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DENGUE - Yemen
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Yemen
Date: Sat 28 Jun 2008
Source: Yemen Observer [edited]
<http://www.yobserver.com/local-news/10014499.html>


A 3-year-old child died in Lahj province in the south of Yemen early
on Wednesday [25 Jun 2008] due to dengue fever, reported local
sources.

The sources also said that many people in the area are suffering from
fever, with symptoms similar to those of dengue fever, including
strong headaches, dizziness and red eyes.

Official sources stated that 115 Yemenis were officially confirmed as
dengue fever patients from among 1903 suspected cases found in
different provinces of the country since the beginning of this year
[2008].

Recently, 3 Yemenis died, most probably because of this epidemic in
the province of Shabwa, in the east of the country, as stated by an
official report released on Tuesday [24 Jun 2008] and carried by the
state-run news agency Saba.

"Until now, we cannot confirm 100 percent that the 3 people died
because of this disease," the deputy Minister of Health, Majed
al-Junaid said to Saba News Agency.

A total of 64 people were confirmed as dengue fever patients in the
eastern province of Hadhramout, 35 cases in the southeastern province
of Shabwa, 9 cases in the western coastal province of Hodeidah, 4
cases in the southern province of Lahj, and 3 cases also in the
southern province of Abyan.

[Byline: Nasser Arrabyee]

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

[The dengue outbreak in Yemen continues (see the 9 Jun 2008 ProMED
archive no. 20080609.1831). A report published in the Yemeni
newspaper Al-Ayyam website on 21 Jun 2008 (in Arabic, accessible
through its web site
<http://www.al-ayyam.info/>)
indicated that official reports and private clinics of Shabwah
Governorate still register daily dozens of people infected with
dengue fever. Medical reports note that the governorate has
registered 1500 infection cases distributed among Hatib directorate,
with 1150 cases; 250 in Mayfa'ah; and 100 in Al-Sa'id and Nisab
directorates. There is no mention made of control measures being
taken in the Yemen Observer report.

ProMED thanks Michelle Sellors <michelle.sellors@masta.org> for
sending in the Al-Ayyam report.

A map of Yemen showing the location of the provinces can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... n_2002.jpg>.
The HealthMap/ProMED-mail interactive map of Yemen can be accessed at:
<http://healthmap.org/promed?v=15.9,47.6,5>.
- Mod.TY]

Jemen - Dengue
02.07.2008

Fast 2.000 verdächtige Erkrankungen, von denen 115 bestätigt werden konnten, wurden seit Jahresbeginn aus verschiedenen Provinzen des Landes gemeldet, die meisten aus Shabwa südöstlich der Hauptstadt Sana'a sowie aus Hadhramout im Osten. Auftritte dieser grippeähnlichen Viruskrankheit sind in den küstennahen Gebieten im SW des Landes seit Jahren bekannt, Häufigkeit und Fallzahlen zeigen wie im benachbarten Saudi-Arabien steigende Tendenz. Schutz vor den vorwiegend tagaktiven Überträgermücken beachten / Quelle: crm

DENGUEFIEBER /DHF UPDATE 2008 - Jemen ( 29 )
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******
Yemen
Date: Mon 14 Jul 2008
Source: Yemen Times [edited]
<http://yementimes.com/article.shtml?i=1172&p=local&a=2>


Member of Parliament Mohammed Al-Assali affirmed on Saturday [12 Jul
2008] that 4 individuals infected with dengue fever all died within a
week in Raymah and Hodeidah governorates. Ahmed Awadh, who heads
WHO's dengue fever center, told the U.N.'s IRIN news service that the
disease has claimed 5 lives so far because doctors were unaware of it
and therefore treated the patients as if it was a mere fever.

Sultan Al-Maqtari, manager of Hodeidah governorate&#146;s Epidemic
Recording Office, states that the office has discovered 12 cases of
those infected with dengue fever since the beginning of May [2008] and
that [samples from] another 112 individuals suspected of carrying
[having] the infection were taken to the central laboratory to be
checked for the disease.

Of the victims, 3, a mother and daughter and another woman, were from
Raymah governorate, while the 4th victim was a 4-year-old girl from
Hodeidah governorate.

Al-Maqtari noted that his office had conducted
anti-mosquito spraying in Dair Al-Atta and
Al-Rahmah villages, in addition to giving
residents the required preventive medicines. He
added that the team told residents about the
necessity of draining swamps and eliminating
stagnant open waters, which attract mosquitoes.
[Draining swamps, which are not breeding habitats
for the _Aedes aegypti_ mosquitoes that transmit
dengue viruses, will not affect transmission of these viruses. - Mod.TY]

MP Ahmed Al-Dhubaibi urged Yemen&#146;s Ministry of Health and Population
to assist citizens in Raymah governorate quickly, adding that a large
number of people in Al-Jabeen district have symptoms similar to those
of dengue fever. Earlier this month [July 2008], 180 new cases of
suspected dengue fever were reported in 5 governorates, 115 of which
were confirmed to be dengue fever sufferers.

According to a Health Ministry report, the total
number of dengue fever cases so far this year now
is approaching 2100. The report notes that the
disease, found in only 5 governorates last year
[2007] -­ Shabwa, Hodeidah, Abyan, Hadramout and
Lah -- has been discovered in 13 governorates this year [2008].

The ministry report states that the number of
confirmed cases in Hadramout increased from 64
last week to 87 this week, while in Shabwa, such
cases increased from 35 to 51, in addition to one
new case in Abyan, making 4 cases in that
governorate so far. According to the report,
Hodeidah and Lahj are witnessing fewer cases due
to awareness campaigns and insecticide spraying.

The report further mentions that the main reason for the disease&#146;s
spread is polluted water in open tanks and containers where mosquitoes
gather. It notes that the main way to prevent the disease in these
districts is to provide safe water sources. However, according to the
World Health Organization, some of these districts do have safe water
sources, but they are pumped irregularly, which causes citizens to
store water in tanks and open containers.

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

[The dengue outbreak in Yemen continues (see the 9 Jun 2008 ProMED
archive no. 20080609.1831 and the 1 Jul 2008 post 20080701.2005).

A map of Yemen showing the location of the provinces can be accessed at:
<http://www.lib.utexas.edu/maps/middle_e ... n_2002.jpg>.
The HealthMap/ProMED-mail interactive map of Yemen can be accessed at:
<http://healthmap.org/promed?v=15.9,47.6,5>. - Mod.TY]

Jemen - Dengue
22.07.2008

Fast 2.100 verdächtige Erkrankungen, wurden seit Jahresbeginn aus insgesamt 13 Provinzen des Landes gemeldet, die meisten aus Shabwa südöstlich der Hauptstadt Sana'a sowie aus Hadhramout im Osten. Auftritte dieser grippe-ähnlichen Viruskrankheit sind in den küstennahen Gebieten im SW des Landes seit Jahren bekannt, Häufigkeit und Fallzahlen zeigen wie im benachbarten Saudi-Arabien steigende Tendenz. Schutz vor den vorwiegend tagaktiven Überträgermücken beachten. / Quelle: crm

HUMAN METAPNEUMOVIRUS, IMMUNOCOMPROMISED PATIENTS - SAUDI ARABIA
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Date: Mon 25 Aug 2008
Source: Red Apple Break [edited]
<http://www.softmedicus.net/blog/index.p ... udi+Arabia>


2 cases of human metapneumovirus in immunocompromised patients in
Saudi Arabia
---------------------------------------------------------
Human metapneumovirus (hMPV) has recently been shown to be a
prominent cause of respiratory infections in immunocompromised hosts,
and is associated with high morbidity and mortality. It has been
increasingly associated with lower respiratory tract infection in
hematopoietic stem cell transplant (SCT) recipients, with mortality
rates up to 50 percent. We report the 1st 2 cases of hMPV pneumonia
in an allogenic peripheral SCT recipient presenting with respiratory
failure and sepsis syndrome in Saudi Arabia.

The 1st case is a 59 year-old patient with recurrent mantle cell
non-Hodgkin lymphoma who was admitted to the intensive care unit 10
days after he received chemotherapy, with bilateral pulmonary
infiltrates and septic shock, required mechanical ventilation,
inotropic support, and broad spectrum antibiotics. hMPV Multiplex PCR
[polymerase chain reaction] was the only identified organism on
bronchoalveolar lavage (BAL). His course was complicated with
spontaneous pneumothorax that was managed with tube thoracotomy. The
patient's condition continued to deteriorate with persistent
respiratory failure, shock syndrome, and acute renal failure
requiring continuous renal replacement therapy. The patient
eventually expired despite maximum support.

The 2nd case is a 20 year-old white male with a relapsed pre B-cell
acute lymphocytic leukemia requiring allogenic peripheral blood SCT 2
weeks prior to his admission to the intensive care unit with
hemoptysis, bilateral pulmonary infiltrates, and severe hypoxemia
requiring mechanical ventilation and broad spectrum antibiotics.
Culture results were all negative except for positive hMPV multiplex
PCR on BAL specimen. The patient's condition deteriorated despite
continued support and he eventually expired.

These 2 cases represent the 1st reported cases of hMPV in Saudi
Arabia in immunocompromised hosts. The 1st case illustrates that
spontaneous pneumothorax may complicate the course of the disease in
adults, as is the case in children.

[Byline: Jumana Jishi, Oussama Mimiish, Raed Kolko, Mazen Kherallah]

--
Communicated by:
Susan Baekeland
La Meute du Ruisseau
Le Ruisseau,
50240 Carnet
Lower Normandy
France
<grolleyog@tele2.fr>

[_Human metapneumovirus_ is a member of the genus _Metapneumovirus_ of
the sub-family _Pneumovirinae_ in the family _Paramyxoviridae_.

The defining member of this genus is turkey rhinotracheitis virus
(avian metapneumovirus), which is responsible for severe respiratory
disease in domestic fowl. The metapneumoviruses are distinguished from
the pneumoviruses (bovine RSV, human RSV, and pneumonia virus of mice)
principally by a genome inversion. The clinical symptoms of children
from whom the human metapneumovirus has been isolated are similar to
those caused by respiratory syncytial virus (RSV) infection, ranging
from upper respiratory tract disease to severe bronchiolitis and
pneumonia. It has been established that human metapneumovirus has been
circulating in humans for at least 50 years and like human RSV, is
prevalent worldwide.

The detection of human metapneumovirus RNA in 2 immunocompromised
stem cell recipient transplant patients is an interesting
observation, but it is unclear to what extent this is related to the
course of the illness suffered by these patients. It is unclear
whether the virus was introduced with the transplanted cells or was
resident in the patients receiving the transplant.

It would be interesting also to know what other respiratory viruses
were detectable by the multiplex PCR system employed by the authors
and can be excluded as causes of the pneumonia observed. - Mod.CP]

RIFT VALLEY FEVER - SAUDI ARABIA: (ASIR), SUSPECTED, REQUEST FOR INFORMATION
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Date: Wed 3 Dec 2008
Source: Saudi Gazette [edited]
<http://www.saudigazette.com.sa/index.cf ... 8120323652>


RVF [Rift Valley fever] disease back in Asir?
---------------------------------------------
A case of a 40-year-old Bangladeshi worker who has been admitted into
the ICU [intensive care unit] in a private hospital in Asir region
with suspected laboratory characteristics of the Rift Valley fever
(RVF) has brought back harsh memories of the early reports of the
outbreak of the disease in Jizan, border city with Yemen, in
September 2000. The man was initially diagnosed with an unknown type
of fever and elevated liver enzyme levels, both indicators of the RVF.

The Asir Agriculture Department has recently acted on media reports
of suspected cattle infected with the disease in different villages
in the region by sending specimens from there for lab analysis in
Riyadh for immunoglobulin M (IgM). The lab tests were positive for
IgM, antibody to Rift Valley fever virus in domestic ruminants.

"There are strong suspicions of the RVF outbreak again in the region,
but they are still not confirmed," said Mubark Al-Mutalqah, director
of the Asir Agriculture Department. The symptoms could be either a
real viral infection or a side effect of the antibody injection
previously used on the animals to ward off the virus, he said. "We
are still waiting for the final lab reports from the Ministry of
Health and the Ministry of Agriculture to confirm the source of the
IgM as we are closely monitoring the area," he said.

If the disease were confirmed, the government agencies would work
hard to combat it through sending planes to spray insecticide to kill
the mosquitoes, which are thought to be spreading the disease. RVF is
a mosquito-borne zoonotic disease affecting domestic ungulates
(especially goats and sheep) characterized by large epizootics during
periods of heavy rainfall with associated outbreaks in humans. Most
human infection is associated with an uncomplicated febrile illness
or is unapparent.

More severe complications include retinitis, hepatitis, renal
failure, hemorrhagic fever, encephalitis, and death. According to
recent research, if the disease breaks out, it may be transmitted in
an approximately 600 km (373 mi) area, including the flood plains of
the wadis [valleys] extending from the Sarawat mountains to the Red
Sea coastal plains. The duration from disease onset to
hospitalization is 3.3 days and the average time from disease onset
to death is 6.3 days. [References to the said data -- probably
derived from previous Saudi observations -- will be appreciated. In
any event, the generally acceptable data on case fatality rate of RVF
in humans does not exceed 1-2 percent. - Mod.AS]

A Health Ministry report said Rift Valley fever killed 124 people in
the Kingdom between September 2000 and May 2001, while 760 of the 884
infected people recovered.

The Kingdom has since either banned or carefully examined the import
of livestock from several African countries as well as from Yemen.

Although Rift Valley Fever was first identified in 1930, after an
epidemic among sheep in Kenya, it has also affected Egypt,
Madagascar, Mauritania, and Somalia, according to the World Health
Organization.

[Byline: Fahd Al-Rubai, Al-Hassan Al-Sayyid]

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

[For the Asir province in southwest Saudi Arabia, bordering Yemen, see map at
<http://www.maplandia.com/saudi-arabia/asir/>.
The HealthMap/ProMED-mail interactive map of Saudi Arabia is available at
<http://healthmap.org/promed/en?g=108180&v=21,42,5>.

In case the described suspected human RVF case is confirmed, this is
bad news since it may be indicative of RVF virus circulation in Saudi
Arabia, provided the patient was not infected elsewhere (East
Africa?). If confirmed, RVF must already have involved (undetected or
unreported) infections in ruminants, particularly sheep and goats.
The virus can spread by vectors (mosquitoes) and by exposure of
humans or susceptible animals to infected tissues.

The most striking features, expected in (unvaccinated) ruminants, are
mass abortions and mortality of offspring (which -- in the most
susceptible animals, namely lambs younger than 4 weeks -- may reach
almost 100 percent). The timing of the current event is most
unfortunate: the Hajj (annual pilgrimage to Mecca) is due to start in
just 3 days, on 6 Dec 2008. The Eid-ul-Adha (Festival of the
Sacrifice), when millions of ruminants will be slaughtered, is due on
8 Dec 2008. The expected influx of over 2 million pilgrims for the
Hajj, as well as the presence of a large migrant population, generate
high human and animal traffic that present a challenging agenda for
public health. Returning pilgrims may, if infected, transfer the
virus to other regions.

The Saudi authorities are expected to take the appropriate measures
avoiding the introduction into Mecca of animals from the south and
prescribing intensive veterinary inspection of the slaughtering
process, particularly antemortem inspections. Infection of humans
with the RVF virus may occur by their exposure to organs,
particularly blood, of viraemic animals. Reportedly, the exposure of
humans to aerosols in slaughtering facilities and home slaughtering,
during the major 1977-78 epizootic in Egypt, was a main contributor
to the very high morbidity and mortality observed.

The potential risks within this period as well as other peculiar
ecological factors have been discussed in the paper, "The evolving
transmission pattern of Rift Valley fever in the Arabian peninsula"
by Shamsudeen F Fagbo, Ann N Y Acad Sci 969: 201-4 (2002) (abstract
available at
<http://www.ncbi.nlm.nih.gov/pubmed/1238 ... t=Abstract>).

Saudi Arabia initially reported the presence of RVF during 2000 and
the 1st quarter of 2001. Saudi investigators raised later the
speculation that the RVF virus had been introduced into the Arabian
peninsula earlier, namely in 1997/1998 during the RVF epidemic in
East Africa, via introduction of infected imported livestock or via
windborne infected mosquitoes, and that climatic conditions have
promoted sufficient vector populations to support transmission in
Saudi Arabia and Yemen. (See A Madani et al: "Rift Valley Fever
Epidemic in Saudi Arabia: Epidemiological, Clinical and Laboratory
Characteristics". Clin Infect Dis. 2003 Oct 15; 37(8):1084-92;
abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/14523773>).

In October 2004, the Saudi authorities reported to the OIE (World
Organisation for Animal Health) that RVF seropositive cases were
detected in 4 sheep flocks, without any clinical evidence either on
the positive cases or on the contact animals. The Saudi 2007 report
to the OIE indicates "confirmed infection without clinical cases"
(animal species not specified). Has the disease become endemic in
certain regions?

RVF vaccination is, reportedly, carried out in Saudi Arabia,
involving sheep, goats, cattle, and camels (2007 data). Vaccination
figures, (geographic and population) coverage, and details of the
vaccine applied (killed or live attenuated?) will be helpful.

Official confirmation or -- hopefully -- denial of the suspected
human cases, and results of recent surveillance in animals, are
anticipated. - Mod.AS]

DENGUE/DHF UPDATE 2008 (52)
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[We apologize for the lateness of this report, which was filed on 1
Dec 2008 but inadvertently not posted. - Mod.LM]

******
Yemen (Taiz)
Date: Mon 24 Nov 2008
Source: Yemen News Agency (SABA) [edited]
<http://www.sabanews.net/en/news169901.htm>


The Heath Office in Taiz province has registered the spread of dengue
fever disease in Al-Ashrooh village in the province.

The director of the health office at Jabal Habash district in Taiz
province, Abdul-Kareem Al-Barakani, told NewsYemen that there are 2
people affected by this disease.

Al-Barakani confirmed that he will send a team to combat this disease
and to raise awareness of this virus.

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

[The dengue outbreak continues to smolder in 2008.

A map of Yemen showing the location of the provinces can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... n_2002.jpg>.
The HealthMap/ProMED-mail interactive map of Yemen can be accessed at
<http://healthmap.org/promed/en?g=6300145&v=15.9,47.6,5>. - Mod.TY]

RIFT VALLEY FEVER - SAUDI ARABIA (02): (ASIR), SUSPECTED
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[1]
Date: Wed 10 Dec 2008
From: Shamsudeen Fagbo <oloungbo@yahoo.com>


1. In response to the moderator's request for information in the posting
"Rift Valley fever - Saudi Arabia: (Asir) suspected, RFI 20081203.3798:"
Firstly, please note that RVF vaccination in Saudi Arabia is applied in
young animals using the live attenuated RVF Smithburn strain vaccine (Ref
1). More details can be found in the said paper and in Ref 2.

2. As to the moderator's hint at a possible East African source, the
possibility of other RVFV-like viruses being involved arises. I would like
to remind the reader that during the 1997/98 outbreak in East Africa,
clinical pictures similar to RVF eventually turned out to be caused by
another member of the _Bunyaviridae_, named Garissa virus (Ref 3). Possible
involvement of other Bunyaviruses deserves consideration also in view of
the lack of observed disease symptoms characteristic of RVF in reportedly
infected animals.

3. The suggested endemicity of RVFV in Saudi Arabia is supported by
evidence from a government lab in the RVF-prone area. In 2004, the Ministry
of Agric workers detected local natural infection in sentinel animals used
in surveillance programs (Ref 1). There were no camels amongst the sentinel
animals.

4. The role of camels in the emergence and spread of RVF in the region
seems not to be given much attention, as shown in local surveys (Ref 2). A
published sero-surveillance report on camels detected one single RVF
IgG-positive camel among 496 animals tested (0.2 per cent) (Ref 4). Details
on exactly where and when the positive sample was taken as well as
information on confirmation of the Indirect ELISA used by other means or
further investigations are not given. These authors again acknowledge the
present lack of camel sentinels. Camels are known to move through extensive
areas that again present exposure determination challenges. Sadly, little
is still known of RVF pathogenicity in camels. In addition, most of the
valuable ELISA protocols are not validated for this species. However,
camels are susceptible, and their movements between the Gulf States (Ref 5)
may constitute a risk pathway that needs to be evaluated. This is of
particular importance to neighbouring countries like UAE where efforts are
being made to export camel products to Europe. The need to increase
camel-related RVF monitoring/research cannot be overemphasized.

5. Even though enzootic, possible routes of RVFV reintroduction still
exist. The government is well aware of this potential problem, and strict
requirements are said to have been applied for newly permitted livestock
imports from Sudan and Eritrea. However, the potential for entry via
nontraditional routes remains. Private zoos and individuals in the region
do import susceptible wildlife from RVF endemic regions of Africa; these
may not be adequately covered by local RVF surveillance and thus may
contribute to undetected local transmission. While efforts to better
understand the role of wildlife in RVF inter-epizootic maintenance are
still ongoing, there is evidence that wildlife is actively infected by RVF.
As reported in postings 20080210.0541 and 20080701.2012, RVF-affected
buffaloes have passed infection to humans in South Africa earlier this year
[2008]; such animals are found in private zoos.

6. The report on the Asir suspected human case says: "The man was initially
diagnosed with an unknown type of fever and elevated liver enzyme levels,
both indicators of RVF." With the RVFV specific IgM unconfirmed,
differential diagnoses such as dengue and Alkhurmah haemorrhagic fever
viruses come to mind; they should receive more consideration if the initial
IgM turns out to be false positive. The latter virus is thought to be
under-diagnosed.

7. Statements such as "the symptoms could be either a real viral infection
or a side effect of the antibody injection previously used on the animals
to ward off the virus" are really confusing and may be due to translation
errors from an Arabic original as well as inaccuracy in reporting
infectious diseases by the media. This was experienced in the 1st RVF
outbreak in 2000. In the same light, the use of the term "cattle" should be
interpreted cautiously, since the word "mawaashi" (which means livestock)
in Arabic has in past reports been mistranslated to "cattle," erroneously
excluding other livestock, particularly small ruminants. Susceptible sheep
and goats are, generally, more ubiquitous than cattle in these regions.

8. The above quoted statement further indicates lack of clarity regarding
the RVF vaccination status of the animals in the affected area. The risk of
reversion to virulence does exist with live attenuated vaccines; these
vaccines also do not allow for the differential identification between
infected and vaccinated animals [DIVA] (Ref 6); it would be interesting to
see the local adoption/trial of the new DIVA recombinant RVF vaccine
developed by these authors. Without more evidence, especially evidence
generated using molecular tools to sequence and characterize any virus
isolated, it would be difficult to trace the source of the virus. Using
such protocols, it might have been possible to judge the possibility of
vaccine reversion.

9. If and when RVF is confirmed (which is not the case so far), the
potential risks for pilgrims in Makkah is not one that can be easily
extrapolated. A general analysis of such potential risks was given by Glyn
Davies in his paper 2 years ago (Ref 7). However, since he probably did not
have the opportunity to be present on location during the pilgrimage
itself, may I add several other dynamic variables for consideration. One's
familiarity with the Haj rites, abattoirs and fellow veterinarians there
may enable suggesting that risk exposure pathways vary greatly amongst the
pilgrims, who come from virtually all over the world. A generalized risk
analysis may not be possible: Potential exposure pathways can only be
developed by factoring in these various dynamic variables. These variables
depend on the pilgrims' nationalities and the attendant cultural
diversities expressed by the country of origin, purchasing power, etc. Even
intra-national variations in potential risk exposure patterns will and do
exist. For example, not all pilgrims are required to slaughter an animal.
How many pilgrims opt for this and why? How many of them carry out the
slaughter and subsequently consume the slaughtered meat? Going into such
details is far beyond the scope of a comment here. It should be noted that
several official sanitary, risk reducing measures have been operational for
many years. For example, there is a system of coupon-mediated proxy
slaughter that limits access of pilgrims to live animals and coordinates
animal movement. It is, however, not known how many of the pilgrims make
use of this facility and at what level. The government has also limited
outward movement of animals from the Makkah area [see item 2]. However, it
is not clear whether the mentioned measures will cover other routes of
transmission, namely mosquitoes and nontraditional hosts. Stray cats are
potential nontraditional alternative hosts. They are present in enormous
numbers in the Makkah region; they can easily access abattoirs, carcasses,
as well as provide meals for abundant tiger mosquitoes, _Aedes (Stegomyia)
albopictus_, which feed on animals and humans.

10. What further abates any fear of a massive RVF epizootic is the fact
that, though there were heavy rains in the RVF-endemic areas in early
November 2008, the expected interval for trans-ovarially infected
mosquitoes to erupt and infect susceptible animals/humans, followed by a
short incubation period, can be said to have elapsed. However, this does
not obviate the need to confirm post rain fall vector dynamics and confirm
whether local RVF epizootics will not be always similar to the rainfall
associated patterns in East Africa.

In summary, while a risk does exist for RVF transmission, its full
evaluation requires detailed information on local conditions and on ground
risk parameters. Until confirmed, there is no need to stoke up fears.
Proactive preventive measures can be heightened. Whenever confirmed,
analytical risk deductions are best done on a nationality to nationality
basis. It is also hoped that the new risk levels will increase commitment
to research on this and other arboviral zoonoses.

References
1. Elfadil AA, Hasab-Allah KA, Dafa-Allah OM, Elmanea AA. The persistence
of rift valley fever in the Jazan region of Saudi Arabia. Rev Sci Tech
2006; 25(3): 1131-6.
2. Elfadil AA, Hasab-Allah KA, Dafa-Allah OM. Factors associated with Rift
Valley fever in south-west Saudi Arabia. Rev Sci Tech 2006; 25(3): 1137-45.
3. Gerrard SR, Li Li, Barrett AD, Nichol ST. Ngari Virus is a Bunyamwera
virus reassortant that can be associated with large outbreaks of
hemorrhagic fever in Africa. J Virol 2004; 78(16): 8922-6.
4. Al-Afaleq AI, Abu-Elzein EE, Hegazy AA, Al-Naeem A. Serosurveillance of
camels (Camelus dromedarius) to detect antibodies against viral diseases in
Saudi Arabia. J Camel Practice Research 2007; 14(2): 91-6.
5. Wernery U, Thomas R, Syriac, G. Raghavan, R. Kletzka S.
Seroepidemiological studies for the detection of antibodies against nine
infectious diseases in dairy dromedaries (Part-I) J Camel Practice Research
2007; 14(2): 85-90.
6. Bird BH, Albarino CG, Hartman AL, Erickson BR, Ksiazek TG, Nichol ST.
Rift valley fever virus lacking the NSs and NSm genes is highly attenuated,
confers protective immunity from virulent virus challenge, and allows for
differential identification of infected and vaccinated animals. J Virol
2008; 82(6): 2681-91.
7. Davies FG. Risk of a rift valley fever epidemic at the haj in Mecca,
Saudi Arabia. Rev Sci Tech 2006; 25(1): 137-47.

--
Shamsudeen Fagbo
Dept of Tropical Veterinary Diseases
University of Pretoria South Africa
<oloungbo@yahoo.com>

******
[2]
Date: Sun 7 Dec 2008
Source: Saudi Gazette [edited]
<http://www.saudigazette.com.sa/index.cf ... 8120723849>


Authorities have imposed a ban on removing livestock from Makkah during
Haj, Dr Fahd Balghunaim, minister of agriculture, said here on Saturday [6
Dec 2008].

He said his ministry has adopted a number of preventive measures to avoid a
recurrence of Rift Valley fever (RVF) and bird flu, pointing out that the
ban on importing live birds was still in place. The government is taking
extra precautions since there was a suspected case of RVF in Asir Region
recently after a Bangladeshi national was hospitalized there with symptoms
of the disease. The minister said importing livestock from Sudan and Syria
has been resumed to meet the increasing demand during this season after
confirming implementation of health specifications by the 2 countries [See
additional media sources on the Saudi animal import policy in the
commentary at the bottom of this posting. - Mod.AS].

"The ministry has provided additional staff for Makkah Region's land and
sea entry points in order to deal with the increasing number of livestock
arriving in Jeddah. The staff include veterinary personnel working round
the clock to examine animals at entry points," Balghunaim said.

[byline: Abdullah Al-Harthi]

--
Communicated by:
Shamsudeen Fagbo
Dept of Tropical Veterinary Diseases
University of Pretoria South Africa
<oloungbo@yahoo.com>

[Subscribers are referred to the following additional newswires, related to
Saudi Arabia's animal import policy:

1. "Ministry prioritizes quarantine promotion, Abukalabeish," published on
Tue 11 Nov 2008 in the Sudanese newspaper Sudan Vision Daily; for the full
text, refer to
<http://www.sudanvisiondaily.com/modules ... &sid=40600>.
2. "Kingdom lifts ban on import of sheep, cows and camels from Eritrea,"
published on Tue 25 Nov 2008 in the Saudi newspaper Saudi Gazette; for the
full text, refer to
<http://www.saudigazette.com.sa/index.cf ... 8112522949>.

The final laboratory results of the hospitalized person suspected with RVF
are expected with great interest. - Mod.AS]

UNDIAGNOSED INFANT DEATHS - ISRAEL: 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: Tue 16 Dec 2008
Source: Haaretz.com [edited]
<http://www.haaretz.com/hasen/spages/1046900.html>


Spate of mysterious infant deaths prompts health ministry investigation
----------------------------------------------------------------------
The Health Ministry has launched an investigation into the sudden
deaths in the past month of 4 babies and the severe illness of 2
others. The cases, some of which were reported to the ministry in
recent weeks by hospitals, including Schneider Children's Medical
Center and the Sourasky Medical Center in Tel Aviv, involved serious
neurological and cardiac damage to the babies, but in most of the
cases, no reason has been determined as yet for the illnesses or the
deaths. The initial ministry probe has turned up no connection among
all 6 cases, although the ministry is still seeking one.

The Health Ministry released a statement to the press Monday [15 Dec
2008] that Schneider Children's had reported 3 recent cases of
unusual illness among young children in the past 3 weeks. Of these, a
14-month-old girl of Even Yehuda died of unknown causes. The child
arrived at the hospital with extreme brain damage that led to her
death. Her parents donated her organs.

Doctors believe the girl had contracted the common intestinal virus
coxsackie B virus, which doctors say can cause severe damage in rare
cases. However, physicians at Schneider are not sure [this or a]
virus was the cause of the child's death.

Two other children are currently hospitalized at Schneider: an
18-month old girl from Ramat Gan and a boy from Bnei Brak 2 years and
9 months old. Both are suffering from various neurological
conditions, and one suffered cardiac arrest.

The hospital said there had been another case of a 14-month-old boy
who died suddenly, but in an autopsy he was found to have been
suffering from an infection of the heart muscle, said Dr Tommy
Scheinfeld, head of intensive care at Schneider, who explained that
this is "not common, but known cause of death in babies."

According to the Health Ministry statement, following the report from
Schneider, it began an investigation in all of its districts, and
turned up 2 more suspicious cases, one of a 15-month-old girl with an
infectious disease who had died in the Dana Children's Hospital at
Tel Aviv's Sourasky Medical Center, and an 18-month-old girl from the
community of Rekhasim in the north, who died suddenly at home. No
other similar cases have been located in any other hospital in the country.

According to ministry statistics, approximately 170 children die each
year in Israel from illness or accidents. Of these cases, 10 children
between ages 1 and 4 die of infectious diseases.

Dr Itamar Grotto, national director of public health in the Health
Ministry, told Haaretz Monday [15 Dec 2008] that the epidemiological
probe had been looking into possible causes for the 6 cases, such as
the presence of the babies in the same places, possible proximity to
animals, or even trips abroad to the same destinations. No such
connections, however, had come up. "We are now focusing on lab tests
of body fluids, and on autopsy. One of the main possibilities under
investigation is the presence of the common intestinal virus
coxsackie B virus."

Scheinfeld said coxsackie B virus [of which there are 6 distinct
types) causes diarrhea and rash, but in rare cases might also lead to
infection of the pericardium or meningitis. He said viruses in this
group [that is enteroviruses in general] are common and in 98 percent
of cases cause only slight illness among the thousands of babies that
contract it. Schneider Children's Medical Center said it currently
has 2 other babies hospitalized with severe convulsions, in whose
spinal fluid coxsackie B virus has been clearly identified, but that
they had recovered. The hospital said the virus is commonly found in
kindergartens and day-care centers.

Scheinfeld told Haaretz Monday [15 Dec 2008] that, "it is very
possible that this is a coincidental accumulation of cases that
usually extend over a whole year, and that this time occurred over a
3-week period. Sometimes there are cases of death and illness among
babies caused by unknown reasons, but that does not mean there is an
epidemic or that the cases are connected. It is highly likely that
there is no common source for the illness among the children, such as
the food they ate, although this must be investigated by the Health Ministry."

Scheinfeld added, however, that, "it is possible that the reasons
will never be known, even after the investigation has been carried
out. No special steps should be taken other than the usual steps.

[Byline: Ran Reznick]

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

[It has not been established that these sporadic deaths are more than
coincidental. However the isolation of a coxsackie B virus from the
spinal fluid of 2 babies suggests a viral etiology in these 2 cases
at least. The coxsackie B viruses, although rarely responsible for
disease, have been associated more than other enteroviruses with
aseptic meningitis, fatal neonatal disease, pleurodynia, and myo- or
pericarditis.

Further information concerning the results of the investigations is
awaited. - Mod.CP

The HealthMap/ProMED-mail interactive map of Israel is available at
<http://healthmap.org/promed/en?v=31.9,34.9,7>. - CopyEd.MJ]

RIFT VALLEY FEVER - SAUDI ARABIA (03): (ASIR), HUMAN, NOT
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 16 Dec 2008
Source: Saudigazette [edited]
<http://www.saudigazette.com.sa/index.cf ... 8121624365>


RVF detected in Asir region
---------------------------
Asir region governorate has banned the transportation including the
entry and exit of livestock to and from Mahayil Governorate
especially in areas and rural centers where positive samples for
antibodies of Rift Valley fever (RVF) virus were detected.

The region's governorate issued directives to Mahayil to prevent the
movement of livestock to and from the governorate and to coordinate
with the concerned authorities. It directed the security authorities
to implement these measures and asked the Ministry of Agriculture
branch to pinpoint the locations of afflicted herds and to cooperate
in vaccinating livestock and spraying animal sheds, to report new RVF
cases immediately and to monitor veterinary pharmacies. Earlier, the
region's governorate set up an operations room to monitor any RVF
cases.

In another development, blood samples taken from the expatriate
Azizul Haq Kalamiyah, 40, suspected of suffering from RVF has tested
negative. The reports came in from the regional laboratory in Jeddah,
said Sa'eed Abdullah Al-Neqair, Director of Health Information and
Public Relations in Asir Region Directorate of Health.

Last month [November 2008] when the reports of the virus 1st came to
light, the authorities took immediate preventive measures.

[Byline: Al-Hasan Aal Sayyid]

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

[Posting 20081203.3798 included media-derived information about a
case of a 40-year-old Bangladeshi worker who has been admitted into
the ICU [intensive care unit] in a private hospital in Asir region
with suspected laboratory characteristics of Rift Valley fever (RVF).
The man was initially diagnosed with an unknown type of fever and
elevated liver enzyme levels, both indicators of the RVF.

If the current newswire addresses the same patient, as it seems, then
it now appears that this was a false alarm.

However, as discussed in posting 20081211.3894, RVF may have become
endemic is certain parts of the Kingdom, mass vaccinations are being
applied in livestock, and alertness deserves to be maintained --
particularly during the rainy season. - Mod.AS]

DENGUE/DHF UPDATE 2008 (55)
****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******
Yemen
Date: Mon 22 Dec 2008
Source: Yemen Times [edited]
<http://yementimes.com/article.shtml?i=1218&p=front&a=2>


The Taiz Governorate has been hit hard by a recent outbreak of dengue
fever, with Al-Jumhoori Hospital reporting up to 525 cases in the
past 3 months alone.

Dengue fever can be tested for by 2 methods, the test cassette and
the ELISA Test, according to Dr. Ahmed Abddulaah Mansur, Chairman of
Virology Department at Al-Jumhoori Hospital. However, the
availability of such methods is reportedly inadequate. "The ELISA
Test is available only at the Aljumhuri Hospital, where cases are
referred to from all other private or public hospitals and
laboratories," Mansur said.

Other private labs have also reported scores of cases, with Alameri
Laboratory reporting 5 this month [December 2008] alone.

"Since there is a shortage of test equipment, we cannot effectively
diagnose patients, as most cases are identified through a general
blood test," said Dr. Waleed Yasin, a lab technician.

Dengue fever is a mosquito-borne infection that can take one of 2
forms: Dengue fever (DF) and dengue hemorrhagic fever (DHF). These
have both affected the rural areas in Taiz, including in Alshrooh
Village in Jabal Habashi District.

The main reasons for the spread of this infectious disease are
stagnant water, open-liquid containers, and rainfall in areas where
mosquitoes breed.

Symptoms of the disease include severe headaches, rashes, muscular
pain, joint pain, back and even eye pain.

Mansur said that to help combat the spread of the disease in areas
where it is endemic, the authorities concerned should raise awareness
on how to take preventative measures.

In June 2008, among the provinces hit by dengue fever was the eastern
province of Shabwa, contributing to more than 2000 cases of infection
and tens of deaths.

According to the World Health Organization (WHO), the epidemic also
took hold in the western province of Hodeidah in 2005, resulting in a
total of 392 cases of infection and 15 deaths.

[Byline: Salah Al-Warafy]

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

[A map of Yemen showing the provinces can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... n_2002.jpg>.
A HealthMap/ProMED-mail interactive map of Yemen can be accessed at
<http://healthmap.org/promed/en?v=15.9,47.6,5>.
- Mod.TY]

LEGIONELLOSIS, FATAL, HOTEL - UNITED ARAB EMIRATES: (DUBAI)
***********************************************************
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 1 Feb 2009
Source: BBC News [edited]
<http://news.bbc.co.uk/2/hi/middle_east/7863810.stm>


A 5-star hotel in Dubai is testing for Legionnaires' disease after 3
guests contracted the illness. One of the guests of the Westin Dubai
Mina Seyahi, a British cricket scorer and broadcaster, died on
Thursday [29 Jan 2009] after leaving Dubai. A spokeswoman for the
hotel said all tests for the bacterium that causes the disease had
been negative so far but that checks were still being made.

The owner of the Westin hotel chain, Starwood Hotels and Resorts,
said it was working with the Dubai authorities to find out how [the
man] and the other 2, unidentified, guests became infected. The
69-year-old was a guest of the hotel in mid-January [2009], returning
to the UK on 20 [Jan 2009] from a tour to Dubai with his charity
cricket team, the Lord's Taverners. The team said no other members
were showing symptoms of Legionnaires' disease.

Tests by European and American experts on the Westin Dubai have so
far not found the bacterium, _Legionella_, that causes the disease,
said Starwood spokeswoman Amalie Craig. The disease has never been
detected at the hotel, according to its own regular checks, she said.
The Westin Dubai's staff has begun contacting guests to inform them
of the 3 cases, Ms. Craig said.

People become infected by inhaling water droplets containing the
bacterium, says the European Working Group for Legionella Infections
(EWGLI) -- a group of scientists working on the disease. Since the
disease was first identified in 1976 -- at a meeting of retired US
military personnel, or legionnaires -- outbreaks have been linked to
hotels, cruise ships, and other types of holiday accommodation. The
_Legionella_ bacterium only poses a risk if it gets into water
distribution systems such as air conditioners or plumbing, says the EWGLI.

About 5-15 percent of cases prove fatal, with elderly people most at risk.

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

[ProMED-mail Rapporteur Susan Baekeland sent another, similar news
release
(<http://7starsdubai.wordpress.com/2009/0 ... uest-dies/>).

Legionnaires' disease is the acute pneumonic form of disease caused
by _Legionella_ bacteria, usually _Legionella pneumophila_. About
80-90 percent of cases are caused by _L. pneumophila_ serogroup 1.
Legionnaires' disease is usually acquired by inhalation by a
susceptible person of an infectious dose of aerosolized _Legionella_.
Risk factors in adults include age over 50 years, cigarette smoking,
diabetes, chronic heart or lung disease, and immunosuppression.

_Legionella_ are usually found primarily in the hot water portion of
plumbing systems and in cooling towers. Warm water temperatures of
25-40 deg C (77-104 deg F) support the highest concentrations of the
organism in plumbing systems. In addition, _Legionella_ are embedded
in a biofilm that lines the inner walls of the plumbing system's
pipes and containers. Concentrations of the organism in the water can
be increased by any disruption of this biofilm. Infectious aerosols
can be generated by a building's faulty air conditioning systems,
shower heads, misters, and whirlpool spas.

Elimination or reduction of legionella colonization in a hot water
system is difficult. For a discussion, please see
<http://www.dhmh.state.md.us/html/legionella.htm>.

An epidemiological and environmental investigation for the source of
_Legionella_ organisms should be initiated when the 1st case of
legionellosis is identified. Genotyping patient and environmental
isolates will help to confirm the environmental source.

Dubai is one of the 7 emirates and the most populous city of the
United Arab Emirates (UAE) (<http://en.wikipedia.org/wiki/Dubai>).
Dubai has been ruled by the Al Maktoum dynasty since 1833. Dubai's
current ruler, Mohammed bin Rashid Al Maktoum, is also the prime
minister and vice president of the UAE (<http://en.wikipedia.org/wiki/Dubai>).

Dubai can be located on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed?v=23.9,54.3,5>. - Mod.ML]

Vereinigte Arabische Emirate - Legionellose
09.02.2009

Insgesamt 3 Touristen erkrankten nach einem Aufenthalt im 5-Sternehotel Westin Dubai an der Legionellose. Ein 69-Brite verstarb an den Folgen der Infektion. Nach Angaben der Hotelleitung, konnte die Infektionsquelle im Hotel bisher nicht nachgewiesen werden. Die zu den Bakterien gehörenden Erreger finden sich nicht selten in unzureichend gewarteten Wasserleitungssystemen, Kühl- oder Klimaanlagen und können durch Tröpfcheninfektion übertragen werden. Gefährdet sind besonders ältere und immungeschwächte Personen. Sie sollten bei Fieber sofort einen Arzt aufsuchen. / Quelle: crm

RABIES, HUMAN - UNITED ARAB EMIRATES ex INDIA
*********************************************
A ProMED-mail post
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: Tue 17 Feb 2009
Source: Gulf News online [edited]
<http://www.gulf-news.com/nation/Health/10287111.html>


Patient's death is 1st rabies fatality in UAE in 10 years
---------------------------------------------------------
A man being treated for rabies at a local hospital died on Monday [16 Feb
2009], the 1st such death in the United Arab Emirates (UAE) in a decade.
Gulf News reported the labourer from India was admitted to Al Baraha
Hospital on 8 Feb 2009 after he started showing symptoms. Rabies is
transmitted through saliva and blood from an infected animal. The most
common method of transmission is through bites, and globally more than 90
per cent of infections come from bites from rabid dogs.

Dr Ali Al Marzouqi, director of public health at the Department of Health
and Medical Services, told Gulf News it was the 1st rabies case in the UAE
in a decade. "The last case was 10 or more years ago. I have been in the
public health sector for 9 years and this is the 1st case we've got," he said.

Dr Ali Shakar, director-general at the Ministry of Health, told Gulf News
the man's hand was bitten 6 months ago, prior to his arrival in the UAE.
"If he had sought treatment immediately after the bite, or even after he
arrived in the UAE, maybe he would have been okay," he said.

Treatment for rabies involves cleaning and disinfecting the wound, and
giving the victim a post-exposure vaccination as soon as possible. Rabies
is almost always fatal when symptoms show up. Dr Shakar said there was no
need to vaccinate anyone as the man's contacts in the UAE have not shown
signs of exposure to the virus. Exposure refers to a case where infected
saliva enters an open wound. "The main thing is this is not a public health
scare so there is no need to panic. It can happen anytime, anywhere in the
world," he said. "It doesn't transfer like other [infectious] diseases.
It's not bird flu," he added.

He also said the body would be buried according to the World Health
Organisation (WHO) procedures, which dictates the immediate burial or
cremation of the body. No special containers are required for the body,
although embalming is discouraged. Despite the case, health authorities are
unlikely to require incoming residents and workers to be screened for rabies.

"We have other more important diseases to watch out for like HIV,
tuberculosis and sexually-transmitted diseases, which are more infectious,"
Dr Marzouqi said. "And if someone gets rabies here, so what? Transmission
is rare and we have vaccines to treat people after they are bitten," he said.

Facts about rabies: Rabies is a zoonotic disease that kills 55 000 people a
year worldwide, mostly in rural areas in Asia and Africa. It 1st shows up
with flu-like symptoms, including fever, headache, and fatigue. Then it
progresses to involve the respiratory, gastrointestinal, and the central
nervous systems. It also leads to hydrophobia or fear of water, due to
spasms in the throat. The patient develops hyperactivity, called furious
rabies, or paralysis, called dumb rabies.

UAE regulations: Pets are required to be vaccinated. Rabies is a notifiable
disease under the public health laws, requiring all sectors to report an
encounter.

[byline: Nina Muslim]

--
communicated by:
ProMED-Mail rapporteur Susan Baekeland

[An unfortunate accompaniment of the global migration of populations.

The HealthMap/ProMED-mail interactive map of the United Arab Emirates is
accessible at <http://healthmap.org/promed/en?v=23.9,54.3,5>. - Mod.CP]

DENGUE/DHF UPDATE 2009 (14)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******

Saudi Arabia (Mecca)
Date: Mon 6 Apr 2009
Source: Arab News [edited]
<http://www.arabnews.com/?page=1&section ... ry=Kingdom>


In the Al-Moaisem area of Makkah (Mecca), 3 Bangladeshi workers have caught
dengue fever. One of them is in critical condition.

Nawar Al-Qurashi, a Saudi, attributed the spread of the disease to
the absence of a sewage system. He said this results in stagnant
water, which causes mosquitoes to thrive. [The _Aedes_ spp.
mosquitoes that transmit dengue virus are doubtless breeding in
catchments of relatively clean water in and immediately around houses
and other buildings, rather than in raw sewage. - Mod.TY]

[One dengue virus infected person said,] "The residents in this place
are suffering from mosquitoes. We can't go outside or leave the
windows open at night," he added. [The _Aedes_ spp. mosquitoes that
transmit dengue viruses usually feed during daylight hours especially
at dawn and dusk, rather than at night. Other human-feeding pest
mosquito species that are not dengue virus vectors appear to be
attracting the resident's attention. - Mod.TY]. Muhammad Shamsulhaq,
a Pakistani, said the solution lies in small planes spraying the
entire area with pesticide. [This would, at best, provide temporary
reductions in the vector mosquito populations. Effective control of
the vector mosquitoes needs to be focused on elimination of
peridomestic breeding sites. - Mod.TY]

Abdul Salam Mashat, deputy mayor of Makkah, told Arab News that the
Makkah Municipality has intensified its operations to combat insects.

According to press reports, there were 84 cases of dengue fever in
Jeddah in the past 4 weeks. Health officials said the number of
mosquitoes that carry the fever have increased, particularly in the
underdeveloped areas of Jeddah, because of a rise in stagnant water
and construction in the city.

[Byline: Zainy Abbas]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[ProMED-mail thanks Dr Scott Chamberlin, DVM, MAJ, USA, VC, USMTM,
Chief Veterinary Preventive Medical Services, Riyadh, Kingdom of
Saudi Arabia, who also sent in this report. ProMED-mail appreciates
subscribers forwarding emerging disease reports that they encounter.

[A HealthMap/ProMED-mail interactive map of Saudi Arabia, showing the
cities mentioned can be accessed at
<http://healthmap.org/r/008R>. - Mod.TY]