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HEPATITIS E - SOUTH SUDAN (03)
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Date: Fri 9 Nov 2012
Source: UNHCR/Sokol [edited]
http://www.unhcr.org/509d084d9.html


"We have seen 1050 cases of hepatitis E in the refugee camps. To date, 26 refugees have died in camps in Upper Nile. This is 10 more deaths since mid-September"

Stretched UNHCR faces difficulties containing hepatitis E outbreak
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The UNHCR [United Nations High Commissioner for Refugees] on Friday [9 Nov 2012] warned that its capacity to contain an outbreak of hepatitis E among the refugee population in South Sudan was increasingly stretched at a time when funding for its emergency operation was depleted. "The risks will grow if, as currently anticipated, we see fresh inflows of refugees from South Kordofan and Blue Nile states in neighbouring Sudan," spokesman Adrian Edwards added. Due to insecurity and worsening humanitarian conditions in South Kordofan and Blue Nile states, UNHCR staff on the ground expect thousands of new refugees to cross in the next weeks as roads become passable after the rainy season. UNHCR and its partners, including South Sudan's national health authorities, are already fighting an outbreak of hepatitis E in Upper Nile and Unity states, 2 regions where the disease is endemic and where
175 000 Sudanese refugees have found shelter.

"We have seen 1050 cases of hepatitis E in the refugee camps," said Edwards. "To date, 26 refugees have died in camps in Upper Nile. This is 10 more deaths since mid-September," he added. Hepatitis E virus is contracted and spread through consuming contaminated food and water. It damages the liver. Potentially fatal, the risk of infection is high in densely populated settings such as refugee camps. This is further exacerbated in the rainy season due to flooding and poor sanitation. Women and small children are the most vulnerable. Early diagnosis is also crucial for the survival of patients. Edwards said UNHCR was working with the United States Centres for Disease Control and Prevention, which has sent 6 staff to test water and blood samples and conduct house-to-house interviews on hygiene practices.

To counter the spread of the disease among the tens of thousands of Sudanese refugees in South Sudan, "We are promoting better hygiene practices through hundreds of trained community workers. In all camps this community outreach exercise includes active case finding," Edwards said. The refugee agency has also been working to improve the supply of clean water in the camps, as well as upgrade latrines and provide more washing stations and soap. These measures have helped to slow the spread of the disease. However, UNHCR is struggling to meet the minimum humanitarian standards such as the provision of 15 to 20 litres of safe drinking water per refugee per day or building enough latrines so that each unit is shared by no more than 20 refugees.

Edwards stressed that UNHCR's South Sudan operation is seriously underfunded. "UNHCR needs a minimum of USD 20 million until the end of the year to keep up basic life-saving activities. Of our revised appeal for USD 186 million, only 40 per cent has been received so far. International NGOs also need additional funding beyond that amount to ensure that all activities can be carried out as needed," he stressed.

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[South Sudan, officially the Republic of South Sudan, previously known as Southern Sudan, is a landlocked state in east-central Africa. South Sudan is bordered by Ethiopia to the east, Kenya to the southeast, Uganda to the south, the Democratic Republic of the Congo to the southwest, the Central African Republic to the west, and Sudan to the north. South Sudan includes the vast swamp region known as the Sudd formed by the White Nile.

The modern states of South Sudan and Sudan were part of Egypt, later being governed as an Anglo-Egyptian protectorate until Sudanese independence was achieved in 1956. Following the First Sudanese Civil War, the Southern Sudan Autonomous Region was formed in 1972 and lasted until 1983. A 2nd Sudanese civil war soon developed and ended with the Comprehensive Peace Agreement of 2005. Later that year, southern autonomy was restored when an Autonomous Government of Southern Sudan was formed. South Sudan became an independent state on 9 July 2011, and it is now a United Nations member state and a member state of the African Union, A map of South Sudan can be accessed at: http://www.unhcr.org/pages/4e43cb466.html.

Hepatitis E is found worldwide and different genotypes of hepatitis E virus determine differences in epidemiology. Genotype 1 is usually seen in developing countries and causes community level outbreaks while genotype 3 is usually seen in developed countries and does not cause outbreaks. Globally, 70 000 deaths and 3.4 million cases of acute hepatitis E are attributable to infection with hepatitis E virus genotypes 1 and 2. The highest seroprevalence rates are observed in regions where low standards of sanitation increase the risk for transmission of the virus. In Egypt, half the population aged above 5 years is serologically positive for hepatitis E virus. [see: http://www.who.int/mediacentre/factshee ... index.html.]

Hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Other transmission routes have been identified, which include foodborne transmission from ingestion of products derived from infected animals, and vertical transmission from a pregnant woman to her fetus. The risk factors for hepatitis E infection are related to poor sanitation in large areas of the world and shedding of hepatitis E virus in faeces. Currently there is no vaccine available for control of hepatitis E virus infection. Fortunately, hepatitis E virus infection is usually self-limiting. However, hospitalization is necessary for people with fulminant hepatitis, and desirable for infected pregnant women.

Lack of adequate sanitation for many of the inhabitants of South Sudan is responsible for the escalating outbreak. On 14 Sep 2012 ProMED-mail reported at least 400 cases and 16 deaths in 3 refugee camps in South Sudan. The death toll has now reached at least 26, and the case number at least 1050. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3q1_.]

YELLOW FEVER - AFRICA (12): SUDAN (DARFUR, KHARTOUM)
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[1]

Date: 10 Nov 2012
Source: Radio Dabanga [edited]
http://www.radiodabanga.org/node/38199


Yellow fever arrives in Khartoum
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The Minister of Health from the state of Khartoum revealed the emergence of the 1st case of yellow fever in the capital of Sudan, according to a press statement from Thu 8 Nov 2012. Minister Mamoun Hamida said this is the same type of fever that has been spreading in Darfur. Hamida explained that the infected patient has been isolated and will be submitted to health care. He advised citizens from Khartoum to use mosquito nets to prevent the disease.

The press statement also read that a vaccination campaign against yellow fever will be launched in Khartoum. In addition, the government will reportedly distribute 150 mosquito nets in areas where most mosquitoes are found and it will monitor the movement of people traveling out of Sudan, who will be obliged to get vaccinated in health centers. The Sudanese Council of Ministers appealed to citizens to restrict their movement to the affected areas, as the disease is infectious and is spread by mosquitoes.

At the same time, the Chairperson of the Committee on Health and Social Affairs of the parliament, Amira al-Sir, announced that airplanes coming from Darfur to Khartoum will be sprayed with pesticide.

Central Darfur
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According to a coordinator of Hamidiya camp in Zalingei, Central Darfur, local citizens are complaining about the lack of vaccinations and the lack of treatment against the yellow fever. They are also discontent with the lack of health education provided by the government concerning information about the disease and how to prevent it. Citizens claimed that ... doctors, specialists and states' ministers are prevented from releasing information about it to the media. Darfur citizens demanded that the government declares the region a 'disaster zone' ...

Central Darfur residents confirmed to Radio Dabanga that both the local and federal ministries of health have not yet launched spraying campaigns or begun the distribution of mosquito nets.

The disease 1st appeared in the region 2 months ago. Civilians appealed to the World Health Organization to immediately intervene in the situation. They also demanded that the government of Sudan lifts movements' restrictions in Darfur so that humanitarian organizations can reach the affected areas.

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Sudan: Fever Kills 78, Reaches 'Epidemic Level'
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The spread of yellow fever in Darfur reached an 'epidemic level' that requires immediate intervention from the central government, according to an announcement made by Member of Parliament Ibrahim Abbaker on Wed 7 Nov 2012.

According to an official from the Ministry of Health from Khartoum, the number of cases of hemorrhagic fever in Darfur has reached more than 220. He revealed that 78 people have died so far in 18 localities.

The official disclosed to Radio Dabanga that the World Health Organization (WHO) sent samples of the virus to Dakar, in Senegal, for examination. This way, he explained, authorities will find out the exact nature of the disease that is spreading across Darfur.

The source hopes that the Sudanese Ministry of Health will receive the result of the tests this week still, so that vaccines against the disease can be ordered and a campaign targeting 3.5 million people in Darfur can be launched. He expects that, once ordered, the vaccines would arrive within 2 weeks in Darfur, Radio Dabanga was informed.

The ministry of health from South Darfur announced that 47 people had been infected with the fever by Tuesday [6 Nov 2012]... In a statement, the ministry stressed the importance of providing vaccinations to citizens of Darfur. At the same time, Issa Mohamed, minister of health of Central Darfur, revealed that yellow fever cases rose to 141, including 58 deaths, until Tuesday.

In West Darfur, the government announced that the total cases of yellow fever reached 51 by Tuesday, and that 22 people have died.

The federal Ministry of Health has reportedly issued strict orders to health ministers from Darfur preventing them from talking or making any statements to the media concerning the yellow fever epidemic and its mortality rates. Instead, ministers are expected to provide facts about the disease to the federal department of epidemiology 3 times a week, sources told Radio Dabanga. This way, they explained, the federal government can process the information before releasing it to the media... In addition, citizens demanded that the government officially declares Darfur a 'disaster area.'

Darfur residents are calling on the international community and humanitarian organizations, including the WHO, to immediately intervene and save human lives in Darfur.

New mosquito type
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Ali Mirghani, South Darfur director of epidemiology revealed to Radio Dabanga that a new type of mosquito has been spreading in 2 Nyala neighborhoods, Sikka Hadeed and Al-Wadi. He called on media campaigns to educate citizens about combating the larval and water stages of these mosquitoes. Meanwhile, the federal Minister of Health, Bahr Idriss Abu Garda, stated that the disease spread by this mosquito can be controlled with vaccinations. Lastly, Mirghani revealed that an armed group has kidnapped 2 vehicles with 3 employees of the ministry of health who were working on spraying areas around Mershing and East Jebel Marra, North Darfur, Radio Dabanga has learned on Thursday [8 Nov 2012].

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I repeat that, since yellow fever vaccination needs 10 days to become protective, it is urgent to start mass vaccination as soon as possible -- but the security situation in Darfur is obviously difficult. - Mod.JW]

WEST NILE VIRUS - NORTH AFRICA (03): TUNISIA
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Date: Tue 6 Nov 2012
Source: Babnet Tunisie [in French, trans. Mod.TY, edited]
http://www.babnet.net/cadredetail-56341.asp


The Jendouba Regional Health Director, Souheil Bali, stated that a 2nd death has been registered following a West Nile virus infection. She was a 56-year-old woman from the Kalaa locality, in the Ghardimaou delegation (Jendouba governorate), who died this past Saturday [3 Nov 2012] following this illness.

The same source added in a statement to a correspondent of the TAP agency in Jendouba that the woman, who suffered from a chronic illness, died in the Aziza Othmana Hospital in Tunis. This 2nd death occurred after that of a 52-year-old diabetic man who died in the Jendouba Regional Hospital on 1 Oct 2012.

The Regional Director stated also that 2 other cases with this illness have been registered. They have been treated, [one] in the Jendouba Regional Hospital and [the other] in one of the Tunis hospitals.

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[Cases of West Nile virus (WNV) infection have continued to appear in Tunisia in recent months. So far this year (2012), the number of human WNV infections in Kebili governorate has reached 11. WNV also has caused other human cases in Tunisia in recent years: in 2010, 3 cases (Jendouba and Tataouine governorates); in 2011, 3 cases (Kebili governorate); and to date in 2012, 28 cases (Gabes, Jendouba, Kebili, Mahdia, and Monastir governorates).

A map of Tunisia can be accessed at
http://www.planetware.com/i/map/TUN/tunisia-map.jpg. - Mod.TY

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

YELLOW FEVER - AFRICA (13): SUDAN (DARFUR, KHARTOUM) CONTROL
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Date: 11 Nov 2012
From: Paul Reiter


The news from Darfur must surely be treated as an international emergency; 3.5 million refugees are housed in camps in the province and water is an increasing problem. The virus has now reached Khartoum (pop. more than 5 million); a major epidemic could spawn the global catastrophe that entomologists and other public health specialists have been predicting for decades.

The most frightening aspect of this emergency is the critical need for refugees to store water. According to the African Union - United Nations Mission in Darfur (UNAMID):

"Understanding that the scarcity of water is one of the lead causes of conflict in Darfur, UNAMID has carried out a large number of projects aimed at helping rural and urban communities in the region gain access to this invaluable resource.

"Recent efforts include helping to organize an international conference on water, bringing together more than 200 experts in water use and distribution and leading development specialists and donors in Khartoum on 27 Jun 2011. This is the first major international effort to build an innovative and sustainable water service system for all communities in Darfur".

_Aedes aegypti_, which is undoubtedly the principal vector in this epidemic, is a container-breeding species. Water storage containers are classic sites. They have been the root cause of some of the most devastating outbreaks of yellow fever in history.

It is irrelevant whether, as reports suggest, a "new species of mosquito" is present, just as the "nature of the disease" is also irrelevant. Yellow Fever has been identified: Yellow Fever vaccination should begin immediately and energetic anti-mosquito measures should also be implemented.

Just as worrying are other articles on the UNAMID pages. For example:

"At the request of the North Darfur State Ministry of Education, the Mission will provide potable water to nearly 12 000 students at examination centers and dormitories for the next 16 days. UNAMID also delivered water earlier in the year for 8th graders taking their secondary school entrance exams".

"As more than 400 000 children nationwide today sat to take their Secondary Certificate Examinations, UNAMID began the first daily delivery of more than 30 000 litres to students in El Fasher, many of whom had travelled from smaller villages".

Once delivered, this water will not come out of a tap. It will be put into pots or drums. Women will carry pots to their homes and to neighboring villages.

Susceptibility of the mosquito(s) to insecticide is the only basic information that is needed. If the mosquito larvae are susceptible to temephos, this should be used to treat water in storage jars. The method has been routinely used for decades in the Caribbean, Latin America and SE Asia. Treatment is simply by dropping a teaspoonful (or other suitable measure) of the granular formulation into each container. Treatment will last at least three weeks, more so if the water is fairly clean

Vehicle-mounted "fogging machines" that dispense insecticidal aerosols to kill adult mosquitoes are very expensive and have little or no impact on _Ae. aegypti_, mainly because the species rests indoors. I suspect this is the case in Darfur, where the humidity outdoors is very low. [Mosquitos resting outdoors would quickly become fatally dehydrated. - Mod.JW.]

Hand-operated foggers inside buildings can be very effective but the treatment is labour-intensive and slow. Treatment could begin in areas known to be affected by the virus.

In the 1960s, the Pan American Health Organization declared the _Aedes aegypti_ eradication campaign an outstanding success; the species had been eradicated from 22 countries. The method used was "focal treatment" of breeding sites: DDT was sprayed into and for 50cm around each container that was positive for mosquito larvae. DDT and the other residual insecticides kill by contact when the insect alights on the treated surface. The method was fast, safe and practical to apply, clearly a vital advantage in this pending catastrophe.

If the mosquito is susceptible to DDT then this would be the method and insecticide of choice: cheap, safe and highly effective. If resistance to DDT is significant, there may well also be resistance to residual pyrethroids such as permethrin and deltamethrin, in which case, the only rapidly available insecticide would be one of the carbamates. All these insecticides are cheap and easy to apply.

During the eradication campaign, treatments remained effective for at least 4 months. The astonishing success of the project was probably driven by the behaviour of the mosquito; females fly from site to site, depositing a few eggs here and there. In this way, even if all the positive breeding sites are not treated, the probability is high that an egg-laying female will hit a treated site [and its eggs will never develop. - Mod.JW]

In Darfur, spray-men with simple, portable hand-pumped sprayers would simply apply insecticides to the sides and surrounding of the water storage jars. No need to search for other sites, no need to inspect for the presence of larvae.

Bed-nets are not generally recommended for protection against _Ae. aegypti_ because the species bites more during daylight than at night. Nevertheless, bed-nets over suspected cases may reduce the numbers of mosquitoes that become infected and the number of infective bites; they should be installed in hospitals and similar sites. Infants can also be protected by bed-nets.

Mosquito screens are expensive to install but should be essential in hospitals and other places where patients are present.

In theory, "Source reduction" -- the elimination of breeding sites -- is an effective approach to suppress the mosquito population but clearly, in a land where water is worth gold, the refugees are not going to empty water storage jars. In theory, jars can be covered, but covers must be a tight fit because mosquitoes are adept at finding the tiniest gaps.

In summary, it is hard to overestimate the seriousness of this situation. As mentioned, the virus has already reached Khartoum (population of the city and adjoining cities over 5 million); water storage is widespread, especially in residential areas.

If transmission becomes epidemic in Khartoum then the world is open to catastrophe; the number of vaccines available is limited and the global dispersion of the virus could affect any place where dengue and chikungunya are transmitted, whether by _Ae. aegypti_, _Ae. albopictus_ or other species.

In other words, more than 2.5 billion people throughout the tropics and subtropics would be at risk.

http://unamid.unmissions.org/Default.as ... uage=en-US

http://unamid.unmissions.org/Default.as ... emID=17224

***These notes are my own opinion: they are not necessarily in agreement with recommendations of my employer or other institutions and organizations.

--
Paul Reiter, PhD, FRES
Unit "Insectes et Maladies Infectieuses"
Institut Pasteur
25-28 rue du Dr Roux
75015 Paris
France
Tel: +33 (0) 1 44 38 95 62
Sec: +33 (0) 1 45 68 89 67
Fax: +33 (0) 1 45 68 87 28
Mobile: +33 (0) 6 08 36 16 70
email: paul.reiter@pasteur.fr

[***"More than 2.5 billion people throughout the tropics and subtropics would be at risk."

Although DDT has been banned in some developed countries, its use in an emergency like this would be well justified.

The Greida refugee camp, south-east of the Darfur town of Nyala, Sudan:
http://static.guim.co.uk/sys-images/Gua ... fur372.jpg
Location of Darfur refugee camps in 2007:
http://upload.wikimedia.org/wikipedia/c ... ps_map.gif
- Mod.JW]

WEST NILE VIRUS - NORTH AFRICA (04): TUNISIA
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Date: Tue 13 Nov 2012
Source: DirectInfo [in French, trans. Mod.TY, edited]
http://directinfo.webmanagercenter.com/ ... -a-mahdia/


M Kamel Ben Salem, regional public health director (Mahdia governorate) reported yesterday [Mon 12 Nov 2012] over [radio] Jawhara FM, that 7 cases of West Nile virus [WNV] infection have been admitted to the Mahdia Regional Hospital.

Three of these cases have been discharged from hospital after their recovery, and the other 4 are still being treated at the Mahdia Regional Hospital.

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[There have been previous cases of WNV infection reported from Mahdia governorate this year (2012). It is not clear whether these are new cases or ones previously reported. So far this year, 28 cases in Gabes, Jendouba, Kebili, Mahdia, and Monastir governorates have been reported.

A map of Tunisia can be accessed at http://www.planetware.com/i/map/TUN/tunisia-map.jpg. - Mod.TY

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

Sudan - Infektionen allgemein
16.11.2012

Darminfektionen, vor allem Durchfallerkrankungen, sind weit verbreitet, auch mit Ruhr und Cholera ist landesweit zu rechnen, vor allem im S. Hohes Risiko für Hepatitis A und E, durch Nahrung und Trinkwasser übertragene Form der infektiösen Gelbsucht, sowie für Hepatitis B durch Blut- und sexuelle Kontakte. Tollwut ist im Land verbreitet und wird vor allem durch streunende Hunde übertragen. Hirnhautentzündungen (Meningokokken) treten saisonal in der Trockenzeit auf. Malaria nimmt nach Süden hin zu. Im Süd-Sudan gibt es auch Schlafkrankheit, Rückfallfieber, Affenpocken sowie virale hämorrhagische Fieber. In der Region Darfur gibt es seit Anfang Oktober einen Ausbruch von Gelbfieber. Größere Ausbrüche von Gelbfieber wurden 2003 und 2005 verzeichnet. Ausbrüche von Ebola-Fieber wurden 1976 und 2004 sowie Rift Valley-Fieber zum Jahreswechsel 2007/8 beobachtet. Hygiene und adäquaten Impfschutz beachten. / Quelle: crm

Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (50): AFRICA
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In this update:
[1] Cholera - Uganda (Arua District)
[2] Cholera - Nigeria (Osun State)
[3] Cholera - Ghana (Western Region)
[4] Cholera - Ghana (Ashanti Region)

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[1] Cholera - Uganda (Arua District)
Date: Mon 26 Nov 2012
Source: AllAfrica, The New Vision (Uganda) report [edited]
http://allafrica.com/stories/201211260410.html


The authorities in Arua municipality have closed Hope Kebir primary school following a cholera outbreak in the area. The school is located among heavily crammed settlements in Kenya ward, Oli division where sporadic cholera cases have been reported since October 2012.

Norah Fathu, the municipal principal health inspector said they found out last week [week of 19 Nov 2012] that 2 cholera patients were sharing a latrine with the children from the school located less than 10 meters away from their house. The school is housed in a building where the landlord rents out some rooms to accommodate other tenants. "This literally put the lives of the children in danger and we advised the education department to close the school," she said.

The latest outbreak brings to 32 the number of cholera patients treated at both Oli health centre IV and Arua hospital since October 2012. 2 of the patients died while another is still being treated in the hospital.

However, the municipal principal education officer Joachim Ozimati told journalists in his office on Thursday [22 Nov 2012] that Hope Kebir was one of the 8 unregistered primary schools operating in the municipality that were earmarked for closure early in 2013. The school had over 130 children in the nursery and 92 in the primary section which has classes only up to primary grade 3.

Ozimati said the school will remain indefinitely closed until the proprietors meet the minimum benchmarks including constructing proper classrooms and separate latrines for boys, girls, and the teachers. He advised schools that do not have capacity to handle both nursery and primary sections to limit themselves to one section until they acquire the necessary facilities for expansion.

[Byline: Richard Drasimaku]

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A HealthMap/ProMED-mail interactive map of Uganda can be found at: http://healthmap.org/r/1wa6. - Mod. LL]

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[2] Cholera - Nigeria (Osun State)
Date: Thu 22 Nov 2012
Source: AllAfrica, The Daily Trust report [edited]
http://allafrica.com/stories/201211230349.html


A pregnant woman and her mother-in-law have been killed by cholera in Ede, Osun State while about 42 people have been hospitalized as a result of the outbreak of the disease. The outbreak of cholera disease was recorded in Ede North and South local government areas of Osun state and is also said to have been responsible for the death of some other residents of the town.

A resident of the town who works with a Non-Governmental Organization known as Eminent Charitable and Humanitarian Foundation told Daily Trust that about 42 people have been placed on admission at various hospitals in the town. It was gathered that the recent outbreak of the disease was the fall out of indiscriminate disposal of refuse by the people of the 2 councils. Some of the patients are being admitted at the Muslim hospital, Prime hospital, and Rombay Hospital all in Ede.

[Byline: Abdul-Hameed Olawale]

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A HealthMap/ProMED-mail interactive map of Nigeria can be found at: http://healthmap.org/r/1qGF. - Mod. LL

*****
[3] Cholera - Ghana (Western Region)
Date: Thu 15 Nov 2012
Source: Ghana Business News, Ghana News Agency (GNA) report [edited]
http://www.ghanabusinessnews.com/2012/1 ... wa-nsueam/


The Tarkwa Government Hospital has recorded an increasing number of cholera cases from certain parts of the Tarkwa Nsueam Assembly. No deaths have been recorded yet. Victims who normally visit the hospital for treatment on the outbreak come mainly from areas such as Akyempim, Old Town, Cyanide, Bankyim, Nkamponase, and Esuoso.

Briefing the Ghana News Agency on the current situation of the epidemic on Wed 14 Nov 2012, the Municipal Disease Control Officer, Mr Ebenezer Tetteh said a total of 140 cases had been recorded since the disease was detected 2 weeks ago. He said his outfit was putting up the necessary measures to contain the outbreak and cited poor sanitation in the constituency as the major contributory factor. Mr Tetteh said to curb the situation, which had become a yearly affair, the Assembly and the environmental department should create an appropriate dumping site for refuse to be properly disposed.

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[Maps of Ghana can be found at http://www.ghanadistricts.com/home/?_=27 and http://healthmap.org/r/1jUt. - Mod.LL]

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[4] Cholera - Ghana (Ashanti Region)
Date: Wed 21 Nov 2012
Source: CitiFM Online [edited]
http://www.citifmonline.com/index.php?id=1.1151419


The Ejura Government Hospital in Ashanti Region has recorded 4 deaths following the outbreak of cholera in the area. 144 persons are also said to have contracted the disease within 2 weeks.

Citi News' Ashanti Regional correspondent, Betty Ohemaa Agyemang, reports that the authorities of the Ejuraman Senior High School in the Region have confirmed the death of a male student as a result of the disease. 9 other infected students have been treated and discharged from the Ejura Government Hospital.

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WEST NILE VIRUS - NORTH AFRICA (05): TUNISIA (BIZERTE)
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Date: Tue 20 Nov 2012
Source: Babnet Tunisie [in French, trans. Mod.TY, edited]
http://www.babnet.net/cadredetail-56914.asp


In the Bizerte governorate, 5 cases of West Nile virus infections have been registered; 4 were treated and one elderly woman died, the Regional Health Director announced.

A working session was held Monday [19 Nov 2012] at the headquarters of the governorate to discuss ways to strengthen surveillance to fight against this disease.

This same meeting was an occasion to restructure the regional commission for the fight against diseases, made up of representatives of the Regional Health Administration, the Regional Agricultural Development Commission, the National Sanitation Office, and the municipalities.

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[This report adds another governorate with clinical cases of West Nile virus infection. As of 14 Nov 2012, this year there have been previous cases of WNV infection reported from Mahdia governorate. As of that date, 28 cases in Gabes, Jendouba, Kebili, Mahdia, and Monastir governorates have been reported. Now, another 5 cases can be added to this total.

A map of Tunisia can be accessed at http://www.planetware.com/i/map/TUN/tunisia-map.jpg. A HealthMap/ProMED-mail interactive map can be accessed at http://healthmap.org/r/1Cft. - Mod.TY]

Sudan - Gelbfieber
26.11.2012

In der Region Darfur gibt es seit Anfang Oktober einen Ausbruch von Gelbfieber, mehr als 500 Personen sind erkrankt. In einigen Regionen wurden bereits Impfkampagnen gestartet, weitere sind geplant. Größere Ausbrüche von Gelbfieber wurden 2003 und 2005 verzeichnet. Impfschutz empfohlen, kosequenten Mückenschutz beachten. / Quelle: crm
___________________

Uganda - Ebola
26.11.2012

Im Distrikt Luwero, etwa 40 km nördlich von Kampala (Z), ist es im November erneut zu einem Ebola-Ausbruch mit bisher 6 bestätigten Fällen, 4 Verdachtsfällen und 5 Todesopfern gekommen. Erst einen Monat zuvor hatte die WHO Uganda für Ebola-frei erklärt. / Quelle: crm

Gruß
Birgitt

RABIES, CANINE - SWAZILAND
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Date: Sat 1 Dec 2012
Source: Observer.org (Swaziland) [edited]
http://www.observer.org.sz/index.php?ne ... Lt6HuSzKSo


A rabies outbreak has been reported in the Manzini region almost 2 months after dogs were vaccinated countrywide.

The most affected areas are Ludzeludze, Ngabezweni and Dwaleni Power Station, and the outbreak is so bad that the ministry of agriculture has decided to revaccinate canines.

The outbreak was 1st spotted at Ngabezweni when a dog from a legislator's family, a Dlamini, went berserk, chasing after people and barking at its shadow.

Because the dog was a nuisance to the community, they decided to team up against it and stoned it to death then called for veterinary assistance from Ludzeludze Rural Development Area (RDA), who took it for tests.

A few days later, another report was received from Dwaleni (Power) about a troublesome dog, whereby veterinary officers took it for tests. "The dogs tested positive to rabies, and it was then that we resolved to undertake the revaccination exercise. Our investigations also revealed that owners of both dogs did not vaccinate them when the ministry conducted the exercise in September [2012?]. One wonders why people fail to vaccinate their dogs when called to do so, because it is free," said a source from the ministry of agriculture.

It was then gathered that the revaccinating exercise began on Monday [26 Nov 2012], and areas within a radius of 7 km also have to be visited, where all the dogs will be revaccinated.

The source revealed that one of the major challenges that might compromise the revaccinating exercise was the shortage of chemicals [vaccines?].

Reached for comment, Director of Veterinary Services Dr Xolani Dlamini said he was not aware of the matter and had to investigate it further.

[Byline: Faith Vilakati]

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[As with the entire African continent, animal rabies is endemic in Swaziland, mainly involving dogs. According to Swaziland's annual OIE reports, the number of cases in dogs for 2011 was 26 and for humans 38 (rate per 100 000 population = 3.2371). For comparison: India, generally regarded to rank high among rabies-stricken countries, reported 162 human cases (0.015 per 100 000) during 2010 (most recent available quantitative information).

During 2011, 60 868 dogs have reportedly been vaccinated in Swaziland. - Mod.AS

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3psa.]

UNDIAGNOSED FATALITIES - NIGERIA: (ADAMAWA) REQUEST FOR INFORMATION
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Date: Fri 7 Dec 2012
Source: All Africa, Daily Trust report [edited]
http://allafrica.com/stories/201212070831.html


At least 5 people have been confirmed dead, while 70 others are lying critically ill at the hospital following an outbreak of a yet to be diagnosed ailment. It was gathered that over 200 households in the border area of Mubi-South in Adamawa State have been affected.

On Wednesday [5 Dec 2012], Usman Lamorde, member representing Mubi-South in the state House of Assembly, confirmed the death toll, saying the nature of the disease has not been determined.

Speaking on the floor of the House, Usman Lamorde said over 200 households were affected in Nduku-Seranyi village. "This disease comes without warning, and by the time it is discovered, it's too late. The disease is characterized by excessive vomiting, diarrhoea, high fever, and in some instances, coughing, hence the need for urgent intervention," he said.

Following the motion, Speaker of the state Assembly, Umaru Ahmad Fintiri, ordered that health officials be deployed with immediate effect to curtail the spread of the disease.

When contacted, the state's Commissioner for Health, Mrs Lilian Stephen, said disease control personnel have moved to the affected areas, and that the state government is waiting for the outcome of the specimen sent for analysis.

According to her, samples have since been sent to the Federal Medical Centre (FMC) Gombe for analysis.

[Byline: Ibrahim Abdul'Aziz]

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[Checking the newswires for additional information on the outbreak mentioned above revealed that there has been flooding in Adamawa state recently (http://nigeria.news24.com/National/News ... s-20121203). The history of recent flooding followed by an outbreak of a febrile illness with gastrointestinal symptoms (excessive vomiting and diarrhea) and, as mentioned above, some respiratory component (coughing) suggests diseases that are more prone in the rainy season including such diseases known to have rodents as intermediate hosts and where there is exposure to rodents and their excretions, such as Lassa fever, Ebola virus disease, and leptospirosis to mention a few. Of note, there was a report of Lassa fever outbreak activity in Taraba state earlier this year (February 2012 -- see ProMED-mail Lassa fever - Nigeria: (03) (TA), fatalities 20120211.1039402). In another report in February 2012, there was mention of Lassa fever cases in Edo, Nasarawa, Plateau, Ebonyi, Taraba, Yobe, Ondo, Rivers, Gombe, Anambra, Delta, and Lagos (see ProMED-mail Lassa fever - Nigeria (04) 20120223.1050129). Another illness that manifests with excessive vomiting and diarrhea is cholera, although high fever is not often seen with cholera.

More information on the results of laboratory and epidemiologic studies of this outbreak would be greatly appreciated.

Adamawa state is located in the northeastern part of Nigeria. Bordering states include Borno to the northwest, Gombe to the west, and Taraba to the southwest. It shares its eastern border with Cameroon. For a map of Nigeria showing states, see http://www.mapsofworld.com/nigeria/nige ... l-map.html. For the HealthMap/ProMED map of Nigeria see http://healthmap.org/r/4s3R. - Mod.MPP]

TYPHOID FEVER UPDATE 2012 (12): ZIMBABWE (HARARE)
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[1]
Date: Wed 5 Dec 2012
Source: Zimeye [edited]
http://www.zimeye.org/?p=68014


A life threatening typhoid outbreak has been reported in Harare's Dzivaresekwa high-density suburb and surrounding areas, about 10 km from the capital city. An alert was sent out last night [4 Dec 2012] through the Harare Residents Trust issuing caution to people in the area. It is reported that school children at Nhamburiko Primary School have recorded the highest figures of affected people to date.

Harare city council authorities have been blamed for the outbreak due to council's failure to provide clean water supplies to residents. The capital is not new to the bacteria [_Salmonella enterica_ serotype Typhi], and earlier this year [2012], environmental scientists revealed that many water sources across the city have been affected due to sewer spillage.

One Hararian protested against the mayor: "The Mayor looks down upon the poor and the marginalised. He thinks they are lazy and do not want to develop. But give him an opportunity, [and] he is convincing in his presentations but lacks on delivery and relevance to the citizenry."

A statement by the Harare Residents Trust reads: "Alert: There has been a typhoid outbreak in Dzivarasekwa. The local clinic has transferred about 15-16 people to Beatrice Infectious [Diseases] Hospital every day since last week. The most affected are the pupils at Nhamburiko Primary School. Harare City Council's failure to provide clean water to the residents is compounding the situation!"

Presidential Health consultant Dr Timothy Stamps has provided guidance on identifying typhoid as follows:

Typhoid is especially an urban disease. The diagnosis can only be made definitely by either a blood culture (which indicates that the infectious organism has gotten into the blood system) or by rectal swab/faecal culture of the causative organism. Indirect methods such as the Widal titre (O and H antigens) are of limited value, especially as an outbreak progresses.

The classical picture of typhoid fever is a temperature which is intermittent for the 1st week or so of the illness, then becoming persistent and sometimes very high, coupled with vague symptoms such as headache, weakness, sore joints, abdominal pains (especially in the appendix area), and constipation (kufufutirwa) rather than diarrhoea (manyoka).

Most typhoid sufferers react badly to aspirin, headache pills, or powders and in a generalised outbreak should be restricted.

Rose spots, which disappear on pressure, occur on the chest and upper abdomen in the 1st week of the disease; they are not easy to detect in most Zimbabweans.

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[2]
Date: Fri 7 Dec 2012
Source: Allafrica.com [edited]
http://allafrica.com/stories/201212080080.html


Zimbabwe's capital city remains on high alert because of the ongoing spread of typhoid, with at least 5 related deaths registered in Harare since October 2012.

These latest deaths have been recorded mainly in the Glenview suburb where a fresh outbreak was reported in October 2012, a year since the 1st outbreak in Harare in 2011. Residents in Dzivarasekwa have also been warned about an outbreak of the disease there, where the local clinic has been transferring about 15-16 people to Beatrice Infectious [Diseases] Hospital every day since last week. According to a local residents association, the main bulk of the patients have been pupils from Nhamburiko Primary School.

Harare City Health Deputy Director Dr Prosper Chonzi said other new cases have also been reported in Mabvuku, Tafara, and other suburbs that have no access to clean water. "The fight against typhoid, which began in the city last year [2011], is far from over, as we continue to record fresh outbreaks," he said.

Typhoid cases have been reported in different parts of Zimbabwe since last year [2011], with the worst affected areas being the densely populated suburbs around Harare's centre, including Kuwadzana and Mufakose. More cases have been reported throughout the year in Bindura, Mashonaland Central, and Norton and Zvimba in Mashonaland West. Chitungwiza and Kadoma have also reported serious outbreaks, with the local authorities being blamed for failing to provide clean water.

The latest outbreak in and around Harare brings the number of suspected cases registered across the country to about 5000. In February this year [2012], the Health Ministry admitted it was not on top of the situation, with a critical lack of medicine and clean water hampering treatment and prevention efforts. Many local councils too have been unable to provide proper sanitation to their residents, blaming broken down sewerage systems and water pipes for this failure.

Dr. Rutendo Bonde, the chairperson of the Zimbabwe Doctors for Human Rights, told SW Radio Africa on Friday [7 Dec 2012] that until there are lasting measures to combat water shortages, [effective] water provision, and sewage maintenance, diseases like typhoid will continue to be a threat.

Bonde, meanwhile, said that there are basic measures of prevention that can be adopted if possible, including following simple sanitation routines. She said measures like hand washing are critical to stop the disease from spreading further.

[Byline: Alex Bell]

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[The densely populated suburbs around Harare have continued to suffer an ongoing outbreak of typhoid fever since October 2011. As of 2 May 2012, a total of 4185 suspected cases of typhoid fever had been identified in Harare (see ProMED-mail post Typhoid fever update 2012 (11): Zimbabwe (Harare) 20120614.1168345). The latest outbreak in and around Harare brings the total number of suspected cases reported to about 5000, with at least 5 related deaths since October 2012.

An investigative team from the U.S. CDC, in collaboration with Zimbabwe government officials, attributed this outbreak to fecal contamination of drinking water in the overcrowded residential suburbs of Harare, where rural-to-urban migration has outpaced maintenance and expansion of water supply and sewerage infrastructure (CDC. MMWR. Notes from the Field: _Salmonella Typhi_ Infections Associated with Contaminated Water -- Zimbabwe, October 2011-May 2012 Weekly June 15, 2012 / 61(23);435-435. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6123a3_e).

Harare is the largest city and capital of Zimbabwe and has an estimated population of 1 606 000 (2009), with 2 800 000 in its metropolitan area (2006) (http://en.wikipedia.org/wiki/Harare). Numerous suburbs surround the city. The northern and northeastern suburbs of Harare are home to the more affluent population of the city. Glenview is in the southern suburbs, and Dzivaresekwa is in the western suburbs (http://en.wikipedia.org/wiki/Harare#Suburbs).

Harare can be located on the HealthMap/ProMED-mail interactive map of Zimbabwe at http://healthmap.org/r/1r1O. - Mod.ML]

UNDIAGNOSED FATALITIES - NIGERIA (02): (ADAMAWA), REQUEST FOR INFORMATION
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Date: Sun 9 Dec 2012
From: Shamsudeen Fagbo <oloungbo@yahoo.com> [edited]


From a One Health and practical point of view, one important differential diagnosis that needs to be considered in situations like this is Rift Valley fever. Work in the once vibrant Rockefeller funded Virology lab in the University of Ibadan by Tomori and others (see one reference below) clearly demonstrated RVFV circulation in Nigeria. Are the clinicians involved in situations such as in Taraba considering RVF as a differential diagnosis? Does lab capacity to diagnose evidence of RVFV exist?

Increased risk for Rift Valley fever transmission post flooding/heavy rainfall is well documented. It would be helpful if data on animal health patterns (especially abortions) and mosquito population dynamics post flooding can be obtained. In Taraba state, especially in the Mambilla Plateau region, there is large-scale livestock farming involving many animals. Without active animal health surveillance, animal illness events (e.g. abortions/neonatal mortalities) preceding human involvement could be missed, limiting the opportunity to incorporate such data into timely, preventive health measures, as expected in the true spirit of One Health.

Reference:
Tomori O, Fabiyi A, Sorungbe A, Smith A, McCormick JB. Viral hemorrhagic fever antibodies in Nigerian populations. Am J Trop Med Hyg. 1988 Mar;38(2):407-10 [abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/3128130].

--
Shamsudeen Fagbo, DVM, MSc
National Coordinator
Zoonotic Diseases Unit
General Directorate of Infectious Disease Control
Ministry of Health
Riyadh 11176

[ProMED-mail would like to thank Dr. Shamsudeen Fagbo for his excellent comments and for reminding us of the possibility of Rift Valley fever (RVF) as a possible etiology for this outbreak. Dr. Fagbo raises excellent points and excellent questions to be addressed. While RVF has not been reported in Nigeria on ProMED-mail, the virus is definitely present in Northwest Africa, as can be verified through the reports of a major outbreak in Mauritania earlier this year (2012, see prior ProMED-mail posts below).

This moderator was not able to identify reports of actual documented outbreaks of RVF in Nigeria, but there are a number of serosurveys that have been conducted demonstrating the presence of antibodies to RVF-V in humans and in domestic farm animals in Nigeria (see references below).

1. Olaleye OD, Tomori O, Ladipo MA, Schmitz H. Rift Valley fever in Nigeria: infections in humans. Rev Sci Tech. 1996 Sep;15(3):923-35. (full article available at http://www.oie.int/doc/ged/D9078.PDF)
2. Olaleye OD, Tomori O, Schmitz H. Rift Valley fever in Nigeria: infections in domestic animals. Rev Sci Tech. 1996 Sep;15(3):937-46. (full article available at: http://www.oie.int/doc/ged/D9079.PDF)
3. Adeyeye AA, Ekong PS, Pilau NN. Rift Valley fever: the Nigerian story. Vet Ital. 2011 Jan-Mar;47(1):35-40. (full article available at: http://www.izs.it/vet_italiana/2011/47_1/35.pdf)
4. Ezeifeka GO, Umoh JU, Belino ED, Ezeokoli CD. A serological survey for Rift Valley fever antibody in food animals in Kaduna and Sokoto States of Nigeria. Int J Zoonoses. 1982 Dec;9(2):147-51. (abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/6820360)
5. Tomori O. Rift Valley fever virus infection in man in Nigeria. J Med Virol. 1980;5(4):343-50. (summary available at: http://www.readcube.com/articles/10.100 ... ab=summary).


More information from knowledgeable sources in the region would be greatly appreciated.

Adamawa state is located in the northeastern part of Nigeria. Bordering states include Borno to the northwest, Gombe to the west, and Taraba to the southwest. It shares its eastern border with Cameroon. For a map of Nigeria showing states, see http://www.mapsofworld.com/nigeria/nige ... l-map.html. For the HealthMap/ProMED-mail map of Nigeria, see http://healthmap.org/r/4s3R. - Mod.MPP]

Yellow fever in the Republic of Congo
12.12.2012 - WHO

The Ministry of Health of the Republic of Congo is launching an emergency mass-vaccination campaign against yellow fever in Ewo District in Cuvette-Ouest region, beginning next week.

The emergency vaccination campaign aims to cover approximately 35,000 people in three health districts of Mbama, Ewo and Okoyo, all of which belong to the administrative district of Ewo.

The emergency vaccination campaign is being carried out after recent confirmation of a case with yellow fever virus infection that occurred in October 2012. The case was identified through the national surveillance programme for yellow fever.

Laboratory confirmation was done at Institut National de Recherche Biomédicale Kinshasa (INRB), and reconfirmed by a WHO regional reference laboratory for yellow fever, Institut Pasteur, Dakar, Senegal.

The vaccination campaign is being supported by the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG1), the GAVI Alliance and the European Commission’s Humanitarian Aid and Civil Protection Department (ECHO).
_____

1 The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotation fund. It is represented by United Nations Children's Fund (UNICEF), Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat. The stockpile was created by GAVI Alliance.


Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (55): AFRICA
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In this update:
[1] Cholera, atypical El Tor strain - Guinea
[2] Diarrhea, cholera - Zimbabwe
[3] Diarrhea, fatal - Somalia (Lower Shabelle Region)
[4] Cholera - Sierra Leone (Southern Province)
[5] Cholera, refugees - Burundi



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[1] Cholera, atypical El Tor strain - Guinea

Date: Tue 18 Dec 2012
Source: UN Integrated Regional Information Networks (IRIN) [edited]
http://allafrica.com/stories/201212181137.html


The cholera that struck more than 7000 people in Guinea in 2012 was caused by a new generation of cholera strains, atypical variants of _Vibrio cholerae_ O1 El Tor, epidemiologists have confirmed.

The new strains secrete a toxin more severe than usual strains, creating a more virulent illness, with harsher symptoms and a higher infection rate, according to cholera experts in the region.

The same types of strain are believed to be in Sierra Leone, where cholera affected 22 345 people in 2012. The bacteria are thought to have come to Guinea from Sierra Leone. For now, genetic sequencing has been done only on samples from Guinea; analysis of Sierra Leone samples is under way.

"This discovery of a atypical El Tor strain is worrying, as it confirms the advance of strains that are more severe and more contagious," said Stanislas Rebaudet, an epidemiologist at the university hospital of Marseilles, France, where the _Vibrio cholerae_ strain found in Guinea has been analysed with the support of the UN Children's Fund (UNICEF). "This demands stronger prevention and response efforts."

Africa, West Africa in particular, is the only region of the world where cholera cases are steadily increasing.

Cholera experts say the strain isolated in Guinea was most likely recently imported and not lying dormant in the environment. "This tells us then that cholera is not an inevitability in this region," he told IRIN. He noted that this year's [2012] situation in Sierra Leone and neighboring Guinea demonstrates the importance of cross-border collaboration.

Scientists are continuing their analyses in a bid to identify the source of the strain, epidemiologist Rebaudet says. This type of strain was present in Zimbabwe in 2009, in the Lake Chad Basin in 2009, and is also found in Haiti currently.

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[For a discussion on these atypical strains, see below. An interactive HealthMap of the area can be found at http://healthmap.org/r/1tx-. - Mod.LL]

******
[2] Diarrhea, cholera - Zimbabwe
Date: Thu 6 Dec 2012
Source: Newsday [edited]
http://www.newsday.co.zw/2012/12/06/dia ... ases-soar/


Cases of diarrhea are on the increase in Zimbabwe owing to the deteriorating sanitation conditions in the country, Health and Child Welfare minister Henry Madzorera has said. Giving an update on the outbreaks of typhoid, cholera, and diarrheal diseases in Harare on Tuesday [4 Dec 2012], the minister said the majority of cases and deaths had been recorded among children under the age of 5.

Madzorera said it would be difficult with the high number of diarrhoea cases to meet the United Nations' Millennium Development Goal number 4 and urged communities to take caution during the rainy season. "As we approach the critical period which will coincide with the festive season, I remind all Zimbabweans to take extra caution to avoid falling victim to typhoid, cholera and other enteric diseases," he said.

"The determinants of these preventable, but highly transmissible and fatal diseases remain largely unaddressed in that sustained provision of adequate and safe water is not guaranteed for both urban and rural communities. Sewerage and solid waste is also poorly processed and managed in all the major urban areas."

Statistics presented by Madzorera showed that there were 6000 cases of diarrhea in 2010, increasing to 10 000 in 2011, while in 2012, 12 500 cases had been recorded.

Among the key drivers of the outbreaks are unregulated food vending, poor personal and community hygiene, poor solid waste management, sewerage bursts, and shortages of household water.

[byline: Garikai Tunhira]

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[A ProMED-mail HealthMap interactive map of the area can be found at http://healthmap.org/r/1AY4. - Mod.LL]

******
[3] Diarrhea, fatal - Somalia (Lower Shabelle Region)
Date: Tue 11 Dec 2012
Source: Mareeg [edited]
http://www.mareeg.com/fidsan.php?sid=26894&tirsan=3


Reports from the Lower Shabelle region in southern Somalia say that an outbreak of diarrhea has produced deaths in different small communities in the region. Outbreaks of diarrhea have been reported in the communities of Dudumo gadud, Madax Marodi, Sahan weyn, Saha Yarey, and other larger communities like Yaqbari weyne and Yaqdomar, all in the Lower Shabelle region.

Residents in those parts of the province who spoke to local media said the outbreak can related to the extreme warm weather, which comes at this part of the season.

According to residents in those areas plagued by the diarrhea, there are no medical centers where the affected patients can seek treatment for the disease, which is easy to cure, but without medical help can otherwise be deadly.

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[Fatalities associated with outbreaks of diarrheal illness can suggest cholera as the cause, but in a setting with no medical care, fatalities certainly can occur with other etiologies.

An interactive HealthMap of the area can be found at http://healthmap.org/r/1Ahv. - Mod.LL]

******
[4] Cholera - Sierra Leone (Southern Province)
Date: Fri 14 Dec 2012
Source: Awoko [edited]
http://www.awoko.org/2012/12/14/cholera-still-in-bo/


The cholera outbreak in Sierra Leone has so far from 16 Jul 2012 to 5 Dec 2012 affected about 633 lives in the district of Bo.

Among this total, 297 are males and 386 are females. Among the 297 males, 45 are under 5 years old, while 252 are above 5 years old. Among the 386 females, 47 are under 5, while 339 are above 5. Of the entire 633 total infected, only 27 died at the Bo Government Hospital, while the rest died either at their homes or while on the way to the hospital. This disclosure was made to Awoko by the Bo District Disease Survey officer John Kannie.

He explained that even the 27 deaths at the hospital were "most times due to the late responding and bringing in of the patients to the hospital." Among the 27 dead, 13 are males (2 deaths under 5 years old) and 14 (5 deaths under 5 years old) are females.

In addition, the Ministry of Health has contained the disease in the 16 chiefdoms of Bo, but with Valunya Chiefdom being the only challenge. "We are just getting new reports of the disease in Valunya chiefdom, but forensic investigation continues," Kannie said. This area, he explained, lacks good sanitation, like good toilet facilities, in almost all of the areas of suspected cases.

[byline: Jenkins Bawoh]

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[An interactive HealthMap of the area can be found at http://healthmap.org/r/1KlT. - Mod.LL]

******
[5] Cholera, refugees - Burundi
Date: Mon 10 Dec 2012
Source: International Fed of Red Cross and Red Crescent Societies [edited]
http://allafrica.com/stories/201212110716.html


Tens of thousands of refugees returning to Burundi are now at risk of a health disaster, as cases of cholera increase in their homeland. Burundi has been tackling a deadly cholera outbreak for 2 months, and as hundreds of refugees from Tanzania's Mtabila camp cross the border each day, the International Federation of Red Cross and Red Crescent Societies (IFRC) fears that the large population movement may make things worse.

"So many people on the move significantly increases the risk of cholera and other diseases spreading to, and devastating, new communities," says Dr Ben Adeiza, Africa Zone health and care coordinator for the IFRC. "This has the potential of becoming a very serious issue."

The government of Tanzania announced the closure of the Mtabila refugee camp earlier in 2012. It was home to many Burundians who fled the country decades ago to escape a civil war. The 38 000 refugees due to be repatriated may be at an increased risk of contracting the diarrheal disease, as many do not have homes to return to, and most will have poor access to water and sanitation facilities.

Burundi's government declared a cholera outbreak and a health disaster in October 2012. The disease has infected hundreds of people and has killed at least one person. The number of people affected has been especially high in those areas that are receiving returnees, particularly Nyanza-Lac and Makamba districts.

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[An interactive HealthMap of the area can be found at http://healthmap.org/r/1f*m.

These atypical El Tor strains referred to in the Guinea post above have been discussed in this forum previously while being referred to as the Matlab variants, which were observed initially in strains isolated between 1991 and 1994 in Matlab, Bangladesh (1). Analysis suggested that these variants were derived from the El Tor biotype, but they harbored certain genes of the classical biotype. Similar strains have been found in Mozambique and, indeed, have also been linked in part to the Hispaniola outbreak of cholera in Haiti. An excellent review of the field can be found in reference 2.

As a review, although there are over 200 O antigen serogroups of _V. cholerae_, only O1 and O139 appear to have the potential to cause epidemics of cholera. The O1 strains can be divided into 2 biotypes based on phenotypic differences, classical and El Tor. The phenotypic differences include sheep red blood cell hemolysis, agglutination of chicken red blood cells, Voges-Proskauer reaction, and the sensitivities or lack of to polymyxin B and specific phages. Classical biotype is generally more severe, with a higher percentage of symptomatic infections but generally less efficient person-to-person spread.

References:
1. Nair GB, Faruque SM, Bhuiyan NA, et al. New variants of _Vibrio cholerae_ O1 biotype El Tor with attributes of the classical biotype from hospitalized patients with acute diarrhea in Bangladesh. J Clin Microbiol 2002; 40: 3296-3299.
2. Safa A, Nair GB, Yang RYC. Evolution of new variant of _Vibrio cholerae_ O1. Trends Microbiol 2009; 18: 46-53. - Mod.LL]