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RIFT VALLEY FEVER - SOUTH SUDAN: (EAST EQUATORIA, UPPER NILE) NOT
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Date: 19 Oct 2013
Sources: see below


[1]
Flutrackers 18 Oct 2013
http://www.flutrackers.com/forum/showth ... p?p=512090


Re: South Sudan: Outbreak of Rift Valley Fever Disease Reported in Rss - Not True per NGO
News media correction requested regarding recent misreport of Rift Valley fever outbreak

Posted on 18 Oct 2013 by Susan MacMillan (Head, Public Awareness, ILRI)
On 16 Oct 2013, a news release titled Outbreak of rift valley fever disease reported in RSS reported that there is an outbreak of Rift Valley fever in South Sudan. This is inaccurate. There is no outbreak of Rift Valley fever in South Sudan that we know of.

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[2]
Date: 18 Oct 2013
Source: International Livestock Research Institute (ILRI) http://clippings.ilri.org/2013/10/18/ne ... -outbreak/


On 16 Oct 2013, a news release titled Outbreak of rift valley fever disease reported in RSS reported that there is an outbreak of Rift Valley fever in South Sudan. This is inaccurate. There is no outbreak of Rift Valley fever in South Sudan that we know of.

Those quoted in the news release were participants of a workshop being held in Juba 15-16 Oct 2013, entitled 'Developing a risk map and decision-support tools for managing Rift Valley fever in South Sudan'. The workshop was organized by the International Livestock Research Institute (ILRI) and the South Sudan Ministry of Agriculture, Forestry, Tourism, Animal Resources, Fisheries, Cooperative and Rural Development. ILRI veterinary epidemiologist Bernard Bett, BVM, MVEE, PhD, of ILRI's Food Safety and Zoonosis Program, took part in that workshop. He reports that all conversations of the participants dealt with historical, not contemporary, information.

In the news release, Bett is misquoted and misnamed. He is a veterinary epidemiologist whose research focus is Rift Valley fever and other arboviruses. He is one of those working on developing the risk map for Rift Valley fever.

The misinformation was further circulated online in several places. ILRI has asked the relevant agencies to issue a statement correcting this misinformation.

For further information, please contact Bernard Bett: b.bett AT CGIAR.org

For more on the Rift Valley fever risk map, see this slide presentation by Bernard Bett and colleagues [available from the URL above].

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[3]
Date: 18 Oct 2013
Source: Statement from Director of Vector and Disease Control, South Sudan, Aluma Araba Ameri [edited]


Dear colleagues,
I am responding to the international alert issued in regards to an outbreak of Rift Valley Fever in South Sudan as misquoted in the GOSS website by a journalist.

Quote "In the website reads JUBA, 16 October 2012 NASS - An outbreak of Rift Valley Fever Disease has been reported in South Sudan's Eastern Equatoria and Upper Nile states, a government official has announced" - "Rift Valley fever is a viral disease spread primarily by mosquitoes, which can affect both humans and animals. This was revealed by Dr. Aluma Araba the Director of Vector and Disease Control in the national Ministry of Agriculture Forestry and Tourism". end of quote

There is no rumor or suspected outbreak of Rift Valley Fever in the whole of South Sudan up to date. The last outbreak recorded in South Sudan was 2007 and 2008 in Eastern Equatoria and Upper Nile States.

The department of Vector and Disease Control conducted a stakeholder workshop in Juba with the theme Workshop on RVF Risk Mapping and Other RVF Decision Support Tools for South Sudan, October 2013. The one day and half workshop brought the stakeholders from States, FAO, NGOs and National Government staff to develop preparedness response and during the event one participant's statement must have been misquoted.

Therefore I, Aluma Araba Ameri, am stating that no report from any part of South Sudan concerning Rift Valley Fever was ever received.

Kindly promptly revert the alert and inform public audience accordingly.

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[ProMED is happy to report that South Sudan is RVF-free.

ProMED posts newsmedia reports of outbreaks in good faith, and also confirmation of them (or otherwise) from official sources when they become available. - Mod.JW]

CHOLERA - NIGERIA (LAGOS)
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Date: Wed 23 Oct 2013
Source: PM News [edited]
http://pmnewsnigeria.com/2013/10/23/3-d ... -in-lagos/


Three people have been confirmed dead as a cholera outbreak hits Lagos. The Lagos State Government in a prompt response has moved to stop the spread of the disease.

At an emergency news conference at the Lagos State Government Secretariat, Alausa, in Ikeja, Lagos, Southwest Nigeria on Wednesday [23 Oct 2013], commissioner for health Dr Jide Idris confirmed that 13 cases of cholera infection had been reported and that 3 people have died so far while some had been treated and discharged from the hospital.

Idris explained that investigations carried out by the ministry had revealed that the suspected cases recorded were contracted from food sources such as the African food salad popularly called 'Abasha', well-water sources, especially in areas like Ikare community, Amuwo-Odofin Local Government area and Badia area of Apapa Local Government area, and other infected foods from food sellers, and other unhygienic habits.

Other suspected areas are Ajeromi, Lagos Island, Oshodi-Isolo and Surulere Local Government. He urged members of the public to be vigilant and report any suspected case to the nearest health facility and the Directorate of Disease Control in the state Ministry of Health.

Idris described cholera as an acute contagious bacterial disease that is characterized by severe form of sudden onset of profuse painless watery stools, nausea, and profuse vomiting. He added that cholera is acquired through the ingestion of an infective dose of contaminated food or water and could be transmitted through many mechanisms like direct or indirect contamination of water or food by faeces of infected individuals.

"Cholera should be suspected in any person who develops diarrhoea with or without vomiting, weakness, restlessness, irritability, dry mucous membranes, low blood pressure, leg cramps, excessive loss of body fluids (dehydration), or dies from frequent stooling, hence, adequate measures should be taken in order to reduce the risk of contracting the disease," he stated.

The commissioner listed measures to be taken to reduce the risk of contracting the disease as washing of hands with soaps and water frequently and thoroughly; boiling of water before drinking if the source of the water was in doubts; washing of fruits and vegetables thoroughly before eating; cooking of food thoroughly before eating; disposing of waste material properly; and keeping of water containers clean.

Idris pointed out that in the case of suspected cholera, members of the public should prepare oral rehydration solution (10 level teaspoonfuls of sugar and one level teaspoonful of salt in two 35cl bottles); give the patient a lot of fluids to drink; keep giving the patient food as soon as it can be tolerated; and thereafter visit the nearest hospital whether the condition of the patient improves or not.

He urged health workers to be on the alert and report suspected outbreaks of more than 5 cases in their facilities to the State Ministry of Health, saying that people could also call the following numbers: 08023169485 or 0802321333 for assistance.

[byline: Kazeem Ugbodaga]

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[ProMED-mail posted on 11 Sep 2013 (see archive 20130911.1937972): "Nigeria suffered cholera epidemics during the rainy seasons of 2010 and 2011 [typically April to September], with nearly 2000 people killed over 2 years. While 2012 saw few reported infections, health officials warn that Nigeria remains vulnerable to further outbreaks because of its high population density and poor sanitation in many areas."

As late in the season as November 2012, ProMED-mail posted (see archive 20121126.1424886): "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."

Lagos city has an estimated population of 21 million, and the airport is an international hub for flights to other Africa countries and all over the world, so both national and international public health implications are huge.

But cholera is easily treated with oral rehydration solution (which can be home-made following the recipe in the report above) and if the patient does not improve, doxycycline or tetracycline. - Mod.JW

Lagos becomes the 4th state after Sokoto, Oyo, and Plateau to report cholera cases in a period of 2 months. This outbreak justifies the need to strengthen cholera preparedness and response in both affected and at-risk states.

The HealthMap/ProMED-mail interactive map of Nigeria can be seen at http://healthmap.org/r/2iLp. A map showing the states in Nigeria can be seen at http://en.wikipedia.org/wiki/States_of_Nigeria and a map of Lagos state at http://www.nigerianmuse.com/images/Lagos_State_LGs.jpg. - Mod.JFW]

MALARIA - CAMEROON: (EXTREME-NORD)
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Date: Fri 25 Oct 2013
Source: Nigerian Tribune [edited]
http://tribune.com.ng/news2013/index.ph ... eroon.html


A malaria upsurge in the town of Maroua, in the far north [Extreme-Nord region] of Cameroon, has led to the death of hundreds of people.

More than 10 000 people have been treated for the disease in the last month, straining the capacity of area hospitals and clinics. Cameroon state radio said the number of people suffering from malaria in the north has made an unprecedented surge in the past 3 weeks [since about 4 Oct 2013].

The news broadcast said that hospitals in the far north of Cameroon are having problems handling the great number of malaria cases. "More than 10 000 cases have been reported in the Town of Maroua alone. Women and pregnant women are the highest hit," it said.

According to statistics from the Maroua Urban health district, the 10 hospitals in the area have treated more than 10 000 malaria patients in the past 21 days. Data on how many have been treated at private and mission hospitals is not available.

Palai Monique, a pediatric nurse at the Maroua Regional Hospital, told VOA that the situation has been alarming.

"All our halls have been occupied by people suffering from malaria, especially children between the ages of 0 to 15 years," she said. "There have been moments we did not have space even for serious cases, and we recorded situations in which children just died as early as they came here."

Local newspapers have reported that at least 1000 people have died, while state radio puts the figure at about 600.

Dr Etienne Fonjo, the secretary of Cameroon's anti-malaria program, acknowledged that child mortality has increased as a result of the upsurge. "Malaria remains a public health concern here," he said. "Today morbidity has risen to 27 percent. The doctor added that they have been struggling to assist the patients with the limited means they have.

"We can cite, for example, the free treatment given to children of less than 5 years, free treatment administered to pregnant women, and recently the free distribution of treated mosquito bed nets to 80 percent of households," said Dr Fonjo.

Health officials in Cameroon blame the upsurge on the refusal of people to use treated mosquito bed nets, the fact that many people do not respect basic hygiene standards, failure to clear outdoor standing water, and people who do not visit health facilities when they have early signs of malaria.

The World Health Organization warns that waiting 6 hours for treatment can mean death to a child sick with malaria. The 1st weeks after the dry season in Maroua are also periods when cases of malaria increase.

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[Maroua is located in the far north (Extreme-Nord) region of Cameroon, an area usually regarded as a relatively low risk area (0.1-1.0 case per 1000 population per year) for malaria compared with the southern part of Cameroon (more than 1 case per 1000 population per year) (WHO. World Malaria Report 2012 http://www.who.int/malaria/publications ... ofiles.pdf). An outbreak of this size in an otherwise endemic area is probably only possible by an increase in the transmission potential and an increase in the number of infected people. Poor compliance with insecticide treated nets is probably nothing new, and can therefore not explain the sudden increase in the number of infected people. Treatment failure could be an explanation, as most 1st line treatments are done with drugs purchased outside hospitals and clinics, and poor quality drugs used for treatment at home could be an explanation. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/8WIe.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (59): AFRICA
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In this update:
Africa
[1] Cholera - Nigeria
[2] Cholera - Nigeria (Lagos)

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[1] Cholera - Nigeria
Date: Sat 26 Oct 2013
Source: AllAfrica, Daily Trust report [summ., edited]
http://allafrica.com/stories/2013102603 ... ?viewall=1


In the last couple of days, some states in Nigeria have come under the spell of cholera epidemic. And aside those still anguishing in hospitals from the attack, the death toll also gives cause for concern. Weekly Trust investigations show that Plateau, Sokoto, Zamfara and Lagos States have been hit by cholera epidemic.

Zamfara recorded 1117 cases with official confirmation of 72 deaths in 2 weeks. Unofficial sources said the casualty figure is higher as the official statistics did not reflect those that died either at home or before reaching the hospitals. According to the Medical teams managing the cholera outbreak in the state, Gusau recorded the highest number of cholera cases, followed by Zurmi, Maradun and Bakura local government areas. At the Shagari Primary Health Care Center, 90 fresh cases were recorded in a day, an official said.

In Namu, a small village in Quan'Pan Local Government Area of Plateau State, with just one Primary Healthcare Clinic (PHC) and no decent source of drinking water, had to suddenly cater for an additional 6490 displaced people from Nasarawa State. Weekly Trust gathered that over 6000 internally displaced persons from the violence in Obi Local Government Area of Nasarawa State have relocated to Namu for refuge and are presently housed in a camp. Reports say the cholera outbreak started in the camp of the displaced persons, who eat, sleep and use the same latrines with the indigenes of Namu. It was observed in the Anguwan Yashi community, which hosts most of the displaced persons that over 50 people squeeze themselves in small compounds. Also, in some houses, about 20 people squat, sharing sleeping space every night in tiny rooms. Also, only wells serve as sources of drinking water, usually open and unhygienic. Based on the set up, cholera epidemic struck the displaced and indigenes, the young and the old, men and women in the community.

Plateau State government admits the outbreak of cholera in the state, and claimed that only 9 people have been killed. But the community claims 30 people have so far died from the cholera outbreak. None could however dispute that over 100 people have been infected and treated from the outbreak.

Health workers claimed that cholera was reported in the Namu village on 5 Oct 2013, but knowledge of the epidemic became public after the State Emergency Management Agency (SEMA) team from Nasarawa and Plateau States visited Namu last week. The District Head of the village, Alhaji Abubakar Sadiq claimed that mortality numbers have been downplayed, adding that most of those killed by the scourge were women nursing their children. Sadiq said "both indigenes of the village and the displaced have been affected because we now live together. And I can count over 10 of the indigenes who have died from this disease, including my brother's wife, my neighbor and her daughter."

Despite claims by the community and officials in Plateau, the Nasarawa State government is denying that its population which is displaced in the neighbouring Plateau State is hit by cholera outbreak. Dr. Abdullahi Idris, Executive Secretary of Nasarawa State Emergency Management Agency (NASEMA), told Weekly Trust that the state Ministry of Health sent a consignment of medicals to Namu to treat the displaced persons there, but insisted that they are merely suffering from vomiting and diarrhea. He said the result of a detailed laboratory test is still being expected to confirm the disease, and added that the state government is not taking chances, and has taken far reaching steps to control vomiting and diarrhea, while also stepping up prevention of possible cholera outbreak.

Similarly, cholera outbreak hit Tambuwal and Kebbe Local Government Areas in Sokoto State. Scores of people were killed and the community blamed poor source of water for the outbreak. The state government official statement on the matter pegged the death toll at 13 by last Thursday, 24 Oct 2013, and put the total number of victims in the 2 local government areas at 152. In Barkeji alone, a village located along Sokoto-Jega road in Tambuwal Local Government Area where the disease was said to have 1st surfaced, 31 cases were recorded between 10 and 21 Oct 2013; 5 persons were confirmed dead, 21 discharged and 2 were still on admission and positively responding to treatment. In Kebbe Local Government Area, which is less than 20 kilometers from Tambuwal, the disease resurfaced in Bakin Dutse, Tuna, 'Yar-Romo, Nabasa, Fakku and Bashi, all in riverine area. At least, out of 121 cases, 8 deaths were recorded.

In the Lagos State cholera outbreak, which has hit 5 local government areas and has so far claimed the lives of at least 3 persons, a few others were reportedly discharged after treatment. Lagos State Commissioner for Health, Dr. Jide Idris, who made the disclosure in Alausa, Ikeja, pleaded with residents to report any case of cholera to the nearest health facility as well as maintain high level of hygiene. Idris said "although many of the cases had been treated and discharged in several health facilities, 3 had been confirmed dead. Most of the suspected cases were from Ajeromi, Apapa, Lagos Island, Oshodi_Isolo and Surulere Local Government Areas."

[Byline: Lami Sadiq, Abubakar Auwal and Hir Joseph]

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[2] Cholera - Nigeria (Lagos)
Date: Sat 26 Oct 2013
Source: Vanguard Nigeria [summ., edited]
http://www.vanguardngr.com/2013/10/chol ... teriously/


Shock, pandemonium, and fear gripped Lagosians as another 5 persons from the Ago area of Lagos reportedly died of cholera recently. Before then, 3 persons were confirmed dead out of the 13 cases reported to the Ministry of Health.

A 25-year-old newspaper vendor in Ago Palace Way, Okota, Lagos state, was found dead on the staircase of a residential building in the area recently. It was also discovered that another young man who tried helping the deceased in his helpless state to the hospital died few hours after [the 1st case's] death. Comments from neighbours suggested that he stooled and vomited profusely the previous day. A resident in a wing of the complex located by Marcity bus-stop, Ago, Lagos, told the Vanguard how the vendor, who made the corridor of the complex his home, had shown no sign of illness until the day before his death eating an African salad popularly known as abacha. He disclosed that the deceased was stooling and vomiting consistently for one day when he was taken to the hospital.

A fashion designer who seldom sleeps in the complex exhibited the same symptoms but had some money to pay for treatment. He approached Treasure Gold Hospital in the area where he promptly received treatment. According him, he had taken about 59 different bottles of intravenous fluids within 72 hours.

That same day, Vanguard gathered a woman and her son who were said to have eaten abacha were both hospitalised after showing similar symptoms. The 15-year-old boy died after a few hours while the mother as at press time, is still receiving treatment in another hospital. When Vanguard visited Treasure Gold Hospital, the doctor in charge, Dr. Tosan Hamsa, disclosed that the hospital had 8 cases of cholera in the past few weeks.

The State Commissioner for Health, Dr. Jide Idris, had in a statement a few days ago said: "The suspected cases that were recorded have been contracted from food sources such as the African salad popularly called abacha, well-water sources, especially in areas like Ikare community, Amuwo-Odofin local government area and Badia area of Apapa local government area, as well as other infected foods from food sellers and other unhygienic habits."

[Byline: Florence Amagiya]

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[ProMED thanks Tayo Babalobi for this submission. Abacha is a staple food from the eastern part of Nigeria. It is also known as African salad, with a base ingredient of dried and shredded cassava. A recipe for it can be found at: http://africanfoodie.wordpress.com/2012 ... can-salad/. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2iLp.]

LASSA FEVER - NIGERIA (12): (EBONYI) NOSOCOMIAL
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Date: Wed 30 Oct 2013
Source: Leadership [edited]
http://leadership.ng/news/301013/fear-a ... r-outbreak


There is growing fear among residents of Abakaliki, the Ebonyi state capital, following an outbreak of Lassa fever in the state. At least one medical doctor in the state was said to have been confirmed hospitalized yesterday [29 Oct 2013] as a result of the outbreak. The victim, according to reports, is believed to have contacted the illness after treating patients infected by it last week [week of 21 Oct 2013].

The state chairman of the Nigerian Medical Association, (NMA), Dr Chidi Esike, in a chat with a Leadership reporter, stated that the victim has been rushed to Eroghowa Hospital in Edo state for treatment. "One of our medical doctors, is affected. It is mostly likely that he must have caught the virus while treating victims of Lassa fever in the state. From the report we got, the medical doctor is now responding to treatment", Esike said.

The President of the National Association of Resident Doctors (NARD), Dr Jibril Abdullahi Donald, according to media reports last weekend [26-27 Oct 2013] cited the outbreak of the disease in the state as part of the reasons for calling off the association's nationwide strike. He said, "We felt in the interest of what is happening in the country, namely: the outbreak of cholera in Lagos and Gusau; the outbreak of Lassa fever in Abakaliki, it was high time we soft-pedaled and allow dialogue to continue, hoping that the government will play its own role in ensuring our agreement is implemented."

An outbreak of Lassa fever was first reported in Ebonyi state in 2008 in which lives of some people including 2 medical doctors and other health workers were lost as a result. Also, in 2011, 4 persons said to be residing at the Military cantonment, Nkwagu near Abakaliki also died of the disease.

[Byline: Obinna Ogbonnaya]

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[There was an error in the previous posting (archive no 20131018.2009142) regarding the location of Abakaliki. Abakaliki is the capital city of the present-day Ebonyi State in southeastern Nigeria. Before the creation of Ebonyi State in 1996, Abakaliki was in Enugu province. Enugu was the capital of the then East Central State. - Sr.Tech.Ed.MJ

Maps of Nigeria can be accessed at http://www.ezilon.com/maps/africa/nigeria-maps.html and http://healthmap.org/r/8_aw.

Lassa fever is an acute viral illness that occurs in West Africa. Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80 percent of people infected with the virus, the remaining 20 percent have severe multisystem disease. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50 percent.

The reservoir, or host, of Lassa virus is a rodent known as the "multimammate rat" of the genus _Mastomys_ (see photograph at http://ec.europa.eu/research/rtdinfo/sp ... 2_3759.jpg). _Mastomys_ rodents breed very frequently, produce large numbers of offspring, and are numerous in the savannas and forests of West, Central, and East Africa. In addition, _Mastomys_ generally readily colonize human homes.

All these factors together contribute to the relatively efficient spread of Lassa virus from infected rodents to humans. Lassa fever may also spread through person-to-person contact. This type of transmission occurs when a person comes into contact with virus in the blood, tissue, secretions, or excretions of an individual infected with the Lassa virus. The virus cannot be spread through casual contact (including skin-to-skin contact without exchange of body fluids). Person-to-person transmission is common in both village and health care settings. - Mod.CP]

PERTUSSIS - SUDAN: (NORTH DARFUR)
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Date: Sat 2 Nov 2013
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/58229


The WHO has reported that the whooping cough outbreak is still on-going in the locality of El Sareif in North Darfur. The total number of suspected cases has reached 58, of which 2 were fatal. All identified cases are being treated.

WHO provided technical and operational support to a rapid response team from the Epidemiology Department of the State Ministry of Health. The team is conducting an active search for cases. Coordination with the Expanded Programme on Immunisation is underway to revise the vaccination coverage in the area.

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[The morbidity and mortality of pertussis is age-related. The major at-risk cohort are unimmunized infants less than 12 months, especially under 6 months.

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1A1E. - Mod.LL]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (60): AFRICA
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In this update:
Africa
[1] Cholera - Nigeria
[2] Dysentery - Zimbabwe (Masvingo), prison

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[1] Cholera - Nigeria
Date: Sun 3 Nov 2013
Source: The Global Dispatch [edited]
http://www.theglobaldispatch.com/nigeri ... ths-34103/


The outbreak of cholera is growing and expanding in the west African country of Nigeria, as the bacterial disease is being reported in higher numbers from more states. According to the Nigerian news source The Guardian, statistics from the Ministry of Health on Thursday [31 Oct 2013] indicated that 1623 cases had been recorded, while 86 deaths had been reported.

The breakdown of cases is as follows: Zamfara State has the highest figure of 1110 cases and 51 deaths, while Plateau State has 130 cases and 11 deaths. Others are Lagos State (134 cases, 4 deaths), Ogun State (115 cases, 5 deaths), Nasarawa State (105 cases, 9 deaths) and Oyo State (29 cases, 6 deaths).

"The outbreak in the states mentioned earlier has been confirmed by our laboratories to be caused by _Vibrio cholerae_ serotypes 01 and 0139. The affected states are being supported to respond to the outbreak by supplying them with emergency drugs, diagnostic kits and other commodities," Special Assistant on Media and Communications, Mr. Dan Nwomeh said.

The infection is often mild or without symptoms but can sometimes be severe. Approximately one in 20 (5 percent) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

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

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[2] Dysentery - Zimbabwe (Masvingo), prison
Date: Fri 1 Nov 2013
Source: The Herald [edited]
http://allafrica.com/stories/201311010627.html


An outbreak of dysentery has hit Masvingo's Mutimurefu Prison and surrounding areas, where nearly 170 cases were reported in the last 2 weeks. There are also unconfirmed reports that the outbreak also claimed one inmate at the prison before the pandemic was finally contained. Out of the 170 cases that were reported, 129 cases were among inmates in the prison, while 39 cases were reported in the Mutimurefu Prison's immediate neighboring community.

Indications are that the outbreak was caused by contaminated water, and the ministry of Health and Child Care, the Zimbabwe National Water Authority, and the International Red Cross Society have since completed an exercise to upgrade and chlorinate the facility's water supply system.

Acting Masvingo provincial medical director Dr Kudzai Masinire on Monday [28 Oct 2013] confirmed the outbreak of the disease at Mutimurefu Prison and surrounding areas, which he said had been contained. Dr Masinire said the water supply system at the prison had been upgraded.

He added that there was nothing conclusive to suggest that the death of an inmate at the prison during the time of the outbreak was caused by dysentery.

[Byline: George Maponga]

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YELLOW FEVER - AFRICA (23): SUDAN (WEST KORDOFAN)
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Date: Mon 4 Nov 2013
Source: Reliefweb [edited]
http://reliefweb.int/report/sudan/yello ... t-kordofan


Sudan's Federal Ministry of Health has notified the World Health Organization (WHO) of a yellow fever outbreak in El-Reif El-Shargi and Lagawa localities in West Kordofan state. A technical committee has been established in Khartoum to follow up on the outbreak. Analysis of the data so far received from the field suggests that this is a focal or localized outbreak of yellow fever in an area endemic for the disease.

Initial investigation of more than 10 blood specimens was conducted at the National Public Health Laboratory in Khartoum. These samples were taken from the suspected cases in El-Reif El-Shargi locality in West Kordofan state. Of those tested, 3 samples tested positive for yellow fever.

WHO is assisting the Federal Ministry of Health in reconfirming the outbreak by sending all yellow fever positive samples to the WHO Collaborating Centre for Yellow Fever, the Pasteur Institute in Dakar, Senegal.

Between 3 Oct and 2 Nov 2013, a total of 20 suspected cases of yellow fever were reported, including 7 deaths, presenting a case fatality rate of 35 per cent. Patients were from Al-behara camp, Tabag and Alarda in Lagawa locality. Al-Behara is a camp for seasonal workers for a gum arabic plantation. Patients were originally from east Sudan who travelled a month ago to Kordofan and are residing at Al-Behara camp. The workers usually travel in groups from east Sudan. Currently, an estimated 200 people are residing in the camp.

Of immediate priority during this outbreak is to strengthen case management, control the vectors, and reinforce the disease surveillance system in Kordofan as well as in Kassala and Gedarif states. WHO, through the Federal Ministry of Health, has sent supplies to the State Ministry of Health -- comprising medical equipment, life-saving medicines, laboratory tools, cleaning tools and disinfectant, mosquito nets, and insecticides -- for the affected area.

Late last year [2012], there was an outbreak of yellow fever in Darfur region [the worst in Africa in 20 years - Mod.TY]. The total number of suspected yellow fever cases [in the Darfur outbreak] has reached 849, including 171 deaths (case-fatality rate 20.1 per cent). [In that Darfur outbreak], 3 emergency vaccination campaigns were conducted, with timely support from donors and active involvement of nongovernmental organizations working in the affected localities. Around 5 million people were vaccinated in the 5 states of Darfur.

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[It is urgent that the surveillance system be strengthened. It is critical to know what proportion of the resident and transient population of the affected area have been vaccinated previously. If that proportion is low, and the mosquito vector population is relatively high, there is a significant risk of a large outbreak developing, as happened in the Darfur states in 2012-2013. One hopes that the response to this relatively small outbreak is more prompt than in the Darfur outbreak, which resulted in over 800 cases and spill-over into neighboring Chad.

There may be some confusion about the location of West Kordofan state mentioned in the above report. The following University of Texas map does not show West Kordofan state. That state was merged into North Kordofan and South Kordofan states in 2005, but was restored in July this year (2013). A map showing Sudan's states can be accessed at http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail interactive map can be accessed at http://healthmap.org/r/3EpA. - Mod.TY]

[It is to be hoped that YF vaccine will be procured and applied in the affected area as soon as possible to prevent further spread. - Mod.JW]

YELLOW FEVER - AFRICA (24): SUDAN (WEST AND SOUTH KORDOFAN) SUSPECTED
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Date: Thu 14 Nov 2013
Source: All Africa, Radio Dabanga (Hilversum) report [edited]
http://allafrica.com/stories/201311151118.html


According to the Sudanese Ministry of Health, between 3 Oct [2013] and 5 Nov [2013], a total of 22 suspected yellow fever cases, resulting in 7 deaths, occurred in West and South Kordofan. The case fatality rate is 36.3 per cent, OCHA [the UN Office for the Coordination of Humanitarian Affairs] reports in its latest Humanitarian Bulletin.

Initial investigations indicate that the people affected came from Gengaro, Selegi, Masalit, Ghara, Alkarkar in Lagawa locality, Dumaik and Barno in Reif Asharqi locality, and Umaddar in Keilak locality. These people are reportedly seasonal workers, coming to Kordofan from eastern Sudan to work in the gum Arabic plantations.

In response, a small-scale vaccination campaign was launched on 29 Oct [2013] targeting 1000 people in the affected areas. To date, 400 of the 1000 people have been vaccinated. Seasonal workers travelling from eastern Sudan to the affected areas have been vaccinated prior to their departure to Kordofan. On 30 Oct 2013, a total of 2000 vaccine doses were made available in the 2 states.

The Sudanese Health Ministry is conducting [has conducted?] a yellow fever vaccination campaign between 9-12 Nov [2013], targeting 45 000 people who have not previously been vaccinated. UNICEF and the World Health Organization (WHO) have provided mosquito nets, vaccines, and financial support to the Ministry.

Late last year [2012], there was an outbreak of yellow fever in [neighboring] Darfur region, in what the WHO termed "Africa's worst in decades." The total number of suspected yellow fever cases has reached 849, including 171 deaths (case fatality rate 20.1 per cent). A 3-phase vaccination campaign was conducted and about 5 million people were vaccinated in the 5 states of Darfur.

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

[Reactive yellow fever vaccination is already underway in West and South Kordofan where mobile populations are being targeted for vaccination to prevent further transmission. Surveillance and communications should be sustained to improve vaccine uptake and assess the impact of vaccination.

For the HealthMap/ProMED-mail interactive map of Sudan, see http://healthmap.org/r/1A1E. - Mod.JFW]

[This outbreak has already been reported on ProMED-mail on 6 Nov 2013 -- see 1st archived post below. - Mod.JW]

UNDIAGNOSED DEATHS - UGANDA: (KIBAALE): REQUEST FOR INFORMATION
***************************************************************
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Date: Wed 13 Nov 2013
Source: New Vision (Uganda) [edited]
http://www.newvision.co.ug/news/649380- ... trict.html


A strange disease is reported to have killed 5 people in Rugashali Sub-County, Kibaale district. The deaths have occurred in the last 2 weeks [approx. between 30 Oct 2013 and 13 Nov 2013].

Rugashali Sub-County chairperson, Tumusime Mutebire, singles out Kanyamunya in Yorudani Parish Buyaga West Kibaale District as the most affected village.

Patients develop symptoms of swollen stomach, legs, arms and stomach complications.

Kibaale District Health Officer, Dr. Dan Kyamanywa, said the disease remains strange but a team of health workers has been dispatched to the affected Sub-County.

[Byline: Andrew Musinguzi]

--
Communicated by:
ProMED-mail
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[The information is very sparse, but a gastrointestinal infection complicated by kidney failure could be an explanation. It would help to know if there was fever, diarrhea or cutaneous or mucosal bleeding. ProMED will be happy to post further details if available. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2Xz8.]

FOODBORNE ILLNESS - MADAGASCAR: (ANALANJIROFO), SHARK MEAT, FATALITIES, RFI
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Date: Fri 15 Nov 2013
Source: LINFO [in French, trans. Corr.SB, edited]
http://www.linfo.re/572705-Intoxication ... Madagascar


A total of 4 people have died from food poisoning caused by the consumption of shark meat in the district of East Fenerive, Madagascar.

According to the local journal Midi, after the death of 2 men, a child and a woman who died of food poisoning after eating shark meat in the village of Ampasibe Manampatrana, Fenerive East [Analanjirofo Region], the death toll increased to 4 persons.

While most of the victims were able to return to their homes, others are still quite ill, said The News. After 4 days of intensive care, 10 patients have not yet awakened from coma, while 3 others are aware but are in a serious condition. Hospital sources say that "23 patients are still being followed day and night, with doctors closely monitoring their health."

According to The News, 4 of them have been transferred to the hospital in Toamasina [Atsinanana Region], as their cases required the use of more appropriate care materials.

Note that this food intoxication goes back to last Monday, 11 Nov 2013, after a local fisherman captured and sold, in the local market, a shark of a weight of 120 kg, suspected to be toxic and harmful to human health.

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[For the most part, eating shark meat has been felt to be safe, but it can contain toxic levels of mercury. However, published reports from eastern Madagascar (essentially the same report published in French in 1994 and in English in 1995) documents a large cluster of foodborne illness from a bull shark (_Carcharhinus leucas_) with gastrointestinal and neurological symptoms and a case fatality rate of almost 30 percent.

From the English language report: Boisier P, Ranaivoson G, Rasolofonirina N, et al: Fatal mass poisoning in Madagascar following ingestion of a shark (Carcharhinus leucas): clinical and epidemiological aspects and isolation of toxins. Toxicon. 1995; 33:1359-1364.

Abstract:
"In November 1993, 188 people were admitted to hospital after eating the meat from a single shark (_Carcharhinus leucas_) in Manakara, a medium-sized town on the south-east coast of Madagascar. This shark and its meat had no unusual characteristics. The attack rate was about 100 percent. The 1st clinical signs appeared within 5-10 hours after ingestion. The patients presented with neurological symptoms almost exclusively, the most prominent being a constant, severe ataxia. Gastrointestinal troubles, like diarrhoea and vomiting, were rare. The overall case mortality ratio was close to 30 percent among the 200 poisoned inhabitants. There were no reports of previous similar poisonings in this area, and fishermen in Manakara usually eat this kind of shark without problems. Bacteriological and chemical causes were eliminated. Two liposoluble toxins were isolated from the liver and tentatively named carchatoxin-A and -B, respectively. They were distinct from ciguatoxin in their chromatographic properties."

The earlier French language report of the same outbreak is: Boisier P, Ranaivoson G, Rasolofonirina N, et al: [Fatal ichthyosarcotoxism after eating shark meat. Implications of two new marine toxins]. Arch Inst Pasteur Madagascar. 1994; 61:81-83.

Additionally, the flesh of a Greenland shark (_Somniosus microcephalus_) is poisonous (http://en.wikipedia.org/wiki/Greenland_shark). This is due to the presence of the toxin trimethylamine oxide, which, upon digestion, breaks down into trimethylamine, producing effects similar to extreme drunkenness. Occasionally, sled dogs that end up eating the flesh are unable to stand up due to the neurotoxins. Similar toxic effects occur with the related Pacific sleeper shark, but not in most other shark species, whose meat is often consumed fresh. However, it can be eaten if it is boiled in several changes of water or dried or fermented for some months to produce kaestur hakarl, often called hakarl for short. Traditionally this was done by burying the shark in the ground, exposing it to several cycles of freezing and thawing. It is considered a delicacy in Iceland and Greenland. Despite being the Icelandic national dish (http://www.theexpeditioner.com/2011/06/ ... -on-earth/), its "putrid smell is said to rival its horrifying taste. When explaining hakarl to foreigners, Icelanders enjoy recounting the reaction of Anthony Bourdain who described the delicacy as the single worst, most disgusting and terrible tasting thing. Andrew Zimmern had a similar reaction, and even more disturbing, the smack-talking Gordon Ramsey reportedly vomited after eating it." - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/9apy.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (62): AFRICA
***************************************************
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In this update:
Africa
[1] Cholera - Nigeria (Benue State)
[2] Cholera - Congo DR (Katanga Province)

******
[1] Cholera - Nigeria (Benue State)
Date: Fri 15 Nov 2013
Source: Codewit World News [edited]
http://www.codewit.com/general-health/1 ... spitalised


The death toll in the recent cholera outbreak in Otukpo Local Government Area of Benue State has continued to rise, with the epidemic claiming 12 more lives, including women and children.

Also, at least 80 victims of the epidemic are now receiving treatment at the Otukpo General Hospital and a few private hospitals in the town. Vanguard gathered that the disease, which earlier broke out in Otukpo Wards 1 and 2, had, as of yesterday [14 Nov 2013], spread to 4 council wards, which include Allan Akpa, Otobi Akpa and Ewulo.

A nurse at the Otukpo General Hospital, who preferred anonymity, told Vanguard that the disease had reached an epidemic level in the town. She said: "Since we noticed the 1st outbreak of the disease in Otukpo main town some few weeks ago, the ailment has continued to spread to other parts of the council, and the fear is that it is becoming excessively prevalent. There is hardly a day that we do not record new cases of the disease in the hospital, and most of the patients are usually from the main town. The situation at the hinterlands and neighbouring villages is even worse, because we hear daily of new cases and deaths in these communities. And the figure keeps rising due mainly to lack of proper medical care for victims."

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

******
[2] Cholera - Congo DR (Katanga Province)
Date: Sat 9 Nov 2013
Source: Vatican Radio [edited]
http://en.radiovaticana.va/news/2013/11 ... en1-745278


Katanga province is the southernmost of 11 provinces which make up the Democratic Republic of Congo, and its eastern border with Tanzania is marked by the length of the enormous Tanganyika Lake, the world's longest freshwater lake. Within Katanga province, Tanganyika district is the worst affected by 2013's cholera outbreak, which has spiked as usual with the advent of the rainy season.

At least 11 687 cases of cholera were recorded in Katanga province before the end October 2013. The death rate stands at approximately 2.5 percent, with more than 264 people killed by the ongoing epidemic since the start of 2013.

--
Communicated by:
ProMED-mail
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[A HealthMap ProMED-mail map of Congo DR can be accessed at http://healthmap.org/r/1Ahy.]

LEPROSY - NIGERIA
*****************
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Date: Sat 16 Nov 2013
Source: Leadership [edited]
http://leadership.ng/news/161113/nigeri ... arly-group


The Leprosy Mission International (TLM) based in Niger State has stated that over 35 000 new cases of leprosy are discovered in Nigeria annually.

In view of this situation, the mission has launched a sensitisation initiative on the danger of leprosy and has expended NGN 18 million [USD 113 300] so far on the fight against the disease in Niger State, Pius Ogbu Sunday, the operations Manager of the Mission, stated at a sensitisation meeting of the mission in Minna. He said the fund was expended on capacity building and sensitisation for prevention as well as control. According to Ogbu, the activities of the mission have been expanded to cover Kebbi, Sokoto, Zamfara and Kogi states. The Mission 1st came to Nigeria through Akwa Ibom State.

He explained that a 5-year action plan has been drawn up to raise funds for the Mission to carry out its activities in collaboration with state governments and religious bodies in the country.

The operations manager stated that the disease is highly contagious and could be found in 30 countries of the world, with India having the highest prevalence rate.

Appealing to the public to be cautious of the early signs of leprosy, he affirmed that the symptoms could be discovered only through clinical examination.

Deputy Director, Rehabilitation and Desk Officer of TLM in the state Ministry of Gender Affairs Hajiya Hajara Ndayako gave assurances of Niger's readiness to collaborate with TLM in order to combat leprosy in the state.

[Byline: Abu Nmodu]

--
Communicated by:
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[Before 1998, Nigeria was one of the most leprosy-endemic countries in the world, with prevalence rates ranging from 16 to 390 per 10 000 (http://www.leprahealthinaction.org/lr/M ... 65_076.pdf). Following introduction of multidrug therapy for leprosy in 1985, Nigeria attained the WHO elimination as a public health problem target of less than one case per 10 000 population at the national level by the end of 1998 (http://www.leprahealthinaction.org/lr/M ... 65_076.pdf). The registered prevalence of leprosy at the end of 2012 was 3915 cases, or a prevalence rate of 0.22 per 10 000 (http://www.who.int/wer/2013/wer8835.pdf).

The number of new cases of leprosy detected in 2012 was 3805 according to the latest data from WHO (http://www.who.int/wer/2013/wer8835.pdf), not over 35 000 as stated in the news report above. In fact, the number of new cases of leprosy was 5276 in 2004, 5024 in 2005, 3544 in 2006, 4665 in 2007, 4899 in 2008, 4219 in 2009, 3913 in 2010 and 3623 in 2011 (http://www.who.int/wer/2013/wer8835.pdf). The number of new cases has never been over 35 000 in the past 9 years. In 2012, Nigeria accounted for 1.6 percent of the total number of new cases (232 857) detected worldwide.

Although the number of new cases of leprosy detected in Nigeria annually decreased from 5276 in 2004 to 3805 in 2012, Nigeria remains one of 16 countries reporting 1000 or more new cases of leprosy during 2012; these 16 countries account for 95 percent of the new cases detected worldwide during 2012 (http://www.who.int/wer/2013/wer8835.pdf).

Nigeria, with an estimated population of 174 507 539 in 2013, is the most populous country in Africa and the 7th most populous country in the world (http://en.wikipedia.org/wiki/Nigeria#Po ... jor_cities). It is located in West Africa on the Gulf of Guinea on the Atlantic Ocean with the Republic of Benin to the west, Chad and Cameroon to the east, and Niger to the north.

Nigeria is a federal constitutional republic with 36 states and the Federal Capital Territory, Abuja. A map showing the states of Nigeria can be accessed at (http://en.wikipedia.org/wiki/Template:N ... states_map). A HealthMap/ProMED-mail interactive map of Nigeria can be seen at http://healthmap.org/r/2lD7. - Mod.ML]

YELLOW FEVER - AFRICA (25): SUDAN (WEST AND SOUTH KORDOFAN), SUSPECTED
********************************************
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Date: Sun 17 Nov 2013
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/59304


Between 3 Oct-13 Nov [2013], 36 cases of suspected yellow fever were recorded in West and South Kordofan; 10 people died.

At least 10 localities are affected by the disease. A small scale vaccination campaign began in the capital of South Kordofan, Kadugli, as well as in Elreef Alshargi, Lagawa and Keilak, targeting 100 000 people, the World Health Organisation (WHO) reports.

According to the WHO report, new cases were recorded in the localities of Talodi, Abu Gibaiha, Habila, Ghadir, Kadugli, Altadamon and Elreef Alshargi in the government-controlled areas of South Kordofan, and Lagawa, Kailak, and Almuglad in West Kordofan.

The Federal Minister of Health, Bahar Idris Abu Garda, reported that 20 cases of yellow fever have been confirmed in 3 South Kordofan localities. He said an investigation team has been sent to Abu Gibaiha locality.

The communicable disease surveillance system has been strengthened in the states of White Nile, Gezira, Kassala, Gedarif, and Khartoum.

--
Communicated by:
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[The yellow fever outbreak in West and South Kordofan continues to grow, with the number of deaths increasing from 7 to 10 and suspected cases from 22 to 36 in the past 48 hours. However, there is no indication in this report and the previous one of 16 Nov 2013 that these suspected cases have been laboratory confirmed. It is good to learn that surveillance and reporting has been strengthened, but it is urgent that the vaccination campaign be initiated as soon as possible. The area has many migrant agricultural laborers, and there is a risk that this mobile population may spread the virus to new localities.

A HealthMap/ProMED-mail interactive map of Sudan can be accessed at http://healthmap.org/r/1A1E. - Mod.TY]

LEPROSY - NIGERIA (02): BACKGROUND
**********************************
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Date: Mon 18 Nov 2013
Source: GIDEON [edited]
http://www.gideononline.com


Leprosy incidence rates in Nigeria have been decreasing slowly since the 1990s and are similar to those of surrounding countries and Africa as a whole. [1,2] See graph [3]: http://cdn.gideononline.com/wp/wp-conte ... Africa.png.

References:
1. Berger SA. Infectious Diseases of Nigeria, 2013. 442 pages, 62 graphs, 2519 references. Gideon e-books, http://www.gideononline.com/ebooks/coun ... f-nigeria/.
2. Berger SA. Leprosy: Global status, 2013. 238 pages, 377 graphs, 276 references. Gideon e-books, http://www.gideononline.com/ebooks/dise ... al-status/.
3. Gideon Graph Tool, see tutorial at http://www.GIDEONonline.com/wp/wp-conte ... Graphs.pps.

--
communicated by:
Steve Berger
Geographic Medicine, Tel Aviv Medical Center
<mberger@post.tau.ac.il>

[ProMED-mail thanks Dr Berger for his continuing contributions.

With 3805 new cases of leprosy detected in 2012, according to WHO (http://www.who.int/wer/2013/wer8835.pdf), the incidence rate of leprosy in Nigeria is 2.2 per 100 000, which fits with the data in the graph supplied by Dr Berger (http://cdn.gideononline.com/wp/wp-conte ... Africa.png). - Mod.ML

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