothers and leave the rest of the community wondering what has happened to the boisterous, playful children they once knew. You see, these once “normal” children have developed what is now being referred to as nodding disease.

Though nodding disease was actually first documented in Tanzania during the 1960s, only recently has it gained media attention from its increased prevalence in Uganda. Usually affecting children between the ages of 3 and 11, nodding disease causes seizures, personality changes, permanently stunted growth, increased aggression (though this is debated), mental retardation, and peculiarly persistent nodding, from which the disease derives its name. One mother says of her daughter, “Her personality has changed greatly from before. She was normal ...[but] now she just moves around and serves no purpose.” Another says of her son, “I feel dark in my heart. This boy has become nothing.”

Sadly, physicians and health professionals are still unsure of what exactly causes the disease. Though they have noted a high correlation between the presence of Black Flies — which carry the parasitic worm _Onchocerca volvulus_ responsible for river blindness — and nodding disease, there is much evidence suggesting that this correlation may be mere coincidence. Other hypotheses for means of infection include tainted monkey meat and chemical exposure resulting from Joseph Kony’s Lord’s Resistance Army. Whatever the cause, much more field and laboratory research must be conducted before effective treatments or cures can be implemented.

To learn more about this mysterious disease, check out this video made by the Centers for Disease Control and Prevention, the resources listed below, and the related material in UAID’s own awareness campaign, Educate Yourself.

[Byline: Nathan Wood]

References:
Wadman, M. (2011, July 13). African outbreak stumps experts. Nature, 475, 148-149. doi:10.1038/475148a

McKenzie, D. (2012, March 19). Mysterious nodding disease debilitates children. CNN. Retrieved from
http://www.cnn.com/2012/03/19/world/afr ... ?hpt=hp_c1

Ferguson, D. (2012, March 21). Mysterious ‘zombie’ disease afflicts thousands of Ugandan children. The Raw Story. Retrieved from http://www.rawstory.com/rs/2012/03/21/m ... -children/

Mick, J. (2012, March 20). Baffling illness strikes Africa, turns children into mindless “zombies.” Message posted to http://www.dailytech.com/article.aspx?newsid=24276

--
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flounder9@verizon.net

[ProMED thanks Terry S. Singeltary Sr. for communicating these 3 news pieces about the Nodding Disease outbreak in Uganda. We agree that the evidence for onchocerciasis and the cause of the disease is circumstantial and not convincing.
The hypothesis put forward in message no. 3 above, that it may indeed be a prion disease has to our knowledge not been investigated as post mortems of the central nervous system have not been performed to our knowledge.

We have previously hypothesized that food items may be involved, for instance the use of mineral oil instead of vegetable oil caused the “Spanish oil syndrome,” and mycotoxins in mouldy food may also cause symptoms from the central nerve system. Neither of these two possibilities have to our knowledge been investigated.

Health Map location: http://healthmap.org/r/2fMh - Mod. EP]

[If the cause is a food item, one would have thought all ages would show symptoms, unless susceptibility wanes dramatically with age.

Case photo:
http://mysteriousuniverse.org/wp-conten ... isease.jpg.
- Mod.JW]

Ghana - Darminfektionen
23.04.2012

Risiko für Durchfallerkrankungen landesweit. Cholera-Ausbrüche kommen landesweit vor. In der Region Greater Accra wurden in den letzten Monaten mindestens 1.570 Erkrankungen und 21 Todesfälle registriert. Auch in der benachbarten Eastern Region gibt es einen Ausbruch, der bisher zu 164 Erkrankungen geführt hat. Hygiene beachten, für Risikoreisende ist die Impfung zu erwägen. Milzbrand, meist durch Verzehr unzureichend gegarten Fleisches kranker Tiere, ist bei Einheimischen nicht selten. Der Norden des Landes gehört weltweit zu den Regionen mit den höchsten Prävalenzen bei Tieren. Polio durch Wildviren wurde 2008 zum ersten Mal seit 2003 aus Nord-Nigeria reimportiert und in 9 Fällen nachgewiesen. Hygiene und Impfschutz beachten. / Quelle: crm

Gruß
Birgitt

LASSA FEVER - NIGERIA (06) TRAVEL ALERT
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Date: Wed 25 Apr 2012
Source: Centers for Disease Control and Prevention (CDC), Travellers' Health [abridged & edited]
http://wwwnc.cdc.gov/travel/notices/in- ... igeria.htm


Lassa Fever in Nigeria
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The Nigerian Federal Ministry of Health has reported an increased number of cases of Lassa [haemorrhagic fever]. Nineteen of the country's 36 states have reported cases since the beginning of 2012. As of April 13, 2012, there were reports of 818 suspected cases, including 84 deaths. At this time, 131 cases have been confirmed by laboratory testing. Seven deaths have also been reported among health care workers. Cases have occurred in the states of Edo, Bauchi, Plateau, and Taraba. The number of reported cases of Lassa fever in Nigeria is greater this year than in previous years. However, cases in previous years could have been underestimated due to the lack of laboratory and disease investigation systems. The Nigerian government is responding to the outbreak by improving the disease investigation, treatment of patients, and conducting awareness campaigns among affected populations. Security and availability of resources are proving to be a major challenge. WHO does not advise or recommend any restrictions on travel or trade with Nigeria.

Lassa fever is a viral illness that is spread by rats [classically the "multimammate mouse" _Mastomys natalensis_, also dubbed "rat"]. People get the disease through direct contact with rat droppings or urine and through touching objects or eating food contaminated with rat droppings or urine. Lassa fever may also spread though person-to-person contact. This happens when a person comes into contact with an infected person’s blood, tissue, or body fluids. The symptoms include fever, pain behind the chest, sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, and bleeding from the mouth or nose. People with Lassa fever may also experience hearing loss, tremors, swelling of the face and eyelids, and swelling of the brain. Pregnant women with Lassa fever often have bleeding from the genitals and miscarriage and may die from the illness.

Lassa fever is seen in West Africa. Cases have been documented in Guinea, Liberia, Sierra Leone, and Nigeria. However, the rats that spread Lassa fever also live in other countries in Africa. The number of Lassa virus infections per year in West Africa is estimated at 100 000 to 300 000, with about 5000 deaths. These numbers are estimates because cases are not investigated everywhere. In some areas of Sierra Leone and Liberia, 10 per cent to 16 per cent of people admitted to hospitals have Lassa fever, which indicates the serious impact of the disease on the population of this region. Lassa fever can occur all year long, but most cases occur from January to May.

How can travelers protect themselves? Avoid contact with rats, especially rat urine and feces. Put food away in rodent-proof containers. Keep the home clean and rodent proof. Trap rats in and around homes. Do not eat rats. Wash hands well and often with soap, and teach children to wash their hands, too. Do not share eating or drinking utensils. Clean surfaces that are frequently touched (such as toys, doorknobs, tables, and counters) regularly with soap and water or with cleaning wipes. Avoid close contact with sick people.

If you have traveled to the area and develop symptoms of fever, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, and abdominal pain, see a doctor or health care provider right away. Be sure to tell your doctor or health care provider that you have recently traveled to Nigeria.

For additional information, see:

Lassa fever (CDC, Special Pathogens Branch) http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... lassaf.htm.

Viral hemorrhagic fevers (CDC Yellow Book, Health Information for International Travel) http://wwwnc.cdc.gov/travel/yellowbook/ ... fevers.htm.

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[Curiously this travel alert identifies only 4 of the 19 states affected by the outbreak of Lassa fever -- Edo, Bauchi, Plateau, and Taraba, whereas the Nigerian Ministry of Health had reported previously that Lassa fever was affecting 12 states -- Edo, Nasarawa, Plu, Ebonyi, Taraba, Yobe, Ondo, Rivers, Gombe, Anambra, Delta, and Lagos [see ProMED-mail report "Lassa fever - Nigeria (04) 20120223.1050129"].

About 80 per cent of human infections are asymptomatic with the remainder experiencing severe multi-system disease with the virus affecting several organs in the body, such as the liver, spleen, and kidneys. Lassa fever is a zoonotic disease and the animal reservoir of Lassa virus is a rodent of the genus _Mastomys_, commonly known as the "multimammate rat". _Mastomys_ rodents infected with Lassa virus do not become ill, but they can shed the virus in their excreta. In the absence of an effective vaccine, rodent control would seem the best option for control of the current outbreak. Images of multimammate rats be viewed at http://www.google.co.uk/search?q=mastom ... 08&bih=404.

Humans usually become infected with Lassa virus from exposure to excreta of infected _Mastomys_ rodents, and the infection may spread further between humans through direct contact with the blood, urine, faeces, or other bodily secretions of a person with Lassa fever. There is little epidemiological evidence supporting airborne spread between humans. Person-to-person transmission occurs in both community and health care settings, where the virus may be spread by contaminated medical equipment, such as reused needles. Sexual transmission of Lassa virus has been reported. (For further information see: http://www.who.int/mediacentre/factshee ... index.html).

A map showing the locations of the provinces of Nigeria can be accessed at http://www.ngex.com/nigeria/places/. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1qGF.]

Nigeria - Darminfektionen
30.04.2012

Risiko für Durchfallerkrankungen landesweit. Cholera-Ausbrüche gab es im vergangenen Jahr in 26 Bundesstaaten. Landesweit traten 2011 über 23.300 Fälle mit 742 Todesfällen auf. Nigeria gehört zu den Polio-Endemie-Ländern, in diesem Jahr wurden schon 24 Fälle registriert, in den vergangenen Jahren waren es 62 (2011), 41 (2010) und 388 (2009). Hygiene beachten, Impfung ist zu empfehlen. / Quelle: crm
__________

Nigeria - Masern
30.04.2012

2011 wurden ca. 27.700 Verdachtsfälle, 7.666 bestätigte Fälle und 194 Todesfälle gemeldet. Seit Jahresbeginn bis Mitte April 2012 wurden 4.863 Verdachtsfälle registriert, 81 Erkrankte sind verstorben. Fehlende Impfungen sollten gemäß den aktuellen STIKO-Empfehlungen nachgeholt werden. / Quelle: crm
__________

Tschad - Infektionskrankheiten
30.04.2012

Risiko für Durchfallerkrankungen landesweit. Die Zahlen von Cholera-Erkrankungen sind dramatisch angestiegen. Im gesamten Jahr 2011 gab es 17.200 Erkrankungen und mehr als 450 Todesfälle. Bereits im Jahr 2010 wurden von internationalen Hilfsorganisationen (Ärzte ohne Grenzen, Internationales Rotes Kreuz) mehr als 6.800 Patienten behandelt. 37 der 61 Distrikte des Landes sind von der Epidemie betroffen. Die meisten Menschen leben unter extrem schlechten sanitären Bedingungen, so dass Trinkwasser mit Fäkalien verunreinigt wird. Im verarmten Bongor im Süden des Landes treten außerdem viele Masern-Fälle auf. Polio, zuvor bereits ausgerottet, wurde seit 2003 aus dem benachbarten Nigeria mehrfach importiert. 2012 wurden bislang 3 Fälle ein Fall gemeldet, 2011 132, 2010 waren es 26. Hygiene und Impfschutz (Polio, Masern) beachten. / Quelle: crm

Gruß
Birgitt

LEPROSY - NIGERIA: (KEBBI)
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Date: Thu 10 May 2012
Source: AllAfrica, Daily Trust report [edited]
http://allafrica.com/stories/201205100676.html


State Coordinator of Leprosy Control Unit, Alhaji Ibrahim Abubakar, has said 254 leprosy cases have been found in Kebbi State in this year's [2012] 1st quarter.

He made this known during a one-day sensitization workshop organized by Kebbi State Office of The Leprosy Mission In Nigeria on how the media can reduce leprosy stigma and discrimination to people affected with leprosy in Birnin-Kebbi.

The coordinator said from 2005 to 2011 a total of 1882 people were found to have contracted the disease with Kalgo local government area having the highest cases totaling to 35 and promised to ensure reduction of the disease by 35 percent by 2015.

[Byline: Umar Jibrilu Gwandu]

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[Before 1998, Nigeria was one of the most leprosy endemic countries in the world, with prevalence rates ranging from 16 to 390 per 10 000 (http://www.leprahealthinaction.org/lr/M ... 65_076.pdf). Following introduction of multidrug therapy for leprosy in 1985, Nigeria attained the WHO elimination target of less than 1 case per 10 000 population at the national level by end of 1998 (http://www.leprahealthinaction.org/lr/M ... 65_076.pdf). The registered prevalence of leprosy at the end of the 1st quarter of 2011 was 4531 cases, or a prevalence rate of 0.27 per 10 000 (http://www.who.int/wer/2011/wer8636.pdf).

Drugs used to treat leprosy (dapsone, rifampin, and clofazimine) are provided by WHO free to all patients in the world since 1995 (see http://www.novartis.com/corporate-respo ... rosy.shtml). Patients are no longer infectious after the 1st dose of the treatment regimen. Patients with paucibacillary leprosy treated with rifampin and dapsone are cured within 6 months and multibacillary patients treated with rifampin, dapsone, and clofazimine are cured within 12 months.

Although the number of new cases of leprosy detected in Nigeria annually decreased from 5276 in 2004 to 3913 in 2010, Nigeria remains one of 17 countries reporting 1000 or more new cases of leprosy during 2010; these 17 countries account for 95 percent of the new cases detected worldwide during 2010 (http://www.who.int/wer/2011/wer8636.pdf).

Birnin Kebbi, a city located in northwestern Nigeria is the capital city of Kebbi State with an estimated population of 115 547 in 2007 (http://en.wikipedia.org/wiki/Birnin_Kebbi). Nigeria, with an estimated population of 170 123 740 in 2012, is the most populous country in Africa and the 7th most populous country in the world (http://en.wikipedia.org/wiki/Nigeria#Po ... jor_cities). It is located in West Africa on the Gulf of Guinea on the Atlantic Ocean with the Republic of Benin to the west, Chad and Cameroon to the east, and Niger to the north.

A map showing the location of Kebbi state can be accessed at http://www.firstbanknigeria.com/annualr ... -kebbi.gif. A HealthMap/ProMED-mail interactive map of Nigeria can be seen at http://healthmap.org/r/2lD7. - Mod.ML]

MALARIA - MADAGASCAR
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Date: Thu, 10 May 2012 18:12:08 +0200
Source: http://www.news24.com/Africa/News/Malar ... r-20120510


Malaria outbreak kills 7 in Madagascar
--------------------------------------
A particularly severe outbreak of malaria in Madagascar has killed 7 people since the beginning of the month [May 2012] and has left 60 others in need of hospitalisation, the country's health minister said on Thursday [10 May 2012].

Madagascar has seen an increase in the number of malaria cases in the 1st months of 2012 when compared with the previous year, government officials say.

Local doctors say the increase is likely a result of changing climate conditions, which have made the region more hospitable to the insects which carry the disease.

Moreover, the country suffered a coup in 2009 and Madagascar has been in a political stalemate ever since, despite regional efforts to reach an agreement between the military-backed rulers and the old regime now in exile.

The stalemate has caused foreign donors to back away from the country, which is also experiencing an economic decline as a result of the political situation. At the same time, its government is becoming less capable of delivering basic health services.

The outbreak has hit the south of the world's 4th largest island, located off southern Africa in the Indian Ocean.

Health Minister Johanita Ndahimananjara said there were enough supplies of medicine to care for the ill, but stressed that early detection and treatment were crucial to preventing the disease from causing the patient to die.

Malaria, a mosquito-borne parasitic disease that can be fatal, ravages many developing countries. Aid groups often hand out mosquito nets to help prevent people from getting bitten and contracting the disease. Owing to the poverty in Madagascar, many people depend on the hand-outs as they cannot afford to buy nets on their own.

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[According to the World Malaria Report 2011, Madagascar reported 215 110 microscopy positive malaria cases with 2986 hospitalizations and 173 deaths. It is conjectural that an increase is due to climate change, most probably the explanation is shortcomings in the control program as alluded to in the posting.

HealthMap location: http://healthmap.org/r/2msl. - Mod. EP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (17): AFRICA
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In this update:
Africa
[1] Cholera - Somalia
[2] Cholera - Ghana (Western Region)
[3] Cholera - Zimbabwe (Masvingo Province)

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[1] Cholera - Somalia
Date: Mon 21 May 2012
Source: Press TV [edited]
http://www.presstv.ir/detail/2012/05/21 ... n-somalia/


The United Nations humanitarian agency has warned of a cholera outbreak in the Somali capital, Mogadishu, and south central Somalia due to unhygienic living conditions, Press TV reports. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported a steady increase in suspected cholera cases from 9 Apr 2012 to 6 May 2012 in southern and central regions of Somalia. Banadir region in southern Somalia accounts for 49 percent of the 777 cases reported in this period, representing an 11 percent increase from the week before the end of April 2012.

OCHA says that although these figures do not suggest a major epidemic, there are serious concerns of an increased risk of a cholera outbreak in Banadir region and the Balcad and Afgooye corridors, where there is a high density of internally displaced persons (IDPs).

"Most of the cases are IDPs, because of lack of water," Wardhere Hassan of the American Refugee Council said.

Somalia remains one of the countries generating the highest numbers of refugees and internally displaced people in the world.

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[A ProMED-mail HealthMap for Somalia can be found at http://healthmap.org/r/1Ahv.]

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[2] Cholera - Ghana (Western Region)
Date: Sat 19 May 2012
Source: My Joy Online [edited]
http://edition.myjoyonline.com/pages/ne ... /86873.php


The Jomoro District Directorate of the Ghana Health Service has appealed to government, benevolent societies and philanthropists to help acquire the necessary drugs to deal with the outbreak of cholera at Elubo. Madam Shallot Dankwa, Acting District Director of Health, made the appeal at Half Assini on Friday [18 May 2012] when he addressed the newly formed District Cholera Outbreak Rapid Respond Team.

Madam Dankwa said cholera cases at the Elubo Health Centre increased from 33 cases on 12 May 2012 to 110 cases on 17 May 2012, adding that 2 persons have so far died. She said 20 of the cases were brought from the Ivorian side of the border, adding that the outbreak was due to the pollution of the Tano River that serves as the drinking water for the people along it.

Madam Dankwa said drugs and other items for the treatment of cholera have run out at the Half Assini, and a request sent to the Western Regional Central Store at Effia Nkwanta in Sekondi for drugs has yet to receive attention.

Meanwhile, the directorate has started an awareness programme at the affected communities on the need to ensure environmental cleanliness and also urged them to boil their water before drinking it.

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******
[3] Cholera - Zimbabwe (Masvingo Province)
Date: Thu 17 May 2012
Source: Voice of America [edited]
http://www.voanews.com/zimbabwe/news/He ... 28535.html


Officials in Masvingo province, southeastern Zimbabwe, have confirmed a fresh cholera outbreak in the sugar-producing town of Chiredzi which has killed 2 people since Mon 14 May 2012. About 100 cases have been recorded, and authorities are blaming the recurrence on serious water shortages.

The outbreak is particularly bad news for the town, which lost more than a dozen lives to the epidemic in 2011. Health officials have since deployed teams to administer treatment and assess the situation. Most people in Chiredzi rely on boreholes for drinking water, but many others use canal water meant to irrigate sugar cane plantations. Such water is highly susceptible to contamination.

Health officials said the fight to contain the disease is being hampered by serious food shortages in the area. Chiredzi Central lawmaker Moses Mare said the situation was tense as the population fears for the worst. He said the lack of properly working water purification pumps has heavily affected people in the area, as 2 pumps aren't functional, and the remaining pump has been stagnant.

Zimbabwe experienced a severe cholera outbreak beginning in 2008 that left at least 4293 dead by 2010. A deepening political and economic meltdown made it difficult for authorities to respond effectively.

[Byline: Obert Pepukai & Tatenda Gumbo]

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[A ProMED-mail HealthMap for Zimbabwe can be found at http://healthmap.org/r/1AY4.]

Meningococcal disease: situation in the African Meningitis Belt
24.05.2012 - WHO

From 1 January to 17 April 2012 (epidemiologic week 17), outbreaks of meningococcal disease have been reported in 42 districts in 10 of the 14 countries of the African Meningitis Belt 1. These outbreaks have been detected as part of the enhanced surveillance.

The 10 countries (Benin, Burkina Faso, Chad, Central African Republic, Côte d'Ivoire, Gambia, Ghana, Mali, Nigeria and Sudan) reported a total of 11 647 meningitis cases including 960 deaths resulting in a case fatality ratio of 8.2%. The outbreaks were mainly caused by the W135 serogroup of Neisseria meningitidis (Nm) bacteria.

In response to the outbreaks, the Ministries of Health implemented a series of preventive and control measures which included enhancement of surveillance, case management, sensitization of the population, strengthening of cross border collaboration and provision of vaccines through the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG).

The ICG released a total of 11 000 vials of antibiotic (Ceftriaxone) and 1 665 673 doses of vaccines to six countries (see table below 2) most affected by the epidemic, upon requests. The vaccines released include 919 023 doses of polysaccharide ACW/ACYW vaccine, 746 650 doses of meningitis A conjugate vaccine and 81 418 doses of polysaccharide AC vaccine.

The ICG is working with manufacturers and partners to ensure the stockpiles of the appropriate vaccines are maintained in sufficient quantities, for responding effectively to epidemics in the future. ICG partners include WHO, International Federation of Red Cross and Red Crescent Societies (IFRC), United Nations Children Fund (UNICEF), and Médecins Sans Frontières (MSF).

The emergency stockpile was established with the support of Global Alliance for Vaccines and Immunization (GAVI). The vaccination campaigns were conducted with the support of MSF, UNICEF, IFRC, the European Community Humanitarian Aid Office (ECHO), and the United Nations through its Central Emergency Response Fund (CERF).

WHO continues to monitor the epidemiological situation closely, in collaboration with partners and Ministries of Health in the affected countries.

1 The 14 countries in the African Meningitis Belt with enhanced surveillance for meningococcal disease include Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Côte d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Mali, Niger, Nigeria, Sudan and Togo.

Gruß
Birgitt

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (07): NODDING DISEASE
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Date: Thu 24 May 2012
Source: The Monitor [edited]
http://www.monitor.co.ug/News/National/ ... index.html


Nodding disease has been widely believed to affect children between 5 and 15 years old, but as cases are cited among adults, worry is rife that families who are unable to cater for their livelihoods will starve.

As the nodding disease syndrome previously notable among children takes its toll on adults, fears of a looming food shortage is rife among residents, who want the government to act fast and salvage livelihoods in Acholi-sub-region.

Nodding disease, which has, according to a WHO report, affected 7000 children, has subdued economic and domestic activities by parents, as most stay at home to take care of their sick children.

The situation is, however, more worrying now that cases of the disease are being cited among adults, with Kitgum Woman MP Beatrice Anwyar placing the figure at about 49.

A 40-year-old female resident of Tumangu village, Akwang Sub-county, Kitgum district has been suffering from nodding disease since 2009 and says that if the government does not provide for affected families, the situation will become more dire.

The HIV-positive mother, who lost her son in 2009 to nodding disease syndrome, says it has become impossible for her to look after her 5-year-old orphaned niece, also suffering from the ailment. "I cannot dig because I have no energy; it is just impossible. The government should provide food items to affected families," says the woman, who believes that nodding disease is contagious and says the government should isolate sick people from the community to avoid further spread and allow for special provisions for victims.

Ms Dorothy Akwero, a clinical officer in Palabek Gem, Pader district, recently put the number of adults affected by the nodding syndrome at 19 and expressed concern about how sick children will be attended to. She said it will be difficult for affected children to adhere to medication if their parents are affected.

A 63-year-old mother is another adult victim of nodding disease syndrome. The resident of Tumangu Ward, Akwang Sub-county says she started experiencing the symptoms 6 months ago. Although she says the medication she started taking a week ago has not had much impact on her health, her greatest worry is about how she will provide food to the 8 children under her care.

Dr Alex Layoo, the medical superintendent of Kitgum Hospital, says although cases of nodding disease in adults are being reported, no confirmation of the cases or the total number of people affected have been compiled.

"We don't know the complete behaviour of the disease, so we can't deny the problem in adults, he said on Saturday [19 May 2012] while speaking to a group of American researchers and a psychiatrist headed by MP Anywar.

Dr Layoo, however, agrees that the disease is affecting families immensely and emphasised the need for broad research to ascertain the cause and mode of spread of the disease.

"Do you expect a child [suffering from nodding disease] to grow up and continue with the family line," he wondered. "It is a big problem that is threatening the existence of families," he said of the nodding disease, which he called a medical insecurity.

[Byline: Harriet Anena]

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[The WHO press release on nodding disease from 21 May 2012 can be found at: http://www.afro.who.int/en/media-centre ... ganda.html.

The etiology of the syndrome is still elusive. The occurrence of adult cases does not help point to the cause of the syndrome. It is suggested in the article that the condition is contagious, but that adult cases appear sometimes in the same households as pediatric cases can just as well point to a common exposure.

Toxicological investigations and autopsy studies are still pending. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6.]

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (08): NODDING DISEASE, COMMENT
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Date: Sat, 26 May 2012
From: Deryck Read


Nodding Disease, Uganda: further data needed
---------------------------------
In several animal species, a clinical presentation of "head nodding" indicates cerebellar involvement. Is there any reason why routine histopathology of the brain, particularly of the cerebellum and related cerebral structures, has not yet been published by PubMed?

Results of such studies should be available within a few days of autopsy. This disease was reported months ago. To date, thousands of people have been afflicted.

Histopathology might quickly and cost-effectively rule in/out an infectious etiology or aquired cerebellar abiotrophy... and also provide a "raison d'etre" for ancillary testing for a possible etiology.

--
Deryck Read BVSc, PhD,
Diplomate, The American College of Veterinary Pathologists
Professor Emeritus
University of California-Davis


[ProMED-mail thanks Professor Deryck Read for his comment. We entirely agree. We have been asking for autopsy studies and more MR imaging studies including the brain stem.

Published and unpublished MR's have not been consistent, and some described as normal. Results from a few spinal taps describe the spinal fluid as macroscopical normal, but cell counts and protein analysis have not been performed to our knowledge. Also to our knowledge no post mortems have been performed and we agree with Professor Read, that this is urgently needed.

With a prevalence of up to 519 per 100 000 in Pader District, it is urgent to increase efforts to define the etiology in order to be able to control the outbreak prevent new outbreaks. HealthMap location: http://healthmap.org/r/2rUf. - Mod. EP]

RABIES- SOUTH AFRICA (03): (KWAZULU-NATAL)
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Date: Thu 7 Jun 2012
Source: IAfrica.com [edited]
http://news.iafrica.com/sa/799099.html


An Underberg farmer and top canoeist has been declared brain dead after contracting rabies from a stray dog, a family spokesman and doctor said on Thursday [7 Jun 2012] in Durban.

"We discovered through a SPECT scan on Wednesday [6 Jun 2012] that [he] was brain dead. His family will have to turn the machines off in the next few days," Dr Grant Lindsay said. The victim (29) has been in the ICU at a Pietermaritzburg hospital for about 5 weeks. "He contracted rabies from the saliva of a sick dog he had taken in and kept in his shed," Lindsay said.

125 rabies cases have been reported in KwaZulu-Natal since the beginning of the year [2012]. Two people have died as a result of the outbreak in the province.

KwaZulu-Natal agriculture and environmental affairs MEC Meshack Radebe launched the rabies campaign in the Royal Hotel in Durban on Thursday [7 Jun 2012]. The World Health Organization has donated R 16.5 million [about USD 2 million] to help fight rabies in the province. Manager of the Rabies Elimination Project, Kevin le Roux, said the money would contribute to the vaccination of about 600 000 animals a year. The department would roll out a vaccination programme aimed at vaccinating 70 per cent of animals in KwaZulu-Natal per year. Awareness campaigns in the media worth R one million [USD 119 240] would be used to encourage people to vaccinate their animals.

"The department of education has agreed to let children go home and collect pets on vaccination days in their communities. "I've suggested that there should be a way of marking all vaccinated dogs and cats, so if someone decides to play with a pet, they will at least know if it has been vaccinated," Radebe said.

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[This report records the final moments of a tragic story. The text of this report now implies, but does not implicitly state, that the victim was infected by contact with a rabid pet dog within KwaZulu-Natal before spending some time in Mozambique. Hopefully, the animal vaccination campaign in KwaZulu-Natal set in train by this unfortunate event will help to prevent a future recurrence. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1EPe.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (19): AFRICA
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In this update:

Africa
[1] Cholera - Ghana
[2] Cholera - Congo DR
[3] Cholera - Zimbabwe (Masvingo Province)

******

[1] Cholera - Ghana

Date: Fri 8 Jun 2012
Source: Spy Ghana [edited]
http://spyghana.com/health-news/health- ... -subsides/


Over 4000 cases and 64 deaths have been recorded nationwide following the cholera outbreak that hit the country during the 1st quarter of 2012, according to available statistics. The Accra metropolis is said to be leading with 2756 cases and 31 deaths.

Dr Simpson Anim Boateng, public health director of the Accra Metropolitan Assembly (AMA) told Daily Guide on Wed Jun 2012 that, although 2012's figures are far lower than 2011, the fatality rates are unacceptable and called for rapid a response to reported cases and the tidying up public places.

Currently health officials in Accra have announced a significant decline in the outbreak but say with the onset of the rains, there are fears of possible fresh outbreaks unless residents continue to adhere to strict personal and environmental hygienic practices.

He said if the sanitation situation in the city returns to a deplorable state, it may trigger a massive outbreak of cholera and even other water borne diseases, attributing the decline to swift public response to the assembly's by-laws on hygiene.

[byline: Stella Danso Addai]

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[A HealthMap/ProMED-mail interactive map of Ghana can be seen at http://healthmap.org/r/1oA-. - Mod.LL]

******

[2] Cholera - Congo DR
Date: Fri 8 Jun 2012
Source: AHN. Gant Daily, UN Integrated Regional Information Networks (IRIN) report [edited]
http://gantdaily.com/2012/06/08/drc-cho ... k-worsens/


A growing cholera outbreak in the Democratic Republic of Congo has claimed nearly 400 lives and affected more than 19 100 people since January 2012, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

"The total number of cholera cases in 2012 is around 90 per cent of cases reported in 2011. Since January 2011, 983 people have died from the outbreak affecting 8 of 11 provinces of the country," Yvon Edoumou, OCHA [UN Office for the Coordination of Humanitarian Affairs] spokesman, told a news conference.

Since the outbreak started, more than 40 795 cases have been reported. Edoumou said the growing epidemic had put a strain on ongoing humanitarian interventions funded mainly by a USD 9.1 million grant by the UN Central Emergency Response Fund, which provides rapid response grants for humanitarian emergencies.

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[A HealthMap/ProMED-mail interactive map of the Democratic Republic of the Congo can be seen at http://healthmap.org/r/1Ahy. - Mod.LL]

******

[3] Cholera - Zimbabwe (Masvingo Province)
Date: Thu 31 May 2012
Source: AllAfrica, The Herald report [edited]
http://allafrica.com/stories/201206010681.html


Government has declared the cholera outbreak reported in Chiredzi a national priority. This comes amid growing fears of a repeat of the 2008 epidemic, which killed over 4000 people countrywide. The director of Epidemiology and Disease Control in the Ministry of Health and Child Welfare, Dr Portia Manangazira, said a national response team was currently on the ground in Chiredzi.

"The permanent secretary urgently sent the national rapid response team and the provincial health executive of Masvingo to support the district health team on the ground since the outbreak has been declared a national priority.

"The outbreak has gone beyond the World Health Organisation benchmark of control due to the quality of water available to households, few functional toilets, and limited numbers of health workers to do both outbreak response and community health education," she said.

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