Wüstenschiff

ROTAVIRUS, SUSPECTED - ZIMBABWE (GOKWE)
***************************************
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Date: Thu 26 Jul 2007
Source: The Herald (Harare), AllAfrica.com [edited]
<http://allafrica.com/stories/printable/ ... 60345.html>


Diarrhoea Outbreak Claims 31 lives in Gokwe
-----------------------------------------------------
The [rural area] of Gokwe in Zimbabwe was last month [June 2007] hit
by a diarrhoea outbreak that has so far claimed 31 lives. The most
affected have been children aged below 5. A total of 17 people died
in Masita in Gokwe South while 14 others died in Siamchembo in Gokwe North.

Speaking in a telephone interview, Deputy Minister of Health and
Child Welfare Dr. Edwin Muguti, however said the situation was under
control after officials from his ministry moved in swiftly to the
affected areas. Dr. Muguti said the cause of the outbreak had not
been ascertained as investigations were still ongoing. "I can confirm
that 14 people have died in Siamchembo area in Gokwe North while
another 17 died in Masita in Gokwe South," he said.

"We suspect that the diarrhoea outbreak is being caused by rotavirus
[infection] which is rife during winter [in the southern hemisphere -
Mod.CP]. Personnel from the Ministry of Health and Child Welfare have
been deployed and are on the ground doing community surveillance on
new cases and advising on how to manage the cases at home. The teams
are also distributing oral rehydration salts in the affected areas
and as far as we are concerned, the situation is now under control."

Dr. Muguti said most of the children died before reaching health
centres after failing to get assistance at their homes. "Lives were
lost that could have been saved because of lack of information. Most
homes failed to prepare the oral rehydration solution because of the
sugar shortage in their areas. This contributed to the high death
rate. They could still have saved lives by simply boiling water and
observing basic hygiene standards," he said. "We urge the villagers
to wash their hands all the time before handling or consuming any
food." The deputy minister expressed gratitude to Medicins San
Frontiers and UNICEF who moved in swiftly and worked together with
ministry officials to contain the outbreak.

Villagers in some parts of Gokwe North said the outbreak was a result
of water shortages in the affected areas. They said they were being
forced to fetch water from unprotected sources, a development that
could have contributed to the outbreak of the disease. The 2
districts of Gokwe have perennial water problems.

--
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[This outbreak of diarrhoeal illness is being attributed to rotavirus
infection due to the young age of the victims and an association with
inadequate water supply, but a final laboratory diagnose is awaited.

Rotavirus infection is the most common cause of severe diarrhea among
children and is responsible for the deaths of more than 600 000
children world-wide per year with 80 percent of deaths occurring in
poorer countries. The incubation period for rotavirus illness is
approximately 2 days and the disease is characterized by vomiting and
watery diarrhea for 3 to 8 days, frequently with fever and abdominal
pain. Immunity after infection is incomplete, but repeat infections
tend to be less severe than the initial infection. The severe outcome
of rotavirus infection in infants and young children can be
ameliorated by prompt rehydration therapy and attention to basic hygiene.

Vaccination may soon be an option for control of rotavirus infection.
The 1st rotavirus vaccines have not been not deployed widely on
account of association with a low frequency of intussusception
(invagination of the intestine) [see ProMED-mail references below].

New rotavirus vaccines and their availability in the developing world
are highlighted in the June 2007 issue of the Bulletin of the World
Health Organization
(<http://www.who.int/bulletin/volumes/85/ ... print.html>).
This report describes advances and partnerships that have made recent
progress possible, along with the next steps needed to bring the
vaccines to the world's children at highest risk for severe diarrheal
disease. Rotavirus vaccines are increasingly becoming a crucial
component of strategies to control diarrheal disease in low-resource
countries, alongside proven interventions such as hand-washing, use
of oral rehydration solution, and exclusive breast-feeding.

Gokwe is a small rural area located in the Midlands Province of
Zimbabwe; see map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf> - Mod.CP]

Poliomyelitis in Angola und der Demokratischen Republik Kongo
WHO - 30.07.2007

On 25 July 2007, four new cases of polio were confirmed in Equateur province of the Democratic Republic of the Congo, bringing the total number of cases in the country this year to 27. In neighbouring Angola, advance notification of two new polio cases was received, which will bring the total number of cases in Angola in 2007 to 8. The two cases are from Luanda and Benguele provinces.

Both countries are continuing synchronized, cross-border outbreak response activities. Large-scale, supplementary immunization activities (SIAs) were launched nationwide in Angola, and in the affected areas of the Democratic Republic of the Congo (Equateur and Bandundu provinces) on 25 July, to reach more than 8 million children under the age of five years. Further immunization campaigns will be conducted later in the year.

In 2005, poliovirus of Indian origin re-infected Angola, before subsequently spreading to the Democratic Republic of the Congo in 2006.

POLIOMYELITIS - WORLDWIDE (07): TSCHAD, REQUEST FOR INFORMATION
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International Society for Infectious Diseases
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Date: 31 Jul 2007
Source: Polio eradication website [edited]
<http://www.polioeradication.org/content ... sitrep.asp>


On [11 Jul 2007], 2 polio cases were reported from Chad, one of which
was in the east of the country, close to the border with Darfur,
Sudan. In May 2004, poliovirus originating in northern Nigeria in
this same area spread into Darfur, leading to a major outbreak across
Sudan, and which subsequently re-infected further countries,
including Yemen and Indonesia. Urgent efforts are underway to
minimise the risk of further polio spread from Chad, as Chad and
Sudan are planning an extensive, cross-border emergency outbreak
response. The risk of polio spread could be further compounded by the
upcoming Omra season (beginning in September 2007) and its large
population movements. These latest cases further underline the risk
polio continues to pose to polio-free countries around the world
until the disease has been eradicated in the remaining endemic hotspots.

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

[Additional information from the polio eradication website is that
the date of onset of the most recent WPV type 1 case (as of 24 Jul
2007) was 28 May 2007; see
<http://www.polioeradication.org/content ... ecount.pdf>.

In addition, Chad will conduct its 1st NIDs (National Immunization
Days) on [3-5 Aug 2007] as part of emergency outbreak activities in
response to the recent confirmation of 2 cases. Sudan will
synchronize its supplementary immunization activities (SIAs) as part
of urgent, internationally-coordinated efforts to minimise the risk
of further polio spread from Chad. Further campaigns are planned for
September [2007] (from <http://www.polioeradication.org/casecount.asp>).

For a map of Chad, see
<http://www.lib.utexas.edu/maps/africa/chad.gif>. - Mod.MPP]

VIRAL HEMORRHAGIC FEVER - UGANDA (KAMWENGE): MARBURG SUSPECTED,
REQUEST FOR INFORMATION
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Date: 31 Jul 2007
Source: New Vision [edited]
<http://www.newvision.co.ug/D/8/12/578876>


Ebola-like virushits Kamwenge
----------------
Two suspected cases of Marburg haemorrhagic fever, a virus similar to
Ebola, have been reported in western Uganda, according to the
Ministry of health.

"The Ministry of Health would like to inform the general public that
2 suspected cases of Marburg haemorrhagic fever have been reported,
of whom one has died," a press release by the director general of
health services, Dr. Sam Zaramba, said.

"Both cases were mine workers in Kitaka mine, located in Kakasi
Forest Reserve in Kamwenge district."

Kamwenge is about 250km west of Kampala with a population of 295 000,
according to the 2002 census.

"The 1st test was positive. We are waiting for the results of the
confirmatory test, which we shall have at 9:00 AM tomorrow," Dr.
Zaramba told The New Vision last night.

"But it is most probably the Marburg virus. We thought we should send
out this information early enough."

Marburg, like Ebola, is a severe and highly fatal disease. It is
characterised by sudden bleeding and high fever, resulting into death
within a few days.
Transmission is through close contact with blood and other body
fluids from patients with clinical signs of the illness. It can also
be transmitted following exposure to contaminated items, such as
bedding and clothing of patients.

The virus is named after Marburg, a city in Germany where the first
outbreak occurred in 1967 among laboratory workers who had been doing
research on monkeys which were imported from Uganda in order to
prepare a polio vaccine.

"The Ministry of Health has set up a national task force that is
tracing all potential contacts of the above cases for further
investigations and tests," the statement added.

It advised people to report any suspicious cases to the nearest heath
unit. The ministry asked the public not to panic "as no new cases
have been reported in the last 2 weeks".

What is Marburg hemorrhagic fever?
Marburg hemorrhagic fever is a rare, severe type of hemorrhagic
(internal bleeding) fever, which affects both humans and monkeys.
Caused by a genetically unique animal-borne RNA virus of the
'filovirus' family, its recognition led to the creation of this virus
family. The 4 species of Ebola virus are the only other known members
of the filovirus family.

Where have cases occurred?
Marburg virus was first recognized in 1967, when outbreaks of
hemorrhagic fever occurred simultaneously in laboratories in Marburg
and Frankfurt (Germany) and in Belgrade (Yugoslavia). A total of 37
people became ill. They included laboratory workers as well as
several medical personnel and family members who had cared for them.
The 1st people infected had been exposed to African green monkeys. In
Marburg, the monkeys had been imported for research and to prepare a
polio vaccine.

Recorded cases have appeared in only a few locations. While the 1967
outbreak occurred in Europe, the disease agent had arrived with
imported monkeys from Uganda. No other case was recorded until 1975,
when a traveler most likely exposed in Zimbabwe became ill in
Johannesburg, South Africa -- and passed the virus to his traveling
companion and a nurse. 1980 saw 2 other cases: one in Western Kenya
not far from the Ugandan source of the monkeys implicated in the 1967 outbreak.

This patient's attending physician in Nairobi became the 2nd case.
Another infection was recognized in 1987 when a young man who had
traveled extensively in Kenya became ill and later died. In 1998, an
outbreak occurred in Durba, the Democratic Republic of the Congo.
Cases were linked to individuals working in a gold mine. After the
outbreak subsided, there were still some sporadic cases that occurred
in the region.

Where does the Marburg virus originate from?
Marburg virus is indigenous to Africa. While the geographic area to
which it is native is unknown, this area appears to include at least
parts of Uganda and Western Kenya, and perhaps Zimbabwe. As with
Ebola, the actual animal host for Marburg virus also remains a
mystery. Both of the men infected in 1980 in western Kenya had
traveled extensively, including making a visit to a cave in that
region. The cave was investigated by placing sentinels animals inside
to see if they would become infected, and by taking samples from
numerous animals and arthropods trapped during the investigation. The
investigation yielded no virus and the sentinel animals remained healthy.

How do humans get it?
Just how the animal host first transmits Marburg virus to humans is
unknown. However, humans who become ill with Marburg hemorrhagic
fever may spread the virus to other people. This may happen in
several ways. Persons who have handled infected monkeys and have come
in direct contact with their fluids or cell cultures, have become
infected. Spread of the virus between humans has occurred in a
setting of close contact, often in a hospital. Droplets of body
fluids, or direct contact with persons, equipment, or other objects
contaminated with infectious blood or tissues are all highly suspect
as sources of disease.

What are the symptoms?
After an incubation period of 5 to 10 days, the onset of the disease
is sudden and is marked by fever, chills, headache, and myalgia.
Around the 5th day, a rash most prominent on the chest, back or
stomach may occur. Nausea, vomiting, chest pain, a sore throat,
abdominal pain, and diarrhea then may appear. Symptoms become
increasingly severe and may include jaundice, inflammation of the
pancreas, severe weight loss, delirium, shock, liver failure, and
multi-organ dysfunction. Because many of the signs and symptoms of
Marburg hemorrhagic fever are similar to those of other infectious
diseases, such as malaria or typhoid fever, diagnosis of the disease
can be difficult, especially if only a single case is involved.

How is it treated
A specific treatment is unknown. However, supportive hospital therapy
should be utilised. This includes balancing the patient's fluids and
electrolytes, maintaining their oxygen status and blood pressure,
replacing lost blood and clotting factors and treating them for any
complicating infections. Sometimes treatment also has used
transfusion of fresh-frozen plasma and other preparations to replace
the blood proteins important in clotting.

Who is at risk?
People who have close contact with a human or non-human primate
infected with the virus are at risk. Such persons include laboratory
or quarantine facility workers who handle non-human primates that
have been associated with the disease. In addition, hospital staff
and family members who care for patients with the disease are at risk
if they do not use proper techniques to prevent direct physical
contact with the patient. Precautions should include wearing of
protective gowns, gloves and masks; placing the infected individual
in strict isolation; and sterilization or proper disposal of needles,
equipment and patient excretions.

How to prevent it from spreading?
Increasing awareness among health-care providers of clinical symptoms
in patients that suggest Marburg fever is critical. Better awareness
can help lead to taking precautions against the spread of virus
infection to family members or health-care providers.

Improving the use of diagnostic tools is another priority. With
modern means of transportation that give access even to remote areas,
it is possible to obtain rapid testing of samples in disease control
centers equipped with Biosafety Level 4 laboratories in order to
confirm or rule out Marburg virus infection.

[Byline: By Fred Ouma]

--
Communicated by ProMED-mail Rapporteur Joseph Dudley

[Marburg virus is one of the viruses responsible for viral
hemorrhagic fevers seen in Africa. The above newswire gives an
excellent description of the virus, clinical manifestations and the
history of Marburg cases and outbreaks since its 1st identification
with the outbreak in Germany in 1967. There is an excellent table
presenting the history of Marburg outbreaks on the CDC website with
links to references published on each of the outbreaks, available
at:
<http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... gtable.htm>.

VIRAL HEMORRAGHIC FEVER - UGANDA (KAMWENGE): MARBURG CONFIRMED
***************************************
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International Society for Infectious Diseases
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Date: 1 Aug 2007
Source: New Vision [edited]
<http://www.newvision.co.ug/D/8/12/579050>


Marburg virusconfirmed
----------------------------------
The Ministry of Health has dispatched an emergency response team to
Kitaka in Kamwenge district, some 250 km [155.34 miles] west of
Kampala, where at least 2 cases of Marburg haemorrhagic fever have
been confirmed.

Health minister Dr. Stephen Malinga has also travelled to the region
to ascertain the outbreak of the deadly virus, which is similar to
Ebola. Both cases, of whom one died, were gold miners in a
privately-owned mine situated in Kakasi Forest Reserve in Kamwenge district.

"Samples we sent to Atlanta US have confirmed Marburg disease," the
director general of health services, Dr. Sam Zaramba, told The New
Vision. "A team of experts is on its way to reinforce the district
team already on the ground. We also intend to close down the mine
until it is deemed safe."

The team, led by Dr. Julius Lutwama of the Uganda Virus Institute,
consists of scientists from Makerere University Institute of Public
Health, the Ministry of Health and the World Health Organisation. One
of the tasks of the team, Zaramba explained, was to track down,
isolate and monitor all persons who had come in close contact with
the 2 victims.

"We have contacted the mine-owners and are tracking all workers and
people who could have looked after the victims or come into direct
physical contact with them. With or without symptoms, we are going to
take their blood samples for testing," he said, adding: "Because the
Marburg disease is rare, when you get one case, it immediately
becomes an epidemic."

He called on the public to remain calm, arguing that the infection
rate of Marburg was far lower than that of Ebola. He also noted that
if no additional cases were reported within 21 days of the outbreak,
the epidemic would be declared over. The 2 victims fell sick 2 weeks
ago, leaving one more week to go.

"The 1st outbreak was reported in Germany in the 1960s, the 2nd was
in South Africa in the 1970s, followed by Uganda, where 19 people
from one family in Kamuli died in 1977. Another outbreak was in Kenya
in the 1980s," he explained.

According to records of the Ministry of Health, the latest Marburg
outbreak was in 1999 in the Democratic Republic of Congo, where at
least 52 people died, mainly gold miners in the remote northeastern
part of the country [The most recent Marburg outbreak was in Angola
in 2004/2005. See prior ProMED-mail postings listed below for more
information. - Mod.MPP].

The Minister of State for Health, Dr. Richard Nduhuura, briefed
Parliament yesterday about the measures taken by the government to
contain the spread. He said more blood samples from the survivor
would be taken and sent to the US for research.

He also told MPs that a separate cabinet team, headed by
vice-president Prof. Gilbert Bukenya, had mapped out a national
strategy on how to curb the outbreak. He later told the press that
literature about the disease would be given to members of Parliament
to sensitise their constituents, in addition to efforts of the health teams.

The Marburg fever, which causes death within 48 hours, is thought to
reside in monkeys and spread by bats and rats. Like Ebola, it does
not respond to treatment. Its symptoms include high fever, headache,
vomiting and bleeding from the gums and skin.

Even in the best hospitals, the virus can be expected to kill up to a
quarter of the people who get infected with it. It is extremely rare
and, for that reason, researchers will want to find out as much as
possible about this latest outbreak.

The virus is named after the North German town of Marburg, where a
laboratory worker, who was taking blood from Ugandan monkeys, became
ill and died in 1967.

[Bylines: Anne Mugisa, Fred Ouma, Apollo Mubiru]

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

******
[2]
Date: 1 Aug 2007
Source: Relief web [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


Uganda on alert as deadly Marburg Hemorrhagic Fever breaks out
---------------------------------------
Health experts in Uganda are on high alert and ready to counter the
spread of the highly deadly and contagious Marburg Hemorrhagic Fever
(MHF) that has been confirmed in the western part of the country.

Richard Nduhuura, the minister of state for health told parliament on
Wednesday [1 Aug 2007] that the ministry in collaboration with
international health experts has already dispatched a rapid response
team to Kamwenge District, 250 km [155.34 miles] west of Kampala,
where the 1st case of the viral disease was recorded.

Health officials on Wednesday [1 Aug 2007] confirmed the 2 cases of
MHF at Kitaka Gold mine, located in Kakasi Forest Reserve in Kamwenge
District, where a miner died of the disease on [14 Jul 2007].

Marburg, like Ebola, is characterized by sudden bleeding and high
fever, resulting into death within a week normally. Transmission is
through close contact with blood and other body fluids from patients
with clinical signs. It can also be transmitted following exposure to
contaminated items, such as bedding and clothing of patients.

In 1977, 19 cases were reported in Bugiri District, eastern Uganda.

Minister Nduhuura who later addressed a press briefing at the
ministry headquarters said the mine has been closed and those
possibly exposed to the virus have been isolated for observation.

"Blood samples are being collected from all the miners and their
contacts are being screened locally and at international
collaborating centers including Center for Disease Control in Atlanta
Georgia, USA," the minister said, flanked by Melville George, World
Health Organization Representative in Uganda.

He said no new cases of the disease have been reported in the last 15
days and after the lapse of 21 days, it can be asserted that the
disease is contained. He noted that given the country's experience in
containing similar outbreaks, the disease will be contained.

According to the WHO, the last 2 recent outbreak of MHF in the
Democratic Republic of Congo during 1998-2000 and in Angola during
2004-2005 have claimed 128 and 323 lives respectively.

--
Communicated by:
ProMED-mail Rapporteur Joseph Dudley

[According to the 2 newswires, confirmation of Marburg virus
infection in the 2 miners was done by the United States Centers for
Disease Control and Prevention laboratories in Atlanta GA. The
articles mention the date of death of one of the cases as 14 Jul
2007, 17 days ago, with reference that an outbreak is considered over
if 21 days have passed without new cases. The criteria usually
applied for declaring an outbreak over is for 2 incubation periods to
have passed without the occurrence of new cases. If past history is
any indicator, caution should be exerted here until results of
follow-up on contacts are known. In prior outbreak of viral
hemorrhagic fevers (VHFs) in Africa, the occurrence of cases leads to
panic, and contacts frequently leave the area defined to them as at
risk, oftentimes having had exposure, and returning to their distant
villages while still incubating the infection. Secondary cases then
occur in these villages on the part of family members that care for
the cases, and where fatalities occur, among those individuals who
prepare the bodies for burial. Both care of ill individuals and
preparation of bodies of deceased for burial involve close contact
with infected bodily fluids. In addition, when these individuals have
been ill, they often seek assistance from a local health facility
that is oftentimes poorly equipped to permit use of universal
precautions, and these local health facilities become locales that
potentiate nosocomial transmission of the virus.

That being said, this moderator doesn't wish to appear as a gloomy
predictor, but rather is exerting caution in giving an "all is clear"
message. One hopes that these 2 cases will end up as sporadic cases
and not part of a larger outbreak as seen in Angola in 2004/2005, and
in the outbreak of Ebola hemorrhagic fever seen in Uganda in 2000/2001.

For more detailed information on Marburg hemorrhagic fever, see the
31 Jul 2007 posting (Viral hemorrhagic fever - Uganda (Kamwenge):
Marburg susp., RFI 20070801.2475)

map of uganda: http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg

Erste Opfer
Marburg-Virus bricht in Uganda aus
01.08.2007

In Uganda ist das tödliche Marburg-Fieber wieder aufgetaucht. Gesundheitsbehörden des ostafrikanischen Landes bestätigten am Mittwoch, dass der Virus bereits bei einem Todesopfer nachgewiesen wurde. Und noch immer sind weder ein Impfstoff noch geeignete Medikamente in Sicht.

HB NAIROBI. Ein Minenarbeiter sei bereits an der Infektion gestorben, ein anderer werde im Krankenhaus behandelt, hieß es. Die Behörden informierten die Öffentlichkeit und setzten eine Arbeitsgruppe ein. Diese werde sämtliche Kontakte der beiden Opfer untersuchen, teilte das Gesundheitsministerium in Kampala mit.

Experten glauben, dass das Fieber entweder von Affen oder Fledermäusen, die sich den Goldminen eingenistet haben, übertragen wurde. Die Öffentlichkeit solle nicht in Panik verfallen, aber Verdachtsfälle sofort dem nächsten Gesundheitsamt melden. Die beiden infizierten Männer stammen nach den Angaben aus der Region Kamwenge nahe der Grenze zur Demokratischen Republik Kongo. Die Ebola-ähnliche Krankheit ist hoch ansteckend. Im Jahr 2000 wütete eine Ebola- Epidemie in Norduganda mit 170 Toten.

Ein Ausbruch von Marburg-Fieber 2004 in Angola kostete mehrere hundert Menschen das Leben. Es war der größte seit der Entdeckung des Virus im Jahr 1967. Damals war der Erreger in Marburg, Frankfurt und Belgrad bei Labormitarbeitern identifiziert worden, die sich bei infizierten Affen aus Uganda angesteckt hatten. Das Marburg-Virus wird über Körperflüssigkeiten übertragen. Dagegen gibt es weder eine Impfung noch Medikamente. Isolierung der Patienten und der Schutz vor Übertragung sind die einzigen Möglichkeiten, einen Ausbruch unter Kontrolle zu bringen.

Quelle: Handelsblatt

Marburg haemorrhagic feverin Uganda
WHO - 03.08.2007

Marburg haemorrhagic fever (MHF) has been confirmed in a 29-year-old man in Uganda. The man became symptomatic on 4 July 2007, was admitted to hospital on 7 July and died on 14 July. The disease was confirmed by laboratory diagnosis on 30 July.

The man had had prolonged close contact with a 21-year-old co-worker with a similar illness to whom he had been providing care. The 21-year-old had developed symptoms on 27 June and was hospitalized with a haemorrhagic illness. He then recovered and was discharged on 9 July. Both men were working in a mine in western Uganda.

The Ministry of Health (MoH), Uganda, has mobilized national rapid response teams to the area, supported by the World Health Organization (WHO) and other partners in the field, to investigate the outbreak. Laboratory investigations are being supported by the Uganda Virology Research Institute (UVRI), the Kenya Medical Research Institute (KEMRI) and the Centers for Disease Control and Prevention (CDC), Atlanta at which the definitive laboratory diagnosis of MHF was made.

Case investigations, including extensive contact tracing and contact monitoring are under-way at the mine, at the health care facilities that cared for the men during their illness, and within the community. Appropriate isolation facilities, active case finding, enhanced surveillance, infection control, safe burial practices and social mobilization activities have been put in place under the oversight of a national Task Force with high level political representation.

Interviews conducted with the mine authorities have identified one additional suspected case and two individuals who were taken ill in mid-June and have since recovered. These individuals are being investigated as a matter of priority. All the miners under investigation for MHF had been at the mine for approximately 8 months with no movements outside the mining area during that time. To date, there have been no reported cases among health care workers.

The MoH has requested WHO to coordinate international assistance to support the MoH in its outbreak response and containment activities. WHO, along with partners in the Global Outbreak Alert and Response Network (GOARN), will also be providing ongoing support in epidemiology, ecological studies, field communications, supplies and logistics. The containment and control measures that have been implemented by the MoH to date are in accordance with international best practice. WHO advises that there is no indication of the need for any restrictions on travel or trade with Uganda.

MARBURG HEMORRHAGIC FEVER- UGANDA (02)
***************************************
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 4 Aug 2007
Source: People's Daily (English) online, Xinhua report [edited]
<http://english.people.com.cn/90001/90777/6231652.html>


Monkey might be source of Marburg disease outbreak
----------------------------------------------------------
Health experts in Uganda have linked the outbreak of the deadly
Marburg hemorrhagic fever (MHF) in the western part of the country to
a monkey similar to those that were responsible for the 1st outbreak in 1967.

Sam Okware, the head of the national task force to fight the spread
of the epidemic told a news conference here on Friday [3 Aug 2007]
that preliminary investigations showed that the virus may [have been]
passed to one of the 2 victims [only one of whom has been confirmed
as a case of Marburg hemorrhagic fever - Mod.CP] by a Colobus monkey
which had been slaughtered.

"The probable case who is alive has been identified to have skinned a
Colobus monkey a week prior to falling ill," Okware said flanked by
the World Health Organization (WHO) representative in Uganda, George
Melville. "The skin of the monkey has been recovered and is in safe
custody at the Uganda Virus Institute. Samples of the skin have been
sent for further analysis," he added.

The Ugandan government on Wednesday [1 Aug 2007] announced that 2
cases of Marburg hemorrhagic fever had been identified at a gold mine
located in Kakasi Forest Reserve, Kamwenge district, 250km [155.34
miles] west of Kampala. One of the 2 miners confirmed to have
contracted the virus died on 14 Jul 2007 and another miner was
recovering after being treated. "The number of cases still remains 2
-- one confirmed who died and one probable who is still alive. Please
note that the situation has not changed since notification of the
outbreak," Okware stated.

He also revealed that the task force is monitoring more than 140
people who are believed to have come into contact with the 2 miners
both in the capital city Kampala and in Kamwege district. "In
Kampala, 46 contacts have been identified. Among these, 8 are close
contacts being relatives of the probable case and the deceased. In
Kamwenge, 100 contacts who are all miners have been identified. Of
the 100, 50 are local miners living in the village, while another 50
are in a camp 200 metres [218.7 yards]from the mine. Of these, 6 are
in very close contact with the probable case, as they participated in
skinning the monkey," Okware said.

The government has set up isolation units at Mulago hospital in
Kampala and Kicheche health center III in Kamwenge. The health
official again urged the public to remain calm and report any
suspected cases to the nearest health unit.

Marburg hemorrhagic fever, like Ebola hemorrhagic fever, is a highly
deadly and contagious disease characterized by sudden onset of high
fever and bleeding, resulting into death within a week if untreated.
The virus can be transmitted through close contact with blood and
other body fluids from carriers who have developed clinical symptoms.
It can also be transmitted following exposure to contaminated items,
such as bedding and clothing of the patients.

The virus is named after Marburg, a city in Germany, where the 1st
outbreak occurred in 1967 among laboratory workers doing research on
monkeys imported from Uganda in order to prepare a polio vaccine.
According to the WHO, the last 2 recent outbreaks of Marburg
hemorrhagic fever in the Democratic Republic of Congo during
1998-2000 and in Angola during 2004-2005 have claimed 128 and 323
lives, respectively.

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

[It is well established that Marburgvirus can infect various
species of monkeys and primates, and indeed the virus was originally
transmitted from imported monkeys to humans in laboratories in
Marburg, Germany, and in the former Yugoslavia. It may be that the
virus responsible for the current outbreak in Uganda was transmitted
from the Colobus monkey that was skinned by the miner who became
subsequently a suspected case of Marburg hemorrhagic fever. However,
this is uncertain since it has not been confirmed that the monkey was
infected with Marburg virus. Likewise it has not been confirmed that
the person who skinned the monkey (and who is no longer ill) was
actually suffering from a Marburgvirus infection.

Even if it is confirmed that the monkey and the miner were infected
by Marburgvirus, the ultimate source of the virus remains unknown.

A description and a photograph of the Colobus monkey can be viewed at
<http://www.awf.org/content/wildlife/det ... obusmonkey>. - Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2007 (25)
**********************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Cholera - Africa: Kenya (Nyanza)
Date: Tue 31 Jul 2007
Source: Kenya Broadcasting Corporation [edited]
<http://www.kbc.co.ke/story.asp?ID=44099>


At least 4 people have died in the past 2 days [29-30 Jul 2007] while
2 others were admitted in critical condition following renewed
cholera outbreak in Milambo village, Siaya district.

Siaya District Commissioner Wilson Litole says the 1st victim died
after complaining of stomach ache, vomiting and diarrhea, symptoms of
the disease. But the Local Medical Officer of Health (MOH) Dr.
Elizabeth Okoth, when contacted, denied any outbreak of the disease.

However KNA has established that a team of Public Health officers has
been dispatched to the affected area to investigate and institute
measures of containing further spread of the disease.

About 4 months ago there was an outbreak of cholera in the district,
which was announced by the Director of Medical Services. The outbreak
covered Siaya, Kisumu, Busia and Bondo districts but the Siaya MOH
dismissed the outbreak and came to admit it when already over 7
people had died of the disease.

[Byline: James Rono]

--
Contributed by:
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[Siaya District is 1 of the 12 districts that comprise Nyanza
Province in the southwest part of Kenya. The location of the province
can be seen on a map at:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

IRIN hat geschrieben: TANZANIA: Cholera outbreak in northern region, says government official

DAR ES SALAAM, 6 August 2007 (IRIN) - Ten people have died and 20 others were admitted to various health centres after an outbreak of cholera in the northern Tanzanian region of Mara over the past week, a senior health official said.

"The disease was confirmed on Thursday. Medical supplies and teams of doctors and nurses were immediately dispatched to Bunda district, where the disease was first reported on Tuesday [31 July]," Valentino Bhangi, medical officer in charge of Mara region told IRIN by phone from Musoma on 4 August.

Cholera is caused by the bacterium Vibrio cholerae. Symptoms include watery diarrhoea and vomiting and it is spread by eating contaminated food or water.

In Tanzania, cases of cholera are regularly reported in the rainy seasons.

In 2006, heavy rains that followed a long drought brought relief but also washed waste into water catchment areas, sparking a cholera outbreak on the mainland and in the Zanzibar archipelago.

At least 22 people died in Zanzibar and 15 on the mainland.

Bhangi told IRIN that Mara regional authorities had launched an aggressive public education campaign in which people were being urged to boil drinking water, use toilets and wash hands before and after eating.

Quelle: http://www.irinnews.org

Grüsse
Alexander

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2007 (26)
************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Comoros Islands (Grand Comoros)
[2] Cholera - Tanzania (Mara)

******
[1] Cholera - Comoros Islands (Grand Comoros)
Date: Tue 7 Aug 2007
Source: CNN International, Reuters report [edited]
<http://www.cnn.com/2007/WORLD/asiapcf/0 ... lera.reut/>


An outbreak of cholera has killed 8 people and infected scores of others on
the Comoros Islands since July 2007, a senior doctor said, blaming the food
at traditional wedding parties for spreading the disease.

The epidemic on Grande Comore (or Grand Comoros), the largest of the 3
islands in the Indian Ocean archipelago, coincided with the holiday months
when villagers prepare feasts for weddings.

"The cholera epidemic has killed 5 in August 2007 and 3 in July 2007,"
Abdoulbar Youssouf, the director general of El-Marouf hospital, the
Comoros' largest, told Reuters.

He added that in at least one outbreak over the weekend, nearly 50 people
were infected at a wedding party, probably through dirty drinking water or
salads. Grande Comore is known for its extravagant weddings, where many
spend their life's savings on gold, gifts, and feasts.

Mohamed Moundhiri Djoubeiri, the doctor in charge of the cholera ward at
El-Marouf, said traditional feasts were to blame for spreading it. "The
government should ban big dinners during the epidemic periods," he said.

--
communicated by:
ProMED-mail
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[Grand Comoros is the largest and most northern and western of this island
nation, which is located in the Indian Ocean between Madagascar and the
African continent. The islands can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... omoros.pdf>. - Mod.LL]

******
[2] Cholera - Tanzania (Mara)
Date: Sat 4 Aug 2007
Source: yahoo.com [edited]
<http://uk.news.yahoo.com/afp/20070804/t ... 3ab_1.html>


A medical official said Sat 4 Aug 2007 that 10 people have died and 19
others have been hospitalized after a cholera outbreak erupted in northern
Tanzania.

Valentino Bhangi, the medical officer in the country's northern Mara
region, said the deaths occurred during the past week, but the disease was
only identified on Thu 2 Aug 2007. Medical supplies and teams of medics
have been dispatched to the region, he added.

--
communicated by:
ProMED-mail rapporteur Joseph P Dudley, PhD

[The Mara region is in extreme north of the country and can be seen on a
map at <http://www.un.org/Depts/Cartographic/ma ... nzania.pdf>. -
Mod.LL]

MARBURG HEMORRHAGIC FEVER - UGANDA ( 03 )
***************************************
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Date: Fri 10 Aug 2007
Source: Daily Monitor online, Hussein, Bogere & Agencies report [edited]
<http://www.monitor.co.ug/news/news08106.php>


Virus hunters, swathed in protective gear, were on Tuesday [7 Aug 2007]
preparing to enter a lead and gold mine in a remote part of western Uganda
in search of what they think may have been the source of the latest
outbreak of deadly Marburg hemorrhagic fever.

The hunt is one of the medium and long term measures being taken by the
Ministry of Health to deal with the Marburg [outbreak] that was declared
'contained' by Health Minister Stephen Mallinga yesterday [Thu 9 Aug 2007].
The announcement was made on the 25th day since the last contact with the
last case of Marburg hemorrhagic fever was buried on 14 Jul 2007.
"Theoretically, the transmission chain has been broken. It has been stopped
and the outbreak contained," Dr Mallinga said. As a precautionary measure,
however, the Ministry has decided to maintain active surveillance, case
management, infection control, and social mobilisation activities for
another 21 days.

The source of the Marburg virus is still a mystery to scientists. Speaking
to journalists yesterday [Thu 9 Aug 2007], Dr Pierre Formenty, a
hemorrhagic fever expert at the World Health Organization (WHO), said
Colobus monkeys that are suspected to be reservoirs could actually be
victims. "We cannot tell what the reservoir is. We are studying bats,
contact tracing is very important," he said. The scientists are therefore
hoping that the recent outbreak in western Uganda can provide them with a
breakthrough, which should explain their visit to the area.

Dr Formenty and about 2 dozen others from WHO, the United States' Centre
for Disease Control and Prevention (CDC), Medecins Sans Frontieres (MSF),
the Ugandan Ministry of Health and other partners, will don special gowns,
boots, masks, goggles, and leather gloves before entering the mine,
swarming with different species of bats, which some believe could play a
role in transmitting the Marburg virus to humans.

The medical investigators will attempt to catch 1000 live bats, to be
transported to a mobile laboratory nearby. There, they will take fresh
blood samples to look for antibodies and live virus, before killing the
animals and removing their livers and spleens.

Marburg [virus infection] causes headaches, nausea, diarrhea, and vomiting.
In severe cases, the central nervous system is attacked, and patients may
bleed from the eyes and ears.

--
communicated by:
ProMED-mail rapporteur Joseph P Dudley, PhD

[It seems likely that the July 2007 Marburg hemorrhagic fever outbreak in
western Uganda has been contained. A deceased mine worker is the only
confirmed case of the disease and infection has not spread to any of his
caretakers or to other workers at the mine. His companion, who cared for
him and became ill and has since recovered, has not been confirmed as a
Marburg hemorrhagic fever case. Likewise it has not been confirmed that the
Colobus monkey, skinned by the deceased worker and his companion, was
Marburg virus infected.

The outcome of the expedition to investigate the role of cave-dwelling bats
in transmission of Marburg virus is awaited with interest. - Mod.CP]

Poliomyelitisin Angola - update
WHO - 09.08.2007

Four new cases of polio have been confirmed from Luanda and Benguela provinces in Angola. The most recent case had onset of paralysis on 8 July. This brings the total number of cases, in Angola, in 2007 to 10. The next Nationwide Immunization Day (NID) will be held on 31 August.

Flood-related cholera outbreak kills 49 in east Sudan

KASSALA, Sudan, Aug 14 (Reuters) - A cholera outbreak in eastern Sudan, which has spread due to devastating floods across the region, has killed 49 people and affected some 710 others, a World Health Organisation (WHO) official said on Tuesday. mehr...

Grüsse
Alexander

Marburg haemorrhagic fever in Uganda - update
WHO - 14.08.2007

Results of laboratory tests on blood samples from Kampala and Kamwenge performed by the Centers for Disease Control and Prevention (CDC), Atlanta, USA have confirmed Marburg virus infection in the putative index case, a mine worker, and in one of his close contacts during his illness. Contact tracing and monitoring has been carried out to ensure no further transmission of disease, and the extended contacts are coming to the end of their period of observation.

An international team, including experts from WHO, Centers for Disease Control and Prevention (CDC), Médecins sans Frontières , Uganda Virus Research Institute (UVRI), African Field Epidemiology Network (AFENET) and local NGOs are supporting the Ministry of Health, Uganda to strengthen active surveillance, contact tracing, infection control, logistics, and social mobilization activities in an effort to contain this outbreak.

Ecological studies are underway by a team of experts from the CDC, WHO and the Government of Uganda , to establish the hosts and mode of natural transmission of the virus in the environment, with particular emphasis on the mines and surrounding area.