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CHOLERA, DIARRHEA AND DYSENTERY UPDATE (22): AFRICA
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Cholera - Somalia (Middle Jubba)
Date: Thu 15 May 2014
Source: RBC Radio [edited]
http://www.raxanreeb.com/2014/05/somali ... dle-jubba/


At least 3 children are confirmed dead and 50 others seriously ill of cholera outbreak in Buale town, middle Jubba region. Cholera broke out 3 days ago in Buale town in middle Jubba under Alshabab administration. According to a local medical staff in Buale town who requested anonymity said that lack of optimum medical care deteriorated the break out of the cholera disease which so far left 2 children dead and dozens under serious illness.

He said that lack of medical supplies into the town is worsening the medical condition of the children and other people in the region since the town is under the control of shabab militants. The death toll is feared to increase if the medical situation continues like this, he added.

Baule general hospital in Baule town has been a military base for the militants since their seizure of the town 3 years back.

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[A HealthMap/ProMED-mail map is available at http://healthmap.org/promed/p/32972.]

YELLOW FEVER - AFRICA (05): DEMOCRATIC REPUBLIC OF THE CONGO
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Date: Mon 12 May 2014
Source: Radio Okapi [in French, machine trans. edited]
http://radiookapi.net/emissions-2/chron ... 3TqwXbt4Sk


The social mobilization team of the Kipamba health zone in Bukama territory claims to have listed, in 6 weeks, 59 cases of yellow fever in this part of Katanga. According to this [radio] service, this disease affects at least 10 localities.

Prevention is by vaccination. A vaccine was introduced in DRC in 2003 as part of the Expanded Programme on Immunization (EPI). Vaccinations for children are generally given from 0-59 months, but if there is an epidemic, we can vaccinate them up to 15 years [9 months? For YF. - Mod.JW].

The doctor for the Kipamba area invites the public to clean up places where they live to protect themselves against the _Aedes aegypti_ mosquito that is the vector of this disease . He also announced there would soon be a vaccination campaign against yellow fever in this health area.

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[Yellow fever occurs sporadically in rural areas of the DRC. With a total of 59 reported yellow fever virus infections in 10 localities in the Kipamba health zone, there is real cause for concern. This report does not indicate whether these cases have been laboratory confirmed. One hopes that the vaccination campaign scheduled to begin soon will bring a halt to transmission. Without a vigorous public education campaign in the affected localities, vector mosquito control through a cleanup campaign is not likely to be successful.

Maps of the DRC can be accessed at http://www.mapsofworld.com/democratic-r ... al-map.jpg and at http://healthmap.org/promed/p/194. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (23): SOUTH SUDAN (CENTRAL EQUATORIA)
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Date: Sat 17 May 2014
Source: Radio Tamazuj [edited]
https://radiotamazuj.org/en/article/56- ... olera-juba


Two days after the formal declaration of a cholera outbreak in Juba, South Sudan, the number of suspected cases rose from 18 to at least 56. The cases of the disease were reported from various neighborhoods of Juba, according to a health source who spoke to Radio Tamazuj on Sat 17 May 2014, with a number of suspected cases also reported elsewhere in the country.

According to Juba Teaching Hospital Director General Wani Lolik Lodu, the number of cholera-infected people is actually higher. He was quoted by Catholic Radio Network as saying the number of cases had increased to 70, coming from at "all corners of Juba town."

Though the Health Ministry on Thursday [15 May 2014] confirmed only one death, UNICEF South Sudan on Saturday [17 May 2014] announced that the number had risen to 4. Five unconfirmed cases have been reported from Kaka in Manyo County and others at Mangalla Barracks in Terekeka County, Central Equatoria State. "With a quick response, it is hoped that the outbreak can be contained," the organization Oxfam said in a press release.

At Juba Teaching Hospital, where several dozen cases are being treated, the organization Medair has begun helping with medical supervision in order to ensure proper case management.

Meanwhile, Doctors Without Borders (MSF) is planning to open another cholera treatment center. The organization said it was expecting to begin its own response to the outbreak on Monday [19 May 2014], after the arrival of a cargo of supplies from Oxford to Juba, including oral rehydration salts, chlorine, water treatment, and disinfectant and soap.

None of the reported cases have yet come from within the UN protection sites, which are the most overcrowded parts of the city. According to an earlier report, one confirmed victim came from the UN House camp, but new information suggests that this victim was not actually in the camp while suffering from the disease, but rather had moved to another neighborhood of Juba.

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[Given the potential disaster of a large outbreak of cholera in the internally displaced persons camps in South Sudan, ProMED will follow this as a stand-alone post for now. One major difference between South Sudan and Haiti is that _V. cholerae_ is not new to the region as it was in Haiti, so some degree of immunity in older children and adults should be present. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/8402.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (24): SOUTH SUDAN (JONGLEI)
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Date: Sun 18 May 2014
Source: Sudan Tribune [edited]
http://www.sudantribune.com/spip.php?article51049


At least 3 people are reported to have died from cholera in South Sudan's Jonglei state after an outbreak of the waterborne disease in the Nyuak and Kongor areas of Twic East county [Jonglei state]. The commissioner of Twic East county, Dau Akoi, said the disease has hit 2 populated payams (districts of Nyuak and Kongor, including the county headquarters of Panyagoor).

"There is [a] cholera outbreak in Twic East county now. 3 people died and 17 others are now admitted" to hospital, said Akoi in Bor on Sun 18 May 2014. A team of medical doctors will be sent to Twic East to investigate the suspected cases of cholera, he said. It is not clear when the team will leave the state capital, Bor, for Twic East county.

South Sudan's ministry of health said last week that one person had died from cholera in Juba, following an outbreak in the South Sudanese capital where 18 suspected cases have been reported.

Oxfam said the source of the disease is not yet known. It is currently working together with other aid agencies to respond to the outbreak and prevent the spread of the highly contagious disease. It says a cargo of supplies was due to arrive in the capital on 18 May 2014. The agency plans to construct latrines, treat water, distribute buckets, mobilize garbage collection, and conduct public education campaigns on good hygiene practices to vulnerable communities. "With a quick response, it is hoped that the outbreak can be contained," Oxfam said in a statement extended to Sudan Tribune last week.

"This outbreak highlights the squalid living conditions of many South Sudanese particularly in urban areas, and the scale of public health risk this poses. It also demonstrates how urgently funds are needed to respond to increasingly dire humanitarian situation in South Sudan," the statement added.

Cholera is contracted through the ingestion of contaminated food and water and generally spreads in places with poor hygiene and sanitation. Symptoms include severe diarrhea, nausea or vomiting, muscle cramps, and dehydration.

Ongoing conflict in South Sudan has forced thousands of displaced people to seek refuge at overcrowded UN bases across the country, placing an enormous strain on already limited water and sanitation facilities. Only 6 per cent of people in South Sudan currently have access to latrines and safe drinking water is also lacking.

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[Cholera has now been found in Jonglei State, which is located in north east South Sudan in the Greater Upper Nile region of the country. It does border with the Central Equatoria State to the south and west somewhat. A map of the states of South Sudan can be found at http://en.wikipedia.org/wiki/File:SouthSudanStates.svg.

The scope of the outbreak in this civil war ravaged country with many areas of internally displaced people is yet to be determined. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/19548.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (25): SOUTH SUDAN, SPREAD
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Date: Mon 19 May 2014
Source: UNICEF [edited]
http://www.unicef.org/media/media_73559.html


The caseload of cholera is rapidly increasing in South Sudan and the potentially deadly, contagious disease appears to be spreading, UNICEF said today, 19 May 2014.

Since the outbreak of cholera in the capital Juba late last week, the reported cholera caseload has doubled every day; now with new reported cases in 2 additional states, Jonglei and Upper Nile. After the 1st case was confirmed in Juba 4 days ago, more than 130 additional cases are now being treated. There are 3 confirmed deaths. Dozens of children are among the affected. "The severity of the cholera outbreak is just one manifestation of a country failing its children," said Jonathan Veitch, UNICEF representative in South Sudan. "Cholera puts ever more strain on the most vulnerable, whose health is already compromised by a nutritional crisis."

Since January 2014, UNICEF has warned of the threat of cholera, due to the desperate overcrowding of camps following continued violence, and now the rainy season. In April 2014, UNICEF said that unless nutrition treatment is scaled up immediately, up to 50 000 children under the age of five are likely to die.

In response to the cholera outbreak, UNICEF has helped establish a Cholera Treatment Centre (CTC) at the Juba Teaching Hospital. It also provided life-saving supplies, including medicines, protective gear and equipment, and is expanding preventive measures to halt further spread across the country.

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[The Upper Nile state is north of, and bordering with, the Jonglei state as can be seen on a map at http://en.wikipedia.org/wiki/File:SouthSudanStates.svg. Over the few days since the cholera outbreak has been reported, the number of cases has increased by an order of magnitude and now 3 states are involved. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/8402.]

MENINGITIS, MENINGOCOCCAL - MOROCCO: (SOUSS-MASSA-DRAA) SUSPECTED, REQUEST FOR INFORMATION
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Date: Mon 19 May 2014
Source: Nouvelle Tribune [in French, machine trans., edited]
http://www.lnt.ma/societe/4-nouveaux-ca ... 03267.html


Two new cases of meningitis were recorded last week [week of 12 May 2014] in Tinghir, [Souss Massa Draa region]. The 2 patients are students at the Assou Oubassalam school. According to a statement from the Department of Health, local health authorities promptly took the necessary measures under the meningitis control program. Both children were transferred to the regional hospital in Ouarzazate [Souss Massa Draa region]. Their families have also been tested and received preventive care, and an epidemiological investigation has been carried out in the affected children's and neighboring douars [an Arabian village consisting typically of a group of tents or huts that encircle an open space]. Similarly, all students, teachers, and school staff have been tested, which revealed 2 new cases among the students. Nearly 800 persons were vaccinated against meningitis and for added efficiency, the health minister, Hussein Al Ouardi, sent a specialized team of the Epidemiology and Infectious Diseases directorate to the site, to carry out an epidemiological investigation and take, if necessary, additional measures.

To date, the 4 students who remain hospitalized are doing well. Finally, the Department of Health wishes to clarify that these are isolated cases, which are controlled.

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[Large epidemics of meningococcal meningitis recur each year during the hot, dry season, between December and June in the semi-arid areas of sub-Saharan Africa, designated the WHO African meningitis belt, which extends from Ethiopia in the East, to Senegal in the West and includes Senegal, Gambia, Guinea-Bissau, Guinea, Mali, Cote d'Ivoire, Burkina Faso, Ghana, Togo, Benin, Niger, Nigeria, Cameroon, Chad, Central African Republic, Sudan, South Sudan, Uganda, Kenya, Ethiopia, and Eritrea (see map at http://wwwnc.cdc.gov/travel/content/yel ... p_3-11.pdf). Serogroup A meningococcus has been the main cause of epidemic meningococcal disease in this region (http://www.who.int/csr/resources/public ... bac983.pdf). However, since the introduction of the meningococcal A conjugate vaccine in countries of the African meningitis belt in 2010, the WHO noted a decrease in the number of cases of meningitis; in fact, the number of cases in 2013 was the lowest recorded during the epidemic season in the last 10 years (http://www.who.int/csr/don/2013_06_06_menin/en/). In addition, _Neisseria meningitidis_ serogroup A was noted to be no longer the predominant pathogen.

We are not told the microbial etiology of the meningitis outbreak in Morocco and Morocco is not part of the African meningitis belt, but the occurrence of serogroup A meningococcus outbreaks in Morocco in 1987 and 1989 may have been provoked by the introduction of a virulent strain of serogroup A meningococcus imported by returning pilgrims. ProMED-mail would appreciate more information on this current outbreak in Morocco from knowledgeable sources.

Tinghir, with a population of 36 000 according to the 2004 census, is a city in central Morocco (http://en.wikipedia.org/wiki/Tinghir). It can be located via the HealthMap/ProMED-mail map at http://healthmap.org/promed/p/39182. Tinghir and Ouarzazate are provinces in the Souss-Massa-Draa Region of Morocco, one of the 16 regions of Morocco (http://en.wikipedia.org/wiki/Souss-Massa-Drâa). - Mod.ML]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (26): AFRICA
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Cholera - Guinea
Date: Mon 12 May 2014
Source: Afriquinfos, Xinhua News Agency report [in French, machine trans., edited]
http://afriquinfos.com/articles/2014/5/ ... 253770.asp


The Guinean minister of health and public hygiene, Dr Remy Lamah, said the Guinean government launched on [Mon 12 May 2014] a vaccination campaign for 140 000 people in several prefectures located on the coasts of the Lower Guinea to prevent an epidemic of cholera. "Through our partners, we have found the necessary vaccines to succeed in this vaccination campaign to prevent the danger associated with the cholera epidemic that is sweeping already in the country," said Dr Lamah.

This national strategy of prevention aims to protect the people living on the Guinean coastline and the islands, victims each year of the cholera epidemic, which occurrence depends on the season of long rains. This vaccination campaign will be extended in other prefectures of the country where there is risk of spread of the epidemic of cholera and other diseases.

Since January 2014, Guinea has recorded 2 fatal cases of cholera in the sub-prefecture of Kamsar located more than 300 km [186 mi] north of Conakry, stated Dr Sakoba of the health ministry division of prevention and fight against cholera. In August 2013, the cholera epidemic claimed more than 60 lives among more than 2000 cases, according to statistics from the Ministry of Health.

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[Maps of Guinea can be seen at http://www.un.org/Depts/Cartographic/ma ... guinea.pdf and http://healthmap.org/promed/p/45. - Sr.Tech.Ed.MJ]

LASSA FEVER - NIGERIA (05): (EBONYI)
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Date: Tue 20 May 2014
Source: Premium Times [edited]
http://www.premiumtimesng.com/news/1611 ... fever.html


The Ebonyi commissioner for health, Sunday Nwangele, said on Tue 20 May 2014 that 6 medical staff of the Federal Teaching Hospital, FETHA, Abakaliki, had tested positive for Lassa fever.

Mr Nwangele confirmed to journalists in Abakaliki that the 6 were among the 11 doctors and 5 nurses who were rushed to the virology laboratory in Irrua, Edo for testing. The state chapter of the Nigerian Medical Association, NMA, last Thursday [15 May 2014] announced that 11 doctors and 5 nurses had contracted the disease after participating in a clinical operation on a pregnant woman in the hospital.

The state NMA chairman, Chidi Esike, told journalists at a news conference in Abakaliki that the woman and her baby died a few days after they were discharged from the hospital.

Mr Esike also said that the state had recorded 25 deaths due to Lassa fever since 2005, adding that many of them were medical personnel.

Commenting on the development, the commissioner said: "No life was lost except for the pregnant woman and her baby through whom the health workers contracted the disease. The 16 patients were rushed to Irrua when they were discovered to be resistant to malaria fever treatment, and 6 of them have been confirmed positive through a laboratory test. They are now undergoing intensive care treatment, and they are all stable. But I want to say that not every case of resistance to malaria fever treatment is a Lassa fever case, he said.

Mr Nwangele said that the joint committee set up by the state Ministry of Health and FETHA on Lassa fever had evolved a 2-way approach for treatment of the disease. According to him, the method involves short and long-term control measures. "On the short-term approach, the suspected patient is administered with prophylaxis tablets, while on the long-term control, the patient that is clinically down receives injectable drugs. The state government is partnering with FETHA on the short-term control method, while government has in this regard donated tablets and personal protection equipment to affected patients. The state would not accept being an endemic state and has mapped out land for the construction of a virology laboratory in Abakaliki," he said.

Mr Nwangele noted that most of the Lassa fever cases in the area were imported, and manifested in the form of "operateable cases." He said that the pregnant woman through whom the health workers contracted the disease was not from the state. "We were contacted by the dermatology team to determine her close contacts and how she got the disease. I want to advise the public to always keep their environment clean, avoid exposing edibles to rats, and if possible exterminate all rats around them," he advised.

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[Lassa fever virus is endemic in Nigeria and is now a serious problem in 23 of the 36 states of Nigeria. Several of the above cases are reported as imported from other regions of Nigeria. As Mod.CP pointed out in his comment in that archived report: "In the countries of Africa, such as Nigeria, where Lassa fever is endemic, the disease is a significant cause of morbidity and mortality. While Lassa fever infection is normally mild or has no observable symptoms in about 80 per cent of people infected with the virus, the remaining 20 per cent have a severe, multi-system disease. Exceptionally, Lassa fever is associated with epidemics, during which the case-fatality rate can reach 50 per cent. There is no preventative vaccine and treatment. The antiviral drug ribavirin has been used with success in Lassa fever patients."

The virus is a member of the family _Arenaviridae_ and causes acute hemorrhagic fever. It is transmitted to humans from contacts with food or household items contaminated with excreta of multimammate rats (_Mastomys_ spp.). Virus transmission can occur in houses or in hospital environments or laboratories in the absence of adequate infection control measures.

Images of _Mastomys_ mice can be seen at http://www.ispot.org.za/node/255877.

Maps of Nigeria can be seen at http://www.ezilon.com/maps/africa/nigeria-maps.html and http://healthmap.org/promed/p/616. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (27): SOUTH SUDAN
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Date: Wed 21 May 2014
Source: The Associated Press [edited]
http://www.kansascity.com/2014/05/21/50 ... break.html


The United Nations says 13 people have died so far in an outbreak of cholera in South Sudan. The 1st case of cholera was reported in the capital, Juba, on 15 May 2014. As of Tue 20 May 2014, the number of cases was 266.

The spokesman for the UN secretary-general told reporters on Wed 21 May 2014 that humanitarian workers are trying to improve sanitation inside UN bases where thousands of civilians have taken refuge since violence erupted in December 2013. Stephane Dujarric says easing the "overcrowded" bases in cities such as Bentiu and Malakal remains a top UN priority.

Efforts to fight the cholera outbreak also include vaccinating 13 000 people so far in Bentiu.

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[The number of reported cases of cholera in South Sudan has doubled since the report on Tue 20 May 2014 [Cholera, diarrhea & dysentery update (25): South Sudan, spread 20140520.2483047]. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/8402.]

UNDIAGNOSED DEATHS, HUMAN, LIVESTOCK - GUINEA: (KOUBIA) REQUEST FOR INFORMATION
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Date: 24 May 2014
Source: Aminata.com (Guinea) [in French, machine trans. edited]
http://aminata.com/koubia-la-peste-bovi ... mestiques/


Reliable sources report that ["peste bovine;" see comment] has been raging for 2 months in [the village] Lenguere Katiya in the rural town of Fafaya, Prefecture Koubia. So far, 9 people and nearly 120 animals have died, and there are 20 sick people.

Speaking of the origin of the epidemic, our sources say the people of this village have eaten the meat of animals infected with the plague. We are informed that local authorities went to the location for fact finding.

"The disease has been reported here for 2 months, but the information reached us on 22 May 2014. While 9 children have died, there is also information on the deaths of 60 sheep, 50 goats, 2 bulls and 6 cows. In addition, 20 people are seriously ill," said Elhadj Mamadou Dian, vice-prefect of Fafaya, who was interviewed by a local radio station.

Patients whose condition is serious were transported to the regional hospital in Koubia where they are receiving intensive care.

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[The French text mentions "peste bovine" (rinderpest) as the disease affecting the animals. This seems highly unlikely: on top of the fact that rinderpest is known to have been globally eradicated (though should not be neglected for differential diagnosis purposes), this morbillivirus rarely affected sheep/goats and is not zoonotic [does not affect humans].

Another report on the same event, dated 25 May 2014, is available at http://www.africaguinee.com/articles/20 ... les-koubia. According to this machine translated report, which similarly mentions "peste bovine" as the disease in the animals _and_ humans, the clinical signs observed in the affected persons included "pimples [French, "boutons"] on the face, inflammation, diarrhea, followed by death" (over 3 victims within 2 days).

According to the (rather blurred) available information, the zoonotic infectious diseases which deserve consideration in this event are anthrax and (less likely) Rift valley fever.

Fafaya is a town and sub-prefecture in the Koubia Prefecture in northern Guinea. For a map showing the location of Koubia prefecture, see http://en.wikipedia.org/wiki/File:GN-Koubia.png.

Guinea has suffered during 2014 Ebola outbreaks (map at http://www.cdc.gov/vhf/ebola/resources/ ... break.html); no cases have been reported from the Koubia prefecture. However, in case the animal disease in Koubia is found to be unrelated to the human epidemic, Ebola should be excluded.

Results of the epidemiological and laboratory investigations, hopefully to be performed cooperatively by public health and veterinary authorities, are anticipated with interest. - Mod.AS

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (28): AFRICA
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[1] Cholera - South Sudan
Date: Fri 23 May 2014
Source: Voice of America [edited]
http://www.voanews.com/content/msf-batt ... 21249.html


Medical aid group Doctors Without Borders, known by its French acronym MSF, has scaled up its operation in conflict-torn South Sudan to contain a cholera outbreak. More than 300 cholera cases have been recorded in South Sudan, and more people suspected to be suffering from the disease are waiting for their medical results.

Brian Moller, head of the (MSF) mission in South Sudan, told VOA that the group is providing assistance to public health centers to treat the increasing number of cases. He says MSF is doing its best to quickly identify cases and send patients to health centers for treatment, and has begun constructing a cholera treatment center in Gudele district, one of the areas most heavily affected by the outbreak.

In April 2014, MSF vaccinated more than 10 000 displaced people against cholera in Malakal, Upper Nile State. The state capital has changed hands several times during more than 5 months of fighting between government and rebel forces.

Humanitarian workers warn the situation is dire and may worsen as the rainy season hits. Hundreds of thousands of people in South Sudan are living in displaced persons camps, which are congested and lack clean water. Moller says MSF will make intensive efforts in the camps, schools and the wider population to curb the spread of the disease, explaining that schools will be closed down by the government to avoid congestion of children in one place to break the spread of the disease.

[Byline: Mohammed Yusuf]

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[2] Diarrhea - Sudan (White Nile State), suspected cholera
Date: Sun 25 May 2014
Source: Star Africa [edited]
http://en.starafrica.com/news/cholera-f ... sudan.html


Fears have spread in the south over suspected cases of cholera in White Nile State, bordering South Sudan, where outbreaks of the disease have been confirmed. Medical sources revealed to APA on Sat 24 May 2014 that the epidemiology and emergency department in the state's Ministry of Health has introduced precautionary measures to contain the situation.

Sources said that more than 100 cases of watery diarrhea have been confirmed at El Zalit village in El Salam locality in Sudan's White Nile State amid concerns of the disease spreading from South Sudan. Since over 106 cases of diarrhea were recorded with 3 deaths in the area, there have been serious concerns about the deteriorating health situation in the state, which is already suffering from a lack of health services.

Cases have since been taken to Kosti Hospital for treatment, while laboratory samples have been sent to Khartoum to confirm them.

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[A ProMED HealthMap is available at http://healthmap.org/promed/p/96.]

DENGUE/DHF UPDATE (38): AFRICA
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Africa
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Ethiopia (Adhare woreda, Afar region). 19 May 2014. Dengue (reported) 704 cases.
http://www.nathnac.org/travel/news/deng ... 190514.htm

[A map of Ethiopia showing the Afar region can be accessed at
http://en.wikipedia.org/wiki/Afar_Region. - Mod.TY]

Tanzania:
- National. 20 May 2014. Dengue as of 19 May 2014, at least 600 cases.
http://sabahionline.com/en_GB/articles/ ... feature-01

[A HealthMap/ProMED-mail map showing the location of Tanzania in East Africa can be accessed at http://healthmap.org/promed/p/200. - Mod.TY]

- Kilimanjaro Region. 21 May 2014. Dengue alert issued, at least (susp.) 2 cases.
http://allafrica.com/stories/201405210615.html

[Normally, ProMED-mail would not post the occurrence of 2 suspected dengue cases. However, the cases in Tanzania previously have occurred in coastal Dar es Salaam. The cases above are in the interior. However, it is not stated whether these cases are dengue virus infection acquired locally or imported from the coast. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (29): SOUTH SUDAN (CENTRAL EQUATORIA)
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Date: Tue 27 May 2014
Source: Radio Tamazuj [edited]
https://radiotamazuj.org/en/article/out ... cases-juba


The infectious disease cholera continues to spread in South Sudan's largest city, Juba, with over 670 cases reported, according to the WHO.

South Sudan's Minister of Health declared a cholera outbreak on 15 May 2014, the 1st outbreak in the city since 2006-2007. Dr Abdinaser Abubakar, the officer-in-charge of World Health Organization in South Sudan, told press in Juba today, 27 May 2014, that the number of cases has been rising.

"So far, as of yesterday 26 May 2014, we have over 670 cases that have received treatment both in Juba Teaching Hospital as well as another CTC [Cholera Treatment Centre] which is run by MSF [Medecins Sans Frontieres] in Gure, and also other facilities within the town," he said.

Abubakar said that 23 people have died of cholera so far, 13 of them inside of health facilities and the others within the community. He said the case fatality rate as of today is 3.4 percent, which is "above the average." The health official said that health workers are working to improve treatment in order to reduce the fatality rate, while also calling for better surveillance in communities so that cases can be referred quickly for treatment. According to WHO, the majority of cases are coming from the neighborhoods of Northern Bari, Munuki, Juba, Rajaf, and Kator, in that order.

Tests performed in a laboratory in Nairobi [Kenya] have confirmed 6 samples while results are awaited for about 100 other samples. A laboratory will be set up in South Sudan to speed up the testing process.

For his part, UN Humanitarian Coordinator Toby Lanzer warned of the seriousness of the outbreak. In a statement via the social media site Twitter he said it was "hard to forecast the evolution but some [are] warning that we could see 10 000 cases."

The outbreak is also now confirmed to have spread within one of the UN bases in Juba, where UN-protected populations are considered at-risk because of overcrowded conditions and poor sanitation. An official of Doctors Without Borders told press in Juba today [27 May 2014] that they have seen one laboratory-confirmed case within the UN House camp, with 8 additional suspected cases.

Dr Abdinaser Abubakar, the WHO official, pointed out that the congestion at UN-protected sites has increased the risk of the disease.

UNICEF, meanwhile, announced at a press conference in Juba today [27 May 2014] that the health response to the outbreak was expensive, disclosing that the agency has already spent USD 10 million on the cholera response so far.

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[The number of cases of suspected cholera, primarily in the city of Juba, has increased dramatically. Given the number of camps for internally displaced persons in the State, it would be surprising if the infection did not wind up there and produce widespread infection with morbidity and mortality in the camps.

A reported case fatality rate (CFR) of 3.4 percent is quite a bit higher than the expected rate of 1 percent or less. Higher CFRs are related, usually, to lack of facilities to deliver adequate oral or intravenous hydration but may be higher with the Matlab strains (classical and El Tor hybrids). - Mod.LL

Photo of a UN refugee camp in Juba:
http://www.timesrecordnews.com/photos/g ... camp/11191. - Mod.JW

Maps of South Sudan can be seen at https://docs.unocha.org/sites/dms/South ... p_2684.pdf and http://healthmap.org/promed/p/13266. - Sr.Tech.Ed.MJ]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (30): AFRICA
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In this update:
Africa
[1] Cholera - Cameroon (Far North Region) ex Nigeria
[2] Cholera, suspected - South Africa (North West Province)
[3] Cholera - Congo DR (South Kivu Province)

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[1] Cholera - Cameroon (Far North Region) ex Nigeria
Date: Wed 28 May 2014
Source: World Bulletin [edited]
http://www.worldbulletin.net/news/13760 ... n-cameroon


The WHO said Wednesday, 28 May 2014, that at least 2 Cameroonians had recently died as a result of a cholera outbreak in the far north of the country. At least 50 cases registered in the Far North Region are now receiving treatment, WHO Coordinator Fannh Mahamat told Anadolu Agency. According to Mahamat, the cholera cases were discovered in the border areas of Mogode, Bourha, Mokolo and Goulfe, all of which are located some 30 km from Nigeria. The 1st 3 cases of cholera were detected in Goulfe on 26 Apr 2014, involving a family from Nigeria's Adamawa State who crossed the border for treatment in Cameroon. It is from there that the epidemic is believed to have begun," she said.

Over the past few years, Cameroon has experienced several cholera outbreaks. Cholera was blamed for 100 deaths in the country in 2004 and 51 in 2009. In 2010, there were 10 759 confirmed cases of cholera, of which 657 were fatal. The most recent outbreak -- which featured 16 804 infections and 636 deaths -- happened in 2011, according to official figures.

[Byline: Firo Needisen]

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[The regions of Cameroon can be seen at: http://en.wikipedia.org/wiki/Regions_of_Cameroon. - Mod.LL]

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[2] Cholera, suspected - South Africa (North West Province)
Date: Tue 27 May 2014
Source: SABC [edited]
http://www.sabc.co.za/news/a/c846ec0044 ... a-outbreak


Bloemhof in the North West could be facing a cholera outbreak, 5 schools in the area have been shut, and thousands of pupils and residents are affected. At Boitumelong township, clinics are swamped with patients with violent diarrhea and symptoms pointing to cholera. The latest outbreak could be caused by untreated waste flowing into the Vaal River. At a private medical clinic, 90 percent of the patients have diarrhea, and medication is fast running out. Communities living around Bloemhof and downstream from the Vaal are warned not to drink the water.

The Health Department has taken water samples to test for cholera.

[Byline: Kabelo Molope]

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[The provinces of South Africa can be seen on a map at: http://www.southafrica.to/provinces/RSA ... vinces.jpg. - Mod.LL]

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[3] Cholera - Congo DR (South Kivu Province)
Date: Tue 20 May 2014
Source: Radio Okapi [machine trans. edited]
http://radiookapi.net/sante/2014/05/20/ ... 4DeqXbt4Sk


The cholera treatment center of Baraka (South Kivu) has recorded in the last week 50 cases of cholera. The manager of this center announced to the press on Mon 19 May 2014 that he was worried about the resurgence of this disease. The districts most affected by the disease are Mwemezi, Aebaz and Macampagne, where water taps are not installed. The inhabitants get their water directly from Lake Tanganyika.

According to the chief physician of the area of health of Fizi, no death has been recorded. The area welcomes the provision of medical care provided by Doctors without Borders/Holland; 7 sites for the chlorination of water have been constructed along Lake Tanganyika.

Baraka has more than 90 000 inhabitants.

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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/6075.

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (32): SOUTH SUDAN (CENTRAL EQUATORIA)
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[1] Juba
Date: Wed 28 May 2014
Source: Medecins Sans Frontieres/Doctors Without Borders (MSF) [edited]
http://www.msf.org/article/msf-cholera- ... outh-sudan


The cholera outbreak in Juba, the capital of South Sudan, continues to spread. The latest official statistics report 733 cholera cases. The majority of cases continue to be treated in the main Ministry of Health hospital in the city, Juba Teaching Hospital, where MSF has sent 4 staff to support their cholera treatment activities.

MSF opened a dedicated 100-bed cholera treatment center in the Gudele 2 district on Sat 24 May 2014, and will open another treatment center and one or more oral rehydration points in the coming days. The plan is to have enough capacity to treat all patients if the epidemic accelerates, and to reduce some of the pressure on the very busy Juba Teaching Hospital. By the morning of Wed 28 May 2014, the Gudele 2 treatment centre had seen 88 patients, with around 20 new patients arriving each day. As news of the new treatment center spreads, we expect more patients to come, as it is close to some of the areas of Juba that are most affected by the outbreak.

Further cholera treatment supplies are being prepared, ready for sending to South Sudan in case the number of cholera patients rises sharply.

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[2] Juba, Yei
Date: Fri 30 May 2014
Source: Radio Tamazuj, Catholic Radio Network [edited]
https://radiotamazuj.org/en/article/hea ... -cases-yei


At least one person is reported dead and 3 others admitted with suspected cholera in Yei on Wed 28 May 2014, the Catholic Radio Network reported.

Yei town lies to the southwest of Juba in Central Equatoria State, near the borders with Uganda and Congo. County Disease Surveillance Officer Michael Lugala said they recorded four cases in the Tarawa neighborhood of Yei. He said that one victim was in Juba before developing the disease. The officer also pointed out that county health facilities lack stand-by drugs to treat emergency cases.

A cholera outbreak in Juba, north of Yei, has affected about 800 people so far. The government is working together with the World Health Organization, MSF, Medair, UNICEF, Oxfam, and other health organizations to contain the disease.

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[The numbers continue to increase from the 1st report less than 2 weeks ago.

A map of the province, showing Juba and Yei, can be found at https://maps.google.com/maps?safe=off&q ... CAgQ_AUoAw. - Mod.LL

Re: county health facilities lack stand-by drugs to treat emergency cases; expensive drugs are not always necessary, many cases can be cured using home-made oral rehydration salts (ORS) solution. A simple recipe for this is at http://rehydrate.org/images/diy3.gif. - Mod.JW]