Wüstenschiff

Meningococcal disease in Sudan
WHO - 15.02.2007

From 1 January to 10 February 2007, the Ministry of Health of the Government of Southern Sudan reported 1129 suspected cases of meningococcal disease including 96 deaths (case-fatality rate, 8.5%) in 8 out of 10 states of Southern Sudan. In a one week period from 4 to 11 February, a total of 79 suspected cases including 8 deaths were reported. However, delayed and irregular reporting as well as incomplete disaggregated population data are leading to difficulties in determining whether districts in these areas have reached the epidemic threshold. Cerebrospinal fluid specimens collected from the 8 affected states have tested positive for Neisseria meningitidis serogroup A by latex test. Medicines for case management as well as emergency supplies for outbreak investigations and technical guidance on outbreak control and management have been provided by the Ministry of Health of the Government of Southern Sudan with the assistance of WHO and partners, including UNICEF, UN Office of Humanitarian Affairs (OCHA), European Commission Humanitarian Aid Department (ECHO), Centers for Disease Control and Prevention (CDC), Médecins sans Frontières (MSF) and MEDAIR.

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 ( 08 )
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Southern Africa (Namibia, Zambia, Congo, Mozambique)
[2] Cholera - Sierra Leone
[3] Cholera - Namibia (Omusati, Kunene)
[4] Cholera - Angola
[5] Cholera - Somalia (south-central)
[6] Cholera - Somalia (Middle Shabelle, Middle Jubba)
[7] Cholera - Congo (Kouilou, Pool)
[8] Cholera - Ghana (Eastern Region)

******
[1] Cholera - Southern Africa (Namibia, Zambia, Congo, Mozambique)
Date: Thu 15 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: AllAfrica.com and SciDev.Net (London) [edited]
<http://allafrica.com/stories/200702150457.html>

Kalumbi Shangula, permanent secretary for the Ministry of Health and
Social Service in Namibia said 5 of the 6 cases were believed to have
been contracted in Angola. "It seems that the epicentre is situated
in Angola spreading from there to Congo, Mozambique, Zambia, Zimbabwe
and now Namibia.
Zambia has registered 5500 cases of cholera and the disease has
claimed about 90 lives in Congo, with 2700 others infected.
Mozambique's capital city, Maputo, has had over 700 cases so far.
[Byline: Rodrick Mukumbira]
--
ProMED-mail
<promed@promedmail.org>

[The edited out parts of this posting contain information on Angola
and Namibia found in individual postings below. - Mod.LL]

[See map of Southern Africa at:
<http://www.geni.org/globalenergy/librar ... africa.gif>
- Mod.JW]

******
[2] Cholera - Sierra Leone
Date: Thu 15 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Int. Federation of Red Cross & Red Crescent Societies (IFRC) [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>

From 20 Jan to 5 Feb 2007, cases of severe diarrhea and vomiting
have been reported in several parts of Sierra Leone, including the
capital (Freetown). Initial laboratory tests conducted on a series of
specimens collected showed presence of _Vibrio cholerae_ amongst
other pathogens that cause diarrhoea.
Prior to this latest epidemic, the country was just recovering from
another cholera outbreak, which mostly affected Kambia District and
Freetown town. This earlier outbreak was confirmed by the government
on 11 Oct 2006, after cases that had begun being reported in August
2006 escalated.
The Ministry of Health and Sanitation (MoH&S) has informed the Sierra
Leone Red Cross Society (SLRCS) of the new cholera outbreak in
Tonkolili District, located in the center of Sierra Leone. So far, 90
cases (with 2 deaths) have been reported, translating to a case
fatality rate of 1.8 percent [sic: actually 2.2 percent - Mod.JW].
The worst hit areas include Magbass and Magburaka townships. Other
affected villages include Maborie, Mamunta, Mabum, Robol, Rogberay,
Mafomba, Mamunabana, Manewa, and Mayoro. This situation has been
confirmed by Medecins Sans Frontieres (MSF) Holland and the SLRCS
Tonkolili branch.
--
ProMED-mail
<promed@promedmail.org>

[A map of Sierra Leone can be found at:
<http://www.un.org/Depts/Cartographic/ma ... errale.pdf>. Both
Tonkolili and Kambia Districts are in the Northern Province but do
not border upon one another. Freetown is in the Western area. - Mod.LL]

******
[3] Cholera - Namibia (Omusati, Kunene)
Date: Tue 13 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Namibian [edited]
<http://www.namibian.com.na/2007/Februar ... 0DF9C.html>

Health authorities are getting ready to tackle a cholera outbreak in
the Outapi area [in the Omusati region], where 50 cases of the
water-borne disease have been reported. The Health Ministry has
activated its Health Emergency Preparedness and Response Committee, a
senior official said yesterday, 12 Feb 2007.
Since November 2006, some 250 cholera cases have been reported in the
country. The 1st outbreak was reported in the Opuwo area of the
Kunene Region in November 2006 and 5 people died from the disease.
The disease reportedly came from Angola.
"Two new cholera deaths were reported to date, bringing the total to
7," Dr. Norbert Forster, Undersecretary in the Health Ministry, told
The Namibian. "These occurred at Outapi. About 50 new cases of
cholera have occurred in that area," Forster added.
"Especially informal settlement areas are affected where water
supply, sanitation and hygiene need much improvement. Given this, the
cholera situation in Opuwo district (Kunene region) and now also in
Outapi district (Omusati region) needs to be regarded with great
concern," Forster said.
[Byline: Brigitte Weidlich]
--
ProMED-mail
<promed@promedmail.org>

[Outapi & Opuwo are located in northern Namibia very close to
Namibia's border with Angola. Outapi can be found on a map at:
<http://www.animalbase.uni-goettingen.de ... amibia.jpg>
and Opuwo on another map at:
<http://newsimg.bbc.co.uk/media/images/3 ... 203map.gif>
Brent Barrett <salbrent@sbcglobal.net> submitted a parallel story. - Mod.LL/JW]

******
[4] Cholera - Angola
Date: Mon 12 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: News24.com [edited]
<http://www.news24.com/News24/Africa/New ... 18,00.html>

More than 200 people have been killed by cholera in Angola since the
start of 2007, according to figures released by the health ministry
on Mon 12 Feb 2007. Of the overall total of 208 fatalities, 42 died
in the capital Luanda. The total number of recorded cases of cholera
was put at 6051, about a third of which were in Luanda, the figures showed.
About 3000 died of cholera in Angola in 2006, but health officials
had been confident that the epidemic, one of Africa's worst, was
gradually abating.
Heavy rains in January 2007, however, exacerbated the situation,
particularly in the southern province of Benguela, where there have
been 1245 cholera cases since 1 Jan 2007, and 27 people have died.
The deadly but easily treatable waterborne disease broke out in
Luanda's northern slum of Boa Vista in February 2006. It then spread
across a country whose infrastructure has been ravaged by a 27-year
civil war and where [clean] drinking water and proper sanitation are luxuries.
--
ProMED-mail
<promed@promedmail.org>

[A map of Angola showing the areas mentioned can be found at:
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

******
[5] Cholera - Somalia (south-central)
Date: Mon 12 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Independent Online [edited]
<http://www.int.iol.co.za/index.php?from ... 742154B254>

Health workers in Somalia's capital Mogadishu have launched a
campaign to educate residents about the growing danger of an outbreak
of acute diarrhea.
Officials say 121 people were killed in a suspected cholera outbreak
in south-central regions in January 2007, and more than 200 are now
admitted in hospitals suffering from acute diarrhea.
"The acute watery diarrhea is spreading," Mohamed Fuje, head of the
WHO in Mogadishu, told Reuters late on Sun 11 Feb 2007. "But we are
not yet sure if it is cholera."
Late in 2006, the Horn of Africa nation was ravaged by the worst
floods in decades. Insecurity following a war between Islamists and
government troops backed by Ethiopian forces has made humanitarian
operations all but impossible.
--
ProMED-mail
<promed@promedmail.org>

[Previously cases of "acute watery diarrhea" in Somalia have been
diagnosed as cholera. It is not clearly stated if Mogadishu is
affected. - Mod.LL]

******
[6] Cholera - Somalia (Middle Shabelle, Lower Shabelle, Middle Jubba)
Date: Tue 13 Feb 2007
From: ProMED-mail <promd@ppromedmail.org>
Source: Shabelle.net [edited]
<http://www.shabelle.net/news/ne2312.htm>

At least 10 children have died of watery diarrhea in the Lower
Shabelle provincial settlements, southern Somalia, where residents
also suffer from difficulties in their livelihood following the
torrential rains and floods, which hard hit southern and central
regions of the country late in 2006.
In the past 24 hours [12 Feb 2007], 8 children passed away in
Awdhegle district southern Somalia, as confirmed to Shabelle by
Mohamoud Ali, a resident in the area.
At least 16 children, most of them under the age of 5, died of watery
diarrhea in settlements and tiny villages in Jilib district of Middle
Jubba province, southern Somalia, on 11 Feb 2007.
On 8 Feb 2007, 30 children also died of the disease in settlements
around Jawhar, 90 km. (55 miles) north of the capital Mogadishu, the
main town of Middle Shabelle province, southern Somalia.
More than 350 cholera patients have been placed in the Inter-SOS
hospital in Jawhar in the past weeks. Doctors in Somalia say the
number of water diarrhea-related deaths is looming over 200. People
use contaminated water from the flood swamps and river, as they have
no access to clean water.
Dr. Abdullahi Hussein Moalim, the director of Jawhar hospital, said
many more children were gravely sick from the disease, calling on the
international relief agencies to bring medical supplies to the area
immediately.
[Byline: Aweys Osman Yusuf]
--
ProMED-mail
<promed@promedmail.org>

A map of Somalia showing the Middle Shabelle (Shabelle Dhexe), Lower
Shabelle (Shabelle Hoose) and Middle Jubba (Jubba Dhexe) provinces
can be found at:
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. - Mod.LL]

******
[7] Cholera - Congo (Kouilou, Pool)
Date: Mon 12 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: International Federation of Red Cross and Red Crescent
Societies (IFRC) [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>

In late December 2006, several cases of diarrhea were reported in
Pointe Noire, the port city of the Republic of Congo. Initially it
was thought that they were caused by food poisoning but authorities
at divisional and national levels later confirmed them to be cholera,
following clinical observations and laboratory tests in Brazzaville.
Towards the end of December 2006, 60 cases had been registered
(including 7 deaths) and on 27 Jan 2007, the Ministry of Health (MoH)
officially declared a cholera outbreak. Since then, the epidemic has
spread rapidly, affecting several families at the same time. By 30
Jan 2007, the figures rose to 3030 (with 50 fatalities).
Pointe-Noire is the economic hub of the country and is located in a
semi swampy area south east of the country, along the Atlantic Ocean.
Some surroundings of Pointe Noire are named Ndjindji, a local word
for swampy area. This geographical position exposes the town to the
risks of waterborne diseases. The majority of the Congolese
populations migrated to Pointe Noire, which is 500 km. (about 310
miles) south of the capital Brazzaville, in the 1990s because of
conflicts that prevailed at the time. The migration resulted in an
increase in the number of inhabitants from 300 000 then to
approximately 1 million today.
Several surroundings of Pointe Noire have been affected and there are
fears that the situation might deteriorate as the rainy season
continues. Currently, cholera patients are being taken care of in 4
cholera treatment centres (CTCs); Adolfe Scice, Tsie Tsie, Loandjili,
and the Army's Central Hospital. However, the teams on duty in these
centers are facing a shortage of beds and a limited number of skilled
staff. The Pointe Noire Central Prison has also been affected, but
sick inmates have not yet received medical attention. As of now, the
epidemic has already spread to Brazzaville where 38 cases have been
registered, including 4 deaths.
--
ProMED-mail
<promed@promedmail.org>

[The city of Pointe-Noire is in Kouilou province in southwestern
Congo and can be seen on a map of the country at:
<http://www.un.org/Depts/Cartographic/ma ... /congo.pdf>.
Brazzaville is in Pool Province in southeastern Congo. - Mod.LL]

******
[8] Cholera - Ghana (Eastern Region)
Date: Mon 12 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: MyJoyOnline [edited]
<http://www.myjoyonline.com/archives/hea ... 2/1544.asp>

Dr. Yaw Otchere, the Akyem Oda District Director of Health Services,
has said that 86 cholera cases were recorded in the district last
year [2006] against 12 cases in 2005.
--
ProMED-mail
<promed@promedmail.org>

[Akyem Oda is in the Eastern Region of Ghana. A Map of Ghana showing
the Eastern District north of the Accra area can be found at:
<http://www.un.org/Depts/Cartographic/ma ... /ghana.pdf>. - Mod.LL]

******

RIFT VALLEY FEVER - EASTERN AFRICA ( 18 ): KENYA, BOVINE
****************************************************************
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International Society for Infectious Diseases
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Date: Sun Feb 18 2007
From: Joseph Dudley <jdudley@eaicorp.com>
Source: Kenya Broadcasting Corporation (KBC) [edited]
<http://www.kbc.co.ke/story.asp?ID=40962>


The 1st 2 confirmed cases of Rift Valley Fever [RVF] in cattle have
been reported in the Kajiado district [in the Rift Valley, Kenya].

Previously, only cases of infected human beings had been reported, a
situation that raised eyebrows as the disease is usually transmitted
from animals to human beings.

The 2 cattle cases were found in the Mashuru division and in
Loitokitok [on the Tanzanian frontier, south of Kajiado], which is
now a district.

Local district veterinary officer Dr. Jackton Achola told a special
district steering group (DSG) meeting that the 2 samples of blood
from cattle, which had tested positive were among hundreds taken at
random across the district.

Following the confirmation that RVF was present in the district, the
veterinary officer said that an existing quarantine in Mashuru
division, which had been issued to control lumpy skin disease, would
continue to be in force.

Achola said that he would share the 100 000 doses of vaccines
supplied by the government with the new Loitokitok district -- which
will get 40 000 doses -- while 60 000 will be used to vaccinate
livestock in the Kajiado district.

He asked livestock keepers in the district to keep off livestock
products for at least 7 days after the vaccination in order to avoid
possible infection. [This sensible precautionary measure seems to
reflect the possibility that vaccination might be applied in
incubating animals or animals that could get infected shortly after
vaccination, before immunity is established. - Mod.AS]

Meanwhile, there are suspicions that a 17-year-old girl died of RVF
in Msabaha, a sub location of the Malindi district [north of
Mombasa], after family members refused to take her to hospital due to
religious beliefs.

Malindi district officer, Herman Shambi, said that the girl's
relatives are members of the Miracle Revival Fellowship Pentecostal
church, which considers medication and hospitalization as sinful as
it amounts to doubting God.

He said the girl died at home as family members were dangerously
handling her, oblivious of the danger they were exposing themselves
to since they had not taken her anywhere for medical examination.

The girl could be the 5th victim to succumb to the viral disease in
Malindi district though it has been difficult to establish the number
of deaths due to reluctance by the locals to seek medical attention.

Malindi district medical officer, Dr. Anisa Omar, said he would
comment on the issue at a later date.

[Byline: Mark Kemoli]

--
Joseph P. Dudley, Ph.D.
EAI Corporation
4301 North Fairfax Drive, Suite 200
Arlington, VA 22203
USA
<jdudley@eaicorp.com>

[According to WHO's most recent available update on the RVF situation
in Kenya and Somalia (31 Jan 2007), the Kajiado district is included
in the regions where numerous human cases have been reported; see map at:
<http://www.who.int/csr/AFRO_RVF_20070130.png>.

Kenya's notification to the OIE of clinical RVF cases in animals
(sheep, goats, cattle, and camels) was submitted to the OIE on 9 Jan
2007, referring to an outbreak in Galmagara, Garissa, the southern
part of the North-Eastern province, which reportedly had started on 4
Dec 2006 and confirmed on 22 Dec 2006. The notification, including a
map, is available at:
<http://www.oie.int/wahid-prod/public.ph ... ortid=4487>.

The current news on the identification of RVF in animals in another
part of the country, likewise exhibiting human cases and mortalities,
is based upon (serological?) surveillance at random in susceptible
species; unfortunately, information on clinical cases in animals is
unavailable, with human patients serving as the sentinels. This is
not a new phenomenon. A forgotten piece of history: RVF was
identified for the 1st time in South Africa, in 1950, only when
several veterinarians got infected, exhibiting influenza-like
symptoms, after performing PM [postmortem] in an affected bull in the
Bloemfontein Artificial insemination (AI) centre. This led to the
discovery that the virus had already been circulating, causing heavy
losses, for about 6 months in rural areas, infecting hundreds of
thousands animals and thousands of humans without being suspected nor
identified. Similar situations have occurred since in several other countries.

In view of the reports on the occurrence of RVF in humans and animals
in Kenya and Tanzania, and in humans in Somalia (wherefrom
information on animal disease is still anticipated), it will not
surprise if the disease occurs in other receptive countries, such as
Uganda, Ethiopia, Eritrea, Sudan, Egypt, and Yemen. Enhanced
alertness and surveillance are required.

TUBERCULOSIS, XDR - SÜDAFRIKA ( 04 )
*************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 20 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 862C923242>


The deadly drug-resistant strain of tuberculosis has claimed its 1st
life in the Western Cape and 5 new sufferers have been diagnosed.

This brings to 8 the number of people identified with "extensively
drug-resistant" tuberculosis -- XDR TB -- in the province so far.

Dr. Keith Cloete, director of TB for the province, said a 23-year-old
Cape Town woman had died in the Brooklyn Chest Hospital on 5 Feb
2007, but XDR TB had only been diagnosed after death.

In 2006, this strain killed more than 50 people in KwaZulu-Natal and
more than 300 cases have been confirmed countrywide.

Four of the 5 new local cases have been admitted to Brooklyn Chest
Hospital, where they are being treated in isolation along with the
1st 2 cases, an 11-month-old baby from Khayelitsha and a 43-year-old
woman from the Eastern Cape, who fell ill while visiting Cape Town
over Christmas.

--
ProMED-mail
<promed@promedmail.org>

[Many of the initial cases described in KwaZulu-Natal also died
before the diagnosis of XDR TB was made. This reflects the rapid
progression of the disease when not treated properly and the
co-infection (in almost all) with HIV.

The presence of XDR TB in an 11-month-old child underscores the
observation that much of the disease is due to acquisition of the
resistant bug, not selection of resistance in a patient non-adherent
to therapy for an initially more sensitive mycobacterium. Young
children with TB usually mean active disease in close family members
or other caretakers.

A map of South Africa showing the Eastern and Western Cape Provinces
can be found at:
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf> - Mod.LL]

MENINGOCOCCAL DISEASE UPDATE 2007 ( 08 )
*****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Burkina Faso
[2] Cote d'Ivoire (Bouake)
[3] Uganda (West Nile)

******
[1] Burkina Faso
Date: Thu 22 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: International Federation of Red Cross And
Red Crescent Societies (IFRC) [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


According to Burkina Faso's Ministry of Health
and the World Health Organization (WHO), there is
a meningitis epidemic in Burkina Faso. So far,
over 1300 cases have been recorded, with 142
deaths (case fatality rate of over 10 percent).
Eight health districts are directly affected:
Banfora, Batie, Dano, Hounde, Nanoro, Ouargaye, Sapouy, and Titao.

The Ministry of Health (MoH) has declared a
meningitis outbreak in the districts of Ouargaye
and Banfora, where the number of cases has
surpassed the epidemic threshold. The ministry
has planned for a vaccination campaign in these
areas. In the other districts, the cases have
exceeded the alert threshold but have not yet
reached the epidemic level. The districts in the
"alert" phase -- 5 cases per 100 000 inhabitants
-- are Batie and Dano (southwest), Hounde (west),
Sapouy (south), Nanoro (centre-south), and Titao
(north). Intense surveillance is being implemented.

The Burkina Faso government, through MoH, has
begun conducting social mobilization. A
vaccination and immunization campaign is
scheduled for this week, with the technical and
financial support of partners. The campaign will
be administered free of charge countrywide and
treatment will also be made available free of charge for affected people.

Burkina Faso is in West Africa's meningitis
"belt", which stretches across the semi-arid
Sahel region -- from Senegal in the west to
Ethiopia in the east. Each year, between December
and June, sand storms combined with seasonal
respiratory infections trigger outbreaks of
meningitis. The causal bacteria are transmitted
through respiratory secretions such as sneezing
or coughing and through direct contact with infected people.

--
ProMED-mail
<promed@promedmail.org>

[A map of Burkina Faso can be found at:
<http://www.un.org/Depts/Cartographic/ma ... urkina.pdf>. - Mod.LL]

******
[2] Cote d'Ivoire (Bouake)
Date: Wed 21 Feb 2007
From: Brent Barrett <salbrent@sbcglobal.net>
Source: IRIN (Integrated Regional Information Networks) [edited]
<http://www.alertnet.org/thenews/newsdes ... 34d477.htm>


Health authorities in Cote d'Ivoire have reported
an outbreak of meningitis in the north of the
country, where the health infrastructure has
deteriorated during a more-than-4-year political
impasse that has divided the country.

As of 5 Feb 2007, 36 cases of bacterial
meningitis, including 6 deaths, had been reported
at the regional hospital in the city of Bouake,
according to the United Nations Humanitarian Coordination Office (OCHA).

"We confirm that there are cases of meningitis in
Bouake," said Souleymane Kone, spokesman for the
WHO in Cote d'Ivoire. "Also, in partnership with
the Ivorian Health Ministry, we are pursuing
investigations in other health facilities in
Bouake to see if there are other cases."

According to the Health Ministry, a vaccination
campaign is being prepared for the region of
Savanes and some districts in the region of
Bouake, 350 km. north of the main city, Abidjan.

Although Cote d'Ivoire has been divided between a
government-run south and rebel-held north since a
brief civil war in 2002, the Health Ministry is
working with WHO in Bouake, which is the rebel stronghold, without hindrance.

The UN Children's Agency (UNICEF) reported 2007's
1st cases of meningitis in mid-January in the
extreme north and northeast of the country in the
regions of Boundiali and Odienne, where 7 cases
were registered, including 1 death. UNICEF recommended mass vaccinations.

Eighty-three cases of meningitis, including 20
deaths, were reported for all of 2006 in C�d'Ivoire.

--
ProMED-mail
<promedmail@promedmail.org>

[A map of the area can be found at:
<http://www.maplandia.com/cote-d-ivoire/bouake/>. - Mod.LL]

******
[3] Uganda (West Nile)
Date: Tue 20 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: AllAfrica.com and New Vision (Kampala) [edited]
<http://allafrica.com/stories/200702210286.html>


The Minister of Health, Dr. Stephen Mallinga,
arrived yesterday [Mon 19 Feb 2007] in West Nile
to assess the on-going mass vaccination against
meningitis. The 1st case of the contagious
disease was reported on 27 Dec 2007 in Arua.
Since then, at least 2000 cases have been registered with 65 deaths.

The mass immunization campaign was launched on 3
Feb 2007, after the disease reached the epidemic
threshold of 10 cases every week. The disease
also spread to Nebbi, Nyadri, Koboko, Moyo, Yumbe, and Adjumani districts.

The Arua district director for health services,
Dr. Patrick Anguzu, reported that there was a
gradual reduction in the number of new cases over
the past 2 weeks [4-18 Feb 2007] mainly due to
the completed 4 rounds of vaccination. "The most
affected sub-counties were all covered and within
the next few weeks the outbreak should be contained."

He expressed concern that there was a fresh
threat posed by an outbreak of meningitis in the
neighboring parts of the DR Congo.

[Byline: Frank Mugabi]

--
ProMED-mail
<promed@promedmail.org>

[A map of Uganda showing the affected districts
in the West Nile Region in northwestern Uganda can be found at:
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

LASSA FEVER - SOUTH AFRICA EX NIGERIA
***************************************
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Date: Thu 22 Feb 2007 04:54:33 -0500
From: Janusz Paweska <januszp@nicd.ac.za>


A 46-year-old public health physician resident in Abuja, Nigeria, who
was involved in an immunization campaign in Jalingo village, Taraba
State, Nigeria, in January 2007, became ill on 6 Feb [2007]. On 10
Feb 2007 he was admitted to the National Hospital Abuja, where he
presented with abdominal tenderness and fever; mildly elevated liver
enzymes; leucopenia and thrombocytopenia were also noted. Malaria and
viral hepatitis were ruled out. He became afebrile after 4 days of
antibiotic treatment, but on 15 Feb [2007] presented with vomiting,
generalized tonic-clonic convulsion, petechial hemorrhages on upper
trunk, bleeding from vena puncture sites, and confusion. Two days
later due to renal failure he was treated with emergency
hemodialysis. On 19 Feb[2007] he was medically evacuated from Nigeria
to a hospital in Pretoria, South Africa. Lassa fever was suspected,
and blood specimens were sent to the Special Pathogens Unit of the
National Institute for Communicable Diseases on 20 Feb 2007, where
Lassa virus infection was confirmed by RT-PCR (reverse transcription
polymerase chain reaction) and serology.

Transmission of Lassa virus from its natural rodent reservoir to
humans can cause hemorrhagic fever syndrome, which is associated with
high death rates. Lassa fever is endemic in West Africa and has been
reported from Sierra Leone, Guinea, Liberia, and Nigeria. Only a few
cases of importation of Lassa virus into other regions have been
documented worldwide. Although importation of a Lassa fever case
raises public concern because of the possibility of human-to-human
transmission and lack of an effective and safe therapy, the actual
risk for infection spread from an imported case appears to be low.

The Lassa fever patient admitted to a hospital in Pretoria is
currently being treated in isolation. He is ill, but stable. South
African health authorities have taken all necessary measures to
prevent transmission of the virus. Medical personnel in contact with
the patient are under observation although no specific incidents
constituting overt exposure to infection have been recorded. Medical
authorities in Nigeria and WHO have been informed of the case.

--
Janusz T. Paweska, DVSc., Dr. hab.
Head Special Pathogens Unit
National Institute for Communicable Diseases
of the National Health Laboratory Service
Private Bag X4
Sandringham-Johannesburg, 2131
Modderfontein Road 1
Gauteng, South Africa
<januszp@nicd.ac.za>

[Excerpts from the US CDC Special Pathogens Branch fact sheet on
Lassa Fever
(<http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... lassaf.htm>
provide the following information [edited]:

"In areas of Africa where the disease is endemic (that is, constantly
present), 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 a severe multisystem disease. Lassa fever is also
associated with occasional epidemics, during which the case-fatality
rate can reach 50 percent.

"Lassa fever is an endemic disease in portions of West Africa. It is
recognized in Guinea, Liberia, Sierra Leone, as well as Nigeria.
However, because the rodent species that carry the virus are found
throughout West Africa, the actual geographic range of the disease
may extend to other countries in the region.

"The number of Lassa virus infections per year in West Africa is
estimated at 100 000 to 300 000, with approximately 5000 deaths.
Unfortunately, such estimates are crude, because surveillance for
cases of the disease is not uniformly performed. In some areas of
Sierra Leone and Liberia, it is known that 10-16 percent of people
admitted to hospitals have Lassa fever, which indicates the serious
impact of the disease on the population of this region."

Rodents in the genus _Mastomys_ are the reservoir hosts, and an image
can be seen at:
<http://www.fieldmuseum.org/congo/images ... stomys.jpg> - Mod.TY]

[A map showing Jalingo and the Taraba State in Nigeria can be accessed at:
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. - CopyEd.MJ]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 ( 09 )
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Ethiopia
[2] Cholera - Sierra Leone (Northern Province)
[3] Cholera - Congo (Kouilou, Pool)
[4] Cholera - Zimbabwe (Harare)


******
[1] Cholera - Ethiopia
Date: Wed 21 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: International Herald Tribune; Associated Press report [edited]
<http://www.iht.com/articles/ap/2007/02/ ... holera.php>


More than 680 people in Ethiopia have died in a suspected cholera
outbreak that has also affected neighboring countries, officials said
Wed 21 Feb 2007. Some 60 000 people have been infected, but the
country's Health Ministry is resisting pressure to declare an
emergency despite a UN warning that the disease is an epidemic.

"The fact that it is spreading to new areas in the country is cause
for serious concern," said Paul Hebert, head of the UN's Office for
the Coordination of Humanitarian Affairs in Ethiopia. "The full
extent of this needs to be addressed."

The UN has not officially declared the outbreak, which began nearly a
year ago, to be cholera. But UN officials speaking privately because
of the sensitivity of the issue are saying it is cholera, something
local officials continue to deny.

Eight of Ethiopia's 11 regions have already been affected by the
outbreak, according to Ethiopia's Health Ministry and the UN. The
remote eastern region of Afar has recorded more than 1000 new cases
in the last week alone. The outbreak started in April 2006 after
heavy rains in the country.

"Once a disease has been present for an extended period of time, then
the likelihood of it being eliminated is quite difficult," Hebert
said. "I don't think we are addressing this issue on the scale that
is needed and it needs to be targeted to have an impact."

Ethiopian health officials, who say the disease is not cholera, are
describing the outbreak as acute watery diarrhea, but they have not
shared any of the test results that they have carried out.

The UN in Ethiopia has said the disease is suspected of having
entered Ethiopia from Sudan in 2006, where the disease was confirmed
in early 2006.

UN officials in Ethiopia are unable to act on their own about the
issue and are obligated to follow the lead of the country's Ministry
of Health. Only after a disease has been recorded as active in an
area for one year, can the WHO declare an emergency and label the
disease as endemic to the country.

Fears are mounting that with the onset of next month's [March 2007]
rainy season the outbreak could worsen. "The rainy season is coming
soon so it might get worse if we do not do something soon," said Dr.
Patrick Mweki, head of the International Medical Corps in Somalia.

--
ProMED-mail
<promed@promedmail.org>

[A map of Ethiopia can be found at:
<http://www.pnm.my/mtcp/images/maps/Ethiopia-map.jpg>. - Mod.LL]

******
[2] Cholera - Sierra Leone (Northern Province)
Date: Tue 20 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Awareness Times [edited]


The Tonkolili District Health Management Team in collaboration with
Medecins Sans Frontieres (MSF) Holland have successfully treated over
190 cases of watery diarrhea and vomiting described to be "suspected
cases of cholera", at the Magburaka Government hospital with only 2
deaths due to the victims arriving too late for treatment.

The suspected cases mostly within Magburaka town and its immediate
environs in the Kholifa Rowala Chiefdom affect about 30 towns and
villages including Magbas in the Tonkolili district, and Rogberay,
Masati, and Massabah in the Bombalili district.

According to the District Medical Officer of Tonkolili and the MSF
Medical Officer, Dr. Susan Reveira, the 2 fatal cases encountered
arrived very late in a dehydrated condition and died few minutes
later [despite] efforts to save their lives.

In an interview with Jonathan Abass Kamara, Public Relations Officer
at the Ministry of Health, during a visit to the erected isolated
wards in the Magburaka Hospital compound, it was revealed that the
outbreak was the result of poor sources of drinking water as most
people drink from the Rokel river and other outlets. The Magbass
Sugar Complex Sewage System running into the river source was also
[identified as] another major source of contamination of the water
the people use for domestic purposes. A good number of the Magbass
workers are said to be infected.

Towns and villages affected include Magburaka, Makeni-Lol, Makaloh,
Magbas Makari-Kabia, Makaprie, Mabum, Masoko, Mabone, Masobinta,
Mafumba, Magbonto, Magbesseh, Mamuta, Rotchen, Masegble, Masampa,
Robiz, and Tongbai. Meanwhile, samples of stool collected have been
sent to Freetown to establish whether it is cholera.

--
ProMED-mail
<promed@promedmail.org>

[A map of Sierra Leone can be found at:
<http://www.un.org/Depts/Cartographic/ma ... errale.pdf>.
Both Tonkolili and Bombalili Districts are in the Northern Province. - Mod.LL]

******
[3] Cholera - Congo (Kouilou, Pool)
Date: Mon 19 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: News.yahoo.com [edited]
<http://news.yahoo.com/s/afp/20070219/hl ... 0219170400>


According to figures from the United Nations Children's Fund
(UNICEF), 82 people have died in a cholera epidemic in the Republic
of Congo. The outbreak was officially declared at the end of January
2007, in Pointe-Noire, the economic heart of the Congo located in the
southwest [of the country], and has since spread to the capital, Brazzaville.

Figures released by UNICEF Mon 19 Feb 2007, compiled from data from
local health authorities, found that 4077 people in Pointe-Noire had
contracted cholera by 14 Feb 2007, of whom 61 died.

North of the town, in the Kouilou area, 106 people have been recorded
with cholera, of whom 7 died, and in Brazzaville, 14 people have
died, and a further 46 have been infected, UNICEF said.

Although the number of new cases has [decreased] markedly in
Pointe-Noire and Brazzaville in the last few days, UNICEF warned that
the disease had appeared in the Mindouli area, between the 2 towns.

"Despite a fall in the fatalities, which shows the good performance
of the care of those (infected) cases, it is important to note that
the epidemic continues to develop in terms of the number of new
registered cases," UNICEF said in its last report on the progress of
the disease.

--
ProMED-mail
<promed@promedmail.org>

[The city of Pointe-Noire is in Kouilou province in southwestern
Congo and can be seen on a map of the country at:
<http://www.un.org/Depts/Cartographic/ma ... /congo.pdf>.
Brazzaville and Mindouli are in Pool Province in southeastern Congo. - Mod.LL]

******
[4] Cholera - Zimbabwe (Harare)
Date: Sun 18 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: International Herald Tribune; Associated Press report [edited]
<http://www.iht.com/articles/ap/2007/02/ ... holera.php>


Cholera has killed 3 people in Zimbabwe's capital, Harare, in the 1st
recorded deaths from the disease in 2007, the official Sunday Mail
newspaper reported. The 3, who include a 75-year-old woman, were all
residents of Epworth, an impoverished shantytown to the south of Harare.

Zimbabwean Health Minister, David Parirenyatwa, said his ministry was
"on high alert" to deal with the outbreak, which he blamed on poor
water supply to the area. "The 3 are the only cases we have received
so far, as the ministry is in control of the situation," Parirenyatwa
said, according to the newspaper. Earlier in February 2007, Harare
authorities worked to contain an outbreak in 2 townships where
residents had been collecting water from unprotected wells. At least
19 people were reported to have contracted cholera in that outbreak,
but there were no recorded deaths.

A 6-year economic and political crisis in Zimbabwe has taken its toll
on public health facilities, sanitation systems, and water provision
in Harare and other major towns and cities, leaving residents exposed
to the threat of cholera and other diseases linked to poor hygiene.
In many suburbs, garbage goes uncollected for weeks because
authorities have no fuel to power waste collection, while sewage
flows freely from broken pipes the authorities say they have no money to fix.

A cholera outbreak in Harare's Glen View township killed 3 people in
January 2006, forcing the authorities to temporarily shut down the
capital's main food and vegetable market.

--
ProMED-mail
<promed@promedmail.org>

[A map of Zimbabwe showing the location of Harare can be found at:
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

Burkina Faso: Über 250 Tote durch Meningitis-Epidemie

Impfstoffe gehen dem Ende zu - Gesundheitsminister bittet internationale Gemeinschaft seine Impfkampagne zu unterstützen

Ouagadougou - Einer Meningitis-Epidemie sind in Burkina Faso seit Jahresbeginn mehr als 250 Menschen zum Opfer gefallen. mehr...

Grüsse
Alexander

UNDIAGNOSED DEATHS - UGANDA (MASINDI): REQUEST FOR INFORMATION
**************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 26 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: All Africa [edited]
<http://allafrica.com/stories/200702260482.html>


Uganda: Masindi killer disease is not meningitis
------------------------------------------------
Medical authorities in Masindi have ruled out meningitis as the cause of
the recent deaths in Mutunda sub-county, Kibanda county.

Seven people, including 5 from one family and a neighbor, have died since
an outbreak was reported in Kajebe village about 3 weeks ago. "There are
only 2 meningitis cases in the district, and those are recovering at
Kiryandongo Hospital, but the disease that is killing our people is elusive
and highly contagious," Dr John Turyagaruka, the district health officer,
said on Saturday [24 Feb 2006]. He was addressing an emergency epidemic
control task force meeting chaired by the district vice-chairperson, Jacob
Karubanga, at the district chambers. The task force has surveillance, case
management, logistics, mobilization and coordination departments.

Up to 110 people have died of meningitis in West Nile and Kotido district,
out of about 3000 reported cases, since the epidemic broke out early this
month [February 2007]. It has left schools, markets and disco halls closed
in 6 districts.

--
ProMED-mail
<promed@promedmail.org>

[In the absence of information on the clinical syndromes associated with
these unexpected deaths in Uganda, it would be exceedingly hazardous to
attempt a differential diagnosis of possible etiologies. More information
on this outbreak from knowledgeable sources would be greatly appreciated.

For a map of the involved area, please see
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg>. Masindi is to
the east of Lake Albert. - Mod.MPP]

TUBERCULOSIS, XDR - SÜDAFRIKA (05)
*************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 28 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Citizen [edited]
<http://www.citizen.co.za/index/article. ... 33051,1,22>


Eight new cases of extensively drug-resistant tuberculosis (XDR TB) have
been diagnosed in the Eastern Cape, the province's health department said
on Wed 28 Feb 2007.

It said this brought to 41 the number of patients identified with the
disease in the province since November 2006. During this period the disease
had claimed at least 5 lives. The new cases were discovered in patients
already admitted to Port Elizabeth's Jose Pearson TB hospital for
multidrug-resistant TB.

"The situation is under control as the infectious disease is not spreading
at an alarming rate in the province," the department said in a statement.
It said it was on full alert, and had established isolation wards at Jose
Pearson, Fort Grey TB Hospital in East London, and Nelson Mandela Academic
Hospital in Mthatha.

XDR TB first emerged in South Africa in the Tugela Ferry region of
KwaZulu-Natal in 2005. The strain has killed more than 50 people in
KwaZulu-Natal and more than 300 cases have been confirmed countrywide.

--
ProMED-mail
<promed@promedmail.org>

[The 5 deaths have already been reported. Many of the initial deaths
occurred before the isolate was grown and sensitivities obtained. Although
not stated, it is possible that since there were no new deaths, initial
anti-tuberculous therapy has been adjusted in response to the XDR strains.

XDR TB is now defined an isolate resistant to INH (isoniazid) and rifampin
(also referred to as rifamycin) that was also resistant to a
fluoroquinolone and to one or more of the following 3 injectable
anti-tuberculosis drugs: capreomycin, kanamycin, and amikacin.

A map of South Africa showing the Eastern Cape Province can be found at:
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. - Mod.LL]

UNDIAGNOSED DEATHS, HUMAN, LIVESTOCK - ELFENBEINKÜSTE: REQUEST FOR INFORMATION
****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 27 Feb 2007
From: Naomi Bryant <naomi.bryant@uclh.nhs.uk>
Source: All Africa / UN Integrated Regional Information Networks (IRIN)
[edited]
<http://allafrica.com/stories/200702270341.html>


Health authorities in Cote d'Ivoire are investigating an acute illness in a
northern village that has claimed the lives of 31 people and sickened at
least 73 others.

People began to fall ill in the village of Diobala in the 3rd week of
December [2006], with symptoms including headache, high fever, neck and
chest pain, and respiratory problems, according to a report by the Ministry
of Health and Public Hygiene obtained by IRIN [UN Integrated Regional
Information Networks.] The illness progressed rapidly over the course of 3
to 5 days and the 1st death was reported on [18 Dec 2006], the report said.

Villagers delayed reporting the illnesses to health authorities until [5
Feb 2007]. By then, 31 people had died among the 104 who had fallen ill,
the report said. Victims in the village of 1500 included men and women,
young and old.

"Almost every family was touched" in the village, an official with the
Seguela health department told IRIN. Seguela, 44 km. [27 miles] away, is
the largest town near Diobala. Seguela is 450 km. [280 miles] north of the
main city, Abidjan.

Local health authorities reported the deaths to officials in Abidjan and
investigators went to Diobala [13-17 Feb 2007]. The team included
specialists from the Pasteur Institute and the Ministry of Health and
Public Hygiene.

They discovered that beginning in October [2006] animals in the village had
begun falling ill. The report said 90 per cent of the village's poultry, as
well as about 500 goats and sheep, had died. Villagers ate sick animals,
but it was not immediately clear if this was how humans contracted the
illness. Health authorities said patients treated with antibiotics
responded well.

"They did an investigation and took blood samples and nasal swabs of the
people, the poultry, the goats and the sheep," the Seguela health official
said. Water samples were also taken. "Surveillance is continuing to see if
other cases come up," he said.

The last cases of human illness were reported on [14 Feb 2007]. There have
been no reports of illness in neighbouring villages. People in the area
have been told to quickly report any illnesses to local health authorities.

Cote d'Ivoire has been divided between a rebel-held north and
government-run south since a brief civil war in 2002. As a result,
humanitarian agencies say health and sanitary conditions in the north have
deteriorated.

--
Naomi Bryant
Information Officer
National Travel Health Network and Centre (NaTHNaC)
<naomi.bryant@uclh.nhs.uk>


[Given the above description of a livestock die-off (including poultry,
sheep, and goats) preceding morbidity and mortality of the human
population, one automatically thinks of zoonotic diseases that might be
consistent with this picture. Adding to the picture is a reported case
fatality rate (CFR) of 30 per cent (31/104), with an estimated attack rate
of 7 per cent (104/1500) with all age groups affected. When one checks
GIDEON (Global Infectious Disease and Epidemiology Network
<http://www.gideononline.net>) for the clinical picture associated with
contact with animals, one gets 3 main possibilities -- Q fever, ornithosis,
and bunyaviridae. Of the bunyaviridae family, one does think of Rift Valley
fever (RVF) as consistent with this clinical picture, but the involvement
of poultry rules this out, as the RVF virus does not affect avians. Gideon
also gives a "1st case scenario", where it "ignores" the geographic
location of the outbreak in the event that this is a new geographic
extension of an otherwise known pathogen. In this case, the GIDEON program
suggested Congo-Crimean hemorrhagic fever (CCHF).

The above report mentions individuals improving with antibiotics. This
suggests a clinical diagnosis of a bacterial disease, such as Q fever, but
the reported CFR in this outbreak is way above that seen with Q fever (Q
fever has a 1-2 per cent mortality associated with untreated cases).

If one decides that the animal outbreak information is a red herring, and
repeats the GIDEON search omitting an ongoing epizootic, the following
comes up as most likely candidates: Leptospirosis, Q fever, legionellosis,
Ebola, Lassa fever, ornithosis, and brucellosis to mention a few -- and
when one looks at the "1st case scenario" plague is on the list.

Anthrax is not on the list provided by GIDEON, but it too could possibly
meet the clinical definition, although one might expect to hear of more
gastrointestinal symptoms.

This moderator has now "mused out loud" probably more than would have been
prudent, so at this point appeals to sources knowledgeable on the findings
of the investigation to enlighten and educate us on what has been going on.
- Mod.MPP]

..................mpp/mj/sh

PLAGUE, PNEUMONIC - UGANDA (MASINDI): CONFIRMED
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 28 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Relief Web [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>


An emergency team has started a campaign to kill fleas and rats in a bid to
control the outbreak of the infectious pneumonic plague that has hit
Masindi district, killing 10 people.

The group is made up of officials from the health ministry, the Uganda
Virus Research Institute, the Centres for Disease Control (USA), the World
Health Organization, district health officials, and the epidemic control
task force.

The commissioner of health services, Dr Sam Okware, said they were
destroying the rats that carry the fleas, through spraying. He revealed
that the disease had been confirmed as pneumonic plague after tests in
laboratories in Kenya and Egypt. "We are sensitising the communities that
this disease is related to poor hygiene. We are teaching them to keep their
environment clean."

Okware pointed out that West Nile and Masindi were the focal areas but
added that the possible source of plague was the DR Congo. He also stressed
that they had enough drugs to deal with the situation. "In fact we don't
expect more than a few hundred cases. We reacted fast enough to the
disease," Okware noted.

The Masindi district director of health services, Dr John Turyagaruka, said
no new cases had been reported while those admitted were improving.
However, he complained that there was a shortage of gloves, masks, and
boots needed for the exercise.

[byline: Alfred Wasike, Steven Candia]

--
ProMED-mail
<promed@promedmail.org>

[Plague is endemic in Uganda and annual outbreaks have been reported over
the past several years (see prior ProMED-mail postings listed below).

Masindi is located in the north west of Uganda near Lake Albert. (Lake
Albert is situated on the border between Uganda and the Democratic Republic
of the Congo (DRC)). The prior outbreaks of plague in Uganda reported on
ProMED-mail were also located in the north west of the country near the
border with the DRC (see
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg> and
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf> for maps of
Uganda).

As both the DRC and Uganda are endemic for plague, in the absence of
information on the index case in the outbreak, it is hard to point a
definite finger as to whether the outbreak began in Uganda or was imported
from the DRC.

For background information on plague, see the WHO fact sheet at:
<http://www.who.int/mediacentre/factsheets/fs267/en/> (excerpted below).

"Plague is a zoonotic disease circulating mainly among small animals and
their fleas. The bacterium _Yersinia pestis_ can also infect humans. It is
transmitted between animals and humans by the bite of infected fleas,
direct contact, inhalation, and rarely, ingestion of infective materials.
Plague can be a very severe disease in people, with a case-fatality ratio
of 30-60 per cent if left untreated.

"Infected persons usually start with "flu-like" symptoms after an
incubation period of 3-7 days. Patients typically experience the sudden
onset of fever, chills, head and body-aches, and weakness, vomiting and
nausea. Clinical plague infection manifests itself in 3 forms depending on
the route of infection: bubonic, septicaemic and pneumonic.

"* Bubonic form is the most common form of plague resulting from the bite
of an infective flea. Plague bacillus enters the skin from the site of the
bite and travels through the lymphatic system to the nearest lymph node.
The lymph node then becomes inflamed because the plague bacteria, _Y.
pestis_, will replicate here in high numbers. The swollen lymph node is
called a "bubo" which is very painful and can become suppurated as an open
sore in advanced stage of infection;

"* Septicaemic form of plague occurs when infection spreads directly
through the bloodstream without evidence of a "bubo". More commonly
advanced stages of bubonic plague will result in the presence of _Y.
pestis_ in the blood. Septicaemic plague may result from flea bites and
from direct contact with infective materials through cracks in the skin.

"* Pneumonic form of plague is the most virulent and least common form of
plague. Typically, pneumonic form is due to a secondary spread from
advanced infection of an initial bubonic form. Primary pneumonic plague
results from inhalation of aerosolized infective droplets and can be
transmitted from human to human without involvement of fleas or animals.
Untreated pneumonic plague has a very high case fatality ratio."

Plague is endemic in many countries in Africa, in the former Soviet Union,
the Americas, and Asia. In 2003, 9 countries reported 2118 cases and 182
deaths. Of [the total number of] cases and deaths, 98.7 per cent and 98.9
per cent, respectively, were reported from Africa. Today the distribution
of plague coincides with the geographical distribution of its natural foci.
- Mod.MPP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (10)
**********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Somalia (Lower Shabelle Province)
[2] Cholera, diarrhea - Sierra Leone (Northern Province)
[3] Cholera - Rwanda (East Province)
[4] Cholera - Angola

******
[1] Cholera - Somalia (Lower Shabelle Province)
Date: Thu 1 Mar 2007
From: ProMED-mail <promed@promedmail.org>
Source: Shabelle Media Network [edited]
<http://www.shabelle.net/news/ne2438.htm>

Watery diarrhea breaks out in the Somali capital Mogadishu. Many children
have been admitted to Banadir Maternal hospital in Mogadishu. A 7 year old
girl died from the disease in Banadir hospital on 28 Feb 2007.

The general director of Banadir hospital, Dr Abdirizak, told Shabelle that
a large number of patients with watery diarrhea were brought to the
hospital. [He added that medicines in the hospital are scarce] "and people
who have been beset by the disease are increasingly admitted to the hospital."

The disease is believed to have claimed the lives of hundreds of children
in the southern and central provinces of Somalia. At least 25 children,
most of them under the age of 5, died of the watery diarrhea in different
settlements and villages in Afgoi district, 30 km. (19 miles) south of the
capital, on Tue 27 Feb 2007, while a larger number of children were ailing
from the disease.

[byline: Aweys Osman Yusuf]

--
ProMED-mail
<promed@promedmail.org>

[Cases of cholera in Somalia are often referred to as "acute watery
diarrhea". The province of Lower Shabelle (Shabelle Hoose), where Mogadishu
and Afgoi are located, can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. - Mod.LL]

******
[2] Cholera, diarrhea - Sierra Leone (Northern Province)
Date: Tue 27 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Int. Fed. of Red Cross and Red Crescent Societies (IFRC), ReliefWeb
[edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>

Period covered by this cholera interim final report: 17 Oct 2006-31 Jan 2007

For the past 2 decades, Sierra Leone has had a history of waterborne
diseases such as diarrhea, vomiting, dysentery, and cholera. The country
has been experiencing heavy rains that have caused serious flooding in
several low lands and river communities for a number of years. This has led
to contamination of streams and wells as they become filled with
uncollected garbage and effluent from sewages, thus exacerbating the
incidence of waterborne diseases as a consequence. This has led to loss of
lives in several parts of the country.

The only available medical services are government hospitals, health
centers, and consultations given by medical practitioners who are
responsible for all or part of public health facilities. Most of these
services are inaccessible to the majority of the Sierra Leone population.
This has led to serious health hazards for more than 60 per cent of the
population, many of whom are already suffering from other socio-economic
conditions such as acute poverty and disability.

At least 1746 cases and 170 deaths were recorded in different hospitals,
mobile outlets, and public health units (PHUs) from Freetown, Lungi, and
Kambia.

As the cholera situation increased, referral hospitals are at the very end
of [their] resources. In addition, diarrhea cases have almost exhausted
their supplies. To support the Ministry of Health and Sanitation (MoH&S),
the Sierra Leone Red Cross Society (SLRCS) worked at community level,
setting up emergency posts with the MoH&S referral facilities and
supporting two-thirds of referral facilities in Freetown with rehydration
fluids.

--
ProMED-mail
<promed@promedmail.org>

[A map of Sierra Leone can be found at
<http://www.un.org/Depts/Cartographic/ma ... errale.pdf>. Most of
the previously reported cases have been in the Northern Province. - Mod.LL]

******
[3] Cholera - Rwanda (East Province)
Date: Mon 26 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: AllAfrica.com and The New Times (Kigali) [edited]
<http://allafrica.com/stories/200702270176.html>

John Mujarugamba who is in charge of social affairs at Tabagwe sector,
Nyagatare district, told Rwandans who returned from Tanzania on Saturday
[24 Feb 2007], to improve their hygiene [and keep their surroundings clean]
to avoid catching cholera, [which has recently claimed several lives in the
sector. Among other measures, the official suggested] constructing
temporary pit latrines.

Majarugamba was speaking after the monthly community clean-up exercise
(Umuganda), which was carried out at the returnees' camp.

[byline: Godfrey Ntagungira]

--
ProMED-mail
<promed@promedmail.org>

[The Nyagatare district is the northernmost district of the East (or
Eastern) Province of Rwanda. Its location can be found at
<http://www.answers.com/topic/east-province-rwanda>. - Mod.LL]

******
[4] Cholera - Angola
Date: Sat 24 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Int Fed of Red Cross and Red Crescent Societies (IFRC), ReliefWeb
[edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>

At least 244 people died of cholera, out of 7438 cases recorded in the
country, from 1 Jan to 22 Feb 2007, an official source told Angop (Angola
Press Agency).

According to health officials, Kwanza Sul reported [the most deaths, 95],
followed by Luanda (45), Benguela (33), Malanje (17), and Cabinda (14).

Over the last 24 hours [23-24 Feb 2007], 2 people died in Bengo, out of 107
infected with the disease, whereas Luanda with 48 cases, Bengo (17), and
Benguela (15) are the most affected provinces.

Meanwhile, the health authorities continue appealing to the populations to
strengthen individual and collective measures.

--
ProMED-mail
<promed@@promedmail.org>

[A map of Angola showing the areas mentioned can be found at
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. - Mod.LL]

MENINGOCOCCAL DISEASE UPDATE 2007 (09)
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Sudan (Southern Sudan)
[2] Uganda (West Nile)

******
[1] Sudan (Southern Sudan)
Date: Thu 1 Mar 2007
From: ProMED-mail <promed@promedmail.org>
Source: AlArab [edited]
<http://english.alarabonline.org/display ... 2%20%C3%A3>

Health workers have launched a mass meningitis vaccination campaign in
southern Sudan, where 174 people have died from the disease [meningitis] in
2007, a World Health Organization (WHO) official said.

"All the payams (districts) that have crossed the epidemic threshold are
either being vaccinated today [1 Mar 2007], or we will be starting there
next week," said William Pera, a WHO coordinator for epidemic readiness and
intervention. The government of southern Sudan and WHO have reported a
total of 2243 cases of suspected meningitis there since the beginning of
2007, he said.

An international coordination group backed by WHO has so far delivered 300
000 of a promised 850 000 doses of vaccine in southern Sudan, said WHO
official, Abdullahi Ahmed.

Sudan, which accounts for more than half of the meningitis cases worldwide
each year, has little or no infrastructure and is particularly at risk for
outbreaks of disease.

--
ProMED-mail
<promed@promedmail.org>

[A map of Sudan showing the affected areas in the south (Central, Western
and Eastern Equatoria, Lakes, Western, and Northern Bahr el-Ghazal,
Jonglei, and Warrap states) can be found at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf> - Mod.LL]

******
[2] Uganda (West Nile)
Date: Wed 28 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Int. Fed. of Red Cross and Red Crescent Societies (IFRC), ReliefWeb
[edited]
<http://www.reliefweb.int/rw/RWB.NSF/db9 ... enDocument>

Since December 2006, a meningitis outbreak has been ravaging Uganda's north
western districts of the West Nile Region. On 19 Feb 2007, the Uganda Red
Cross Society (URCS) reported a total of 2728 cases, with 100 deaths in
Arua/Maracha-Terego, Adjumani, Yumbe, Koboko, Nebbi, and Moyo districts.
147 cases were also reported in the northeastern districts of Kotido,
Moroto, and Nakapiripirit in the Karamoja area.

The 2 strains of meningitis detected include serogroup A and serogroup X.
While serogroup A can be controlled through immunization (and is
predominant in the West Nile), the Karamoja area is dominated by serogroup
X that cannot be controlled through immunization. There are also
unconfirmed reports of similar outbreaks in the neighboring Southern Sudan
and eastern Democratic Republic of Congo (DRC), according to WHO. Reports
from WHO indicate that Uganda falls within the traditional African
'Meningitis Belt', which includes the 21 most vulnerable African countries.

The Red Cross Action Teams (RCATs) in Adjuman and Arua branches are
carrying out intensive awareness campaigns and social mobilization using
the African Red Cross Health Initiative (ARCHI) 2010 toolkit for community
volunteers. The teams continue to disseminate the Ministry of Health's
(MoH) case management guidelines to the community. The URCS branches are
also monitoring the situation and volunteers have been mobilized for the
immunization campaigns.

Vaccination has started in Arua district, spearheaded by MSF (Medecins Sans
Frontieres) France. So far, a total of 14 sub-counties have been covered.
However, having realized that the pace is too slow to contain the epidemic,
a change in strategy has been agreed upon by all partners. At the time of
reporting, a team including WHO, URCS, MSF, and UNICEF (United Nations
Children's Fund) was planning to travel to the affected districts in West
Nile Region in the week starting 26 Feb 2007 for micro-planning.

Mass vaccination campaigns in the 5 districts started on 24 Feb 2007,
planned to last for one week.

--
ProMED-mail
<promed@promedmail.org>

[The following information is from Dr Pierre Nicolas' comments in
ProMED-mail posting Meningococcal disease update 2007 (04) 20070129.0379:

"Serogroup X meningococcus is well known and has been isolated since 1970
in Africa. It was responsible for sporadic cases and small epidemics in the
90s (83 cases in Niger in 1997). In 2006 in Niger, 4185 meningitis cases
were reported between Jan and Jun 2006. _N. meningitidis_ group X
represented 51 per cent of 1139 laboratory-confirmed meningococcal
meningitis, but in southwestern Niger, it represented 90 per cent. Among
the 18 serogroup X isolates characterized in Marseille, 16 had the same
phenotype (X:NT:P1.5, nontypeable and subtype P1.5) and 2 were NT:NST
(non-typeable, non-subtypeable), 16 belonged to the same sequence-type
(ST)-181 as the serogroup X isolates circulating in Niamey in the 1990s and
2 to the ST-5789 (one locus difference from ST-181)."

As a reminder, the serogroups (capsular types) of meningococci can be
further characterized by serotypes and subtypes based on class 2/3 and
class 1 outer membrane proteins (OMPs). These OMPs are porin proteins,
water-filled channels that play important roles as molecular sieves in the
outer membranes of Gram-negative bacteria.

A map of Uganda showing the affected districts in the West Nile Region in
northwestern Uganda can be found at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL]

PLAGUE - UGANDA (MASINDI) (O2): REQUEST FOR INFORMATION
*******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 1 Mar 2007
From: Joseph Dudley <jdudley@eaicorp.com>
Source: All Africa [edited]
<http://allafrica.com/stories/200702280906.html>


According to a ministry of health official, the plague that has infected 15
people and killed 9 in Masindi (in the north west of Uganda) is in fact, a
modified strain of the bubonic plague that killed an estimated 25 million
people in just 5 years (1347-1352.)

The director general of health services, Sam Zaramba, said the 1st case was
reported 3 weeks ago but the spread has been contained. There has not been
a new infection reported in the last week. When the 1st deaths occurred in
Masindi, initial suspicions were that either meningitis or Ebola were the
cause.

Blood samples from the deceased were quickly tested [and the results
confirmed] that it was bubonic plague that caused the deaths. [The results
of additional tests performed] in South Africa and in Denmark, further
confirmed the suspicions.

This is not the 1st time bubonic plague has occurred in Uganda in the
recent past. Dr Zaramba said it has occurred on and off in Nebbi [also in
north western Uganda] a number of times over the past 30 years. He further
said that after discovering the occurrence of plague, the 1st priority is
to contain the spread. Plague originates in rats and spreads to humans
through fleas.

The 1st measure taken in Masindi was to stop people from sleeping on the
floor. Dr Zaramba said this reduced the prevalence of rats. Smearing floors
with cow dung also helps contain the spread of plague as it discourages
rats from entering domestic environments.

[byline: Ben Simon]

--
Joseph P Dudley, PhD
EAI Corporation
4301 North Fairfax Drive, Suite 200
Arlington, VA 22203
USA
<jdudley@eaicorp.com>

[In yesterday's ProMED-mail posting (Plague - Uganda (Masindi): pneumonic
20070301.0725), the newswire mentioned that the form of plague in this
current outbreak was the pneumonic form. In the above newswire describes
the plague as bubonic (see yesterday's [1 Mar 2007] moderator comment for a
description of the different forms of plague). In the pneumonic form of
plague person-to-person transmission occurs at a higher frequency than in
the bubonic form as there is respiratory spread from aerosolized droplets.
The mortality rate with pneumonic plague is much higher than seen with the
bubonic form. In the above newswire, the "observed" case fatality rate is
60 per cent, within the range expected with untreated disease. ProMED-mail
would appreciate clarification of the epidemiologic picture in this current
outbreak from knowledgeable sources. - Mod.MPP]