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LASSA FEVER - NIGERIA: (NASSARAWA)
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Date: 10 Jan 2014
Source: Premium Times [edited]
http://premiumtimesng.com/regional/1530 ... fever.html


The Nasarawa state commissioner for health, Emmanuel Akabe, on Thursday [9 Jan 2014] confirmed that there is an outbreak of Lassa fever in Lafia, which has so far claimed the life of one person.

Mr Akabe, who confirmed the death of the victim in an interview in Lafia, said the victim died on Tuesday [7 Jan 2014] at the Dalhatu Araf Specialist Hospital. He said that the infected person was admitted into the hospital last week with symptoms of severe fever and bleeding. The commissioner explained that these symptoms prompted the medical personnel to send his blood specimen to the Lassa fever diagnostic centre at Irua in Edo, where he was confirmed positive to Lassa infection.

Mr Akabe explained that the hospital did its best to quickly isolate and treat him, and he became fairly stable until Tuesday [7 Jan 2014] when he died. He disclosed that a blood specimen taken from the victim's wife and others who had close contact with him was sent for examination, and all came out negative.

The commissioner said a team of medical personnel had been deployed to the Bukan Sidi area of the town, where the deceased resided, with a view to educating the people about Lassa fever. He said that the ministry had commenced a sensitisation programme in Lafia and its environs, educating the people to look out for such symptoms to quickly save lives, saying early detection of the disease would guarantee proper management and treatment.

"If the deceased had reported early enough to the hospital, the situation would not have gotten this bad. He came to the hospital at the bleeding stage of the disease," Mr Akabe said.

The commissioner, therefore, charged members of the public to shun self-medication but to visit the nearest hospital for proper medical attention in order to stay alive. He also encouraged the people to properly cook and cover their food as well as maintain good environmental habits that would keep rodents, "which are the major agents of Lassa fever, away from sources of food."

On the need to have a Lassa fever diagnostic centre in the state, Mr Akabe said that, considering the capital intensive nature of such centres, it would be difficult to establish for now. He noted that there were only 2 of such centres in the country at present. He recalled that the federal government through the Ministry of Health in 2013 promised to establish a Lassa fever diagnostic centre in each of the geopolitical zones, considering the recurrent outbreak of the disease and its fatality rate in parts of the country. Mr Akabe, therefore, appealed to the federal government to expedite action on the plan to establish such centres, saying, "it will go a long way to save more lives through early detection and treatment."

The commissioner said that the state government was working in collaboration with an organisation in the USA with the aim of establishing a research institute in Lafia to handle issues related to diagnosis and treatment of viral diseases, including Lassa fever, TB and HIV/AIDS, among others. He explained that the project was expected to be funded by the USA, adding that a Memorandum of Understanding will soon be signed to that effect.

The victim was a civil servant who worked in the office of the deputy governor, Dameshi Luka.

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[Nigeria's latest Weekly Epidemiology Report dated 3 Jan 2014 covers the last week (52) of 2013. It says:

"3.1. No suspected Lassa fever case/death was reported in week 52 (2013) compared with 33 suspected cases with 0 deaths from Edo State in the same period in 2012.

3.2. Between weeks 1 and 52 (2013), 1192 suspected Lassa fever cases with 161 lab confirmed and 36 deaths (CFR, 3.02 percent) were reported in 27 LGAs [Local Government Areas] across 14 states compared with 1723 cases with 197 lab confirmed and 112 deaths (CFR, 6.50 percent) in 42 LGAs (23 states) at the same period in 2012 (Figure 6)."

Unfortunately, the latest weekly report on Nigeria's Ministry of Health website at http://www.health.gov.ng/doc/EpidReport1.pdf is only for Week 49, dated 13 Dec 2013, but Fig. 7 on p. 6 is very similar to the Fig. 6 referred to above.

Brief information on Lassa fever disease and the vector rodent (with photo) was provided by Mod.CP in his comment in ProMED-mail posting: Lassa fever - Nigeria: (BE), nosocomial 20130117.1503116, listed below. - Mod.JW

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

LASSA FEVER - NIGERIA (02): (BAUCHI) FATAL
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Date: Thu 16 Jan 2014
Source: All Africa, Daily Trust report [edited]
http://allafrica.com/stories/201401160449.html


The Bauchi State Primary Health Care Development Agency has warned people of the state to take measures to protect themselves against Lassa fever, as the disease recently killed a medical doctor. It was gathered that the doctor became infected after he treated a patient with Lassa fever virus.

Executive chairman of the agency, Dr Nisser Ali Umar, while briefing newsmen yesterday as part of the sensitization exercise embarked upon to educate citizens on the dangers of the disease, said: "The disease is deadly and infectious. Recently, a medical doctor got infected by the disease after treating a patient who had the fever. The doctor died, and about 8 other doctors got infected after treating a pregnant woman who had the disease." Umar said the state recorded 7 cases of Lassa fever between 2012 and March 2013, but with only a single death.

He said the federal and state governments have taken adequate steps to address the problem. "People can easily contract the disease by eating rat [meat] or eating food contaminated by rat urine," he said. He advised people with suspected cases to report to the nearest hospital for treatment. He commended the Federal Ministry of Health for providing Ribavirin tablets and enough personal protective equipment to health care providers in the state to prevent nosocomial infection.

[byline: Ahmed Mohammed]

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[Bauchi is a state in northern Nigeria. Its capital is Bauchi. The state was formed in 1976 when the former North-Eastern State was broken up. It originally included the area now in Gombe State, which became a distinct state in 1996. The state shares borders with Plateau State to the west, Kano State to the north and Yobe and Gobe states to the north east.

Maps of Nigeria can be accessed at http://www.ezilon.com/maps/africa/nigeria-maps.html and http://healthmap.org/r/3LpD.

Lassa fever is an acute viral haemorrhagic illness caused by Lassa fever virus, a member of the family _Arenaviridae_. It is transmitted to humans from contacts with food or household items contaminated with rodent excreta. The disease is endemic in the rodent population in parts of West Africa. Person-to-person infections and laboratory transmission can also occur, particularly in the hospital environment in the absence of adequate infection control measures. Diagnosis and prompt treatment are essential. - Mod.CP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (04): AFRICA
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In this update:
Africa
[1] Cholera - Congo DR (South Kivu Province)
[2] Cholera - Namibia (Kunene Region)
[3] Cholera - Nigeria (Jigawa State)
[4] Cholera - Nigeria (Bauchi State)


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[1] Cholera - Congo DR (South Kivu Province)
Date: Fri 17 Jan 2014
Source: Radio Okapi [in French, mach. trans., edited]
http://radiookapi.net/regions/sud-kivu/ ... nes-sange/


In the space of 3 weeks, 224 cholera cases and 3 deaths have been recorded in the general hospital in Ruzizi in Sange [South Kivu Province], the chief physician of area of health has indicated Friday [17 Jan 2014]. For the physician director of the general hospital of Ruzizi in Sange, Ndugu Kanyegere, the resurgence of this disease is related to the non-compliance of the rules of hygiene by the population. He has also called on the community to "well observe the measures of food hygiene, especially the water that they drink."

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[An interactive map of the area can be found at: http://healthmap.org/r/9Mw7.]

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[2] Cholera - Namibia (Kunene Region)
Date: Fri 17 Jan 2014
Source: The Southern Times [edited]
http://www.southerntimesafrica.com/news ... 20&type=95


Local and international health authorities in Namibia say they are making progress in efforts to contain a cholera outbreak that has already killed 11 people and affected hundreds in the country's northern region of Kunene. The outbreak of the waterborne disease in Kunene has worsened the situation in the region that is already reeling under severe drought. Many people in the region have been grappling with food and water shortages, as well as grazing for their animals, a situation compounded by failed rains over the past 2 years. An international health official has blamed the cholera outbreak on the prevailing drought. Aid workers from the Centres for Disease Control and Prevention in the Ministry of Health and Social Services, the Namibian Red Cross Society, and the WHO have been battling to contain the disease since it was 1st reported in early November 2013.

Recent statistics from the Ministry of Health and Social Services indicate that 11 people have died because of the disease, while 361 have been affected, with the majority being treated at Opuwo District Hospital.

New areas in the region with increasing suspected cases are Tjiuuo, Otjithoko and Tjomauuvi villages in the region, she said, adding that the Etanga catchment area that was affected most is now stabilizing with a fewer new suspected cholera cases being reported.

Currently, 35 people have been hospitalized at the Opuwo District Hospital, and the Ministry of Health and Social Services is urging community members with cholera symptoms to seek treatment immediately.

According to UNICEF, there are between 1.4 million and 4.3 million reported cholera cases per year worldwide, resulting in 28 000 to 142 000 deaths per year among the 1.4 billion people at risk in countries in which the disease is endemic. In these countries, children under 5 account for about half of the global incidence and deaths caused by cholera.

The Etanga area, where most of the cases of this waterborne disease are coming from, lies about 100 km [about 62 miles] from Opuwo. The majority of the people in that area are from the Ovahimba tribe, which still lives a nomadic lifestyle, making it virtually impossible to construct fixed and decent housing infrastructure for them.

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[It is well recognized that drought, not just flooding, can be linked to cholera and other waterborne diseases. - Mod.LL

An interactive map of the area can be found at: http://healthmap.org/r/7F8f.]

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[3] Cholera - Nigeria (Jigawa State)
Date: Fri 17 Jan 2014
Source: The Global Dispatch [edited]
http://www.theglobaldispatch.com/choler ... ate-17416/


An outbreak of cholera in Nigeria's Jigawa State has killed at least 11 people, health officials note, according to a Premium Times report Thursday, 16 Jan 2014.

According to a statement from Mati Ali, the Public Relations Officer in the state Ministry of Health, a total of 153 cholera cases were reported in the state since 1 Jan 2014. He added that 4 people died at the hospital, while the remaining 7 died at home. Ali says that the cholera cases were reported in Taura, Birnin Kudu, Garki, Ringim, Babura and Gwaram local government areas of the state.

[Byline: Robert Herriman]

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[An interactive map of the area can be found at: http://healthmap.org/r/9Pe8.]

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[4] Cholera - Nigeria (Bauchi State)
Date: Mon 13 Jan 2014
Source: Punch [edited]
http://www.punchng.com/news/three-hospi ... in-bauchi/


No fewer than 3 persons have been hospitalized as cholera broke out in Khandahar and Doya communities in Bauchi Local Government Area of Bauchi State. Executive Secretary of the Bauchi State Primary HealthCare Development Agency, Dr Nisser Umar, said the 2 communities lacked clean sources of water, adding that their only sources of water had been chlorinated against the spread of the disease.

He said his agency was also making effort to avert the outbreak of cholera in the entire state, adding that apart from the 3 suspected cases of cholera, no death had been recorded. Umar said, "We got information that 2 Alimajiri children and another person were cholera positive in the area but not too serious; and we immediately took them to the hospital for treatment and they have been discharged.

He added, "It was discovered that they don't have clean drinking water and we have chlorinated all the wells in the area. Also the management of water board has moved to the area to clean and repair any pipe leakages. Presently, we don't have cholera epidemic, but we are on a red alert because we are surrounded by cholera-prone states and because our environment has exposed us like any other state, we may have similar situation. So, there is a need to avert the outbreak."

[Byline: Jude Owuamanam]

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LEPROSY - NIGERIA
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Date: Thu 23 Jan 2014
Source: Nigerian Tribune [edited]
http://www.tribune.com.ng/news2013/inde ... -2013.html


The Leprosy Mission Nigeria, on Wednesday [22 Jan 2014], raised alarm over new cases of leprosy in Nigeria, as about 3805 new cases of the disease were recorded last year [2013]. The National Director of the Leprosy Mission Nigeria, Dr Udo Sunday, disclosed that of this number, 10 per cent were children, and 12 per cent were already deformed as a result of lack of care. According to him, the North East zone of the country accounted for most of the cases.

Speaking at an event to mark the 61st World Leprosy Day, he expressed fears of likely resurgence of the disease in the country if the Federal Government did not step up on the gains of what it did before. He warned that Tanzania and Liberia were already experiencing resurgence of the disease, while 16 countries in the world today still found more than 1000 new cases every year, of which Nigeria was one of them.

"Nigeria needs to put in more efforts in order to detect early cases, because if they are not detected on time, they are bound to cause disabilities which have a socio-economic impact on the society," he said. Dr Sunday stated that a survey carried out revealed that 27 per cent of street beggars across the country were leprosy victims.

He regretted that Nigeria's healthcare system was solely focused on AIDS, tuberculosis and malaria (ATMs), while neglecting other diseases that have the potential of causing devastating damages to the system. He therefore warned that over 27 diseases, including leprosy, which the government was not giving attention, could cause harm to a large number of the population.

He called for the passage of the Bill on Disabilities, which is still pending before the National Assembly, saying that leprosy is not hereditary, but it is exacerbated by lack of political commitment, inadequate low referral and high level of stigmatization of sufferers.

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[The news release above says that Nigeria reported 3805 new cases of leprosy in 2013, which, if correct, is the exact same number of new cases of leprosy detected in 2012 according to WHO (Table 3, http://www.who.int/wer/2013/wer8835.pdf). The news report above also says that 12 percent of the new cases reported in 2013 already had deformities resulting from untreated leprosy, which indicates the cases were detected late in the course of the disease; and another 10 percent of the new cases were children, which indicates continued transmission of the disease in the community. In 2012, according to WHO (Table 8, http://www.who.int/wer/2013/wer8835.pdf), 13.8 percent had deformities and 8.7 percent occurred in children.

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.lepra.org.uk/platforms/lepra ... 65_076.pdf). Following introduction of multidrug therapy for leprosy in 1985, Nigeria attained the WHO target for elimination as a public health problem of less than one case per 10 000 population at the national level by the end of 1998 (http://www.lepra.org.uk/platforms/lepra ... 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).

Although the number of new cases of leprosy detected in Nigeria decreased from 5276 in 2004 to 3805 in 2013, (http://www.who.int/wer/2013/wer8835.pdf), 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). In 2012, Nigeria accounted for 1.6 percent of the total number of new cases (232 857) detected worldwide.

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). It is located in West Africa on the Gulf of Guinea 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/1qGF. - Mod.ML]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (05): AFRICA
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In this update:
Africa
[1] Diarrhea - South Africa (Limpopo Province)
[2] Cholera - Nigeria (Kebbi State)
[3] Diarrhea, dysentery - Zimbabwe (Masvingo, Mashonaland west Provinces)

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[1] Diarrhea - South Africa (Limpopo Province)
Date: Mon 27 Jan 2014
Source: South African Press Association (SAPA) [edited]
http://www.enca.com/south-africa/dozens ... a-outbreak


At least 45 people were admitted to hospital after contracting diarrhea in Limpopo, the provincial health department said on Mon 27 Jan 2014.

"Officials were attending a workshop at a lodge when they were taken to hospital, severely affected," said spokesman Macks Lesufi. "Our provincial Diseases Outbreak Response team is on site. Further tests are being conducted to determine the cause, and the results will be made available."

Nine of those admitted to hospital were in a critical condition, while 36 were treated and discharged from the Voortrekker Hospital on Sun 26 Jan 2014.

Contaminated water or food was suspected to be the source of the outbreak at the lodge, Lesufi said. Lesufi advised those with diarrhea symptoms not to panic but to visit their local health institutions.

The province is prone to disease outbreak, especially during rainy seasons. Cholera and malaria cases have recently been reported in parts of the province.

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[The mortalities here suggest that cholera may well be underlying this outbreak. - Mod.LL

A ProMED-mail HealthMap for South Africa is available at http://healthmap.org/r/1EPe.]

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[2] Cholera - Nigeria (Kebbi State)
Date: Sun 26 Jan 2014
Source: All Africa [edited]
http://allafrica.com/stories/201401270336.html


A cholera outbreak in Koko/Besse local government area of Kebbi State has led to the deaths of 3 people and several others being hospitalized. Chairman of the local government Alh Aliyu Buhari Koko disclosed this to journalists during a tour of the local government.

Koko stated that because of the outbreak, the council quickly constructed 5 boreholes across the 3 villages affected by the epidemic.

Koko said that the gesture became necessary considering the scores of lives involved in the outbreak in order to prevent people from drinking contaminated water.

[Byline: Yahya Sarki]

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[3] Diarrhea, dysentery - Zimbabwe (Masvingo, Mashonaland west Provinces)
Date: 13 Jan 2014
Source: The Herald [edited]
http://allafrica.com/stories/201401130736.html


26 people died of diarrheal diseases countrywide in one week alone during the festive season, a weekly disease surveillance report has revealed. According to the report, 16 died of common diarrhea, while 10 others died from dysentery during the week ending 26 Dec 2013. The majority of the diarrhea deaths were recorded in Gutu in Masvingo, while most of the dysentery cases were recorded in Hurungwe in Mashonaland West province. An additional 6415 people were treated for diarrhea, while 729 were treated for dysentery in the same week.

Epidemiology and disease control director in the Ministry of Health and Child Care Dr Portia Manangazira said of late that there was an increase in the number of diarrhea cases. Dr Manangazira attributed the increase to flooding and stagnant water bodies common during this season. "It is difficult to contain diseases such as typhoid, cholera, and dysentery as we are in the middle of the rainy season," Dr Manangazira said. In 2013, a total of 598 people died of diarrheal diseases throughout the country, while 579 932 others received treatment from the same diseases.

The government was worried about deaths from diarrheal diseases saying no one should die from diarrhea because it was preventable and treatable. However, the diseases continue to affect many people and claim lives due to lack of adequate and safe water and sanitary conditions in many parts of the country.

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MALARIA - SOUTH AFRICA: (VHEMBE, MOPANE)
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Date: Tue 27 Jan 2014
Source: Zoutnet [edited]
http://www.zoutnet.co.za/details/27-01- ... ases/22927


The Vhembe and Mopane regions are the most fragile areas where one could easily be infected with malaria, especially during the rainy season.

According to the Department of Health in Limpopo, a record number of 765 malaria cases were recorded over the past 3 months, with 217 cases reported in October 2013, 347 in November 2013 and 201 in December 2013. The Donald Fraser, Malamulele, and Musina hospitals are the hospitals that recorded the highest number of malaria cases in Mopane.

The Department of Health has warned that during October to February the number of malaria cases increases. The reason for the increase is because of the rain and the subsequent breeding of mosquitoes. The department also warned travellers, especially those who visit high-risk areas during the festive season, to be watchful for malaria signs and symptoms. Some of those symptoms include fever, body pains, headache, nausea and diarrhoea. "If any of these symptoms are experienced, patients should immediately proceed to the closest clinic or health centre for a malaria test," said the Department of Health's spokesperson, Ms Adele van der Linde.

Ms van der Linde said that the higher incidence of malaria was caused by travelling and human behaviour. "During December [2013], many community members and migrant workers from the province visited high-risk malaria areas outside the provincial boundaries. People also spent more time outdoors in the evenings during December [2013]," she said. "Unfortunately, there are still patients who delay consulting when they fall sick, resulting in fever and complicated malaria that can lead to malaria-related fatalities," she said. It was established that only 7 suspected fatalities had occurred, with 4 in November 2013 and 3 in December 2013.

The department has embarked on an operation to minimize the transmission of the disease. "All 42 malaria teams from the department are fully operational in the communities with indoors residual spraying," she said. The department was also educating communities about early treatment-seeking behaviour.

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[Vhembe and Mopane are located close to the border with Zimbabwe and about 50 km from the Kruger National Park. Malaria transmission is known in the area, and it is included in the transmission areas indicated for South Africa in the 2012 World Malaria Report (http://www.who.int/wmr2012), with an annual incidence between 0 and 0.1 per 1000 population. - Mod.EP

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

UNDIAGNOSED OUTBREAK - SUDAN: (NORTH DARFUR) SCHOOL, REQUEST FOR INFORMATION
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Date: Sun 2 Feb 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/65762


About 50 basic school students in Jebel Eisa, north of El Malha in North Darfur, have been stricken by an unknown disease. Multiple sources told Radio Dabanga that the people are scared and in panic because of the "mysterious disease". The 1st symptoms appeared in the region on 25 Dec [2013].

The symptoms of the disease are pain, and spasms, or "tightened nerves", in various parts of the body, in particular the hands, legs, neck, and the mouth. The patients are not able to walk, talk, eat or drink.

The sources appealed to the authorities and UN health care organisations to visit the area, and examine the patients to diagnose the disease and define its treatment.

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[2]
Date: Tue 26 Jan 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/65188


About 145 school students in the area of Um Jerhaman, El Taweisha locality in North Darfur, are suffering from an unknown disease that makes them faint.

The director of the Um Jerhaman basic school for girls, Ali Mohamed Ali, told reporters that 75 of the 240 pupils at the school are suffering from the disease, as well as 70 pupils of the neighbouring basic school for boys. He said that the symptoms of the disease are headaches, fever, vomiting, and abdominal pain, causing the students to faint. A medical team from El Taweisha that visited the area diagnosed the cases as malaria.

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[The news reports above describe 2 outbreaks among school children in 2 different towns in North Darfur. The distance between the towns is unknown. One outbreak started on 25 Dec 2013 and is ongoing, involving 50 schoolchildren with an incapacitating illness characterized by pain and spasms in various parts of the body. The other outbreak of fainting, with headaches, fever, vomiting, and abdominal pain involves 145 children, 75 of 240 at a girls' school and 70 at a nearby boys' school. A diagnosis of malaria had been made in the 2nd outbreak, but no mention was made of the students having fever or chills.

The outbreaks could possibly be due to an exposure to a toxin, perhaps in food or water, or the outbreaks could be due to epidemic hysteria, also called mass psychogenic illness, in which a constellation of symptoms suggestive of organic illness occurs without an identifiable cause (http://epirev.oxfordjournals.org/conten ... 3.full.pdf). Schools are frequent settings for outbreaks of mass psychogenic illness and symptoms commonly reported are nausea or vomiting, headache, and dizziness or light-headedness. A more detailed description of the clinical manifestations, epidemiology, and laboratory data is clearly needed. More information on the North Darfur school outbreaks would be greatly appreciated from knowledgeable sources.

North Darfur, with an estimated population of about 1.6 million (2006) (http://en.wikipedia.org/wiki/North_Darfur#cite_note-3), is one of the 18 wilayat or states of Sudan and it is the largest of the 5 states composing the Darfur region (http://en.wikipedia.org/wiki/Sudan). For maps of Sudan that show the Darfur region, see http://en.wikipedia.org/wiki/File:Polit ... y_2010.svg and http://sites.duke.edu/stefanijones/file ... dan-UN.jpg. - Mod.ML

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/4-5_.]

DENGUE/DHF UPDATE (11): AFRICA
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Africa: Tanzania (Dar es Salaam)
Date: 1 Feb 2014.
From: Belia Klaassen <bklaassen@istclinic.com> [edited]


This message is to make sure ProMED-mail is informed of increasing cases of dengue fever in Dar es Salaam city, Tanzania. In our private clinic, IST Medical Scheme clinic, at least 10 proven cases (with rapid antigen/antibody test kits) have been diagnosed, starting halfway through December 2013 and increasingly so in the last 2 weeks. Most of these patients are expatriate residents in Dar es Salaam. Some needed hospitalisation because of gastritis and vomiting; 2 cases had very low platelets but are recovering.

The Tanzanian ministry of health has been informed and is assisting in serological testing.

In 2010, over 60 cases had been seen in our clinic as well; before 2010, cases were only sporadically diagnosed in Tanzania.

--
Belia Klaassen, MD
IST Medical Scheme clinic
Dar es Salam, Tanzania
http://www.istclinic.com
<bklaassen@istclinic.com>

[ProMED-mail thanks Dr Belia Klaassen for sending in this firsthand report. We especially appreciate receiving dengue reports from Africa, since information coming from there is scarce.

A HealthMap/ProMED-mail interactive map showing the location of Tanzania in East Africa can be accessed at http://healthmap.org/promed/en?v=-6,35,5. - Mod.TY]

CHIKUNGUNYA (13): UGANDA, REQUEST FOR INFORMATION
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Date: 3 Feb 2014
Source: New vision [edited]
http://www.newvision.co.ug/news/652072- ... ganda.html


Dr Myers Lugemwa, the head of the malaria control programme at the health ministry, has confirmed cases of chikungunya [virus] infection in Uganda, especially around the River Semliki and in the West Nile region. He said there were few incidences, however, so there was no need for panic.

Chikungunya [virus], transmitted by mosquitoes and whose signs and symptoms are similar to those of malaria, has no known vaccine or cure at the moment. Patients bitten by a mosquito carrying the virus present with severe muscle pains, high temperature, lymph node pains and swellings and may develop a rash that eventually bleeds if unattended to. They develop red eyes and also have severe headaches and backaches and may start vomiting.

The World Health Organization (WHO) has already sounded a concern regarding the growing incidences of the viral infection, especially around the Caribbean islands in the Atlantic Ocean [Caribbean]. The Centres for Disease Control and Prevention have sent out a health advisory to doctors in the United States to consider chikungunya infection in patients with acute onset of fever and joint pain.

Chikungunya [virus], which was 1st isolated in Tanzania in 1953, is commonly spread by the _Aedes aegypti_ mosquitoes that also transmit dengue fever [virus], a similar but more serious illness with a deadly haemorrhagic form.

Unlike the female _Anopheles_ mosquito that transmits malaria plasmodium and is common in Uganda, Lugemwa says the _Aedes aegypti_ mosquitoes are rare, except around the prone areas surrounding River Semliki and the West Nile region.

Lugemwa says once bitten by a mosquito carrying the virus, the incubation takes between 3-12 days before symptoms manifest. The illness is not life-threatening, but there is no vaccine.

The diagnosis is carried out using specialised equipment, lest the disease is mistaken for malaria or another form of haemorrhagic fever. Several methods can be used for diagnosis. Lugemwa says the infection can also infect other animals, especially monkeys, and can also be transmitted from mother-to-child when the baby is still in the womb.

"There are many types of mosquitoes, and some transmit viruses. However, the fact that mosquitoes can also transmit viruses should not cause alarm, because mosquitoes cannot transmit the human immunodeficiency virus (HIV). The _Aedes aegypti_ mosquitoes transmit a virus scientifically called alphavirus, whereas HIV is a retrovirus (a family of enveloped viruses that replicate in a host cell)," he added. Lugemwa explains that HIV cannot survive inside the body of the mosquito, while the chikungunya [virus] can. He says cases of the chikungunya virus [infection] have, in the past, also been reported in Asia, Latin America, the Congo, and in Europe.

Lugemwa says in Tanzania, chikungunya means "break your back," because the person with the disease has a severe backache ["that which bends up" because of severe joint pain. - Mod.TY].

He says the ministry's antimalarial interventions like indoor spraying and distributing free mosquito nets also help in the prevention of these and other diseases such as malaria.

[byline: John Agaba]

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[ProMED-mail very rarely receives reports of chikungunya virus outbreaks in Africa. The most recent reports were in 2011 and 2012, from the Republic of the Congo and the Democratic Republic of the Congo. No previous reports of chikungunya virus infections in Uganda have been received by ProMED-mail. It would be of interest to learn how many cases have occurred in Uganda and the dates of their occurrence. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6.]

UNDIAGNOSED OUTBREAK - SUDAN (02): (NORTH DARFUR) SCHOOL, COMMENT
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[1]
Date: Mon 3 Feb 2014
From: Jack Woodall <jackwoodall13@gmail.com> [edited]


re: ProMED-mail. Undiagnosed outbreak - Sudan: (ND) school, RFI 20140203.2251458
---------------------------------------------------------------
Mass hysteria can be triggered by stress. Due to intertribal warfare and the flight of refugees, the population of North Darfur is now considerably less than it was in 2006, and the school kids could have been stressed by fighting in the area. See http://www.irinnews.org/report/97434/ca ... rth-darfur (8 Feb 2013).

--
Jack Woodall
<jackwoodall13@gmail.com>

******
[2]
Date: Tue 4 Feb 2014
From: Jawad Mofleh <jmofleh@yahoo.com> [edited]


re: ProMED-mail Undiagnosed outbreak - Sudan: (ND) school, RFI 20140203.2251458
--------------------------------------------------------------
Since 2009, school girls in elementary and intermediate classes, their teachers, administration staff of the schools, and in some cases the parents of the students in Afghanistan suffer from an unknown disease so far called "mass poisoning of school girls". [http://www.ctvnews.ca/mass-poisoning-fe ... l-1.397584 (11 May 2009)].

The symptoms are fainting, dizziness, nausea/vomiting, headache, shivering, weeping, rash, hot flashes, redness on face, loss of consciousness and normal to small pupils. Symptoms start when students are going to their classes in the mornings and in matter of minutes to an hour tens of students and others fall sick. In the emergency rooms patients are treated with oxygen, dextrose and sometime atropine. All recover in hours and no mortality is reported to date.

So far not only ministry of health of Afghanistan, but also World Health Organization and well equipped armies of our 30 countries that are working in Afghanistan to bring peace and stability could not detect the agent and could not diagnose the disease.

The drama is [occurring] during the time that schools are open in Afghanistan (March-December), and remitting while schools are [closed] or there is no hot political issue. Incidents are happening in localities that are safe or relatively safe and not in the areas of suicide attacks or frequent explosions. Though the Afghan minister of education threatened to punish schoolgirls who claim to suffer from alleged poisonings [http://www.thehindu.com/todays-paper/tp ... 697439.ece (9 May 2013)], [the incidences are] continuing. Sometimes they call it a mysterious disease [http://www.pajhwok.com/en/photo/177773 (7 May 2012)], sometimes a mass poisoning with malathion, and sometimes mass hysteria. No matter what, the children are suffering.

To conclude, school children are endangered everywhere civil unrest, war, or political unrest exists. Only those who have lost their childhood in the war know what costs are paid.

This is a personal view and does not reflect our institutional views.

--
communicated by:
Jawad Mofleh
Eastern Mediterranean Public Health Network
<jmofleh@yahoo.com>

[

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/4-5_.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (06): AFRICA
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In this update:
Africa
[1] Cholera - Nigeria (Benue State)
[2] Cholera - Namibia (Kunene Region)

******
[1] Cholera - Nigeria (Benue State)
Date: Tue 4 Feb 2014
Source: AllAfrica, Leadership (Abuja) report [edited]
http://allafrica.com/stories/201402040115.html


No fewer than 30 people including children and nursing mothers have reportedly died following a fresh cholera outbreak in Makurdi, the Benue State capital. This is even as scores of people are hospitalized in various hospitals in Wadata, Wurukum, and High Level areas of the town while others continue to stool and vomit relentlessly.

Leadership's visit to Jolua Hospital located on Benue Crescent and Hope Hospital, all in Wadata area of Makurdi revealed that a high percentage of residents of the area had contracted the killer disease. The situation was not different at the Benue State University Teaching Hospital (BSUTH).

The medical director of Jolua Hospital, Dr Adole Victor Edoh told Leadership that, "we have recorded over 80 per cent of cholera outbreak in this hospital and 97 per cent of the entire Wadata area is currently affected with this disease." He said more than 10 people were admitted in the hospital and 2 had died while others were treated and discharged, adding that the hospital gets between 2 and 3 patients daily and that the ailment was tested and confirmed by medical experts to be cholera.

At Hope Hospital, the matron, Mrs Agatha Nyietagher said more than 20 patients were so far admitted and 2 casualties were recorded yesterday [3 Feb 2014] including a 10 year old girl and a 37 year old man.

Meanwhile, the public relations officer of BSUTH, Mr Cephas Hough who admitted that some patients were admitted in the hospital with reported cases of stooling and vomiting however denied that there was an outbreak of cholera in the state capital.

[byline: Solomon Ayado]

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[Maps of Nigeria can be seen at http://www.un.org/Depts/Cartographic/ma ... igeria.pdf and http://healthmap.org/r/a1dX. - Sr.Tech.Ed.MJ]

******
[2] Cholera - Namibia (Kunene Region)
Date: Tue 28 Jan 2014
Source: AllAfrica, The Namibian [edited]
http://allafrica.com/stories/201401281010.html


The Ministry of Health and Social Services says the number of cholera deaths in the Kunene Region has risen to 15. Although the ministry insists it has the situation under control, 7 people have reportedly died at health facilities, while 8 others were reported from the community, one of which was a pregnant woman.

The acting director of the Kunene Regional Office, Joyce Mashaamba, said the number of suspected cholera patients who received treatment at health facilities since the disease broke out now stands at 453. He said only 5 more patients were admitted at the Opuwo District Hospital.

"The field workers in the region continue to provide health education, distribution of water purification kits and oral dehydration solutions, surveillance of the disease, referral of community members to health facilities, etc.," he said. Mashaamba also said the Ministry has been receiving clean drinking water at health facilities from the Ministry of Defence and the Ministry of Agriculture. "Even though these efforts are appreciated, most health facilities remain without water just like in most parts of the region," he said.

[byline: Theresia Tjihenuna]

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[Maps of Namibia can be seen at http://www.maplibrary.org/stacks/Africa ... /index.php and http://healthmap.org/r/7F8f. - Sr.Tech.Ed.MJ]

SALMONELLOSIS - SOUTH AFRICA: (LIMPOPO) NOT CHOLERA
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Date: Thu 30 Jan 2014
From: Lucille Blumberg <lucilleb@nicd.ac.za> [edited]


The information reported by ProMED-mail [Cholera, Diarrhea and Dysentery Update (05): Africa, Asia; archive no 20140129.2235497], on the outbreak of diarrheal disease in the Limpopo Province of South Africa requires modification. The information was reported from a media source and the conclusions of the moderator are not correct.

There have been 44 cases of diarrheal disease all linked to the attendance of an event at a lodge. Of these cases, all were treated in hospital but only 9 were admitted over the course of 7 days and have recovered. There have been no deaths. Patients presented at the local hospital with diarrhea and vomiting within 48 hours of first checking into the lodge and enjoying several meals (checked in on 20 Jan 2014 and 1st case presented on 22 Jan 2014.) A non-typhoidal _Salmonella_ species was confirmed by laboratory tests on stool specimens from the patients, and will be further characterized. The outbreak is currently under investigation but preliminary reports would point to a foodborne illness directly related to food consumed by attendees of the event at the lodge. No further cases have been reported since 28 Jan 2014 and all reported cases were discharged in good health.

There is no evidence whatsoever -- clinically or on laboratory testing --to suggest cholera. The last outbreak of cholera in the Limpopo province was between November 2008 and June 2009. Last year [2013] there were only 2 cases of imported cholera reported in Limpopo. There have been no local outbreaks since 2009.

--
Prof Lucille Blumberg
Deputy Director
Division of Public Health Surveillance and Response
National Institute for Communicable Diseases
Johannesburg, South Africa
<lucilleb@nicd.ac.za>

[ProMED-mail thanks Professor Blumberg for correcting the information regarding this outbreak, now known to be caused by a serotype of _S. enterica_. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7GD-.]

RABIES - SOUTH AFRICA: (LIMPOPO) HUMAN
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Date: Thu 6 Feb 2014
Source: AllAfrica, SA News report [edited]
http://allafrica.com/stories/201402070665.html


One person has died of rabies in Limpopo [province, South Africa] this week [week of 2 Feb 2014], bringing the total number of rabies-related deaths to 4 in the last 10 months [since April 2013].

Provincial Health spokesperson Adele van der Linde said the recent death was reported in Malamulele near Giyani. "The department once again issues a warning to residents of Limpopo, but especially in the Vhembe and Mopani districts, to immediately seek help when bitten or scratched by a domestic or wild animal that is suspected of being rabid," said Van der Lind. She said the average incidence of human rabies in Limpopo was 3 deaths per financial year, mostly in the Vhembe district.

Van der Linde said a series of training sessions had been held at all health institutions in Vhembe last year [2013] to focus on case management and the prevention of human rabies. Annual road shows were also held in Vhembe and Mopani district in September [2013], which was World Rabies Month. "Our main challenge remains the issue of ignorance. People do not seek medical attention soon enough," Van der Linde said. "People are bitten or scratched by their own animals but don't see the need to go to a health facility for treatment."

She said rabies was a re-emerging disease in South Africa, particularly in densely populated rural areas, but that infected people can survive if they are treated in time. "If a person comes into contact with a rabid animal, whether it be a bite or a scratch, they should seek immediate medical attention. There is an effective, safe vaccine against rabies," she said. She stressed that domestic pets must be vaccinated against rabies regularly. The Department of Agriculture is currently vaccinating pets free of charge in communities across the province. "Dogs and cats should be vaccinated at 3 months of age, with a booster at 9 months, and then every 3 years afterwards. In high risk areas, annual revaccination is recommended," she said.

She said stray animals, animals that are behaving strangely or that appear sick must be avoided. Once the rabies virus has entered the body, it goes to the brain where the virus multiplies, causing brain dysfunction and ultimately death. The disease is spread from animal to animal, and occasionally from animals to humans.

[byline: Sydney Masinga]

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[Limpopo is the northernmost province of South Africa. It is named after the Limpopo River that flows across the province. The province was formed from the northern region of Transvaal Province in 1994, and initially named Northern Transvaal. The following year, it was renamed Northern Province, which remained the name until 2003, when the name of the province was formally changed to the name of its most important river -- on the border with Zimbabwe and Botswana -- after deliberation by the provincial government and amendment of the Constitution. Limpopo is the South African province with the highest level of poverty, with 78.9 per cent of the population living below the national poverty line. In 2011, 74.4 per cent of local dwellings were located in a tribal or traditional area, compared to a national average of 27.1 per cent.

From the above press report it appears that adequate amounts of rabies vaccine are available, but that the vaccine is not distributed effectively.

A map of South Africa showing the location of Limpopo province can be accessed at http://www.places.co.za/html/visualfind.html. A HealthMap/ProMED-mail interactive map is available at http://healthmap.org/r/7GD-. - Mod.CP]

UNDIAGNOSED OUTBREAK - SUDAN (03): (NORTH DARFUR) SCHOOL, MASS HYSTERIA
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Date: Sun 9 Feb 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/66326


The Sudanese Federal Ministry of Health has classified the mysterious condition that recently emerged among school students of Al Taweisha locality in North Darfur as cases of hysteria and not paralysis. [A diagnosis of "paralysis" had previously been made for patients seen at El Fasher Teaching Hospital about 1 week ago. See a related news report at https://www.radiodabanga.org/node/65964.]

A report issued by the Federal Department of Epidemiology has acknowledged 90 cases at Al Taweisha Hospital after the federal investigation team's arrival. They report 30 cases of hysteria on [23 Jan 2014] among basic schoolgirls between 7-14 years. The Epidemiology Department statement pointed out that after the arrival of the team, the cases rose to more than 90, complaining of abdominal pain and headaches.

These were diagnosed as hysteria after ruling out all other diseases. Likewise, 90 cases from a school for boys at the same village, were also diagnosed as hysteria. The statement reported 2 cases at the same school on [29 Jan 2014], followed by 7 new cases recorded in the following day, ruling out contaminated meals at schools in the region.

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DENGUE/DHF UPDATE (13): AFRICA
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*****

Africa - Tanzania (Dar es Salaam). 7 Feb 2014. Dengue, hospitalized 21 cases; Past cases: in 2010, 40 cases; in July 2013, 172 cases.
http://www.24tanzania.com/dengue-fever- ... le-in-dar/

[ProMED-mail seldom receives reports of dengue in Africa. Given this report, cases have been occurring in past years, leading one to suspect that there is significant underreporting. The report above increases to 21 the number of individuals hospitalized in Dar es Salaam due to dengue from the 10 reported the previous week (see ProMED-mail archive 20140203.2252372).

Maps of Tanzania in East Africa can be accessed at http://www.un.org/Depts/Cartographic/ma ... nzania.pdf and http://healthmap.org/r/a8G3. - Mod.TY]