Aktuelle Epidemien in Afrika

[Birgitt]

Algerien - Tollwut
11.10.2010

Tierbisse sind ein großes und ernst zu nehmendes Gesundheitsrisiko in Algerien. Allein in der Stadt Setif werden täglich 17 Tierbisse bekannt; die meisten von Hunden, gefolgt von Katzen und Ratten. Ggf. Impfschutz beachten! / Quelle: crm

[Birgitt]

TROPICAL SPASTIC PARAPARESIS - ANGOLA: (LUNDA NORTE)
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Date: Wed 13 Oct 2010
Source: AllAfrica, Angola Press Agency (Angop) report [edited]
<http://allafrica.com/stories/201010130688.html>

Angola: possible illness hitting Caungula District revealed
-----------------------------------------------------------
The medical commission created by the Chancellery of the state run
Agostinho Neto University (UAN) suspects that the illness that has been
hitting Caungula District, in the eastern Lunda-Norte Province, is tropical
spastic paraparesis [TSP], ANGOP [Angola Press Agency] has learnt. This was
stated in a press conference by the dean of the Medicine Faculty with UAN
and coordinator of the mentioned commission, Miguel Bettencourt, who
travelled to the locality.

"In a clinical assessment made mainly in the villages of Monakaje and
Lukwokeza, at Caungula District, it was concluded that the disease tropical
spastic paraparesis (TSP), an illness that has already been reported in
Mozambique and in the Democratic Republic of the Congo (DRC). At this
moment, it is not possible to say what is the cause of this illness,
although there are indications that it is caused [either] by the bitter
manioc which contains cyanide, a chemical and toxic element, [or] HTLV
[human T-cell lymphotropic virus] infection."

The expert said that the illness is characterised by reduction of muscular
strength of the arms, marked by a rigidity of the legs, hindering thus the
movements. "This situation is worrying and with serious social and economic
results, particularly in Monacaje village, were 40 per cent of the cases
were recorded, among children and adults," he explained.

Samples of the bloods of patients, as well as of the manioc, have already
been sent to a laboratory in South Africa.

--
communicated by:
Thomas James Allen
<tjallen@pipeline.com>

[Tropical spastic paraparesis (TSP) predominantly affects the spinal cord,
resulting in an upper motor neuron syndrome, mostly affecting the lower
limbs. TSP results in inflammation, demyelination, and necrotic lesions in
the spinal cord. It is a progressive disease involving the degeneration of
neurons in the spinal cord, leading to a gradual paralysis of the lower limbs.

The cause of TSP was obscure until the mid-1980s, when an important
association was established between the human retrovirus -- human T-cell
lymphotropic virus type 1 (also known as HTLV-1) -- and TSP. TSP is now
called HTLV-1 associated myelopathy/tropical spastic paraparesis or
HAM/TSP. The HTLV-1 retrovirus is thought to cause at least 80 per cent of
the cases of HAM/TSP by impairing the immune system. In addition to
neurological symptoms of weakness and muscle stiffness or spasms, in rare
cases individuals with HAM/TSP also exhibit uveitis (inflammation of the
uveal tract of the eye), arthritis (inflammation of one or more joints),
pulmonary lymphocytic alveolitis (inflammation of the lung), polymyositis
(an inflammatory muscle disease), keratoconjunctivitis sicca (persistent
dryness of the cornea and conjunctiva), and infectious dermatitis
(inflammation of the skin). The other serious complication of HTLV-1
infection is the development of adult T-cell leukemia or lymphoma. Nervous
system and blood-related complications occur only in a very small
proportion of infected individuals, while most remain largely without
symptoms throughout their lives.

The HTLV-1 virus is transmitted person-to-person via infected cells:
breast-feeding by mothers who are seropositive (in other words, have high
levels of virus antibodies in their blood), sharing infected needles during
intravenous drug use, or having sexual relations with a seropositive
partner. Less than 2 per cent of HTLV-1 seropositive carriers will become
HAM/TSP patients. HAM/TSP is a progressive disease, but it is rarely fatal.
Most individuals live for several decades after the diagnosis. Their
prognosis improves if they take steps to prevent urinary tract infection
and skin sores, and if they participate in physical and occupational
therapy programs (see
<http://www.ninds.nih.gov/disorders/trop ... aresis.htm>).

Populations at risk include those in areas where the HTLV-1 virus is
endemic such as the Caribbean, equatorial Africa, South America, the
Seychelles, and southern Japan. It is estimated that 10-20 million people
worldwide are infected with HTLV-1.

In the case of the outbreak of illness in Caungula District, in the eastern
Lunda-Norte Province of Angola it is uncertain whether the outbreak can be
attributed to HTLV-1 infection or is a consequence of manioc poisoning.

Cassava [manioc] is the 3rd largest source of carbohydrates for human food
in the world. Cassava is classified as "sweet" or "bitter" depending on the
level of toxic cyanogenic glucosides; improper preparation of bitter
cassava causes a disease called konzo. Nevertheless, farmers often prefer
the bitter varieties because they deter pests, animals, and thieves. Konzo
is a paralytic disease among very poor rural populations whose diets for
the weeks and months prior to onset consist almost exclusively of roots of
bitter cassava.

The outcome of diagnostic testing in South Africa is awaited.

The provinces of Angola can be seen on the map at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf> and the
HealthMap/ProMED-mail interactive map of the country can be accessed at
<http://healthmap.org/r/0dn9>. - Mod.CP]

[Birgitt]

LEPTOSPIROSIS - ALGERIA: (SETIF)
********************************
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******
[1]
Date: Fri 15 Oct 2010
Source: ElWatan.com [in French, machine trans., edited]
<http://www.elwatan.com/regions/centre/a ... 66_221.php>


The town of El Eulma has been thrown into commotion following the death the
day before yesterday [13 Oct 2010] at the Hospital of Setif of a woman aged
52. She had been admitted as an emergency with her son after drinking
polluted water from a well in the mosque Ibn Okba Nafaa.

Since last Friday [8 Oct 2010], almost 26 people residing in the same city
who consumed the same water have been admitted as emergencies to hospital
in El Eulma. These people have suffered from abdominal pain, headache, and
vomiting. Prevention services have analysed water and found it to be
polluted with dead rats in an advanced state of decomposition. The
possibility of typhoid has been ruled out. Some sources have reported that
leptospirosis, a serious disease caused by germs from these animals, has
been diagnosed in all patients who are still under observation in hospital.
The well in question has been closed, and a major information and awareness
has been initiated by the prevention services to stem any possible spread
of the epidemic.

--
communicated by:
Viki Hansen-Landis, MPH, CHES
Senior Medical Communications Specialist
Medical Information and Analysis
International SOS
<viki.hansen@internationalsos.com>

******
[2]
Date: Thu 14 Oct 2010
Source: ElWatan.com [in French, trans. by Corr.SB, edited]
<http://afriquehebdo.com/14104168-epidem ... sees-setif>


A total of 3 people, including a child aged 7, have died during the last 48
hours, in the wilaya (province) of Setif, after having contracted
leptospirosis. This infectious disease has been transmitted by sewage from
a well located at the Okba Ibn Nafaa mosque, located in the city Bourefref,
south of the city of El-Eulma.

The dead are a woman aged 52 years, a mother of 8 children, her 22 year old
son, and another of her children, aged 7. In addition, 26 others have been
hospitalized since the beginning of the week, at the CHU (Centre
hospitalier universitaire) Saadna Abdenour, Setif. The hospital cases have
the same symptoms as the victims who died -- vomiting, diarrhea, and
stomach pain accompanied by bleeding. Tests carried out have confirmed the
cause to be leptospirosis, an infectious disease caused by bacteria, also
called "rat fever", whose transmission has occurred indirectly through
contaminated water from the well of the Okba Ibn Nafa mosque.

Residents of the city told us that the infiltration of rain water and the
presence of rats in the wells would be at the origin of this epidemic. This
situation has put the health and civil authorities on alert. Officials then
decided to close the well and reviewed the distribution system for drinking
water. Doxycycline [doxycycline is the standard oral antibiotic used to
treat uncomplicated infection that does not require hospitalization and is
also used for chemoprophylaxis of leptospirosis] was distributed to the
population of the region, which, it must be noted, has been living in fear
since the death of one of the victims of this epidemic. According to
medical sources, the duration of treatment is 10 to 15 days for routine
cases but 2 months of hospital treatment may be required in severe cases.

[byline: Faouzi Senoussaoui]

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

[Leptospirosis occurs worldwide usually as a result of contact with the
urine of animals chronically infected with one of the several hundred
serovars of the spirochete _Leptospira interrogans_. Rodents, dogs, cattle,
and pigs are the usual reservoirs for this organism. As in the current
Algerian outbreak, leptospirosis has previously been reported to be aused
by drinking contaminated well-water (see
<http://www.bt.cdc.gov/disasters/earthqu ... _brief.asp>,
and <http://www.nih.go.jp/JJID/LEC-128.html>. Most patients with
leptospirosis have a non-specific mild, flu-like illness. Some patients
develop severe disease with myocardial, pulmonary, renal, or hepatic
involvement. Multiorgan failure, thrombocytopenia, and bleeding (as
occurred in some patients in the current Algerian outbreak) may develop.
Severe infection may be fatal in 5-40 per cent of cases.

Because of the relatively nonspecific nature of the clinical presentation
of many infections, including leptospirosis, the diagnosis of leptospirosis
cannot be made confidently without laboratory confirmation. (See prior
ProMED posts: Leptospirosis, military personnel - Australia (QLD): not
20050329.0910 and Leptospirosis - Jamaica (02) 20071018.3409.) Although the
text is somewhat confusing, it seems that the diagnosis of leptospirosis
was confirmed by laboratory tests according to the 2nd news release above.

El Eula is a city in Algeria, located some 210 miles east of the capital
Algiers. It is the 2nd-largest city in Setif Province with a population of
105 130 (1998 census). (<http://en.wikipedia.org/wiki/El_Eulma>). The
HealthMap/ProMED-mail interactive map of Algeria can be accessed at
<http://healthmap.org/promed/index.php?n ... 1&v=28,3,5>.

[Birgitt]

INFLUENZA (08 ): ZIMBABWE
************************
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Date: Sun 17 Oct 2010
Source: Sunday Mail, Zimbabwe [abbreviated & edited]
<http://www.sundaymail.co.zw/inside.aspx ... 9199&cat=1>


A life-threatening flu bug with symptoms similar to those of the deadly
H1N1 virus [that is, the 2009 pandemic A (H1N1) influenza virus] has hit
all of the country's 10 provinces, affecting thousands of people.
Confirming the outbreak last week, Dr Portia Manangazira of the
Epidemiology and Disease Control Unit in the Ministry of Health and Child
Welfare said the flu [outbreak] might be a combination of H1N1 (swine flu)
and H3N2 (common cold flu) [i.e. seasonal influenza]. "There is a spread of
a combination of H1N1 and H3N2 countrywide, but cases of common cold flu
[seasonal influenza] are usually reported between May and September," she
said. She urged all those who show signs and symptoms of cold to seek
medication as soon as possible, as common cold [seasonal] flu can also be
deadly. "Those who show signs related to swine or common cold [seasonal]
flu should seek immediate medication, as the vaccine [medication?] can be
accessed countrywide," said Dr Manangazira [Vaccine does not protect after
symptoms have developed. - Mod.CP].

"We do not have laboratory samples, and we base our surveys on signs and
symptoms to give medication. We are still using the same drug oseltamivir,
which treats both swine and [seasonal] flu to treat this bug," she said.
The symptoms of the flu bug are runny nose, sneezing, sore throat which may
lead to loss of voice, reddening of the eyes, general body ache, loss of
appetite and headaches.

Meanwhile, a suspected outbreak of the deadly H1N1 influenza virus has been
detected in Tsholotsho district [Matabeleland North province] where a total
of 300 people -- mostly school-children -- have been affected. According to
officials, 2 of the 7 preliminary tests carried out at Tsholotsho District
Hospital on Friday [15 Oct 2010] have come out positive. In a telephone
interview on Friday, the district administrator for Tsholotsho District, Mr
Themba Moyo, who is also the chairperson of the District Civil Protection
Unit, said the suspected cases have been recorded in 8 wards in the
district. The affected areas include Mbamba, Malanda, Tshitawatsha,
Dlamini, Bemba, Magama School, Nhembe and Makhazi. "Yes, we have recorded
about 300 cases of the suspected virus [2009 A/(H1N1) influenza virus] in
about 8 wards so far. Most of the cases are schoolchildren. So far, the
hospital has carried out tests on 7 of these, and the preliminary findings
point towards a possible outbreak of the H1N1 influenza virus, as 2 have so
far come out positive," said Mr Moyo.

Mr Moyo said the district was appealing for assistance to contain the
outbreak. He said the district required vehicles, fuel, oxygen tanks among
other things. "We are appealing to non-governmental organisations to come
forward and assist in containing this outbreak. As a matter of urgency, we
require 2 vehicles, about 600 litres of fuel, oxygen tanks, NS fluids,"
said Mr Moyo. By midday yesterday [16 Oct 2010], NGOs had already
dispatched teams to the affected areas. The NGO's Plan International and
Medecins Sans Frontiers had already reached some of the affected areas.

Efforts to get a comment from the provincial administrator, Ms Latitso
Dlamini, were fruitless, as her mobile phone went unanswered. Dr
Manangazira, confirmed that they have received reports of the outbreak and
had already dispatched surveillance teams to the affected areas. "We are in
receipt of reports of a possible outbreak of swine flu. At the moment, the
department has dispatched teams to investigate the outbreak. We want to
take samples for testing," said Dr Manangazira. She said the outbreak
appears to be localised and expressed confidence that the teams will be
able to contain the outbreak.

Dr Manangazira said her department was yet to ascertain whether the
affected areas had been covered by the national programme of immunisation
against the virus, adding that the programme had in the period covering
July and August this year [2010] reached over a million people.

The disease control officer for Matabeleland North, Dr Efison Dlodlo, also
confirmed the outbreak. "We had 2 cases involving schoolchildren from
Magama School, who tested positive for influenza Type A. This is not swine
flu as yet, so we are in the process of carrying out further tests on those
samples to verify whether or not we have an outbreak of swine flu. He said
the teams investigating the outbreak were also giving out the
anti-influenza drug Tamiflu in those affected areas. He said the Ministry
of Health had adequate stocks of the drug.

According to the US Centres for Disease Control and Prevention (CDC), in
humans the symptoms of the 2009 "swine flu" (H1N1 virus) are similar to
those of influenza and of influenza-like illness in general. The 2009
outbreak has shown an increased percentage of patients reporting diarrhoea
and vomiting.

Last year [2009], the country was on high alert following a few recorded
cases of people who had contracted the virus outside Zimbabwe. The 1st case
was of an unidentified man who flew into the country from London, and the
2nd case was of a schoolboy who had gone to South Africa for a sports
tournament. These cases prompted a heightened medical alert countrywide for
swine flu, which was declared a global pandemic by the World Health
Organization (WHO).

[byline: Patience Rusare and Mduduzi Moyo]

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

[It is clear from this report that there is currently an outbreak of
influenza in all 10 provinces of Zimbabwe, in some situations (in
Tsholotsho district of Matabeleland North province) mainly affecting
children. However, in the absence of confirmatory laboratory diagnoses, the
identity of the influenza viruses involved is uncertain. The 2009 pandemic
(H1N1) virus and seasonal influenza A (H3N2) virus are suspected. However,
according to the WHO Global Surveillance Network, as of 26 Sep 2010, in
Africa influenza B viruses have been the most common (44 per cent) ,
followed by influenza A (H3) (31 per cent); see ProMED-mail archived
report: Influenza (07): USA & worldwide 20101007.3643. Precise information
is awaited.

A map of the provinces of Zimbabwe can be accessed at:
<http://www.mapsofworld.com/zimbabwe/zim ... l-map.html>. The
HealthMap/ProMED-mail interactive map of Zimbabwe is available at:
<http://healthmap.org/r/00aK>. - Mod.CP]

[Birgitt]

LASSA FEVER - SIERRA LEONE (03): (NORTHERN)
*******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 17 Oct 2010
From: Daniel Bausch <dbausch@tulane.edu>


re: Lassa fever -- Sierra Leone (02): (NO) 20101008.3662
--------------------------------------------------------
We are writing to provide further information regarding the recent postings
on Lassa fever in Sierra Leone:

1. The index case was a 17 year old pregnant woman who delivered at 28
weeks gestational age. Both she and the baby (not a 6 year old) died.
Although she and her family occasionally caught and consumed rodents, there
is no history of her running a "rat meat restaurant".

2. In all, there were 35 identified contacts of this woman and child, but
only 4 developed Lassa fever. All had direct contact with the index case or
secondary cases, and all 4 survived. We have not identified any more cases,
and, since the time from the last known contact of any of the confirmed
cases has now exceeded the 3-week maximum incubation period for Lassa
fever, we do not anticipate more cases related to this particular chain of
transmission.

3. Whether "the disease has migrated from the forest region of the east to
the savannah grasslands of the north" is a very open question. The index
case denied travel to the known endemic area in the east, but it is always
possible that the infection resulted from unrecognized contact from an
infected person coming from the east to her village in Bombali District.
Our zoology team is presently trapping rodents in the home and village of
the index case. Identification of Lassa virus-positive _Mastomys
natalensis_ would confirm the notion that the endemic area has expanded.
However, it should be noted that suspected cases of Lassa fever have been
reported from this area before, but laboratory facilities were not
available at the time to confirm them.

4. There has indeed been a significant increase in reported cases of Lassa
fever in Sierra Leone over the last 9 months or so. However, this
observation largely coincides with the implementation of Sierra Leone's new
policy of providing free care to children under 5 and pregnant and
lactating mothers (<http://news.bbc.co.uk/2/hi/8645968.stm>). The numbers
of patients seen in hospitals and health clinics sky-rocketed, driving
upward the perceived incidence of virtually every disease that affects
these groups, including Lassa fever. Whether the observed increase in cases
of Lassa fever is purely reflective of the change in policy or also has
concomitant biological determinants is unknown. It should also be noted
that, for reasons unknown, there is significant seasonal and yearly
fluctuation in the incidence of Lassa fever.

--
communicated by:
Foday Dafae, MD
National Disease Surveillance Coordinator, Sierra Leone
Ministry of Health and Sanitation
James Bangura
Lassa Fever Surveillance Coordinator, Eastern Province,
Sierra Leone Ministry of Health and Sanitation
Daniel Bausch, MD, MPH&TM
Director, Tulane University Research and Training Program in the Mano River
Union Countries of West Africa

[ProMED-mail thanks Daniel Bausch and colleagues for these valuable
first-hand observations on the Lassa fever situation in the Northern region
of Sierra Leone, and for correcting some aspects of the previous report.

The HealthMap/ProMED-mail interactive map of Sierra Leone is available at
<http://healthmap.org/r/0bj5>. - Mod.CP]

[Birgitt]

Nigeria - Darminfektionen
25.10.2010

Risiko für Durchfallerkrankungen landesweit. Ein Cholera-Ausbruch hat laut Regierungsangaben über 1.500 Todesopfer gefordert. Fast 40.000 Erkrankungen wurden in 15 der Bundesstaaten Nigerias registriert. Der Ausbruch ist noch nicht vorbei und breitet sich auch weiter aus. Auch die Hauptstadt ist betroffen. Schwere Überflutungen und die Vertreibung von großen Menschenmengen erschweren die Lage. Hygiene beachten, Impfung ist zu empfehlen. / Quelle: crm

[Birgitt]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (25)
************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Nigeria
[2] Cholera - Benin
[3] Cholera - Uganda (Nakapiripirit)
[4] Cholera - Cameroon (Douala)
[5] Cholera - Nigeria (Sokoto)
[6] Cholera - Central Africa: WHO
[7] Diarrhea - South Africa (Free State)

******
[1] Cholera - Nigeria
Date: Mon 25 Oct 2010
Source: The Washington Post, Associated Press (AP) report [edited]
<http://www.washingtonpost.com/wp-dyn/co ... 00657.html>


UN officials say Nigeria has seen more than 1500 deaths from cholera
in 2010, doubling the government's most recent fatality count.

Geneva-based UNICEF spokeswoman Marixie Mercado said Monday [25 Oct
2010] that as of 20 Oct 2010, there were 1555 deaths in Nigeria from
the waterborne disease, with 38 173 cases recorded in 2010 alone.

According to the WHO, the current outbreak is the worst in Nigeria
since 1991, when 7654 people died.

[Byline: John Gambrell]

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

[Maps of Nigeria are available at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/007*>. - Sr.Tech.Ed.MJ]

******
[2] Cholera - Benin
Date: Thu 21 Oct 2010
Source: AllAfrica, RFI report [edited]
<http://allafrica.com/stories/201010211031.html>


Two thirds of the African nation of Benin is underwater, with at
least 43 people killed and nearly 100 000 made homeless.

Heavy rain began falling at the start of October 2010, and the Oueme
and Mono rivers soon overflowed. Thousands of hectares of land,
mostly used for growing rice and other vegetables are now underwater.

The UN's children's fund, UNICEF, reports 800 cases of cholera and
warns of the risk of other waterborne diseases.

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

[Maps of Benin are available at
<http://www.izf.net/upload/Documentation ... /benin.png>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/016k>. - Sr.Tech.Ed.MJ]

******
[3] Cholera - Uganda (Nakapiripirit)
Date: Wed 20 Oct 2010
Source: The Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/News/National/ ... index.html>


To date, 7 people have died and about 20 others are admitted at
Bokora Health Centre IV and Nakapiripirit Health Centre II following
an outbreak of cholera. According to the District health officer, Dr
John Anguzo, the disease broke out in Nakapiripirit Town Council,
Nabunet, Lobulyo, Katanga, and Nangoronit parish 5 days ago.

In 2008, cholera hit districts of eastern Uganda killing about 33.

[Byline: David Mafabi]

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

[Maps of Uganda are available at
<http://www.reliefweb.int/rw/fullmaps_af ... penElement>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0ect>. - Sr.Tech.Ed.MJ]

******
[4] Cholera - Cameroon (Douala)
Date: Mon 18 Oct 2010
Source: La Nouvelle Expression [in French, machine trans., & summ., edited]
<http://www.lanouvelleexpression.info/in ... le&id=1953>


Cholera in epidemic proportions has been reported in the coastal
region. Health and administrative authorities have received reports
that 16 people have been found to be positive for cholera in the area
of New Bell Douala 2.

There are also 145 cases suspected in the district of Douala.

[Byline: Carole Yemelong]

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

[Maps of Cameroon are available at
<http://www.lib.utexas.edu/maps/africa/c ... _pol98.jpg>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0ecu>. - Sr.Tech.Ed.MJ]

******
[5] Cholera - Nigeria (Sokoto)
Date: Thu 21 Oct 2010
Source: Nigerian Tribune [edited]
<http://www.tribune.com.ng/index.php/new ... -in-sokoto>


An outbreak of cholera at Lugu village, in Wurno Local Government
Area of Sokoto State, has claimed 9 lives from 7 Oct 2010. Nigerian
Tribune reported on Wednesday [20 Oct 2010] that the deceased
included children and adults.

It was also confirmed that the victims were from the isolation camp
set up in the village by the Medicines Sans Frontiers and assisted by
health officials from the Wurno Local Government Area. A local
government health official overseeing the operations of the camp,
Mallam Sambo Idris, said so far 1185 cases had been recorded at the camp.

[Byline: Bello Gusau]

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

[Maps of Nigeria are available at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0ecv>. - Sr.Tech.Ed.MJ]

******
[6] Cholera - Central Africa: WHO
Date: Fri 8 Oct 2010
Source: WHO Global Alert and Response (GAR) Disease Outbreak News [edited]
<http://www.who.int/csr/don/2010_10_08/en/index.html>


The current wave of cholera outbreaks affecting Central Africa
started a few months ago. As of 3 Oct 2010, 40 468 cases and 1879
deaths have been reported in 4 countries (Cameroon, Chad, Niger, and
Nigeria). Seasonal factors, such as the rainy season with flooding,
as well as poor hygiene conditions and population movements in the
area contribute to this unusually high incidence of cholera.
Nevertheless this area known to be endemic for cholera is regularly
affected by small outbreaks.

Breakdown by country

Cameroon
--------
7869 cases including 515 deaths (case fatality rate CFR 6.5 percent)
have been reported in 6 regions (Centre, Extreme Nord, Littoral,
Nord, Ouest, Sud Ouest) between 6 May and 3 Oct 2010. The majority of
cases (97 percent) are reported from the Extreme Nord region.
Preventive and control measures are ongoing. A Cholera Command and
Control Centre has been set up in Maroua in the Extreme Nord region
by the Ministry of Health with the support from WHO as health cluster
lead and in close collaboration with other health and water and
sanitation partners.

Chad
----
2508 cases including 111 deaths (CFR 4.4 percent) are reported in 12
health districts in 6 regions between 13 Jul and 3 Oct 2010.
Prevention and control measures are being implemented by national
authorities with support from several partners (Medecins Sans
Frontieres (MSF), National Red Cross, Oxfam, The International Rescue
Committee (IRC), International Medical Corps (IMC), UNICEF, WHO).

Niger
-----
976 cases including 62 deaths (CFR 6.4 percent) have been reported in
Diffa, Maradi, Tahoua, and Zinder regions between 3 Jul and 1 Oct
2010. Preventive and control measures are ongoing.

Nigeria
-------
29 115 cases including 1191 deaths (CFR 4.1 percent) have been
reported between 4 Jan and 3 Oct 2010, in 144 LGAs [local government
areas] in 15 states including the Federal Capital Territory (FCT).
The outbreak is still ongoing and spreading to new geographical
areas. Severe flooding and displacement of large numbers of people
have occurred, aggravating the situation.

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

[The countries mentioned can be seen on the map at
<http://www.un.org/Depts/Cartographic/ma ... africa.pdf>. - Sr.Tech.Ed.MJ]

******
[7] Diarrhea - South Africa (Free State)
Date: Thu 21 Oct 2010
Source: Times Live, South African Press Association (SAPA) report [edited]
<http://www.timeslive.co.za/local/articl ... -Kroonstad>


The Free State health department expressed concern over the high
number of diarrhea cases experienced in the Moqhaka Local
Municipality. Provincial health spokesman Jabu Mbalula said a task
team was formed with the district municipality to address the
situation of water safety, which focused on the Kroonstad region.

"We got concerned after people complained and found as a result that
the municipality's water, which people are using, is not purified."
Mbalula said more than 300 diarrhea cases were recorded recently in
the Kroonstad, Steynsrus, and Viljoenskroon areas.

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

[The etiology or etiologies of the increased number of cases of
diarrhea related to contaminated water is not stated. - Mod.LL]

[Maps of South Africa are available at
<http://www.sa-venues.com/maps/south-afr ... vinces.htm>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0ecw>. - Sr.Tech.Ed.MJ]

[Birgitt]

CONJUNCTIVITIS - EGYPT NORTH
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 25 Oct 2010
Source: Manila Bulletin, Xinhua report [edited]
<http://www.mb.com.ph/articles/284048/ou ... orth-egypt>


Some areas of northern Egypt reported an outbreak of pinkeye
[conjunctival] infections with the number of cases close to 2000, the
official MENA news agency reported on Sun 24 Oct 2010. The number of
people infected with this viral conjunctivitis, known as pinkeye, has
risen to 1831, Egyptian Health Ministry spokesman Abdel-Rahman Shahin
said, according to the report.

As many as 1703 cases are found in Daqahliya, 92 in Port Said and 36
in Damietta, the report said, adding most of the cases are students,
with 1042 in Daqahliya, 40 in Port Said and 12 in Damietta.

Pinkeye, an inflammation of the conjunctiva, may make the eyes
extremely red and can spread quickly, which usually causes no
long-term eye or vision damage.

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

[Conjunctivitis is an inflammation of the thin layer (conjunctiva)
that lines the inside of the eyelid and covers the white part of the
eye. Inflammation can cause blood vessels in the eye to become
larger, and that can make the white of the eye look pink or red.
Conjunctivitis is a common health condition worldwide. The 3 most
common types of conjunctivitis are viral, bacterial, and allergic.
Currently, outbreaks are occurring throughout the world (see
ProMED-mail references below).

ProMED-mail does not routinely report outbreaks of conjunctivitis
where there has been no identification of the etiologic agent. This
particular outbreak is reported because it embraces 3 contiguous
coastal governorates in the Nile Delta region of Egypt and is being
attributed to virus infection, although the species of virus is not
stated. Precise information would be appreciated, if available.

Daqahliya, Port Said and Damietta can be located at 7, 19 and 8
respectively in the map of the governorates of Egypt at:
<http://wapedia.mobi/en/Governorates_of_Egypt#1>. The
HealthMap/ProMED-mail interactive map of Egypt can be accessed at
<http://healthmap.org/r/03Jb>. - Mod.CP]

[Birgitt]

Ägypten - Bindehautentzündung (Konjunktivitis)
29.10.2010

In der Nildelta-Region wird ein Konjunktivitis-Ausbruch mit fast 2.000 Fällen gemeldet. Kontakte mit Erkrankten und gemeinsame Benutzung von Gegenständen (z.B. Handtüchern) meiden. Hygiene beachten, bei Auftreten von Symptomen sofort Arzt aufsuchen. / Quelle: crm
______________________

Benin - Darminfektionen
29.10.2010

Risiko für Durchfallerkrankungen landesweit. Ende Oktober berichtete UNICEF von einem Cholera-Ausbruch mit bisher über 800 Erkrankten. Aufgrund starker Regenfälle sind derzeit etwa zwei Drittel des Landes überflutet. Nach einer Pause von vier Jahren kam es 2008 erstmals wieder zu 6 Fällen von importierter Polio. 2009 waren es 21 Erkrankungen. Hygiene und Impfschutz für Polio und ggf. Cholera beachten. / Quelle: crm
_______________________

Südafrika - Durchfallerkrankungen
29.10.2010

Aufgrund von verunreinigtem Trinkwasser kam es in der Region um Kroonstad (Zentral-Südafrika) zu über 300 Fällen von Durchfall. Hygiene beachten. / Quelle: crm
_______________________

Uganda - Darminfektionen
29.10.2010

Risiko für Durchfallerkrankungen landesweit. Im Osten des Landes kam es Mitte Oktober zu einem Ausbruch der Cholera, bei dem bisher 7 Menschen gestorben und 20 weitere im Krankenhaus sind. Hygiene beachten und ggf. Impfung. / Quelle: crm

[Birgitt]

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

In this update:
Africa
[1] Cholera - Zambia (Southern)
[2] Cholera - Chad
[3] Cholera - Nigeria (Government statistics)
[4] Cholera - Nigeria (Bauchi)
[5] Cholera - Cameroon
[6] Cholera - Benin


******
[1] Cholera - Zambia (Southern)
Date: Mon 1 Nov 2010
Source: The Post [summ., edited]
<http://www.postzambia.com/post-read_art ... leId=15115>


Confirming the deaths of 2 children from suspected cholera in Monze,
district medical officer Dr Kenneth Chibwe said that 14 people were
admitted to Chikuni Mission Hospital for suspected cholera on Tuesday
[26 Oct 2010].

Dr Chibwe said 12 were still admitted to Chikuni Mission Hospital for
diarrhea and vomiting and were receiving treatment, adding that 2 out
of the 14 had died.

[Byline: Edwin Mbulo, George Zulu]

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

[An administrative map of Zambia can be seen at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. Monze
District is located in the Southern province. The
HealthMap/ProMED-mail interactive map of Zambia is available at
<http://healthmap.org/r/0eVa>. Sr.Tech.Ed.MJ]

******
[2] Cholera - Chad
Date: Thu 28 Oct 2010
Source: Thomson Reuters Foundation AlertNet [summ., edited]
<http://www.alertnet.org/db/an_art/58388 ... 5840-1.htm>


Chad began providing relief this week to 3200 families who fled their
homes when River Chari burst its banks, raising fears a cholera
outbreak would spread as floodwaters inundate neighborhoods in the
capital. Experts fear the river, which burst its banks earlier this
month [October 2010], could breach its banks again and flood bigger
areas of the capital N'Djamena, home to about 800 000 inhabitants.

The UN Children's Agency (UNICEF) has warned that a cholera outbreak
that has infected about 4000 people and killed at least 135 across
Chad, may deepen as floodwaters sweep contaminated water from
latrines into wells.

[Byline: George Fominyen]

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

[Maps of Chad are available at
<http://www.un.org/Depts/Cartographic/ma ... e/chad.pdf> and the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0eVd>. - Sr.Tech.Ed.MJ]

******
[3] Cholera - Nigeria (Government statistics)
Date: Thu 28 Oct 2010
Source: Nigerian Bulletin [summ., edited]
<http://nigerianbulletin.com/2010/10/28/20959/>


Contrary to a widely published United Nations (UN) report that put
the cholera cases and death tolls in Nigeria at 38 173 and above 1500
respectively, the Federal Ministry of Health (FMOH) has said that the
country had 37 289 cholera cases and 1434 deaths between 1 Jan 2010
and 25 Oct 2010.

Chief epidemiologist FMOH, Dr Henry Akpan, told The Guardian: "We
base our figures from reports we get from the states and our partners
who are working in the states. We do not base our figures on
newspaper reports."

[Byline: Bunmi Awolusi]

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

******
[4] Cholera - Nigeria (Bauchi)
Date: Tue 26 Oct 2010
Source: AllAfrica, Daily Trust report [edited]
<http://allafrica.com/stories/201010260602.html>


The Bauchi State government says 100 persons died as a result of a
cholera epidemic in the state in the last 3 months. The commissioner
for health Alhaji Muhammad Yahaya Jalam told newsmen in Bauchi on 25
Oct 2010 only a few patients were still in hospital unlike in the
past when between 50 and 100 patients were admitted in one day,
saying over 11 220 cases were recorded all over the state out of
which 100 died.

Yahaya Jalam said the situation reduced due to measures put in place
by the state government in collaboration with the Doctors Without
Borders (Medecins san Frontieres) adding that part of the measures
was the chlorination of over 6000 wells in all parts of the state
while the health team works 24 hours to control the spread.

[Byline: Ahmed Mohammed]

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

[A map showing the states in Nigeria can be seen at
<http://en.wikipedia.org/wiki/States_of_Nigeria>. The
HealthMap/ProMED mail interactive map of the country can be accessed
at <http://healthmap.org/r/01MI>. - Sr.Tech.Ed.MJ]

******
[5] Cholera - Cameroon
Date: Tue 26 Oct 2010
Source: Hindustan Times, Indo-Asian News Service (IANS) report [edited]
<http://www.hindustantimes.com/Cholera-k ... 17924.aspx>


A cholera epidemic in Cameroon since April 2010 has led to the death
of 559 people, the country's health minister has said. The disease
has affected a total of 8528 people, health minister Andre Mama Fouda
said on Mon 25 Oct 2010. The North Rim area suffered the most, with
8227 cases and 542 deaths, followed by the Northern region with 261
cases and 10 deaths, Littoral region with 173 cases and 5 deaths and
the Centre with 27 cases and 2 deaths, Prensa Latina reported.

Dirty water consumption was the main cause of the epidemic, according
to a research conducted by the Shepherd Center in collaboration with
the health ministry.

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

A map showing the regions of Cameroon can be seen at
<http://www.lib.utexas.edu/maps/africa/c ... _pol98.jpg>. The
HealthMap/ProMED mail interactive map of Cameroon can be accessed at
<http://healthmap.org/r/05Xt>. - Sr.Tech.Ed.MJ]

******
[6] Cholera - Benin
Date: Tue 26 Oct 2010
Source: Irish Times [summ., edited]
<http://www.irishtimes.com/newspaper/wor ... 04302.html>


Benin is at risk of a major cholera outbreak, an international aid
agency warned yesterday [25 Oct 2010], as the West African nation
reeled from its worst flooding since 1963. 55 000 homes have been
destroyed or damaged, and 250 000 people left homeless by the
flooding, leaving many susceptible to the water borne disease, said
Care International.

"The latrines are flooded, so people are bathing, cooking, and
drinking with water that has human waste in it," Helen Hawkins, a
water and sanitation specialist with Care in Benin told The Irish Times.

"Some people have obviously stayed in their homes to protect their
belongings but that means they are living in flooded homes surrounded
by water. So there is quite a risk of a possible outbreak." So far,
846 cases of cholera and 7 deaths from the disease have been recorded.

[Byline: Jody Clarke]

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

[Maps of Benin are available at
<http://www.izf.net/upload/Documentation ... /benin.png>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/016k>. - Sr.Tech.Ed.MJ]

[Birgitt]

UNDIAGNOSED PARALYTIC ILLNESS - REPUBLIC OF
CONGO: (POINTE-NOIRE), REQUEST FOR INFORMATION
******************************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 2 Nov 2010
Source: Casafree [Trans. by Mod.MPP, edited]
<http://www.casafree.com/modules/news/ar ... ryid=52171>


Congo: 8 dead in Pointe-Noire in an epidemic related to poliomyelitis
---------------------------------------------------------------------
An epidemic similar to poliomyelitis has been
raging in Pointe-Noire, the principal economic
and industrial center of the Congo, for nearly 2
weeks. There are already 8 deaths and 20 cases
reported, the Congolese Ministry of Health announced on Tuesday [2 Nov 2010].

"Patients have been admitted to hospitals with
symptoms of an influenza-like illness. They also
have paralysis starting with the legs and
[ascending] to the upper extremities." said the
Director General [DG] of Health, Professor Alexis Elira Dockekias.

"This epidemic is very similar to poliomyelitis
which has raged [in the past] with the difference
that this time the disease is affecting teenagers
and adults, unlike polio, which mainly affects
young children," said Professor Elira Dockekias.

According to the DG of Health, the disease is
probably caused by a virus that invades the digestive tract.

The Congolese Ministry of Health has already
notified the World Health Organization (WHO), in
accordance with the provisions concerning
international health epidemics [this probably
refers to the International Health Regulations (IHR)].

However, Professor Elira Dockekias urged the
public not to panic but to observe basic hygiene
measures in consuming only potable water.

"Water must be boiled before consumption; one can
also use the products recommended by health
services to citizens," said the DG of Health.

Due to the lack of potable water in some
districts of Pointe-Noire, especially in the
periphery [outside of the center of town], people
can consume water from wells and some poorly
maintained boreholes that, during the rainy
season, serve as homes for multiplication of many
parasites, bacteria and viruses that cause epidemics.

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

[The brief description of the disease sounds like
an ascending paralysis that is often seen with
Guillain-Barre syndrome (GBS) -- an autoimmune
disease with an inflammatory demyelination of
peripheral nerves. GBS often follows a
respiratory or gastrointestinal illness (notably
following campylobacteriosis -- see ref. 2
below). The illness presents with a subacute
onset of progressive and symmetrical weakness in
the legs and arms, with loss of reflexes. Sensory
abnormalities are seen as well as involvement of
cranial nerves, and paralysis of respiratory
muscles also can occur. In areas with good
supportive care, there is low case fatality rate.

Some notable distinctions between GBS and polio
include the observation that 90 percent of those
with paralytic disease related to poliovirus
infection have residual paralysis, whereas
approximately 90 percent of those with GBS have
complete recovery from their paralysis. Another
distinction is that the neurologic disease seen
with poliovirus infection involves pure motor
deficit with sensory sparing, whereas GBS
typically has significant sensory deficits along with the motor impairment.

GBS has also been associated with organophosphate poisoning (see ref. 1 below).

The newswire does not give further details on the
clinical picture to know if the paralysis is
flaccid or spastic, the latter having been
associated with a disease known as konzo, related
to cyanide toxicity from cassava (see ref.4 below).

There have been cases of paralytic disease
similar to that seen with poliomyelitis
associated with infection with enterovirus 71
(see ref. 6), and a report of a polio like
paralysis with Echovirus 7 infection (see ref. 5).

As Pointe-Noire is a coastal city, the
possibility of exposure to a neurotoxin in
seafood such as seen in paralytic shellfish
poisoning or tetrodotoxin is also there,
especially with the description of the outbreak
as "raging", suggesting an acute process.

That being said, the most common etiology of an
outbreak of a poliomyelitis-like illness is
infection with wild poliovirus (WPV). The
observation that the majority of cases are in
teenagers and adults may well represent the
accumulation of pockets of susceptibles at older
ages following the interruption of WPV
transmission in the area due to intensive
National Immunization Days through the years of
the polio eradication efforts. The last reported
cases of WPV associated polio reported in the
Congo were in 2000 (WPV1 date of onset 29 Sep
2000 and WPV3 date of onset 28 Nov 2000 -- see
<http://www.polioeradication.org/Dataand ... slist.aspx>).

What is unusual here is the reported CFR of
approximately either 28.6 percent or 40 percent
(the article is unclear if the 8 deaths were
included in the count of 20 cases or if they were
in addition to the 20 cases mentioned)... -- very high for both polio and GBS.

On checking the ProMED-mail archives, in 2006
there was a report of 7 fatalities and an
additional 24 individuals hospitalized in
Maranhao Brazil with an undiagnosed paralytic
illness (see Undiagnosed neurologic syndrome,
deaths - Brazil (Maranhao): RFI
20060622.1727). (This was the heralding event
for an investigation that identified a large
outbreak of beriberi -- thiamine deficiency -- in
the state of Maranhao, related to
citreoviridin-producing _Penicillum citreonigrun_
grow in the rice stored in the affected region -- see ref 7 below)

Clearly more information from knowledgeable
sources on the clinical presentation of cases,
incubation period, along with information from
laboratory studies would be very much appreciated.

For a map of the Republic of Congo showing
Pointe-Noire, see
<http://www.ecoi.net/file_upload/dh935_01460con.gif>.
Pointe-Noire is located on the Atlantic
Coast. For the interactive HealthMap/ProMED map
of the Republic of the Congo, see <http://healthmap.org/r/0f0G>.

References:
1: London L, Bourne D, Sayed R, Eastman R.
Guillain-Barre syndrome in a rural farming
district in South Africa: a possible relationship
to environmental organophosphate exposure. Arch
Environ Health. 2004 Nov;59(11):575-80. [Abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/16599005>]

2: Wierzba TF, Abdel-Messih IA, Gharib B, Baqar
S, Hendaui A, Khalil I, Omar TA, Khayat HE,
Putnam SD, Sanders JW, Ng LK, Price LJ, Scott DA,
Frenck RR. Campylobacter infection as a trigger
for Guillain-Barre syndrome in Egypt. PLoS One.
2008;3(11):e3674. Epub 2008 Nov 12. [Full test
available at
<http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed>]

3: Millogo A, Sawadogo A, Lankoandé D, Sawadogo
AB. [Guillain-Barre syndrome in HIV-infected
patients at Bobo-Dioulasso Hospital (Burkina
Faso)]. Rev Neurol (Paris). 2004 May;160(5 Pt
1):559-62. [abstract available at:
<http://www.ncbi.nlm.nih.gov/pubmed/15269674>]

4: Mbelesso P, Yogo ML, Yangatimbi E,
Paul-Sénékian V, Nali NM, Preux PM.[Outbreak of
konzo disease in health region No. 2 of the
Central African Republic]. Rev Neurol (Paris).
2009 May;165(5):466-70. Epub 2008 Dec 10.
[Abstract in English available at <http://www.ncbi.nlm.nih.gov/pubmed/19081587>

5: Rakoto-Andrianarivelo M, Raobijaona H,
Razanamparany M. [Pseudo-poliomyelitis paralysis
caused by Echovirus 7]. Arch Inst Pasteur
Madagascar. 2000;66(1-2):55-7. [Abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/12463037>]

6: Huang CC, Liu CC, Chang YC, Chen CY, Wang ST,
Yeh TF. Neurologic complications in children with
enterovirus 71 infection. N Engl J Med. 1999 Sep
23;341(13):936-42. [Full article available at:
<http://www.nejm.org/doi/full/10.1056/NE ... 9233411302>

7: Lima HC, Porto EA, Marins JR, Alves RM,
Machado RR, Braga KN, de Paiva FB, Carmo GM,
Silva e Santelli AC, Sobel J. Outbreak of
beriberi in the state of Maranhão, Brazil:
revisiting the mycotoxin aetiologic hypothesis.
Trop Doct. 2010 Apr;40(2):95-7. [Full article
available at:
<http://td.rsmjournals.com/cgi/content/f ... type=HWCIT>

- Mod.MPP]

[Birgitt]

UNDIAGNOSED FATALITIES - MAURITANIA: (ADRAR) REQUEST FOR INFORMATION
************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Wed 3 Nov 2010
Source: FluTrackers, CRIDEM (Carrefour de la Republique Islamique de
Mauritanie) report [in French, trans. Mod.MPP, edited]
<http://www.cridem.org/C_Info.php?article=48945>


Adrar Health: the unknown fever in Amogjar continues to kill
----------------------------------------------------------
A 3rd victim died this morning [3 Nov 2010]. He was the brother of
the 2 sisters who died the day before yesterday [1 Nov 2010] from a
particular fever.

After registration of the of new cases, who arrived yesterday [2 Nov
2010] and this morning [3 Nov 2010] at the hospital in Atar, which is
near the DRASS [Regional Directorate for Health and Social Action],
the Regional Health Director himself, went immediately to the
location of the drama.

This fatal fever, which is characterized by joint pain, vomiting, and
elevated temperature, suddenly raged on Sunday [31 Oct 2010] in an
encampment near Amogjar.

Despite an autopsy done on one of the girls who died on the 1st day
and examination of other victims, the doctors are dumbfounded by this
disease, which they have not as yet identified. The population of
Atar has begun to worry.

[Byline: Ely Salem Khayari]

--
Communicated by:
Andrew S.
Philadelphia, USA
<mathleteowl@aol.com>
and
FluTrackers
<flutrackers@earthlink.net>

******
[2]
Date: Tue 2 Nov 2010
Source: FluTrackers, Le Quotidien de Nouakchott report [in French,
trans. Mod.MPP, edited]
<http://www.quotidien-nouakchott.com/dec ... ysterieuse>


Deaths of 2 women in Adrar, following a mysterious illness
----------------------------------------------------------
The correspondent of the AMI [Mauritanian Information Agency], in the
wilaya [region] of Adrar, quoting several sources in agreement,
reported on the deaths of 2 women following an unknown illness, which
occurred 2 days ago [1 Nov 2010] in Agjett, a locality belonging to
the Tawaz commune (45 km [28 mi] to the east of Atar town).

The correspondent also indicated that 2 members of the same family
are still under medical supervision in hospital in Atar, stating that
their health has improved, according to the treating doctor.

The deaths of the 2 women coincided with the death of camels in the
same area. The veterinary services of the province could not, so far,
determine the cause of these strange deaths.

Some citizens expressed concern that these deaths are due to
consumption of contaminated meat.

Such a hypothesis however has been rejected by the local authorities
who have stated that this may be malaria affecting individuals who
are physically weak, noting that neighbors of the victims who ate the
same meat, are healthy.

The authorities also noted that the women died a week after consuming
the "suspicious" meat.

According to a report by a veterinary mission that visited the
affected site in recent days, "no general symptom has occurred in the
animals" in this region.

The report concluded that it is impossible to confirm the existence
of a disease, without the detection of specific symptoms and
conducting tests on samples taken from animals exhibiting these signs.

These same services have also mentioned cases of deaths in camels in
other moughataas [departments] of the region, which they believe
requires intensified surveillance measures against the contagious
animal diseases.

The correspondent of the AMI in the region also reported that the
Wali [governor] of Adrar, Mr Saidou Sall, in a statement made Monday
[1 Nov 2010] in Atar, indicated "that the victims died after
suffering from fever and muscle pain."

The governor has also vigorously denied the news relayed by some
sites claiming that the cause of the deaths was food poisoning
resulting from the consumption of meat from camels affected by a
rapidly spreading epidemic in that region, stating that "to speak of
the existence of such a pandemic in animals is baseless."

The governor concluded by saying that, "to talk of the deaths of 40
camels is totally false, because the veterinary mission that was
dispatched to the area, has only found the corpse of only one camel."

--
Communicated by:
Andrew S.
Philadelphia, USA
<mathleteowl@aol.com>
and
FluTrackers
<flutrackers@earthlink.net>

[The 2 newswires above mention that the clinical presentation of
these cases has been one of high fever, arthralgia (joint pains), and
vomiting. Locally, there are numerous hypotheses being proposed for
the possible etiology of these deaths and illnesses, including
malaria, and an association with the consumption of camel meat, with
rumors that there may have been a camel die-off in the area where the
fatalities resided. As with many as yet undiagnosed outbreaks
associated with high fatalities, newswire reports often present
conflicting pieces of information reflecting a level of panic and
concern among the population and a health sector that is trying to
reassure the population. This appears to be the case where there are
rumors of a camel die-off, consumption of camel meat that is
suspected to be contaminated, and results of a field trip that
theoretically identified only one camel death in the area.

Just looking at the reported symptoms, high fever, arthralgia, and
vomiting, with an observed high case fatality rate, the differential
diagnosis would be a lengthy list of diseases including those of
viral, bacterial, and parasitic etiologies, and including diseases
that are known zoonotic as well as those not known to be zoonotic.

The rumors surrounding a possible concurrent camel die off in the
area combined with a history of consumption of camel meat increases
the temptation to put known zoonotic diseases higher on the
differential diagnosis (this presumes a probable contact with the raw
meat and blood of animals who may have been infected with viral
agents such as Crimean-Congo hemorrhagic fever and Rift Valley
fever). But it is possible that these cases are not related to
possible diseases in the camels in the area.

It should be noted that the Adrar region (province) of Mauritania is
in the Saharan desert (the majority of the country is located in
desert and semiarid regions), with migratory populations that live in
encampments near water sources. From the above given information, it
sounds as though this outbreak is occurring in one such encampment.
While rain is scarce in this region, sudden deluges do occur. Keeping
that in mind, another disease that comes to mind with the
presentation of arthralgias, vomiting, and fever is leptospirosis.

One can keep discussing the factors in favor of one or more of the
possible etiologic agents, but at this point it seems prudent to
await further information from knowledgeable sources in the region on
results of laboratory studies conducted on the hospitalized cases.

For a map of Mauritania with regions, see
<http://www.bestcountryreports.com/zoomi ... RMaur_Pol2>.
The location of Amogjar can be seen on the interactive
HealthMap/ProMED map at <http://healthmap.org/r/0f1j>. - Mod.MPP]
...................................mpp/arn/cp/mj/mpp

[Birgitt]

UNDIAGNOSED ILLNESS, SCHOOLCHILDREN - NAMIBIA: (KARAS), REQUEST FOR INFORMATION
*******************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 3 Nov 2010
Source: The Namibian, relayed by allAfrica.com [edited]
<http://allafrica.com/stories/201011050199.html>


Unidentified Virus Infection Hits Karas Region in Namibia
---------------------------------------------------------
A total of 90 people, most of them schoolchildren, have been treated
at the Keetmanshoop State Hospital for a yet unidentified virus
infection. The patients complained of headaches, runny noses, sore
throats, fever and coughing, according to Keetmanshoop primary health
supervisor Rauna Namukwambi.

Namukwambi said health officials had taken 6 samples to test whether
it is H1N1 [influenza] virus infection, but only one of the results
has been received and it was negative. "We're still waiting for the
outcome of the remaining samples," she said. Namukwambi said the
affected people, of whom 6 were admitted to the hospital for one-day
close observation, were given medical treatment according to their symptoms.

She urged the public not to panic, adding that the situation is under
control. Namukwambi advised that people should take care of basic
hygiene such as washing hands to avoid any virus infection,

Similar cases were reported at Bethanie, Berseba and Aroab.
Namukwambi said health officials will visit all schools in and around
Keetmanshoop to treat ill children.

[Byline: Luqman Cloete]

--
Communicated by:
FluTrackers
<flutrackers@earthlink.net>

[This outbreak of undiagnosed illness among schoolchildren in the
Karas region of Namibia does not correspond to any of the infections
reported during the past year in Namibia (see the ProMED-mail see
also list, below). The illnesses are assumed to be virus infections
and appear to be relatively mild, short-lived and non-specific. Any
of a variety of childhood infections could be responsible. Influenza
virus infection has been suspected, but (the pandemic) H1N1-type
virus has been excluded. Further information is awaited.

The map of Namibia at
<http://en.wikipedia.org/wiki/File:Namib ... lFinal.jpg> shows the
location of Keetmanshoop in the southern Karas region of Namibia. The
HealthMap/ProMED-mail interactive map of Namibia can be accessed at:
<http://healthmap.org/r/009K>. - Mod.CP]

[Birgitt]

MALARIA - SENEGAL: (DAKAR)
************************
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 5 Nov 2010
Source: Le Soleil [In French, trans. Corr.SB, edited]
<http://www.lesoleil.sn/article.php3?id_article=65102>


Resurgence of malaria in the suburbs of Dakar
---------------------------------------------
At the end of winter, malaria is reappearing in certain districts of
the suburbs of Dakar. At the health center, Dominic Pikine, 13 813
cases were recorded between July and October 2010. This disease is at
the top for consultation in this center.

According to the head doctor, Dr. Dia Marieme Ndiaye, at the Dominic
Pikine health center, although many people sleep under a mosquito
net, they spend a lot of time outdoors during the night, when the
mosquito that transmits the disease starts to bite at 1 o'clock in
the morning. Yesterday [4 Nov 2010], she received a team of French
and Senegalese journalists, as part of a field trip organized by the
National Programme to Fight Against and the Roll Back Malaria.

Dr. Ndiaye has explained that the period from July to October, 50
percent of suspected cases of malaria were recorded positive. Of the
patients 87 percent are aged 5 years or more, 11 percent under 5
years, and 1.25 percent are pregnant women. However, no deaths have
been noted. All patients were treated on the spot, because drugs are
available in quantity.

After Dominique, the journalists visited the health post at Deggo, a
few kilometers from here. Patients are lying on the ground because of
severe pain. A young patient suffers fever like other patients, along
with his mother, who get an annoyed glance from the health post chief
nurse, Ms Fatou Ndiaye Koba. The nurse seems overwhelmed, but takes
time to watch everyone.

"We welcome more than 250 patients per day, whereas we are only 2
nurses. We're really overwhelmed," she says. More than 50 percent of
patients suffer from malaria. "Every month we receive 6000 patients
with more than 2000 suffering from malaria. We are overwhelmed by
this disease at the end of winter," said Ndiaye.

[Byline: Eugene Kaly, Le Soleil]

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

[Malaria is endemic in the southern parts of Senegal, but so far the
prevalence in Dakar has been regarded as low. The increasing number
of cases are in contrast to a recent study using satellite mapping of
Dakar, which concluded that "the results indicated there are benefits
of urbanization in Dakar, since the proportion of the low risk
population increased while urbanization progressed" (Machault V et
al. Malar J. 2010 Sep 3;9:252).

Another recent study from Dakar found that severe malaria was found
as much in adults and in children, showing that transmission in Dakar
is not high enough to induce clinical immunity (Bob et al. PLoS One.
2010 Mar 23;5(3):e9817). A 3rd study found that "malaria transmission
was highly focal in Dakar" and the The Human Biting Rate ranged from
0.1 bites per person per night in Yoff Village to 43.7 in Almadies
(Machault V et al. Malar J. 2009 Jun 24;8:138). - Mod.EP]

[The interactive HealthMap/ProMED map for Senegal is available at:
<http://healthmap.org/r/00-e> - CopyEd.EJP]

[Birgitt]

TUNGA PENETRANS - UGANDA: REQUEST FOR INFORMATION
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 22 Oct 2010 [delayed access to report]
Source: The Associated Press [edited]
<http://www.msnbc.msn.com/id/39796049/ns ... s_diseases>


Jiggers blamed for epidemic which has killed at least 20
--------------------------------------------------------
A disease whose progression and symptoms seem straight out of a
horror movie but which can be treated has killed at least 20 Ugandans
and sickened more than 20 000 in just 2 months.

Jiggers [also called chiggers], small insects which look like fleas,
are the culprits in the epidemic which causes parts of the body to
rot. They often enter through the feet. Once inside a person's body,
they suck the blood, grow and breed, multiplying by the hundreds.
Affected body parts -- buttocks, lips, even eyelids -- rot away.

James Kakooza, Uganda's minister of state for primary health care,
said jiggers can easily kill young children by sucking their blood
and can cause early deaths in grown-ups who have other diseases. Most
of those infected, especially the elderly, cannot walk or work.

"It is an epidemic which we are fighting against and I am sure over
time we will eradicate the jiggers," Kakooza said. The insects breed
in dirty, dusty places. The medical name for the parasitic disease is
tungiasis, which is caused by the female fly burrowing into the skin.

It exists in parts of Latin America and the Caribbean, besides
sub-Saharan Africa. Kakooza said health workers are telling residents
of the 12 affected districts in Uganda that jiggers thrive amid poor
hygienic conditions.

"We are also telling them to use medicated soap. They can apply
petrol and paraffin in places infested by jiggers and they die," Kakooza said.

The most affected part of Uganda is the Busoga region in the east,
150 kilometers (90 miles) from Kampala, Uganda's capital. Some cases
have been reported in the central region, less that 70 kilometers (43
miles) from the city, which has led to fears the whole country might
be affected.

Some think jiggers -- whose scientific name is Tunga penetrans --
were brought to Uganda and other east African countries by migrants
from India who constructed the railway from Mombasa, the Kenyan
seaport, to Kampala in the 19th century. Others say they came to
Africa aboard a British ship that sailed from Brazil.

Over time locals were affected. One observer near the turn of the
century called jiggers "the most fearful calamity that has ever
afflicted the East African peoples" after seeing affected people on
the slopes of Mount Kilimanjaro crawling around on all fours and
groaning with pain.

Colonial governments brought it under control but jiggers have since
re-emerged where hygiene is poor. Some affected people in rural
Uganda, think they are bewitched and simply wait to die instead of
trying to remove the insects. "For the last 3 years I have been
suffering from jiggers," [a] 60-year-old said. "I lost 2 children
killed by jiggers.They were sent to me by my neighbor who wants to
grab my piece of land."

"It is common to find graves of whole families wiped away by
jiggers," said Simon Wanjala, a ministry of health official in eastern Uganda.

Uganda's government has allocated one million US dollars to fight the
epidemic. Treatment involves removal of the insect or topical
medication. A study a few years ago in Nigeria concluded that raising
pigs, having sand or clay floors inside the home and having a resting
place outside the house increased the risk of getting jiggers.
Wearing closed shoes and using insecticides indoors helps prevent infestations.

[Byline: Godfrey Olukya, AP]

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

[Tunga penetrans is not a fly as stated above but a flea, which
burrows into the skin, grows, discharges its eggs and dies. The eggs
once on the ground develop into new fleas. The flea lives in soil and
feeds on warm-blooded hosts including humans. Tunga penetrans
infestation may cause secondary infection around the flea with much
local irritation, but multiple fatalities as described above are
highly unusual. One complication may be tetanus in persons who never
received a tetanus immunization. ProMED would be happy to post
further detail of this outbreak. - Mod.EP]

[According to wikipedia, the Busoga region is a kingdom of the
Busoga/Soga people in the eastern region of the country. The capital
of this region is Bugembe, near Jinja, the 2nd largest city in Uganda
(see <http://en.wikipedia.org/wiki/Busoga>). For a map of Uganda
showing regions, see
<http://en.wikipedia.org/wiki/Districts_of_Uganda>. For the
interactive HealthMap/ProMED map of Uganda, see
<http://healthmap.org/r/0089>. - Mod.MPP]
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